AOU Santa Maria della Misericordia

Santa Maria della Versa, Italy

AOU Santa Maria della Misericordia

Santa Maria della Versa, Italy
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Migliorino M.R.,A.O. San Camillo Forlanini | Santo A.,Azienda Ospedaliera Universitaria Integrata | Romano G.,Ospedale V. Fazzi | Cortinovis D.,Ospedale San Gerardo | And 12 more authors.
Journal of Cancer Research and Clinical Oncology | Year: 2017

Purpose: Non-small cell lung cancer (NSCLC) is a condition with significant clinical burden for patients and relevant economic impact. Limited evidence exists on the management costs of NSCLC patients, especially in the late phases of the disease. The main objective of this analysis was to evaluate the economic impact of clinical management of NSCLC patients in the Italian population. Methods: This evaluation was an economic analysis of the observational and multicentre study LIFE, which described the therapeutic approach in routine clinical practice for NSCLC patients, progressing after first-line treatment. This study evaluated resource consumption in different Italian hospitals, including specialist visits, hospitalizations, accesses to first aid, pharmacological treatment, laboratory tests and palliative care. The National Healthcare Service perspective was adopted. Results: In this study, N = 191 patients enrolled in the LIFE study were included. Patients were aged 64.2 years and were predominantly males (66%). In the different line of treatments, monthly costs of patients ranged between €1471 (first line) and €1788 (third line). The overall healthcare cost over the average period of observation (16.4 months) was €25,859 per patient. Overall, oncology therapy was the cost driver, although the composition of medical costs changed across the different lines of treatment, with costs for concomitant medication and palliative care being predominant in late phase of the disease. Conclusions: The economic burden of NSCLC is extremely high during the overall period of treatment, and a significant level of care is required in each stage of the disease. © 2017 Springer-Verlag Berlin Heidelberg


Cereda S.,San Raffaele Scientific Institute | Milella M.,Instituto Nazionale Tumori Regina Elena | Cordio S.,Struttura Complessa di Oncologia Medica Ospedale Garibaldi | Leone F.,University of Turin | And 16 more authors.
Cancer Chemotherapy and Pharmacology | Year: 2016

Purpose: Advanced biliary tract adenocarcinoma (BTA) is a rare tumor with a poor prognosis. Since no standard salvage chemotherapy regimen exists, we explored the activity of capecitabine alone or combined with mitomycin C. Methods: Patients aged 18-75 years and with KPS >50, with pathological diagnosis of BTA stratified based on site and stage of disease, were randomized to receive capecitabine 2000 mg/m2 day 1-14 alone (ARM A) or in combination with mitomycin C 6 mg/m2 day 1 (ARM B) as second-line therapy. Cycles were repeated in both arms every 3 weeks. Tumor assessment was performed every 2 months. The primary endpoint was the probability of being progression free at 6 months (PFS-6) from treatment start. According to the Fleming design, the study aimed to enroll 26 pts per arm. An exploratory endpoint was to assess thymidylate synthase (TS) and thymidine phosphorylase (TP) expression, as biomarkers predictive for clinical outcomes of capecitabine treatment. Results: Between October 2011 and 2013, 57 metastatic pts were enrolled: ARM A/B 28/29. Accordingly, 55 (26/29) pts were assessable for the primary endpoint: 2 (8 %) ARM A and 3 (10 %) ARM B pts were PFS-6. Main G3-4 toxicities were: hand-foot syndrome and transaminitis in 4/0 %, and thrombocytopenia, diarrhea and fatigue in 0/3 % of pts. No statistically significant correlation was found between TS or TP expression and pts' outcome. Conclusions: Since capecitabine yielded a disappointing outcome and the addition of mitomycin C did not improve the results, new therapeutic strategies need to be explored to improve survival in this disease setting. © 2015 Springer-Verlag Berlin Heidelberg.


Bernardi S.,Ospedale Civile | Bertozzi S.,AOU Santa Maria della Misericordia | Londero A.P.,University of Udine | Angione V.,University of Udine | And 2 more authors.
Nuclear Medicine Communications | Year: 2013

INTRODUCTION: Sentinel lymph node biopsy (SLNB) has progressively replaced complete axillary lymph node dissection in the evaluation of breast cancer patients with clinically node-negative disease. Our study investigates the rate of and risk factors involved in sentinel node identification failure. MATERIALS AND METHODS: We collected data on SLNBs performed during 2002-2010, focusing on tumor, patient, and breast characteristics, radioactivity parameters, and operators' experience. Data were analyzed by R (v2.14.2), considering significance at P values lower than 0.05. RESULTS: Among 1050 women who underwent an SLNB, the rate of identification failure was 2% (23/1050), which, on bivariate analysis, was seen to be significantly influenced (P<0.05) by the preoperative and intraoperative low radiotracer uptake (axilla/lesion radiotracer uptake ratio<1%), low level of experience of the specialist in nuclear medicine, luminal A subtype, and radiotracer uptake localization in internal mammary lymph nodes. On multivariate analysis, significant risk factors for sentinel node identification failure were found to be: axilla/lesion radiotracer uptake ratio less than 1%, radiotracer uptake localization in internal mammary lymph nodes, and luminal A subtype. Considering only the preoperative variables in our multivariate analysis, axilla/lesion radiotracer uptake ratio less than 1%, negative lymph node scintiscan, and radiotracer uptake localization in internal mammary lymph nodes had an area under the curve (receiver operating characteristic curve) of 96% (95% confidence interval 92-100%). Further, we built a nomogram based on these simple parameters for counseling the patient about the probability of not finding the sentinel lymph node during the surgical procedure. CONCLUSION: The relatively low prevalence of SLNB failure (2%) is indicative of the accuracy of the procedure when performed by experienced surgeons. The sentinel node identification failure in our population seemed to be related to biological tumor factors (luminal A subtype) and probably to physiological or pathological variations in the lymphatic drainage (axilla/lesion radiotracer uptake ratio<1% and radiotracer uptake localization in internal mammary lymph nodes). © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Cedolini C.,University of Udine | Bertozzi S.,University of Udine | Seriau L.,University of Udine | Londero A.P.,University of Udine | And 6 more authors.
Oncology Reports | Year: 2014

Intraoperative radiotherapy (IORT) consists of an accelerated, single-dose, partial breast irradiation, performed immediately after breast conservative surgery. In the present study, we report the results of our feasibility protocol study using IORT between 2005 and 2009. We analyzed the data from a single-center, open, non-randomized, prospective pilot study including patients who underwent breast conservative surgery for invasive breast cancer between January 2005 and December 2009 at our Clinic of Surgery. Patients were divided based on IORT performance and stratified by age (≥48 or <48 years). Data were analyzed using R (version 2.15.2), considering a level of significance at P<0.05. Among the 247 eligible patients, 81 accepted the IORT protocol. Intraoperative IORT feasibility was 95.1% (77/81). In 71.4% (55/77) of the cases no postoperative complication was registered. Concerning local recurrence and overall survival, no significant difference was observed between women who underwent the IORT protocol or standard treatment. Among the patients aged <48 years, no local recurrence was noted after IORT protocol, and among women aged ≥48, local recurrences developed later in patients treated with IORT than with standard treatment. IORT represents a feasible and promising technique for the treatment of early breast cancer, with low morbidity, and beneficial aesthetic and oncologic results. Further studies are required in order to extend the inclusion criteria and offer IORT to a larger number of breast cancer patients.


PubMed | University of Perugia, University of Udine and AOU Santa Maria della Misericordia
Type: Clinical Trial | Journal: Oncology reports | Year: 2014

Intraoperative radiotherapy (IORT) consists of an accelerated, single-dose, partial breast irradiation, performed immediately after breast conservative surgery. In the present study, we report the results of our feasibility protocol study using IORT between 2005 and 2009. We analyzed the data from a single-center, open, non-randomized, prospective pilot study including patients who underwent breast conservative surgery for invasive breast cancer between January 2005 and December 2009 at our Clinic of Surgery. Patients were divided based on IORT performance and stratified by age (48 or <48 years). Data were analyzed using R (version 2.15.2), considering a level of significance at p<0.05. Among the 247 eligible patients, 81 accepted the IORT protocol. Intraoperative IORT feasibility was 95.1% (77/81). In 71.4% (55/77) of the cases no postoperative complication was registered. Concerning local recurrence and overall survival, no significant difference was observed between women who underwent the IORT protocol or standard treatment. Among the patients aged <48 years, no local recurrence was noted after IORT protocol, and among women aged 48, local recurrences developed later in patients treated with IORT than with standard treatment. IORT represents a feasible and promising technique for the treatment of early breast cancer, with low morbidity, and beneficial aesthetic and oncologic results. Further studies are required in order to extend the inclusion criteria and offer IORT to a larger number of breast cancer patients.


Angelini M.,Clinic of Obstetrics and Gynecology | Barillari G.,Transfusion Center | Londero A.P.,Clinic of Obstetrics and Gynecology | Bertozzi S.,AOU Santa Maria della Misericordia | And 4 more authors.
Journal of Thrombosis and Thrombolysis | Year: 2013

Ovarian vein thrombosis (OVT) is an uncommon but potentially serious complication in the early postpartum. Two case studies seem to prove the point: Case 1 A 24-year-old woman was transferred to our hospital with the chief complaint of abdominal pain radiating to the right thigh, vomit, diarrhea, and a slight pyrexia (37.6 C rectal). Five days earlier, she had a spontaneous vaginal delivery after labor induction. The woman appeared slightly distressed because of pain; vital signs were found to be normal and the CRP elevated (129.9 mg/L). Abdominal examination was remarkable for tenderness by palpation in the right lower quadrant with no rebound tenderness or guarding. Pelvic examination was remarkable for mild right adnexal tenderness. Abdominal-pelvic computer tomography with contrast medium revealed a 2.5-cm OVT having extended into the inferior vena cava for 14 cm with a slight peripheral edema. The patient was treated with nadroparin 0.6 cc (5700 IU) bid and warfarin 5 mg since the attainment of the therapeutic INR range. Case 2 A 31-year-old twin-pregnant woman had an emergency cesarean section at 35 gestational weeks because of hypertension complicated by increased liver enzymes, diuresis contraction, and continuous lower back pain bilaterally radiating to the groins. One day after delivery, CT scan that was performed because of onward anemia showed a pelvic, perihepatic, and perisplenic blood effusion, and a 1-cm right OVT extended to the inferior vena cava below renal veins for 28 mm. She underwent exploratory laparotomy and blood transfusion, and because of respiratory insufficiency she was transferred to a second level center with ICU facility, where she was placed under a suprarenal inferior vena cava filter, and AngioJet Rheolytic Thrombectomy for acute pulmonary embolism was performed. © 2012 Springer Science+Business Media, LLC.


Driul L.,University of Udine | Bernardi S.,Unit of Surgery | Bertozzi S.,AOU Santa Maria della Misericordia | Schiavon M.,AOU Santa Maria della Misericordia | And 2 more authors.
Minerva Ginecologica | Year: 2013

Aim: From radical mastectomy by Halstedt to quadrantectomy by Veronesi, surgical treatment of breast cancer has become more and more conservative in order to preserve women quality of life. We analyzed the evolution of breast interventions through a nine-year period. Methods: We collected data about all breast surgery interventions performed between 2002 and 2010 in our Department Of Surgery, focusing on patients' age, tumor histology, TNM classification, hormonal status, intervention radicality on the breast and axilla, and eventual plastic surgery. Data were analyzed by R (version 2.14.2), considering significant P<0.05. Results: A total of 3320 breast surgery interventions were performed on 2300 patients. Absolute yearly number of interventions has strongly increased with the introduction of the mammography screening (291 to 430). Conservative breast surgery (55% to 62%) and skin-sparing mastectomy (1% to 8%) have been performed more frequently in premenopausal patients, and significantly increased in time, with a consequent decrease of classical radical mastectomy (38 to 15%) but an increase of margins widening after primary surgery (2% to 6%). Sentinel lymph node biopsy is mostly replacing complete axillary lymph node dissection (93% to 31%). Skinglandular reshaping progressively increased (up to 20%) as also breast reconstruction (23% to 40%), which since 2008 has been performed also in women older than 75 years, while flaps have been used in strictly selected patients. Conclusion: Conservative surgery represents the target of current breast cancer treatment where possible, and skin-sparing mastectomy an interesting alternative to classical one when radicality is required. Sentinel lymph node biopsy has replaced complete axillary lymph node dissection by clinically negative nodal status. Breast reshaping and reconstruction are increasing in every age group, including women older than 75 years.


The Health Technology Assessment Engine (HTAE) of the Academic Hospital of Udine aggregates about one hundred of health technology assessment websites. It was born thanks to Google technology in 2008 and after about four years of testing it became public for everybody from the Homepage of the Italian Society of Health Technology Assessment (SIHTA). In this paper the first results obtained with this resource are reported. The role of the scientific librarian is examined not only as a support specialist in bibliographic search but also as a creative expert in managing new technologies for the community. Copyright - Il Pensiero Scientifico Editore.


PubMed | AOU Santa Maria della Misericordia
Type: | Journal: International journal of hepatology | Year: 2013

Introduction. The role of hepatic resection in patients with liver metastases from gastroenteropancreatic neuroendocrine tumors (GEP-NETs) is still poorly defined. Therefore, we examined the results obtained with surgical resection and other locoregional or systemic therapies by reviewing the recent literature on this topic. We performed the meta-analysis for comparing surgical resection of hepatic metastases with other treatments. Materials and Methods. In this systematic review and meta-analysis of observational studies, the literature search was undertaken between 1990 and 2012 looking for studies evaluating the different survivals between patients treated with surgical resection of hepatic metastases and with other surgical or nonsurgical therapies. The studies were evaluated for quality, publication bias, and heterogeneity. Pooled hazard ratio (HR) estimates and 95% confidence intervals (CI.95) were calculated using fixed-effects model. Results. We selected six studies in the review, five of which were suitable for meta-analysis. We found a significant longer survival in patients treated with hepatic resection than embolisation HR 0.34 (CI.95 0.21-0.55) or all other nonsurgical treatments HR 0.45 (CI.95 0.34-0.60). Only one study compared surgical resection with liver transplantation and meta-analysis was not feasible. Conclusions. Our meta-analysis provides evidence supporting the hypothesis that hepatic resection increases overall survival in patients with liver metastases from GEP-NETs. Further randomized clinical trials are needed to confirm these findings and it would be desirable to identify new markers to properly select patients for surgical treatment.

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