Terrin G.,University of Rome La Sapienza |
Passariello A.,University of Naples Federico II |
Passariello A.,Monaldi Hospital |
De Curtis M.,University of Rome La Sapienza |
And 7 more authors.
Pediatrics | Year: 2012
BACKGROUND AND OBJECTIVES: Gastric acidity is a major nonimmune defense mechanism against infections. The objective of this study was to investigate whether ranitidine treatment in very low birth weight (VLBW) infants is associated with an increased risk of infections, necrotizing enterocolitis (NEC), and fatal outcome. METHODS: Newborns with birth weight between 401 and 1500 g or gestational age between 24 and 32 weeks, consecutively observed in neonatal intensive care units, were enrolled in a multicenter prospective observational study. The rates of infectious diseases, NEC, and death in enrolled subjects exposed or not to ranitidine were recorded. RESULTS: We evaluated 274 VLBW infants: 91 had taken ranitidine and 183 had not. The main clinical and demographic characteristics did not differ between the 2 groups. Thirty-four (37.4%) of the 91 children exposed to ranitidine and 18 (9.8%) of the 183 not exposed to ranitidine had contracted infections (odds ratio 5.5, 95% confidence interval 2.9-10.4, P < .001). The risk of NEC was 6.6-fold higher in ranitidine-treated VLBW infants (95% confidence interval 1.7-25.0, P = .003) than in control subjects. Mortality rate was significantly higher in newborns receiving ranitidine (9.9% vs 1.6%, P = .003). CONCLUSIONS: Ranitidine therapy is associated with an increased risk of infections, NEC, and fatal outcome in VLBW infants. Caution is advocated in the use of this drug in neonatal age. Copyright © 2012 by the American Academy of Pediatrics.
Pisano A.,Monaldi Hospital |
Monti G.,San Raffaele Scientific Institute |
Landoni G.,San Raffaele Scientific Institute |
Landoni G.,Vita-Salute San Raffaele University
Current Opinion in Anaesthesiology | Year: 2016
Purpose of review In the last years, the perioperative use of levosimendan in cardiac surgery patients is spreading. Moreover, newer indications have been suggested such as the treatment of sepsis-associated myocardial dysfunction. In the present review, we discuss the most recent evidences in these settings. Recent findings Levosimendan has been seemingly confirmed to reduce mortality in patients undergoing cardiac surgery. In particular, it appears to be the only inotropic drug to have a favorable effect on survival in any clinical setting. Moreover, levosimendan has been shown to exert a cardioprotective action and to reduce acute kidney injury, renal replacement therapy, and ICU stay in cardiac surgery patients. Finally, levosimendan has been suggested to reduce mortality in patients with severe sepsis and to improve renal outcomes in critically ill patients. Summary Although a strong rationale likely exists to use levosimendan in the setting of perioperative and critical care medicine, evidence mainly comes from small and often poor-quality randomized clinical trials, whose results acquire significance only when pooled in meta-analyses. Moreover, some aspects related to which subgroups of patients may derive the most benefits from receiving levosimendan, to the optimal timing of administration, and to the potential adverse effects need to be further clarified. Important insights will be hopefully provided soon by the several large multicenter investigations which are currently ongoing. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Cuccurullo D.,Monaldi Hospital |
Piccoli M.,New santAgostino Estense Hospital |
Agresta F.,S Maria Regina Degli Angeli Hospital |
Magnone S.,Ospedali Riuniti |
And 3 more authors.
Hernia | Year: 2013
Purpose: The laparoscopic treatment of ventral incisional hernias is the object of constant attention and is becoming increasingly widespread in the international scientific-surgical community; however, there is ample debate on its technical details and indications. In order to establish a common approach on laparoscopic ventral incisional hernia repair, the first Italian Consensus Conference was organized in Naples (Italy) on 14-15 January 2010. Methods: The format of the Consensus Conference was freely adapted from the standards of the National Institute of Health and the Italian Health Institute. The parties involved included the followings: a Promotional Committee, a Scientific Committee, a group of Experts, the Jury Panel and a Scientific Secretariat. Results: Eleven statements, regarding three large chapters on the indications, the technical details and the management of complications were drafted on the basis of literature references collected by the Scientific Committee, documents developed by the Experts, reports presented and discussed during the Consensus Conference, and discussion among the members of the Jury. Conclusions: The laparoscopic approach is safe and effective for defects larger than 3 cm in diameter; old age, obesity, previous abdominal operations, recurrence and strangulation are not absolute contraindications. Ensuring an adequate overlap, careful adhesiolysis and correct fixing of the prosthesis are among the technical details recommended. Complications and recurrences are comparable to, and in some cases, less numerous than with the open approach. © 2013 Springer-Verlag France.
Canani R.B.,University of Naples Federico II |
Buccigrossi V.,University of Naples Federico II |
Passariello A.,University of Naples Federico II |
Passariello A.,Monaldi Hospital
Current Opinion in Gastroenterology | Year: 2011
Purpose of review For over a decade, the importance of zinc in the treatment of acute diarrhea has beenrecognized. More recently, the mechanisms of action of zinc are becoming clearer. This review is focused on the new evidence on the mechanisms of action of zinc in acute diarrhea. Recent findings The vast majority of data derive from in-vitro studies using intestinal cell lines or from animal model. The positive action by zinc in acute diarrhea derives from a regulation of intestinal fluid transport, mucosal integrity, immunity, gene expression, and oxidative stress. A complex homeostatic network is also able to regulate zinc status at cellular and extracellular level. Summary All these data support the use of zinc in the treatment of acute diarrhea, but further clinical studies are needed to explore the selective effects of zinc against specific pathogens responsible for diarrhea. © 2010 Wolters Kluwer Health.
Pichi F.,University of Milan |
Morara M.,Ophthalmology Unit |
Torrazza C.,Ophthalmology Unit |
Manzi G.,Monaldi Hospital |
And 6 more authors.
American Journal of Ophthalmology | Year: 2013
Purpose: To evaluate the anatomic and functional results of the treatment with intravitreal bevacizumab in complicated retinal arterial macroaneurysm (RAM). Design: A multicenter interventional, prospective, nonrandomized study. Methods: Thirty-eight macroaneurysms of 37 patients with foveal complications were evaluated. All patients underwent a comprehensive ophthalmologic examination, fluorescein angiography (FA), and spectral-domain optical coherence tomography (SD OCT) examination. Each patient underwent 3 monthly injections of bevacizumab 1.25 mg/0.05 mL; 3 follow-up visits were planned at week 2, 6, and 12. Results: Both best-corrected visual acuity (BCVA), expressed in logarithm of minimal angle of resolution (logMAR), and central retinal thickness (CRT) significantly improved during the follow-up visits (0.57 ± 0.21 vs 0.41 ± 0.15 vs 0.23 ± 0.13 vs 0.09 ± 0.10 and 520.38 ± 191.05 vs 396.24 ± 136.18 vs 283.86 ± 71.87 vs 214.84 ± 26.86, respectively, Friedman test P <.0001 for all variables). At 6 weeks of follow-up, FA showed complete closure of the RAM in 36 of 38 cases (94.7%). Four weeks following the third injection, the macular edema had completely resolved and hard exudates regressed slowly in 100% of patients. Conclusions: Intravitreal bevacizumab is an effective therapy for complicated RAM, quickly improving BCVA and CRT. Anti-vascular endothelial growth factor (VEGF) drugs might actively close the involved pathologically permeabilized retinal artery and normalize the vessel wall formation by localized inhibition of VEGF. © 2013 Elsevier Inc.
Weisz S.H.,University of Liège |
Weisz S.H.,Monaldi Hospital |
Magne J.,University of Liège |
Dulgheru R.,University of Liège |
And 3 more authors.
Journal of the American Society of Echocardiography | Year: 2014
Background In aortic stenosis (AS), the combination of risk factors can progressively lead to an increased arterial rigidity, which can be evaluated by the carotid artery and aortic stiffness (β index). The aim of this study was to investigate the relationship between carotid and aortic β index, left ventricular (LV) function, plasma brain natriuretic peptide (BNP) level, and symptoms in patients with AS. Methods Comprehensive echocardiography including Doppler tissue imaging of the mitral annulus was performed in 53 patients with AS (aortic valve area < 1.2 cm2) and preserved LV ejection fractions (50%). Carotid β index was automatically derived from ultrasound wall tracking of the right carotid artery. The mitral E/e′ ratio was used to estimate LV filling pressures. Results Carotid β index was higher in women than in men and was significantly correlated with age (P <.0001), diastolic arterial pressure (P =.046), pulse pressure (P =.006), and systemic arterial compliance (P =.001). Interestingly, carotid β index was significantly correlated with E/e′ ratio (P <.0001) and plasma BNP level (P =.011). In multivariate regression analysis, carotid β index was an independent predictor of E/e′ ratio (P <.0001) and of BNP level (P =.02). Moreover, carotid β index was significantly higher in symptomatic patients (P =.009). Aortic β index was significantly correlated with carotid β index (P <.0001), E/e′ ratio (P =.004), and BNP (P <.001) and was significantly higher in symptomatic patients (P =.037). Conclusions In patients with moderate to severe AS and preserved LV ejection fractions, the presence of increased carotid artery and aortic stiffness, assessed using carotid and aortic β index, is independently associated with elevated LV filling pressures, BNP level, and symptoms. © 2014 by the American Society of Echocardiography.
Montaldo P.,The Second University of Naples |
Rosso R.,Monaldi Hospital |
Chello G.,Monaldi Hospital |
Giliberti P.,Monaldi Hospital
Journal of Perinatology | Year: 2014
Objective:To investigate whether creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) can be used to predict neurodevelopmental outcome at 18 months in infants with perinatal asphyxia (PA). The diagnostic value of cTnI to assess myocardial dysfunction was considered as well.Study Design:Retrospective study of 178 neonates admitted with PA. cTnI concentrations measured within 12 h of birth were compared with medium-term outcome assessed with the Bayley Scales of Infant Development. cTnI concentrations measured within 12 h of birth were compared with clinical grade of hypoxic-ischemic encephalopathy (HIE) and with duration of inotropic support. Two-dimensional Doppler and color Doppler findings were recorded. Fractional shortening, tricuspid and mitral regurgitation were evaluated.Result:A statistically significant correlation between cTnI concentration and BSID-II score was found (mental development index r -0.69, P<0.05 and psychomotor development index r -0.39, P<0.05). There was no statistically significant correlation between CK-MB and BSID-II score (P>0.05).Serum cTnI concentrations and duration of inotropic support were significantly greater with increasing severity of PA. cTnI was negatively correlated with fraction shortening (r -0.64; P<0.05). The severity of tricuspid regurgitation was correlated with the cTnI concentration (r 0.61; P<0.05).Conclusion:In asphyxiated neonates, cTnI concentrations within 12 h of birth correlate with medium-term outcome. Early cTnI concentration correlates with severity of HIE, myocardial dysfunction and with Bayley II scores at 18 months. © 2014 Nature America, Inc.
Ancona R.,Monaldi Hospital |
Comenale Pinto S.,Monaldi Hospital |
Caso P.,Monaldi Hospital |
Di Salvo G.,The Second University of Naples |
And 3 more authors.
Journal of the American Society of Echocardiography | Year: 2013
Background: The aim of this study was to assess systolic left atrial (LA) reservoir function in patients with mitral stenosis (MS) using two-dimensional (2D) strain (ε) and strain rate imaging and its prognostic value in predicting atrial fibrillation (AF) at 4-year follow-up. Methods: One hundred one asymptomatic patients with pure rheumatic MS and 70 healthy controls were evaluated using standard Doppler echocardiography (mitral valve area, mean gradient, systolic pulmonary pressure, LA width, LA volumes, and LA ejection fraction) and 2D speckle-tracking. Results: LA width, volumes, and systolic pulmonary pressure were significantly increased (P <.0001), and LA 2D ε and strain rate were significantly impaired in patients with MS (P <.0001). At 4-year follow-up, 20 patients (20%) showed AF on standard electrocardiography or 24-hour Holter electrocardiography. Patients with MS who had AF were older than those who did not, without significant differences in LA dimensions, volumes, ejection fraction, and compliance index. Instead, atrial myocardial systolic 2D ε was significantly impaired in patients with events. On multivariate analysis (age, LA volume, planimetric mitral area, average annular Ea, and LA strain) the best predictor of AF was average LA peak systolic ε (coefficient, 0.43; SE, 0.098; P < .01), with an area under the receiver operating characteristic curve of 0.761 (SE, 0.085; 95% confidence interval, 0.587-0.888, P =.002) for a cutoff value of 17.4%. Conclusions: The results of 2D ε imaging are abnormal in patients with asymptomatic MS and predict AF at 4-year follow-up.Copyright 2013 by the American Society of Echocardiography.
Lirici M.M.,Bianchi Melacrino Morelli Hospital |
Califano A.D.,Bianchi Melacrino Morelli Hospital |
Angelini P.,Monaldi Hospital |
Corcione F.,Monaldi Hospital
American Journal of Surgery | Year: 2011
Background In recent years, new devices providing multiple channels have made the performance of laparoscopic cholecystectomy through a single access site not only feasible but much easier. The potential benefits of laparoendoscopic single-site (LESS) cholecystectomy may include scarless surgery, reduced postoperative pain, reduced postoperative length of stay, and improved postoperative quality of life. There are no comparative data between LESS cholecystectomy and standard laparoscopic cholecystectomy (LC) available at present with which to quantify these benefits. Methods This study was a prospective, randomized, dual-institutional pilot trial comparing LESS cholecystectomy with standard LC. The primary end point was postoperative quality of life, measured as length of hospital stay, postoperative pain, cosmetic results, and SF-36 questionnaire scores. Secondary end points included operative time, conversion to standard LC, difficulty of exposure, difficulty of dissection, and complication rate. Results No significant differences in postoperative lengths of stay were found in the two groups. Postoperative pain evaluation using a visual analogue scale showed significantly better outcomes in the standard LC arm on the same day of surgery (P =.041). No differences in postoperative pain were found at the next visual analogue scale evaluation or in the postoperative administration of pain-relieving medications. Cosmetic satisfaction was significantly higher in the LESS group at 1-month follow-up (mean, 94.5 ± 9.4% vs 86 ± 22.3%; median, 100% vs 90%; P =.025). Among the 8 scales of the SF-36 assessing patients' physical and mental health, scores on the Role Emotional scale were significantly better in the LESS group (mean, 80.05 ± 29.42 vs 68.33 ± 25.31; median, 100 vs 66.67; P <.0001). Conclusions In this pilot trial, LESS cholecystectomy resulted in similar lengths of stay and improved cosmetic results and SF-36 Role Emotional scores but performed less well on pain immediately after surgery. A larger multicenter trial is needed to confirm and further investigate these results. © 2011 Elsevier Inc. All rights reserved.
Mosca F.,Monaldi Hospital |
Grassia R.,Monaldi Hospital |
Leone C.A.,Monaldi Hospital
Acta Otorhinolaryngologica Italica | Year: 2014
In patients with a cochlear implant (CI), the first critical point in processing auditory information from sound stimuli that leads to comprehension is the interface between the electrode and the cochlear nerve, which is dependent on providing appropriate current input. The purpose of this work was to evaluate the longitudinal differences in psychoacoustic fitting parameters in CI users. We studied 26 profoundly deaf adults, aged between 18 and 58 years, who had been implanted in our department between 2009 and 2011. The lowest current levels that evoked an auditory sensation (T-level) and the highest current levels that did not elicit an uncomfortable loud sensation (C-level) were recorded at the time of activation, approximately 30 days after implantation (mean 28.5 days) (T0), after one month (T1), 3 months (T3), 6 months (T6) and one year (T12). Impedance values were calculated for electrode groups: basal, middle and apical. In all cases, the same model of perimodiolar implant (Cochlear™ Nucleus® CI24RE) and the same surgical technique (cochleostomy) were used. The values of T-level and C-level showed significant incremental changes between T0 and T1 and between T1 and T3. T-levels in the basal regions of the cochlea were higher than in other sites. T-levels in the basal turn exhibited higher values consistent with a greater amount of fibrosis, as reported in other studies. Our findings suggest that fitting sessions should be scheduled more frequently during the first three months as indicated by the greater slope of T- and C- level variations during that time frame.