Annali italiani di chirurgia最新文献

{"title":"Appendectomy in the Training Program of General Surgery: Entrustable Professional Activity?","authors":"Anna Rossetto, Vittoria Morinelli, Davide Muschitiello, Rosanna Quattrin, Giovanni Terrosu, Vittorio Bresadola","doi":"10.62713/aic.3957","DOIUrl":"10.62713/aic.3957","url":null,"abstract":"<p><strong>Aim: </strong>The training of medical specialists is a decisive issue for the quality of medical practice. Autonomization in simple procedures and applying the peer education concept seem promising, particularly for general surgery. With this work, we wanted to assess whether there are differences between appendectomy operations performed by differently composed teams with the active involvement of resident doctors at a university centre.</p><p><strong>Methods: </strong>We retrospectively analyzed the laparotomies and laparoscopic appendicectomies carried out at the Udine Surgery Clinic over a period of 10 years. The interventions were divided into groups according to the experience of the surgical team that performed them: G1 (consultant), G2 (senior resident + consultant), G3 (junior resident + consultant), and G4 (junior resident + senior resident).</p><p><strong>Results: </strong>510 appendectomy procedures were considered for the present analysis. 214 (42.0%) were performed by G1, 139 (27.3%) by G2, 79 (15.5%) by G3 and 78 (15.3%) by G4 group. No difference between the groups was shown in terms of complications, reinterventions, readmissions, length of stay, and duration of surgery. A statistically significant difference was shown in the age of the observed population with respect to the degree of experience of the surgical teams: younger patients were mainly operated on by more experienced teams, and in particular, pediatric laparoscopic appendectomy was performed mainly by consultants.</p><p><strong>Conclusions: </strong>Appendectomy surgery can be performed by teams with varying levels of experience and is an example of an activity that can be used in Peer Education. It allows for the empowerment of younger residents and the autonomization of older residents in maintaining a medically, ethically, and legally correct standard of safe clinical practice.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"269-276"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipofilling of the Upper Eyelid for Patients Affected by Facial Nerve Palsy.","authors":"Valentina Terenzi, Marco Della Monaca, Marco Marenco, Ingrid Raponi, Danilo Di Giorgio, Daniele Di Carlo, Fiorenza Dal Cortivo, Andrea Cassoni, Valentino Valentini","doi":"10.62713/aic.3956","DOIUrl":"10.62713/aic.3956","url":null,"abstract":"<p><strong>Aim: </strong>The use of upper eyelid lipofilling to prevent ocular complications in patients affected by facial nerve palsy is compared to other treatment options.</p><p><strong>Case presentation: </strong>Ten patients treated with lipofilling of the upper eyelid, who were indicated for facial rehabilitation were identified from the Maxillo-facial Surgery Unit, Policlinico Umberto I. For all patients, fat harvested from the abdomen was processed with soft and short centrifugation.</p><p><strong>Results: </strong>Satisfactory aesthetical and functional results were obtained in most cases. All patients reported a considerable reduction in the use of artificial tear drops and ointment for corneal lubrication. A second procedure was needed in one case to refill the eyelid, and in another one to correct poor aesthetical results. No patients developed postoperative ocular surface disorders.</p><p><strong>Conclusions: </strong>The lipofilling of the upper eyelid procedure was easy to perform, leading to minimal complications rate. Given the small sample size and variability of samples collected in the current study, future studies involving larger cohorts are required to validate the efficacy of upper eyelid lipofilling in comparison to other treatments.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"138-142"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Reappraisal of Lymph Node Dissection for Gastric Adenocarcinoma during Upfront Gastrectomy-An Institutional Report.","authors":"Chun-Hao Lee, Hui-Ting Lee, Shin-Ting Yeh, Chang-Youh Tsai, Heng-Hui Lien, Chen-Sung Lin","doi":"10.62713/aic.3552","DOIUrl":"10.62713/aic.3552","url":null,"abstract":"<p><strong>Aim: </strong>The role of lymph node dissection (LND) in gastric adenocarcinoma (GAC) remained some controversy. This study reappraised the clinical implications of LND for GAC in terms of the numbers of total lymph node (TLN), positive lymph node (PLN) and negative lymph node (NLN).</p><p><strong>Methods: </strong>A total of 106 GAC patients receiving an upfront gastrectomy (laparoscopic/laparotomy surgery, 19/87) with LND (D1/D1+/D2 dissection, 5/53/48) between Jan 2017 and Dec 2021 in Cathay General Hospital, Taipei were analyzed. The surgical-pathological T-/N-/M-status and cancer stage were determined according to the American Joint Committee on Cancer (AJCC) 8th edition. The numbers of TLN, PLN and NLN were recorded for analysis (TLN = PLN + NLN). The associations between prognosis and related variables, including pathological findings, the clinical implications of TLN/PLN/NLN and extent for LND, were all deeply studied.</p><p><strong>Results: </strong>Advanced T-status (p < 0.001), N-status (p = 0.025), M-status (p = 0.001) and cancer stage (p = 0.001) had a negative effect on survival. The severity of N-status was associated with the progression of T-status (p < 0.001), M-status (p = 0.015) and cancer stage (p < 0.001). For all 106 GAC patients (p = 0.002/0.017) and the 25 T1 GAC patients (p = 0.052/0.015), those undergoing TLN >17 (≥18) had a more PLN and a higher rate of N(+) than those ≤17. For 65 N(+) GAC patients, an extension of TLN to ≥23 allowed the detection of a median value for PLN of 7, the N3-status. NLN >9 (≥10) was related to a better prognosis (p = 0.066) and lower HR (p = 0.073) for N(+) GAC patients. TLN with threshold value ≥20 owned the best power to distinguish NLN >9 (≥10) from ≤9 among N(+) GAC patients (p < 0.001). A D2 dissection could achieve these thresholds, including TLN ≥18 (p = 0.001) for GAC patients, TLN ≥23 (p = 0.028) for N(+) GAC patients, and NLN ≥10 (p = 0.012) as well as TLN ≥20 (p = 0.011) for N(+) GAC patients, more effectively than a D1/D1+ dissection.</p><p><strong>Conclusions: </strong>A value of TLN ≥18 is necessary for de-novo GAC patients during gastrectomy to detect possible N(+) status, and ≥23 is recommended for N(+) GAC patients to identify the possible N3-status. A value of NLN ≥10 could reach a better survival for N(+) GAC patients and it requires a value of TLN ≥20 to achieve. A D2 dissection is recommended for GAC patients during gastrectomy. LND establishes adequate N-status staging and increases survival for GAC patients.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"228-243"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastrointestinal Complications and Laparotomy after Cardiac Surgery: A Retrospective Cohort Study.","authors":"Thomas French, Dimitrios Damaskos, Darja Clinch, Charilaos-Panagiotis Koutsogiannidis","doi":"10.62713/aic.3819","DOIUrl":"10.62713/aic.3819","url":null,"abstract":"<p><strong>Aim: </strong>Gastrointestinal (GI) complications following cardiac surgery are infrequent, but associated with high rates of postoperative mortality. The aim of our study was to identify risk factors predisposing patients to GI complications following cardiac surgery and describe the outcomes of patients suffering a GI complication.</p><p><strong>Methods: </strong>This was a retrospective cohort study of 6769 consecutive patients undergoing cardiac surgeries (at least one of coronary artery bypass grafting (CABG), aortic valve replacement, mitral valve replacement, or surgery on thoracic aorta) at a single Scottish centre between 1 January 2015 and 27 September 2023. Cohort demographics, intra-operative details and postoperative outcomes were compared between patients who did and who did not experience a gastrointestinal GI complication.</p><p><strong>Results: </strong>Patients who experienced a GI complication had greater rates of thirty-day mortality (14.4% vs 2.4%, p < 0.001) and in-hospital mortality (6.8% vs 1.1%, p < 0.001) compared with those who did not. We identified previous percutaneous coronary intervention (PCI) (Odds ratio (OR) 2.27 [1.24-4.17], p = 0.007) and combined cardiac surgery (OR 1.67 [1.02-2.74], p = 0.043) as two risk factors for developing a GI complication, in addition to several previously identified risk factors (postoperative atrial fibrillation, postoperative vascular complication, use of pre-operative inotropes and increased age).</p><p><strong>Conclusions: </strong>GI complications frequently occur in elderly, co-morbid patients and in conjunction with other complications. Particularly lethal are mesenteric ischemia, GI bleeding, and small bowel obstruction. Extra caution should be observed in the patient group undergoing more than one cardiac procedure or those with a prior history of coronary artery disease. Prompt emergency laparotomy is a potentially life-saving intervention in promptly diagnosed patients, but confers a high risk of intra-operative and thirty-day mortality.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 3","pages":"409-420"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Del Nido Cardioplegia Versus Plegisol Solution on Myocardial Protection in Cardiopulmonary Bypass.","authors":"Bişar Amaç, Ertuğrul Ertuğrul, Mustafa Abanoz, Mesut Engin","doi":"10.62713/aic.3817","DOIUrl":"https://doi.org/10.62713/aic.3817","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to compare the efficacy of the routinely used modified del Nido cardioplegia and Plegisol® solution in myocardial protection.</p><p><strong>Methods: </strong>In this retrospective study, patients who underwent cardiopulmonary bypass (CPB) guided cardiac surgery and received del Nido cardioplegia solution (Group 1) and Plegisol® solution (Group 2) were compared in terms of early clinical data and myocardial protection.</p><p><strong>Results: </strong>This study included 68 patients with similar demographic characteristics who received 38 modified del Nido cardioplegia and 30 Plegisol® solutions. Creatine kinase-myocardial bound (CK-MB) and cardiac troponin T (CTnT) levels on postoperative day 1 and CTnT levels on postoperative day 5 were higher in Group 2 and there was a significant difference between the groups (p = 0.025, p = 0.001, p = 0.001, respectively). In addition, the postoperative inotrope requirement and postoperative vasoactive-inotropic score were higher in Group 2 and there was a significant difference between the two groups (p = 0.004, p = 0.002, respectively).</p><p><strong>Conclusions: </strong>In this study, the del Nido cardioplegia solution was found to be more advantageous regarding the need for intracardiac defibrillation and myocardial necrosis, although it showed similar results in some points when compared with the Plegisol® solution.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 4","pages":"488-495"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Early and Delayed Fat Transplantation on Scar Quality in Post-Traumatic Reconstruction.","authors":"Jing Liu, Chang Liu, Yangang Song, Ting Shang, Chen Yang, Hongyu Yin, Yanfu Han","doi":"10.62713/aic.3889","DOIUrl":"https://doi.org/10.62713/aic.3889","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the effects of early versus delayed fat transplantation on post-traumatic scars using adipose-derived stem cells (ADSCs) to enhance scar quality and address the aesthetic and psychological challenges in reconstructive surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included 223 patients treated at Capital Medical University Beijing Shijitan Hospital between June 2022 and June 2023. Scar quality was evaluated using the Vancouver Scar Scale (VSS) and scar width measurements at 1, 3, and 4 months postoperatively. Complications were monitored during hospital stays and follow-up visits, while Quality of Life was assessed using the World Health Organization Quality of Life brief version (WHOQOL-BREF).</p><p><strong>Results: </strong>A retrospective cohort study of 223 patients with post-traumatic scars was conducted to compare the outcomes of early (n = 108) versus delayed (n = 115) fat grafting. Scar width reduction was significantly greater in the early group at 3 months (1.19 ± 0.30 cm) and 4 months (1.97 ± 0.58 cm) compared to the delayed group (1.31 ± 0.34 cm at 3 months and 2.15 ± 0.55 cm at 4 months; p < 0.05). The early group also demonstrated better VSS scores at 3 months (6.35 ± 1.26) and 4 months (2.16 ± 0.78) than the delayed group (6.81 ± 1.48 at 3 months and 2.37 ± 0.28 at 4 months; p < 0.05). However, the early group exhibited a higher complication rate (9.26% vs. 2.61%; p = 0.034). No significant difference was found in Quality of Life scores between the two groups.</p><p><strong>Conclusions: </strong>Early fat transplantation improves scar quality but is associated with a higher complication rate.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 4","pages":"505-513"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Perioperative Finger Sensory Rehabilitation in Patients Undergoing Fingertip Amputation and Reimplantation: A Retrospective Study.","authors":"Shibo Gao, Chao Yang","doi":"10.62713/aic.3755","DOIUrl":"10.62713/aic.3755","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;Finger reimplantation is an effective method for the treatment of amputated fingertips. However, there are several shortcomings in traditional postoperative rehabilitation programs, which may affect a patient's functional recovery after surgery. Finger sensory rehabilitation is a comprehensive program that helps patients restore sensory and motor function to their fingers through the use of specific training methods and equipment. Thus, this study aimed to analyze the effect of finger sensory rehabilitation on a group of patients who had undergone fingertip amputation and reimplantation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The medical records of 106 patients having undergone fingertip amputation and reimplantation from January 2022 to January 2024 were retrospectively analyzed. The patients were classified into experimental group (n = 52, receiving conventional rehabilitation training + finger sensory rehabilitation training) and the control group (n = 54, receiving only conventional rehabilitation training). Patients in both groups participated in a 20-week rehabilitation training, and the Semmes-Weinstein monofilament test was used to evaluate the finger touch pressure sensation after completing the rehabilitation training in both groups, and the Visual Analogue Scale (VAS) score, Generic Quality of Life Inventory-74 (GQOLI-74) score to evaluate their pain sensation and quality of life on the 2nd postoperative day and at the end of rehabilitation training.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;After completing rehabilitation, a specialized method for assessing the patient's tactile sensory deficits was used, showing that the number of cases with light tactile hypoesthesia to single-fiber sensation in the reimplanted fingertips was higher in the experimental group than in the control group (p &lt; 0.01), while there was no significant difference in the number of cases of protective hypoesthesia between the two groups (p &gt; 0.05), the number of cases of protective sensory loss was significantly lower in the experimental group than in the control group (p &lt; 0.01). There was no significant difference in the pain scores and comfort scores between the two groups before management (p &gt; 0.05). However, the pain level of the two groups after management was significantly lower than that before management (p &lt; 0.01), whereas the post-management comfort scores of both groups were significantly higher than that before management (p &lt; 0.001). The experimental group's degree of improvement was significantly higher than that of the control group (p &lt; 0.001). The pre-management GQOLI-74 scores were not significantly different between the groups (p &gt; 0.05), whereas after management, the experimental group outperformed the control group in all dimensions of the scores, except in thinking ability (p &lt; 0.01). Although not statistically significant (p &gt; 0.05), the total perioperative complication rate of the experimental group was lower than that of the c","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"55-62"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrochemotherapy for Cancers Affecting the Skin: Ten Years of Experience in a Tertiary Referral Hospital.","authors":"Piero Covarelli, Carlo Boselli, Francesco Barberini, Matteo Matteucci, Georgi Popivanov, Vincenzo De Giorgi, Gianmarco Tomassini, Mario Mandalà, Roberto Cirocchi","doi":"10.62713/aic.3718","DOIUrl":"10.62713/aic.3718","url":null,"abstract":"<p><strong>Aim: </strong>Electrochemotherapy (ECT) combines chemotherapy with an electric pulse to directly target tumor cells by increasing cell membrane permeability, facilitating the efficient uptake of chemotherapeutic agents by tumor cells and improving their therapeutic efficacy. It is widely used for treating skin metastatic nodules or metastases of subcutaneous tissue. Therefore, the aim of this study is to report the experience regarding the use of ECT in a tertiary referral hospital and explore its safety and efficacy in treating skin cancer.</p><p><strong>Methods: </strong>This study included 97 skin cancer patients treated with ECT at the Surgical Oncological Unit of the University of Perugia, Italy, between 2013 and 2024. ECT was performed using the Cliniporator® device (model EP02, IGEA, Carpi, Italy). The individuals with life expectancy greater than three months and American Society of Anesthesiologists physical status classification of I-III were included in this study, while those with arrhythmia and allergies to bleomycin were excluded.</p><p><strong>Results: </strong>In this study, melanoma was the most frequently observed malignancy, accounting for 47.4% of all cases. A total of 46 melanoma patients aged between 42 and 93 years underwent ECT treatment. Most of these patients presented with in-transit metastases (67.4%) and often had multiple lesions (71.74%). Furthermore, 21 patients received only one session, while 25 underwent multiple sessions. Almost all procedures were performed with intravenous administration of bleomycin. However, in two cases, intralesional cisplatin was used for a recurrence of melanoma localized in the scalp. Notably, no adverse events were observed during ECT procedure. Moreover, most of the patients (70.45%) were alive one year after the first ECT session. The 5-year probability of survival was 24% after the first ECT session.</p><p><strong>Conclusions: </strong>Electrochemotherapy represents a safe and effective therapeutic strategy for various malignancies, with significant potential for future clinical applications.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"194-204"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of the Cancer Inflammation Prognostic Index with Microsatellite Instability, Tumor Budding and Prognosis in Colorectal Adenocarcinoma.","authors":"Uğur Topal, Sercan Yüksel, Mehmet Zişan Songür, Rabia Doğukan, Erdal Karaköse, Zafer Teke, Hasan Bektaş","doi":"10.62713/aic.3858","DOIUrl":"10.62713/aic.3858","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to investigate the relationship between the Cancer Inflammation Prognostic Index (CIPI) and microsatellite instability (MSI), tumor budding, and prognosis in colorectal cancer cases.</p><p><strong>Methods: </strong>Patients with stage 1-3 colorectal cancer who underwent curative surgical treatment between May 2020 and January 2022 were included. Serum CIPI was calculated, a cut-off point was established using Receiver Operating Characteristic (ROC) analysis and Patients were divided into two groups according to their CIPI scores: Group 1 (low CIPI) consisted of 94 patients, and Group 2 (high CIPI) consisted of 95 patients.</p><p><strong>Results: </strong>A CIPI score >8.54 predicted mortality with 82.2% sensitivity and 59.7% specificity (area under the curve (AUC): 0.712). There were differences in tumor localization (p = 0.01). Group 2 had higher C-reactive protein (CRP) levels (4.2 vs 11.7, p < 0.001), lower albumin levels (4.1 vs 4, p = 0.04), higher neutrophil counts (3.76 vs 4.83, p = 0.002), and higher levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 19.9 (Ca 19.9) (2.08 vs 8.27, p < 0.001 and 8.85 vs 13.9, p = 0.014, respectively). Tumor diameter was larger in high CIPI group (3 vs 3.8 cm, p = 0.001) , disease-free survival (37.7 vs 27.6 months, p < 0.001) and overall survival (39.6 vs 30.6 months, p < 0.001) were lower in high CIPI group 2. In the multivariate Cox regression analysis, a high CIPI score remained a strong independent predictor of poor overall survival (hazard ratio (HR) = 3.383, 95% confidence interval (CI): 1.445-7.921, p = 0.005) disease-free survival, a high CIPI score again stood out as a critical prognostic factor (HR = 3.280, 95% CI: 1.695-6.347, p < 0.001).</p><p><strong>Conclusions: </strong>A high CIPI score is associated with poor histopathological features and decreased survival. Closer monitoring or more aggressive treatment might improve prognosis for patients with high CIPI values.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 3","pages":"362-370"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Myocardial Infarction Due to Spontaneous Coronary Artery Dissection at 36 Weeks of Pregnancy: A Case Report.","authors":"Paolo Meloni, Paolo Izzo, Luciano Izzo, Manfredi Arioti, Terenzia Simari, Federico Ariel Sanchez, Cristian Cascione, Andrea Montevecchi, Chiara Boccherini, Fausta Orsi, Claudia De Intinis, Sara Izzo","doi":"10.62713/aic.3747","DOIUrl":"10.62713/aic.3747","url":null,"abstract":"<p><strong>Aim: </strong>Acute myocardial infarction in pregnancy (pAMI) is a rare event that is often caused by non-classical factors rather than atherosclerosis. The management of such complications requires a multidisciplinary team, and it is important to bring together the specialties involved to ensure that these teams are coordinated and ready to respond. The management of pAMI poses unique challenges because it requires consideration of both maternal and fetal well-being.</p><p><strong>Case presentation: </strong>We present the case of a 36-week pregnant woman who presented with anterolateral ST elevation myocardial infarction (STEMI) complicated by cardiogenic shock. To ensure comprehensive decision making, an emergency Pregnancy Heart Team meeting was convened, which comprised interventional cardiologists, gynecologists, and anesthesiologists. The team prioritized interventional treatment for pAMI, according to European Society of Cardiology (ESC) guidelines, and opted for primary percutaneous coronary intervention (PCI) due to the unstable maternal condition.</p><p><strong>Results: </strong>The patient underwent primary PCI as the chosen intervention for pAMI. A rapid response gynecology team closely monitored the procedure and was prepared to intervene in case of irreversible hemodynamic compromise leading to cardiac arrest. An emergency cesarean section was deemed necessary if cardiac activity was not restored within 4 minutes.</p><p><strong>Conclusions: </strong>Managing pAMI requires a multidisciplinary approach that balances the maternal and fetal well-being. In this particular case, the Pregnancy Heart Team decided to prioritize interventional treatment with primary PCI due to the unstable maternal condition. The presence of a closely monitored gynecology team ensured prompt action in case of complications.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 3","pages":"309-314"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}