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Bolzano, Italy

Manno E.,Maria Vittoria Hospital | Navarra M.,Intensive Care Unit | Faccio L.,Intensive Care Unit | Motevallian M.,Intensive Care Unit | And 4 more authors.
Anesthesiology | Year: 2012

Background: Ultrasound can influence the diagnosis and impact the treatment plan in critical patients. The aim of this study was to determine whether, without encountering major environment- or patient-related limitations, ultrasound examination under a critical care ultrasonography protocol can be performed to detect occult anomalies, to prompt urgent changes in therapy or induce further testing or interventions, and to confirm or modify diagnosis. Methods: One hundred and twenty-five consecutive patients admitted to a general intensive care unit were assessed under a critical care ultrasonography protocol, and the data were analyzed prospectively. Systematic ultrasound examination of the optic nerve, thorax, heart, abdomen, and venous system was performed at the bedside. Results: Environmental conditions hampered the examination slightly in 101/125 patients (80.8%), moderately in 20/125 patients (16%), and strongly in 4/125 patients (3.2%). Ultrasonographic findings modified the admitting diagnosis in 32/125 patients (25.6%), confirmed it in 73/125 patients (58.4%), were not effective in confirming or modifying it in 17/125 patients (13.6%), and missed it in 3/125 patients (2.4%). Ultrasonographic findings prompted further testing in 23/125 patients (18.4%), led to changes in medical therapy in 22/125 patients (17.6%), and to invasive procedures in 27/125 patients (21.6%). Conclusions: In this series of patients consecutively admitted to an intensive care unit, ultrasound examination revealed a high prevalence of unsuspected clinical abnormalities, with the highest number of new ultrasound abnormalities detected in patients with septic shock. As part of rapid global assessment of the patient on admission, our ultrasound protocol holds potential for improving healthcare quality. Copyright © 2012, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. Source

Toccoa M.P.,Thoracic Surgery Unit | Ballardini M.,Microbiology Unit | Masala M.,Infectious Disease Unit | Perozzi A.,San Filippo Neri Hospital
European Journal of Cardio-thoracic Surgery | Year: 2013

OBJECTIVES: The goal of this study was to investigate alternative strategies to the sternal resection in the treatment of post-sternotomy osteomyelitis. We report our experience in the treatment of chronic infection of median sternotomy following open heart surgery without sternal resection. METHODS: A 4-year retrospective study was performed, consisting of 70 patients affected by post-sternotomy sternocutaneous fistulas due to chronic osteomyelitis: 45 patients underwent only medical treatment and 25 underwent steel wire removal and surgical debridement (conservative surgery). Of the 25, 7 patients underwent an additional vacuum assisted closure (VAC) therapy due to widespread infected subcutaneous tissue. The diagnosis of osteomyelitis was supported via 3D CT scan images. RESULTS: Complete wound healing was achieved in 67 patients including a patient who achieved healing after being affected by a fistula for over 24 years before coming under our observation, another, affected by mycobacteria other than tuberculosis osteomyelitis, who needed antimicrobial treatment for a period of 30 months and 2 who were affected by Aspergillus infection and needed radical cartilage removal. Fistula relapses were observed in 6 patients of the total 70, possibly due to the too short-term antibiotic therapy used in the presence of coagulase-negative Staphylococcus (CoNS) with multiple resistances and in the presence of Corynebacterium species. CONCLUSIONS: Post-sternotomy chronic osteomyelitis can be successfully treated mainly by systemic antimicrobial therapy alone, without mandatory surgical treatments, provided that accurate microbiological and radiological studies are performed. The presence of CoNS and Corynebacterium species seemed to be associated with a need for a prolonged combined antimicrobial therapy with a minimum of 6 months up to a maximum of 18 months. The CT scan and the 3D reconstruction of the sternum proved to be a good method to evaluate the status of the sternum and support the treatments. The VAC therapy was not useful in treating osteomyelitis, although, if used appropriately in the postoperative deep sternal wound infection with the sponge fitted between the sternal edges, it seems to be an effective method to eradicate the infection in the sternum and to prevent chronic osteomyelitis. © The Author 2012.Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. Source

Moro M.,Tumor Genomics Unit | Bertolini G.,Tumor Genomics Unit | Pastorino U.,Thoracic Surgery Unit | Roz L.,Tumor Genomics Unit | Sozzi G.,Tumor Genomics Unit
Journal of Thoracic Oncology | Year: 2015

The existence of specific cellular subpopulations within primary tumors with increased tumorigenic potential and chemotherapy resistance (tumor-initiating cells, TICs) holds great therapeutic implications. Resistant cells can remain quiescent for long periods and be responsible for local relapses and metastasis. We and others have previously described in non-small-cell lung cancer the presence of cisplatin-resistant CD133+ cells with tumor-initiating potential and co-expression of CXCR4 as possible indicator of TICs with disseminating potential. In this study, we report, by in vitro cell fate tracing systems, heterogeneity within the TIC compartment with a highly quiescent pool and a slowly dividing subpopulation, both containing CD133+ cells but respectively enriched for CD133+/CXCR4- and CD133+/CXCR4+ cells. Pretreatment with differentiating agent all-trans retinoic acid counteracts cisplatin resistance specifically of the slowly dividing compartment indicating effect on CD133+/CXCR4+ cells. The same effects are appreciable also in vivo in patient-derived xenografts, where several cycles of all-trans retinoic acid and cisplatin treatment are able to stably reduce this fraction of TICs and tumor dissemination. Thus, partially affecting the heterogeneous TICs compartment, differentiating therapy has promising effects in counteracting cisplatin resistance of CD133+ cells, reducing both local tumor growth and dissemination. In addition, our approach discloses a further level of complexity of chemotherapy-resistant CD133+ TICs, revealing phenotypical and functional heterogeneity of the cancer stem cell compartment in lung cancer. © 2015 by the International Association for the Study of Lung Cancer. Source

Rena O.,Thoracic Surgery Unit | Casadio C.,Thoracic Surgery Unit
Lung Cancer | Year: 2012

The effects on long-term post-operative quality of life (QoL) and disease-control in malignant pleural mesothelioma (MPM) of extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D) are compared. Seventy-seven patients affected by early-stage MPM received EPP (40) or P/D (37) associated with multimodal treatment between 1998 and 2009 at our institution. The last consecutive 39 (19 EPP and 20 P/D) were asked to answer the EORTC-QLQ-C30 questionnaire at baseline and at 6- and 12-months after treatment completion to evaluate the impact on QoL of both procedures. QoL evaluation was stopped at recurrence demonstration. Twenty-five (62%) EPP vs 9 (24%) P/D patients (p= 0.002) had in-hospital major complications, and 2/40 (5%) EPP vs no one P/D patients died after surgery. Both procedures caused a significant impairment of all the considered variables of the EORTC-QLQ-C30 questionnaire after treatment completion; only P/D patients returned at baseline levels after12 months. EPP patients had a worse long-term post-operative QoL when compared with P/D. Median post-operative disease-free period was longer for EPP patients (14 vs 11 months) whereas the residual life to death period after recurrence detection was significantly longer for P/D patients (13 vs 9 months) (p= 0.01). Median long-term survival was longer, even not significant, for P/D patients (25 vs 20 months). MPM patients submitted to EPP had a higher post-operative complication rate, a worse long-term QoL, a shorter residual life time after recurrent disease, despite a similar long-term survival when compared to P/D. © 2012 Elsevier Ireland Ltd. Source

Viti A.,Thoracic Surgery Unit | Bertolaccini L.,Thoracic Surgery Unit | Cavallo A.,Thoracic Surgery Unit | Fortunato M.,Pathology Service | And 2 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2014

Objectives: To investigate the usefulness of 18-fluorine fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET-CT) in the pretreatment evaluation of thymic epithelial neoplasms (TENs). We previously demonstrated that the ratio between standardized uptake value of the tumour and aortic arch (SUV T/M) correlates with World Health Organization (WHO) classification. We now focused our evaluation on thymomas only, excluding carcinomas. We also searched for the expression of a pathological biomarker, Ki-67, that gained both diagnostic and prognostic relevance for various solid tumours. Its correlation with SUV T/M and WHO classification was evaluated. Methods: We performed a retrospective dynamic cohort study of data from January 2006 to December 2012, on 23 consecutive patients with pathologically proven TEN, excluding thymic carcinomas, evaluated with PET-CT. For each patient, SUV T/M was calculated. The patients were then categorized, according to WHO classification, into two groups (low-risk: 3 A, 9 AB, 5 B1; high-risk: 5 B2, 1 B3) and Ki-67 labelling index (LI) was defined. We employed the Spearman rank non-linear correlation coefficient (ρ) to estimate the correlations between variables. Results: SUV T/M proved to be significantly higher for high-positive Ki-67 samples, indicating a strong correlation between SUV T/M and Ki-67 LI (ρ = 0.8). Furthermore, high Ki-67 LI samples correlate with the higher-risk WHO subgroup (ρ = 0.9). Conclusions: FDG PET-CT can provide a useful tool in the preoperative work-up of TEN, reflecting its proliferation capacity, as described also by the Ki-67 expression. In particular, SUV T/M could provide a 'metabolic biopsy' to divide TEN into high-risk and low-risk neoplasms. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. Source

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