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Article ; Online: Acute abdomen in post- Covid 19 multisystem inflammatory syndrome in children. A case report.

Campanella, Piergaetano / Papa, Gennaro / Zito, Francesca / Travascia, Mattia / Cecinati, Valerio / Cervellera, Maurizio

Annali italiani di chirurgia

2022 Volume 11

Abstract: Aim: As more data about coronavirus disease-2019 (COVID-19) has been gathered it has become evident that children who have had or have been exposed to COVID-19 can develop a rare complication; multisystem inflammatory syndrome in children (MIS-C). We ... ...

Abstract	Aim: As more data about coronavirus disease-2019 (COVID-19) has been gathered it has become evident that children who have had or have been exposed to COVID-19 can develop a rare complication; multisystem inflammatory syndrome in children (MIS-C). We report the case of a 9-year-old boy, who was brought to the emergency room with suspected acute abdomen and was diagnosed with MIS-C. Methods: The patient had had a positive molecular test for COVID-19, 25 days earlier and fever that started 4 days prior to presentation, He tested negative for COVID on arrival at the emergency room. After physical examination, and diagnostic tests were performed the differential diagnosis included appendiceal inflammation and MIS-C. Surgical exploration was performed laparoscopically. Results: The immune morphological picture was reactive lymphogranular hyperplasia. Postoperatively the abdominal symptoms improved rapidly but the patient developed diffuse erythema as well as some cardiovascular and neurological disturbances. The patient was discharged on postoperative day 14 in good general condition with a diagnosis of MIS-C. Conclusions: In patients with a recent positive COVID test and mainly gastroenterological manifestations surgical exploration is necessary in order to prevent delayed diagnosis and inadequate/inappropriate treatment. Key words: Acute abdomen, COVID-19, MIS-C, Gastrointestinal symptoms.
MeSH term(s)	Child ; Male ; Humans ; COVID-19/complications ; Abdomen, Acute/etiology ; Systemic Inflammatory Response Syndrome/diagnosis ; Systemic Inflammatory Response Syndrome/etiology ; Emergency Service, Hospital
Language	English
Publishing date	2022-10-24
Publishing country	Italy
Document type	Case Reports ; Journal Article
ZDB-ID	418927-9
ISSN	2239-253X ; 0003-469X
ISSN (online)	2239-253X
ISSN	0003-469X
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Article ; Online: Proteogenomic biomarkers in colorectal cancers: clinical applications.

Binetti, Margherita / Lauro, Augusto / Vaccari, Samuele / Cervellera, Maurizio / Tonini, Valeria

Expert review of proteomics

2020 Volume 17, Issue 5, Page(s) 355–363

Abstract: Introduction: Colorectal cancer (CRC) is one of the leading cancers in terms of incidence and mortality, rate requiring a multidisciplinary approach. The discovery of specific CRC biomarkers has caused a paradigm shift in its clinical management.: ... ...

Abstract	Introduction: Colorectal cancer (CRC) is one of the leading cancers in terms of incidence and mortality, rate requiring a multidisciplinary approach. The discovery of specific CRC biomarkers has caused a paradigm shift in its clinical management. Areas covered: The aim is to illustrate the possible clinical applications of CRC biomarkers through an updated literature review (from 2015 to 2020) based on the PubMed database. A relationship between cancer localization and genetic profile has been identified. Nowadays, the tumor markers are largely used to select patients that could really benefit from a specific type of adjuvant therapy, in order to optimize treatment programs, especially in metastatic patients. This review highlights both CRC biomarkers' advantages and critical issues. Expert opinion: New biomarker discoveries allow to set noninvasive tests that could increase patient's compliance with therapy. They also permit a cost-effective early diagnosis, as well as patient-tailored treatments, improving the overall survival. The CRC biomarkers could also have a prognostic value, and usually, they are included in follow-up programs. However, despite the continuous progression of new technologies, their clinical validation is still debated. In this context, additional clinical studies are still necessary to identify, among potential markers, the most effective ones.
MeSH term(s)	Biomarkers, Tumor/genetics ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/genetics ; Colorectal Neoplasms/pathology ; Early Detection of Cancer ; Humans ; Prognosis ; Proteogenomics
Chemical Substances	Biomarkers, Tumor
Language	English
Publishing date	2020-06-22
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2299100-1
ISSN	1744-8387 ; 1478-9450
ISSN (online)	1744-8387
ISSN	1478-9450
DOI	10.1080/14789450.2020.1782202
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Article ; Online: Obstructing Left-Sided Colonic Cancer: Is Endoscopic Stenting a Bridge to Surgery or a Bridge to Nowhere?

Lauro, Augusto / Binetti, Margherita / Vaccari, Samuele / Cervellera, Maurizio / Tonini, Valeria

Digestive diseases and sciences

2020 Volume 65, Issue 10, Page(s) 2789–2799

Abstract: For the 8-29% colorectal cancers that initially manifest with obstruction, emergency surgery (ES) was traditionally considered the only available therapy, despite high morbidity and mortality rates and the need for colostomy creation. More recently, ... ...

Abstract	For the 8-29% colorectal cancers that initially manifest with obstruction, emergency surgery (ES) was traditionally considered the only available therapy, despite high morbidity and mortality rates and the need for colostomy creation. More recently, malignant obstruction of the left colon can be temporized by endoscopic placement of a self-expanding metallic stent (SEMS), used as bridge to surgery (BTS), facilitating a laparoscopic approach and increasing the likelihood that a primary anastomosis instead of stoma would be used. Despite these attractive outcomes, the superiority of the BTS approach is not clearly established. Few authors have stressed the potential cancer risk associated with perforations that may occur during endoscopic stent placement, facilitating neoplastic spread and negatively impacting prognosis. For this reason, the current literature focuses on long-term oncologic outcomes such as disease-free survival, overall survival and recurrence rate that do seem not to differ between the ES and BTS approaches. This lack of consensus has spawned differing and sometimes discordant guidelines worldwide. In conclusion, 20 years after the first description of a colonic stent as BTS, the debate is still open, but the growing number of articles about the use of SEMS as a BTS signifies a great interest in the topic. We hope that these data will finally converge on a single set of recommendations supporting a management strategy with well-demonstrated superiority.
MeSH term(s)	Colonoscopy/adverse effects ; Colonoscopy/instrumentation ; Colorectal Neoplasms/complications ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/therapy ; Humans ; Intestinal Obstruction/etiology ; Intestinal Obstruction/pathology ; Intestinal Obstruction/therapy ; Patient Safety ; Risk Assessment ; Risk Factors ; Self Expandable Metallic Stents ; Treatment Outcome
Language	English
Publishing date	2020-06-25
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	304250-9
ISSN	1573-2568 ; 0163-2116
ISSN (online)	1573-2568
ISSN	0163-2116
DOI	10.1007/s10620-020-06403-2
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Article ; Online: Drains, Germs, or Steel: Multidisciplinary Management of Acute Colonic Diverticulitis.

Lauro, Augusto / Pozzi, Eleonora / Vaccari, Samuele / Cervellera, Maurizio / Tonini, Valeria

Digestive diseases and sciences

2020 Volume 65, Issue 12, Page(s) 3463–3476

Abstract: The medical and surgical management of uncomplicated diverticulitis has changed over the last several years. Although immunocompetent patients or those without comorbidities can be treated with antibiotics as an outpatient, the efficacy of high-fiber ... ...

Abstract	The medical and surgical management of uncomplicated diverticulitis has changed over the last several years. Although immunocompetent patients or those without comorbidities can be treated with antibiotics as an outpatient, the efficacy of high-fiber intake or drugs such as mesalamine or rifaximin is not yet clearly established in the treatment of acute episodes and in the prevention of recurrences. On the other hand, the choice between antibiotic treatment and percutaneous drainage is not always obvious in diverticulitis complicated by abscess formation, especially for larger abscesses; although the results of studies comparing the two approaches remain controversial, surgery must be pursued for abscesses > 8 cm. For emergency surgery, the debate is still ongoing regarding laparoscopic lavage and surgical resection followed by primary anastomosis, since for both approaches the published reports are not in agreement regarding possible benefits. Therefore, these approaches are recommended only for selected patients under the care of experienced surgeons. Also, the contribution of elective surgery toward the overall approach has been revised; currently, it is reserved primarily for patients with a high risk of recurrence and whenever more conservative treatments were not effective.
MeSH term(s)	Acute Disease ; Conservative Treatment/adverse effects ; Conservative Treatment/methods ; Diverticulitis, Colonic/therapy ; Humans ; Patient Selection ; Risk Adjustment/methods ; Surgical Procedures, Operative/adverse effects ; Surgical Procedures, Operative/methods
Language	English
Publishing date	2020-09-27
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	304250-9
ISSN	1573-2568 ; 0163-2116
ISSN (online)	1573-2568
ISSN	0163-2116
DOI	10.1007/s10620-020-06621-8
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Article ; Online: Letter to the Editor:

Lauro, Augusto / Marino, Ignazio R / D'Andrea, Vito / Cervellera, Maurizio / Tonini, Valeria

Population health management

2021 Volume 24, Issue 6, Page(s) 748–749

MeSH term(s)	COVID-19 ; Diagnostic Tests, Routine ; Humans ; Pandemics/prevention & control ; SARS-CoV-2
Language	English
Publishing date	2021-08-02
Publishing country	United States
Document type	Letter
ZDB-ID	2454546-6
ISSN	1942-7905 ; 1942-7891
ISSN (online)	1942-7905
ISSN	1942-7891
DOI	10.1089/pop.2021.0173
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Article ; Online: Acute pancreatitis due to a Bochdalek hernia in an adult patient.

Tonini, Valeria / Gozzi, Guglielmo / Cervellera, Maurizio

BMJ case reports

2018 Volume 2018

MeSH term(s)	Acute Disease ; Adult ; Hernias, Diaphragmatic, Congenital/complications ; Hernias, Diaphragmatic, Congenital/diagnostic imaging ; Hernias, Diaphragmatic, Congenital/surgery ; Humans ; Male ; Pancreatitis/etiology ; Tomography, X-Ray Computed
Language	English
Publishing date	2018-02-02
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2017-223852
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Article ; Online: Giant abdominal metastasis from cardiac liposarcoma.

Tonini, Valeria / Gozzi, Guglielmo / Pirini, Maria Giulia / Cervellera, Maurizio

BMJ case reports

2018 Volume 2018

MeSH term(s)	Abdominal Neoplasms/secondary ; Fatal Outcome ; Heart Neoplasms/pathology ; Humans ; Liposarcoma/secondary ; Male ; Middle Aged
Language	English
Publishing date	2018-07-10
Publishing country	England
Document type	Case Reports
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2018-225616
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Article ; Online: Effect of antithrombotic therapy on postoperative outcome of 538 consecutive emergency laparoscopic cholecystectomies for acute cholecystitis: two Italian center's study.

Vaccari, Samuele / Lauro, Augusto / Cervellera, Maurizio / Bellini, Maria Irene / Palazzini, Giorgio / Cirocchi, Roberto / Tonini, Valeria / D'Andrea, Vito

Updates in surgery

2021 Volume 73, Issue 5, Page(s) 1767–1774

Abstract: The risk of developing hemorrhagic complications during or after emergency cholecystectomy (EC) for acute cholecystitis (AC) in patients with antithrombotic therapy (ATT) remains uncertain. In this double-center study, we evaluated post-operative ... ...

Abstract	The risk of developing hemorrhagic complications during or after emergency cholecystectomy (EC) for acute cholecystitis (AC) in patients with antithrombotic therapy (ATT) remains uncertain. In this double-center study, we evaluated post-operative outcomes in patients with ATT undergoing EC. We retrospectively evaluated 538 patients who underwent laparoscopic EC for AC between May 2015 and December 2019 at two referral centers. 89 of them (17%) were on ATT. We defined postoperative complication rates, including bleeding, as our primary outcome. Mortality was higher in the ATT group. Morbidity was higher in the ATT group as well; however, the difference was not statistically significant. 12 patients (2%) experienced intraoperative blood loss over 500 ml and ten (2%) had postoperative bleeding complications. Two patients (< 1%) experienced both intraoperative and postoperative bleeding. On multivariate analysis, ATT was not significantly associated with worse postoperative outcomes. Antithrombotic therapy is not an independently associated factor of severe postoperative complications (including bleeding) or mortality. However, these patients still represent a challenging group and must be carefully managed to avoid postoperative bleeding complications.
MeSH term(s)	Blood Loss, Surgical ; Cholecystectomy, Laparoscopic/adverse effects ; Cholecystitis, Acute/surgery ; Fibrinolytic Agents/therapeutic use ; Humans ; Italy/epidemiology ; Postoperative Complications/epidemiology ; Postoperative Complications/prevention & control ; Retrospective Studies ; Treatment Outcome
Chemical Substances	Fibrinolytic Agents
Language	English
Publishing date	2021-02-13
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-021-00994-9
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Article: Laparoscopic appendectomy, stump closure and endoloops: A meta-analysis.

Zorzetti, Noemi / Lauro, Augusto / Bellini, Maria Irene / Vaccari, Samuele / Dalla Via, Barbara / Cervellera, Maurizio / Cirocchi, Roberto / Sorrenti, Salvatore / D'Andrea, Vito / Tonini, Valeria

World journal of gastrointestinal surgery

2022 Volume 14, Issue 9, Page(s) 1060–1071

Abstract: Background: Acute appendicitis (AA) is one of the main indications for urgent surgery. Laparoscopic appendectomy (LA) has shown advantages in terms of clinical results and cost-effectiveness, even if there is still controversy about different devices to ...

Abstract	Background: Acute appendicitis (AA) is one of the main indications for urgent surgery. Laparoscopic appendectomy (LA) has shown advantages in terms of clinical results and cost-effectiveness, even if there is still controversy about different devices to utilize, especially with regards to the endoloop (EL) Aim: To compare safety and cost-effectiveness of EL Methods: From a prospectively maintained database, data of 996 consecutive patients treated by LA with a 3 years-follow up in the department of Emergency General Surgery - St Orsola University Hospital, Bologna (Italy) were retrieved. A meta-analysis was performed in terms of surgical complications, in comparison to the international literature published from 1995 to 2021. Results: The meta-analysis showed no evidence regarding wound infections, abdominal abscesses, and total post-operative complications, in terms of superiority of a surgical technique for the stump closure in LA. Conclusion: Even when AA is complicated, the routine use of EL is safe in most patients.
Language	English
Publishing date	2022-09-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2573700-4
ISSN	1948-9366
ISSN	1948-9366
DOI	10.4240/wjgs.v14.i9.1060
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Article ; Online: A systematic review on the cost evaluation of two different laparoscopic surgical techniques among 996 appendectomies from a single center.

Zorzetti, Noemi / Lauro, Augusto / Vaccari, Samuele / Ussia, Alessandro / Brighi, Manuela / D'andrea, Vito / Cervellera, Maurizio / Tonini, Valeria

Updates in surgery

2020 Volume 72, Issue 4, Page(s) 1167–1174

Abstract: Acute appendicitis is one of the main indications for urgent surgery representing a high-volume procedure worldwide. The current spending review in Italy (and not only in this country) affects the health service and warrants care regarding the use of ... ...

Abstract	Acute appendicitis is one of the main indications for urgent surgery representing a high-volume procedure worldwide. The current spending review in Italy (and not only in this country) affects the health service and warrants care regarding the use of different surgical devices. The aim of our study is to perform a cost evaluation, comparing the use of endoloops and staplers in complicated acute appendicitis (phlegmonous and gangrenous), taking into consideration the cost of the device in relation to the management of any associated postoperative complications. We retrospectively evaluated 996 laparoscopic appendectomies of adult patients performed in the Emergency General Surgery-St. Orsola University Hospital in Bologna (Italy). Surgical procedures together with the related choice of using endoloops or staplers were performed by attending surgeons or resident surgeons supervised by a tutor. A systematic review was performed to compare our outcomes with those reported in the literature. In our experience, the routine use of endoloop leads to a real estimated saving of 375€ for each performed laparoscopic appendectomy, even considering post-operative complications. Comparing endoloop and stapler groups, the total number of complications is significantly lower in the endoloop group. Our systematic review confirmed these findings even if the superiority of one technique has not been proved yet. Our analysis shows that the routine use of endoloop is safe in most patients affected by acute appendicitis, even when complicated, and it is a cost-effective device even when taking into consideration extra costs for potential post-operative complications.
MeSH term(s)	Acute Disease ; Appendectomy/economics ; Appendectomy/instrumentation ; Appendectomy/methods ; Appendicitis/economics ; Appendicitis/surgery ; Cost Savings/economics ; Cost-Benefit Analysis ; Costs and Cost Analysis ; Hospitals, University/economics ; Italy ; Laparoscopy/economics ; Laparoscopy/instrumentation ; Laparoscopy/methods ; Postoperative Complications/economics ; Retrospective Studies ; Surgical Staplers/economics ; Wound Closure Techniques/economics ; Wound Closure Techniques/instrumentation
Language	English
Publishing date	2020-05-30
Publishing country	Italy
Document type	Journal Article ; Systematic Review
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-020-00817-3
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