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Scilletta R.,University of Catania | Pagano D.,University of Palermo | Spada M.,University of Palermo | Mongiovi S.,Humanitas Centro Catanese Of Oncologia | And 5 more authors.
Journal of Surgical Research | Year: 2014

Background The aim of this study was to identify the incidence of surgical site infections (SSIs) and postoperative complications, as defined by the Clavien-Dindo classification, after hepatic resection for metastatic colorectal cancer in patients with and without associated neoadjuvant chemotherapy. Methods A total of 181 patients were studied retrospectively. Patients were divided into two groups: The first group comprised patients with associated neoadjuvant chemotherapeutic treatment for liver metastases with a latency time <8 wk and the second group comprised patients without associated neoadjuvant chemotherapy. Results Variables of duration of liver surgery, length of total hospital stay, and length of postoperative hospital stay seem to be correlated with SSIs and postoperative complications, P < 0.005 and P < 0.0001, respectively. Duration of surgery is a risk factor for SSIs, with an odds ratio of 1.15, and for complications according to the Clavien-Dindo classification, with an odds ratio of 1.35. Conclusions Neoadjuvant chemotherapy was not a significant risk factor for SSIs, whereas the total length of hospital stay, length of postoperative hospital stay, and duration of surgery were independent predictors of SSIs and complications according to the Clavien-Dindo classification. © 2014 Elsevier Inc. All rights reserved.


Cesinaro A.M.,Azienda Ospedaliero Universitaria Policlinico
APMIS | Year: 2012

Fibroplasia is a peculiar stromal reaction at the base of melanocytic lesions, particularly observed in so-called dysplastic nevi. This study evaluates a series of clinico-pathological features in nevi with fibroplasia, their frequence in comparison to usual nevi, and the association of fibroplasia with the risk for the development of melanoma. A total of 209 consecutive nevi showing fibroplasia, belonging to 203 patients, was reviewed. Nevi with fibroplasia were more frequent in men, about half of the lesions belonged to patients aged 11-40 years, and the highest number (52%) were located on the posterior trunk. Lesions 6 mm or greater were 152 (72.73%). Junctional and compound nevi were 52 (24.8%), and 157 (75.2%), respectively. Inflammatory infiltrate was present in 67.8% of cases, melanophages in 56.4%, a lentiginous pattern in 31.1%, focal pagetoid infiltration in three lesions. Nevi with fibroplasia constituted 4.27% of all junctional and compound nevi diagnosed in the same period. A total of 23 patients (11.3%) had a personal history of melanoma. The total number of nevi excised from the 203 patients ranged between 1 and 21, and significantly correlated with the patient's personal history of melanoma (p < 0.001). Fibroplasia is relatively infrequent in melanocytic nevi, it does not appear related to a process of senescence of the lesion, and does not represent a particularly strong predictor of risk of melanoma. © 2012 The Authors APMIS © 2012 APMIS.


Urbinati S.,Ospedale Bellaria | Olivari Z.,Ospedale Ca Foncello | Gonzini L.,Research Center | Savonitto S.,Ospedale Alessandro Manzoni | And 6 more authors.
European Journal of Preventive Cardiology | Year: 2015

Background To describe drug adherence and treatment goals, and to identify the independent predictors of smoking persistence and unsatisfactory lifestyle habits six months after an acute myocardial infarction (AMI). Methods and results 11,706 patients with AMI (30% female, mean age 68 years) were enrolled in 163 large-volume coronary care units (CCUs). At six months, drug adherence was ≥90%, while blood pressure (BP) <140/90 mmHg, low density lipoprotein (LDL) <100 mg/dl (in patients on statins), HbA1c <7% (in treated diabetics), and smoking persistence were observed in 74%, 76%, 45%, and 27% of patients, respectively. Inadequate fish intake decreased from 73% to 55%, inadequate intake of fruit and vegetables from 32% to 23%, and insufficient exercise in eligible patients from 74% to 59% (p < 0.0001). At multivariable analysis, a post-discharge cardiac visit and referral to cardiac rehabilitation at follow-up were independently associated with a lower risk of insufficient physical exercise (odds ratio (OR) 0.71 and 0.70, respectively) and persistent smoking (OR 0.68 and 0.60), whereas only referral to cardiac rehabilitation was associated with a lower risk of inadequate fish and fruit/vegetable intake (OR 0.70 and 0.65). Conclusions Six months after an AMI, despite a high adherence to drug treatments, BP, LDL, and diabetic goals are inadequately achieved. Subjects with healthy lifestyles improved after discharge, but the rate of those with regular exercise habits and adequate fish intake could be further improved. Access to post-discharge cardiac visit and referral to cardiac rehabilitation were associated with better adherence to healthy lifestyles. Knowledge of the variables associated with specific lifestyle changes may help in tailoring secondary prevention programmes. © European Society of Cardiology 2014.


Cesinaro A.M.,Azienda Ospedaliero Universitaria Policlinico | Lonardi S.,University of Brescia | Facchetti F.,University of Brescia
American Journal of Surgical Pathology | Year: 2013

The pathogenesis of granuloma faciale (GF), framed in the group of cutaneous vasculopathic dermatitis, is poorly understood. The present study investigated whether GF might be part of the spectrum of IgG4-related sclerosing diseases (IgG4-RD). Erythema elevatum diutinum (EED), believed to belong to the same group of disorders as GF, was also studied for comparison. Thirty-one biopsies of GF obtained from 25 patients (18 men, 7 women) and 5 cases of EED (4 women and 1 man) were analyzed morphologically and for the expression of IgG and IgG4 by immunohistochemistry. The distribution of Th1, T regulatory and Th2 T-cell subsets, respectively, identified by anti-T-bet, anti-FoxP3, and anti-GATA-3 antibodies, was also evaluated. The dermal inflammatory infiltrate in GF contained eosinophils and plasma cells in variable proportions. Obliterative venulitis was found in 16 cases, and storiform fibrosis, a typical feature of IgG4-RD, was observed in 8 cases and was prominent in 3 of them. On immunohistochemical analysis 7 of 31 biopsies (22.6%) from 6 GF patients fulfilled the criteria for IgG4-RD (IgG4/IgG ratio >40%, and absolute number of IgG4 per high-power field >50). Interestingly, the 6 patients were male, and 4 showed recurrent and/or multiple lesions. In an additional 5 cases, only the IgG4/IgG ratio was abnormal. None of the 5 EED cases fulfilled the criteria for IgG4-RD. The T-cell subsets in GF were quite variable in number, GATA-3 lymphocytes were generally more abundant, but no relationship with the number of IgG4 plasma cells was found. The study indicates that a significant number of GF cases are associated with an abnormal content of IgG4 plasma cells; this association was particularly obvious in male patients and in cases presenting with multiple or recurrent lesions. As morphologic changes typically found in IgG4-RD, such as obliterative vascular inflammation and storiform sclerosis, are found in GF, we suggest that GF might represent a localized form of IgG4-RD. Copyright © 2012 by Lippincott Williams &Wilkins.


Violini R.,Azienda Ospedaliera S. Camillo Forlanini | Vairo U.,Azienda Ospedaliero Universitaria Policlinico | Hijazi Z.M.,Rush University Medical Center
Catheterization and Cardiovascular Interventions | Year: 2013

This report describes the use of the Edwards Sapien THV in a patient who had a short regurgitant/stenotic homograft with early bifurcation stenoses of the pulmonary arteries. A 48-mm AndraStent was positioned in the right pulmonary artery-homograft jailing the left pulmonary artery (LPA). To have an unobstructed access to the LPA, the stent strut leading to the LPA was broken using high-pressure balloon. A 23-mm Edwards Sapien THV was positioned in the stented homograft just proximal to the LPA origin with resolution of the stenosis and regurgitation. © 2012 Wiley Periodicals, Inc.

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