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4. Surgical management of acute pancreatitis in Italy: lessons from a prospective multicentre study

Author

De Rai, Paolo, Zerbi, Alessandro, Castoldi, Laura, Bassi, Claudio, Frulloni, Luca, Uomo, Generoso, Gabbrielli, Armando, Pezzilli, Raffaele, Cavallini, Giorgio, Di Carlo, Valerio, Agugiaro, S., Turri, L., Bartoli, A., Barberini, F., Cavazzoni, G., Bartolo, F., Della Papa, D., Bassi, N., Massani, M., Benedetti, A., Macarri, G., Piergallini, L., Briani, G., Bartolasi, L., Bugnano, L., Buonanno, G. M., Esposito, C., Cordovana, A., Cavina, E., Seccia, M., Lippolis, P., Musco, B., Barletta, M., Chilovi, E., De Guelfi, A., Chirletti, P., Caronna, R., Scozzafava, S., Cardi, M., Cirino, E., Buffone, A., Colangelo, E., Caracino, V., Cortese, F., Casentini, A., Costamagna, G., Trincali, A., Curzio, M., Clivio, S., Segato, S., D'Alessandro, A., Ambrosiani, V., D'Ambrosio, B., Chiodo, C., Dicillo, M., Reale, L., Grandolfo, A., Fabbrucci, P., Bruscino, A., Mugnaini, P., Ferrarese, S., Ugenti, I., Forte, G. B., Rocco, P., Franzè, A., Bertelè, A., Sereni, G., Friedman, Daniele, Mariani, L., Morelli, F., Gai, V., Antro, C., Garcea, D., Gardini, A., Lucci, E., Giulianotti, P. C., Sbrana, F., Balestracci, T., Giulini, S. M., Pellizzari, A., Ronconi, M., Cimaschi, S., Grassini, M., Lacignola, S., Calandro, L., Mazzitelli, L., Costarella, S. M., Egidio, A., Mello Teggia, P., Stefano, E., Cassini, P., Modica, G., Lupo, F., Giraci, G., Mosca, F., Del Chiaro, M., Mosella, G., Benassai, G., Nanni, M., D'Aristotile, A., Negro, P., Pirazzoli, A., Rabitti, P. G., Romano, C., Gerardi, G., Troianello, B., Russello, D., Di Stefano, A., Avelli, S., Salval, N., Bellini, N., Scalon, P., Staudacher, C., Parolini, D., Strazzabosco, M., Signorelli, S., Tedeschi, U., Testoni, P. A., Masci, E., Mariani, A., Torelli, E., Garcea, M. R., Lombardi, V., Lecconi, L., Valeri, L., Presenti, L., Alessio, F., Ventrucci, M., Virzi, S., Cipolla, A., De Rai, P, Zerbi, A, Castoldi, L, Bassi, C, Frulloni, L, Uomo, G, Gabbrielli, A, Pezzilli, R, Cavallini, G, Di Carlo, V, Proinf, Aisp, and Testoni, PIER ALBERTO

Subjects
Male, Time Factors, Pancreatitis, Alcoholic, medicine.medical_treatment, Acute pancreatitis, Surgery, Aged, Biliary Tract Diseases, Chi-Square Distribution, Cholangiopancreatography, Endoscopic Retrograde, Cholecystectomy, Laparoscopic, Female, Guideline Adherence, Humans, Italy, Pancreatitis, Pancreatitis, Acute Necrotizing, Practice Guidelines as Topic, Prospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, Treatment Outcome, Cholecystectomy, Jejunostomy, Pancreatectomy, Practice Patterns, Physicians', Hepatology, Gastroenterology, Physician's Practice Patterns, Practice Patterns, surgery, Endoscopic Retrograde, Medicine, Cholangiopancreatography, Laparoscopic, Acute Necrotizing, Alcoholic, Prospective cohort study, health care economics and organizations, acute pancreatitis, Corrigendum, Risk assessment, medicine.medical_specialty, education, Severity of illness, Intensive care medicine, Physicians', business.industry, General surgery, Original Articles, medicine.disease, business
Abstract

OBJECTIVE: This study aimed to evaluate the surgical treatment of acute pancreatitis in Italy and to assess compliance with international guidelines. METHODS: A series of 1173 patients in 56 hospitals were prospectively enrolled and their data analysed. RESULTS: Twenty-nine patients with severe pancreatitis underwent surgical intervention. Necrosectomy was performed in 26 patients, associated with postoperative lavage in 70% of cases. A feeding jejunostomy was added in 37% of cases. Mortality was 21%. Of the patients with mild pancreatitis, 714 patients with a biliary aetiology were evaluated. Prophylactic treatment of relapses was carried out in 212 patients (36%) by cholecystectomy and in 161 using a laparoscopic approach. Preoperative endoscopic retrograde cholangiopancreatography was associated with cholecystectomy in 83 patients (39%). Forty-seven patients (22%) were treated at a second admission, with a median delay of 31 days from the onset of pancreatitis. Eighteen patients with severe pancreatitis underwent cholecystectomy 37.9 days after the first admission. There were no deaths. DISCUSSION: The results indicate poor compliance with published guidelines. In severe pancreatitis, early surgical intervention is frequently performed and enteral feeding is seldom used. Only a small number of patients with mild biliary pancreatitis undergo definitive treatment (i.e. cholecystectomy) within 4 weeks of the onset of pancreatitis.

Published
2010
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5. Surgical management of acute pancreatitis in Italy: lessons from a prospective multicentre study

Author

DE RAI, P, Zerbi, A, Castoldi, L, Bassi, C, Frulloni, L, Uomo, G, Gabbrielli, A, Pezzilli, R, Cavallini, G, DI CARLO, V, PROINF AISP PROGETTO INFORMATIZZATO PANCREATITE ACUTA, ASSOCIAZIONE ITALIANA PER LO STUDIO DEL PANCREAS COMPUTERIZED PROJECT ON ACUTE PANCREATITIS, COLLABORATORS AGUGIARO S, ITALIAN ASSOCIATION FOR THE STUDY OF THE PANCREAS STUDY G. R. O. U. P., Turri, L, Bartoli, A, Barberini, F, Cavazzoni, G, Bartolo, F, Papa, Dd, Bassi, Nicolo', Massani, M, Benedetti, A, Macarri, G, Piergallini, L, Briani, G, Bartolasi, L, Bugnano, L, Buonanno, Gm, Esposito, C, Cordovana, A, Cavina, E, Seccia, M, Lippolis, P, Musco, B, Barletta, M, Chilovi, E, DE GUELFI, A, Chirletti, P, Caronna, R, Scozzafava, S, Cardi, M, Cirino, E, Buffone, A, Colangelo, E, Caracino, V, Cortese, F, Casentini, A, Costamagna, G, Trincali, A, Curzio, M, Clivio, S, Segato, S, D'Alessandro, A, Ambrosiani, V, D'Ambrosio, B, Chiodo, C, Dicillo, M, Reale, L, Grandolfo, A, Fabbrucci, P, Bruscino, A, Mugnaini, P, Ferrarese, S, Ugenti, I, Forte, Gb, Rocco, P, Franzãˆ, A, Bertelãˆ, A, Sereni, G, Friedman, D, Mariani, L, Morelli, F, Gai, V, Antro, C, Garcea, D, Gardini, A, Lucci, E, Giulianotti, Pc, Sbrana, F, Balestracci, T, Giulini, Sm, Pellizzari, A, Ronconi, M, Cimaschi, S, Grassini, M, Lacignola, S, Calandro, L, Mazzitelli, L, Costarella, Sm, Egidio, A, Teggia, Pm, Stefano, E, Cassini, P, Modica, G, Lupo, F, Giraci, G, Mosca, F, DEL CHIARO, M, Mosella, G, Benassai, G, Nanni, M, D'Aristotile, A, Negro, P, Pirazzoli, A, Rabitti, Pg, Romano, C, Gerardi, G, Troianello, B, Russello, D, DI STEFANO, A, Avelli, S, Salval, N, Bellini, N, Scalon, P, Staudacher, C, Parolini, D, Strazzabosco, M, Signorelli, S, Tedeschi, U, Testoni, Pa, Masci, E, Mariani, A, Torelli, E, Garcea, Mr, Lombardi, V, Lecconi, L, Valeri, L, Presenti, L, Alessio, F, Ventrucci, M, Virzi, S, and Cipolla, A.

Published
2010

6. Diagnostic assessment and outcome of acute pancreatitis in Italy: results of a prospective multicentre study. ProInf-AISP: Progetto informatizzato pancreatite acuta, Associazione Italiana Studio Pancreas, phase II

Author

Uomo, G, Pezzilli, R., Gabbrielli, A., Castoldi, L., Zerbi, A., Frulloni, L., De Rai, P., Cavallini, G., Di Carlo, V., Agugiaro, S., Turri, L., Bartoli, A., Barberini, F., Cavazoni, G., Bartolo, F., Della Papa, D., Bassi, C., Bassi, N., Massani, M., Benedetti, A., Macarri, G., Piergallini, L., Briani, G., Bartolasi, L., Brugnano, L., Buonanno, G. M., Esposito, C., Cardovana, A., Cavina, E., Seccia, M., Lipollis, P., Musco, B., Barletta, M., Chilovi, E., De Guelmi, A., Chirletti, P., Caronna, R., Scozzafava, S., Cardi, M., Cirrino, E., Buffone, A., Colangelo, E., Caracino, V., Cortese, F., Cosentini, A., Costamagna, G., Tringali, A., Curzio, M., Clivio, S., Segato, S., D'Alessandro, A., Ambrosini, V., D'Amborsio, B., Chiodo, C., Dicillo, M., Reale, L., Grandolfo, A., Fabbrucci, P., Bruscino, A., Mugnaini, P., Ferrarese, S., Ugenti, I., Forte, G. B., Rocco, P., Franzè, A., Bertelè, A., Sereni, G., Friedman, Daniele, Mariani, L. M., Murelli, Federica, Gai, V., Antro, C., Garcea, D., Gardini, A., Lucci, E., Giulianotti, P. C., Sbrana, F., Balestracci, T., Giulini, S. M., Pellizzari, A., Ronconi, M., Cimaschi, S., Grassini, M., Lacitignola, S., Caliandro, L., Mazzitelli, R., Costarella, S. M., Egidio, A., Mello Teggia, P., Stefano, E., Cassini, P., Modica, G., Lupo, F., Giraci, G., Mosca, F., Del Chiaro, M., Mosella, G., Benassai, G., Nanni, M., D'Aristotile, A., Negro, P., Pirazzoli, A., Rabitti, P. G., Romano, C., Gerardi, G., Troianello, B., Russello, D., Di Stefano, A., Avelli, S., Salvai, M., Bellini, N., Scalon, P., Staudacher, C., Parolini, D., Strazzabosco, M., Signorelli, S., Tedeschi, U., Testoni, P. A., Masci, E., Mariani, A., Torelli, E., Garcea, M. R., Lombardi, V., Cecconi, L., Valeri, A., Presenti, L., Alessio, F., Ventrucci, M., Virzì, S., and Cipolla, A.

Subjects
Adult, Male, Pancreatic necrosis, Severity of Illness Index, Body Mass Index, Acute Pancreatitis, Clinical outcome, Computed tomography, Diagnosis, Pancreatitis, Prognosis, Ultrasonography, Aged, Aged, 80 and over, Cholangiopancreatography, Endoscopic Retrograde, Creatinine, Female, Humans, Italy, Middle Aged, Prospective Studies, Treatment Outcome, Hepatology, Gastroenterology, Endoscopic Retrograde, 80 and over, treatment, Medicine (all), Cholangiopancreatography, acute pancreatitis, diagnosis
Abstract

Up till now, only one study providing practically complete information on acute pancreatitis in Italy has been published. The aim of this prospective study was to evaluate the clinical characteristics, in terms of diagnostic assessment and outcome, of a large series of patients affected by acute pancreatitis in Italy.The study involved 56 Italian centres, homogeneously distributed throughout the entire national territory. Each participating centre was furnished with an ad hoc software including 530 items along with subsequent collection, tabulation and quality control of the data.One thousand five hundred and forty case report forms of patients affected by acute pancreatitis were collected but 367 of them (24%) were subsequently eliminated from the final analysis. Therefore, 1173 patients (581 females and 592 males) were recruited. Mean age of patients was 62.0+/-18.2 years (95% confidence interval, 60.9-63.0). On the basis of Atlanta classification, 1006 patients (85.8%) were defined as mild and 167 (14.2%) as severe pancreatitis. Biliary forms represented the most frequent aetiological category (813 cases, 69.3%) while alcoholic forms only 6.6% (77 cases); the remaining aetiologies accounted for 7.1% (83 cases) while 200 cases (17.1%) remained without a definite aetiological factor. Complete recovery was achieved in 1016 patients (86.6%) whereas morphological sequelae were found in 121 patients (10.3%) and mortality in 36 patients (3.1%; 0.4% in mild and 19.2% in severe acute pancreatitis). Ultrasonography was largely utilised as a first line diagnostic tool in all patients, with valuable visualisation of the pancreas in 85% of patients. Computer tomography scan was also widely used, with 66.7% of exams in mild and 33.3% in severe pancreatitis. Patients affected by biliary pancreatitis presented more severe (p=0.004) and necrotizing forms (p=0.021). Mortality was significantly related (p0.001) with the extension of pancreatic necrosis and with an age of over 70 years. Body mass index presented significantly greater values in severe than in mild forms (p0.001).Association of creatinine serum level over 2mg/dl with an abnormal chest X-ray showed a high significant correlation with a more severe outcome in terms of morphological sequelae and mortality (p=0.0001). Acute pancreatitis in Italy more commonly presents biliary aetiology and favourable outcome with low rate of complications and mortality. From a cost-effectiveness standpoint, diagnostic approach to this disease needs to be better standardised.

Published
2007

7. A prospective multicentre survey on the treatment of acute pancreatitis in Italy

Author

Pezzilli, R, Uomo, G., Gabbrielli, A., Zerbi, A., Frulloni, L., De Rai, P., Castoldi, L., Cavallini, G., Di Carlo, V., Agugiaro, S., Turri, L., Bartoli, A., Barberini, F., Cavazoni, G., Bartolo, F., Della Papa, D., Bassi, C., Bassi, N., Massani, M., Benedetti, A., Macarri, G., Piergallini, L., Briani, G., Bartolasi, L., Brugnano, L., Buonanno, G. M., Esposito, C., Cardovana, A., Cavina, E., Seccia, M., Lipollis, P., Musco, B., Barletta, M., Chilovi, E., De Guelmi, A., Chirletti, Piero, Caronna, Roberto, Scozzafava, S., Cardi, Maurizio, Cirino, E., Buffone, A., Colangelo, E., Caracino, V., Cortese, F., Cosentini, A., Costamagna, G., Tringali, A., Curzio, M., Clivio, S., Segato, S., D'Alessandro, A., Ambrosini, V., D'Amborsio, B., Chiodo, C., Dicillo, M., Reale, L., Grandolfo, A., Fabbrucci, P., Bruscino, A., Mugnaini, P., Ferrarese, S., Ugenti, I., Forte, G. B., Rocco, P., Franzè, A., Bertelè, A., Sereni, G., Friedman, D., Mariani, L. M., Murelli, F., Gai, V., Antro, C., Garcea, D., Gardini, A., Lucci, E., Giulianotti, P. C., Sbrana, F., Balestracci, T., Giulini, S. M., Pellizzari, A., Ronconi, M., Cimaschi, S., Grassini, M., Lacitignola, S., Caliandro, L., Mazzitelli, R., Costarella, S. M., Egidio, A., Mello Teggia, P., Stefano, E., Cassini, P., Modica, G., Lupo, F., Giraci, G., Mosca, F., Del Chiaro, M., Mosella, G., Benassai, G., Nanni, M., D'Aristotile, A., Negro, P., Pirazzoli, A., Rabitti, P. G., Romano, C., Gerardi, G., Troianello, B., Russello, D., Di Stefano, A., Avelli, S., Salvai, M., Bellini, N., Scalon, P., Staudacher, C., Parolini, D., Strazzabosco, M., Signorelli, S., Tedeschi, U., Testoni, P. A., Masci, E., Mariani, A., Torelli, E., Garcea, M. R., Lombardi, V., Cecconi, L., Valeri, A., Presenti, L., Alessio, F., Ventrucci, M., Virzi, S., and Cipolla, A.

Subjects
Adult, Male, medicine.medical_specialty, ERCP, Pancreatitis, Pancreatitis acute necrotising, Aged, Aged, 80 and over, Analgesics, Anti-Bacterial Agents, Digestive System Surgical Procedures, Female, Histamine Antagonists, Humans, Italy, Middle Aged, Prospective Studies, Severity of Illness Index, Treatment Outcome, Medicine (all), Hepatology, Gastroenterology, Therapeutic approach, Internal medicine, Severity of illness, 80 and over, Medicine, Prospective cohort study, business.industry, medicine.disease, Surgery, medicine.anatomical_structure, Acute pancreatitis, Tramadol, business, Pancreas, medicine.drug
Abstract

The Italian Association for the Study of the Pancreas released a diagnostic and therapeutic algorithm for acute pancreatitis in 1999.This study focused on the analysis of the therapeutic approach for the treatment of acute pancreatitis in Italy.One thousand, one hundred and seventy-three patients were recruited: 1006 patients (85.8%) had mild acute pancreatitis (MAP) and 167 (14.2%) had the severe acute pancreatitis (SAP); 161 patients showed pancreatic necrosis at computed tomography; 121 patients (10.3%) had sequelae and 36 (3.1%) died.Non-steroidal anti-inflammatory drugs and tramadol were used more frequently in patients with the MAP whereas opioids and the association schedules were used more frequently in patients with the SAP (P0.001). Gabexate mesilate was utilised in 831 out of 1173 patients (70.8%); in particular, gabexate mesilate was used in 70.6% patients with MAP and in 73.1% of those with SAP (P=0.521). The duration of the drug administration was significantly shorter in those having MAP than in those having the SAP (P0.001). The antibiotics most frequently used for the prophylaxis against infection from pancreatic necrosis (43.1%) were carbapenems. Only a small number of patients received enteral nutrition (4.7%). Endoscopic retrograde cholangiopancreatography was carried out in 344 of the 1173 patients (29.3%). Surgery was performed in 48 with SAP (19 had elective biliary surgery and 29 had pancreatic surgery).The results of this survey indicate a lack of compliance with the guidelines which regard the indications mainly for interventional endoscopy and surgery.

Published
2007

8. Raccomandazioni cliniche per i principali tumori solidi

Author

Allegrini, G., Amoroso, D., Angioli, D., Arcangeli, Annarosa, Bechi, Paolo, Biti, G., Calvaruso, V., Celona, G., Di Giorgi, U., Di Lieto, M., Fabbrucci, P., Fiorentini, G., Franceschini, F., Fucini, Claudio, Galardi, A., Gasperoni, S., Genuardi, M., Goletti, O., Grazzini, G., Janni, A., Lazzi, S., Manetti, A., Mantellini, P., Masi, A., Mazza, E., Medi, F., Messerini, L., Mignogna, M., Mini, E., Moretti, R., Morettini, A., Mosca, F., Naspetti, R., Paci, E. £., Pinto, E., Ponticelli, P., Pirtoli, L., Piliti, M., Ribecco, A. S., Sainato, A., Sarnelli, R., Seccia, M., Tagliagambe, A., Tanzini, G., Tonelli, F., Valanzano, R., Valeri, A., and Venturini, G.

Subjects
raccomandazioni cliniche, tumori solidi
Published
2005

9. Long term outcome of acute pancreatitis in Italy: Results of a multicentre study

Author

Castoldi, L, De Rai, P, Zerbi, A, Frulloni, L, Uomo, G, Gabbrielli, A, Bassi, C, Pezzilli, R, Agugiaro, S, Turri, L, Bartoli, A, Barberini, F, Cavazzoni, G, Bartolo, F, Papa, D, Bassi, N, Massani, M, Benedetti, A, Macarri, G, Piergallini, L, Briani, G, Bartolasi, L, Bugnano, L, Buonanno, G, Esposito, C, Cordovana, A, Cavina, E, Seccia, M, Musco, B, Barletta, M, Chilovi, E, De Guelfi, A, Chirletti, P, Caronna, R, Scozzafava, S, Cardi, M, Cirino, E, Buffone, A, Colangelo, E, Caracino, V, Cortese, F, Casentini, A, Costamagna, G, Trincali, A, Curzio, M, Clivio, S, Segato, S, D'Alessandro, A, Ambrosiani, V, D'Ambrosio, B, Chiodo, C, Dicillo, M, Reale, L, Grandolfo, A, Fabbrucci, P, Bruscino, A, Mugnaini, P, Ferrarese, S, Ugenti, I, Forte, G, Rocco, P, Franzè, A, Bertelè, A, Sereni, G, Friedman, D, Mariani, L, Morelli, F, Gai, V, Antro, C, Garcea, D, Gardini, A, Lucci, E, Giulianotti, P, Sbrana, F, Balestracci, T, Giulini, S, Pellizzari, A, Ronconi, M, Cimaschi, S, Grassini, M, Lacignola, S, Martina, C, Mazzitelli, L, Costarella, S, Reggio, E, Mello Teggia P., N, Stefano, E, Cassini, P, Modica, G, Lupo, F, Giraci, G, Mosca, F, Del Chiaro, M, Mosella, G, Benassai, G, Nanni, M, D'Aristotile, A, Negro, P, Pirazzoli, A, Rabitti, P, Romano, C, Gerardi, G, Troianello, B, Ruscello, D, Di Stefano, A, Avelli, S, Salval, N, Bellini, N, Scalon, P, Staudacher, C, Parolini, D, Strazzabosco, M, Signorelli, S, Tedeschi, U, Testoni, P, Masci, E, Mariani, A, Torelli, E, Garcea, M, Lombardi, V, Lecconi, L, Valeri, L, Presenti, L, Alessio, F, Ventrucci, M, Virzi, S, Cipolla, A, FERRARESE, SAMUELE, Mello Teggia P. , n, Cipolla, A., STRAZZABOSCO, MARIO, Castoldi, L, De Rai, P, Zerbi, A, Frulloni, L, Uomo, G, Gabbrielli, A, Bassi, C, Pezzilli, R, Agugiaro, S, Turri, L, Bartoli, A, Barberini, F, Cavazzoni, G, Bartolo, F, Papa, D, Bassi, N, Massani, M, Benedetti, A, Macarri, G, Piergallini, L, Briani, G, Bartolasi, L, Bugnano, L, Buonanno, G, Esposito, C, Cordovana, A, Cavina, E, Seccia, M, Musco, B, Barletta, M, Chilovi, E, De Guelfi, A, Chirletti, P, Caronna, R, Scozzafava, S, Cardi, M, Cirino, E, Buffone, A, Colangelo, E, Caracino, V, Cortese, F, Casentini, A, Costamagna, G, Trincali, A, Curzio, M, Clivio, S, Segato, S, D'Alessandro, A, Ambrosiani, V, D'Ambrosio, B, Chiodo, C, Dicillo, M, Reale, L, Grandolfo, A, Fabbrucci, P, Bruscino, A, Mugnaini, P, Ferrarese, S, Ugenti, I, Forte, G, Rocco, P, Franzè, A, Bertelè, A, Sereni, G, Friedman, D, Mariani, L, Morelli, F, Gai, V, Antro, C, Garcea, D, Gardini, A, Lucci, E, Giulianotti, P, Sbrana, F, Balestracci, T, Giulini, S, Pellizzari, A, Ronconi, M, Cimaschi, S, Grassini, M, Lacignola, S, Martina, C, Mazzitelli, L, Costarella, S, Reggio, E, Mello Teggia P., N, Stefano, E, Cassini, P, Modica, G, Lupo, F, Giraci, G, Mosca, F, Del Chiaro, M, Mosella, G, Benassai, G, Nanni, M, D'Aristotile, A, Negro, P, Pirazzoli, A, Rabitti, P, Romano, C, Gerardi, G, Troianello, B, Ruscello, D, Di Stefano, A, Avelli, S, Salval, N, Bellini, N, Scalon, P, Staudacher, C, Parolini, D, Strazzabosco, M, Signorelli, S, Tedeschi, U, Testoni, P, Masci, E, Mariani, A, Torelli, E, Garcea, M, Lombardi, V, Lecconi, L, Valeri, L, Presenti, L, Alessio, F, Ventrucci, M, Virzi, S, Cipolla, A, FERRARESE, SAMUELE, Mello Teggia P. , n, Cipolla, A., and STRAZZABOSCO, MARIO

Abstract

Background: In Italy, no long-term studies regarding the natural history of acute pancreatitis have been carried out. Aim: To report the results of a follow-up on a large series of patients hospitalised for pancreatitis. Methods: Data of 631 patients admitted to 35 Italian hospitals were retrospectively evaluated 51.7 ± 8.4 months after discharge. Results: The average recovery time after mild or severe pancreatitis was 28.2 and 53.4 days respectively. Fourteen sequelae were not resolved and 9 cases required late surgical intervention. Eighty patients (12.7%) had a second hospital admission. Of the patients with mild biliary pancreatitis, 67.9% underwent a cholecystectomy. The overall incidence of relapse was 12.7%. Mortality was 9.8% and no death was related to pancreatitis. Three patients died from carcinoma of the pancreas. Conclusion: Reported recovery time after an attack of pancreatitis was longer than expected in the mild forms. The treatment of sequelae was delayed beyond one year after discharge. The incidence of relapse of biliary pancreatitis in patients not undergoing a cholecystectomy was low, due to endoscopic treatment. Mortality from pancreatic-related causes is low, but there is an association with malignant pancreatic or ampullary tumours not diagnosed during the acute phase of the illness. © 2013 Editrice Gastroenterologica Italiana S.r.l

Published
2013

10. La Puntura Ad Occhiello: l'esperienza Dei Centri Dialisi Della Azienda USL Di Rimini

Author

Sgreccia, Marina, Molari, Manuela, Pacifero, Deborah, Cecchini, Sabrina, Fabbrucci, Stella, Fronda, Patrizia, Tamagnini, Marisa, and Bignardi, Patrizia

Abstract

The buttonhole technique represents an arteriovenous fistula puncture tool that allows positioning the needle always at the same site. This procedure not only is more comfortable for patients, but is also appreciated by nurses because it reduces hemostasis time and offers the advantage of an easy cannulation.The only negative outcome of the buttonhole technique is, possibly, an increased incidence of skin infections. We introduced the buttonhole technique at the dialysis centers of the Rimini Hospital in 2009 and we here investigate the results and complications recorded during the following 5 years.

Published
2014
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11. [Liver resection with the water dissector; preliminary experience of 8 cases].

Author

Fabbrucci P, Androsoni G, Falchi A, Lazzeri V, and Becchio A

Subjects
Adult, Aged, Aged, 80 and over, Biliary Fistula etiology, Colonic Neoplasms pathology, Female, Gallbladder Neoplasms pathology, Hepatectomy methods, Humans, Liver Neoplasms secondary, Liver Neoplasms surgery, Male, Middle Aged, Postoperative Complications, Hepatectomy instrumentation
Abstract

New methods for the resection of liver parenchyma was developed in order to simplify liver surgery. The object of our study was to test a method using the water dissector, a rather new equipment. Eight patients, four men end four women, have been operated, from March to September 1997, using the water dissector. Age of the patients ranged from 42 to 83 years (mean age 67 years). Indication for surgery was liver metastasis from colon cancer (6 patients), and gallbladder cancer (2 patients). 1 right lobectomy, 1 left side segmentectomy, 2 V and IV segments resection, 1 unitectomy of the VII segment and 2 III and IV segment resections was performed. In the first four patients we used the Pringle manoeuvre (clamping of the liver stalk), while we did not do it in the last four so we could compare both the operation time and the loss of blood with or without this manoeuvre. One patient died of ARDS in the seventh post-operative day, another patient, who underwent a right lobectomy, developed a biliary fistula which healed in the 10 degrees postoperative day. All the seven surviving patients was in good health, with normal liver ultrasonography when checked on the 31/12/1997. Our results show that the water dissector offers the possibility to isolate vascular stalks very easily, both with a posterior ilar approach and with an intraparenchymal approach, making possible a very accurate haemostasis, in such minimizing blood and biliary losses. This method allows the performing of oncologically correct dissections and in the meanwhile the saving of as much healthy parenchyma as possible.

Published
1999

12. [Leiomyoma of the small intestine. Case report].

Author

Rinnovati A, Cassi R, Nocentini L, Frullini A, Tinacci G, and Fabbrucci P

Subjects
Humans, Ileum pathology, Male, Middle Aged, Ileal Neoplasms pathology, Ileal Neoplasms surgery, Leiomyoma pathology, Leiomyoma surgery
Abstract

The paper reports the case of a 53-year-old man admitted to hospital with melena. The initial diagnosis was bleeding duodenal ulcer; after 8 weeks of therapy the duodenal ulcer was completely healed, but renewed intestinal bleeding occurred three months later. Angiography of the upper mesenteric artery revealed a clear tumour form. A tumour of the small intestine the size of a fist was found during surgery. An ileal resection was performed. Histopathological tests confirmed the diagnosis of leiomyoma of the small intestine.

Published
1992

13. [Carcinoma of the gallbladder. Our experience].

Author

Trucco P, Frullini A, Nocentini L, Poggesi G, and Fabbrucci P

Subjects
Adenocarcinoma pathology, Carcinoma, Small Cell pathology, Carcinoma, Squamous Cell pathology, Cholecystectomy, Female, Gallbladder Neoplasms parasitology, Humans, Male, Middle Aged, Neoplasm Staging, Palliative Care, Adenocarcinoma surgery, Carcinoma, Small Cell surgery, Carcinoma, Squamous Cell surgery, Gallbladder Neoplasms surgery
Abstract

A series of 11 patients (3 males and 8 females, mean age 63.4 yrs.) suffering from gallbladder cancer has been reviewed. Authors' purpose in reviewing their experience was to identify factors either in patient characteristics or treatment, that may influence statistic data. Symptoms, signs, laboratory and imaging studies were uniformly unhelpful in determining the diagnosis. Early diagnosis at a stage amenable to surgical excision remains the only therapeutical possibility.

Published
1992

14. [Intensive therapy in general surgery].

Author

Frullini A, Trucco P, Butini P, Bussolin L, Cassi R, and Fabbrucci P

Subjects
Humans, Italy, Critical Care statistics & numerical data, Postoperative Care statistics & numerical data, Surgical Procedures, Operative mortality, Surgical Procedures, Operative statistics & numerical data
Abstract

A good diagnostic protocol as well as a proper preparation to surgery and a careful intensive observation (associated if necessary with an intensive therapy) can lead to a better prognosis in major surgical procedures or routine surgery in poor risk patients. Candidates to ICU are divided in three classes: type A is a stable patient requiring constant monitoring for high probability of complications, type B is still a stable patient who needs an intensive nursing; finally type C is an instable patient who requires a true intensive care. In the surgical department of USL 20/B Figline Valdarno (FI) a postoperative Intensive Care Unit (ICU) has been established in the last three years: a three-bed section with its own staff is located in the surgical department itself. In 37 months 467 operated patients requiring intensive observation or intensive therapy have been admitted.

Published
1991

15. [Subscapular elastofibroma (elastofibroma dorsi)].

Author

Conti U, Trucco P, Frullini A, and Fabbrucci P

Subjects
Female, Humans, Middle Aged, Scapula, Fibroma surgery
Abstract

The Authors describe a case of elastofibroma in its typical location; the most interesting aspect of this lesion is the microscopic appearance. The benignity of this lesion is absolute, from the clinical and microscopic points of view.

Published
1991

16. [A personal case of spontaneous pneumoperitoneum and review of the literature].

Author

Fabbrucci P and Attolini G

Subjects
Adolescent, Female, Humans, Pneumoperitoneum therapy, Pneumoperitoneum etiology
Abstract

A personal case of spontaneous pneumoperitoneum is reported and the nosographic importance of this form is reviewed. It is showed that primary forms, as opposed to those secondary to visceral perforation, always display a benign outcome. In some clearly-defined situations, therefore, a wait-and-see policy may be adopted, provided continuous surveillance of the position is assured.

Published
1980

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