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Search Results: 1 - 10 of 2910 matches for " Enrico Ferri "
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In-hospital brain natriuretic peptide and N-terminal prohormone brain natriuretic peptide variations are predictors of short-term and long-term outcome in acute decompensated heart failure
Salvatore Di Somma, Laura Magrini, Enrico Ferri
Critical Care , 2011, DOI: 10.1186/cc9970
Abstract: In the present issue of Critical Care, Noveanu and colleagues evaluated brain natriuretic peptide (BNP) and N-terminal prohormone brain natriuretic peptide (NT-proBNP) serial measurements as predictive of 30-day and 1-year mortality and readmission in patients admitted to the emergency department for acute decompensated heart failure (ADHF) [1].The usefulness of measuring BNP and NT-proBNP in the diagnosis and management of congestive heart failure is well known [2,3]. Both BNP and NT-proBNP are useful for diagnosis in patients presenting with undifferentiated dyspnoea in the emergency department and have been shown to accurately reflect heart failure severity and prognosis [3-6]. Moreover, in some studies, serial BNP evaluations have been demonstrated to be useful in clinical management [7].Noveanu and colleagues showed during 1-year followup in a multivariate analysis that BNP at 24 hours (mean 95% confidence interval) (1.02 (1.01 to 1.04), P = 0.003), at 48 hours (1.04 (1.02 to 1.06), P < 0.001) and at discharge (1.02 (1.01 to 1.03), P < 0.001) independently predicted 1-year mortality, while only predischarge NT-proBNP was predictive (1.07 (1.01 to 1.13), P = 0.016). Comparable results could be obtained for the secondary endpoint of 30-day mortality but not for 1-year heart failure readmissions.These results from Noveanu and colleagues' paper are in accordance with data reported by our group [8]. We demonstrated that a reduction of BNP >46% at hospital discharge coupled with a BNP absolute value <300 pg/ml resulted in a very powerful negative prognostic value for future cardiovascular outcomes in patients hospitalised with ADHF [8].Other studies demonstrated the usefulness of repeated measurements of natriuretic peptides during hospitalisation in predicting survival of ADHF patients [8-11]. BNP variations during hospitalisation could give prognostic information, particularly at discharge, and could also suggest a qualitative variation of treatment (intensificatio
Focus Harmonic Scalpel Compared to Conventional Haemostasis in Open Total Thyroidectomy: A Prospective Randomized Trial
Emanuele Ferri,Enrico Armato,Giacomo Spinato,Roberto Spinato
International Journal of Otolaryngology , 2011, DOI: 10.1155/2011/357195
Abstract: The aim of this prospective randomized trial was to compare operative factors, postoperative outcomes and surgical complications of open total thyroidectomy when using the Harmonic Scalpel (HS) versus Conventional Haemostasis (CH). Methods. 100 consecutive patients underwent open total thyroidectomy were randomized into two groups: group CH (Conventional Haemostasis) and group HS (Harmonic Scalpel). We recorded the following: age, sex, pathology, thyroid volume, haemostatic technique, operative time, drainage volume, thyroid weight, postoperative pain, postoperative complications, and hospital stay. The results were analyzed using the Student’s t test and 2 test. Results. No significant difference was found between the two groups concerning mean thyroid weight and mean hospital stay. The mean operative time was significantly shorter in the HS group. The total drainage fluid volume was lower in HS group. Two (4%) transient recurrent laryngeal nerve palsies were observed in CH group and no one (0%) in the HS group. Postoperative transient hypocalcemia occurred more frequently in the CH group. HS group experienced significantly less postoperative pain at 24 and 48 hours. Conclusions. In patients undergoing thyroidectomy, HS is a reliable and safe tool. Comparing with CH techniques, its use reduces operative times, postoperative pain, drainage volume and transient hypocalcemia.
Congenital nasal pyriform aperture stenosis: diagnosis and management
Enrico Sesenna, Massimiliano Leporati, Bruno Brevi, Gabriele Oretti, Andrea Ferri
Italian Journal of Pediatrics , 2012, DOI: 10.1186/1824-7288-38-28
Abstract: Three cases of congenital nasal pyriform aperture stenosis were reviewed for presentation of the disorder, management and effectiveness of the surgical treatment.All the patients underwent a surgical correction of the pyriform aperture stenosis using a sublabial approach followed by nasal stenting. During the follow-up no cases of restenosis, respiratory failure or cyanosis were detected.Congenital pyriform aperture stenosis should be suspected in newborns with clinical signs of severe nasal obstruction associated with a difficulty to pass a small catheter though the anterior nasal valve. Timely recognition is mandatory to prevent a potential deadly outcome. Surgical correction of the stenosis though a sublabial approach followed by a nasal stenting revealed to be most effective treatment for these patients.
Endovascular aortic graft infection resulting in retroperitoneal abscess: report of a case
Enrico Ferri,Laura Magrini,Marco Alfano,Michela Del Parco
Emergency Care Journal , 2010, DOI: 10.4081/ecj.2010.2.7
Abstract: Infection is a rare complication of aortoiliac endovascular procedures, with an incidence inferior to 0.5%, and it may result in a retroperitoneal abscess potentially evolving to sepsis and gastrointestinal bleeding. In more than 50% of cases endovascular aortoiliac prosthetic grafts infection occur months or years after the procedure. The growing number of endovascular procedures, and as the actually midterm follow up in most cases, septic sequelae will no doubt continue to occur with increased frequency and may represent an emerging problem in the ED for the emergency physician. Endovascular graft infection begins with unspecific clinical manifestations. An high index of suspicion in any patient with an aortic stent graft presenting prolonged or recurrent fever and or abdominal or back pain and a low threshold for obtaining CT scan should increase the clinician’s ability to make a timely diagnosis in the ED setting.
How public ambulance arrivals impact on Emergency Department workload and resource use
Enrico Ferri,Laura Magrini,Marco Alfano,Michele Del Parco
Emergency Care Journal , 2010, DOI: 10.4081/ecj.2010.1.23
Abstract: Objectives: To examine patient’s characteristics associated with ED arrival mode, and to determine EMS impact on ED clinical resource use, workload and crowding. Methods: This is a retrospective study of patients seen at Sant’Andrea Hospital ED. Comparison focused on visit characteristics, and on resource use. Results: The use of EMS ambulance confirms association to older age, higher rate of hospital admission, longer length of stay, and severity of injury. Moreover our data show that ambulance referred patients are triaged into a higher acuity category and have a greater intensive care unit admission. Conclusion: Ambulance arrivals have a significant impact on ED resource use, workload and crowding.
Focus Harmonic Scalpel Compared to Conventional Haemostasis in Open Total Thyroidectomy: A Prospective Randomized Trial
Emanuele Ferri,Enrico Armato,Giacomo Spinato,Roberto Spinato
International Journal of Otolaryngology , 2011, DOI: 10.1155/2011/357195
Abstract: The aim of this prospective randomized trial was to compare operative factors, postoperative outcomes and surgical complications of open total thyroidectomy when using the Harmonic Scalpel (HS) versus Conventional Haemostasis (CH). Methods. 100 consecutive patients underwent open total thyroidectomy were randomized into two groups: group CH (Conventional Haemostasis) and group HS (Harmonic Scalpel). We recorded the following: age, sex, pathology, thyroid volume, haemostatic technique, operative time, drainage volume, thyroid weight, postoperative pain, postoperative complications, and hospital stay. The results were analyzed using the Student’s t test and test. Results. No significant difference was found between the two groups concerning mean thyroid weight and mean hospital stay. The mean operative time was significantly shorter in the HS group. The total drainage fluid volume was lower in HS group. Two (4%) transient recurrent laryngeal nerve palsies were observed in CH group and no one (0%) in the HS group. Postoperative transient hypocalcemia occurred more frequently in the CH group. HS group experienced significantly less postoperative pain at 24 and 48 hours. Conclusions. In patients undergoing thyroidectomy, HS is a reliable and safe tool. Comparing with CH techniques, its use reduces operative times, postoperative pain, drainage volume and transient hypocalcemia. 1. Introduction The pioneers of thyroid surgery, Theodor Kocher and Theodor Billroth, developed an acceptable technique of standardized thyroid surgery between 1873 and 1883. By 1920, the principles of safe and efficient thyroid surgery were already established [1]. They consist of three basic phases: identification and ligation of vessels, identification and preservation of laryngeal nerves, and parathyroid glands. Basic surgical instruments are not significantly changed; the main innovations are new methods of coagulation and vascular section. During the last decade, alternative techniques for improving safety, effectiveness, and even invasiveness of thyroidectomy have been proposed, including video-assisted, and endoscopic surgery, nerve monitoring, and less invasive forms of anesthesia [2]. Bleeding remains one of the major postoperative complications of thyroid surgery, with the potential to cause life-threatening airway obstruction. During thyroidectomy, bleeding can obscure the operative field, making safe dissection of the recurrent laryngeal nerve (RLN), and parathyroid glands difficult. Effective vessel haemostasis can be achieved by using the conventional clamp-and-tie
Harmonic Scalpel versus Conventional Haemostasis in Neck Dissection: A Prospective Randomized Study
Emanuele Ferri,Enrico Armato,Giacomo Spinato,Marcello Lunghi,Giancarlo Tirelli,Roberto Spinato
International Journal of Surgical Oncology , 2013, DOI: 10.1155/2013/369345
Abstract: Purpose. The aim of this prospective randomized trial was to compare operative factors, postoperative outcomes, and surgical complications of neck dissection (ND) when using the harmonic scalpel (HS) versus conventional haemostasis (CH) (classic technique of tying and knots, resorbable ligature, and bipolar diathermy). Materials and methods. Sixty-one patients who underwent ND with primary head and neck cancer (HNSCC) resection were enrolled in this study and were randomized into two homogeneous groups: CH (conventional haemostasis with classic technique of tying and knots, resorbable ligature, and bipolar diathermy) and HS (haemostasis with harmonic scalpel). Outcomes of the study included operative time, intraoperative blood loss, drainage volume, postoperative pain, hospital stay, and incidence of intraoperative and postoperative complications. Results. The use of the HS reduced significantly the operating time, the intraoperative blood loss, the postoperative pain, and the volume of drainage. No significant difference was observed in mean hospital stay and perioperative, and postoperative complications. Conclusion. The HS is a reliable and safe tool for reducing intraoperative blood loss, operative time, volume of drainage and postoperative pain in patients undergoing ND for HNSCC. Multicenter randomized studies need to be done to confirm the advantages of this technique and to evaluate the cost-benefit ratio. 1. Introduction Major otolaryngology procedures are often complicated by challenging anatomy, complex reconstructions, and long operative times. Furthermore, many patients undergoing these treatments have comorbid medical conditions that complicate their care and may cause perioperative complications. Neck dissection (ND) has been recognized as an integral part of the surgical therapy of head and neck cancer since the 19th century [1, 2]. Since then, many technical changes have been proposed; in particular, it has been modified to preserve vital vascular and nervous structures while maintaining its therapeutic efficacy. ND is commonly used in the treatment of cervical lymphatic metastases of malignant disease of the upper aerodigestive tract, thyroid, parotid, and skin of the head and neck. Although the rate of complications following ND accounts from 6% to 28%, it is generally a well-tolerated procedure. Most complications affect local tissue only and typically do not require additional hospitalization. Placement of closed suction drains has been demonstrated to minimize postoperative complications [3–6]. In major head and neck surgery,
Intratympanic Steroid Treatment for Idiopathic Sudden Sensorineural Hearing Loss after Failure of Intravenous Therapy
Emanuele Ferri,Antonio Frisina,Anna Chiara Fasson,Enrico Armato,Giacomo Spinato,Maurizio Amadori
ISRN Otolaryngology , 2012, DOI: 10.5402/2012/647271
Abstract: Purpose. The aim of this study is the investigation of the effectiveness of intratympanic steroids therapy (IST) in patients with idiopathic sudden sensorineural hearing loss (ISSHL) who had not responded to intravenous treatment, evaluating the overall hearing recovery and comparing the results with different variables. Materials and Methods. Our study consisted of 55 patients with refractory ISSHL who, at the end of 10 days of therapy with intravenous steroids, had puretone 4-frequency average (PTA) of worse than 30?dB. The patients received 0.5?mL of methylprednisolone by direct intratympanic injection. The procedure was carried out up to 7 times within a 20-days period. Statistical analysis was carried out. Results. Overall 29 patients (52.7%) showed improvement in PTA, 24 (43.8%) had no change in hearing, and 2 (3.5%) worsened. There was a significant statistical correlation between hearing recovery and time to onset of symptoms, severity of hearing loss and frequency of hearing loss. Conclusions. IST is an effective and safe therapy in sudden sensorineural hearing loss cases that are refractory to standard treatment. The earlier IST, the hearing losses less than 90 dB and the involvement of the low frequencies seem to influence positively the hearing recovery. 1. Introduction Nearly 60 years after the first report of idiopathic sudden sensorineural hearing loss (ISSHL) [1], the otologists are still searching answers to the etiology, physiopathology and therapeutical management of this disorder. The most common theories of the etiology of ISSHL include viral infection, vascular occlusion with microcirculatory disturbances, immunologic diseases, and intralabyrinthine membrane breaks [2–6]. ISSHL usually presents as an acute unilateral deafness of more than 30?dB hearing loss involving three contiguous frequencies, with an abrupt onset, generally within three days or less. It occurs in 5–20 cases per 100.000 population. This is approximately the same incidence as Ménière’s syndrome (15 per 100000) and twenty times more common than acoustic neurinoma (1 per 100000) [2, 7]. The true incidence of ISSHL is probably underestimated because many who recover hearing early are unlikely to seek medical therapy. Many treatments for ISSHL have been tested and found ineffective. These include hyperbaric oxygen, agents that decrease blood viscosity (osmotic diuretics, pentoxifylline, procaine, and heparin), vasodilator drugs (histamine, papaverine, verapamil, and carbogen), free radical scavenging vitamins, gingko biloba, and magnesium. At this time, the only
Experimental evidence of high-resolution ghost imaging and ghost diffraction with classical thermal light
Davide Magatti,Fabio Ferri,Alessandra Gatti,Morten Bache,Enrico Brambilla,Luigi A. Lugiato
Physics , 2004, DOI: 10.1103/PhysRevLett.94.183602
Abstract: High-resolution ghost image and ghost diffraction experiments are performed by using a single source of thermal-like speckle light divided by a beam splitter. Passing from the image to the diffraction result solely relies on changing the optical setup in the reference arm, while leaving untouched the object arm. The product of spatial resolutions of the ghost image and ghost diffraction experiments is shown to overcome a limit which was formerly thought to be achievable only with entangled photons.
Additive value of blood neutrophil gelatinase-associated lipocalin to clinical judgement in acute kidney injury diagnosis and mortality prediction in patients hospitalized from the emergency department
Salvatore Di Somma, Laura Magrini, Benedetta De Berardinis, Rossella Marino, Enrico Ferri, Paolo Moscatelli, Paola Ballarino, Giuseppe Carpenteri, Paola Noto, Biancamaria Gliozzo, Lorenzo Palladino, Enrico Di Stasio
Critical Care , 2013, DOI: 10.1186/cc12510
Abstract: This is a multicenter Italian prospective emergency department (ED) cohort study in which we enrolled 665 patients admitted to hospital from the ED.Blood NGAL and serum creatinine (sCr) where determined at ED presentation (T0), and at: 6 (T6), 12 (T12), 24 (T24) and 72 (T72) hours after hospitalization. A preliminary assessment of AKI by the treating ED physician occurred in 218 of 665 patients (33%), while RIFLE AKI by expert nephrologists was confirmed in 49 of 665 patients (7%). ED physician's initial judgement lacked sensitivity and specificity, over predicting the diagnosis of AKI in 27% of the cohort, while missing 20% of those with AKI final diagnosis. The area under the receiver operating characteristic curve (AUC), obtained at T0, for blood NGAL alone in the AKI group was 0.80. When NGAL at T0 was added to the ED physician's initial clinical judgment the AUC was increased to 0.90, significantly greater when compared to the AUC of the T0 estimated glomerular filtration rate (eGFR) obtained either by modification of diet in renal disease (MDRD) equation (0.78) or Cockroft-Gault (0.78) formula (p=0.022 and p=0.020 respectively). The model obtained by combining NGAL with ED physician's initial clinical judgement compared to the model combining sCr with the ED physician's initial clinical judgement, resulted in a net reclassification index of 32.4 percentage points. Serial assessment of T0 and T6 hours NGAL provided a high negative predictive value (NPV) (98%) in ruling out the diagnosis of AKI within 6 hours of patients' ED arrival. NGAL (T0) showed the strongest predictive value for in-hospital patient's mortality at a cut-off of 400 ng/ml.Our study demonstrated that assessment of a patient's initial blood NGAL when admitted to hospital from the ED improved the initial clinical diagnosis of AKI and predicted in-hospital mortality. Blood NGAL assessment coupled with ED physician's clinical judgment may provide utility in deciding the appropriate strategies for
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