Italian journal of gastroenterology and hepatology
A retrospective study was conducted to determine incidence and predisposing factors of incisional... more A retrospective study was conducted to determine incidence and predisposing factors of incisional hernia after an emergency midline laparotomy. The study population consisted in 197 patients of whom 138 were followed-up for 2 years after surgery. An incisional hernia developed in 25 (18.1%) patients at a mean follow-up of 11.2 months. Multivariate analysis showed the importance of age (> 60 years, p < 0.004), obesity (p < 0.008) and occurrence of post-operative wound infection (p < 0.00001) for the development of an incisional hernia. Univariate analysis showed that intestinal occlusion (p < 0.02), peritonitis (p < 0.006), upper abdominal access (p < 0.04) and post-operative wound infection (p < 0.003) in older patients and obesity (p < 0.003) and the presence of a neoplasm (p < 0.006) in younger patients, played a significant role. The comparison between young and old patients showed that upper abdominal access (p < 0.007), interrupted and layered w...
Background: Pneumomediastinum creation, in blunt chest trauma, results from Mackin effect in more... more Background: Pneumomediastinum creation, in blunt chest trauma, results from Mackin effect in more than 95% of cases. Objectives: In this article we report two cases of blunt chest trauma, underlining the relationship between Macklin effect, pneumomediastinum and pneumoperitoneum, and analysing conservative and invasive treatment. Case reports: We report two cases of blunt chest trauma with Pneumomediastinum creation and no evidence of airway lesions. The first patient presented with malignant pneumomediastinum, created by Macklin effect, and pneumoperitoneum with intra-abdominal hypertension. He underwent invasive treatment. The second case shows how Macklin effect can be self-limiting. This patient underwent conservative treatment. Conclusions: In any case of post-traumatic pneumomediastinum, the Macklin effect should be suspected. Clinical observation is the treatment of choice since Macklin effect is self-limiting. There are some life-threatening event, like malignant pneumomediastinum and intra-abdominal hypertension that must be relieved and treated immediately.
European Journal of Vascular and Endovascular Surgery, 1999
Introduction previous operations. Duplex scan and angiography showed occlusion of the common ilia... more Introduction previous operations. Duplex scan and angiography showed occlusion of the common iliac artery, site of Because chronic renal failure is a known risk factor for previous transplants, and mild atherosclerotic lesions atherosclerosis and longer survival for haemodialysis in the infrainguinal vessels. The ankle-brachial index patients has been reported, 1 the occurrence of chronic was 0.3. The reconstruction did well for 30 months. arterial disease and the need for peripheral arterial One month before re-admission he started a therapy reconstruction are increasing in this group of patients. 2 based on rHuEPO (3000 IU 3 times/week) because of Human erythropoietin (rHuEPO) has been introduced moderate anaemia (red blood cell count=2.8×10 6 / to reverse the severe anaemia of end-stage renal disl reference range: 3.9-5.5×10 6 / l-platelet count= ease and to improve life quality of chronic uraemic 85×10 3 / l, reference range: 150-450×10 3 / l-haemopatients. 3 globin=8.8 g/dl, reference range: 14.0-17.5 g/dl-Several reports have recently focused on the risky haematocrit=27%, reference range: 41-50%). At preside-effect of this therapy if haemoglobin concentration sentation he was afebrile, blood pressure was in the is normalised to levels of 13.5-16.5 g/dl. An increased reference values. Laboratory tests showed a red blood thrombogenicity of prosthetic arterial access for cell count of 4.26×10 6 / l, a haematocrit of 37.4%, haemodialysis and an increase in cardiac-related fata haemoglobin of 10.8 g/dl, a platelets count of alities are possible side-effects of this therapy. 4-6 128×10 3 / l and a white blood cell count of 2.72 (reference range: 4.5-11.0×10 3 / l). Studies to assess the coagulative profile (PT, PTT, fibrinogen and AT-III) were within the reference range. The right lower limb Case Report was cold and no distal pulses were palpable. A thrombectomy of the occluded graft was successfully A 53-year-old patient under recombinant human carried out. No signs of infection or myointimal hypererythropoietin (rHuEPO) had recurrent thrombosis of plasia were observed. Postoperatively all distal pulses an axillofemoral bypass graft. In 1981, he made two unsuccessful kidney transplants for chronic glo-were present and the ankle-brachial index was 0.8. The merulonephritis that resulted in end-stage renal failpostoperative course was complicated by an episode of ure. Thereafter, he started chronic haemodialysis on a angina pectoris. rHuEPO therapy was continued at 3-day basis. In 1995, he underwent a right axillofemoral the same dosage. One month after discharge the patient bypass graft (externally supported Dacron, 8 mm in was re-admitted for critical ischaemia of the right diameter) for critical ischaemia. An abdominal upper and lower limbs. The bypass was occluded procedure was contraindicated because of multiple and the ispilateral upper and lower limb pulses were absent. Laboratory tests were comparable to those of the last admission. An emergency operation was * Please address all correspondence to: A. Mingoli, First Department planned, but the patient had a fatal myocardial in
Small bowel intussusception in adults is a rare surgical disease which almost always occurs as a ... more Small bowel intussusception in adults is a rare surgical disease which almost always occurs as a complication of either benign or malignant lesion of the bowel that is working as a leading point. In adults, the surgical approach consists of the resection of the bowel involved to ensure the excision of the lesion below. The authors report a case of ileocecal intussusception occurred in a young woman, 35 years old, observed for abdominal pain and signs of small bowel occlusion. She underwent surgical resection of the ileocecal segment with laparoscopic approach. The authors discuss the feasibility of the laparoscopic approach in this rare surgical disease and its benefits in terms of patient's postoperative comfort and outcome.
A case of grade IV renal trauma is reported and the literature reviewed. A 29-year-old man was ad... more A case of grade IV renal trauma is reported and the literature reviewed. A 29-year-old man was admitted in an emergency setting for a grade IV renal and splenic trauma as a result of a motorcycle accident. Since the patient was haemodynamically stable and the retroperitoneal haematoma was neither expanding nor pulsating, a conservative approach was adopted and the renal trauma was managed with interventional radiology. The case shows that major renal traumas can be usefully managed by non-operative treatment, necessarily consisting in a mutidisciplinary approach
Italian journal of gastroenterology and hepatology
A retrospective study was conducted to determine incidence and predisposing factors of incisional... more A retrospective study was conducted to determine incidence and predisposing factors of incisional hernia after an emergency midline laparotomy. The study population consisted in 197 patients of whom 138 were followed-up for 2 years after surgery. An incisional hernia developed in 25 (18.1%) patients at a mean follow-up of 11.2 months. Multivariate analysis showed the importance of age (> 60 years, p < 0.004), obesity (p < 0.008) and occurrence of post-operative wound infection (p < 0.00001) for the development of an incisional hernia. Univariate analysis showed that intestinal occlusion (p < 0.02), peritonitis (p < 0.006), upper abdominal access (p < 0.04) and post-operative wound infection (p < 0.003) in older patients and obesity (p < 0.003) and the presence of a neoplasm (p < 0.006) in younger patients, played a significant role. The comparison between young and old patients showed that upper abdominal access (p < 0.007), interrupted and layered w...
Background: Pneumomediastinum creation, in blunt chest trauma, results from Mackin effect in more... more Background: Pneumomediastinum creation, in blunt chest trauma, results from Mackin effect in more than 95% of cases. Objectives: In this article we report two cases of blunt chest trauma, underlining the relationship between Macklin effect, pneumomediastinum and pneumoperitoneum, and analysing conservative and invasive treatment. Case reports: We report two cases of blunt chest trauma with Pneumomediastinum creation and no evidence of airway lesions. The first patient presented with malignant pneumomediastinum, created by Macklin effect, and pneumoperitoneum with intra-abdominal hypertension. He underwent invasive treatment. The second case shows how Macklin effect can be self-limiting. This patient underwent conservative treatment. Conclusions: In any case of post-traumatic pneumomediastinum, the Macklin effect should be suspected. Clinical observation is the treatment of choice since Macklin effect is self-limiting. There are some life-threatening event, like malignant pneumomediastinum and intra-abdominal hypertension that must be relieved and treated immediately.
European Journal of Vascular and Endovascular Surgery, 1999
Introduction previous operations. Duplex scan and angiography showed occlusion of the common ilia... more Introduction previous operations. Duplex scan and angiography showed occlusion of the common iliac artery, site of Because chronic renal failure is a known risk factor for previous transplants, and mild atherosclerotic lesions atherosclerosis and longer survival for haemodialysis in the infrainguinal vessels. The ankle-brachial index patients has been reported, 1 the occurrence of chronic was 0.3. The reconstruction did well for 30 months. arterial disease and the need for peripheral arterial One month before re-admission he started a therapy reconstruction are increasing in this group of patients. 2 based on rHuEPO (3000 IU 3 times/week) because of Human erythropoietin (rHuEPO) has been introduced moderate anaemia (red blood cell count=2.8×10 6 / to reverse the severe anaemia of end-stage renal disl reference range: 3.9-5.5×10 6 / l-platelet count= ease and to improve life quality of chronic uraemic 85×10 3 / l, reference range: 150-450×10 3 / l-haemopatients. 3 globin=8.8 g/dl, reference range: 14.0-17.5 g/dl-Several reports have recently focused on the risky haematocrit=27%, reference range: 41-50%). At preside-effect of this therapy if haemoglobin concentration sentation he was afebrile, blood pressure was in the is normalised to levels of 13.5-16.5 g/dl. An increased reference values. Laboratory tests showed a red blood thrombogenicity of prosthetic arterial access for cell count of 4.26×10 6 / l, a haematocrit of 37.4%, haemodialysis and an increase in cardiac-related fata haemoglobin of 10.8 g/dl, a platelets count of alities are possible side-effects of this therapy. 4-6 128×10 3 / l and a white blood cell count of 2.72 (reference range: 4.5-11.0×10 3 / l). Studies to assess the coagulative profile (PT, PTT, fibrinogen and AT-III) were within the reference range. The right lower limb Case Report was cold and no distal pulses were palpable. A thrombectomy of the occluded graft was successfully A 53-year-old patient under recombinant human carried out. No signs of infection or myointimal hypererythropoietin (rHuEPO) had recurrent thrombosis of plasia were observed. Postoperatively all distal pulses an axillofemoral bypass graft. In 1981, he made two unsuccessful kidney transplants for chronic glo-were present and the ankle-brachial index was 0.8. The merulonephritis that resulted in end-stage renal failpostoperative course was complicated by an episode of ure. Thereafter, he started chronic haemodialysis on a angina pectoris. rHuEPO therapy was continued at 3-day basis. In 1995, he underwent a right axillofemoral the same dosage. One month after discharge the patient bypass graft (externally supported Dacron, 8 mm in was re-admitted for critical ischaemia of the right diameter) for critical ischaemia. An abdominal upper and lower limbs. The bypass was occluded procedure was contraindicated because of multiple and the ispilateral upper and lower limb pulses were absent. Laboratory tests were comparable to those of the last admission. An emergency operation was * Please address all correspondence to: A. Mingoli, First Department planned, but the patient had a fatal myocardial in
Small bowel intussusception in adults is a rare surgical disease which almost always occurs as a ... more Small bowel intussusception in adults is a rare surgical disease which almost always occurs as a complication of either benign or malignant lesion of the bowel that is working as a leading point. In adults, the surgical approach consists of the resection of the bowel involved to ensure the excision of the lesion below. The authors report a case of ileocecal intussusception occurred in a young woman, 35 years old, observed for abdominal pain and signs of small bowel occlusion. She underwent surgical resection of the ileocecal segment with laparoscopic approach. The authors discuss the feasibility of the laparoscopic approach in this rare surgical disease and its benefits in terms of patient's postoperative comfort and outcome.
A case of grade IV renal trauma is reported and the literature reviewed. A 29-year-old man was ad... more A case of grade IV renal trauma is reported and the literature reviewed. A 29-year-old man was admitted in an emergency setting for a grade IV renal and splenic trauma as a result of a motorcycle accident. Since the patient was haemodynamically stable and the retroperitoneal haematoma was neither expanding nor pulsating, a conservative approach was adopted and the renal trauma was managed with interventional radiology. The case shows that major renal traumas can be usefully managed by non-operative treatment, necessarily consisting in a mutidisciplinary approach
Background: Rome hosts thousands of sensible targets. Healthcare reaction has been guaranteed by ... more Background: Rome hosts thousands of sensible targets. Healthcare reaction has been guaranteed by 6 advanced Emergency Departments (EDs) and 7 basic ones. Everyday Rome hosts 6 millions of people/die, ± 2 million in particular occasions. About National Stockpile Antidotes (SNA), Rome hosts 3 warehouses. In case of events, stockpiles are activated with a long-time call; then stockpiles are charged in delivering trucks. Methods: Study analyzes PEIMAF (State of emergency plans for massive influx of injures) of advanced EDs in Rome and their adequacy in a possible CBRNe attack. Hypothesis of C/N attack on Saint Peter’s Square during Angelus on Wednesday (at 12.00 AM) or E attack in Trastevere on Saturday (at 9.00 PM). Analysis of activation of SNA and travel times between SNA warehouse and EDs. Comparison with French EDs during Paris attacks. Finding: EDs are chronically undermanned in ordinary conditions already, and would have issues in hosting a very large number of critical patients all at once. Some hospitals do not inform their workers about PEIMAF or they do not consider CBRNe emergencies in their PEIMAF, and even if it has been considered, hardly any simulation/exercitation is ever performed. Moreover, news of the CBRNe attack may not reach immediately the healthcare personal already at work in EDs; this is extremely problematic since they could be at major risk of contamination in case of CBRNe attacks. Furthermore, without a standardize protocol active in the whole city, no cross-hospital organization can be performed.
Conclusion: All data point towards the weakness and fragmentation of actual organizative system. Time of activation and charging are crucials for first aid efficacy and efficiency; a smart call system can reduce the activation time of SNA. A better organization of SNA in major Rome hospitals can reduce delivering time and help save more lives.
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Papers by Claudio Modini
About National Stockpile Antidotes (SNA), Rome hosts 3 warehouses. In case of events, stockpiles are activated with a long-time call; then stockpiles are charged in delivering trucks.
Methods: Study analyzes PEIMAF (State of emergency plans for massive influx of injures) of advanced EDs in Rome and their adequacy in a possible CBRNe attack.
Hypothesis of C/N attack on Saint Peter’s Square during Angelus on Wednesday (at 12.00 AM) or E attack in Trastevere on Saturday (at 9.00 PM).
Analysis of activation of SNA and travel times between SNA warehouse and EDs.
Comparison with French EDs during Paris attacks.
Finding: EDs are chronically undermanned in ordinary conditions already, and would have issues in hosting a very large number of critical patients all at once.
Some hospitals do not inform their workers about PEIMAF or they do not consider CBRNe emergencies in their PEIMAF, and even if it has been considered, hardly any simulation/exercitation is ever performed.
Moreover, news of the CBRNe attack may not reach immediately the healthcare personal already at work in EDs; this is extremely problematic since they could be at major risk of contamination in case of CBRNe attacks.
Furthermore, without a standardize protocol active in the whole city, no cross-hospital organization can be performed.
Conclusion: All data point towards the weakness and fragmentation of actual organizative system. Time of activation and charging are crucials for first aid efficacy and efficiency; a smart call system can reduce the activation time of SNA. A better organization of SNA in major Rome hospitals can reduce delivering time and help save more lives.