3D Lipogluing: Preliminary Results of a Novel Technique for Direct Three-dimensional Fat Grafting in Breast Reconstruction Surgery.

Lipofilling has emerged as an effective technique in breast reconstruction for enhancing aesthetic outcomes and addressing residual deformities. Traditionally, fat grafting has been performed as a secondary step in implant-based breast reconstruction during the replacement of the expander with a breast implant or as a revisional procedure. Our study investigates the technical feasibility and presents preliminary results of a new promising technique for delivering fat grafting in a three-dimensional (3D) shape, directly during mastectomy with immediate breast reconstruction or in delayed breast reconstructive procedures. Our new 3D lipogluing technique involves securing the fat tissue in a 3D manner using fibrin glue. This method enhances the coverage of soft tissues and provides improved volume and shape supplementation. In selected cases between December 2015 and September 2023, we treated 24 patients using the 3D lipogluing technique and five patients using 3D lipocubing (without use of fibrin glue).The patient cohort consisted of different indications for breast reconstructions: direct-to-implant, expander-based breast reconstruction, and "conservative" surgery. Preliminary findings suggest the technique is a safe and effective approach that can enhance the soft-tissue envelope of reconstructed breasts by acting as an autologous scaffold, owing to its regenerative properties. This technique not only improves the overall aesthetic outcome but also has the potential to reduce implant-related complications. Furthermore, ongoing studies are investigating methods to optimize the results and explore the potential application of 3D lipogluing and 3D lipocubing in breast-conserving oncoplastic surgery, cosmetic breast surgery, and other areas of plastic reconstructive and aesthetic surgery.

Collagen treatment of complex anorectal fistula: 3 years follow-up.

Fistula in ano is a common anorectal disease in adults. Currently, surgery remains the definitive therapeutic approach, but in some cases, it can lead to serious complications as faecal or gas incontinence. Therefore, sphincter sparing treatments should be considered for complex fistulas. One of the sphincteric preserving treatment is the filling with a dermal extract commonly called "collagen glue" as Salvecoll-E® gel. This is a multicentric, prospective, observational study on the use of Salvecoll-E® gel in treatment of complex anal fistulas. We treated 70 patients from May 2016 to May 2017. In the first phase, we debrided the fistula tract using a loose seton kept for 4-6 weeks. In the second phase, the seton was removed and the fistula tract was filled with Salvecoll-E® gel. In this article, we report results at 36 months of follow-up. Fifty patients (71.4%) had completely healed fistula within 36 months of follow-up. Twenty-eight patients (28.2%) had recurrences. Among these failures, 65% were within 6 months. All low transphincteric fistulas healed. Recurrences occurred only in median and high transphincteric fistulas. No patient had a worsening of continence status measured with Cleveland Clinic Florida Incontinence Severity score. Salvecoll-E® gel is a recent finding among sphincter-sparing treatments. In this study, we demonstrate that it is a safe option in the treatment of complex fistulas. Final results are satisfactory and in line with the best results published in literature among mini-invasive treatments.

Clown therapy for procedural pain in children: a systematic review and meta-analysis.

Among the distraction techniques used for the non-pharmacological management of acute pediatric pain, one of the most performed is clown therapy. Despite the presence in the literature of some systematic reviews that evaluate its effectiveness, none of them examines its outcomes on procedural pain which has therefore been investigated in this study. The literature search for randomized controlled trials (RCTs) was performed on the Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and Scopus over a time frame ranging from each database setup date to 31 July 2021. The primary outcome was the procedural pain of children. We used the Cochrane Risk of Bias tool to assess the risk of bias of the included studies. Six RCTs were selected for this review, which included a total of 517 pediatric subjects. Children undergoing clown therapy during the venipuncture or peripheral vein cannulation procedure reported less pain than those exposed to the standard of care (SMD = -0.55; 95% CI: -1.23, 0.13) but the result was not found to be statistically significant. School-aged children and adolescent reported significantly less pain (SMD = -0.51; 95% CI: -0.92, -0.09). Compared to the standard of care, children's anxiety was significantly lower with clown therapy (SMD = -0.97; 95% CI: -1.38, -0.56). CONCLUSION: Clown therapy seems effective in reducing procedural pain in children, particularly for older age groups, but due to poor methodological quality and the high risk of bias of the studies included, the results obtained should be considered with caution. WHAT IS KNOWN: • Clown therapy is one of the most used techniques in the non-pharmacological management of acute pediatric pain. • Laughter physiologically stimulates the production of beta-endorphins, substances with an effect similar to opiates. WHAT IS NEW: • Clown therapy seems effective in reducing procedural pain and anxiety in children. • The intervention in school-age children or adolescents produces a statistically significant decrease in the symptom.

Laparoscopy management for spontaneous bladder rupture: a case report.

We present a case of a 79-year-old man with lower abdominal pain and negative Blumberg sign. An indwelling bladder catheter was inserted for urinary retention due to a tight phimosis 2 months earlier. A contrast-enhanced computed tomography scan revealed a huge gastrectasia and small bowel distention due to a suspected adherent bridle. The clinical signs and the laboratory tests were highly suspicious for bowel obstruction and emergency surgery was indicated. Exploratory laparoscopy showed a bladder hole tamponade by an ileum loop. The perforation was sutured laparoscopically and the patient was discharged on the 14th postoperative day. In our case, emergency laparoscopic exploration was useful for the diagnosis and the treatment of spontaneous bladder rupture. We hope this case report can be useful to give these patients better outcomes. Notably we would like to emphasize that the presence of a urinary catheter can be a risk factor for intraperitoneal bladder rupture.

Complications and mortality in a cohort of patients undergoing emergency and elective surgery with perioperative SARS-CoV-2 infection: an Italian multicenter study. Teachings of Phase 1 to be brought in Phase 2 pandemic.

Since the beginning of the pandemic due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its related disease, coronavirus disease 2019 (COVID-19), several articles reported negative outcomes in surgery of infected patients. Aim of this study is to report results of patients with COVID-19-positive swab, in the perioperative period after surgery. Data of COVID-19-positive patients undergoing emergent or oncological surgery, were collected in a retrospective, multicenter study, which involved 20 Italian institutions. Collected parameters were age, sex, body mass index, COVID-19-related symptoms, patients' comorbidities, surgical procedure, personal protection equipment (PPE) used in operating rooms, rate of postoperative infection among healthcare staff and complications, within 30-postoperative days. 68 patients, who underwent surgery, resulted COVID-19-positive in the perioperative period. Symptomatic patients were 63 (92.5%). Fever was the main symptom in 36 (52.9%) patients, followed by dyspnoea (26.5%) and cough (13.2%). We recorded 22 (32%) intensive care unit admissions, 23 (33.8%) postoperative pulmonary complications and 15 (22%) acute respiratory distress syndromes. As regards the ten postoperative deaths (14.7%), 6 cases were related to surgical complications. One surgeon, one scrub nurse and two circulating nurses were infected after surgery due to the lack of specific PPE. We reported less surgery-related pulmonary complications and mortality in Sars-CoV-2-infected patients, than in literature. Emergent and oncological surgery should not be postponed, but it is mandatory to use full PPE, and to adopt preoperative screenings and strategies that mitigate the detrimental effect of pulmonary complications, mostly responsible for mortality.

[Effectiveness and safety of non-pharmacological interventions for the prevention of venous thromboembolism in stroke patients: an overview of systematic reviews]. / Efficacia e sicurezza degli interventi non farmacologici per la prevenzione del tromboembolismo venoso nei pazienti con stroke: una overview di revisioni sistematiche.

INTRODUCTION: Half of the deaths recorded in non-surgical patients attributable to venous thromboembolism (VTE) affect those with stroke. The uncertain benefit of anticoagulant therapy has increased interest in non-pharmacological intervention to prevent VTE. AIM: To evaluate the efficacy and safety of non-pharmacological interventions to prevent VTE in stroke patients. METHODS: Overview of systematic reviews with retrieval of documents in compliance with the PICOS Framework and through a research strategy implemented on 4 April 2019 in six biomedical databases and in the PROSPERO registry. The tools used to assess the methodological quality and the risk of bias were the AMSTAR checklist and the ROBIS tool, respectively. The results have been synthesized with narrative modality. RESULTS: Seven systematic reviews of different methodological quality and risk of bias met the inclusion criteria. The non-pharmacological interventions of prophylaxis used are graduated compression stockings (GCS) and intermittent pneumatic compression devices (IPCD). The first has no effect on VTE and has important side effects, the second is promising in reducing mortality from all causes and decreases the incidence of deep vein thrombosis. DISCUSSION: The use of IPCD, despite the efficacy observed, should be reserved, after a risk assessment of VTE and a subgroup analysis, for patients who can derive the maximum benefit from the intervention. CONCLUSIONS: In stroke patients the use of GCS to prevent VTE is not recommended because it is not superior to standard care and can cause damage. IPCD as a intervention of prophylaxis appears to be effective but further confirmation is needed from future studies.

[Health determinants in irregular migrants with chronic diseases: analysis of the accesses to the clinic of a non-governmental organization]. / Determinanti di salute nei migranti irregolari con patologie croniche:analisi degli accessi all'ambulatorio di una organizzazionenon governativa.

. Health determinants in irregular migrants with chronic diseases: analysis of the accesses to the clinic of a non-governmental organization. INTRODUCTION: Of the 112 thousand irregular migrants in Lombardy, 49 thousand reside in the area of Milan. Data on their health conditions and needs are scarce and fragmented, especially about their socio-demographic and clinical determinants. AIM: To describe the main socio-demographic and clinical characteristics of irregular migrants with chronic diseases who access the clinic of a non-governmental organization that provides primary care and their association with the number of accesses. METHOD: Retrospective observational study of a dataset containing information on irregular migrants with chronic diseases (N = 411) carried out at the Naga Onlus clinic in 2017. RESULTS: The males come essentially from Africa and are often affected by back pain or low back pain (BP-LBP); females, mostly from East Europe or Central-South America, are frequently hypertensive. Up to 24 years of age, anxiety or depression prevails; at 25-44 years BP-LBP, at 45-64 years diabetes and in advanced age, hypertension. The knowledge of a EU language and the diagnosis of BP-LBP are respectively positively and negatively associated to the number of accesses. DISCUSSION: Following the progressive aging with the increasing prevalence of chronic conditions, marginalization and stigma, the "healthy migrant" effect once characterizing irregular migrants is being replaced by the "exhausted migrant" effect and the assimilation of a state of health similar to that of native counterparts.

[Consequences of alcohol consumption mixed with Energy Drink. Overview of systematic reviews]. / Conseguenze del consumo di alcol miscelato ad Energy Drink. Overview di revisioni sistematiche.

INTRODUCTION: The habit of teenagers and young adults to take alcoholic beverages mixed with Energy Drinks (AmED) is increasing. Epidemiological data are of concern but awareness of the problem between consumers and health workers is scarce. OBJECTIVE: To compare the effects and damages from consumption of AmED compared to alcohol. METODI: Finding documents through the interrogation of seven biomedical databases. Overview of systematic reviews assessed for methodological quality and risk of bias respectively with the AMSTAR checklist and ROBIS tool with narrative synthesis of results. RESULTS: Six systematic reviews of low quality and high risk of bias met the inclusion criteria. The intake of AmED seems to determine the increase in state of vigilance, reduction of sedation and possible effects at physiological level; there are no significantly different cognitive or psychomotor effects. The evidence to support a lower perception of alcohol intoxication is insufficient; controversial are those in favour of an increase in alcohol intake or risky behavior. DISCUSSION AND CONCLUSIONS: The results of experimental studies, which unlike nonexperimental could identify a cause-effect relationship, are often statistically insignificant and do not lead to a unanimous consensus on the different effects/damages of two consumption patterns. The authors of three reviews declare conflicts of interest with an ED producer, raising the problem of industry's influence on research. The current evidence is insufficient to confirm or refute the hypothesis that intake of AmED results in significantly different effects/damage compared to alcohol. However, the magnitude of phenomenon must act as a push for further studies promoted by independent researchers.

[Synopses of systematic reviews on effectiveness of heparin to prevent occlusion in central venous access devices]. / Sinossi di revisioni sistematiche sull'efficacia dell'eparina per prevenire le occlusioni nei dispositivi di accesso venoso centrale.

INTRODUCTION: Prevention of central venous access devices (CVAD) occlusion is crucial to the continuity and quality of care. There is wide consensus on the need to carry out a periodic flushing of the lumen of device in order to ensure its patency. The most commonly used solutions are the heparin solution (HS) and the physiological solution (NaCl 0.9% - PS). There are still controversial opinions on HS's effectiveness over PS. OBJECTIVE: To evaluate the effectiveness of HS compared to PS to prevent occlusion in CVAD. METHODS: A search strategy on four electronic databases (The Cochrane Library, Medline, Embase, CINAHL) was implemented on April 4, 2017. Records returned were independently analyzed; those complying with inclusion criteria were found in full text. They've been included systematic reviews of RCT or quasi-experimental studies that have compared the use of HS with PS. The quality assessment of reviews was done with AMSTAR checklist. RESULTS: Seven moderate-high quality systematic reviews met inclusion criteria. HS is was not superior to PS in preventing CVAD occlusions. DISCUSSION: Reviews included were of high quality methodological. The statistical heterogeneity between RCT was low while the clinical and methodological heterogeneity was high. CONCLUSIONS: HS was no longer effective than PS to prevent CVAD occlusions. Waiting for better quality studies to evaluate the overall DAVC management process, it seems reasonable to recommend using PS.

[Effectiveness of oral nutritional supplements to prevent hospital malnutrition. Overview of systematic reviews]. / Efficacia dei supplementi nutrizionali orali per prevenire la malnutrizione ospedaliera.Overview di revisioni sistematiche.

. Effectiveness of oral nutritional supplements to prevent hospital malnutrition. Overview of systematic reviews. INTRODUCTION: Although oral nutritional supplements (ONSs) are among most popular interventions to prevent a condition of hospital malnutrition, their real benefits need to be clarified. AIM: To evaluate in adults the effectiveness of ONSs to prevent hospital malnutrition. METHODS: Papers retrieval by querying biomedical databases The Cochrane Library, Medline, Embase, CINAHL. Overview of systematic reviews evaluated for methodological quality according to R-AMSTAR checklist with narrative synthesis of results. RESULTS: Twenty-five systematic reviews met the inclusion criteria. Methodological quality was better in more recent studies. Low-moderate quality evidence showed a trend for decreasing mortality, complications, length of stay; there was no clear reduction in readmissions. Inadequate data do not allow to assess the impact on quality of life. The intervention seems promising for subjects over 75 years, malnourished, with pathological conditions of geriatric interest, in hospital or long-term care services, but differences are not always significant. The definition of malnutrition, screening procedures and assessment tools adopted varies widely, as well as the characteristics of participants, intervention and duration of studies included in systematic reviews; this makes difficult to estimate the net benefit due to ONSs. CONCLUSIONS: The intervention should be included in a general approach to nutrition in clinical practice. At present the role of ONSs to prevent hospital malnutrition is still unclear.

[Is repositioning regimen effective to prevent pressure injuries? Synopsis of systematic reviews.] / Il regime di riposizionamento è efficace per la prevenzione di lesioni da pressione? Sinossi di revisioni sistematiche.

INTRODUCTION: Repositioning regimen is an intervention recommended by guidelines and traditionally used in daily care practice but its benefit for preventing pressure injuries (PI) is not clinically proved. OBJECTIVE: To determine the effect of repositioning regimen to prevent PI. METHODS: A research on five electronic databases (The Cochrane Library, Medline, Embase, CINAHL, Web of Science) was conducted on March 23, 2017. Records returned by the search strategy were independently analyzed and those that respected inclusion criteria have been found in full text. In synopsis have been included systematic reviews of controlled clinical trials or quasi-experimental studies that compare repositioning regimen with usual care. The AMSTAR checklist has been used for quality evaluation. RESULTS: Five systematic reviews met inclusion criteria. The methodological quality of included studies have been very heterogeneous. Compared to usual cares, intervention is not associated with a statistically significant reduction of PI. DISCUSSION: A few and small available studies do not allow to ascertain a benefit from the intervention, if any. At the moment, the application of an individualized repositioning regimen seems a reasonable solution. Further researches are needed to confirm that a more frequent repositioning and a 30° lateral decubitus intake help to prevent PI. It is also necessary to evaluate the economic impact, the acceptability and risks associated with the intervention. CONCLUSION: It is still unclear the role of repositioning regimen to prevent PI.

[Effectiveness of blood pressure home monitoring. Synopsis of systematic reviews.] / Efficacia del monitoraggio domiciliare della pressione arteriosa. Sinossi di revisioni sistematiche.

INTRODUCTION: Home blood pressure monitoring (HmBPM) is as a valuable and useful tool for hypertension management; some uncertainties remain about benefits of intervention in clinical practice. OBJECTIVE: To assess the effects of home blood pressure monitoring on blood pressure values. METHODS: A search on the following databases The Cochrane Library, Medline, CINAHL, Embase, Web of Science was carried out on January the 12 2016 . The records retrieved were analysed independently and those which met the inclusion criteria were gathered as full text. In the synopsis were included only systematic reviews with meta-analysis of Randomised Controlled Trials comparing home blood pressure monitoring with ambulatory (ABPM) or hospital (HsBPM) blood pressure monitoring. AMSTAR checklist was used to evaluate reviews quality while for comparing meta-analysis it was proceeded to index of Higgins I2 analysis. RESULTS: Five systematic reviews met inclusion criteria. The overall methodological quality of included studies was high. Range of I2 was equal to 37%-72% (moderate to high heterogeneity). Compared to ABPM, HsBPM or standard of care, HmBPM was associated with moderate but statistically significant reduction in systolic blood pressure (weighted mean difference from -2.50 mmHg to -4.25 mmHg) and diastolic blood pressure (weighted mean difference from -1.45 mmHg to -2.37 mmHg). DISCUSSION: The reduced size of HmBPM effect results in a moderate benefit in clinical practice. Potential advantages on blood pressure control are dependent on patient ability to perform and interpret HmBPM results as well as health professionals to use recorded data to introduce or modify drug therapy and improve the overall compliance to antihypertensive treatment. CONCLUSIONS: HmBPM is more effective in reducing systolic and diastolic blood pressure compared to other interventions but the clinical significance of its effect is moderate.

Moral distress among nurses in medical, surgical and intensive-care units.

AIM: To assess the frequency, intensity and level of moral distress perceived by nurses working in medical, surgical and intensive care units. BACKGROUND: Moral distress among nurses compromises their ability to provide optimal patient care and may cause them to leave their job. METHODS: A cross-sectional questionnaire survey of 283 registered nurses was conducted to evaluate the frequency, intensity and levels of moral distress. A revised version of the Moral Distress Scale (MDS-R) was used. RESULTS: The highest level of moral distress was associated with the provision of treatments and aggressive care that were not expected to benefit the patients and the competency of the health-care providers. Multivariate regression showed that nurses working in medical settings, nurses with lower levels of experience working in medical, surgical or intensive care settings, and nurses who intend to leave their job experienced the highest levels of moral distress. CONCLUSIONS: The present study indicates that nurses experience an overall moderate level of moral distress. IMPLICATIONS FOR NURSING MANAGEMENT: Gaining further insight into the issue of moral distress among nurses and the clinical situations that most frequently cause this distress will enable development of strategies to reduce moral distress and to improve nurse satisfaction and, consequently, patient care.

Tumor shrinkage and improved quality of life in a heavily pretreated metastatic breast cancer patient treated with eribulin.

Eribulin mesylate is approved for the treatment of metastatic breast cancer after progression with anthracyclines and taxanes. Here we report the case of a woman with triple-negative breast cancer who, after nine lines of chemotherapy, showed striking primary tumor shrinkage and regression of metastatic lesions with eribulin treatment. This response allowed the patient to undergo debulking surgery. Even though the patient was heavily pretreated, eribulin was well tolerated and improved her quality of life. Biological analysis of tumor specimens was performed to investigate the underlying mechanism of action of the drug.

Emergency treatment of violent trauma: clinical cases and surgical treatment of penetrating thoracoabdominal, perineal and anorectal trauma.

AIM: The authors analyse clinical cases of penetrating thoracic, abdominal, perineal and anorectal injury and describe the traumatic event and type of lesion, the principles of surgical treatment, the complication rate and follow up. MATERIALS AND METHODS: In the last 24 months, we analyzed 10 consecutive cases of penetrating thoracic and abdominal wounds [stab wound (n=7), with evisceration (n=4), gunshot wound (n=1)], and penetrating perineal and anorectal wounds (impalement n=4). In addition, we report an unusual case of neck injury from a stab wound. All the patients underwent emergency surgery for the lesions reported. RESULTS: In 7 cases of perforating vulnerant thoracoabdominal trauma from stab wounds there was hemoperitoneum due to bleeding from the abdominal wall (n=3), the omentum (n=1), the vena cava (n=1) and the liver (n=2). Evisceration of the omentum was observed in 4 cases. In 2 cases laparoscopy was performed. In one case laparotomy and thoracoscopy was performed. In a patient with an abdominoperineal gunshot wound, exploration was extraperitoneal. The 4 cases of perineal and anorectal impalement were treated with primary reconstruction, while in one case a laparotomy was needed to suture the rectum and fashion a temporary colostomy. In one case of anorectal injury rehabilitation resulted in a gradual improvement of fecal continence, while in the patient with the colostomy follow up at 2 months was scheduled to plan colostomy closure. CONCLUSIONS: Based on the our clinical experience and the literature, in penetrating abdominal trauma laparotomy may be required if patients are hemodynamically unstable (or in hemorrhagic shock), in patients with evisceration and peritonitis, or for exploration of penetrating thoracoabdominal and epigastric lesions. In anterior injuries of the abdominal wall from gunshot or stab wounds, laparotomy is indicated when there is peritoneal violation and significant intraperitoneal damage. In patients with actively bleeding wounds of the abdominal wall muscles minimal laparotomy is often necessary for control of hemorrhage and abdominal wall reconstruction to avoid herniation. If patients are asymptomatic, in cases of anterior lesions the indications for diagnostic laparoscopy are uncertain. Selective conservative treatment is reserved for asymptomatic patients who are hemodynamically stable. Further controlled studies are needed. Early surgery for perineal and anorectal trauma, and also for complex injuries, is the gold standard for treatment.

PPH-01 versus PPH-03 to perform STARR for the treatment of hemorrhoids associated with large internal rectal prolapse: a prospective multicenter randomized trial.

PURPOSE: This multicenter randomized study was designed to compare the clinical and functional results of stapled transanal rectal resection (STARR) performed with 2 staplers (PPH-01 vs. PPH-03) in the treatment of hemorrhoidal disease associated with a large internal rectal prolapse. METHODS: From a total of 937 patients, referred for hemorrhoidal disease in the 20 centers involved in the study, 425 (45.3%) with prolapsed hemorrhoids associated with a large internal rectal prolapse were randomized to undergo STARR with PPH-01 or PPH-03. Postoperative evaluation was made at 3, 6, and 12 months. RESULTS: The incidence of bleeding at the stapled line was significantly lower in the PPH-03 group than in the PPH-01 group (58/207 [28.0%] vs. 145/201 [72.1%]; P < .0001); the mean number of hemostatic stitches was significantly higher in the PPH-01 than in the PPH-03 group (3.2 ± 0.1 vs. 1.8 ± 0.8; P < .0001). The mean operative time was 25.1 ± 11.5 minutes in the PPH-03 group and 38.1 ± 15.7 minutes in the PPH-01 group (P < .0001). No major complications occurred in either of the groups. At 12-month follow-up, the success rate in the 2 groups was 94.5% in the PPH01 group and 94.2% in the PPH03 group. CONCLUSION: STARR performed for the treatment of hemorrhoidal disease associated with a large rectal prolapse is a safe and effective procedure. The use of the PPH-03 stapler instead of the PPH-01 guarantees a statistically significant reduction of intraoperative bleeding and a significant decrease of the operative time.

[Anal Masson's tumor]. / Il tumore di Masson a localizzazione anale.

The Authors report on an extremely rare case of anal Masson's tumour and has described clinical and histological considerations. Is important the surgical resection of the lesion because this tumour is similar to angiosarcoma.