133 research outputs found
Semplificazione funzionale ed individualità degli schemi occlusali in protesi fissa: ipotesi nel paziente disfunzionale
No full textPrevalenza delle diverse forme di Disordini Temporomandibolari secondo i criteri RDC/TMD.
No full textPerioperative Management
No full textThe ERAS method (Enhanced Recovery After Surgery) is a multimodal protocol of perioperative care aimed at ensuring a rapid postoperative recovery. It takes into account the latest available scientific evidences in the various disciplines that operate around the patients requiring major surgery, leading to positively change the response and preserving the physiological functional reserve. In fact it protects patients’ autonomy limiting stress, significantly reducing the length of hospital stay and also the rate of complications and readmission. In the ERAS protocol, the surgical process is totally redesigned, taking into account some important items in the preoperative, intraoperative and postoperative time. As known, elderly patients have specific and different features, multiple diseases, cognitive-behavioral and psychological problems, and a high risk of complications, representing their typical fragility. The ERAS pathway is capable of responding to the needs of the elderly patients, in order to respect the complexity of their multiple health conditions
High adherence to enhanced recovery pathway independently reduces major morbidity and mortality rates after colorectal surgery: A reappraisal of the iCral2 and iCral3 multicenter prospective studies
No full textBackground: Enhanced recovery after surgery (ERAS) offers lower overall morbidity rates and shorter hospital stay after colorectal surgery (CRS); high adherence rates to ERAS may significantly reduce major morbidity (MM), anastomotic leakage (AL), and mortality (M) rates as well.
Methods: Prospective enrollment of patients submitted to elective CRS with anastomosis in two separate 18- and 12-month periods among 78 surgical centers in Italy from 2019 to 2021. Adherence to ERAS pathway items was measured upon explicit criteria in every case. After univariate analysis, independent predictors of primary endpoints (MM, AL, and M rates) were identified through logistic regression analyses, presenting odds ratios (OR) and 95% confidence intervals.
Results: An institutional ERAS status was declared by 48 out of 78 (61.5%) participating centers. The median overall adherence to ERAS was 75%. Among 8,359 patients included in both studies, MM, AL, and M rates were 6.3%, 4.4%, and 1.0%, respectively. Several patient-related and treatment-related variables showed independently higher rates for primary endpoints: male gender, American Society of Anesthesiologists class III, neoadjuvant treatment, perioperative steroids, intra- and/or postoperative blood transfusions, length of the operation >180’, surgery for malignancy. On the other hand, ERAS adherence >85% independently reduced MM (OR, 0.91) and M (OR, 0.25) rates, whereas no mechanical bowel preparation independently reduced AL (OR, 0.68) rates.
Conclusions: Among other patient- or treatment-related variables, ERAS adherence >85% independently reduced MM and M rates, whereas no mechanical bowel preparation independently reduced AL rates after CRS
Stereoselective synthesis and beta-blocking activity of substituted (E)- and (Z)- 4(1H) - [1- (3 - alkylamino - 2 - hydroxypropyl) oximino - 2,3 - dihydro - 1,8 - naphthyridine. Potential antihypertensive agents. Part VI
No full textThe synthesis of R-(+)- and S-(-)-isomers of substituted (E)- and (Z)-4(1H)-[1-(3-alkylamino-2-hydroxypropyl)-oximino]-2,3-dihydro-1,8-naphthyridine, in enantiomeric pure form, is described. These compounds showed an interesting beta-blocking activity. Generally, the (S)-enantiomers possess a slighthly higher affinity for beta receptors than the (R)-enantiomers
Synthesis and alfa2-adrenergic activity of 2-(methyleneamino)oxy-N-(guanidino)ethaneimines. A bioisosteric replacementof the aryl of guanabenz-type benzylideneaminoguanidinic alfa2-agnists with the (methyleneamino)oxymethyl moiety
No full textSome 2-[(methyleneamino)oxy]-N-(guanidino)ethaneimines were synthesized as analogs of guanabenz-type benzylideneaminoguanidine α2-agonists in which the aryl portion (Ar) is substituted by the [(methyleneamino)oxy]methyl moiety (MAOMM). The α2-adrenergic activity of the synthesized MAOMM derivs. was evaluated by functional tests on guinea-pig ileum. The MAOMM-derivs. exhibited an α2-adrenergic stimulating activity fairly similar to that of the benzylideneaminoguanidine ref. drug guanabenz, thus supporting the hypothesis of the existence of a bioisostere-like relationship between the MAOMM and the Ar in the class of guanabenz-type α2-adrenergic agonists
Enhanced Recovery Independently Lowers Failure to Rescue After Colorectal Surgery
No full textBACKGROUND: High adherence to the enhanced recovery after surgery pathway reduces morbidity and mortality rates after elective colorectal surgery. OBJECTIVE: To evaluate the effect of adherence to the enhanced recovery after surgery pathway on the failure to rescue rates after elective colorectal surgery. DESIGN: Retrospective analysis of a prospective database. PATIENTS: Adults (≥ 18 years old) who underwent elective colorectal resection with anastomosis for benign and malignant disease. SETTINGS: Prospective enrolment in 78 centers in Italy from 2019 to 2021. INTERVENTIONS: All the outcomes were measured at 60 days after surgery. Several patient-, disease-, treatment-, hospital-, and complication-related variables were analyzed for the outcomes. After univariate analyses, independent predictors of the endpoints were identified through logistic regression analyses, presenting odds ratios and 95% confidence intervals. MAIN OUTCOME MEASURES: Failure to rescue after any adverse event, defined as the ratio between the number of deaths and the number of patients showing any adverse event; failure to rescue after any major adverse event, with the denominator represented by the number of patients showing any major adverse event. RESULTS: An adverse event was recorded in 2,321 out of 8,359 patients (27.8%), a major adverse event in 523 patients (6.3%), and death in 88 patients (1.0%). The failure to rescue rates were 3.8% after any adverse event and 16.8% after any major adverse event. Independent predictors of primary endpoints were identified among patient- (age, American Society of Anesthesiologists class, nutritional status), treatment- (type of resection), and complication-related (anastomotic leakage, reoperation) variables. Enhanced recovery pathway adherence > 70% independently reduced failure to rescue rates. LIMITATIONS: Clustering from multicenter data, and unmeasured confounding from observational data. CONCLUSIONS: Following elective colorectal resection, adherence > 70% to the enhanced recovery pathway independently decreased failure to rescue rates, along with other patient- or treatment-related factors. See Video Abstract
Three-row versus two-row circular staplers for left-sided colorectal anastomosis: a propensity score-matched analysis of the iCral 2 and 3 prospective cohorts
No full textBACKGROUND: Since most anastomoses after left-sided colorectal resections are performed with a circular stapler, any technological change in stapling devices may influence the incidence of anastomotic adverse events. The aim of the present study was to analyze the effect of a three-row circular stapler on anastomotic leakage and related morbidity after left-sided colorectal resections. MATERIALS AND METHODS: A circular stapled anastomosis was performed in 4255 (50.9%) out of 8359 patients enrolled in two prospective multicenter studies in Italy, and, after exclusion criteria to reduce heterogeneity, 2799 (65.8%) cases were retrospectively analyzed through a 1:1 propensity score-matching model including 20 covariates relative to patient characteristics, to surgery and to perioperative management. Two well-balanced groups of 425 patients each were obtained: group (A) - true population of interest, anastomosis performed with a three-row circular stapler; group (B) - control population, anastomosis performed with a two-row circular stapler. The target of inferences was the average treatment effect in the treated (ATT). The primary endpoints were overall and major anastomotic leakage and overall anastomotic bleeding; the secondary endpoints were overall and major morbidity and mortality rates. The results of multiple logistic regression analyses for the outcomes, including the 20 covariates selected for matching, were presented as odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: Group A versus group B showed a significantly lower risk of overall anastomotic leakage (2.1 vs. 6.1%; OR 0.33; 95% CI 0.15-0.73; P =0.006), major anastomotic leakage (2.1 vs. 5.2%; OR 0.39; 95% CI 0.17-0.87; P =0.022), and major morbidity (3.5 vs. 6.6% events; OR 0.47; 95% CI 0.24-0.91; P =0.026). CONCLUSION: The use of three-row circular staplers independently reduced the risk of anastomotic leakage and related morbidity after left-sided colorectal resection. Twenty-five patients were required to avoid one leakage
Total mesorectal excision for mid and low rectal cancer: Laparoscopic vs robotic surgery
No full textAIM: To compare the short- and long-term outcomes of laparoscopic and robotic surgery for middle and low rectal cancer.
METHODS: This is a retrospective study on a prospectively collected database containing 111 patients who underwent minimally invasive rectal resection with total mesorectal excision (TME) with curative intent between January 2008 and December 2014 (robot, n = 53; laparoscopy, n = 58). The patients all had a diagnosis of middle and low rectal adenocarcinoma with stage I-III disease. The median follow-up period was 37.4 mo. Perioperative results, morbidity a pathological data were evaluated and compared. The 3-year overall survival and disease-free survival rates were calculated and compared.
RESULTS: Patients were comparable in terms of preoperative and demographic parameters. The median surgery time was 192 min for laparoscopic TME (L-TME) and 342 min for robotic TME (R-TME) (P < 0.001). There were no differences found in the rates of conversion to open surgery and morbidity. The patients who underwent laparoscopic surgery stayed in the hospital two days longer than the robotic group patients (8 d for L-TME and 6 d for R-TME, P < 0.001). The pathologic evaluation showed a higher number of harvested lymph nodes in the robotic group (18 for R-TME, 11 for L-TME, P < 0.001) and a shorter distal resection margin for laparoscopic patients (1.5 cm for L-TME, 2.5 cm for R-TME, P < 0.001). The three-year overall survival and disease-free survival rates were similar between groups.
CONCLUSION: Both L-TME and R-TME achieved acceptable clinical and oncologic outcomes. The robotic technique showed some advantages in rectal surgery that should be validated by further studies
Blood Transfusions and Adverse Events after Colorectal Surgery: A Propensity-Score-Matched Analysis of a Hen–Egg Issue
No full text: Blood transfusions are considered a risk factor for adverse outcomes after colorectal surgery. However, it is still unclear if they are the cause (the hen) or the consequence (the egg) of adverse events. A prospective database of 4529 colorectal resections gathered over a 12-month period in 76 Italian surgical units (the iCral3 study), reporting patient-, disease-, and procedure-related variables, together with 60-day adverse events, was retrospectively analyzed identifying a subgroup of 304 cases (6.7%) that received intra- and/or postoperative blood transfusions (IPBTs). The endpoints considered were overall and major morbidity (OM and MM, respectively), anastomotic leakage (AL), and mortality (M) rates. After the exclusion of 336 patients who underwent neo-adjuvant treatments, 4193 (92.6%) cases were analyzed through a 1:1 propensity score matching model including 22 covariates. Two well-balanced groups of 275 patients each were obtained: group A, presence of IPBT, and group B, absence of IPBT. Group A vs. group B showed a significantly higher risk of overall morbidity (154 (56%) vs. 84 (31%) events; OR 3.07; 95%CI 2.13-4.43; p = 0.001), major morbidity (59 (21%) vs. 13 (4.7%) events; OR 6.06; 95%CI 3.17-11.6; p = 0.001), and anastomotic leakage (31 (11.3%) vs. 8 (2.9%) events; OR 4.72; 95%CI 2.09-10.66; p = 0.0002). No significant difference was recorded between the two groups concerning the risk of mortality. The original subpopulation of 304 patients that received IPBT was further analyzed considering three variables: appropriateness of BT according to liberal transfusion thresholds, BT following any hemorrhagic and/or major adverse event, and major adverse event following BT without any previous hemorrhagic adverse event. Inappropriate BT was administered in more than a quarter of cases, without any significant influence on any endpoint. The majority of BT was administered after a hemorrhagic or a major adverse event, with significantly higher rates of MM and AL. Finally, a major adverse event followed BT in a minority (4.3%) of cases, with significantly higher MM, AL, and M rates. In conclusion, although the majority of IPBT was administered with the consequence of hemorrhage and/or major adverse events (the egg), after adjustment accounting for 22 covariates, IPBT still resulted in a definite source of a higher risk of major morbidity and anastomotic leakage rates after colorectal surgery (the hen), calling urgent attention to the implementation of patient blood management programs
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