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Orbassano, Italy

Gerbino G.,University of Turin | Zavattero E.,University of Turin | Berrone M.,San Luigi Gonzaga Hospital | Berrone S.,University of Turin
Journal of Oral and Maxillofacial Surgery

This report describes a peculiar case of needle breakage during inferior alveolar nerve block to perform third molar extraction that was removed with the aid of a BrainLAB VectorVision neuronavigation system. This report adds to the currently limited scientific literature on the image-guided removal of foreign bodies from the oral cavity. © 2013 American Association of Oral and Maxillofacial Surgeons. Source

Volpicelli G.,San Luigi Gonzaga Hospital
European journal of emergency medicine : official journal of the European Society for Emergency Medicine

During the last few years, a growing number of studies have shown the accuracy of lung ultrasound in the diagnosis of pulmonary diseases. The latest developments in lung ultrasound are not because of technological advance, but are based on new applications and discovering the meanings of sonographic artifacts. Real-time sonography of the lung in the emergency department saves time and cost, providing immediate information to the clinician, relying on very easy-to-acquire data. The bedside sonographic recognition of pulmonary diseases practically guides management and reduces the amount of negative radiologic image testings. This review describes some innovative practical applications of B-mode lung ultrasound in the diagnosis of alveolar consolidations and interstitial syndrome in the emergency department. Source

Langenhuijsen J.,Radboud University Nijmegen | Birtle A.,Rosemere Cancer Center | Klatte T.,Medical University of Vienna | Porpiglia F.,San Luigi Gonzaga Hospital | Timsit M.-O.,University of Paris Descartes
European Urology Focus

Context: Controversy exists regarding the choice for surgical approach and the role of lymph node dissection (LND) in adrenocortical carcinoma (ACC) treatment. ACC surgery is increasingly advocated to be performed in specialist referral centres. Objective: To review systematically the evidence of oncologic outcomes for ACC surgery by open adrenalectomy (OA) or laparoscopic adrenalectomy (LA), and for concomitant LND. The influence of surgical volume is also analysed. Evidence acquisition: A systematic review of Ovid Medline, Embase, and the Cochrane Library was performed in June 2015 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Twenty-six publications were selected for inclusion in the analysis. Meta-analyses were performed when appropriate. Evidence synthesis: Included studies reported on oncologic outcomes after surgical treatment of ACC (11 studies), compared different surgical approaches (7 studies), evaluated the role of LND (3 studies), and analysed the effect of surgical volume on outcome (5 studies). From the available studies and the meta-analysis, no differences were found in the rate of positive surgical margins, disease-free survival, and overall survival between OA and LA in localised disease. In patients with histologically proven positive lymph nodes, a shorter time to recurrence was seen when no proper LND was performed. A trend for better recurrence-free survival and disease-specific survival after LND was found. In high-volume centres, more aggressive and open surgery was performed. In low-volume centres, higher local recurrence and distant metastases rates, and a shorter time to recurrence were seen. Our findings are limited due to the low level of evidence of selected studies, patient and disease heterogeneity, and heterogeneous surgeon populations. Conclusions: After adequate clinical staging for localised disease, LA is as effective and oncologically safe as OA, as long as oncologic principles are respected. LA should be performed by surgeons with extensive experience in laparoscopic adrenal surgery in high-volume centres. Patients with locally advanced disease and metastatic disease, for debulking purposes, should be operated on extensively with open surgery with adequate margins and concomitant LND to optimise staging, which may contribute to survival in locally advanced disease. Patient summary: Laparoscopic surgery for localised adrenocortical carcinoma is safe and effective when performed by expert surgeons in high-volume centres. Patients with more extensive tumours should be operated with open surgery; lymph node dissection is mainly applied to determine the stage of the disease. Laparoscopic surgery for localised adrenocortical carcinoma is safe and effective when performed by expert surgeons at high-volume centres. Patients with more extensive disease should be operated with open surgery, and lymph node dissection is indicated mainly for staging. © 2015 European Association of Urology. Source

Volpicelli G.,San Luigi Gonzaga Hospital
American Journal of Emergency Medicine

Treatment of nontraumatic cardiac arrest in the hospital setting depends on the recognition of heart rhythm and differential diagnosis of the underlying condition while maintaining a constant oxygenated blood flow by ventilation and chest compression. Diagnostic process relies only on patient's history, physical findings, and active electrocardiography. Ultrasound is not currently scheduled in the resuscitation guidelines. Nevertheless, the use of real-time ultrasonography during resuscitation has the potential to improve diagnostic accuracy and allows the physician a greater confidence in deciding aggressive life-saving therapeutic procedures. This article reviews the current opinions and literature about the use of emergency ultrasound during resuscitation of nontraumatic cardiac arrest. Cardiac and lung ultrasound have a great potential in identifying the reversible mechanical causes of pulseless electrical activity or asystole. Brief examination of the heart can even detect a real cardiac standstill regardless of electrical activity displayed on the monitor, which is a crucial prognostic indicator. Moreover, ultrasound can be useful to verify and monitor the tracheal tube placement. Limitation to the use of ultrasound is the need to minimize the no-flow intervals during mechanical cardiopulmonary resuscitation. However, real-time ultrasound can be successfully applied during brief pausing of chest compression and first pulse-check. Finally, lung sonographic examination targeted to the detection of signs of pulmonary congestion has the potential to allow hemodynamic noninvasive monitoring before and after mechanical cardiopulmonary maneuvers. © 2011 Elsevier Inc. All rights reserved. Source

Buffi N.M.,Vita-Salute San Raffaele University | Lughezzani G.,Vita-Salute San Raffaele University | Fossati N.,Vita-Salute San Raffaele University | Lazzeri M.,Vita-Salute San Raffaele University | And 7 more authors.
European Urology

Background Laparoendoscopic single-site surgery (LESS) has gained popularity in urology over the last few years. Objective To report a stage 2a study of robot-assisted single-site (R-LESS) pyeloplasty for ureteropelvic junction obstruction (UPJO). Design, setting, and participants This study is an investigative pilot study of 30 consecutive cases of R-LESS pyeloplasty performed at two participating institutions between July 2011 and September 2013. Surgical procedure Dismembered R-LESS pyeloplasty was performed at two surgical centers. Measurements Feasibility (conversion rate), safety (complication rate and Clavien-Dindo classification), efficacy (clinical outcome) of the procedure were assessed. Results and limitations The median patient age was 37 yr (range: 19-65 yr) and median body mass index was 23 kg/m2 (range: 19-29 kg/m2). The median operative time was 160 min (range: 101-300 min), the median postoperative stay was 5 d (range: 3-13 d), and the median time to catheter removal was 3 d (range: 2-10). Two cases required conversion, the first one to standard laparoscopic technique and the second one to standard robotic technique. No intraoperative complications were reported. In three cases, an additional 5-mm trocar was needed. The postoperative complications rate was 26% (n = 8). Most of them were grade 1 complications (n = 4; 13%), followed by grade 2 (n = 3; 10%) and grade 3 (n = 1; 3.3%) complications, according to the Clavien-Dindo classification. One patient needed a surgical reintervention with standard robotic technique 3 d after surgery for urinary leakage. The overall success rate, considered as the resolution of symptoms and the absence of functional impairment at postoperative imaging, was 93.3% (n = 28) at a median follow-up of 13 mo (range: 3-21 mo). The main limitations of this study are the limited number of patients included and the short-term follow-up. Conclusions Single-site robotic pyeloplasty is a feasible technique in selected patients, with good cosmetic results and excellent short-term clinical outcomes. Prospective studies are needed to further assess its role for the treatment of UPJO. Patient summary Single-site robot-assisted pyeloplasty is a feasible technique with good cosmetic results and excellent short-term clinical outcomes. © 2014 Published by Elsevier B.V. Source

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