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Two-stage surgical treatment for septic non-union of the forearm

World Journal of Orthopedics 2017年第6期8卷 471-477页

作者： fabrizio Perna Federico Pilla Matteo Nanni Lisa Berti Giada Lullini Francesco Traina Cesare Faldini Istituto Ortopedico Rizzoli

AIM To investigate the effectiveness of a two-stage surgical procedure for the treatment of septic forearm *** Septic non-unions are rare complications of forearm fractures. When they occur, they modify the relationship between forearm bones leading to a severe functional impairment. Treatment is challenging and surgery and antibiotic therapy are required to achieve infection resolution. It is even harder to obtain non-union healing with good functional results. The aim of this study is to present a two stages surgical treatment for septic forearm non-union with revision and temporary stabilization of the non-union until infection has cleared and subsequently perform a new synthesis with plate, opposite bone graft strut and intercalary graft. We retrospectively reviewed 18 patients with a mean age at the time of primary injury of 34.5 years(19-57 years) and a mean follow-up of 6 years(2-10 years). All patients presented an atrophic nonunion with a mean length of the bone defect of 1.8 cm(1.2-4 cm). Complications and clinical results after surgical treatment were recorded. RESULTS Mean time to resolution of the infectious process was 8.2 wk(range 4-20 wk) after the first surgery and specific antibiotic therapy. All the non-union healed with an average time of 5 mo(range 2-10 mo) after the second step surgery. Cultures on intraoperative samples werepositive in all cases. No major intraoperative complications occurred. Two patients developed minor complications and one needed a second surgical debridement for infection resolution. At the last follow-up functional results were excellent in 5(27.8%) patients, satisfactory in 10(55.5%) and unsatisfactory in 3(16.7%) patients. No activities of daily living(ADLs) limitations were reported by 12(66.6%) patients, slight by 3(16.6%) and severe limitation by 3(16.6%) patients. Mean visual analog scale at the last follow-up was 1(0-3).CONCLUSION The two-step technique has proven to be effective to achieve resolutio

关键词： Forearm fractures Non-union Delayed union Infection Open fracture External fixation Bone graft

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Long term follow-up and outcome of liver transplantation from hepatitis B surface antigen positive donors

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World Journal of Gastroenterology 2017年第12期23卷 2095-2105页

作者： Roberto Ballarin Alessandro Cucchetti Francesco Paolo Russo Paolo Magistri Matteo Cescon Umberto Cillo Patrizia Burra Antonio Daniele Pinna fabrizio Di Benedetto Hepatopancreatobiliary Surgery and Liver Transplant Unit University Hospital "Policlinico" University of Modena and Reggio Emilia Department of Medical and Surgical Sciences DIMEC S. Orsola-Malpighi Hospital Alma Mater Studiorum University of Bologna Gastroenterology/Multivisceral Transplant Unit Department of Surgery Oncology and Gastroenterology Padua University Hospital Department of Medical and Surgical Sciences and Translational Medicine Sapienza University of Rome

Liver transplant for hepatitis B virus(HBV) currently yields excellent outcomes: it allows to rescue patients with an HBV-related advanced liver disease, resulting in a demographical modification of the waiting list for liver transplant. In an age of patient-tailored treatments, in liver transplantation as well the aim is to offer the best suitable graft to the patient who can benefit from it, also expanding the criteria for organ acceptance and allocation. With the intent of developing strategies to increase the donor pool, we set-up a multicenter study involving 3 Liver Transplant Centers in Italy: patients undergoing liver transplantation between March 03, 2004, and May 21, 2010, were retrospectively evaluated. 1408 patients underwent liver transplantation during the study period, 28(2%) received the graft from hepatitis B surface antigen positive(HBs Ag)-positive deceased donors. The average follow-up after liver transplantation was 63.7 mo [range: 0.1-119.4; SD ± 35.8]. None Primary nonfunction, re-liver transplantation, early or late hepatic artery thrombosis occurred. The 1-, 3-and 5-year graft and patient survival resulted of 85.7%, 82.1%, 78.4%. Our results suggest that the use of HBs Agpositive donors liver grafts is feasible, since HBV can be controlled without affecting graft stability. However, the selection of grafts and the postoperative antiviral therapy should be managed appropriately.

关键词： Liver transplantation Hepatitis B virus Hepatitis B surface antigen Hepatocellular carcinoma Organ allocation Organ procurement Multicenter study

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Early graft dysfunction following adult-to-adult livingrelated liver transplantation:Predictive factors and outcomes

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World Journal of Gastroenterology 2009年第36期15卷 4556-4560页

作者： Salvatore Gruttadauria fabrizio di Francesco Giovanni Battista Vizzini Angelo Luca Marco Spada Davide Cintorino Sergio Li Petri Giada Pietrosi Duilio Pagano Bruno Gridelli Department of Surgery University of PittsburghCoordinator Abdominal Adult Transplant.ISMETT (Mediterranean Institute for Transplant and Advanced Specialized TherapiesUniversity of Pittsburgh Medical Center in Italy)Via E. Tricomi N.190127 PalermoItaly Thomas Starzl Transplantation Institute University of Pittsburgh Medical CenterPittsburgh15213 PAUnited States

AIM:To describe a condition that we define as early graft dysfunction(EGD)which can be identified preoperatively. METHODS:Small-for-size graft dysfunction following living-related liver transplantation(LRLT)is characterized by EGD when the graft-to-recipient body weight ratio(GRBWR)is below 0.8%.However, patients transplanted with GRBWR above 0.8%can develop dysfunction of the *** 73 recipients of LRLT(GRBWR>0.8%),we identified 10 patients who developed *** main measures of outcomes analyzed were overall mortality,number of re-transplants and length of stay in days(LOS).Furthermore we analyzed other clinical pre-transplant variables,intraoperative parameters and post transplant ***:A trend in favor of the non-EGD group(3-mo actuarial survival 98%vs 88%,P=0.09;3-mo graft mortality 4.7%vs 20%,P=0.07)was observed as well as shorter LOS(13 d vs 41.5 d;P=0.001)and smaller requirement of peri-operative Units of Plasma (4 vs 14;P=0.036).Univariate analysis of pre- transplant variables identified platelet count,serum bilirubin,INR and Meld-Na score as predictors of EGD. In the multivariate analysis transplant Meld-Na score (P=0.025,OR:1.175)and pretransplant platelet count(P=0.043,OR:0.956)were independently associated with EGD. CONCLUSION:EGD can be identified preoperatively and is associated with increased morbidity after LRLT. A prompt recognition of EGD can trigger a timely treatment.

关键词： Small-for-size graft dysfunction Livingrelated liver transplantation Graft-to-recipient bodyweight ratio Partial liver transplantation Allograftdysfunction

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Titanium elastic nailing in diaphyseal femoral fractures of children below six years of age

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世界骨科杂志：英文版 2017年第2期8卷 156-162页

作者： fabrizio Donati Giuseppe Mazzitelli Marco Lillo Amerigo Menghi Carla Conti Antonio Valassina Emanuele Marzetti Giulio Maccauro Orthopedic and Traumatology Institute Catholic University of the Sacred Heart

AIM To report the clinical and radiographic results of titanium elastic nail(TEN) in diaphyseal femoral fractures of children below age of six *** A retrospective analysis of 27 diaphyseal femoral fractures in children younger than six years treated with TEN between 2005 and 2015 was conducted. Patients were immobilized in a cast for 5 wk and the nails were removed from 6 to 12 wk after surgery. Twenty-four cases were clinically and radiographically re-evaluated using the Flynn's scoring criteria, focusing on: Limb length discrepancy, rotational deformity, angulation, hip and knee range of motion(ROM), functional status, complications, and parent's *** Sixteen males and eight females with a mean age of 3.2 years at the time of treatment were re-evaluated at an average follow-up of 58.9 mo. No cases of delayed union were observed. The mean limb lengthening was 0.3 cm. Four cases experienced limb lengthening greater than 1 cm and always minor than 2 cm. Twelve point five percent of the cases showed an angulation mobilization. According to the Flynn's scoring criteria, excellent results were obtained in 79.2% of patients and satisfactory results in the remaining 20.8%, with an average parent's satisfaction level of 9.1/*** TEN is as a safe, mini-invasive and surgeon-friendly technique and, considering specific inclusion criteria, it represents a useful and efficacy option for the treatment of diaphyseal femoral fractures even in patients younger than six years of age.

关键词： Titanium elastic nailing Pediatric femoral fractures Elastic stable intramedullary nailing Surgical treatment Femural shaft

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Role of lateral soft tissues release in percutaneous hallux valgus correction:A medium term retrospective study

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World Journal of Orthopedics 2023年第12期14卷 843-852页

作者： Fabio Zanchini Ottorino Catani fabrizio Sergio Alessia Boemio Angelo Sieczak Davide Piscopo Salvatore Risitano Gabriele Colò Federico Fusini Division of Orthopaedics and Traumatology Multidisciplinary Department of Medical-Surgical and Dental SpecialtiesClinical OrthopeadicsUniversity of Campania“Luigi Vanvitelli”Naples 80138Italy Department of Foot Surgery Casa di cura Santa MariaSanta Maria Capua Vetere 81055Italy Department of Foot an Ankle Surgery Casa di cura Santa MariaSanta Maria Capua Vetere 81055Italy Multidisciplinary Department of Medical-Surgical and Dental Specialties Clinical OrthopeadicsAOU Luigi VanvitelliNapoli 80138Italy Clinical Orthopeadics University of Campania Luigi VanvitelliNaples 80138Italy Department of Orthopaedic and Traumatology Orthopaedic and Trauma CentreCittàdella Salute e della Scienza di TorinoTurin 10126Italy Department of Orthopaedics and Traumatology Regional Center for Joint ArthroplastyASO AlessandriaAlessandria 15121Italy Department of Orthopaedic and Traumatology Regina Montis Regalis HospitalCuneo 12084Italy

BACKGROUND In the field of minimally invasive surgery(MIS)for the treatment of hallux valgus(HV),different techniques have begun to emerge in the literature concerning the distal osteotomy of the first metatarsal bone,the synthesis or not of the metatarsal head,the possible association with lateral soft tissues release(LSTR)and osteotomy of the base of the first *** To evaluate the role of LSTR on percutaneous HV correction,evaluating functional and radiographical *** From January 2012 to May 2016 a total of 396 patients with mild to moderate symptomatic HV treated with the MIS technique were included in this retrospective *** technique provides no internal fixation(WOS).Patients were divided into the LSTR group and no LSTR group(LSTR N).This surgical procedure(LSTR)was reserved for insufficient HV angle(HVA)correction during fluoroscopic *** were evaluated at each follow-up by two other authors after appropriate training by senior authors(first practitioners).Clinical evaluation was performed before surgery,6 mo after surgery,and 48 mo *** Orthopaedic Foot and Ankle Society(AOFAS)and visual analog scale(VAS)score was used to evaluate pain and function,and complications were *** addition,the incidence of relapses and the degree of joint range of motion(ROM)with the association with the LSTR(capsule,adductor tendon,phalanx-sesamoid ligament,and the deep transverse metatarsal ligament)were *** parameters included HVA and intermetatarsal angle(IMA).Patient satisfaction was *** t-test and Fisher exact test were used to assess statistical *** From our study it is clear that no differences in term of HVA,VAS,IMA correction,rate of complications,and AOFAS score were found between groups,while a significant improvement of the same variables was found in each group between pre and postoperative values.A significant improvement in ROM at 6 mo(P=0.018)and 48 mo(P=0.02)of

关键词： Hallux valgus Percutaneous distal osteotomy Lateral release Minimally invasive surgery Without ostheosynthesis Range of motion

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陶瓷表面mo-Ni-Si金属化及其与Ag的润湿性研究（英文）

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稀有金属材料与工程 2018年第3期47卷 759-765页

作者：赵三团张相召刘桂武 Valenza fabrizio Muolo Maria Luigia 乔冠军 Passerone Alberto 西安交通大学金属材料强度国家重点实验室陕西西安710049 江苏大学江苏镇江212013 Institute for Energetics and Interphases IENI-CNRGenoa 16149Italy 河南科技大学河南洛阳471003

采用真空熔烧工艺在SiC陶瓷表面制备了3种化学成分的mo-Ni-Si金属化涂层,研究了涂层的相组成和涂层/SiC陶瓷界面的微结构。通过座滴法实验考察了纯Ag在SiC 陶瓷涂层上的润湿与铺展特性,分析和讨论了Ag/金属化SiC陶瓷体系的界面行为。结... 详细信息

采用真空熔烧工艺在SiC陶瓷表面制备了3种化学成分的mo-Ni-Si金属化涂层,研究了涂层的相组成和涂层/SiC陶瓷界面的微结构。通过座滴法实验考察了纯Ag在SiC 陶瓷涂层上的润湿与铺展特性,分析和讨论了Ag/金属化SiC陶瓷体系的界面行为。结果表明,该金属化涂层主要由mo_5Si_3、moSi_2、Ni_2Si、NiSi_2和moNiSi组成,同时随着涂层中mo金属由20%增加至40% (摩尔分数),位于涂层表面的具有四方结构的moSi_2晶粒逐渐消失。Ag对mo20-Ni32-Si48、mo30-Ni28-Si42、mo40-Ni24-Si36金属化SiC陶瓷在1000℃保温30min后对应的最终接触角分别为45°,79°和85°,该结果与Ag滴和3种mo-Ni-Si涂层之间的相互作用密切相关。同时,在润湿试验前后,在mo-Ni-Si涂层/SiC衬底界面没有发现明显的反应层。

关键词：表面金属化 mo-Ni-Si涂层 SiC陶瓷润湿界面

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Is there a role for treatment-oriented surgery in liver metastases from gastric cancer?

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World Journal of Clinical Oncology 2020年第7期11卷 477-494页

作者： Fabio Uggeri Lorenzo Ripamonti Enrico Pinotti Mauro Alessandro Scotti Simone Famularo Mattia Garancini Luca Gianotti Marco Braga fabrizio Romano School of Medicine and Surgery University of Milano-BicoccaDepartment of SurgerySan Gerardo HospitalMonza 20900Italy Department of Surgery San Gerardo HospitalMonza 20900Italy

BACKGROUND Distant metastases are found in approximately 35%of patients with gastric cancer at their first clinical observation,and of these,4%-14%involves the ***,only 0.4%-2.3%of patients with metastatic gastric cancer are eligible for radical *** surgical resection for gastric cancer metastases is still debated,there have been changes in recent years,although several clinical issues remain to be defined and that must be taken into account before surgery is *** To analyze the clinicopathological factors related to primary gastric tumor and metastases that impact the survival of patients with liver metastatic gastric *** We performed a systematic review of the literature from 2000 to 2018 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses *** study protocol was based on identifying studies with clearly defined purpose,eligibility criteria,methodological analysis,and patient *** We selected 47 studies pertaining to the purpose of the review,which involved a total of 2304 *** survival was 7-52.3 mo,median disease-free survival was 4.7-18 *** 1-,2-,3-,and 5-year overall survival(OS)was 33%-90.1%,10%-60%,6%-70.4%,and 0%-40.1%,*** five papers reported the 10-year OS,which was 5.5%–31.5%.The general recurrence rate was between 55.5%and 96%,and that for hepatic recurrence was between 15%and 94%.CONCLUSION Serous infiltration and lymph node involvement of the primary cancer indicate an unfavorable prognosis,while the presence of single metastasis or≤3 metastases associated with a size of<5 cm may be considered data that do not contraindicate liver resection.

关键词： Hepatic metastases Gastric cancer Prognostic factor Survival Hepatectomy Surgery

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Serial physical examinations, a simple and reliable tool for managing neonates at risk for early-onset sepsis

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World Journal of Clinical Pediatrics 2016年第4期5卷 358-364页

作者： Alberto Berardi Anna Maria Buffagni Cecilia Rossi Eleonora Vaccina Chiara Cattelani Lucia Gambini Federica Baccilieri Francesca Varioli fabrizio Ferrari Neonatal Intensive Care Unit Department of Mother and Child Policlinic University Hospital Neonatal Intensive Care Unit Department of Obstetric and Pediatric Arcispedale Santa Maria Nuova

AIM To investigate whether serial physical examinations(SPEs) are a safe tool for managing neonates at risk for early-onset sepsis(EOS). METHODS This is a retrospective cohort study of neonates(≥ 34 wks' gestation) delivered in three high-volume level Ⅲbirthing centres in Emilia-Romagna(Italy) during a 4-mo period(from September 1 to December 31, 2015). Neonates at risk for EOS were managed according to the SPEs strategy, these were carried out in turn by bedside nursing staff and physicians. A standardized form detailing general wellbeing, skin colour and vital signs was filled in and signed at standard intervals(at age 3, 6, 12, 18, 36 and 48 h) in neonates at risk for EOS. Three independent reviewers reviewed all charts of neonates and abstracted data(gestational age, mode of delivery, group B streptococcus status, risk factors for EOS, duration of intrapartum antibiotic prophylaxis, postpartum evaluations, therapies and outcome). Rates of sepsis workups, empirical antibiotics and outcome of neonates at-risk(or not) for EOS were *** There were 2092 live births and 1 culture-proven EOS(Haemophilus i)(incidence rates of 0.48/1000 live births). most newborns with signs of illness(51 out of 101, that is 50.5%), and most of those who received postpartum antibiotics(17 out of 29, that is 58.6%) were not at risk for EOS. Compared to neonates at risk, neonates not at risk for EOS were less likely to have signs of illness(51 out of 1442 vs 40 out of 650, P = 0.009) or have a sepsis workup(25 out of 1442 vs 28 out of 650, P mong 216 neonates managed through the SPEs strategy, only 5.6%(n = 12) had subsequently a sepsis workup and only 1.9%(n = 4) were given empirical antibiotics. Al

关键词： Sepsis Group B streptococcus Intrapartum antibiotic prophylaxis Newborn Prevention

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Endoscopic ultrasound diagnostic gain over computed tomography and magnetic resonance cholang-iopancreatography in defining etiology of idiopathic acute pancreatitis

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World Journal of Gastrointestinal Endoscopy 2022年第6期14卷 376-386页

作者： Stefano Mazza Biagio Elvo Clara Benedetta Conti Andrea Drago Maria Chiara Verga Sara Soro Annalisa De Silvestri fabrizio Cereatti Roberto Grassia Gastroenterology and Digestive Endoscopy Unit ASST CremonaCremona 26100Italy Gastroenterology and Endoscopy Unit Federico Ⅱ UniversityNapoli 80131Italy Interventional Endoscopy Unit ASST MonzaMonza 20900Italy Biometry and Clinical Epidemiology Scientific DirectionIRCCS San Matteo Hospital FoundationPavia 27100Italy Department of Gastroenterology and Digestive Endoscopy Castelli HospitalAriccia(Rm)00040Italy

BACKGROUND About 10%-30%of acute pancreatitis remain idiopathic(IAP)even after clinical and imaging tests,including abdominal ultrasound(US),contrast-enhanced computed tomography(CECT)and magnetic resonance cholangiopancreatography(MRCP).This is a relevant issue,as up to 20%of patients with IAP have recurrent episodes and 26%of them develop chronic *** data are available on the role of EUS in clarifying the etiology of IAP after failure of one or more cross-sectional *** To evaluate the diagnostic gain after failure of one or more previous crosssectional *** We retrospectively collected data about consecutive patients with AP and at least one negative test between US,CECT and MRCP,who underwent linear EUS between January 2017 and December *** investigated the EUS diagnostic yield and the EUS diagnostic gain over different combinations of these crosssectional imaging techniques for the etiologic diagnosis of *** and frequency of EUS diagnosis were also analyzed,and EUS diagnosis was compared with the clinical *** EUS,patients were followed-up for a median of 31.5 mo to detect cases of pancreatitis *** We enrolled 81 patients(63%males,mean age 61±18,23%with previous cholecystectomy,17%with recurrent pancreatitis).Overall EUS diagnostic yield for AP etiological diagnosis was 79%(20%lithiasis,31%acute on chronic pancreatitis,14%pancreatic solid or cystic lesions,5%pancreas divisum,5%autoimmune pancreatitis,5%ductal abnormalities),while 21%remained ***,CECT and MRCP,taken alone or in combination,led to AP etiological diagnosis in 16(20%)patients;among the remaining 65 patients,49(75%)obtained a diagnosis at EUS,with an overall EUS diagnostic gain of 61%.Sixty-eight patients had negative US;among them,EUS allowed etiological diagnosis in 59(87%).Sixty-three patients had a negative CECT;among them,47(74%)obtained diagnosis with ***-four had a negative MRCP;among them,20(83%)had EUS diag

关键词： Endoscopic ultrasound Idiopathic acute pancreatitis Diagnostic gain Computed tomography Magnetic resonance cholangiopancreatography

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Clinical and economic impact of infliximab one-hour infusion protocol in patients with inflammatory bowel diseases:A multicenter study

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2017年第2期8卷 131-136页

作者： Anna Viola Giuseppe Costantino Antonino Carlo Privitera fabrizio Bossa Angelo Lauria Laurino Grossi Maria Beatrice Principi Nicola Della Valle Maria Cappello Gastroenterology and Hepatology Section Dipartimento Biomedico di Medicina Interna e Specialistica University of Palermo IBD Unit Dipartimento di Medicina Interna e Terapia Medica University of Messina IBD and PelvicF loor Unit Azienda Ospedaliera per l’Emergenza Ospedale Cannizzaro Gastroenterology Section Casa Sollievo della Sofferenza S. Giovanni Rotondo Gastroenterology and Endoscopy Unit A.O.Bianchi-Melacrino-Morelli Fisiopatologia Digestiva Ospedale Spirito Santo Gastroenterology Section Gastroenterologia

AIM To assess the impact of short infliximab(IFX) infusion on hospital resource utilization and *** All inflammatory bowel diseases(IBD) patients who received IFX 1 h infusion from March 2007 to September 2014 in eight centers from Southern Italy were included in the analysis. Demographic, clinical and infusion related data were collected. The potential benefits related to the short infusion protocol were assessed both in terms of time saving and increased infusion unit capacity. In addition, indirect patient-related cost savings were *** One hundred and twenty-five patients were recruited(64 with ulcerative colitis and 61 with Crohn's disease). Median duration of disease was of 53 mo and mean age of pts at diagnosis was of 34 years(SD: ± 13). Adverse infusion reactions were reported in less than 4% both before and after short infusion. The total number of infusions across the selected centers was of 2501(30.5% short infusions). In the analyzed cohort, 1143 h were saved(762 in the infusion and 381 in observation phases) through the rapid IFX infusion protocol. This time saving(-15% compared to the standard protocol in infusion phase) represents, from the hospital perspective, an opportunity to optimize infusion unit capacity by allocating the saved time in alternative cost-effective treatments. This is the case of opportunity cost that represents the value of forgone benefit which could be obtained from a resource in its next-best alternative use. Hence, an extra hour of infusion in the case of standard 2-h IFX represents a loss in opportunity to provide other cost effective services. The analysis showed that the short infusion increased the infusion units capacity up to 50% on days when the IFX infusions were scheduled(infusion phase). Furthermore, the analysis showed that the short IFX infusion protocol leads to time savings also in the post-infusion phase(observation) leading to a time saving of 10% on average among the analyzed centers. F

关键词： Infliximab One-hour infusion Cost savings Economic impact Multicenter study

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