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Article ; Online: Outpatient Non-operative Management of Uncomplicated Acute Appendicitis: A Non-inferiority Study.

Ceresoli, Marco / Fumagalli, Chiara / Fugazzola, Paola / Zanini, Nicola / Magnone, Stefano / Ravasi, Michela / Bonalumi, Jacopo / Morezzi, Daniele / Bova, Raffaele / Sargenti, Benedetta / Schiavone, Luca / Lucianetti, Alessandro / Catena, Fausto / Ansaloni, Luca / Braga, Marco

World journal of surgery

2023 Volume 47, Issue 10, Page(s) 2378–2385

Abstract: Introduction: Non-operative management (NOM) of uncomplicated acute appendicitis is a well-established alternative to upfront surgery. The administration of intravenous broad-spectrum antibiotics is usually performed in hospital, and only one study ... ...

Abstract	Introduction: Non-operative management (NOM) of uncomplicated acute appendicitis is a well-established alternative to upfront surgery. The administration of intravenous broad-spectrum antibiotics is usually performed in hospital, and only one study described outpatient NOM. The aim of this multicentre retrospective non-inferiority study was to evaluate both safety and non-inferiority of outpatient compared to inpatient NOM in uncomplicated acute appendicitis. Methods: The study included 668 consecutive patients with uncomplicated acute appendicitis. Patients were treated according to the surgeon's preference: 364 upfront appendectomy, 157 inpatient NOM (inNOM), and 147 outpatient NOM (outNOM). The primary endpoint was the 30-day appendectomy rate, with a non-inferiority limit of 5%. Secondary endpoints were negative appendectomy rate, 30-day unplanned emergency department (ED) visits, and length of stay. Results: 30-day appendectomies were 16 (10.9%) in the outNOM group and 23 (14.6%) in the inNOM group (p = 0.327). OutNOM was non-inferior to inNOM with a risk difference of-3.80% 97.5% CI (- 12.57; 4.97). No difference was found between inNOM and outNOM groups for the number of complicated appendicitis (3 vs. 5) and negative appendectomy (1 vs. 0). Twenty-six (17.7%) outNOM patients required an unplanned ED visit after a median of 1 (1-4) days. In the outNOM group, the mean cumulative in-hospital stay was 0.89 (1.94) days compared with 3.94 (2.17) days in the inNOM group (p < 0.001). Conclusions: Outpatient NOM was non-inferior to inpatient NOM with regard to the 30-day appendectomy rate, while a shorter hospital stay was found in the outNOM group. Further, studies are required to confirm these findings.
MeSH term(s)	Humans ; Appendicitis/surgery ; Appendicitis/drug therapy ; Outpatients ; Retrospective Studies ; Treatment Outcome ; Anti-Bacterial Agents/therapeutic use ; Acute Disease
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-05-20
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-023-07065-7
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Article: Biliary Sepsis Due to Recurrent Acute Calculus Cholecystitis (ACC) in a High Surgical-Risk Elderly Patient: An Unexpected Complication.

Sermonesi, Giacomo / Rampini, Alessia / Convertini, Girolamo / Bova, Raffaele / Zanini, Nicola / Bertelli, Riccardo / Vallicelli, Carlo / Favi, Francesco / Stacchini, Giacomo / Faccani, Enrico / Fabbri, Nicola / Catena, Fausto

Pathogens (Basel, Switzerland)

2022 Volume 11, Issue 12

Abstract: Acute calculus cholecystitis (ACC) is increasing in frequency within an ageing population, in which biliary tract infection, including cholecystitis and cholangitis, is the second most common cause of sepsis, with higher morbidity and mortality rates. ... ...

Abstract	Acute calculus cholecystitis (ACC) is increasing in frequency within an ageing population, in which biliary tract infection, including cholecystitis and cholangitis, is the second most common cause of sepsis, with higher morbidity and mortality rates. Patient's critical conditions, such as septic shock or anaesthesiology contraindication, may be reasons to avoid laparoscopic cholecystectomy-the first-line treatment of ACC-preferring gallbladder drainage. It can aid in patient's stabilization with also the benefit of identifying the causative organism to establish a targeted antibiotic therapy, especially in patients at high risk for antimicrobial resistance such as healthcare-associated infection. Nevertheless, a recent randomized clinical trial showed that laparoscopic cholecystectomy can reduce the rate of major complications compared with percutaneous catheter drainage in critically ill patients too. On the other hand, among the possibilities to control biliary sepsis in non-operative management of ACC, according to recent meta-analysis, endoscopic gallbladder drainage showed better clinical success rate, and it is gaining popularity because of the potential advantage of allowing gallstones clearance to reduce recurrences of ACC. However, complications that may arise, although rare, can worsen an already weak clinical condition, as happened to the high surgical-risk elderly patient taken into account in our case report.
Language	English
Publishing date	2022-11-26
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2695572-6
ISSN	2076-0817
ISSN	2076-0817
DOI	10.3390/pathogens11121423
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Article ; Online: Focal liver lesions suspected of being cholangiocarcinomas.

Zanini, Nicola / Jovine, Elio / Landolfo, Giovanni

The American journal of gastroenterology

2015 Volume 110, Issue 4, Page(s) 599

MeSH term(s)	Adenoma ; Bile Duct Neoplasms ; Bile Ducts, Intrahepatic ; Carcinoma, Hepatocellular ; Cholangiocarcinoma/diagnosis ; Focal Nodular Hyperplasia ; Hemangioma ; Humans ; Liver Neoplasms
Language	English
Publishing date	2015-04
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	390122-1
ISSN	1572-0241 ; 0002-9270
ISSN (online)	1572-0241
ISSN	0002-9270
DOI	10.1038/ajg.2015.56
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Article ; Online: Operative Drainage Following Pancreatic Resections: We Need More Evidence.

Zanini, Nicola / Lombardi, Raffaele / Masetti, Michele / Jovine, Elio

Annals of surgery

2015 Volume 261, Issue 6, Page(s) e160

MeSH term(s)	Drainage ; Female ; Humans ; Male ; Pancreatectomy
Language	English
Publishing date	2015-06
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000000539
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Article ; Online: Off-line washing effectiveness on a multistage axial compressor

Aldi Nicola / Casari Nicola / Fadiga Ettore / Friso Riccardo / Oliani Stefano / Pinelli Michele / Spina Pier Ruggero / Suman Alessio / Vulpio Alessandro / Zanini Nicola

E3S Web of Conferences, Vol 312, p

2021 Volume 11016

Abstract: The interaction between gas turbines and airborne particles determines detrimental effects on the performance, efficiency, and reliability of the power unit. When it is possible, the interaction is reduced by the use of inlet separators and filtration ... ...

Abstract	The interaction between gas turbines and airborne particles determines detrimental effects on the performance, efficiency, and reliability of the power unit. When it is possible, the interaction is reduced by the use of inlet separators and filtration systems. In an aero engine, these barriers are difficult to implement, and only bigger particles (usually greater than 10 μm) are separated from the airflow. Small units, especially those equips helicopters, are usually affected by fouling issues, especially when the aircraft is employed in harsh environments such as firefighting and rescue activities. To recover this contamination, the unit is washed after the mission by ground operations to restore the unit performance by removing the deposits. This operation occurs during a sub-idle unit operation, and the washing process has to be effective when the engine operates in this off-design condition. In this paper, the evaluation of the washing performance during a sub-idle unit operation is carried out. The compressor unit is a multistage axial compressor that equips the Allison 250-C18 engine. The washing operation was performed by water, and a sensitivity analysis is carried out to discover the capability of water droplets to remove the contaminants. The experimental analysis involves the contamination of the unit by micro-sized soot particles and a washing operation by micro-sized water droplets. These experimental results are compared to numerical simulations to discover the effects of the washing operation on a small power unit during sub-idle operating conditions. The off-design regime imposes a specific evaluation of the proper setup of the washing strategy: flow separations involve wider regions in the compressor unit, and the removal capability is strongly related to the droplet path through the stages. The results show how in the off-design washing operation, the droplet diameter has greater importance than the water flow rate for reducing the deposits over the compressor stages.
Keywords	Environmental sciences ; GE1-350
Subject code	620
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	EDP Sciences
Document type	Article ; Online
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Article ; Online: Intraoperative endoscopy with immediate suture reinforcement of the defect in colorectal anastomosis: a pilot study.

Vallicelli, Carlo / Pirrera, Basilio / Alagna, Vincenzo / Fantini, Enrico / Palini, Gian Marco / Zanini, Nicola / Garulli, Gianluca

Updates in surgery

2020 Volume 72, Issue 4, Page(s) 999–1004

Abstract: Colorectal anastomosis is the one at higher risk of complication in alimentary tract surgery. Several techniques have been used to intraoperatively check a colorectal anastomosis, without reaching a clear consensus. The aim of the present study is to ... ...

Abstract	Colorectal anastomosis is the one at higher risk of complication in alimentary tract surgery. Several techniques have been used to intraoperatively check a colorectal anastomosis, without reaching a clear consensus. The aim of the present study is to evaluate the addition of intraoperative flexible endoscopy to indocyanine green fluorescence in detecting colorectal anastomotic defects in a consecutive series of patients. This was a pilot study conducted over a 15-month period. Patients were scheduled for an elective laparoscopic left colectomy or anterior resection with a planned stapled colorectal anastomosis. Pre-, intra- and postoperative data were collected. Intraoperative endoscopy was routinely performed and the anastomotic defects were classified. A suture reinforcement of the defect encountered was immediately performed either laparoscopically or transanally. The primary endpoint of the study was the rate of postoperative complications. Fitfty-two patients were enrolled. At intraoperative endoscopy, 12 anastomotic defects were detected and corrected with immediate suture reinforcement. Defects were classified as two leaks, two mucosal crash, one simultaneous leak and crash, one mucosal edema and six active bleedings. None of these patients developed any postoperative complication. Moreover, there was no postoperative bleeding complication in the entire cohort. The three patients developing a postoperative leak requiring anastomosis takedown were at high risk due to general status and cancer characteristics. Even though more data and a comparative group are needed, the results of this pilot study are very promising regarding the role of intraoperative endoscopy and suture reinforcement of a colorectal anastomotic defect.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/adverse effects ; Anastomotic Leak/diagnosis ; Anastomotic Leak/etiology ; Anastomotic Leak/surgery ; Colectomy/methods ; Colon/surgery ; Endoscopy ; Female ; Humans ; Indocyanine Green ; Intraoperative Complications/diagnosis ; Intraoperative Complications/etiology ; Intraoperative Complications/surgery ; Laparoscopy/methods ; Male ; Middle Aged ; Pilot Projects ; Pliability ; Rectum/surgery ; Retrospective Studies ; Suture Techniques
Chemical Substances	Indocyanine Green (IX6J1063HV)
Language	English
Publishing date	2020-03-17
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/s13304-020-00746-1
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Article ; Online: Body tattooing: efficacy of a “new” practice.

Fornelli, Adele / Fabbri, Carlo / Zanini, Nicola / Jovine, Elio

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.

2013 Volume 13, Issue 4, Page(s) 449

MeSH term(s)	Adenocarcinoma/surgery ; Aged ; Female ; Humans ; Laparoscopy/methods ; Pancreas/diagnostic imaging ; Pancreatectomy/methods ; Pancreatic Neoplasms/surgery ; Preoperative Care ; Tattooing/methods ; Ultrasonography
Language	English
Publishing date	2013-07-25
Publishing country	Switzerland
Document type	Case Reports ; Journal Article
ZDB-ID	2056680-3
ISSN	1424-3911 ; 1424-3903
ISSN (online)	1424-3911
ISSN	1424-3903
DOI	10.1016/j.pan.2013.04.324
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Article ; Online: Signet Ring Cell Carcinoma of the Ampulla of Vater With Focal Neuroendocrine Differentiation of the Amphicrine Type: Report of a Case With Long-Term Survival.

Fornelli, Adele / Zanini, Nicola / De Biase, Dario / Lega, Stefania / Lombardi, Raffaele / Masetti, Michele / Jovine, Elio / Fabbri, Carlo / Larghi, Alberto

International journal of surgical pathology

2018 Volume 27, Issue 1, Page(s) 89–93

Abstract: Carcinoma of the ampulla of Vater is an uncommon neoplasm and represents 0.5% of all gastrointestinal malignancies, being less common than carcinoma of the pancreas and bile ducts. The most common ampullary tumor is the adenocarcinoma with tubular growth ...

Abstract	Carcinoma of the ampulla of Vater is an uncommon neoplasm and represents 0.5% of all gastrointestinal malignancies, being less common than carcinoma of the pancreas and bile ducts. The most common ampullary tumor is the adenocarcinoma with tubular growth pattern. Signet ring cell carcinoma is extremely rare. In this article, we report a case of signet ring cell carcinoma of the ampulla of Vater showing focal neuroendocrine amphicrine differentiation and intestinal phenotype, which occurred in a 49-year-old male who is still alive 7 years after surgery, without evidence of recurrence. This long-term survival might be attributed not only to the early stage of the disease but also to the neuroendocrine differentiation and the absence of genetic alterations.
MeSH term(s)	Ampulla of Vater/pathology ; Carcinoma, Signet Ring Cell/mortality ; Carcinoma, Signet Ring Cell/pathology ; Cell Differentiation ; Duodenal Neoplasms/mortality ; Duodenal Neoplasms/pathology ; Humans ; Male ; Middle Aged
Language	English
Publishing date	2018-07-11
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	1336393-1
ISSN	1940-2465 ; 1066-8969
ISSN (online)	1940-2465
ISSN	1066-8969
DOI	10.1177/1066896918784666
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Article ; Online: Urgent and emergency surgery for secondary peritonitis during the COVID-19 outbreak: an unseen burden of a healthcare crisis.

Updates in surgery

2021 Volume 73, Issue 2, Page(s) 753–762

Abstract: The COVID-19 pandemic has raised concerns about the negative impact of the fear of contagion on people's willingness to seek medical care and the subsequent effects on patients' prognosis. To date, not much is known about the outcomes of acute surgical ... ...

Abstract	The COVID-19 pandemic has raised concerns about the negative impact of the fear of contagion on people's willingness to seek medical care and the subsequent effects on patients' prognosis. To date, not much is known about the outcomes of acute surgical diseases in this scenario. The aim of this multicenter observational study is to explore the effects of COVID-19 outbreak on the outcomes of patients who underwent surgery for peritonitis. Patients undergoing surgery for secondary peritonitis during the first COVID-19 surge in Italy (March 23-May 4, 2020-COVID period group) were compared with patients who underwent surgery during the same time interval of year 2019 (no-COVID period group). The primary endpoint was the development of postoperative complications. Logistic regression analysis was conducted to identify predictors of complications. Of the 332 patients studied, 149 were in the COVID period group and 183 were in the no-COVID period group. Patients in the COVID period group had an increased frequency of late presentations to the emergency departments (43% vs. 31.1%; P = 0.026) and a higher rate of postoperative complications (35.6% vs. 18%; P < 0.001). The same results were found in the subset analysis of patients with severe peritonitis at surgical exploration. The ASA score, severity of peritonitis, qSOFA score, diagnosis other than appendicitis, and COVID period resulted independent predictors of complications. During the COVID-19 pandemic patients with peritonitis had a higher rate of complicated postoperative courses, weighing on hospital costs and assistance efforts already pressured by the ongoing sanitary crisis.
MeSH term(s)	Adult ; COVID-19/epidemiology ; Emergencies ; Female ; Humans ; Italy/epidemiology ; Male ; Middle Aged ; Pandemics ; Peritonitis/surgery ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/virology ; Postoperative Complications/epidemiology ; Prospective Studies ; SARS-CoV-2
Language	English
Publishing date	2021-01-04
Publishing country	Italy
Document type	Journal Article ; Multicenter Study ; Observational Study
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-020-00943-y
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Article ; Online: Surgery for isolated liver metastases from pancreatic cancer.

Zanini, Nicola / Lombardi, Raffaele / Masetti, Michele / Giordano, Marco / Landolfo, Giovanni / Jovine, Elio

Updates in surgery

2015 Volume 67, Issue 1, Page(s) 19–25

Abstract: The resection of liver metastases from pancreatic ductal adenocarcinoma has been discouraged because it is commonly thought that it does not improve survival. However, the role of potential prognostic factors is unclear, and universally accepted ... ...

Abstract	The resection of liver metastases from pancreatic ductal adenocarcinoma has been discouraged because it is commonly thought that it does not improve survival. However, the role of potential prognostic factors is unclear, and universally accepted strategies have not been proposed. Between 2003 and 2014, 15 patients with isolated synchronous or metachronous metastases from pancreatic cancer underwent liver resection in our department. The role of potential prognostic factors was analyzed to predict survival. One right hepatectomy, 1 bisegmentectomy and 13 wedge resections were performed. Eleven patients underwent simultaneous pancreatic and liver resection for synchronous disease. The median overall survival (OS) was 9.1 months (95% CI 8.6-9.7). The only potential prognostic factor that significatively affected survival was the timing of metastases (metachronous vs. synchronous). Median OS in patients with metachronous disease was 11.4 months (95% CI 0-25.1) vs. 8.3 months (95% CI 6.9-9.7), p = 0.038. Surgery for liver metastases from pancreatic cancer is not suggested for most patients. If resection is considered, timing of metastatic disease could be a prognostic factor for survival after surgery.
MeSH term(s)	Adult ; Aged ; Biopsy, Fine-Needle ; Carcinoma, Pancreatic Ductal/diagnosis ; Carcinoma, Pancreatic Ductal/secondary ; Carcinoma, Pancreatic Ductal/surgery ; Endosonography ; Female ; Follow-Up Studies ; Hepatectomy/methods ; Humans ; Liver Neoplasms/diagnosis ; Liver Neoplasms/secondary ; Liver Neoplasms/surgery ; Male ; Middle Aged ; Neoplasm Metastasis ; Pancreatectomy/methods ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/surgery ; Prognosis ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome
Language	English
Publishing date	2015-03
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/s13304-015-0283-6
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