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2. Baseline plasma SARS-CoV-2 RNA detection predicts an adverse COVID-19 evolution in moderate to severe hospitalized patients

Author

Rizzi, M., Patrucco, F., Trevisan, M., Faolotto, G., Mercandino, A., Strola, C., Ravanini, P., Costanzo, M., Tonello, S., Matino, E., Casciaro, G. F., Croce, A., Rizzi, E., Zecca, E., Pedrinelli, A., Vassia, V., Landi, R., Bellan, M., Castello, L. M., Minisini, R., Mallela, V. R., Avanzi, G. C., Pirisi, M., Lilleri, D., Solidoro, P., Gavelli, F., and Sainaghi, P. P.

Subjects
General Medicine
Abstract

SARS-CoV-2 is a single-stranded RNA virus, known to be the causative agent of COVID-19. As the resulting disease shows a very heterogeneous range of clinical manifestations, the identification of early biomarkers allowing patients stratification according to the expected disease severity is still an unmet clinical need.In this observational prospective cohort study, 137 consecutive patients, testing positive for SARS-CoV-2 infection by nasopharyngeal swab RT-PCR or antigenic test, were enrolled to evaluate their plasma viral load at the time of hospitalization.Even if all of them had a molecular diagnosis of COVID-19, only 29 patients showed a detectable plasma SARS-CoV-2 RNAemia. Such viremic patients also showed other clinical and laboratory finding alterations (increased troponin I, IL-6, RDW-CV, and creatinine levels along with decreased platelet count and glomerular filtration rate). A plasma detectable RNA viral load predicted in hospital death or ICU admission with an odds ratio of 3.53 (CI: 1.44-8.64, P=0.0058), while the lack of a detectable viral load was associated with a faster recovery, with an odds ratio of 4.06 (CI: 1.72-9.59, P=0.0014). These findings were confirmed in multivariate models including age, sex and baseline National Early Warning Score 2 and arterial oxygen tension over inspired oxygen fraction ratio.Our data thus suggest that plasma viral RNA load at the time of hospital admission could represent a useful independent biomarker allowing early patients' stratification according to the expected disease evolution, and driving clinical decisions tailored on the specific needs of the individual patient.

Published
2022

5. Simple parameters from complete blood count predict in-hospital mortality in covid-19

Author

Bellan, M., Azzolina, D., Hayden, E., Gaidano, G., Pirisi, M., Acquaviva, A., Aimaretti, G., Valletti, P. A., Angilletta, R., Arioli, R., Avanzi, G. C., Avino, G., Balbo, P. E., Baldon, G., Baorda, F., Barbero, E., Baricich, A., Barini, M., Barone-Adesi, F., Battistini, S., Beltrame, M., Bertoli, M., Bertolin, S., Bertolotti, M., Betti, M., Bobbio, F., Boffano, P., Boglione, L., Borre, S., Brucoli, M., Calzaducca, E., Cammarata, E., Cantaluppi, V., Cantello, R., Capponi, A., Carriero, A., Casciaro, G. F., Castello, L. M., Ceruti, F., Chichino, G., Chirico, E., Cisari, C., Cittone, M. G., Colombo, C., Comi, C., Croce, E., Daffara, T., Danna, P., Corte, F. D., de Vecchi, S., Dianzani, U., Benedetto, D. D., Esposto, E., Faggiano, F., Falaschi, Z., Ferrante, D., Ferrero, A., Gagliardi, I., Galbiati, A., Gallo, S., Garavelli, P. L., Gardino, C. A., Garzaro, M., Gastaldello, M. L., Gavelli, F., Gennari, A., Giacomini, G. M., Giacone, I., Via, V. G., Giolitti, F., Gironi, L. C., Gramaglia, C., Grisafi, L., Inserra, I., Invernizzi, M., Krengli, M., Labella, E., Landi, I. C., Landi, R., Leone, I., Lio, V., Lorenzini, L., Maconi, A., Malerba, M., Manfredi, G. F., Martelli, M., Marzari, L., Marzullo, P., Mennuni, M., Montabone, C., Morosini, U., Mussa, M., Nerici, I., Nuzzo, A., Olivieri, C., Padelli, S. A., Panella, M., Parisini, A., Pasche, A., Patrucco, F., Patti, G., Pau, A., Pedrinelli, A. R., Percivale, I., Ragazzoni, L., Re, R., Rigamonti, C., Rizzi, E., Rognoni, A., Roveta, A., Salamina, L., Santagostino, M., Saraceno, M., Savoia, P., Sciarra, M., Schimmenti, A., Scotti, L., Spinoni, E., Smirne, C., Tarantino, V., Tillio, P. A., Tonello, S., Vaschetto, R., Vassia, V., Zagaria, D., Zavattaro, E., Zeppegno, P., Zottarelli, F., Sainaghi, P. P., Aiosa, G., Airoldi, A., Barco, A., Bargiacchi, O., Bazzano, S., Berni, P., Bianchi, B., Bianco, S., Biffi, S., Binda, V., Bolgeo, T., Bolla, C., Bonato, V., Bonizzoni, G., Bragantini, A., Brustia, D., Bullara, V., Burlone, M., Brustia, F., Caccia, S., Calareso, A., Cammarota, G., Cancelliere, L., Carbone, R., Cassinari, A., Ceriani, E., Cena, T., Clivati, E., Collimedaglia, L., Colombatto, A., Cornella, C., Costanzo, M., Croce, A., de Benedittis, C., Delorenzi, S., Dionisio, R., Donato, P., Esposito, M., Fangazio, S., Feggi, A., Ferrillo, S., Foci, V., Fra, G. P., Gaggino, C., Gambaro, E., Gattoni, E., Gattoni, L., Giacchero, F., Gianfreda, R., Giubertoni, A., Grecu, L., Grossi, F., Guglielmetti, G., Guido, S., Iannantuoni, G., Ingrao, S., Jona, A., Lazzarich, E., Lissandrin, R., Maduli, E., Magne, F., Mantia, E., Marangon, D., Massara, M., Matino, E., Mauri, M. G., Menegatti, M., Moglia, R., Molinari, R., Morelli, S., Morlino, P., Naldi, P., Nebbiolo, C., Omodeo, P., Palmieri, D., Panero, A., Parodi, M., Pedrazzoli, R., Pelazza, C., Penpa, S., Perucca, R., Pirovano, A., Pittau, S., Pochetti, P., Poletti, F., Polla, B., Prandi, P., Prodam, F., Prosperini, P., Puma, A., Quaglia, M., Raie, A., Rapetti, R., Ravera, S., Re, A., Reale, M., Rossati, A., Rossi, M., Rossi, P., Rostagno, R., Salomoni, G., Sama, M. T., Sarchi, E., Sarcoli, M., Sarda, C., Sguazzotti, I., Soddu, D., Sola, D., Stobbione, P., Todoerti, M., Vallese, G. C., Varrasi, C., Veia, A., Vignazia, G. L., Zanotti, I., Zecca, E., Zichittella, D., Zisa, G., and Zoppis, E.

Subjects
Adult, Male, medicine.medical_specialty, Medicine (General), Multivariate analysis, Article Subject, Clinical Decision Rules, COVID-19, Prognosis, Blood Cell Count, Hospital Mortality, Severity of Illness Index, Clinical Biochemistry, Asymptomatic, Severity of Illness Index, NO, R5-920, Internal medicine, Clinical Decision Rules, Severity of illness, Genetics, 80 and over, Medicine, Humans, Hospital Mortality, Molecular Biology, Aged, Retrospective Studies, Aged, 80 and over, medicine.diagnostic_test, business.industry, Biochemistry (medical), Complete blood count, COVID-19, Retrospective cohort study, Red blood cell distribution width, General Medicine, Odds ratio, Middle Aged, Prognosis, Female, Italy, Multivariate Analysis, Blood Cell Count, Cohort, medicine.symptom, business, Research Article
Abstract

Introduction. The clinical course of Coronavirus Disease 2019 (COVID-19) is highly heterogenous, ranging from asymptomatic to fatal forms. The identification of clinical and laboratory predictors of poor prognosis may assist clinicians in monitoring strategies and therapeutic decisions. Materials and Methods. In this study, we retrospectively assessed the prognostic value of a simple tool, the complete blood count, on a cohort of 664 patients ( F 260; 39%, median age 70 (56-81) years) hospitalized for COVID-19 in Northern Italy. We collected demographic data along with complete blood cell count; moreover, the outcome of the hospital in-stay was recorded. Results. At data cut-off, 221/664 patients (33.3%) had died and 453/664 (66.7%) had been discharged. Red cell distribution width (RDW) ( χ 2 10.4; p < 0.001 ), neutrophil-to-lymphocyte (NL) ratio ( χ 2 7.6; p = 0.006 ), and platelet count ( χ 2 5.39; p = 0.02 ), along with age ( χ 2 87.6; p < 0.001 ) and gender ( χ 2 17.3; p < 0.001 ), accurately predicted in-hospital mortality. Hemoglobin levels were not associated with mortality. We also identified the best cut-off for mortality prediction: a NL ratio > 4.68 was characterized by an odds ratio for in-hospital mortality OR = 3.40 (2.40-4.82), while the OR for a RDW > 13.7 % was 4.09 (2.87-5.83); a platelet count > 166,000 /μL was, conversely, protective (OR: 0.45 (0.32-0.63)). Conclusion. Our findings arise the opportunity of stratifying COVID-19 severity according to simple lab parameters, which may drive clinical decisions about monitoring and treatment.

Published
2021

8. Clinical strategies for the management of intestinal obstruction and pseudo-obstruction. A Delphi Consensus study of SICUT (Società Italiana di Chirurgia d'Urgenza e del Trauma)

Author

Costa, G., Ruscelli, P., Balducci, G., Buccoliero, F., Lorenzon, L., Frezza, B., Chirletti, P., Stagnitti, F., Miniello, S., Stella, F., Agresta, F., Ansaloni, L., Basile, G., Bellanova, G., Blandamura, V., Buonanno, G., Calderale, S., Caronna, R., Casciaro, G., Catena, F., Ceci, F., Chiara, O., Chiarugi, M., Cimbanassi, S., Coccolini, F., Gianfranco Cocorullo, Manzoni, G., Di Grezia, G., Frego, M., Fusco, B., Giulini, S., Greco, M., Gaspare Gulotta, Lippolis, P., Mandala, V., Marini, P., Martino, A., Marzaioli, R., Mecarelli, V., Mingoli, A., Mirabella, A., Morelli, M., Padalino, P., Picardi, N., Portolani, N., Ribaldi, S., Ricci, G., Salamone, Giuseppe, Sartelli, M., Staudacher, C., Tonelli, P., Tricarico, F., Trojaniello, B., Tugnoli, G., Valeri, A., Venezia, P., Zago, M., Costa, G., Ruscelli, P., Balducci, G., Buccoliero, F., Lorenzon, L., Frezza, B., Chirletti, P., Stagnitti, F., Miniello, S., Stella, F., Agresta, F., Ansaloni, L., Basile, G., Bellanova, G., Blandamura, V., Buonanno, G., Calderale, S., Caronna, R., Casciaro, G., Catena, F., Ceci, F., Chiara, O., Chiarugi, M., Cimbanassi, S., Coccolini, F., Cocorullo, G., De Manzoni, G., Di Grezia, G., Frego, M., Fusco, B., Giulini, S., Greco, M., Gulotta, G., Lippolis, P., Mandala, V., Marini, P., Martino, A., Marzaioli, R., Mecarelli, V., Mingoli, A., Mirabella, A., Morelli, M., Padalino, P., Picardi, N., Portolani, N., Ribaldi, S., Ricci, G., Salamone, G., Sartelli, M., Staudacher, C., Tonelli, P., Tricarico, F., Trojaniello, B., Tugnoli, G., Valeri, A., Venezia, P., and Zago, M.

Subjects
Hernia, Delphi Technique, Contrast Media, Acidosis, Conservative Treatment, Diatrizoate Meglumine, Disease Management, Emergencies, Emergency Medicine, General Surgery, Humans, Intestinal Obstruction, Intestinal Pseudo-Obstruction, Intubation, Gastrointestinal, Laparotomy, Societies, Medical, Stents, Symptom Assessment, Tomography, X-Ray Computed, Stent, Large bowel obstruction, Emergencie, Small bowel, Delphi study, Intestinal obstruction, Large bowel obstruction, Pseudo-obstruction, Small bowel, Delphi study, Acidosi, Pseudo-obstruction, Human
Abstract

Intestinal obstructions/pseudo-obstruction of the small/large bowel are frequent conditions but their management could be challenging. Moreover, a general agreement in this field is currently lacking, thus SICUT Society designed a consensus study aimed to define their optimal workout.The Delphi methodology was used to reach consensus among 47 Italian surgical experts in two study rounds. Consensus was defined as an agreement of 75.0% or greater. Four main topic areas included nosology, diagnosis, management and treatment.A bowel obstruction was defined as an obstacle to the progression of intestinal contents and fluids generally beginning with a sudden onset. The panel identified four major criteria of diagnosis including absence of flatus, presence of3.5 cm ileal levels or6 cm colon dilatation and abdominal distension. Panel also recommended a surgical admission, a multidisciplinary approach, and a gastrografin swallow for patients presenting occlusions. Criteria for immediate surgery included: presence of strangulated hernia, a10 cm cecal dilatation, signs of vascular pedicles obstructions and persistence of metabolic acidosis. Moreover, rules for non-operative management (to be conducted for maximum 72 hours) included a naso-gastric drainage placement and clinical and laboratory controls each 12 hours. Non-operative treatment should be suspended if any suspects of intra-abdominal complications, high level of lactates, leukocytosis (18.000/mm3 or Neutrophils85%) or a doubling of creatinine level comparing admission. Conversely, consensus was not reached regarding the exact timing of CT scan and the appropriateness of colonic stenting.This consensus is in line with current international strategies and guidelines, and it could be a useful tool in the safe basic daily management of these common and peculiar diseases.Delphi study, Intestinal obstruction, Large bowel obstruction, Pseudo-obstruction, Small bowel.Le ostruzioni e pseudo-ostruzioni del piccolo/ grande intestino sono condizioni frequenti, ma la loro gestione risulta spesso difficile per cui è necessario avere un adeguato e condiviso percorso gestionale. A tal proposito la Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT) ha disegnato uno studio volto a definire il management ottimale dei pazienti con occlusione intestinale.Lo studio è stato condotto utilizzando la metodologia Delphi coinvolgendo un panel di 47 chirurghi italiani con maturata esperienza clinica. Il consenso è stato definito come un accordo uguale o superiore al 75.0%. Lo studio si è focalizzato su quattro aree tematiche comprendenti la nosologia, la diagnosi, la gestione e il trattamento delle ostruzioni e delle pseudo-ostruzioni intestinali. Un occlusione intestinale è stata definita come un ostacolo alla progressione del contenuto intestinale. RISULTATI: in genere ad esordio improvviso. Il panel ha identificato quattro principali criteri di diagnosi, tra i quali l’assenza di canalizzazione ai gas, la presenza di livelli ileali3.5 cm o di una dilatazione del colon6 cm nonché di una distensione addominale. Viene inoltre consigliato il ricovero in chirurgia, un approccio multidisciplinare e un transito con Gastrografin per tutti i pazienti che presentano un’occlusione. Tra i criteri per un intervento chirurgico immediato sono inclusi: la presenza di un’ernia strozzata, una dilatazione del cieco10 cm, segni di ostruzione del peduncolo vascolare e la persistenza di acidosi metabolica. La gestione non operatoria dei pazienti (la cui durata massima dovrebbe essere di 72 ore) include il posizionamento di un sondino nasogastrico e la necessità di effettuare controlli clinici e laboratoristici ogni 12 ore. Il trattamento non operatorio deve essere sospeso in caso insorga il sospetto di complicanze intra-addominali, compaia un alto livello di lattati, una leucocitosi (18.000 / mm3 o neutrofili85%) o un raddoppiamento del livello di creatinina rispetto ai valori basali al ricovero. Al contrario il panel non ha raggiunto alcun consenso riguardo l’esatta tempistica della TAC e l’opportunità di stenting del colon come intervento palliativo in attesa di chirurgia definitiva.Le raccomandazioni stabilite sono in linea con le strategie e le linee guida internazionali, e potrebbero essere uno strumento utile per la gestione del paziente affetto da occlusione intestinale.

Published
2016

10. Clinical strategies for the management of intestinal obstruction and pseudo-obstruction (Article)

Author

Costa, G., Ruscelli, P., Balducci, G., Buccoliero, F., Lorenzon, L., Frezza, B., Chirletti, P., Stagnitti, F., Miniello, S., Stella, F., Agresta, F., Ansaloni, L., Basile, G., Bellanova, G., Blandamura, V., Buonanno, G., Calderale, S., Caronna, R., Casciaro, G., Catena, F., Ceci, F., Chiara, O., Chiarugi, M., Cimbanassi, S., Coccolini, F., Cocorullo, G., Manzoni, D., X, G., Grezia, D., G. y, F., M. z, F., Aa, B., Giulini, S. M., A., Greco, Ac, M., Gulotta, G., Lippolis, P., Mandala, Ad, V., Marini, Ag, P., Martino, Ah, A., Marzaioli, Ai, R., Mecarelli, Aj, V., Mingoli, Ak, A., Mirabella, Af, A., Morelli, M. M., A., Padalino, Am, P., Picardi, An, N., Portolani, Ab, N., Ribaldi, S., Ricci, Ae, G., Salamone, Ao, G., Sartelli, Ap, M., Staudacher, Aq, C., Tonelli, Ar, P., Tricarico, F., Trojaniello, B., Tugnoli, Af, G., Valeri, Venezia, Ai, P., Zago, and Ar, M.

Subjects
Clinical strategies for the management of intestinal obstruction and pseudo-obstruction (Article)
Published
2016

11. Small bowel intussussception due to metastatic melanoma of unknown primary site. Case report

Author

STAGNITTI, F., ORSINI, S., MARTELLUCCI, A., TUDISCO, A., AVALLONE, M., AIUTI, F., DI GIROLAMO, V., STEFANELLI, F., DE ANGELIS, F., COSTANTINO, A., DI GRAZIA, C., NAPOLEONI, A., NICODEMI, S., CIPRIANI, B., CECI, F., MOSILLO, R., CORELLI, S., CASCIARO, G., and SPAZIANI, E.

Subjects
Male, Oncology, Pathology, medicine.medical_specialty, Ileum, Metastasis, Clinical Practice, Internal medicine, medicine, Humans, Malignant melanoma, Unknown primary, Intestinal intussusceptions, Disseminated disease, Melanoma, Gastrointestinal tract, business.industry, Middle Aged, medicine.disease, Ileal Neoplasms, medicine.anatomical_structure, Iron-deficiency anemia, Neoplasms, Unknown Primary, Segmental resection, business, Intestinal Obstruction, Brain metastasis
Abstract

Malignant melanoma is characterized by metastases also to the gastrointestinal tract, especially in the small bowel. The diagnosis is often delayed because unspecific clinical presentation (frequently as chronic iron deficiency anemia, rectal bleeding or intestinal obstruction). We present a case of melanoma of unknown primary site, with clinical presentation of intestinal obstruction. A segmental resection of the ileum was performed including mesentery with lymph nodes. Histology revealed metastatic melanoma from unknown primary. PET and MRI confirmed disseminated disease without brain metastasis.

Published
2014

14. Multiple abdominal visceral transplantation: clinical experience of organ preservation by University of Wisconsin (UW) solution

Author

paolo bruzzone, Alfani D, Berloco P, Caricato M, Casciaro G, Iappelli M, Marciani A, Rossi M, Urbano D, and Cortesini R

Subjects
Adult, Male, Adenosine, Carcinoma, Hepatocellular, Duodenum, Allopurinol, Liver Neoplasms, Organ Preservation Solutions, Organ Preservation, Middle Aged, Glutathione, Liver Transplantation, Pancreatic Neoplasms, Solutions, Adenoma, Bile Duct, Raffinose, Bile Duct Neoplasms, Duodenal Neoplasms, MULTIVISCERAL TRANSPLANTATION, Colonic Neoplasms, Intestine, Small, Humans, Insulin, Female, Pancreas Transplantation
Published
1991

18. Risk management in surgery.

Author

MESSANO, G. A., SPAZIANI, E., TURCHETTA, F., CECI, F., CORELLI, S., CASCIARO, G., MARTELLUCCI, A., COSTANTINO, A., NAPOLEONI, A., CIPRIANI, B., NICODEMI, S., DI GRAZIA, C., MOSILLO, R., AVALLONE, M., ORSINI, S., TUDISCO, A., AIUTI, F., and STAGNITTI, F.

Published
2013

24. [Transplantation of the pancreas: surgical aspects]

Author

Alfani D, Berloco P, Rossi M, Iappelli M, Marco Caricato, Pretagostini R, Casciaro G, Poli L, Pisani G, and Nezzo A

Subjects
Postoperative Care, Postoperative Complications, Humans, Diabetic Nephropathies, Pancreas Transplantation
Abstract

Based on their personal as well as international experiences, the authors describe different surgical techniques employed in pancreatic allograft related to different complications rate and patient and graft outcome. In fact, the surgical technique represents an only partially solved problem, because of the high percentage of complications dealing with the different approaches. Even though several procedures concerning either the site of implantation either the treatment of the exocrine function have been so far used, the results up to now obtained are the main limiting factor for a large clinical application of pancreatic transplantation.

26. [The evolution of immunosuppression in clinical kidney transplantation: the experience of 700 cases]

Author

Alfani D, paolo bruzzone, Bachetoni A, Berloco P, Caricato M, Casciaro G, Cinti P, Iappelli M, Marciani A, and Poli L

Subjects
Immunosuppression Therapy, Italy, Actuarial Analysis, Graft Survival, Cyclosporine, Humans, Kidney Transplantation
Abstract

Kidney transplantation was first introduced in Italy in 1966 by the II Surgical Pathology of the University of Rome giving a great contribution to the development of the transplant surgery in this country. The authors report their 25-year experience analyzing the results obtained in more than 700 kidney allografts. A progressive refinement in the surgical transplant technique both from cadaver and live as well as clinical trials on new immunosuppressive protocols characterized their work.

27. [Surgical technique aspects in multiorgan transplantation: personal experience]

Author

Cortesini R, Alfani D, Berloco P, Marco Caricato, Casciaro G, Cicalese L, Iappelli M, Pisani G, Poli L, and Pretagostini R

Subjects
Adult, Male, Carcinoma, Hepatocellular, Duodenum, Liver Neoplasms, Adenocarcinoma, Middle Aged, Liver Transplantation, Intestines, Adenoma, Bile Duct, Postoperative Complications, Intestine, Small, Humans, Female, Pancreas Transplantation
Abstract

The Authors report their experience with multiorgan transplantation performed in 3 patients affected by multifocal cancer of the liver, either primitive (2 cases) or secondary (1 case). The rationale for this new approach was the unfeasible single liver transplantation taking into account the extracapsular diffusion of the neoplasia.

29. 94 consecutive living unrelated kidney transplants: 8-year graft and patient actuarial survival

Author

Cortesini R, Berloco P, Pretagostini R, Rossi M, Iappelli M, Caricato M, Poli L, Casciaro G, Vetere A, and paolo bruzzone

Subjects
Adult, Graft Rejection, Immunosuppression Therapy, Male, Bacterial Infections, Kidney Transplantation, Survival Analysis, Tissue Donors, Postoperative Complications, Actuarial Analysis, Virus Diseases, Creatinine, Humans, Family, Female

36. Kidney transplantation in elderly patients

Author

Pretagostini, R., Berloco, P., Poli, L., Rossi, M., Marco Caricato, Casciaro, G., Cocciolo, P., Colonnello, M., Venettoni, S., Bruzzone, P., Novelli, G., Alfani, D., and Cortesini, R.

Subjects
Graft Rejection, Incidence, Graft Survival, Middle Aged, elderly patients, Kidney Transplantation, Tissue Donors, Survival Rate, Actuarial Analysis, kidney transplantation, Cause of Death, Cadaver, Cyclosporine, Humans, Family, Immunosuppressive Agents, Retrospective Studies

37. Clinical strategies for the management of intestinal obstruction and pseudo-obstruction

Author

Costa, G., Ruscelli, P., Balducci, G., Buccoliero, F., Lorenzon, L., Frezza, B., Chirletti, P., Stagnitti, F., Miniello, S., Stella, F., Agresta, F., Ansaloni, L., Basile, G., Bellanova, G., Blandamura, V., Buonanno, G. M., Calderale, S. M., Caronna, R., Casciaro, G., Catena, F., Ceci, F., Chiara, O., Chiarugi, M., Cimbanassi, S., Coccolini, F., Gianfranco Cocorullo, Manzoni, G., Di Grezia, G., Frego, M., Fusco, B., Giulini, S. M., Greco, M., Gulotta, G., Lippolis, P. V., Mandala, V., Marini, P., Martino, A., Marzaioli, R., Mecarelli, V., Mingoli, A., Mirabella, A., Morelli, M. M., Padalino, P., Picardi, N., Portolani, N., Ribaldi, S., Ricci, G., Salamone, G., Sartelli, M., Staudacher, C., Tonelli, P., Tricarico, F., Trojaniello, B., Tugnoli, G., Valeri, A., Venezia, P., Zago, M., and Obow-Sicut, The Collaborative Study Group

40. Impact of the COVID-19 outbreak on an Italian cohort of systemic sclerosis patients.

Author

Bellan M, Parisi S, Stobbione P, Pedrinelli AR, Rizzi E, Casciaro GF, Vassia V, Landi R, Cittone MG, Rigamonti C, Patrucco F, Ditto MC, Finucci A, Realmuto C, Todoerti M, Parodi M, Rossi P, Pirisi M, Fusaro E, and Sainaghi PP

Subjects
Adrenal Cortex Hormones therapeutic use, Antirheumatic Agents therapeutic use, Cohort Studies, Female, Humans, Hydroxychloroquine therapeutic use, Italy, Lung Diseases, Interstitial therapy, Male, Middle Aged, Oxygen Inhalation Therapy, Pulmonary Arterial Hypertension therapy, Retrospective Studies, SARS-CoV-2, Scleroderma, Systemic drug therapy, Telemedicine, Telephone, COVID-19, Lung Diseases, Interstitial physiopathology, Pulmonary Arterial Hypertension physiopathology, Raynaud Disease physiopathology, Scleroderma, Systemic physiopathology, Ulcer physiopathology
Published
2020
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41. Small bowel intussussception due to metastatic melanoma of unknown primary site. Case report.

Author

Stagnitti F, Orsini S, Martellucci A, Tudisco A, Avallone M, Aiuti F, Di Girolamo V, Stefanelli F, De Angelis F, Di Grazia C, Napoleoni A, Nicodemi S, Cipriani B, Ceci F, Mosillo R, Corelli S, Casciaro G, and Spaziani E

Subjects
Humans, Male, Middle Aged, Ileal Neoplasms complications, Ileal Neoplasms secondary, Intestinal Obstruction etiology, Melanoma complications, Melanoma secondary, Neoplasms, Unknown Primary pathology
Abstract

Malignant melanoma is characterized by metastases also to the gastrointestinal tract, especially in the small bowel. The diagnosis is often delayed because unspecific clinical presentation (frequently as chronic iron deficiency anemia, rectal bleeding or intestinal obstruction). We present a case of melanoma of unknown primary site, with clinical presentation of intestinal obstruction. A segmental resection of the ileum was performed including mesentery with lymph nodes. Histology revealed metastatic melanoma from unknown primary. PET and MRI confirmed disseminated disease without brain metastasis.

Published
2014

42. Biliodigestive fistulae and gallstone ileus: diagnostic and therapeutic considerations. Our experience.

Author

Stagnitti F, Tudisco A, Ceci F, Nicodemi S, Orsini S, Avallone M, Di Girolamo V, Stefanelli F, De Angelis F, Di Grazia C, Cipriani B, Aiuti F, Napoleoni A, Mosillo R, Corelli S, Casciaro G, Costantino A, Martellucci A, and Spaziani E

Subjects
Adolescent, Aged, Aged, 80 and over, Female, Gallstones complications, Humans, Ileus etiology, Male, Middle Aged, Biliary Fistula diagnosis, Biliary Fistula surgery, Gallstones diagnosis, Gallstones surgery, Ileus diagnosis, Ileus surgery, Intestinal Fistula diagnosis, Intestinal Fistula surgery
Abstract

The biliodigestive fistula is not a rare affection in the context of acute pathology of the gastrointestinal tract. It often affects patients between 63 and 85 years old , particularly the female sex, and the most common cause is acute or chronic cholecystolithiasis. Open issues are the delayed in the pre-operative diagnosis, and controversies exist regarding the best surgical approach. The choice of treatment options is influenced by the age of the patients and their clinical conditions and also by the presence of comorbidities and of a delayed right diagnosis. In the 1 to 3% of cases, the biliodigestive fistula presents a gallstone ileus as complication, whose diagnosis is particularly difficult for the lack of specific signs and symptoms. The contrast-enhanced CT is considered the gold standard for a specific pre-operative diagnosis, as it directly shows the fistula. Surgical treatments include one-stage procedure or two-stage procedure. Many studies seem to favor a deferred definitive procedure. The Authors describe 4 cases: in 3 cases, women between 70 and 80 years old presenting an history of recurrent cholecystitis, in 2 cases, and in 1 case presenting a bowel obstruction; in 1 case a 50-years-old man, with no significant past medical history, presenting a bowel obstruction. The Authors have performed in the 2 cases of gallstone ileus an enterolithotomy with cholecysto-duodenal fistula repair and cholecystectomy, in one-stage, and this has been possible because of the good clinical conditions of the patients and their low operative risk. In the case of fistula without the complication of gallstone ileus, the treatment approach has been cholecysto-gastric fistula closure with a gastroplastic using separate stitches and cholecystectomy, in one-stage. We are in agreement with data in the literature regarding the delay into the diagnosis of biliodigestive fistula and with the importance to suspect it or gallstone ileus presence, although the clinical presentation is extremely non-specific. In our experience, cholangiopancreatography-CT and CECT have made easier the pre-operative diagnosis and so reducing the delay of the treatment.

Published
2014

43. Multiorgan female pelvic prolapse: pelvic organ prolapse suspension (P.O.P.S.) stapled transanal rectale resection (S.T.A.R.R.): new surgical tecniques and results.

Author

Ceci F, Spaziani E, Casciaro G, Corelli S, Martellucci A, Costantino A, Nicodemi S, Avallone M, Orsini S, Tudisco A, Aiuti F, and Stagnitti F

Subjects
Anal Canal, Female, Gynecologic Surgical Procedures methods, Humans, Middle Aged, Rectum surgery, Surgical Stapling, Pelvic Organ Prolapse surgery
Abstract

Aim: To demonstrate the surgical treatment validity and the post-operative complication decrease., Material of Study: Seventythree women who underwent P.O.P.S. + S.T.A.R.R. treatment, follow-up one year., Results: We observed an important reduction or a completely disappearance about pre-operative signs and symptoms., Discussion: We are aware that the proposed technique, if taken into account by urogynecologists, will raise several arguments and will raise many doubts and perplexities. For this reason we wanted develop a follow-up sufficiently long and many case studies with data to support our claims., Conclusions: We believe that the procedure proposed by us, given the results, was excellent in patients with multiorgan pelvic prolapse, especially with the vagina walls elongated and that retain a good trophism.

Published
2013

44. Risk management in surgery.

Author

Messano GA, Spaziani E, Turchetta F, Ceci F, Corelli S, Casciaro G, Martellucci A, Costantino A, Napoleoni A, Cipriani B, Nicodemi S, Di Grazia C, Mosillo R, Avallone M, Orsini S, Tudisco A, Aiuti F, and Stagnitti F

Subjects
Checklist, Humans, Italy, Risk Management, Surgical Procedures, Operative standards
Abstract

Malpractice is the responsible for the greatest number of legal claims. At the present time, legal actions against physicians in Italy are 15,000 per year, and a stunning increase about costs to refund patients injured by therapeutic and diagnostic errors is expected. The method for the medical prevention is "Risk Management", that is the setting-up of organizational instruments, methods and actions that enable the measurement or estimation of medical risk; it allows to develop strategies to govern and reduce medical error. In the present work, the reconstruction about the history of risk management in Italy was carried out. After then the latest initiatives undertaken by Italy about the issue of risk management were examined.

Published
2013
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45. Single-incision laparoscopic appendectomy is comparable to conventional laparoscopic and laparotomic appendectomy: our single center single surgeon experience.

Author

Ceci F, Orsini S, Tudisco A, Avallone M, Aiuti F, Di Girolamo V, Stefanelli F, De Angelis F, Martellucci A, Costantino A, Di Grazia C, Nicodemi S, Cipriani B, Napoleoni A, Mosillo R, Corelli S, Casciaro G, Spaziani E, and Stagnitti F

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Retrospective Studies, Young Adult, Appendectomy methods, Laparoscopy methods, Laparotomy
Abstract

Several studies have demonstrated the clinical and technical benefits of the laparoscopic surgery for complicated and uncomplicated appendicitis. Our retrospective study included 12 patient who underwent SILS appendectomy (SILS-A), 14 who received conventional laparoscopic surgery (VL-A), and 12 who received laparotomic appendectomy (OA); performed in all cases by the same surgeon (C.F.). The aim of this study was the comparison between this three different surgical techniques on same features: post operative leukocytosis, post operative pain, need abdominal drainage, esthetic viewpoint, incidence of complication, hospital stay. The results showed no significant differences between SILS-A and VLS-A, while an evident improvement shows versus O-A, even though not statistically significative. SILS was more effective in decreasing the risk of postoperative wound infection.

Published
2013
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46. Technique and outcomes about a new laparoscopic procedure: the Pelvic Organ Prolapse Suspension (POPS).

Author

Ceci F, Spaziani E, Corelli S, Casciaro G, Martellucci A, Costantino A, Napoleoni A, Cipriani B, Nicodemi S, Di Grazia C, Avallone M, Orsini S, Tudisco A, Aiuti F, and Stagnitti F

Subjects
Female, Follow-Up Studies, Gynecologic Surgical Procedures methods, Humans, Middle Aged, Treatment Outcome, Laparoscopy, Pelvic Organ Prolapse surgery
Abstract

Pelvic organ prolapse suspension (POPS) is a recent surgical procedure for one-stage treatment of multiorgan female pelvic prolapse. This study evaluates the preliminary results of laparoscopic POPS in 54 women with a mean age of 55.2 and a BMI of 28.3. Patients underwent at the same time stapled transanal rectal resection (STARR) to correct the residual rectal prolapse. We had no relapses and the preliminary results were excellent. We evaluated the patients after 1 year follow-up and we confirmed the validity of our treatment. The technique is simpler than traditional treatments with an important reduction or completely disappearance of the pre-operative symptomatology.

Published
2013
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47. Liver resection for hemoperitoneum caused by spontaneous rupture of unrecognized hepatocellular carcinoma.

Author

Casciaro GE, Spaziani E, Costantino A, Ceci F, Di Grazia C, Martellucci A, Pecchia M, Cipriani B, De Angelis F, Corelli S, Napoleoni A, Stefanelli F, Salvadori C, Parisella M, Nicodemi S, and Stagnitti F

Subjects
Aged, 80 and over, Humans, Male, Rupture, Spontaneous, Carcinoma, Hepatocellular complications, Carcinoma, Hepatocellular surgery, Hemoperitoneum etiology, Hemoperitoneum surgery, Hepatectomy, Liver Neoplasms complications, Liver Neoplasms surgery
Abstract

Hepatocellular carcinoma (HCC) is an increasingly common form of cancer. Although its spontaneous rupture is rare in Western countries, it constitutes a surgical emergency and is associated with high mortality. There is a lack of consensus as to the best approach and what parameters to use in choosing it. The three main approaches are conservative, endovascular and resection - the treatment of choice for acute abdominal bleeding. We report a case of hemoperitoneum following the spontaneous rupture of an unrecognized HCV-related HCC in a patient with no history of liver disease. The patient was successfully treated by emergency surgery, with resection of two segments of the left liver.

Published
2012

48. [Traumatic retroperitoneal haematoma].

Author

Stagnitti F, Toccaceli S, Spaziani E, Casciaro GE, Corelli S, Gammardella P, Diana M, Dandolo R, Stagnitti A, Persico Stella L, and Di Pucchio E

Subjects
Adult, Aged, Angiography, Female, Hematoma mortality, Humans, Injury Severity Score, Italy epidemiology, Male, Middle Aged, Retroperitoneal Space, Retrospective Studies, Accidents, Traffic statistics & numerical data, Accidents, Traffic trends, Hematoma etiology, Hematoma surgery, Kidney injuries, Pelvis injuries, Thoracic Injuries complications
Abstract

The management of traumatic retroperitoneal haematomas is still a much debated question. Although the diagnosis has become easier using CT with contrast medium, the therapeutic decisions are still difficult because of the great variability of the lesions, which may be simple but very often complicated. Our study is based on 1086 treated patients, 29.5% of the 3682 critical abdominal polytrauma seen in 35 years. Mortality has been 12.9% with a medium ISS (Injury Severity Score) of 23.4. 71.4% of the cases were closed traumas, 28,6% were open traumas. The most common single lesions have been pelvic (43%), followed by the renal traumas (39%). Regarding the associated lesions, the thoracic traumas cause an increment of the ISS score up to 26.2% and of mortality up to 14.6%. The maxillofacial traumas associated with traumatic retroperitoneal haematomas represent 11%, mainly associated with motorcycle accidents, which have increased in the last years from 2,4% in the 70s to 32% these days. Our approach to these patients has been basically conservative. Following the indications obtained by the CT, we widely used interventional angiography, especially for renal lesions and, after pelvic stabilization, for pelvic haematomas. We have chosen surgery considering the kind of traumas (open or closed), the location of the haematoma and especially, the clinical course of the patient's hemodynamic condition.

Published
2007

49. [Total thyroidectomy: initial experience of a territorial reference center].

Author

Toccaceli S, Persico Stella L, Diana M, Dandolo R, Budak A, Martellucci A, Casciaro GE, Spaziani E, Tasciotti C, Di Pucchio E, and Stagnitti F

Subjects
Female, Humans, Male, Middle Aged, Referral and Consultation, Thyroid Diseases surgery, Thyroidectomy methods
Abstract

Authors report their initial experience in surgical treatment of thyroid diseases in an area with high percentage of thyroid tumors. Since January 2006, we examinated 428 patients. By clinical features, hormonal profile, imaging and US-guided FNAB, we selected 134 of them for surgery; 93 patients underwent thyroidectomy in January-November 2006. The Authors analyse therapeutic choises and surgical techniques, stressing the high percentage of thyroid neoplasms.

Published
2007

50. [Gastrointestinal opportunistic infections and human immunodeficiency virus (HIV). Case report].

Author

Stagnitti F, Vavalà T, Corelli S, Gammardella P, Martellucci A, Tartaglione L, Di Pucchio E, Calì B, Toccaceli S, Spaziani E, Casciaro GE, Marenga G, and Soda G

Subjects
Adult, Fatal Outcome, Humans, Male, AIDS-Related Opportunistic Infections virology, Cytomegalovirus Infections etiology, Gastrointestinal Diseases virology, HIV Seropositivity complications, Peritonitis virology
Abstract

There have been millions of people found to have AIDS. Death rates from AIDS have declined 15% to 20% in the past 5 years. However, nearly 75000 people will die with AIDS in this year. Patients with AIDS are also at risk for developing both Aids-defining cancers, such as Kaposi's sarcoma and non-Hodgkin lymphoma, and non-Aids-defining cancers and opportunistic infections. In patients with advanced Aids, the Cytomegalovirus is a frequent cause of chorioretinitis, pneumonitis, chronic perineal ulcerations and oesophagitis. It has been involved in endocrine, bone marrow, central nervous system and kidney abnormalities. CMV infection of the small bowel accounts for only 4.3% of all cytomegalovirus infection of the GI tract (large bowel 47%, duodenum 21,7%, stomach 17,4%); isolated cases of small bowel perforation due to CMV have been reported in AIDS patients, and all but one patient died. The Authors report a rare case of an HIV-positive young man with gastroenteric Cytomegalovirus infection responsible for generalized peritonitis from multiple perforations.

Published
2007

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