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Robotic assisted radical prostatectomy accelerates postoperative stress recovery: Final results of a contemporary prospective study assessing pathophysiology of cortisol peri-operative kinetics in prostate cancer surgery

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Asian Journal of Urology 2016年第2期3卷 88-95页

作者： Antonio B.Porcaro Nicolo`de Luyk Paolo Corsi Marco Sebben Alessandro Tafuri Davide inverardi Davide De Marchi irene Tamanini Matteo Brunelli Maria Angela Cerruto Gian Luca Salvagno Gian Cesare Guidi Walter Artibani Urologic Clinic University HospitalOspedale PoliclinicoAzienda Ospedaliera Universitaria IntegrataVeronaItaly Department of Pathology University HospitalOspedale PoliclinicoAzienda Ospedaliera Universitaria IntegrataVeronaItaly Department of Laboratory Medicine University HospitalOspedale PoliclinicoAzienda Ospedaliera Universitaria IntegrataVeronaItaly

Objective:To investigate the effects of prostate cancer(PCa)surgery on the stress system and to identify potential independent factors associating with stress recovery.Methods:The design of the study was prospective and PCa surgery included robot assisted radical prostatectomy(RARP)or retropubic radical prostatectomy(RRP).Between February 2013 to December 2014,315 consecutive patients were evaluated.The effects of PCa surgery on the stress system were measured by cortisol serum levels before and after surgery on postoperative day(POD)0,1,3,5 and 45.Cortisol variations in the population and subpopulation(RARP vs.RRP)of patients were investigated by statistical methods.Factors associating with stress recovery were assessed by simple linear regression(SLR)and multiple linear regression(MLR)analysis.Results:RARP was performed in 75.9%of cases.in the patient population,there were wide serum cortisol perioperative variations.PCa surgery triggered the stress system which immediately(POD 0)responded by cortisol overproduction which induced the negative feedback mechanism that started on POD 1,continued on POD 3,was still ongoing on POD 5 and completely settled on POD 45(stress recovery).in the subpopulation of patients,significantly lower cortisol serum levels were detected on POD 3e5 in RARP cases inwhomcortisol levels were close to preoperative levels(stress recovery)on POD 5.independent predictive factors of serum cortisol on POD 5(stress recovery)were preoperative cortisol(p Z 0.02),cortisol levels on POD 3(pin which the association was negative(stress recovery faster than RRP).Conclusion:Our study shows that PCa surgery immediately(POD 0)triggers the stress system which respond by overproduction of cortisol which induces the negative feedback mechanism that starts on POD 1,is still ongoing on POD 5,but is completely settled on POD 45.Moreover,after surgical trauma,our study gives evidence that the RARP procedure associates with stress recovery faster than RRP.Further confirmatory studies ar

关键词： Prostate cancer Robot assisted radical prostatectomy Retropubic radical prostatectomy Stress system

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The importance of being ＂not transplantable＂

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Journal of Geriatric Cardiology 2016年第12期13卷 1002-1004页

作者： Rossana Taravella Marco Caruso Massimo Benedetto Renato Ciofalo Giuliana Pace Salvatore Asciutto Salvatore Novo Giuseppe Cirrincione Division of interventional Cardiology Arnas Civico Hospital. Division of Cardiology University Hospital 'Policlinico P. Giaccone ' Palermo Italy Division of lnterventional Cardiology Arnas Civico Hospital Palermo Italy Division of Cardiology University Hospital 'Policlinico P. Giaccone' Palermo Italy

MitraClip therapy for mitral regurgitation (MR) in advanced-end stage heart failure (HF),could open a final bridge to improve symptoms and quality of life in “not transplantable" patients. Functional MR is a complica... 详细信息

关键词： Endstage 心失败心移植 MitraClip 僧帽形的流回 NYHA 功能的班

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Left atrium veno-arterial extra corporeal membrane oxygenation as temporary mechanical support for cardiogenic shock:A case report

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世界临床病例杂志 2023年第27期11卷 6531-6536页

作者： Rossana Lamastra David Michael Abbott Antonella Degani Carlo Pellegrini Roberto Veronesi Stefano Pelenghi Chiara Dezza Giulia Gazzaniga Mirko Belliato Department of Surgical Pediatric and Diagnostic SciencesUniversity of PaviaPavia 27100PVItaly Department of Cardiothoracic Surgery Fondazione IRCCS Policlinico San MatteoPavia 27100PVItaly Clinical SurgicalDiagnostic and Pediatric Sciences DepartmentUniversity of PaviaItaly-Department of Cardiac SurgeryFondazione IRCCS Policlinico San Matteo FoundationPavia 27100PVItaly SC-AR2 Anestesia e Terapia intensiva Cardiotoracica Fondazione iRCCS policlinico San Matteo Pavia 27100PVItaly Department of Cardiac Surgery 1 IRCCS University Hospital Foundation"San Matteo"Pavia 27100Italy

BACKGROUND Veno-arterial extra corporeal membrane oxygenation(VA-ECMO)support is commonly complicated with left ventricle(LV)distension in patients with cardiogenic shock.We resolved this problem by transeptally converting VAECMO to left atrium veno-arterial(LAVA)-ECMO that functioned as a temporary paracorporeal left ventricular assist device to resolve LV distension.in our case LAVA-ECMO was also functioning as a bridge-to-transplant device,a technique that has been scarcely reported in the literature.CASE SUMMARY A 65 year-old man suffered from acute myocardial injury that required percutaneous stents.Less than two weeks later,noncompliance to antiplatelet therapy led to stent thrombosis,cardiogenic shock,and cardiac arrest.Femorofemoral VA-ECMO support was started,and the patient underwent a second coronary angiography with re-stenting and intra-aortic balloon pump placement.The VA-ECMO support was complicated by left ventricular distension which we resolved via LAVA-ECMO.Unfortunately,episodes of bleeding and sepsis complicated the clinical picture and the patient passed away 27 d after initiating VA-ECMO.CONCLUSiON This clinical case demonstrates that LAVA-ECMO is a viable strategy to unload the LV without another invasive percutaneous or surgical procedure.We also demonstrate that LAVA-ECMO can also be weaned to a left ventricular assist device system.A benefit of this technique is that the procedure is potentially reversible,should the patient require VA-ECMO support again.A transeptal LV venting approach like LAVA-ECMO may be indicated over impellaTM in cases where less LV unloading is required and where a restrictive myocardium could cause LV suctioning.Left ventricular over-distention is a well-known complication of peripheral VA-ECMO in cardiogenic shock and LAVA ECMO through transeptal cannulation offers a novel and safe approach for treating LV overloading,without the need of an additional percutaneous access.

关键词： Left atrium venoarterial extra corporeal membrane oxygenation Shock Case report

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Resected specimen evaluation,anorectal manometry,endoanal ultrasonography and clinical follow-up after STARR procedures

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World Journal of Gastroenterology 2011年第19期17卷 2411-2416页

作者： Gabriele Naldini Guido Cerullo Claudia Menconi Jacopo Martellucci Simone Orlandi Nicola Romano Mauro Rossi Fourth Unit of Surgery Santa Chiara Hospital of Pisa Department of General Surgery University of Siena-Policlinico Le Scotte

AiM:To investigate stapled transanal rectal resection (STARR) procedures as surgical techniques for obstructed defecation syndrome (ODS) by analyzing specimen evaluation,anorectal manometry,endoanal ultrasonography and clinical follow-up.METHODS:From January to December 2007,we have treated 30 patients.Fifteen treated with double PPH-01 staplers and 15 treated using new CCS 30 contour.Resected specimen were measured with respect to average surface and volume.All patients have been evaluated at 24 mo with clinical examination,anorectal manometry and endoanal ultrasonography.RESULTS:Average surface in the CCS 30 group was 54.5 cm2 statistically different when compared to the STARR group (36.92 cm2).The average volume in the CCS 30 group was 29.8 cc,while in the PPH-01 it was23.8 cc and difference was statistically significant.The mean hospital stay in the CCS 30 group was 3.1 d,while in the PPH-01 group the median hospital stay was 3.4 d.As regards the long-term follow-up,an overall satisfactory rate of 83.3% (25/30) was achieved.Endoanal ultrasonography performed 1 year following surgery was considered normal in both of the studied groups.Mean resting pressure was higher than the preoperative value (67.2 mmHg in the STARR group and 65.7 mmHg in the CCS30 group vs 54.7 mmHg and 55.3 mmHg,respectively).Resting and squeezing pressures were lower in those patients not satisfied,but data are not statistically significant.CONCLUSiON:The STARR procedure with two PPH-01 is a safe surgical procedure to correct ODS.The new Contour CCS 30 could help to increase the amount of the resected tissue without differences in early complications,post-operative pain and in hospital stay compared to the STARR with two PPH-01 technique.

关键词：临床检查直肠超声标本测压肛门评价程序

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Lumen-apposing-metal stent misdeployment in endoscopic ultrasound-guided drainages:A systematic review focusing on issues and rescue management

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World Journal of Gastroenterology 2023年第21期29卷 3341-3361页

作者： Elia Armellini Flavio Metelli Andrea Anderloni Anna Cominardi Giovanni Aragona Michele Marini FabioPace Department of Gastroenterology ASST-BergamoestSeriate 24068BergamoItaly Gastroenterology and Digestive Endoscopy Unit Fondazione IRCCS Policlinico San MatteoPavia 27100Italy Department of Gastroenterology “Guglielmo da Saliceto”HospitalPiacenza 29121Italy Department of General Surgery ASST-BergamoestSeriate 24068Italy

BACKGROUND The introduction of lumen-apposing metal stents(LAMS)for endoscopic ultrasound(EUS)-guided drainages has marked a turning point in the field of interventional ultrasound and it is gathering worldwide diffusion in different clinical settings.Nevertheless,the procedure may conceal unexpected pitfalls.LAMS misdeployment is the most frequent cause of technical failure and it can be considered a procedure-related adverse event when it hampers the conclusion of the planned procedure or results in significant clinical consequences.Stent misdeployment can be managed successfully by endoscopic rescue maneuvers to allow the completion of the procedure.To date,no standardized indication is available to guide an appropriate rescue strategy depending on the type of procedure or of misdeployment.AiM To evaluate the incidence of LAMS misdeployment during EUS-guided choledochoduodenostomy(EUS-CDS),gallbladder drainage(EUS-GBD)and pancreatic fluid collections drainage(EUS-PFC)and to describe the endoscopic rescue strategies adopted under the circumstance.METHODS We conducted a systematic review of the literature on PubMed by searching for studies published up to October 2022.The search was carried out using the exploded medical subject heading terms“lumen apposing metal stent”,“LAMS”,“endoscopic ultrasound”and“choledochoduodenostomy”or“gallbladder”or“pancreatic fluid collections”.We included in the review on-label EUS-guided procedures namely EUS-CDS,EUS-GBD and EUS-PFC.Only those publications reporting EUS-guided LAMS positioning were considered.The studies reporting a technical success rate of 100%and other procedure-related adverse events were considered to calculate the overall rate of LAMS misdeployment,while studies not reporting the causes of technical failure were excluded.Case reports were considered only for the extraction of data regarding the issues of misdeployment and rescue techniques.The following data were collected from each study:Author,year of publication,study design,study population,clinical indic

关键词： Lams misdeployment Endoscopic ultrasound-guided drainage Lams maldeployment Biliary drainage Gallbladder drainage Pancreatic fluid collections Lumen-apposing metal stents

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Safety and efficacy of DEM-TACE performed with drug-eluting microspheres smaller than 300μm in patients with HCC and TiPS

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Hepatoma Research 2022年第1期8卷 193-206页

作者： Pierleone Lucatelli Simone Zilahi De Gyurgyokai Gianluca De Rubeis Renato Argirò Simone Ciaglia Bianca Rocco Flaminia Ferri Simona Parisse Mariana Forlino Alessandro Cannavale FabrizioBasilico Pier Giorgio Nardis Mario Corona Vito Cantisani Carlo Catalano Vascular and interventional Radiology Unit Department of Radiological Oncological and Anatomo-Pathological SciencesPoliclinico Umberto I Sapienza University of RomeViale Regina Elena 324Rome 00161Italy Department of interventional Radiology San Camillo Forlanini HospitalCirconvallazione Gianicolense 87Rome 00152Italy Department of imaging and interventional Radiology Azienda Ospedaliera Universitaria Policlinico Tor VergataViale Oxford 81Rome 00133Italy Department of Translational and Precision Medicine Sapienza University of RomeViale Regina Elena 324Rome 00161Italy Department of Radiology Policlinico Umberto I Sapienza University of RomeViale Regina Elena 324Rome 00161Italy

Aim:Safety and efficacy evidence of drug-eluting-microspheres trans-arterial chemoembolization(DEM-TACE)in patients with hepatocellular carcinoma(HCC)and trans-jugular intrahepatic portosystemic shunt(TiPS)is lacking.The aim of this retrospective study was to report the safety and efficacy of DEM-TACE procedures performed with microspheres smaller than 300μm in patients with HCC and TiPS in a high-volume transplant center.Methods:Embolization was standardized by initiating DEM-TACE with microspheres smaller than 100μm,and if stasis was not achieved,adjunctive embolization with 100-300 or 200μm microspheres was administered.With regards to efficacy,the oncological response was evaluated and categorized according to mRECiST criteria at 1,3-6,9-12,and 15-18 months.Reporting the safety profile,detailed laboratory analysis was performed before,at 36-48 h,and 30-60 days after the procedure.Adverse events(AEs)were recorded;post-embolic syndrome was defined as the onset of fever/nausea/pain after the procedure.Late onset hepatobiliary complications were evaluated by follow-up imaging with computed tomography or magnetic resonance(CT/MR).Results:From December 2007 to November 2020,17 HCC patients(25 HCC nodules)with patent TiPS underwent 20 DEM-TACE.Embolization was performed only with microspheres smaller than 100μm in 3/20 DEM-TACE(15%);adjunctive embolization with 100-300 or 200μm microspheres was required in 17/20 DEMTACE(85%).Reported early AEs were post-embolic syndrome(9/20;45%)all of grade 1-2,late AEs were asymptomatic acute liver bile duct injury(2/20;10%),and in one case we observed hepatic abscess(1/20;5%)resulting in death due to sepsis.With regards to efficacy,the oncological response was evaluated and categorized according to mRECiST criteria.Complete response(CR)at 1,3-6,9-12,and 15-18 months was 52%,50%,50%,and 50%,respectively.Objective response(CR+partial response)at 1,3-6,9-12,and 15-18 months was 95%,71%,70%,and 50%,respectively.Conclusion:DEM-TACE with drug-eluting-microspheres smaller than 300μm can

关键词： HCC TiPS DEM-TACE CT MR

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is Autonomic Nervous System involved in the Epileptogenesis in Preterm Neonates?

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Maternal-Fetal Medicine 2023年第3期5卷 173-181页

作者： Raffaele Falsaperla Giovanna Vialiti Janette Mailo Giovanni Corsello Martino Ruggieri Neonatal intensive Care Unit San Marco HospitalUniversity Hospital Policlinico-“G.Rodolico-San Marco”Via Azeglio CiampiCatania 95100Italy Unit of Pediatrics and Pediatric Emergency University Hospital Policlinico-“G.Rodolico-San Marco”Via Azeglio CiampiCatania 95100Italy Division of Pediatric Neurology University of AlbertaStollery Children’s Hospital8440-112 St NWEdmontonAlbertaCanada Department of Maternal and Child Health University of PalermoVia del Vespro 129Palermo 90127Italy Unit of Rare Diseases of the Nervous System in Childhood Department of Clinical and Experimental MedicineSection of Pediatrics and Child NeuropsychiatryUniversity of CataniaCatania 95124Italy

Autonomic nervous system dysfunction has been described with focal and generalized epileptic seizures;occurring during their ictal,interictal,or postictal states.international League Against Epilepsy Seizure Classification Manual defines autonomic seizures as a distinct alteration of autonomic nervous system function involving cardiovascular,pupillary,gastrointestinal,sudomotor,vasomotor,and thermoregulatory functions.Autonomic seizures represent a great challenge for neonatologists and neurophysiologists;and distinguishing between ictal and non-ictal autonomic changes in neonates is rarely straightforward,especially in the premature ones.To avoid overdiagnosis and overtreatment,international League Against Epilepsy and the American Clinical Neurophysiology Society currently require electrographic correlation for any seizure diagnosis,including preterm neonates.There is very little scientific evidence about the pathophysiology of autonomic seizures.The data reporting on their incidence,clinical features,and diagnostic pathway is also insufficient.in this paper,we hypothesize that in the developing brain of preterm neonates,seizures involving deeper autonomic networks and subcortical structures might not propagate sufficiently to the cortex,and therefore the association of the seizures with specific ictal electrographic changes on surface electroencephalogram might be lacking.We propose considering autonomic seizures in the differential diagnosis of unexplained autonomic changes in neonates,especially preterm neonates,even in the absence of clear initial electrographic correlation.Unexplained autonomic changes could therefore be thought of as a“seizure alarm”in this population.

关键词： Premature Apnea Autonomic seizures Brain Neonatal epilepsy Neonates

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Ten-year experience with penile prosthetic surgery for the treatment of erectile dysfunction:outcomes of a tertiary referral center and predictors of early prosthetic infection

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Asian Journal of Andrology 2022年第1期24卷 32-39页

作者： Franco Palmisano Luca Boeri Riccardo ievoli Josvany Sánchez-Curbelo Matteo Giulio Spinelli Andrea Gregori Antonio Maria Granata Eduard Ruiz-Castane Emanuele Montanari Joaquim Sarquella-Geli ASST Fatebenefratelli-Sacco Department of UrologyLuigi Sacco University HospitalMilan 20157Italy iRCCS Foundation Ca’Granda Ospedale Maggiore policlinico Department of UrologyUniversity of MilanMilan 20122Italy Department of Economics and Management University of FerraraFerrara 44121Italy FundacióPuigvert Department of AndrologyUniversity of BarcelonaBarcelona 08025Spain

We aimed to evaluate ten-year outcomes of penile prosthesis(PP)implantation for the treatment of erectile dysfunction and to assess predictors of early prosthetic infection(EPi).We identified 549 men who underwent 576 PP placements between 2008 and 2018.Univariate and multivariate analyses were used to identify potential predictors of EPi.An EPi predictive nomogram was developed.Thirty-five(6.1%)cases of EPi were recorded with an explant rate of 3.1%.in terms of satisfaction,82.0%of the patients defined themselves as“satisfied,”while partner’s satisfaction was 88.3%.Diabetes(P=0.012),longer operative time(P=0.032),and reinterventions(P=0.048)were associated with EPi risk,while postoperative ciprofloxacin was inversely associated with EPi(P=0.014).Rifampin/gentamicin-coated 3-piece inflatable PP(r/g-c 3iPP)showed a higher EPi risk(P=0.019).Multivariate analyses showed a two-fold higher risk of EPi in diabetic patients,redo surgeries,or when a r/g-c 3iPP was used(all Piabetes,longer operative time,and secondary surgeries were the risk factors for EPi.Postoperative ciprofloxacin was associated with a reduced risk of EPi,while r/g-c 3iPP had higher EPi rates without an increased risk of PP explant.After further validation,the proposed nomogram could be a useful tool for the preoperative counseling of PP implantation.

关键词： Boston Coloplast Titan three-piece penile prosthesis erectile dysfunction impotence inhibizone patient satisfaction penile prosthesis prosthesis infection rifampin soaking

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Endoscopic ultrasound-guided ablation of solid pancreatic lesions:A systematic review of early outcomes with pooled analysis

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World Journal of Gastrointestinal Oncology 2022年第2期14卷 533-542页

作者： Marco Spadaccini Milena Di Leo Andrea iannone Daan von den Hoff Alessandro Fugazza Piera Alessia Galtieri Gaia Pellegatta Roberta Maselli Andrea Anderloni Matteo Colombo Peter D Siersema Silvia Carrara Alessandro Repici Endoscopic Unit Department of GastroenterologyIRCCS Humanitas Research HospitalRozzano 20089MilanItaly Department of Biomedical Sciences Humanitas UniversityPieve Emanuele 20090MilanItaly Endoscopy Unit Azienda Ospedale PoliclinicoBari 70124Italy Endoscopy Unit Radboud University Medical CenterNijmegen 6525 GANetherlands

BACKGROUND Endoscopic ultrasound-guided radiofrequency ablation(EUS-RFA)is emerging as a complementary therapeutic approach for pancreatic solid masses.However,results of published data are difficult to interpret because of a retrospective design and small sample size.AiM To systematically review data on EUS-RFA for solid lesions and to pool the results of the different experiences in order to provide more consistent evidence in terms of safety and efficacy.METHODS A comprehensive systematic literature search on the main databases was performed to identify articles in which patients with pancreatic solid lesions underwent EUS-RFA.The primary outcomes were procedure-related adverse events(AEs)and mortality.Secondary outcomes were the technical success rate and the effects on primary tumor growth.Statistical analyses were performed using Stata version 14.0.RESULTS in total,14 studies were included,with 120 patients undergoing 153 ablations of 129 solid pancreatic lesions.The STARmed technology was used in seven studies,the Habib system in six studies,and the HybridTherm probe in one study.The pooled technical success rate was 99.0%(i2:25.82%).The pooled overall AE rate was 8.0%(i2:11.46%).Excluding mild AEs,the pooled rates of serious AEs was 1.0%(i2:0%).No mortality related to the procedure was reported.CONCLUSiON The present pooled analysis confirms the safety and feasibility of EUS-RFA.

关键词： Pancreatic cancer Neuroendocrine tumors Habib Cryotechnology Pancreas Endoscopic ultrasound

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Far lateral lumbar disc herniation part 1: imaging, neurophysiology and clinical features

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World Journal of Orthopedics 2021年第12期12卷 961-969页

作者： Luigi Valentino Berra Andrea Di Rita Federico Longhitano Enrico Mailland Paolo Reganati Alessandro Frati Antonio Santoro Department of Neurosurgery Policlinico Umberto I-Sapienza Universitàdi RomaRoma 00161Italy Department of Neurosurgery San Carlo Borromeo HospitalMilano 20153Italy Department of Neurology San Carlo Borromeo HospitalMilano 20153Italy Department of Neuroradiology Manzoni HospitalLecco 23900Italy Neurosurgery Division Human Neurosciences Department Sapienza UniversityRoma 00135Italy andDepartment of NeurosurgeryIRCCS NeuromedPozzilli IS 86077Italy Department of Human Neurosciences Sapienza Universitàdi RomaRoma 00161Italy

Far lateral lumbar disc herniations(FLLDH)represent a separate category of disc pathology which includes both intraforaminal and extraforaminal lumbar disc herniations,that are characterized by a peculiar clinical presentation,diagnostic and treatment modalities as compared to the more frequent median and paramedian disc hernias.Surgical treatment often represents the only effective weapon for the cure of this disease and over the years different approaches have been developed that can reach the region of the foramen or external to it,with different degrees of invasiveness.The diagnosis is more demanding and still underestimated as it requires a more detailed knowledge in the spine anatomy and dedicated radiological studies.Computerized tomography and in particular magnetic resonance imaging are the appropriate tools for the diagnosis of FLLDH.Despite the widespread use of these diagnostic tests,many cases of FLLDH are overlooked due to insufficiently detailed radiological examinations or due to the execution of exams not focused to the foraminal or the extraforaminal region.Neurophysiological studies represent a valid aid in the diagnostic classification of this pathology and in some cases they can facilitate the differential diagnosis with other types of radiculopathies.in the present study,a comprehensive review of the clinical presentation,epidemiology,radiological study and the neurophysiological aspects is presented.

关键词： Far lateral lumbar disc herniaton Magnetic resonance imaging diagnosis Clinical presentation Neurophysiology Epidemiology

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