Policlinico Universitario accone

Palermo, Italy

Policlinico Universitario accone

Palermo, Italy
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Legnani C.,IRCCS Galeazzi Orthopaedic Institute | Zini S.,Policlinico Universitario accone | Borgo E.,San Siro Clinical Institute | Ventura A.,San Siro Clinical Institute
Joints | Year: 2017

Purpose The purpose of this study was to retrospectively evaluate the clinical outcome of revision anterior cruciate ligament (ACL) reconstruction with contralateral hamstring tendon autografts, specifically with regard to patient satisfaction, return to preinjury activity level, and postoperative functional outcomes. Methods Between 2004 and 2011, 23 patients underwent revision ACL reconstruction with contralateral autogenous hamstring tendon grafts and were retrospectively reviewed at an average follow-up of 6.3 years. Subjective and functional evaluations were performed. The Tegner score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) Subjective Knee Form were used. Objective evaluation included range of motion, Lachman test, pivot-shift test, and KT-1000 instrumented laxity testing. Wilcoxon test was used to compare the preoperative and follow-up status. Differences with a p-value of <0.05 were considered statistically significant. Results No major complications were reported. The mean KOOS significantly increased from a preoperative mean of 62.8 ± 8.3 to 85.8 ± 6.9 (p < 0.001). IKDC subjective score significantly improved from 29.2 ± 10.4 to 72.8 ± 5.2 (p < 0.001). The median Tegner activity score significantly improved froma preoperative mean of 6.5 (range: 4–10) to 7.5 (range: 7–10) (p < 0.001). Most of the patients increased or returned to the same activity level, with 61% of the patients returning to cutting and pivoting sports. Conclusion The use of contralateral hamstring tendon autografts for ACL revision surgery represents a valid option following a failed primary ACL reconstruction and confirms subjective and objective clinical improvement 6 years after surgery. Level of Evidence Level IV, therapeutic case series. © 2017 Georg Thieme Verlag KG Stuttgart · New York.


Legnani C.,Instituto Ortopedico G Pini | Zini S.,Policlinico Universitario accone | Borgo E.,Instituto Ortopedico G Pini | Ventura A.,Instituto Ortopedico G Pini
Archives of Orthopaedic and Trauma Surgery | Year: 2016

Introduction: With the increasing number of primary anterior cruciate ligament (ACL) reconstructions, revision surgery has become more frequent. The purpose of the present study is to retrospectively compare the clinical outcome of contralateral hamstring tendon autografts vs. allografts for ACL revision surgery, specifically with regard to patient satisfaction, return to preinjury activity level, and postoperative functional outcomes. Materials and methods: Between 2004 and 2011, 59 patients underwent ACL revision surgery. 44 were successfully recontacted and retrospectively reviewed at an average follow-up of 5.2 years. 23 subjects underwent revision ACL reconstruction with contralateral autogenous hamstring tendon grafts; 21 underwent allograft revision ACL surgery. Clinical, arthrometric, and functional evaluations were performed. The Tegner, Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) Subjective Knee Form were used. Objective evaluation included range of motion, Lachman test, pivot-shift test and KT-1000 instrumented laxity testing. Results: No major complications were reported. Follow-up examination showed that there were no significant differences IKDC and KOOS scores between the groups. The percentage of patients returning to pre-injury level was high in both groups. Anterior tibial translation according to manual laxity testing and as measured with KT-1000 arthrometer was not statistically different in the two groups. With regard to return to sports, patients undergoing revision surgery with autografts experienced a quicker return to sports compared to patients who underwent allograft revision surgery. Conclusions: The use of contralateral hamstring tendon autografts for ACL revision surgery produced similar subjective and objective outcomes at 5.2 years follow-up compared to revision with allograft patellar or Achilles tendon. Patients undergoing revision surgery with autografts experienced a quicker return to sports compared to patients who underwent allograft revision surgery. © 2016, Springer-Verlag Berlin Heidelberg.


Terenziani M.,Fondazione IRCCS Instituto Nazionale dei Tumori | D'Angelo P.,ARNAS Civico | Inserra A.,Ospedale Pediatrico IRCCS Bambino Gesu | Boldrini R.,Ospedale Pediatrico IRCCS Bambino Gesu | And 12 more authors.
Pediatric Blood and Cancer | Year: 2015

Background: Teratomas demonstrate a benign clinical behavior, however they may recur with malignant components or as teratoma, and in a small group of patients prognosis could be fatal. After the first Italian study, we collected cases of teratoma, alongside the protocol for malignant germ cell tumors. Procedure: Patients with teratoma were collected from 2004 to 2014. Teratomas were classified according to the WHO classifications, as mature and immature. Patients with pathological aFP and/or bHCG, and those with a malignant germ cell component were not included. Results: The study enrolled 219 patients (150 mature, 69 immature teratomas) with a median age at diagnosis of 42 months. The primary sites involved were: 118 gonadal and 101 extragonadal teratomas. Two females with ovarian teratoma had a positive family history. Complete and incomplete surgeries were performed in 85% and 9% of cases. Seventeen events occurred: six females had a second metachronous tumor (5 contralateral ovarian teratoma, 1 adrenal neuroblastoma) and 11 teratomas relapsed/progressed (3 mature, 8 immature teratomas). Two patients died, one of progressive immature teratoma and one of surgical complications. At a median follow up of 68 months, the event-free, relapse-free, and overall survival rates were 90.6%, 94.3%, 98.6%, respectively. Conclusions: Teratomas show a good prognosis, especially the mature ones: surgery and follow-up remain the standard approach. Incomplete surgery in immature teratoma is the group at greatest risk of relapse. Bilateral ovarian tumors are a possibility, and the rare family predisposition to ovarian mature teratoma warrants further analyses. Pediatr Blood Cancer 2015;62:1202-1208. © 2015 Wiley Periodicals, Inc.


PubMed | Policlinico Universitario accone and Instituto Ortopedico G Pini
Type: Comparative Study | Journal: Archives of orthopaedic and trauma surgery | Year: 2016

With the increasing number of primary anterior cruciate ligament (ACL) reconstructions, revision surgery has become more frequent. The purpose of the present study is to retrospectively compare the clinical outcome of contralateral hamstring tendon autografts vs. allografts for ACL revision surgery, specifically with regard to patient satisfaction, return to preinjury activity level, and postoperative functional outcomes.Between 2004 and 2011, 59 patients underwent ACL revision surgery. 44 were successfully recontacted and retrospectively reviewed at an average follow-up of 5.2years. 23 subjects underwent revision ACL reconstruction with contralateral autogenous hamstring tendon grafts; 21 underwent allograft revision ACL surgery. Clinical, arthrometric, and functional evaluations were performed. The Tegner, Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) Subjective Knee Form were used. Objective evaluation included range of motion, Lachman test, pivot-shift test and KT-1000 instrumented laxity testing.No major complications were reported. Follow-up examination showed that there were no significant differences IKDC and KOOS scores between the groups. The percentage of patients returning to pre-injury level was high in both groups. Anterior tibial translation according to manual laxity testing and as measured with KT-1000 arthrometer was not statistically different in the two groups. With regard to return to sports, patients undergoing revision surgery with autografts experienced a quicker return to sports compared to patients who underwent allograft revision surgery.The use of contralateral hamstring tendon autografts for ACL revision surgery produced similar subjective and objective outcomes at 5.2years follow-up compared to revision with allograft patellar or Achilles tendon. Patients undergoing revision surgery with autografts experienced a quicker return to sports compared to patients who underwent allograft revision surgery.


Santini D.,Biomedical University of Rome | Tampellini M.,University of Turin | Vincenzi B.,Biomedical University of Rome | Ibrahim T.,Instituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori | And 29 more authors.
Annals of Oncology | Year: 2012

Background: Data are limited regarding bone metastases from colorectal cancer (CRC). The objective of this study was to survey the natural history of bone metastasis in CRC. Patients and methods: This retrospective, multicenter, observational study of 264 patients with CRC involving bone examined cancer treatments, bone metastases characteristics, skeletal-related event (SRE) type and frequency, zoledronic acid therapy, and disease outcomes. Results: Most patients with bone metastases had pathologic T3/4 disease at CRC diagnosis. The spine was the most common site involved (65%), followed by hip/pelvis (34%), long bones (26%), and other sites (17%). Median time from CRC diagnosis to bone metastases was 11.00 months; median time to first SRE thereafter was 2.00 months. Radiation and pathologic fractures affected 45% and 10% of patients, respectively; 32% of patients had no reported SREs. Patients survived for a median of 7.00 months after bone metastases diagnosis; SREs did not significantly affect survival. Subgroup analyses revealed that zoledronic acid significantly prolonged median time to first SRE (2.00 months versus 1.00 month, respectively, P = 0.009) and produced a trend toward improved overall survival versus no zoledronic acid. Conclusion: This study illustrates the burden of bone metastases from CRC and supports the use of zoledronic acid in this setting. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


PubMed | University of Genoa, Unit of Pathology, E.O. Ospedali Galliera, Unit of Microcitemia and Hereditary Anaemias and 3 more.
Type: | Journal: BioMed research international | Year: 2015

To assess the diagnostic performance of a T1-independent, T2*-corrected multiecho magnetic resonance imaging (MRI) technique for the quantification of hepatic steatosis in a cohort of patients affected by chronic viral C hepatitis, using liver biopsy as gold standard.Eighty-one untreated patients with chronic viral C hepatitis were prospectively enrolled. All included patients underwent MRI, transient elastography, and liver biopsy within a time interval <10 days.Our cohort of 77 patients included 43/77 (55.8%) males and 34/77 (44.2%) females with a mean age of 51.31 11.27 (18-81) years. The median MRI PDFF showed a strong correlation with the histological fat fraction (FF) (r = 0.754, 95% CI 0.637 to 0.836, P < 0.0001), and the correlation was influenced by neither the liver stiffness nor the T2* decay. The median MRI PDFF result was significantly lower in the F4 subgroup (P < 0.05). The diagnostic accuracy of MRI PDFF evaluated by AUC-ROC analysis was 0.926 (95% CI 0.843 to 0.973) for S 1 and 0.929 (95% CI 0.847 to 0.975) for S = 2.Our MRI technique of PDFF estimation allowed discriminating with a good diagnostic accuracy between different grades of hepatic steatosis.


Vernuccio F.,Sezione di Science Radiologiche | Grutta G.,Policlinico Universitario accone | Fazio G.,Poliambulatorio medico Riabiliter SNC
Recenti Progressi in Medicina | Year: 2014

Sudden cardiac death (SCD) in athletes is a rare but tragic event particularly considering that in some cases it is preventable. In young athletes with cardiovascular disease the risk of SCD is 2,5 times higher than in non-athletes. In young athletes (<35 years old), the most common causes of SCD are related to pre-existing cardiovascular disorders including hypertrophic cardiomyopathy, congenital coronary anomalies, arrhythmogenic right ventricular dysplasia, commotio cordis, some channelopathies and cardiac sarcoidosis. Actually there are two approches to pre-participation athletic screening: the American one based on anamnesis and physical examination and the European one based on anamnesis, physical examination and ECG at rest. However, some disorders responsible for SCD can't be suspected through these exams and it could be useful to implement preparticipation athletic screening. © 2014 II Pensiero Scientifico Editore.


Tumminello F.M.,Policlinico Universitario accone | Badalamenti G.,Policlinico Universitario accone | Fulfaro F.,Policlinico Universitario accone | Incorvaia L.,Policlinico Universitario accone | And 4 more authors.
Clinical and Experimental Metastasis | Year: 2010

The clinical significance of circulating follistatin (FLST), an inhibitor of the multifunctional cytokine activin A (Act A), was investigated in patients with prostate cancer (PCa). The serum concentrations of this molecule were determined by an enzyme-linked immunosorbent assay (ELISA) in PCa patients with (M+) or without (M0) bone metastases, in patients with benign prostate hyperplasia (BPH) and in healthy subjects (HS). The effectiveness of FLST in detecting PCa patients with skeletal metastases was determined by the receiver operating characteristic (ROC) curve analysis. Serum FLST was significantly higher in PCa patients than in BPH patients (P = 0.001) or HS (P = 0.011). Conversely, in BPH patients, FLST levels resulted lower than in HS (P = 0.025). In cancer patients the serum concentrations of FLST significantly correlated with the presence of bone metastases (P = 0.0005) or increased PSA levels (P = 0.04). Interestingly, significant differences in the ratio between FLST and Act A serum concentrations (FLST/Act A) were observed between HS and BPH patients (P = 0.001) or PCa patients (P = 0.0005). Finally, ROC curve analysis, highlighted a sound diagnostic performance of FLST in detecting M+ patients (P = 0.0001). However, the diagnostic effectiveness of FLST did not result significantly superior to that of Act A or PSA. These findings suggest that FLST may be regarded as a potential, molecular target in the treatment of metastatic bone disease while its clinical role as soluble marker in the clinical management of PCa patients with bone metastases needs to be better defined. © 2010 Springer Science+Business Media B.V.


Cabibi D.,Policlinico Universitario accone | Tutino R.,University of Palermo | Cocorullo G.,University of Palermo | Agrusa A.,University of Palermo | Gulotta G.,University of Palermo
Annali Italiani di Chirurgia | Year: 2016

We report a case of peritoneal biphasic mesothelioma with cystic areas in a patient with professional exposure to asbestos. It showed focal epithelial glandular and papillary proliferations, also presenting fluid filled cysts, whose wall consisted of a proliferation of spindle cells. Atypia and mitoses were very scanty. EMA, vimentin, CK5/6, D2-40, calretinin and P53 were positive and desmin was negative in both epithelial and spindle areas, including the ones surrounding the cystic spaces. These findings gave an essential aid in the differential diagnosis with a benign cystic mesothelioma and with a cystic epithelial mesothelioma with secondary pseudosarcomatous myofibroblastic proliferation. The presence of cystic areas in a malignant mesothelioma could make difficult the diagnosis. A large amount of tumour tissue is necessary for confirming the biphasic histotype, an aggressive histotype, even in the presence of mild histological features and of some others favourable clinical prognostic indices as in this case. To our knowledge this is the first case of malignant peritoneal biphasic mesothelioma with cystic features reported in the literature.


PubMed | IRCCS Galeazzi Orthopaedic Institute, San Siro Clinical Institute and Policlinico Universitario accone
Type: | Journal: European journal of orthopaedic surgery & traumatology : orthopedie traumatologie | Year: 2017

With the increasing number of primary anterior cruciate ligament (ACL) reconstructions, the need for revision ACL surgery has risen over the past few years. The purpose of the present study is to retrospectively compare the clinical outcome of ipsilateral versus contralateral hamstring tendon autografts for ACL revision surgery, specifically with regard to patient satisfaction, post-operative functional outcomes, and return to sports.Between 2004 and 2011, 64 patients underwent ACL revision surgery. Forty-five were successfully recontacted and retrospectively reviewed at an average follow-up of 6.3years. Twenty-two subjects underwent revision ACL reconstruction with ipsilateral autogenous hamstring tendon grafts; in 23 subjects contralateral hamstring were used for reconstruction. Clinical, arthrometric, and functional evaluations were performed. The Tegner activity level, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) Subjective Knee Form were used. Objective evaluation included range of motion, Lachman test, pivot shift test and KT-1000 instrumented laxity testing.No major complications were reported. Follow-up examination showed that there were no significant differences in the IKDC and KOOS scores between the groups. No differences in anterior tibial translation as measured with KT-1000 arthrometer were reported between the groups, although there was a trend for more of the patients undergoing ipsilateral DGST reconstruction to have a glide on the pivot shift test. The percentage of patients returning to pre-injury level was high in both groups.The use of contralateral hamstring tendon autografts for ACL revision surgery produced similar subjective and objective outcomes at 6-years follow-up compared to revision with ipsilateral hamstring tendon autografts. Patients undergoing revision surgery with contralateral autografts experienced a quicker return to sports compared to patients who underwent ipsilateral DGST revision surgery.

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