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1.
Minim Invasive Ther Allied Technol ; 32(6): 323-328, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37493491

RESUMEN

OBJECTIVE: Proposing hysteroscopic morcellation (HM) as a surgical-therapeutic approach in the treatment of retained products of conception (RPOC) to prevent intrauterine adhesions (IUAs). DESIGN: Prospective analysis. SETTING: A teaching and university hospital. PATIENTS: Women with RPOC. INTERVENTIONS: Office -HM with 'Truclear 5 C'. MATERIAL AND METHODS: Twenty-two consecutive patients presenting with trophoblastic residue retention after miscarriage and interruption of pregnancy or placenta remnants after cesarean section or delivery were enrolled. These women underwent office-HM with 'Truclear 5 C'. Primary outcomes were median time and rate of hospitalization. The quality of the specimen was also analyzed. A hysteroscopic second look for IUAs was performed. RESULTS: Mean procedure time was six minutes (SD ± 5). Tissue samples had a mean collection size 2.5 cm3+0.9. 38% of the samples had spotting or abnormal vaginal discharge. Dilatation of the cervical canal was not performed in any case. Second-look hysteroscopy did not show any de novo IUAs in any of the enrolled patients. CONCLUSIONS: In the hysteroscopic treatment of RPOC, HM is a valid choice in an office setting without the use of cervical dilatation. Removal of RPOC was uneventful in all cases, simple and carried out faster without any adverse outcomes.


Asunto(s)
Morcelación , Complicaciones del Embarazo , Enfermedades Uterinas , Embarazo , Humanos , Femenino , Cesárea , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/cirugía , Enfermedades Uterinas/cirugía , Histeroscopía/efectos adversos , Estudios Retrospectivos
2.
Int J Mol Sci ; 23(20)2022 Oct 21.
Artículo en Inglés | MEDLINE | ID: mdl-36293522

RESUMEN

Autoimmune pancreatitis (AIP) is a rare disease. The diagnosis of AIP is difficult and should be made by a comprehensive evaluation of clinical, radiological, serological, and pathological findings. Two different types of AIP have been identified: autoimmune pancreatitis type 1 (AIP-1), which is considered a pancreatic manifestation of multiorgan disease related to IgG4, and autoimmune pancreatitis type 2 (AIP-2), which is considered a pancreas-specific disease not related to IgG4. Although the pathophysiological conditions seem to differ between type 1 and type 2 pancreatitis, both respond well to steroid medications. In this review, we focused on the pathogenesis of the disease to develop a tool that could facilitate diagnosis and lead to the discovery of new therapeutic strategies to combat autoimmune pancreatitis and its relapses. The standard therapy for AIP is oral administration of corticosteroids. Rituximab (RTX) has also been proposed for induction of remission and maintenance therapy in relapsing AIP-1. In selected patients, immunomodulators such as azathioprine are used to maintain remission. The strength of this review, compared with previous studies, is that it focuses on the clear difference between the two types of autoimmune pancreatitis with a clearly delineated and separate pathogenesis. In addition, the review also considers various therapeutic options, including biologic drugs, such as anti-tumor necrosis factor (TNF) therapy, a well-tolerated and effective second-line therapy for AIP type 2 relapses or steroid dependence. Other biologic therapies are also being explored that could provide a useful therapeutic alternative to corticosteroids and immunosuppressants, which are poorly tolerated due to significant side effects.


Asunto(s)
Enfermedades Autoinmunes , Pancreatitis Autoinmune , Productos Biológicos , Humanos , Pancreatitis Autoinmune/diagnóstico , Pancreatitis Autoinmune/tratamiento farmacológico , Pancreatitis Autoinmune/etiología , Rituximab/uso terapéutico , Azatioprina/uso terapéutico , Enfermedades Autoinmunes/tratamiento farmacológico , Enfermedades Autoinmunes/etiología , Inmunoglobulina G/uso terapéutico , Factores Inmunológicos/uso terapéutico , Inmunosupresores/uso terapéutico , Corticoesteroides/uso terapéutico , Esteroides/uso terapéutico , Recurrencia , Productos Biológicos/uso terapéutico
3.
J Obstet Gynaecol ; 41(2): 290-297, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33432869

RESUMEN

The aim of current study was to estimate the impact of vulvovaginal atrophy (VVA) on sexual function in a clinical population of Italian postmenopausal women. Women aged 45-75 years with at least one VVA symptom completed three questionnaires: Day-to-Day Impact of Vaginal Aging (DIVA), Female Sexual Function Index (FSFI) and Female Sexual Distress Scale revised (FSDS-R). A gynaecological examination was performed for VVA confirmation. Among the 1,066 evaluable patients, VVA was confirmed in around 90% of the sample. Sexual function impairment was significantly higher in patients with confirmed VVA as observed by significant differences in the sexual function component of the DIVA questionnaire (p = .014), the FSDS-R (p < .0005), and the FSFI (p < .0005), as well as for all the FSFI subdomains: desire (p < .0005), arousal (p < .0005), lubrication (p < .0005), orgasm (p < .0005), satisfaction (p < .0005) and pain (p < .0005). Significant impairment of sexual function was demonstrated in Italian postmenopausal women who were clinically confirmed with signs of VVA through gynaecological examination.IMPACT STATEMENTWhat is already known on this subject: At least half of postmenopausal women report VVA associated symptoms with significant impact on sexual function and ultimately on sexual activity.What the results of this study add: As compared with patients without confirmed VVA, the negative impact on sexual function was significantly higher in patients with confirmed VVA. This difference was observed for the sexual function component (DIVA-C) of the DIVA questionnaire, for the overall FSDS-R result, and for the overall FSFI score, as well as for all the FSFI subdomains (desire, arousal, lubrication, orgasm, satisfaction and pain).What the implications are of these findings for clinical practice and/or further research: An impairment of sexual function is significantly associated with VVA diagnosis in Italian post-menopausal women, especially when diagnosis was objectively confirmed by clinical signs of VVA visible in the gynaecological examination. In addition, this study demonstrates that inquiring about VVA using a structured questionnaire may increase the diagnosis of VVA related changes in sexual function.


Asunto(s)
Envejecimiento , Posmenopausia , Calidad de Vida , Disfunciones Sexuales Fisiológicas , Vagina/patología , Vulva/patología , Anciano , Envejecimiento/patología , Envejecimiento/psicología , Atrofia , Estudios de Cohortes , Femenino , Examen Ginecologíco/métodos , Humanos , Italia/epidemiología , Persona de Mediana Edad , Posmenopausia/fisiología , Posmenopausia/psicología , Conducta Sexual/fisiología , Disfunciones Sexuales Fisiológicas/diagnóstico , Disfunciones Sexuales Fisiológicas/epidemiología , Disfunciones Sexuales Fisiológicas/etiología , Disfunciones Sexuales Fisiológicas/psicología , Encuestas y Cuestionarios , Enfermedades Vaginales/diagnóstico , Enfermedades Vaginales/psicología , Enfermedades de la Vulva/diagnóstico , Enfermedades de la Vulva/psicología
4.
Int J Cancer ; 145(10): 2670-2681, 2019 11 15.
Artículo en Inglés | MEDLINE | ID: mdl-30892690

RESUMEN

High-grade serous epithelial ovarian cancer (HGS-EOC) is a systemic disease, with marked intra and interpatient tumor heterogeneity. The issue of spatial and temporal heterogeneity has long been overlooked, hampering the possibility to identify those genomic alterations that persist, before and after therapy, in the genome of all tumor cells across the different anatomical districts. This knowledge is the first step to clarify those molecular determinants that characterize the tumor biology of HGS-EOC and their route toward malignancy. In our study, -omics data were generated from 79 snap frozen matched tumor biopsies, withdrawn before and after chemotherapy from 24 HGS-EOC patients, gathered together from independent cohorts. The landscape of somatic copy number alterations depicts a more homogenous and stable genomic portrait than the single nucleotide variant profile. Genomic identification of significant targets in cancer analysis identified two focal and minimal common regions (FMCRs) of amplification in the cytoband 3q26.2 (region α, 193 kb long) and 8q24.3 (region ß, 495 kb long). Analysis in two external databases confirmed regions α and ß are features of HGS-EOC. The MECOM gene is located in region α, and 15 genes are in region ß. No functional data are yet available for the genes in the ß region. In conclusion, we have identified for the first time two FMCRs of amplification in HGS-EOC, opening up a potential biological role in its etiopathogenesis.


Asunto(s)
Carcinoma Epitelial de Ovario/genética , Cromosomas Humanos Par 3/genética , Cromosomas Humanos Par 8/genética , Variaciones en el Número de Copia de ADN , Neoplasias Ováricas/genética , Biopsia , Carcinoma Epitelial de Ovario/patología , Estudios de Cohortes , Biología Computacional , Bases de Datos Genéticas , Conjuntos de Datos como Asunto , Femenino , Genómica , Humanos , Clasificación del Tumor , Neoplasias Ováricas/patología , Ovario/patología , Secuenciación del Exoma
5.
Biophys J ; 114(6): 1433-1439, 2018 03 27.
Artículo en Inglés | MEDLINE | ID: mdl-29590600

RESUMEN

Shock waves are used clinically for breaking kidney stones and treating musculoskeletal indications. The mechanisms by which shock waves interact with tissue are still not well understood. Here, ultra-high-speed imaging was used to visualize the deformation of individual cells embedded in a tissue-mimicking phantom when subject to shock-wave exposure from a clinical source. Three kidney epithelial cell lines were considered to represent normal healthy (human renal epithelial), cancer (CAKI-2), and virus-transformed (HK-2) cells. The experimental results showed that during the compressive phase of the shock waves, there was a small (<2%) decrease in the projected cell area, but during the tensile phase, there was a relatively large (∼10%) increase in the projected cell area. The experimental observations were captured by a numerical model with a constitutive material framework consisting of an equation of state for the volumetric response and hyper-viscoelasticity for the deviatoric response. To model the volumetric cell response, it was necessary to change from a higher bulk modulus during the compression to a lower bulk modulus during the tensile shock loading. It was discovered that cancer cells showed a smaller deformation but faster response to the shock-wave tensile phase compared to their noncancerous counterparts. Cell viability experiments, however, showed that cancer cells suffered more damage than other cell types. These data suggest that the cell response to shock waves is specific to the type of cell and waveforms that could be tailored to an application. For example, the model predicts that a shock wave with a tensile stress of 4.59 MPa would increase cell membrane permeability for cancer cells with minimal impact on normal cells.


Asunto(s)
Tratamiento con Ondas de Choque Extracorpóreas , Modelos Biológicos , Neoplasias/patología , Neoplasias/terapia , Análisis de la Célula Individual , Estrés Mecánico
6.
Exp Eye Res ; 168: 19-27, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29288023

RESUMEN

Experimental protocols have been developed to measure the spatial variation of the mechanical strains induced in the lens capsule during ex vivo lens stretching. The paper describes the application of these protocols to porcine lenses. The deformations and mechanical strains developed in the anterior capsule during each experiment were determined using full field digital image correlation techniques, by means of a speckle pattern applied to the lens surface. Several speckling techniques and illumination methods were assessed before a suitable combination was found. Additional data on the cross section shape of the anterior lens surface were obtained by Scheimpflug photography, to provide a means of correcting for lens curvature effects in the determination of the strains developed in the plane of the capsule. The capsule strains in porcine lenses exhibit non-linear behaviour, and hysteresis during loading and unloading. Peripheral regions experience higher magnitude strains than regions near the lens pole. The paper demonstrates the successful application of a procedure to make direct measurements of capsule strains simultaneously with ex vivo radial lens stretching. This experimental technique is applicable to future investigations on the mechanical characteristics of human lenses.


Asunto(s)
Acomodación Ocular/fisiología , Cápsula Anterior del Cristalino/fisiología , Cápsula del Cristalino/fisiología , Animales , Longitud Axial del Ojo/fisiología , Modelos Animales , Porcinos
8.
Oncologist ; 22(12): 1463-1469, 2017 12.
Artículo en Inglés | MEDLINE | ID: mdl-28860412

RESUMEN

BACKGROUND: Second-line therapy has consistently demonstrated survival benefit if compared with best supportive care; however, there is limited evidence whether further lines of treatment may improve the prognosis of advanced gastric cancer (AGC) patients. MATERIALS AND METHODS: Starting from a real-world cohort of 868 AGC patients, we retrospectively analyzed baseline parameters, tumor characteristics, and treatment data of those treated with at least three lines. Categorical features were described through cross-tables and chi-square test. We explored the impact of treatment intensity and progression-free survival (PFS) experienced in previous lines on PFS and overall survival in third-line by uni- and multivariate Cox regression models and described by Kaplan-Meier estimator plot with log-rank test. RESULTS: Overall, 300 patients were included in the analysis. The most common site of primary tumor was gastric body; 45.3% of cancers had an intestinal histotype, 14% were human epidermal growth receptor 2 positive. In third-line, 45.7% of patients received a single-agent chemotherapy, 49.7% a combination regimen. Patients who had experienced a first-line PFS ≥6.9 months had a better prognosis compared with those who had achieved a shorter one. Consistently, a second-line PFS ≥3.5 months positively influenced the prognosis. Patients receiving a third-line combination regimen had better outcomes compared with those treated with a single-agent chemotherapy. CONCLUSION: Our real-world study confirms that selected AGC patients may receive third-line treatment. Longer PFS in previous lines or a more intense third-line treatment positively influenced prognosis. Further efforts are warranted to define the best therapeutic sequences, and to identify the optimal candidate for treatment beyond second-line. IMPLICATIONS FOR PRACTICE: The benefit of third-line treatment to advanced gastric cancer patients is controversial. This study depicts a real scenario of the clinical practice in Italy, confirming that a non-negligible proportion of patients receive a third-line therapy. Longer progression-free survival in previous treatment lines or higher third-line treatment intensity positively influenced prognosis. Including a large number of real-world patients, this study provides information on third-line treatment from the daily clinical practice; moreover, its results help in defining the best therapeutic sequence and offer some hints to select the optimal candidate for treatment beyond second-line.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Pronóstico , Neoplasias Gástricas/tratamiento farmacológico , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Estudios de Cohortes , Supervivencia sin Enfermedad , Femenino , Humanos , Italia/epidemiología , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/patología , Resultado del Tratamiento
9.
Gastric Cancer ; 20(5): 825-833, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28028664

RESUMEN

BACKGROUND: Although second-line therapy is often considered for advanced gastric cancer patients, the optimal candidates are not well defined. METHODS: We retrospectively collected baseline parameters, tumour features, and treatment data for 868 advanced gastric cancer patients exposed to multiple treatment lines at 19 Italian centres. Cross-tables and chi-square tests were used to describe categorical features. To predict the impact of clinical variables on progression-free survival and overall survival, Kaplan-Meier and Cox regression analyses were performed. RESULTS: At the start of second-line therapy, median age was 64.8 years (25th-75th percentiles: 55.2-71.9 years). Overall, 43% of patients received single-agent chemotherapy, 47.4% a doublet, and 7.3% a triplet. Median second-line progression-free survival was 2.8 months (25th-75th percentiles: 1.8-5.2 months) and median second-line overall survival was 5.6 months (25th-75th percentiles: 2.9-10.0 months). Multivariate analysis showed that performance status, LDH level, neutrophils/lymphocytes ratio, and progression-free survival in the first-line therapy all impacted on prognosis. Based on these four prognostic factors, a prognostic index was constructed that divided patients into good, intermediate, and poor risk groups; median second-line overall survival for each group was 7.7, 4.5, and 2.0 months, respectively (log-rank p < 0.0001). CONCLUSIONS: Advanced gastric cancer patients with a favourable ECOG performance status, lower LDH levels, and a lower neutrophils/lymphocytes ratio at the start of second-line therapy seem to have better outcomes, regardless of age and intensity of treatment. A longer progression-free survival in the first-line therapy also had positive prognostic value. Our real-life study might help clinicians to identify the patients who may benefit most from a second-line therapy.


Asunto(s)
Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Gástricas/tratamiento farmacológico , Anciano , Antineoplásicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Supervivencia sin Enfermedad , Femenino , Humanos , Italia , Estimación de Kaplan-Meier , Recuento de Leucocitos , Linfocitos/citología , Masculino , Persona de Mediana Edad , Neutrófilos/citología , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Neoplasias Gástricas/patología , Tasa de Supervivencia , Resultado del Tratamiento
10.
Future Oncol ; 13(25): 2265-2275, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-28976226

RESUMEN

AIM: To evaluate the impact on overall survival (OS) of gastrectomy in asymptomatic metastatic esophago-gastric cancer. PATIENTS & METHODS: Five hundred and thirteen patients were included. The role of surgery and other clinico-pathological factors was evaluated by univariate and Cox regression analyses. OS was the primary end point. RESULTS: Multivariate analysis confirmed that gastrectomy was a predictor of longer OS (p < 0.001), as well as preserved performance status and benefit from first-line chemotherapy. None of the investigated clinico-pathological variables identified preferable candidates for surgery (all p > 0.05). CONCLUSION: Palliative gastrectomy might play a role in asymptomatic metastatic esophago-gastric cancer patients with good performance status who received benefit from first-line chemotherapy. Future prospective trials integrating tumor biology among inclusion criteria may help defining the optimal candidates.


Asunto(s)
Neoplasias Esofágicas/patología , Neoplasias Esofágicas/cirugía , Unión Esofagogástrica/patología , Gastrectomía , Selección de Paciente , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Neoplasias Esofágicas/diagnóstico por imagen , Neoplasias Esofágicas/mortalidad , Femenino , Gastrectomía/métodos , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Estadificación de Neoplasias , Estudios Retrospectivos , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/mortalidad , Resultado del Tratamiento
11.
J Heart Valve Dis ; 26(4): 397-404, 2017 07.
Artículo en Inglés | MEDLINE | ID: mdl-29302938

RESUMEN

BACKGROUND AND AIM OF THE STUDY: The study aim was to compare long-term results of Marfan syndrome (MFS) patients affected by aortic root disease undergoing aortic root replacement with the Bentall or David operation. METHODS: Since 1994, a total of 59 patients has been followed at the authors' Marfan Center, having undergone either a Bentall operation (Bentall group, n = 30) or a David operation (David group, n = 29). RESULTS: No operative mortality was recorded. After 20 years (mean follow up 97 ± 82 months; range 1 to 369 months) no prosthesis-related major bleeding or thromboembolic events had been observed; the 20-year survival was 94 ± 6% in the Bentall group, and 100% in the David group (p = 0.32). Freedom from reintervention for aortic valve dysfunction was 100% in the Bentall group, and 75 ± 13% in the David group (p = 0.04). This inter-group difference became relevant after the first eight-year period of follow-up, and was mainly associated with a particular familiar genetic phenotype involving three out of four reoperated patients. Freedom from all-cause death, myocardial infarction, stroke, prosthetic valve-related complications, and reintervention on any aortic segment was 69 ± 12% in the Bentall group, and 67 ± 14% in the David group (p = 0.33). CONCLUSIONS: The Bentall and David operations are both associated with satisfactory long-term results in MFS patients. The low rate of valve prosthesis-related complications suggested that the Bentall operation would continue to be a standard surgical treatment. The reimplantation technique, adopted for less-dilated aortas, provides satisfactory freedom from reoperation. Careful attention should be paid to the reimplantation technique in patients affected by a serious familiar genetic phenotype.


Asunto(s)
Aneurisma de la Aorta/cirugía , Insuficiencia de la Válvula Aórtica/cirugía , Implantación de Prótesis Vascular , Implantación de Prótesis de Válvulas Cardíacas , Síndrome de Marfan/cirugía , Adulto , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/mortalidad , Aneurisma de la Aorta/fisiopatología , Insuficiencia de la Válvula Aórtica/patología , Insuficiencia de la Válvula Aórtica/fisiopatología , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/mortalidad , Dilatación Patológica , Supervivencia sin Enfermedad , Femenino , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Humanos , Estimación de Kaplan-Meier , Masculino , Síndrome de Marfan/diagnóstico por imagen , Síndrome de Marfan/mortalidad , Síndrome de Marfan/fisiopatología , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Falla de Prótesis , Reimplantación , Estudios Retrospectivos , Factores de Riesgo , Ciudad de Roma , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
12.
Acta Oncol ; 55(5): 619-24, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-26882959

RESUMEN

Objective To evaluate the safety, local tumor efficacy and relief of symptoms of electrochemotherapy (ECT) treatment in patients affected by recurrence of vulvar cancer (VC), unsuitable for standard treatments. Methods Ten patients were recruited with histological diagnosis of recurrence of VC. Intravenous bleomycin was injected, after an accurate mapping of all lesions and ECT was performed. Response to therapy was evaluated and quality of life (QoL) was evaluated via questionnaires. Results Diagnosis stage of primary tumors, according to the FIGO system, was: four patients respectively at stage IB (40%), and at stage II (40%), one patient at stage IIIA (10%), one patient with Paget cancer (10%). Mean age was 76 years (SD ± 7) at time of enrollment. Eight patients (80%) were previously submitted to surgery and/or radio-chemotherapy. Mean treatment time was 20 (range 10-20) min. After a median follow-up of 12 (3-22) months, six patients (60%) were alive. Conclusions Objective responses (ORs) with local control of the tumor were obtained in 80%. After a mean follow-up of 12 (3-22) months six patients (60%) were alive. The favorable outcome of this study, indicates that ECT is a reliable treatment option that may improve their functioning, thus enhancing the care provided in the palliative setting.


Asunto(s)
Antibióticos Antineoplásicos/uso terapéutico , Bleomicina/uso terapéutico , Electroquimioterapia/métodos , Recurrencia Local de Neoplasia/tratamiento farmacológico , Cuidados Paliativos/métodos , Neoplasias de la Vulva/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Antibióticos Antineoplásicos/administración & dosificación , Antibióticos Antineoplásicos/efectos adversos , Bleomicina/administración & dosificación , Bleomicina/efectos adversos , Electroquimioterapia/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intravenosas , Persona de Mediana Edad , Calidad de Vida , Encuestas y Cuestionarios , Resultado del Tratamiento , Neoplasias de la Vulva/cirugía
14.
J Heart Valve Dis ; 24(5): 570-6, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26897835

RESUMEN

BACKGROUND AND AIM OF THE STUDY: Bicuspid aortic valve (BAV), though normally functioning, is frequently associated with dilatation of the aortic root and ascending aorta. Optimal surgical treatment remains controversial. The study aim was to evaluate the fate of the normally functioning spared BAV at long-term follow up. METHODS: Forty patients (26 males, 14 females; mean age 59 +/- 11 years; range: 38-81 years) who underwent aortic surgery for proximal aortic disease between 1996 and 2011, with spared BAV at surgery, were included in the study. The main indication for surgery was ascending aorta aneurysm. Of the patients, 37 had ascending aorta replacement and three underwent a semi-Yacoub procedure. Adjunctive subcommissural annuloplasty was performed in 12 cases. The clinical and echocardiographic follow up (median 62 months; range: 7-175 months) was 100% complete. RESULTS: In-hospital survival was 100%. Pre-discharge echocardiography showed no cases of significant aortic regurgitation (grade > or = 3+) or stenosis. The probability of survival at five and 10 years was 93 +/- 7% and 79 +/- 10%, respectively. Two surviving patients (5%) required reoperation for the development of aortic insufficiency. Freedom from aortic valve replacement was 100% and 90 +/- 10% at five and 10 years, respectively, and freedom from thromboembolic or bleeding events was 100% and 90 +/- 10% at five and 10 years, respectively. No cases of endocarditis were reported. The composite event-free survival at five and eight years was 85 +/- 6% and 69 +/- 11%, respectively. There were no cases of root enlargement during the follow up period. CONCLUSION: A spared BAV offers a good time-span of functional integrity. The conservative approach seems to be a valid strategy, with a low risk of reintervention and cardiovascular events during long term follow up, in selected patients.


Asunto(s)
Aorta/cirugía , Aneurisma de la Aorta/cirugía , Válvula Aórtica/anomalías , Implantación de Prótesis Vascular , Enfermedades de las Válvulas Cardíacas/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Aorta/fisiopatología , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/etiología , Aneurisma de la Aorta/mortalidad , Aneurisma de la Aorta/fisiopatología , Válvula Aórtica/fisiopatología , Válvula Aórtica/cirugía , Enfermedad de la Válvula Aórtica Bicúspide , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Anuloplastia de la Válvula Cardíaca , Supervivencia sin Enfermedad , Femenino , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/mortalidad , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Modelos de Riesgos Proporcionales , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
15.
J Minim Invasive Gynecol ; 22(7): 1287-92, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26070727

RESUMEN

Minimally invasive surgery represents the gold standard for the management of deep infiltrating endometriosis (DIE) involving the rectovaginal septum (RVS). This analysis aimed to evaluate the feasibility of robotic-assisted laparoscopy (RAL) and clinical outcomes in terms of long-term complications, pain relief, and recurrence rate for the treatment of DIE of the RVS. A prospective cohort study of robotic procedures was performed between October 2010 and July 2014, including removal of endometriotic nodules from the RVS with rectal shaving alone or in combination with accessory procedures. In all cases, the revised American Society for Reproductive Medicine (rASRM) score for endometriosis was >40 points (stage IV). Twenty-five consecutive patients underwent RAL, with a successful complete nodule debulking by the wall shaving technique. Pathology confirmed the adequacy of the surgical specimen and the median largest endometriotic nodule was of 21 mm (range, 10-60 mm), with free margins in all cases. The median operative time from skin opening to closure was 174 minutes (range, 75-300 minutes), and blood loss was close to 0 mL. The median revised Enzian score for location A (RVS) was 2 (range, 1-3). The most frequent Enzian class was A2B0C0 (48%), followed by A3B0C0 (12%). In 3 cases (12%), partial vaginal resection was required to remove endometriotic nodules of the RVS (1 each in classes A3B0C1FI, A3B0C0FO, and A3B0C0). No intraoperative complications occurred. This series has a median long-term follow up of 22 months (range, 6-50 months) currently available with an optimal operative time, demonstrating good long-term outcomes. Our data support robotics as a safe and attractive alternative for comprehensive surgical treatment of DIE.


Asunto(s)
Endometriosis/cirugía , Laparoscopía , Recto/cirugía , Procedimientos Quirúrgicos Robotizados , Vagina/cirugía , Adulto , Endometriosis/patología , Estudios de Factibilidad , Femenino , Humanos , Laparoscopía/métodos , Tempo Operativo , Estudios Prospectivos , Recto/patología , Procedimientos Quirúrgicos Robotizados/métodos , Resultado del Tratamiento , Vagina/patología
16.
J Minim Invasive Gynecol ; 22(5): 759-66, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25820113

RESUMEN

STUDY OBJECTIVE: To compare the effects of local anesthetic intraperitoneal nebulization with intraperitoneal instillation during laparoscopic ovarian cystectomy on postoperative morphine consumption and pain. DESIGN: Multicenter, randomized, case-control trial. DESIGN CLASSIFICATION: Canadian Task Force Classification I. SETTING: University hospitals in Italy. PATIENTS: One hundred forty patients scheduled for laparoscopic ovarian cystectomy. INTERVENTIONS: Patients were randomized to receive either nebulization of ropivacaine 150 mg before surgery or instillation of ropivacaine 150 mg before surgery. Nebulization was performed using the Aeroneb Pro device (Aerogen, Galway, Ireland). MEASUREMENTS AND MAIN RESULTS: One hundred forty patients were enrolled, and 123 completed the study. There was no difference between the 2 groups in average morphine consumption (7.3 ± 7.5 mg in the nebulization group vs 9.2 ± 7.2 mg in the instillation group; p = .17). Eighty-two percent of patients in the nebulization group required morphine compared with 96% in the instillation group (p < .05). Patients receiving nebulization had a lower dynamic Numeric Ranking Scale compared with those in the instillation group in the postanesthesia care unit postanesthesia care unit and 4 hours after surgery (p < .05). Ten patients (15%) in the nebulization group experienced shivering in the postanesthesia care unit compared with 2 patients (4%) in the instillation group (p = .035). CONCLUSION: Nebulization of ropivacaine prevents the use of morphine in a significant proportion of patients, reduced postoperative pain during the first hours after surgery, and was associated with a higher incidence of postoperative shivering when compared with instillation.


Asunto(s)
Amidas/administración & dosificación , Anestésicos Locales/administración & dosificación , Procedimientos Quirúrgicos Ginecológicos , Laparoscopía , Morfina/administración & dosificación , Quistes Ováricos/cirugía , Dolor Postoperatorio/tratamiento farmacológico , Adulto , Método Doble Ciego , Femenino , Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Humanos , Inyecciones Intraperitoneales , Laparoscopía/efectos adversos , Persona de Mediana Edad , Nebulizadores y Vaporizadores , Quistes Ováricos/complicaciones , Dimensión del Dolor , Dolor Postoperatorio/etiología , Ropivacaína , Resultado del Tratamiento
18.
Thorac Cardiovasc Surg ; 61(5): 392-7, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23169106

RESUMEN

BACKGROUND: Left atrial ablation is a surgical standard technique for the treatment of persistent or chronic atrial fibrillation (p-AF and c-AF, respectively).Objective The aim of the study is to evaluate midterm results of left atrial ablation according to modified Maze procedure in patients affected by p-AF or c-AF and concomitant mitral or aortic valve disease requiring surgical treatment. METHODS: A total of 108 patients (age, mean ± standard deviation [SD]: 66 ± 8.5 years) underwent left atrial ablation by means of unipolar (n = 62) or bipolar (n = 66) radiofrequency for p-AF (n = 28) or c-AF (n = 100) in association with mitral (n = 93) or mitral and aortic valve (n = 35) surgery. RESULTS: In-hospital mortality was 0.8%. Patients with preoperative c-AF had preoperative greater value of left atrial diameter (56.7 ± 7.4 vs. 52 ± 9 mm, p = 0.05) than those with p-AF. At 9 years after Maze procedure, 86% (n = 24/28) of patients with preoperative p-AF were in sinus rhythm versus 28% (n = 27/95) with c-AF (p < 0.0001). Preoperative c-AF and left atrial diameter of 75 mm or more predicted atrial fibrillation recurrence. In patients in sinus rhythm compared with those in residual atrial fibrillation, survival was 100 versus 86% ± 6.4%, New York Heart Association class was 1.3 ± 0.5 versus 1.7 ± 0.6, and need of lifelong anticoagulation therapy was 43 versus 91% (p < 0.05, for all comparisons). CONCLUSIONS: Left atrial Maze procedure for p-AF offers better chances to conversion in sinus rhythm as compared with long-standing c-AF. Survival, functional status, and quality of life are superior in patients who benefit from sinus rhythm.


Asunto(s)
Fibrilación Atrial/cirugía , Procedimientos Quirúrgicos Cardíacos , Ablación por Catéter , Enfermedades de las Válvulas Cardíacas/cirugía , Anciano , Válvula Aórtica/fisiopatología , Válvula Aórtica/cirugía , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/mortalidad , Fibrilación Atrial/fisiopatología , Función del Atrio Izquierdo , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Ablación por Catéter/efectos adversos , Ablación por Catéter/mortalidad , Distribución de Chi-Cuadrado , Enfermedad Crónica , Femenino , Atrios Cardíacos/fisiopatología , Atrios Cardíacos/cirugía , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/mortalidad , Enfermedades de las Válvulas Cardíacas/fisiopatología , Mortalidad Hospitalaria , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Válvula Mitral/fisiopatología , Válvula Mitral/cirugía , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
19.
J Minim Invasive Gynecol ; 20(2): 230-3, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23340444

RESUMEN

The laparotenser instrument is used to perform isobaric laparoscopy to avoid adverse effects in the pneumoperitoneum. To decrease hospitalization time and increase the rate of same-day discharge, we investigated the safety of isobaric laparoscopy using the Laparotenser, a new subcutaneous abdominal wall-lifting system, with transversus abdominis plane (TAP) block combined with locoregional anesthesia (subarachnoid, peridural, spino-peridural) for patients undergoing minor and major gynecologic surgeries. With this combination of anesthetics, TAP block enabled us to anesthetize the supraumbilical region while the pelvic region was covered by locoregional anesthesia. We describe our experience with TAP blockade associated with locoregional anesthesia during gasless laparoscopy. We performed ultrasound-guided TAP block with ropivacaine 0.25% 20 mL to cover the supraumbilical region in association with locoregional anesthesia (lumbar subarachnoid-peridural-spinoperidural) and bupivacaine 0.5% (10 mg/3 mL) to cover the lower pelvic region. Successful outcome was reported in 81.3% (13/16) of the patients.


Asunto(s)
Amidas , Anestesia Local , Bupivacaína , Enfermedades de los Genitales Femeninos/cirugía , Laparoscopía/métodos , Bloqueo Nervioso , Músculos Abdominales , Pared Abdominal , Adulto , Femenino , Enfermedades de los Genitales Femeninos/diagnóstico , Humanos , Laparoscopía/efectos adversos , Laparoscopía/instrumentación , Persona de Mediana Edad , Ropivacaína
20.
J Minim Invasive Gynecol ; 20(5): 686-90, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23623267

RESUMEN

In this prospective analysis, the feasibility and outcome of isobaric laparoscopy in gynecologic oncology was evaluated. Total laparoscopic radical hysterectomy type A and B, with or without pelvic lymphadenectomy, according to the Querleu-Morrow classification was performed in 22 consecutive patients. Seven patients had early cervical cancer (adenocarcinoma stage 1B1 in 1, and squamous carcinoma stage 1B1 in 4, stage 1A2 in 1, and stage 1B2 in 1), and 15 patients had endometrial cancer (stage IA in 4, stage IB in 9, and stage IIIA in 2). Radical hysterectomy was performed using the LaparoTenser, a subcutaneous wall-lifting device. Visual analog score, duration of surgery, blood loss, complications, and postoperative course were recorded. Pathologic analysis confirmed the adequacy of the surgical specimens in type B radical hysterectomies and the number of lymph nodes removed. Low-pressure CO2 insufflation was us to improve field exposure in patients with high body mass index. Postoperatively, no patient reported substantial abdominal discomfort caused by lifting of the abdominal wall. Operative time, blood loss, and hospital stay were consistent with published data for CO2 laparoscopy. One complication related to insertion of the subcutaneous needle of the wall lifter occurred. We conclude that total laparoscopic radical hysterectomy can be successfully completed via isobaric laparoscopy using the LaparoTenser device in patients with early cervical and endometrial cancer. Gasless laparoscopy has become the first choice in our department to overcome the detrimental effects of pneumoperitoneum and represents a logical advance in the evolution of minimally invasive surgery. The LaparoTenser device is being used to perform increasingly complex procedures in high-risk patients and situations.


Asunto(s)
Laparoscopía/instrumentación , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/cirugía , Neoplasias Endometriales/cirugía , Femenino , Humanos , Laparoscopía/métodos , Escisión del Ganglio Linfático/métodos , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Neoplasias del Cuello Uterino/cirugía
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