Central Hospital of Bolzano

Bolzano, Italy

Central Hospital of Bolzano

Bolzano, Italy
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Mayr R.,Central Hospital of Bolzano | May M.,St Elisabeth Hospital | Martini T.,Central Hospital of Bolzano | Lodde M.,Central Hospital of Bolzano | And 8 more authors.
European Urology | Year: 2012

Background: Comorbidity and performance indices allow assessment of preoperative health status. However, the optimal tool for use in patients with urothelial carcinoma of the bladder (UCB) who are undergoing radical cystectomy (RC) has not yet been established. Objective: To evaluate correlation of Adult Comorbidity Evaluation-27 (ACE27), Charlson Comorbidity Index, Age-Adjusted Charlson Comorbidity Index, Eastern Cooperative Oncology Group performance status, and American Society of Anesthesiologists (ASA) score with survival. Design, setting, and participants: A retrospective multicenter study was carried out on 555 unselected consecutive patients who underwent RC for UCB from 2000 to 2010. Intervention: RC with pelvic lymph node dissection in patients with UCB without neoadjuvant chemotherapy. Outcome measurements and statistical analysis: Cox regression models were calculated with established variables to assess predictive capacity for cancer-specific mortality (CSM) and cancer-independent mortality (CIM). Results and limitations: All indices were independent predictors for CIM but not for CSM. The ASA score was the only index that significantly increased the predictive accuracy of the predefined CIM model (+2.3%; p = 0.045). To create a clinically valuable tool, we devised a weighted prognostic model including age and the best prognosticators within the performance and comorbidity scores (ASA/ACE27 0-1/2-3). A 3-yr CIM rate of 8%, 26%, and 47% was calculated for the low-, intermediate-, and high-risk groups, respectively. Patients >75 yr of age with ASA 3/4 and ACE27 >1 exhibited a CIM risk seven times greater than patients ≤75 yr with ASA 1/2 and ACE27 0/1. This study is limited by the short follow-up and its retrospective nature. Conclusions: Comorbidity and performance assessment is mandatory in the preoperative prediction of CIM for patients undergoing RC for UCB. The present results indicate that the ASA score is the tool of choice. External and prospective validation is warranted. © 2012 European Association of Urology.

Mayr R.,University of Regensburg | Pycha A.,Central Hospital of Bolzano | Burger M.,University of Regensburg
European Urology Focus | Year: 2016

We briefly describe the perioperative management of patients with metabolically active adrenal tumors. The potential intraoperative and postoperative complications that occur in patients with an adrenal tumor are reviewed with emphasis on recognition, treatment, and prevention. © 2015 European Association of Urology.

Cortese S.,University of Verona | Cortese S.,New York University | Angriman M.,Central Hospital of Bolzano
Postgraduate Medicine | Year: 2014

The exact etiopathophysiology of attention-deficit/hyperactivity disorder (ADHD) remains elusive, likely because of its phenotypic heterogeneity. Given the involvement of iron in neurocognitive and behavioral functions, iron deficiency (ID) has been suggested as a possible etiopathophysiological factor in a subsample of individuals with ADHD. Most studies assessing ID in ADHD have focused on serum ferritin, a marker of peripheral iron status. Results from these studies are mixed, and the largest studies failed to find a significant association between ADHD and low serum ferritin levels. However, serum ferritin may be influenced by several conditions, including inflammatory status. Increasing evidence, especially from epidemiological studies, points to a significant association between ADHD and obesity. Interestingly, obesity is associated with a chronic inflammatory status, characterized by ID with normal-to-high serum ferritin levels. This article reviews the literature on iron status in ADHD and on the relationship between ADHD and obesity; discusses a possible link among ADHD, ID, and obesity; and proposes that comorbid obesity contributes to ID, via chronic inflammation, in a subsample of individuals with ADHD. Thus, the comorbidity between ADHD and obesity suggests moving beyond serum ferritin levels and assessing the molecular pathways of chronic inflammation that lead to ID in individuals with ADHD and obesity. In turns, this may pave the way for novel treatment strategies for cognitive and behavioral dysfunctions related to ID in ADHD. © 2014, Postgraduate Medicine.

Cortese S.,NYU Langone Medical Center | Cortese S.,University of Verona | Cortese S.,French Institute of Health and Medical Research | Angriman M.,Central Hospital of Bolzano | And 2 more authors.
Expert Review of Neurotherapeutics | Year: 2012

The authors systematically reviewed evidence on iron status, as well as studies of iron supplementation, in individuals with attention deficit/hyperactivity disorder (ADHD). PubMed, Ovid, EMBASE and Web of Knowledge were searched on 4 July 2012. Quantitative appraisal of trials was performed using Jadad's score. Most (n = 20) of the retrieved studies assessed an index of peripheral iron status (i.e., serum ferritin), with overall mixed results - that is, both significant and nonsignificant association between ADHD symptoms and serum ferritin levels. One MRI study reported significantly lower indices of thalamic iron in ADHD versus comparison subjects. Two trials, an open-label and a pilot randomized placebo-controlled study with high Jaded score (4), showed improvement in some but not all measures of ADHD symptoms. Three studies showed that children with ADHD plus sleep disorders, in particular restless legs syndrome, are at risk of iron deficiency. Finally, two studies suggested that iron deficiency might decrease the effectiveness of psychostimulant treatment. The authors discussed how the field could move from initial research mainly focused on serum ferritin towards a more comprehensive and translational investigation of iron in ADHD, with the potential to inform clinical practice in terms of screening and treating iron deficiency in individuals with ADHD. © 2012 Expert Reviews Ltd.

Wiedermann C.J.,Central Hospital of Bolzano | Joannidis M.,Innsbruck Medical University
Intensive Care Medicine | Year: 2014

Purpose: To systematically review clinical and preclinical data on hydroxyethyl starch (HES) tissue storage. Methods: MEDLINE (PubMed) was searched and abstracts were screened using defined criteria to identify articles containing original data on HES tissue accumulation. Results: Forty-eight studies were included: 37 human studies with a total of 635 patients and 11 animal studies. The most frequent indication for fluid infusion was surgery accounting for 282 patients (45.9 %). HES localization in skin was shown by 17 studies, in kidney by 12, in liver by 8, and in bone marrow by 5. Additional sites of HES deposition were lymph nodes, spleen, lung, pancreas, intestine, muscle, trophoblast, and placental stroma. Among major organs the highest measured tissue concentration of HES was in the kidney. HES uptake into intracellular vacuoles was observed by 30 min after infusion. Storage was cumulative, increasing in proportion to dose, although in 15 % of patients storage and associated symptoms were demonstrated at the lowest cumulative doses (0.4 g kg-1). Some HES deposits were extremely long-lasting, persisting for 8 years or more in skin and 10 years in kidney. Pruritus associated with HES storage was described in 17 studies and renal dysfunction in ten studies. In one included randomized trial, HES infusion produced osmotic nephrosis-like lesions indicative of HES storage (p = 0.01) and also increased the need for renal replacement therapy (odds ratio, 9.50; 95 % confidence interval, 1.09-82.7; p = 0.02). The tissue distribution of HES was generally similar in animals and humans. Conclusions: Tissue storage of HES is widespread, rapid, cumulative, frequently long-lasting, and potentially harmful. © 2013 Springer-Verlag Berlin Heidelberg and ESICM.

Wiedermann C.J.,Central Hospital of Bolzano | Dunzendorfer S.,Innsbruck Medical University | Gaioni L.U.,Central Hospital of Bolzano | Zaraca F.,Central Hospital of Bolzano | Joannidis M.,Innsbruck Medical University
Critical Care | Year: 2010

Introduction: It has been hypothesized that hyperoncotic colloids might contribute to acute kidney injury (AKI). However, the validity of this hypothesis remains unclear.Methods: A meta-analysis was conducted of randomized controlled trials evaluating AKI after infusion of hyperoncotic albumin and hydroxyethyl starch (HES) solutions. Mortality was a secondary endpoint. Eligible trials were sought by multiple methods, and the pooled odds ratios (OR) for AKI and death and 95% confidence intervals (CI) were computed under a random effects model.Results: Eleven randomized trials with a total of 1220 patients were included: 7 evaluating hyperoncotic albumin and 4 hyperoncotic HES. Clinical indications were ascites, surgery, sepsis and spontaneous bacterial peritonitis. Hyperoncotic albumin decreased the odds of AKI by 76% (OR, 0.24; CI, 0.12-0.48; P < 0.0001), while hyperoncotic HES increased those odds by 92% (OR, 1.92; CI, 1.31-2.81; P = 0.0008). Parallel effects on mortality were observed, with hyperoncotic albumin reducing the odds of death by 48% (OR, 0.52; CI, 0.28-0.95; P = 0.035) and hyperoncotic HES raising those odds by 41% (OR, 1.41; CI, 1.01-1.96; P = 0.043).Conclusions: This meta-analysis does not support the hypothesis that hyperoncotic colloid solutions per se injure the kidney. Renal effects appear instead to be colloid-specific, with albumin displaying renoprotection and HES showing nephrotoxicity. © 2010 Wiedermann et al.; licensee BioMed Central Ltd.

Wiedermann C.J.,Central Hospital of Bolzano | Joannidis M.,Innsbruck Medical University
Swiss Medical Weekly | Year: 2012

BACKGROUND: Hydroxyethyl starch (HES) is in widespread clinical use for volume therapy with colloids. According to the most recent meta-analysis performed in 2010, published studies are of poor quality and report too few events to reliably estimate the benefits or risks of administering 6% HES 130/0.4. As results from new trials, reporting on a large number of events became available in 2011 and 2012, an updated meta-analysis was performed. METHODS: Randomised controlled trials comparing the effects of 6% HES 130/0.4 with other colloid or crystalloid solutions were analysed for pooled effect size on mortality in eligible studies published up to 20 February 2012. RESULTS: Overall, 13 studies reporting 1,131 participants met the inclusion criteria. The weight of evidence contributed by the two new trials was 51.3%. The pooled relative risk (RR) for mortality increased to 1.14 with a 95% confidence interval (CI) of 0.89 to 1.46. Publication bias favoring HES 130/0.4 was present (p = 0.038). Adjustment for the observed publication bias increased the RR for mortality to 1.25 (CI, 0.98 to 1.58; p = 0.069). No heterogeneity was found (I2, 0%; CI, 0% to 32%; p = 0.81). CONCLUSIONS: Large-scale trials should help more precisely to determine the effect of HES 130/0.4 on mortality. In the interim, best current evidence suggests a trend toward higher mortality among HES 130/0.4 recipients.

Bellmann R.,Innsbruck Medical University | Feistritzer C.,Innsbruck Medical University | Wiedermann C.J.,Central Hospital of Bolzano
Clinical Pharmacokinetics | Year: 2012

Background: Intravenously infused hydroxyethyl starch (HES) can be found in urine, plasma and tissues.HES remaining in plasma and tissues is thought to increase the risk of clinical complications.HES solutions of lower molecular weight and substitution have been developed to increase urinary excretion and reduce plasma persistence. However, their effect on tissue uptake of HES has not been investigated in human subjects. Objective: Our objective was to test the hypothesis that lower molecular weight and substitution decrease tissue uptake of HES. Data sources: Computer searches were performed of MEDLINE; EMBASE; the Cochrane Library; meeting abstract databases in surgery, anaesthesiology and intensive care; ClinicalTrials.gov; and Google. Supplementary sources were reference lists and electronic tables of journal contents. No time period or language restrictions were imposed. Study Selection: Clinical studies were eligible for inclusion in the meta-analysis, if data were reported both for cumulative urinary excretion ofHES over 24 hours after infusion and for plasmaHES concentration at 24 hours. Data Extraction: Data were extracted on 24-hour urinary excretion of HES, 24-hour HES plasma concentration, plasma volume, HES molecular weight and substitution, study design, type and demographics of subjects, indication for fluid infusion, andHES infusion regimen. Tissue uptake ofHES was computed as the difference between the infused dose and the sum of urinary excretion and residual plasma HES at 24 hours. Data Synthesis: Twenty-five clinical studies totalling 287 subjects were included. Tissue uptake of lowmolecular- weight HES (≤200 kD) was 42.3%(95% confidence interval [CI] 39.6, 45.0) compared with 24.6% (CI 17.8, 31.4) for high-molecular-weight HES (p< 0.001). Similarly, tissue uptake of lower-substitution HES (≤0.5) was 42.4% (CI 39.5, 45.3) versus 26.6% (CI 19.6, 33.6) for higher-substitution HES (pp< 0.001). Among the three most often investigated singleHES solutions, tissue uptake of 130/0.4 (42.6%;CI 35.0, 50.2) and HES 200/0.5 (43.3%; CI 39.4, 47.2) closely coincided, whereas uptake of HES 450/0.7 (22.2%; CI 14.8, 29.6) was lower (p = 0.001 and p<0.001, respectively). Conclusions: This meta-analysis did not support the hypothesis that lower molecular weight and substitution decrease tissue uptake of HES. Further clinical studies of HES tissue uptake are needed. © 2012 Adis Data Information BV. All rights reserved.

Lehner G.F.,Innsbruck Medical University | Wiedermann C.J.,Central Hospital of Bolzano | Joannidis M.,Innsbruck Medical University
Minerva Anestesiologica | Year: 2014

Background. High volume hemofiltration (HVHF) has been proposed as method for blood purification, especially under the condition of systemic inflammatory syndromes. Our goal was to evaluate the effects of HVHF in critically ill patients. Methods. A systematic review and meta-analysis was conducted of randomized controlled trials containing original data comparing HVHF defined by a dose of >50 mL/kg/h versus standard volume hemofiltration in critically ill patients. The primary outcome assessed was mortality. Additional endpoints assessed were renal recovery, vasopressor dependency, cytokine reduction and adverse events. Results. Four studies investigating continuous HVHF and three studies examining pulse high volume hemofiltration (PHVHF) using prescribed doses between 62 and 85 mL/kg/h met the criteria for this systematic review and provided data eligible for meta-analysis on a total of 558 patients. Meta-analyses did not show an effect of continuous HVHF (odds ratio, OR: 0.85; 95% confidence interval [CI]: 0.50-1.45; 4 trials; N.=473) or PHVHF (OR: 0.62; 95% CI: 0.22-1.74; 3 trials; N.=85) on mortality (both combined: OR: 0.85; 95% CI: 0.60-1.22; 7 trials; N.=558). Continuous HVHF had no significant beneficial effect on renal recovery of survivors (OR: 0.62; 95% CI: 0.17-1.97; 3 trials; N.=445). Inconsistent reports of a more rapid hemodynamic stabilization or improved cytokine clearance were mainly restricted to PHVHF. Conclusion. No clear overall beneficial effect of HVHF or PHVHF compared to standard volume hemofiltration can be detected.

Comploj E.,Central Hospital of Bolzano | Pycha A.,Central Hospital of Bolzano
European Urology, Supplements | Year: 2012

Among males born at full term or prematurely, 1-30% are affected by cryptorchidism. Approximately 70% of cryptorchid testes will spontaneously descend by 3 mo.The cause of cryptorchidism is multifactorial. A prerequisite for testicular descent is a normal hypothalamic-pituitary-gonadal axis. In addition, an undisturbed interaction with the anatomic structures is required, as well as the appropriate hormonal milieu and environmental conditions. Hereditary factors also play a major role.The Kaplan classification distinguishes between palpable testes (80%) and nonpalpable testes (20%). The nonpalpable group includes intra-abdominal, inguinal, and absent (vanishing) testes, whereas palpable testes can be between the internal and external inguinal ring, high scrotal, or in a superficial pouch between the oblique and the Scarpa fascia in the so-called Denis Browne pouch.Therapy for undescended testis (UDT) is usually carried out when a child is between 6 and 12 mo; individuals with high UDT especially benefit from an early orchidopexy. The lower the pretreatment position, the more chance there is of spontaneous descent as well as better results of surgical intervention.Although the management of a palpable testis is standardized, there are no guidelines for the management of boys with a nonpalpable testis. It seems that both preoperative and postoperative hormonal treatment may have a beneficial effect on fertility later in life. Because of the increased risk of testicular malignancy, lifelong follow-up is mandatory. The etiology of cryptorchidism is multifactorial and remains little understood. Treatment can be through hormonal manipulation but often requires surgery. In all cases, it should be performed when the patient is aged between 6. mo and 1 yr because spontaneous descent rarely occurs at >6. mo. © 2012 European Association of Urology.

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