Binda G.A.,Galliera Hospital |
Amato A.,Borea Hospital |
Serventi A.,San Giacomo Hospital |
Arezzo A.,University of Turin
Digestive Diseases | Year: 2012
Background: A recurrent episode of diverticulitis is a new distinct episode of acute inflammation after a period of complete remission of symptoms. Outdated literature suggested a high recurrence rate (>40%) and a worse clinical presentation with less chance of conservative treatment. More recent studies showed a more benign course with no need toward an aggressive policy of treatment. Methods: We report data from revised literature and from our study: a 4-year multicenter retrospective and prospective database analysis of 743 patients hospitalized for acute diverticulitis (AD) treated medically or surgically and then followed for a minimum of 9 years. Results: The literature showed a recurrence rate of 25-35% at 5 years of follow-up, with a reduced risk of severe complications (i.e. perforations), a risk of subsequent emergency surgery of 2-14% and a risk of stoma and related death of 0-2.7%. Several risk factors of recurrence have been advocated: family history, abscess, severe CT stage, comorbidities (renal failure, collagen vascular disease) and nonsteroidal anti-inflammatory drugs. Young age is still a matter of debate. These studies have different limitations: retrospective, lack of definition of AD, small number of patients, long recruiting time, short follow-up, study population or hospital-system based. In our study of 320 followed-up, medically treated patients, 61% were asymptomatic and 22% complained of chronic symptoms: the 12-year actuarial risk of recurrence, emergency surgery, stoma and death was 21.2, 8.3, 1 and 0%, respectively. Recurrence was related to very young age (<40 years) and more than 3 previous episodes of AD. Conclusion: This study confirms the benign course of diverticulitis treated conservatively, with a low long-term risk of serious complications and death, and does not support an aggressive surgical policy to prevent them. Copyright © 2012 S. Karger AG, Basel.
Tammaro L.,Gastroenterology and Digestive Endoscopy |
Buda A.,University of Padua |
Di Paolo M.C.,Gastroenterology and Digestive Endoscopy |
Zullo A.,Gastroenterology and Digestive Endoscopy |
And 58 more authors.
Digestive and Liver Disease | Year: 2014
Background: Pre-endoscopic triage of patients who require an early upper endoscopy can improve management of patients with non-variceal upper gastrointestinal bleeding. Aims: To validate a new simplified clinical score (T-score) to assess the need of an early upper endoscopy in non variceal bleeding patients. Secondary outcomes were re-bleeding rate, 30-day bleeding-related mortality. Methods: In this prospective, multicentre study patients with bleeding who underwent upper endoscopy were enrolled. The accuracy for high risk endoscopic stigmata of the T-score was compared with that of the Glasgow Blatchford risk score. Results: Overall, 602 patients underwent early upper endoscopy, and 472 presented with non-variceal bleeding. High risk endoscopic stigmata were detected in 145 (30.7%) cases. T-score sensitivity and specificity for high risk endoscopic stigmata and bleeding-related mortality was 96% and 30%, and 80% and 71%, respectively. No statistically difference in predicting high risk endoscopic stigmata between T-score and Glasgow Blatchford risk score was observed (ROC curve: 0.72 vs. 0.69, p=0.11). The two scores were also similar in predicting re-bleeding (ROC curve: 0.64 vs. 0.63, p=0.4) and 30-day bleeding-related mortality (ROC curve: 0.78 vs. 0.76, p=0.3). Conclusions: The T-score appeared to predict high risk endoscopic stigmata, re-bleeding and mortality with similar accuracy to Glasgow Blatchford risk score. Such a score may be helpful for the prediction of high-risk patients who need a very early therapeutic endoscopy. © 2014 Editrice Gastroenterologica Italiana S.r.l.
Pupella V.,University of Genoa |
Tagliati A.,University of Genoa |
Secondo G.,Borea Hospital |
Dentone C.,Borea Hospital |
And 4 more authors.
2014 IEEE-EMBS International Conference on Biomedical and Health Informatics, BHI 2014 | Year: 2014
In the last century, antibiotics have been one of the most important discoveries for defeating numerous types of bacteria, but in recent times, microbes have become increasingly antibiotic resistant, causing severe consequences for human beings. The scientific community has been operating in this area for many years, developing projects always more focused on a multidisciplinary collaboration among partners. One of the most recent examples is the new cross border project between Italy and France, financed in 2013 by the European Union. It was established with the goal of fighting antibiotic resistances and optimizing antibiotic usage and patients' care in both countries. These goals can only be achieved by comparison of differences between the two countries in prescribing patterns and usage of antibiotics, and related emerging inconveniences and disadvantages. In order to make the evaluation as efficient and automated as possible, a relevant part of this project is placed in the IT field. For this purpose, a highly normalized and standardized database was designed, managed by a web platform that collects data concerning antibiotic resistance and data on surveys among populations at risk. The proposed platform is at a prototypal level, currently available on the internet. 64 patients have already been inserted. © 2014 IEEE.