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5. The prognostic importance of chronic end-stage diseases in geriatric patients admitted to 163 Italian ICUs

Author

Poole, D., Finazzi, S., Nattino, G., Radrizzani, D., Gristina, G., Malacarne, P., Livigni, S., Bertolini, G., Sorgato, C., Mannoni, R., Agnelli, V., Chiani, C., Lanza, G., Venturini, E., Gianni, M., Olivieri, M. C., Guerriero, B., Della Mora, E., Palmer, M., Blasetti, A., Coletta, R., Covani Frigieri, F., Guarducci, M. D., Caracciolo, A., Lain, G., Bernard, M., DE Blasio, E., Zanni, V., Marchesi, G., Madeira, S. M., Spagarino, E., Potalivo, A., Mengoli, F., Parrini, V., Sagliaschi, U., Prandini, A., Rosano, A., Natalini, G., Piccioni, G., Schiavuzzi, M., Bronzini, N., Piva, S., Besozzi, A., Napoleone, A., Patrignani, L., Pisu, M., Mancosu, S., Chiarello, M., Pastorini, S., Bassi, G., Negro, G., Orsini, I., Marifoglou, D., Pota, V., Pegoraro, M., Sucre, M. J., DI Masi, P., Castiglione, G., Morello, G., Garofalo, G., Caroleo, S., Visconti, M. G., Gamberini, E., Mastroianni, A., Liccardi, M. M., Anelati, D., Martinelli, S., Bonato, A., Adorni, A., Colombo, D., Dal Cero, P., Crema, L., Petrucci, N., Beck, E., Alleva, S., Giuntini, R., DA Re, D., Casalini, P., Fabi, M. C., Galeotti, E., Bagalini, G., Bellonzi, A., Zoppellari, R., Lamborghini, S., Pera, L., Doni, L., Bonizzoli, M., Librenti, M., Barattini, M., Mangani, V., Terzitta, M., Guagliardi, C., Bruzzone, C., Arditi, E., Cerana, M., Tavola, M., Falini, S., Vespignani, M. G., Salvi, G., Ramello, P. L., Molesi, A., Ceradelli, M., Buonanno, R., Righini, E., DI Cocco, A., DI Martino, R., Cinque, E., Bonfiglio, M., Ciceri, R., Colombo, L., Nardini, M., Rossi, G., Boccalatte-Rosa, D. L., Babini, M., Zompanti, V., Negri, G., Antonini, B., Baratta, A., Zuccaro, F., Rossi, M., Pedeferri, M., Bellin, M., Sicignano, A., Pezzi, A., Leggieri, C., Fontana, G., Faraldi, L., Cigada, M. G., Magenta, P., Colombo, R., Colombo, S., Gonzi, S., Pizzali, M., Girardis, M., Piccinini, P., Bignone, P., Padovan, L., Bianchin, A., Caria, F. C., Randellini, R., Roticiani, V., Grassi, M., Belluomo Anello, C., Decristofaro, M., Postiglione, M., Giacomello, S., Olivieri, C., Vaccari, C., Dal Ferro, M., Messina, M., Belgiorno, N., Odetto, L., Pasetti, G. S., Balicco, B., Pizzaballa, M. L., Muraro, L., Pignataro, A., Guadagna, A., Fabbri, P. G., Tetamo, R., Bottazzi, A., Mediani, T. S., Gorietti, A., Breschi, C., Ciani, A., Segalini, P., Codeluppi, V., Berruto, F., Pastorelli, M., Comite, C., Pelati, E., Bertolini, R., Lefons, U., DI Pasquale, D. A., Mannolini, G., Vlassich, F., Becarelli, S., Garelli, A., Salsi, P., Rossi, S., Facondini, F., Alampi, D., Cingolani, E., Molino, F. M., Nardi, G., Casula, M., DE Blasi, R. A., Vulcano, G. A., Azzolini, M., Bernasconi, M. O., Bellato, V., Calicchio, G., Righetti, F., Turati, M., Dei Poli, M., Zaro, G., Brizio, E., Coaloa, M., Falzetti, G., Mamprin, F., Liverani, C. M., Clementi, S., Bonucci, P., Varesio, V., Pannacci, R., Fiore, G., Gallo, M., Torta, M., Selvaggi, P., Bert, P. P., Segala, V., Pettazzi, G., Bensi, M., Bocchi, A., Cima, M., Morbelli, M., Peta, M., DI Stella, R., Maggiolo, C., Lembo, R., Pero, A., Marafon, S., Carnevale, L., Vanzino, R., Vecchiarelli, P., and Marino, G.

Subjects
Male, medicine.medical_specialty, Cirrhosis, Disease, Severity of Illness Index, law.invention, 03 medical and health sciences, 0302 clinical medicine, Patient Admission, Postoperative Complications, law, Internal medicine, 80 and over, aged, critical care, prognosis, Medicine, Dementia, Humans, Hospital Mortality, Elective surgery, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Critical care, Prognosis, Female, Intensive Care Units, Italy, Chronic Disease, 030208 emergency & critical care medicine, Odds ratio, medicine.disease, Comorbidity, Intensive care unit, Anesthesiology and Pain Medicine, 030228 respiratory system, Cohort, business
Abstract

BACKGROUND The number of elderly patients undergoing major surgical interventions and then needing admission to intensive care unit (ICU) grows steadily. We investigated this issue in a cohort of 232,278 patients admitted in five years (2011-2015) to 163 Italian general ICUs. METHODS Surgical patients older than 75 registered in the GiViTI MargheritaPROSAFE project were analyzed. The impact on hospital mortality of important chronic conditions (severe COPD, NYHA class IV, dementia, end-stage renal disease, cirrhosis with portal hypertension) was investigated with two prognostic models developed yearly on patients staying in the ICU less or more than 24 hours. RESULTS 44,551 elderly patients (19.2%) underwent emergency (47.3%) or elective surgery (52.7%). At least one severe comorbidity was present in 14.6% of them, yielding a higher hospital mortality (32.4%, vs. 21.1% without severe comorbidity). In the models for patients staying in the ICU 24 hours or more, cirrhosis, NYHA class IV, and severe COPD were constant independent predictors of death (adjusted odds ratios [ORs] range 1.67-1.97, 1.54-1.91, and 1.34-1.50, respectively), while dementia was statistically significant in four out of five models (adjusted ORs 1.23-1.28). End-stage renal disease, instead, never resulted to be an independent prognostic factor. For patients staying in the ICU less than 24 hours, chronic comorbidities were only occasionally independent predictors of death. CONCLUSIONS Our study confirms that elderly surgical patients represent a relevant part of all ICUs admissions. About one of seven bear at least one severe chronic comorbidity, that, excluding end-stage renal disease, are all strong independent predictors of hospital death.

Published
2017

6. Multicenter, Prospective Surveillance Study of Staphylococcus aureus Nasal Colonization in 28 Italian Intensive Care Units: The ISABEL Study

Author

Viale, P, Gesu, G, Privitera, G, Allaria, B, Petrosillo, N, Zamparini, E, Scudeller, L, Albertario, F, Ferrari, L, Alvisi, R, Rita Rossi, M, Betto, C, Ripamonti, M, Castiglione, G, Di Vincenzo, F, Cerchiari, E, Gaspari, G, Pizzardi, Ca, Corsi, A, Piscina, A, De Zen, G, Tesser, A, Dei Poli, M, Costa, E, Ortisi, G, De Vivo, P, Libergoli, M, Della Rocca, G, Lanzafame, P, Favaro, M, Viola, G, Guarino, A, Capuzzo, R, Villa, Ao, Laudi, C, Sturla, C, Antonio Abate, S, Martinelli, G, Nannetti, A, Orsola, Os, Massei, R, Vaiani, R, Alessandra Manzoni, O, Mastroni, P, Sanna, S, Minoja, G, Tognolo, A, Onali, S, Sardi, B, Pelaia, P, Manso, E, Peris, A, Nicoletti, P, Perugini, M, Baldasarri, G, Piccinni, P, Rassu, M, Sinardi, A, Costa, G, Tetamo, R, Monastero, R, Tufano, R, Rossano, F, Tulli, G, Zamponi, E, Milano, F., Viale P, Gesu G, Privitera G, Allaria B, Petrosillo N, Zamparini E, and Scudeller L

Subjects
Microbiology (medical), Male, Methicillin-Resistant Staphylococcus aureus, medicine.medical_specialty, Staphylococcus aureus, Epidemiology, intensive care units, Staphylococcal infections, medicine.disease_cause, law.invention, law, Intensive care, medicine, Humans, Colonization, Prospective Studies, Intensive care medicine, Prospective cohort study, Proportional Hazards Models, Cross Infection, business.industry, biochemical phenomena, metabolism, and nutrition, Staphylococcal Infections, prospective multicenter study, bacterial infections and mycoses, medicine.disease, Methicillin-resistant Staphylococcus aureus, Intensive care unit, nasal colonization, Nasal Mucosa, Staphylococcus aureus, nasal colonization, intensive care units, Italy, prospective multicenter study, Infectious Diseases, Carriage, Italy, Emergency medicine, Female, business, Sentinel Surveillance
Abstract

The role of methicillin-resistant Staphylococcus aureus (MRSA) colonization as a predictor of invasive disease in intensive care unit (ICU) patients was established many years ago. The role of mefhicillin-susceptible Staphylococcus aureus (MSSA) colonization is more debated, although in a recent report patients who were carriers of MRSA or MSSA at ICU admission were found to be at increased risk. Whether carriage at ICU admission involves a higher risk of invasive infection than carriage acquired during an ICU stay has not been established. We report the results of a study aimed at estimating the frequency of S. aureus (MRSA and MSSA) colonization at admission and at discharge in patients admitted to several ICUs in Italy and at estimating the relationship between colonization status and infection by S. aureus.

Published
2011

7. External validation of the Simplified Acute Physiology Score (SAPS) 3 in a cohort of 28,357 patients from 147 Italian intensive care units

Author

Poole, D, Rossi, C, Anghileri, A, Giardino, M, Latronico, N, Radrizzani, D, Langer, M, Bertolini, G, Acciarri, C, Acquarolo, A, Adorni, A, Alberti, A, Alborghetti, A, Antonini, B, Archi, D, Arditi, E, Badii, F, Balata, A, Barattini, M, Barbagli, R, Barbieri, P, Baroncia, M, Bartoccini, A, Bartoli, T, Bassi, F, Beck, E, Bellato, V, Bellorini, M, Belluomo Anello, C, Benanti, C, Berardino, M, Bernasconi, Mo, Besozzi, A, Bianchin, A, Bindi, Ml, Biolino, P, Blasetti, A, Boccalatte, D, Bonaccorso, G, Bonfà, A, Bonfiglio, M, Boniotti, C, Bonizzoli, M, Bottari, V, Breschi, C, Brunori, E, Buonanno, R, Buzzetti, V, Calicchio, G, Calva, S, Capannolo, B, Caracciolo, A, Carnevale, L, Carsana, C, Casadei, E, Casagli, S, Casagrande, L, Casalini, P, Castiglione, G, Cavallo, R, Chiarello, M, Chieregato, A, Chinelli, E, Cigada, M, Coaloa, M, Colombo, R, Colombo, S, Corsini, W, Corvi, D, Cosentino, E, Costa, R, Costanzo, E, Cottignoli, T, Crema, L, Crestan, E, Da Re, D, Dal Cero, P, Dal Ferro, M, David, Antonio, De Blasi RA, De Blasio, E, De Luca, A, De Negri, P, Dei Poli, M, Del Sarto, P, Di Lorenzo, G, Di Masi, P, Di Pasquale, D, Di Serafino, G, Donato, I, Fabbri, L, Fabbri, E, Fabbri, Pg, Fabi, Mc, Faccio, L, Ferla, F, Ferri, F, Fiore, G, Fognani, G, Galeotti, E, Gamberini, E, Garelli, A, Garofalo, G, Garzilli, T, Giacopuzzi, L, Gianni, M, Giannoni, S, Giugiaro, Pm, Gorietti, A, Grassi, P, Greco, M, Guadagnucci, A, Guagliardi, C, Isetta, M, Lapolla, A, Lefons, U, Livigni, S, Madonna, R, Maestrone, C, Magatti, Mf, Maggiolo, C, Malacarne, P, Mancosu, S, Mangani, Va, Mantovani, G, Marafon, S, Martinez Escobar, R, Mastroianni, A, Mastropierro, R, Meloni, A, Messina, M, Miglioranzi, R, Molino, Fm, Morigi, A, Mosca, C, Murri, V, Nardi, G, Nascimben, E, Natalini, G, Negri, G, Negro, G, Neri, M, Nicolini, A, Nuovo, D, Odetto, L, Olivieri, C, Ortoleva, A, Pacini, Dm, Paganini, G, Paganoni, G, Palmer, M, Papiri, S, Parma, A, Parrini, V, Pastorelli, M, Pastorini, S, Pegoraro, M, Pezzi, A, Pinciroli, D, Piredda, G, Piva, S, Pizzaballa, M, Possamai, C, Postiglione, M, Potalivo, A, Pulici, M, Quattrocchi, P, Raffaeli, M, Ranzini, L, Righini, E, Rona, R, Rossi, G, Rossi, S, Rossi, M, Rottoli, F, Salcuni, R, Salvi, G, Savioli, M, Scarrone, S, Schellino, Mm, Segala, V, Segalini, Pa, Sera, G, Sforza, D, Sicignano, A, Sorbara, C, Spadini, E, Staccioli, P, Stefani, M, Sucre, Mj, Tartari, S, Tavola, M, Tetamo, R, Tibaldi, G, Tinacci, S, Todesco, L, Torta, M, Tosi, L, Tripepi, C, Ughi, L, Vaj, M, Vecchiarelli, P, Vespignani, Mg, Visconti, Mg, Vulcano, Ga, Zappa, S, Zocaro, R, and Zuccaro, F.

Subjects
Male, medicine.medical_specialty, Time Factors, genetic structures, Critical Care, Critical Illness, Critical Care and Intensive Care Medicine, law.invention, Bias, law, Predictive Value of Tests, Risk Factors, Intensive care, Anesthesiology, Outcome Assessment, Health Care, medicine, Humans, Hospital Mortality, Prospective Studies, Simplified Acute Physiology Score, Intensive care medicine, Prospective cohort study, Diagnosis-Related Groups, APACHE, Aged, Chi-Square Distribution, business.industry, Data Collection, Benchmarking, Critical care, Hospital mortality, Outcome assessment, Validation study, Discriminant Analysis, Middle Aged, Prognosis, Intensive care unit, Intensive Care Units, Logistic Models, Italy, ROC Curve, Predictive value of tests, Cohort, Calibration, Female, business, Chi-squared distribution
Abstract

To evaluate the SAPS 3 score predictive ability of hospital mortality in a large external validation cohort.Prospective observational study.A total of 28,357 patients from 147 Italian ICUs joining the Project Margherita national database of the Gruppo italiano per la Valutazione degli interventi in Terapia Intensiva (GiViTI).None.Evaluation of discrimination through ROC analysis and of overall goodness-of-fit through the Cox calibration test.Although discrimination was good, calibration turned out to be poor. The general and the South-Europe Mediterranean countries equations overestimated hospital mortality overall (SMR values 0.73 with 95% CI 0.72-0.75 for both equations) and homogeneously across risk classes. Overprediction was confirmed among important subgroups, with SMR values ranging between 0.47 and 0.82.The result strictly supported by our data is that the SAPS 3 score calibrates inadequately in a large sample of Italian ICU patients and thus should not be used for benchmarking, at least in Italian settings.

Published
2009

8. [The choice of surgical therapy in adenocarcinoma of the cardia]

Author

Solerio, D, Camandona, Michele, Gasparri, Guido, Casalegno, Pa, Raggio, E, and DEI POLI, M.

Subjects
Adult, Aged, 80 and over, Male, Esophageal Neoplasms, Anastomosis, Surgical, Cardia, Adenocarcinoma, Middle Aged, Survival Analysis, Treatment Outcome, Stomach Neoplasms, Humans, Female, Esophagogastric Junction, Aged, Neoplasm Staging, Retrospective Studies
Abstract

From 1996 the adenocarcinoma of the esophago-gastric junction (AEG) is divided into 3 types according to Siewert's classification. For AEG type I and III the surgical treatment is codified, while for type II is still controversial. The aim of our study is to understand what is the better surgical treatment for AEG type II.From 1990 to 2002 we have performed 111 resections for adenocarcinoma of the cardia: 25 for AEG type I (all esophago-gastric resection), 39 for type II (22 esophago-gastric resection, 17 extended total gastrectomy with esophageal resection) and 47 for type III (8 esophago-gastric resection, 39 extended total gastrectomy with esophageal resection).The morbidity and mortality rates are 17 and 5.4%, without significant difference between the different surgical treatment (p0.01). The 5 year survival rate is 35%. Significant prognostic factors are the staging TNM (p=0.002) and principally the presence of metastatic lymph nodes (p=0.001). For AEG type II any significant difference in survival is associated with surgical strategy, also in early stage (p0.01).According to the results of our study and those of the other authors, who have showed that a 10 cm distance of the neoplasm by the gastric side and the esophageal one could assure oncologic radicality and also that metastatic lymph nodes below pylorus and near greater curvature are uncommon, we can consider esophago-gastric resection for AEG II a speedy, safe and oncologically correct surgical treatment.

Published
2005

12. Clinical importance of tumour markers in the diagnosis of squamous-cell carcinoma of the esophagus

Author

Dei Poli, M., Albertino, B., Gasparri, G., Casalegno, P. A., Alberto Oliaro, Rapellino, M., and Pecchio, F.

Subjects
Adult, Male, Esophageal Neoplasms, Antigens, Neoplasm, Biomarkers, Tumor, Carcinoma, Squamous Cell, Humans, Antigens, Tumor-Associated, Carbohydrate, Female, Middle Aged, Aged, Carcinoembryonic Antigen
Abstract

In order to evaluate the diagnostic value of three tumour markers, CEA, CA 19-9 and TA4-scc, 50 patients affected by squamous-cell carcinoma of the esophagus were studied together with 70 normal controls and 22 patients affected by benign esophageal pathologies. The three tumour markers were assessed in all patients and data were evaluated statistically in order to reveal their sensitivities, specificities and diagnostic values. It was concluded that further studies should be carried out on the marker TA4-scc given its high specificity and sensitivity towards esophageal neoplasias at a relatively early stage.

Published
1990

14. 2 OP C-kit proto-oncogene and the cell associated forms of its ligand stem cell factor are differentially expressed in normal, premalignant and malignant lesions of colon mucosa

Author

Tibaudi, D., primary, Carbone, A., additional, Smirne, C., additional, Ferrero, I., additional, Sozzi, M., additional, Gramigni, C., additional, Nano, M., additional, Dughera, L., additional, Bellone, G., additional, Dei Poli, M., additional, and Emanuelli, G., additional

Published
2002
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17. Letters to the Editor

Author

Ferruccio Conte, Dei Poli M, Castelli L, Adalberto Sessa, and Cioffi A

Subjects
Pediatrics, medicine.medical_specialty, business.industry, Renal glycosuria, Medicine, business, medicine.disease
Published
1978
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18. Traumatic diaphragmatic hernias

Author

Mario NANO, Dei Poli M, Mossetti C, and Maggi G

Subjects
Adult, Male, Radiography, Laparotomy, Adolescent, Humans, Thoracic Surgery, Female, Middle Aged, Hernia, Diaphragmatic, Traumatic, Aged
Abstract

In every serious thoracic or abdominal injury, or both, a hernia of the diaphragm should be suspected and always sought clinically and roentgenologically. If a hernia is present, compatible with the condition of the patient, it should be operated upon immediately. The choice of surgical access depends upon the associated lesions. We prefer thoracotomy as the surgical approach if important submesocolic lesions are not present. In instances of a late diagnosis, the approach should always be through the chest. The late results, in patients diagnosed and operated upon early, are good and are comparable with those obtained in operations of the thorax for nonneoplastic conditions. The surgical approach of choice for the treatment of such hernias is a thoracotomy both in the early as well as in the late stages, provided that no important submesocolic lesions are present.

Published
1980

19. [Leiomyoma of the lung. Apropos of 5 cases]

Author

Salizzoni, Mauro, Ardissone, Francesco, Chiampo, G., Borasio, P., DEI POLI, M., and Andrion, A.

Subjects
Male, Lung Neoplasms, Adolescent, Leiomyoma, Humans, Female, Middle Aged, Aged
Published
1985

21. [Multifocal early cancer of the esophagus]

Author

Albertino, F., BOTTO MICCA, F., Gasparri, Guido, Casalegno, Pa, Oliaro, A., and DEI POLI, M.

Subjects
Male, Neoplasms, Multiple Primary, Radiography, Esophageal Neoplasms, Humans, Middle Aged
Published
1987

22. [Traumatic hernias of the diaphragm. Review of cases]

Author

Mossetti C, Coluccia C, Mario NANO, Dei Poli M, Pischedda F, and Oliaro A

Subjects
Adult, Male, Adolescent, Middle Aged, Hernia, Diaphragmatic, Traumatic, Pleural Effusion, Dyspnea, Postoperative Complications, Humans, Female, Child, Empyema, Respiratory Insufficiency, Pleurisy, Aged
Published
1982

24. [Sequential study of the immunologic picture in neoplasm patients before and after surgical intervention]

Author

Albertino, B., Borgialli, R., Guerra, Mg, Gasparri, Guido, Oliaro, A., and DEI POLI, M.

Subjects
Male, Immunity, Cellular, Esophageal Neoplasms, Immunologic Deficiency Syndromes, Middle Aged, T-Lymphocytes, Regulatory, Leukocyte Count, Postoperative Complications, Adjuvants, Immunologic, Esophagoplasty, Carcinoma, Squamous Cell, Humans, Female, Aged, Skin Tests
Abstract

The results obtained in the study of the pre- and postoperative immunological picture in 25 patients suffering from carcinoma of the pavement epithelium of the oesophagus are reported. From this study it emerges that in the preoperative period, the serum levels of immunoglobulin and complement as well as the lymphocyte subpopulations do not present significant changes, whereas 44% of the patients present cell-mediated immunity certified by the skin test. On the other hand, in the postoperative period there is a sharp reduction in the OKT4/8 ratio due in the main to a relative increase in suppressor lymphocytes. In conclusion, the value of skin tests in "in vivo" anergic patient research is underlined, evidencing the need for a programme of immunostimulation in the postoperative period.

Published
1989

27. Cancer of the esophagus: ten years' experience

Author

Dei Poli, M., Gasparri, G., Casalegno, P. A., Michele Camandona, Casadio, C., Ferrarotti, G., Albertino, B., Stella, A., and Oliaro, A.

Subjects
Adult, Male, Survival Rate, Esophageal Neoplasms, Humans, Female, Prospective Studies, Middle Aged, Aged, Retrospective Studies
Abstract

The paper reports the authors' ten-year experience of the surgical treatment of cancer of the esophagus. A total of 625 patients with esophageal carcinoma were observed during the period 1980-89 of whom 490 were admitted to hospital and, of the latter, 172 (35.1%) were operated with a sectile rate of 86% (148 patients). Data from this period were analysed both retrospectively and prospectively using a computerised system. There were 105 radical operations (70.9%) and 43 palliative operations (29.1%). The 3-year actuarial survival rate was 21.7% and the difference between radical and palliative resections was at the limit of significance (p less than 0.1).

38. [Continuous brachial plexus blockade for shoulder surgery]

Author

Grossi P, Pavesi M, Dei Poli M, Bertini L, Casati A, Borghi B, Guido Fanelli, Broring K, Bono D, and Narcisi S

Subjects
Shoulder, Time Factors, Humans, Brachial Plexus, Nerve Block, Orthopedic Procedures
Abstract

Continuous brachial plexus block is the technique of choice for postoperative shoulder pain treatment. The localization of the plexus is usually obtained drawing landmarks on the skin and using the electrical nerve stimulator; these and other different modalities are applied in order to reach safely and precisely nerve roots to be blocked with an anaesthetic solution. The Author presents a new anatomical perspective to guide the localization of the brachial plexus. It is shown how it is possible to detect the pathway of the brachial plexus from the cutaneous surface, linking between each other various landmarks: a) the apex of the scalene triangle, at the cross of a line leaving from the cricoid process and directed posterior to the posterior border of the sternocleidomastoid muscle, b) the midline of the clavicle c)the deltoid-pectoral sulcus d) the midpoint between the coracoid process and the chest profile e) the pulsation of the artery in the axylla. Following the guide of the so formed anesthetic line, is possible to place the needle, with a direction from distal to proximal, in a tangential route towards the interscalenic groove, thus allowing to perform a block of the plexus in a simple and efficacious way.

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