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PubMed | Bambino Gesu Hospital, Juntendo University, University of Padua, Wrocław University and 7 more.
Type: Journal Article | Journal: World journal of urology | Year: 2016

To compare the outcome of laparoscopic and retroperitoneoscopic approach for partial nephrectomy in infants and children with duplex kidneys.Data of 102 patients underwent partial nephrectomy in a 5-year period using MIS procedures were analyzed. Fifty-two children underwent laparoscopic partial nephrectomy (LPN), and 50 children underwent retroperitoneoscopic partial nephrectomy (RPN). Median age at surgery was 4.2years. Statistical analysis was performed using (2) test and Students t test.The overall complications rate was significantly higher after RPN (15/50, 30%) than after LPN (10/52, 19%) [ (2)=0.05]. In LPN group, complications [4 urinomas, 2 symptomatic refluxing distal ureteral stumps (RDUS) and 4 urinary leakages] were conservatively managed. In RPN group, complications (6 urinomas, 8 RDUS, 1 opening of remaining calyxes) required a re-operation in 2 patients. In both groups no conversion to open surgery was reported. Operative time (LPN:166.2min vs RPN: 255min; p<0.001) and hospitalization (LPN: 3.5days vs RPN: 4.1days; p<0.001) were significantly shorter in LPN group. No postoperative loss of renal function was reported in both groups.Our results demonstrate that RPN remains a technically demanding procedure with a significantly higher complications and re-operation rate compared to LPN. In addition, length of surgery and hospitalization were significantly shorter after LPN compared to RPN. LPN seems to be a faster, safer and technically easier procedure to perform in children compared to RPN due to a larger operative space and the possibility to perform a complete ureterectomy in refluxing systems.


PubMed | Bambino Gesu Hospital, Juntendo University, University of Naples Federico II, Nice University Hospital Center and 2 more.
Type: Journal Article | Journal: Journal of laparoendoscopic & advanced surgical techniques. Part A | Year: 2015

Retroperitoneoscopic partial nephrectomy (RPN) in children is considered a complex technique with limited diffusion among pediatric surgeons and urologists. We aimed to report the outcome of this technique in infants and children with duplex kidney in a 5-year retrospective multicentric international survey.Data on 50 children who underwent RPN (41 upper-pole nephrectomies and 9 lower-pole nephrectomies) were retrospectively collected in this six-institution survey. Median age at surgery was 3.3 years. There were 35 girls and 15 boys. The left side was affected in 28 patients, versus the right side in 22 patients. We assessed intraoperative and postoperative morbidity. Follow-up (median, 2.5 years; range, 12 months-5 years) was based on clinical controls and echo color Doppler renal ultrasound scans.Median duration of surgery was 255 minutes. Surgery was always performed with the patient in a lateral position. Special hemostatic devices were used for dissection and parenchymal section in all centers. Three patients from two centers (6%) required conversion to open surgery. We recorded seven complications (six peritoneal perforations, one opening of the remaining calyxes) in the 50 cases. Re-operation rate was 0%. Average length of hospital stay was 4.1 days.Our survey shows that RPN remains a challenging procedure with a long learning curve, performed only in pediatric centers with huge experience in this field. In our survey operative time was longer than 4 hours. The complication rate remains high (7/50, or 14%), with complications classified as Grade II according to the Clavien-Dindo classification. They did not require further surgery, but they were associated with a prolonged hospital stay.


Riboni F.,University of Novara | Riboni F.,University Aavogadro | Vitulo A.,University of Padua | Plebani M.,University of Padua | And 3 more authors.
Archives of Gynecology and Obstetrics | Year: 2012

Purpose The aim of this study was to evaluate the predictive performances of some biochemical markers in predicting pre-term delivery in asymptomatic women. Methods We included 491 asymptomatic women at 24 weeks' gestation, who underwent the endocervical phosphorylated insulin-like growth factor binding protein (phIGFBP-1) test, cervico-vaginal interleukins 6 (IL-6) and 8 (IL-8), and serum C-reactive protein (CRP). A receiveroperating characteristics (ROC) curve was used to determine the most useful cut off point. A multivariate logistic regression model was used in order to analyze the combination of significant predictive variables for pre-term delivery following univariate analysis. Results ROC curves indicated that 33 lg/l was the optimal cut off value for phIGFBP-1 test, 21.3 ng/l for IL-6, 324 ng/l for IL-8, and 8.42 mg/l for CRP in predicting preterm delivery. The univariate logistic regression analyses revealed an odds ratio of 3.04 for phIGFBP-1 test, 4.82 for IL-6, and 3.08 for CRP. The multivariate analysis of phIGFBP- 1 test, IL-6, and CRP showed that they were independent variables and therefore useful in combination for predicting pre-term delivery. Conclusions The phIGFBP-1 test, the cervico-vaginal IL-6, and the serum CRP are independent variables that can be used together to predict pre-term delivery in asymptomatic women. © Springer-Verlag 2011.


Riboni F.,University of Novara | Riboni F.,Buzzi Hospital | Vitulo A.,University of Padua | Vitulo A.,Buzzi Hospital | And 8 more authors.
Archives of Gynecology and Obstetrics | Year: 2011

Purpose: The aim of this study was to evaluate the efficacy of the phosphorylated insulin-like growth factorbinding protein (phIGFBP-1) and of the fetal fibronectin test (fFN) in predicting pre-term delivery in symptomatic women. Methods: We included 210 symptomatic women at 24-34 weeks' gestation, who underwent the phIGFBP-1 and fFN test. We analyzed the prevalence of pre-term delivery in these patients within 7 days upon admission, before the 34th and the 37th weeks' gestation. Results: The 3.8% of women delivered within 7 days upon the admission, the 7.6% before 34 weeks and the 16.2% before 37 weeks' gestation. The phIGFBP-1 and fFN test had a high specificity and a high negative predictive value in predicting pre-term delivery within 7 days, before 34 and before 37 weeks' gestation. The logistic regression of phIGFBP-1 was statistically significant in predicting pre-term delivery with an odds ratio of 10.08 <34 weeks' gestation. The multivariate analysis showed that the phIGFBP test had a higher OR <34 weeks' gestation (p < 0.001) and that the two variables were independent and useful in combination to predict pre-term delivery (<37 weeks' gestation). Conclusion: The phIGFBP-1 test may be better that the fFN test in predicting pre-term delivery before 34 weeks' gestation. © Springer-Verlag 2011.


PubMed | University La Sapienza, University of Insubria, University of Milan, University of Rome Tor Vergata and 3 more.
Type: Journal Article | Journal: Neurourology and urodynamics | Year: 2016

The role of urodynamics (UDS) before surgery for stress urinary incontinence (SUI) remains a debated issue in female urology as well as in urogynaecology and it has been recently questioned on the basis of data coming from selected population of patients defined as uncomplicated. The aim of this study was to investigate the percentage of uncomplicated patients undergoing urodynamic evaluations in six referral Italian centers. The secondary aim was to assess the prevalence of women, for whom the urodynamic evaluation could add new information to the pre-urodynamic picture and in how many cases these findings had a significant impact on patient management.The data of women who underwent urodynamic evaluation prior to surgery for stress urinary incontinence between 2008 and 2013 were retrospectively analyzed. According to the definition of the Value of Urodynamic Evaluation (ValUE) trial criteria, patients presenting with SUI were classified as uncomplicated or complicated. Urodynamic observations were then compared with pre-urodynamic data.Overall, 2,053 female patients were considered. Only 740/2,053 (36.0%) patients were defined uncomplicated according to the definition used in the ValUE trial. The urodynamic observations were not consistent with the pre-urodynamic diagnosis in 1,276 out of 2,053 patients (62.2%). Voiding dysfunctions were urodynamically diagnosed in 394 patients (19.2%). Planned surgery was cancelled or modified in 304 patients (19.2%), due to urodynamic findings.Uncomplicated patients represent a minority among female SUI patients evaluated before surgery. In complicated patients, the role of urodynamic has not been challenged yet and UDS seems still mandatory. Neurourol. Urodynam. 35:809-812, 2016. 2015 Wiley Periodicals, Inc.


PubMed | Buzzi Hospital, University of Rome La Sapienza, University of Rome Tor Vergata, EOC Beata Vergine Hospital and 2 more.
Type: Journal Article | Journal: Urologia | Year: 2016

Pelvic floor disorders (PFDs), which include urinary incontinence, pelvic organ prolapse, sexual dysfunction and gastrointestinal disorders, affect over 20% of adult population. The prevalence and demand for care of PFDs appear to be increasing more quickly than would be expected from simple population growth, creating substantial physical and emotional distress and a large financial burden. Suitable diagnostic tools are necessary to investigate these problems. The aim of this article is to list Symptom and Quality of Life questionnaires [briefly identified as patient-reported outcomes (PROs)] formally validated into the Italian language to provide Italian clinicians and researchers a tool for the assessment of pelvic area dysfunctions in our country. A synthetic key points summary concerning concepts behind Symptom and Quality of Life Questionnaires will be also provided.PubMed/MEDLINE databases and websites were used to identify Italian-validated questionnaires for PFDs. Once identified, the possibility to get a copy of the questionnaire was verified and steps to obtain it are reported in the table.Questionnaires validated into the Italian language, for diagnosis and overall management of common urinary, vaginal, sexual and bowel conditions, are listed in the table.This format is intended to serve as a tool to promote appropriateness in PROs adoption while investigating PFDs in Italian patients.


Esposito C.,University of Naples Federico II | Riccipetitoni G.,Buzzi Hospital | Chiarenza S.F.,San Bortolo Hospital | Roberti A.,University of Naples Federico II | And 6 more authors.
Journal of Laparoendoscopic and Advanced Surgical Techniques | Year: 2013

Background: This report describes three Italian centers' experience in the treatment of children with esophageal achalasia. Patients and Methods: Between June 2000 and June 2012, 31 children (13 girls and 18 boys, with a median age of 8.4 years) affected by esophageal achalasia were treated in three different institutions with an esophagomyotomy according to Heller's procedure via laparoscopy associated with a Dor antireflux procedure. Between 2000 and 2005 (for 14 patients) we used mono-or bipolar coagulation to perform myotomy; after 2005 (for 17 patients) we used the new hemostatic devices to perform it. Results: Median length of surgery was 120 minutes. Median hospital stay was 4 days. We recorded eight complications in our series: 3 patients (9.6%) had a mucosal perforation, and 5 children (16.1%) presented dysphagia after surgery. When comparing the data before and after 2005, it seems that the new hemostatic devices statistically shortened the length of surgery (P<.01, Student's t test). Conclusions: On the basis of our experience, laparoscopic Heller's myotomy associated with an antireflux procedure is a safe and effective method for the treatment of achalasia in the pediatric population. Intraoperative complications were <10%, and they occurred mostly at the beginning of our experience. Residual dysphagia occurred in about 16% of cases. The use of the new hemostatic devices seems to reduce the length of surgery and intraoperative bleeding. Considering the rarity of this pathology, we believe that patients with achalasia have to be treated only at centers with a strong experience in the treatment of this pathology. © 2013 Mary Ann Liebert, Inc.


Riboni F.,University of Piemonte Orientale | Garofalo G.,University of Piemonte Orientale | Pascoli I.,University of Padua | Vitulo A.,University of Padua | And 3 more authors.
Archives of Gynecology and Obstetrics | Year: 2012

Purpose: The aim of this multicentric study is to compare clinical, biophysical and molecular parameters in the prediction of the success of labour induction with prostaglandins. Methods: We included 115 women, who underwent to labour induction at term with vaginal prostaglandin gel. We evaluated the diagnostic efficiency of endocervical phosphorylated insulin-like growth factor-binding protein (phIGFBP-1), cervicovaginal interleukins 6 (IL-6) and 8 (IL-8). We analyzed the transvaginal sonographic measurement of cervical length. A receiver-operating characteristics (ROC) curve was used to determine the most useful cut-off point. A multivariate logistic regression model was used to analyze the combination of significant predictive variables following univariate analysis. We analyzed all the data searching for the parameters that best predict the beginning of the active phase of labour within 12 h. Results: 36.5 % of the patients delivered within 12 h. The Bishop score was >4 in the 43 % of patients with an active phase. The best cut-off values at ROC curves for cervical length, IL-6 and IL-8 were respectively 22 mm, 5 mg/dl and 20,237 mg/dl. At univariate analysis, all predictors of success, with the exception of IL-6, were significantly associated with the beginning of the active phase. Multivariate analysis of the Bishop score (OR 2.3), phIGFBP-1 test (OR 11.2) and IL-8 (OR 6.6) showed that the variables were independent and therefore useful in combination to predict the success of labour induction. Conclusion: The phIGFBP-1 test is a fast and easy test that can be used with Bishop score and IL-8 to reach an high positive predictive value in the prediction of the success of labour induction with prostaglandins. © 2012 Springer-Verlag.


Mauri P.A.,University of Milan | Ceriotti E.,Buzzi Hospital | Soldi M.,University of Milan | Guerrini Contini N.N.,Buzzi Hospital
Nursing and Health Sciences | Year: 2015

In this phenomenological-hermeneutic study, we explored how midwives perceive the burden of care, while assisting termination of pregnancy after 16 weeks' gestation. Between February and April 2013, 17 Italian midwives from three different units were interviewed. Data were collected using semistructured interviews. Four themes emerged from the interviews: influences, supports, empathy, and emotions. At the end of the study, researchers observed that midwives assert conscientious objection to the termination of pregnancy, which does not influence their experiences and memories. The midwives felt that it was important to share experiences with colleagues, discussing cases together and with the rest of the team. The midwives also suggested some strategies to improve this type of care: organize shifts in a way that could lead to improved and personalized care for women, continuous development, involvement of relatives, and special measures for these women's rooms. Moreover, they considered help from other professionals as fundamental in order to manage the clinical and emotional complexities related to these terminations. © 2014 Wiley Publishing Asia Pty Ltd.


PubMed | Buzzi Hospital, Scientific Institute Irccs Emedea, Scientific Institute Irccs E Medea, Urbino University and University of Milan
Type: Case Reports | Journal: Brain & development | Year: 2014

Homozygous and compound heterozygous mutations in SETX are associated with AOA2 disease, a recessive form of ataxia with oculomotor apraxia and neuropathy with onset of ataxia between the first and second decade of life. The majority of the AOA2 mutated cell lines tested show hypersensitivity to oxidative DNA damaging agents, with one exception.We describe a patient presenting with early-onset progressive ataxia, oculomotor apraxia, axonal sensory-motor neuropathy, optic atrophy, delayed psychomotor development, and a behavior disorder. The patient carries two novel missense variants in the SETX gene. Based on the hypothesis that the patients clinical phenotype may represent an atypical form of the AOA2 disease, we tested the patient-derived cell line for hypersensitivity to oxidative DNA damaging agents, with negative results.The lack of hypersensitivity we observed may be explained either by considering the atypical clinical picture of the patient analyzed or, alternatively, by hypothesizing that the variants detected are not the cause of the observed phenotype. Consistent with the first hypothesis of an atypical AOA2 form and based on the multiple functions of senataxin reported so far, it is likely that different sets of SETX mutations/variants may have variable functional effects that still need to be functionally characterized. The possibility that the severe and complicated clinical picture presented by the patient described here represents a clinical entity differing from the known recessive ataxias should be considered as well.

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