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Coagulopathy and transfusion therapy in pediatric livertransplantation

World Journal of Gastroenterology 2016年第6期22卷 2005-2023页

作者： Mirco Nacoti Davide Corbella francesco fazzi Francesca Rapido Ezio Bonanomi Pediatric Intensive Care Unit Ospedale Papa Giovanni XXIII Piazza OMS24127 BergamoItaly Department of Anesthesia Ospedale Papa Giovanni XXIII24127 BergamoItaly Faculty of Medicine UniversitàStatale di Milano20122 MilanoItaly

Bleeding and coagulopathy are critical issues complicating pediatric liver transplantation and contributing to morbidity and mortality in the cirrhotic child. The complexity of coagulopathy in the pediatric patient is illustrated by the interaction between three basic models. The first model, "developmental hemostasis", demonstrates how a different balance between pro- and anticoagulation factors leads to a normal hemostatic capacity in the pediatric patient at various ages. The second, the "cell based model of coagulation", takes into account the interaction between plasma proteins and cells. In the last, the concept of "rebalanced coagulation" highlights how the reduction of both pro- and anticoagulation factors leads to a normal, although unstable, coagulation profile. This new concept has led to the development of novel techniques used to analyze the coagulation capacity of whole blood for all patients. For example, viscoelastic methodologies are increasingly used on adult patients to test hemostatic capacity and to guide transfusion protocols. However, results are often confounding or have limited impact on morbidity and mortality. Moreover, data from pediatric patients remain inadequate. In addition, several interventions have been proposed to limit blood loss during transplantation, including the use of antifibrinolytic drugs and surgical techniques, such as the piggyback and lowering the central venous pressure during the hepatic dissection phase. The rationale for the use of these interventions is quite solid and has led to their incorporation into clinical practice; yet few of them have been rigorously tested in adults, let alone in children. Finally, the postoperative period in pediatric cohorts of patients has been characterized by an enhanced risk of hepatic vessel thrombosis. Thrombosis in fact remains the primary cause of early graft failure and re-transplantation within the first 30 d following surgery, and it occurs despite prolongation of standard coagulation assays. Data, however, are currently

关键词： Children Coagulation Thrombosis Liverdisease Transfusion Transplantation Point of carecoagulation

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Neuraxial anesthesia versus general anesthesia in patients undergoing three-dimensional laparoscopic radical prostatectomy:Preliminary results of a prospective comparative study

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Asian Journal of Urology 2023年第3期10卷 329-336页

作者： Stefano Alba Deborah Fimognari Fabio Croceross Luigi Ascalone Carmine Pullano Fernando Chiaravalloti francesco Chiaradia Umberto Carbonara Matteo Ferro Ottavio de Cobelli Vincenzo Pagliarulo Giuseppe Lucarelli Michele Battaglia Rocco Damiano francesco Cantiello Department of Urology Romolo HospitalRocca di NetoKrItaly Department of Urology Magna Graecia University of CatanzaroCatanzaroItaly Department of Anesthesiology Villa PiaRomaItaly Department of Anesthesiology Romolo HospitalRocca di Neto KrItaly Universita degli Studi di Bari Aldo Moro Department of UrologyBariItaly Division of Urology European Institute of Oncology(IEO)IRCCSMilanItaly Department of Oncology and Hematology Oncology Faculty of Medicine and SurgeryUniversity of MilanMilanItaly Department of Urology Vito Fazzi HospitalLecceItaly Department of Emergency and Organ Transplantation-Urology Andrology and Kidney Transplantation UnitUniversity of BariBariItaly

Objective:Neuraxial anesthesia(NA)showed to reduce both morbidity and mortality in patients undergoing laparoscopic surgery.We aimed to investigate the use of NA in patients undergoing transperitoneal three-dimensional laparoscopic radical prostatectomy(t-3DLRP)and compare the intraoperative and postoperative outcomes with a control group of patients undergoing t-3DLRP under general anesthesia(GA).Methods:A prospective,double-center,double-surgeon study cohort of 84 consecutive patients undergoing t-3DLRP between June 2019 and June 2021 was analyzed.A study group of 42 patients undergoing t-3DLRP under NA was compared with a control group of 42 patients undergoing t-3DLRP under GA.Results:The two group were similar in all demographic,clinical,and pathological variables.Postoperative blood gas parameters were within physiologic limits in both groups.Muscle relaxation was adequate for surgery during both NA and GA.Median length of stay was 1 day shorter for NA group than GA group(5 days vs.6 days,p=0.05).t-3DLRP under NA had a statistically lower rate of minor complications(4.8%vs.19.0%,p=0.03)and less postoperative pain(median numeric rating scale 3 vs.4,p=0.01)compared to GA.No major complications were observed in both groups.Significantly more patients were willing to undergo a similar intervention under NA than GA(p=0.04).Conclusion:t-3DLRP under NA is a feasible and safe procedure,with less postoperative pain and fewer minor complications than the same procedure under GA.NA allows the maintenance of muscle relaxation and respiratory excursions without interfering with surgery.

关键词： Laparoscopy Prostate cancer Radical prostatectomy Postoperative complications Neuraxial anesthesia General anesthesia

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Sonographic markers for early diagnosis of fetal malformations

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World Journal of Radiology 2013年第10期5卷 356-371页

作者： Maria Daniela Renna Paola Pisani francesco Conversano Emanuele Perrone Ernesto Casciaro Gian Carlo Di Renzo Marco Di Paola Antonio Perrone Sergio Casciaro National Council of Research Institute of Clinical Physiology c/o Campus Universitario Ecotekne Department of Ob-stetrics and Gynecology University of Perugia Santa Maria della Misericordia University Hospital Obstetrics and Gynecology Department "Vito Fazzi" Hospital Piazza Filippo Muratore

Fetal malformations are very frequent in industrialized countries.Although advanced maternal age may affect pregnancy outcome adversely,80%-90%of fetal malformations occur in the absence of a specific risk factor for parents.The only effective approach for prenatal screening is currently represented by an ultrasound scan.However,ultrasound methods present two important limitations:the substantial absence of quantitative parameters and the dependence on the sonographer experience.In recent years,together with the improvement in transducer technology,quantitative and objective sonographic markers highly predictive of fetal malformations have been developed.These markers can be detected at early gestation(11-14 wk)and generally are not pathological in themselves but have an increased incidence in abnormal fetuses.Thus,prenatal ultrasonography during the second trimester of gestation provides a"genetic sonogram",including,for instance,nuchal translucency,short humeral length,echogenic bowel,echogenic intracardiac focus and choroid plexus cyst,that is used to identify morphological features of fetal Down’s syndrome with a potential sensitivity of more than 90%.Other specific and sensitive markers can be seen in the case of cardiac defects and skeletal anomalies.In the future,sonographic markers could limit even more the use of invasive and dangerous techniques of prenatal diagnosis(amniocentesis,etc.).

关键词： Prenatal diagnosis Prenatal sonography Chromosome abnormalities nuchal translucency Fetal echocardiography Skeletal dysplasia

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