Research

11 pages, 1019 KiB

Open AccessArticle

Application of ERAS Protocol after VATS Surgery for Chronic Empyema in Immunocompromised Patients

by Beatrice Leonardi, Caterina Sagnelli, Alfonso Fiorelli, Francesco Leone, Rosa Mirra, Davide Gerardo Pica, Vincenzo Di Filippo, Francesca Capasso, Gaetana Messina, Giovanni Vicidomini, Antonello Sica and Mario Santini

Healthcare 2022, 10(4), 635; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10040635 - 28 Mar 2022

Cited by 4 | Viewed by 3679

Abstract

Enhanced recovery after surgery protocols have shown improved clinical outcomes after lung resection surgery, but their application after empyema surgery is still limited. We retrospectively evaluated the outcomes of an adapted enhanced recovery after surgery (ERAS) protocol for immunocompromised patients who underwent video-assisted [...] Read more.

Enhanced recovery after surgery protocols have shown improved clinical outcomes after lung resection surgery, but their application after empyema surgery is still limited. We retrospectively evaluated the outcomes of an adapted enhanced recovery after surgery (ERAS) protocol for immunocompromised patients who underwent video-assisted thoracoscopic surgery (VATS) surgery for chronic empyema between December 2013 and December 2021. The patients were divided into an ERAS group and a conventional treatment group. Peri-operative data were collected and compared between the two groups. The primary outcome was post-operative length of stay. Secondary outcomes were post-operative pain and post-operative complications (air leaks, atelectasis). A total of 86 patients, 45 in the ERAS group and 41 in the non-ERAS group, were considered. Chest tube duration (6.4 ± 2.3 vs. 13.6 ± 6.8 days) and post-operative length of stay (7.6 ± 1.6 vs. 16.9 ± 6.9 days) were significantly shorter in the ERAS group. The volume of chest drainage (103 ± 78 vs. 157 ± 89 mL/day) was significantly smaller in the ERAS group. There were no significant differences in operative time, blood loss, need for transfusion, tube reinsertion and median VAS score. The incidence of air leaks and atelectasis was significantly reduced in the ERAS group, as was the need for bronchoscopic aspiration. The application of an ERAS protocol after empyema VATS surgery for immunocompromised patients improved the surgical outcome, reducing the post-operative length of stay and rate of complications. Full article

(This article belongs to the Special Issue Skin Disorders in Hematological Disease)

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9 pages, 263 KiB

Open AccessArticle

The Impact of Direct Oral Anticoagulant Prophylaxis for Thromboembolism in Thrombophilic Patients Undergoing Abdominoplastic Surgery

by Pasquale Verolino, Caterina Sagnelli, Roberto Grella, Giovanni Francesco Nicoletti, Antonello Sica and Mario Faenza

Healthcare 2022, 10(3), 476; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10030476 - 03 Mar 2022

Cited by 2 | Viewed by 2351

Abstract

Congenital or acquired thrombophilia is observed in 10–15% of the general population; therefore, careful screening is carried out in patients at higher risk of venous thrombo-embolism (VTE). High risk of VTE is a contraindication in patients undergoing abdominoplasty. We evaluated rivaroxaban, an oral [...] Read more.

Congenital or acquired thrombophilia is observed in 10–15% of the general population; therefore, careful screening is carried out in patients at higher risk of venous thrombo-embolism (VTE). High risk of VTE is a contraindication in patients undergoing abdominoplasty. We evaluated rivaroxaban, an oral Xa inhibitor, with enoxaparin, a subcutaneously low molecular weight heparin (LMWH), in 48 female patients with documented thrombophilia, undergoing thrombo-prophylaxis after abdominoplasty. Patients were stratified into two groups according to thrombo-prophylaxis procedure: enoxaparin Group (n = 28) and rivaroxaban Group (n = 20). Hematologic outcomes were evaluated including VTE and hematoma. No episodes of VTE occurred in both groups; two patients during their course of enoxaparin presented severe hematoma for drainage and hemostasis revision. This study suggests that abdominoplasty, in patients with thrombophilia, in combination with thrombo-prophylaxis can be performed safely. Rivaroxaban was as effective as LMWH for preventing VTE, with only a moderate risk of clinically relevant bleeding. More research is needed to determine the optimal timing and duration of prophylaxis in patients undergoing plastic surgery. Full article

(This article belongs to the Special Issue Skin Disorders in Hematological Disease)

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9 pages, 3868 KiB

Open AccessArticle

Ultrasound-Guided Anterior Mediastinotomy: A Feasible Tool for Critical Lymphoma Patients

by Roberto Cascone, Annalisa Carlucci, Gaetana Messina, Antonio Noro, Mary Bove, Giovanni Natale, Caterina Sagnelli, Giorgia Opromolla, Mario Martone, Carlo Santoriello, Elena Santoriello, Pasquale Verolino, Massimiliano Creta, Giovanni Vicidomini, Alfonso Fiorelli, Mario Santini and Antonello Sica

Healthcare 2021, 9(6), 770; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9060770 - 21 Jun 2021

Viewed by 1697

Abstract

A significant part of all neoplasms growing in anterior mediastinum are lymphomas (25%). Achieving a correct diagnosis and a clear definition of a lymphoma’s subtype is crucial for beginning chemotherapy as soon as possible. However, most patients present a large mediastinal mass that [...] Read more.

A significant part of all neoplasms growing in anterior mediastinum are lymphomas (25%). Achieving a correct diagnosis and a clear definition of a lymphoma’s subtype is crucial for beginning chemotherapy as soon as possible. However, most patients present a large mediastinal mass that compresses vessels and airway, with serious cardiorespiratory repercussions. Therefore, having multiple tools available to biopsy the lesion without worsening morbidity becomes fundamental. Patients enrolled in this study were unfit for a surgical biopsy in general anesthesia and the need to begin chemotherapy as fast as possible prompted us to avoid percutaneous fine needle aspiration to prevent diagnostic failures. Our observational study included 13 consecutive patients with radiological findings of anterior mediastinal mass. Ultrasonography was performed directly in the theatre to mark the lesion and to localize vessels and vascularized neoplastic tissue. Open biopsy was carried out in spontaneous breathing with a laryngeal mask and with short-acting medications for a rapid anesthesia, performing an anterior mediastinotomy. The mean operative time was 33.4 ± 6.2 min and spontaneous respiration was maintained throughout the procedure. No complications were reported. All patients were discharged in the first or second postoperative day after a chest X-ray (1.38 ± 0.5 days). The diagnostic yield of this approach was 100%. With the addition of ultrasonography right before the procedure and with spontaneous breathing, anterior mediastinotomy still represents a useful tool in critical patients that could hardly tolerate a general anesthesia. The diagnostic yield is high, and the low postoperative morbidity allows a rapid onset of chemotherapy. Full article

(This article belongs to the Special Issue Skin Disorders in Hematological Disease)

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12 pages, 590 KiB

Open AccessArticle

Chronic Chest Pain Control after Trans-Thoracic Biopsy in Mediastinal Lymphomas

by Antonello Sica, Beniamino Casale, Caterina Sagnelli, Maria Teresa Di Dato, Marco Rispoli, Mario Santagata, Pietro Buonavolontà, Alfonso Fiorelli, Paola Vitiello, Stefano Caccavale, Massimiliano Creta, Anna Maria Salzano, Evangelista Sagnelli, Elisabetta Saracco, Giuseppe Gazzerro, Vincenzo Famiglietti, Dario Tammaro and Alfonso Papa

Healthcare 2021, 9(5), 589; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9050589 - 18 May 2021

Cited by 2 | Viewed by 1823

Abstract

Chest pain following a trans-thoracic biopsy often has multiple etiologies, especially in patients with lymphomas. Pathological neuronal mechanisms integrate with an overproduction of IL-6, TNF-α, IL1-β by macrophages and monocytes, which amplifies inflammation and pain. In consideration of this complex pathogenesis, international guidelines [...] Read more.

Chest pain following a trans-thoracic biopsy often has multiple etiologies, especially in patients with lymphomas. Pathological neuronal mechanisms integrate with an overproduction of IL-6, TNF-α, IL1-β by macrophages and monocytes, which amplifies inflammation and pain. In consideration of this complex pathogenesis, international guidelines recommend diversified analgesia protocols: thoracic epidural, paravertebral block, and systemic administration of opioids. This study reports an attempt to reduce chest pain and prevent chronic pain in 51 patients undergoing trans-thoracic biopsy for mediastinal lymphoma. The entity of pain, measured 72nd hour after biopsy by the Numerical Rating Scale (NRS), was compared with that seen at a 6th month checkpoint in 46 patients. The pain decreased in all cases. At the 6th month checkpoint, among 31 opioid-treated patients, none of the 16 patients with NRS < 6 within the 72nd hour post biopsy had developed chronic chest pain, while 8 of the 15 with higher values did (p < 0.01). Of 10 patients undergoing thoracotomy and treated with opioids, eight had a NRS of no more than 2, of which six had no chronic pain. Of the twenty-one patients who underwent VATS biopsy and were treated with opioids, fifteen had NRS no greater than 2, of which ten had no chronic pain. Subgroups of patients biopsied under mediastinotomy or video-assisted thoracoscopic surgery (VATS) and treated with thoracic epidural analgesia (TEA) or PVB were too small for such analysis. Full article

(This article belongs to the Special Issue Skin Disorders in Hematological Disease)

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Review

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12 pages, 665 KiB

Open AccessReview

A Review on Secondary Immune Thrombocytopenia in Malaysia

by Muhamad Aidil Zahidin, Noor Haslina Mohd Noor, Muhammad Farid Johan, Abu Dzarr Abdullah, Zefarina Zulkafli and Hisham Atan Edinur

Healthcare 2022, 10(1), 38; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10010038 - 26 Dec 2021

Cited by 2 | Viewed by 3493

Abstract

Immune thrombocytopenia (ITP) is an acquired autoimmune disease that occurs in adults and children. In Malaysia, the clinical practice guideline (CPG) for the management of ITP was issued in 2006, which focused almost exclusively on primary ITP (pITP), and only a few secondary [...] Read more.

Immune thrombocytopenia (ITP) is an acquired autoimmune disease that occurs in adults and children. In Malaysia, the clinical practice guideline (CPG) for the management of ITP was issued in 2006, which focused almost exclusively on primary ITP (pITP), and only a few secondary ITP (sITP) forms were addressed. All published (twenty-three) sITP articles among children and adults in Malaysia, identified on the academic databases were retrieved. The articles were published between 1981 and 2019, at a rate of 0.62 publications per year. The publications were considered low and mainly focused on rare presentation and followed-up of secondary diseases. This review revealed that sITP in Malaysia is commonly associated with autoimmune diseases (Evan’s syndrome, SLE and WAS), malignancy (Kaposi’s sarcoma and breast cancer) and infection (dengue haemorrhagic fever, Helicobacter pylori and hepatitis C virus). The relationship between ITP and autoimmune diseases, malignancy and infections raise the question concerning the mechanism involved in these associations. Further studies should be conducted to bridge the current knowledge gap, and the further information is required to update the existing CPG of management of ITP in Malaysia. Full article

(This article belongs to the Special Issue Skin Disorders in Hematological Disease)

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20 pages, 768 KiB

Open AccessReview

Fournier’s Gangrene in Patients with Oncohematological Diseases: A Systematic Review of Published Cases

by Massimiliano Creta, Antonello Sica, Luigi Napolitano, Giuseppe Celentano, Roberto La Rocca, Marco Capece, Armando Calogero, Gianluigi Califano, Luigi Vanni, Francesco Mangiapia, Davide Arcaniolo, Lorenzo Spirito, Ferdinando Fusco, Marco De Sio, Ciro Imbimbo, Vincenzo Mirone, Caterina Sagnelli and Nicola Longo

Healthcare 2021, 9(9), 1123; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9091123 - 30 Aug 2021

Cited by 7 | Viewed by 2191

Abstract

Patients suffering from hematological malignancies are at increased risk of Fournier’s gangrene (FG) due to immunosuppression caused by the disease itself or by disease-related treatments. A systematic review of PubMed, ISI Web of Knowledge, and Scopus databases was performed in June 2021. We [...] Read more.

Patients suffering from hematological malignancies are at increased risk of Fournier’s gangrene (FG) due to immunosuppression caused by the disease itself or by disease-related treatments. A systematic review of PubMed, ISI Web of Knowledge, and Scopus databases was performed in June 2021. We included full papers that met the following criteria: original research, human studies, and describing clinical presentation, treatment, and outcomes of FG in patients with oncohematological diseases. We identified 35 papers published from 1983 to 2021 involving 44 patients (34 males, 8 females) aged between 4 days and 83 years. The most common malignant hematological disorders were acute myeloid leukemia (n = 21) and acute lymphocytic leukemia (n = 9). In 10 patients FG represented the first presentation of hematological malignancy. Scrotum (n= 27) and perineum (n = 11) were the sites most commonly involved. Pseudomonas aeruginosa (n = 21) and Escherichia coli (n = 6) were the most commonly isolated microorganisms. Surgery was performed in 39 patients. Vacuum-assisted closure and hyperbaric oxygen therapy were adopted in 4 and in 3 patients, respectively. Recovery was achieved in 30 patients. FG-related mortality was observed in 11 patients. FG should be carefully considered in patients with oncohematological diseases. Full article

(This article belongs to the Special Issue Skin Disorders in Hematological Disease)

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Other

Jump to: Research, Review

5 pages, 1551 KiB

Open AccessCase Report

Epithelioid Hemangioma of the Nose: A Challenging Diagnosis

by Fabrizio Schonauer, Annachiara Cavaliere, Giuseppe Pezone, Armando Calogero, Caterina Sagnelli, Antonello Sica, Luca D’Andrea and Antonello Baldo

Healthcare 2022, 10(4), 633; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10040633 - 28 Mar 2022

Cited by 2 | Viewed by 2220

Abstract

Epithelioid hemangioma is a rare reactive vasoproliferative disease presenting with painless vascular nodules in the dermal and subcutaneous tissues of the head and neck. Clinical diagnosis can be difficult as, in most cases, the only symptom is a progressively tender swelling next to [...] Read more.

Epithelioid hemangioma is a rare reactive vasoproliferative disease presenting with painless vascular nodules in the dermal and subcutaneous tissues of the head and neck. Clinical diagnosis can be difficult as, in most cases, the only symptom is a progressively tender swelling next to a vessel course. Thus far, few cases of epithelioid hemangioma localized to the nose have been described in the literature. Herein, we present a case of a 47-year-old woman with just such a lesion of the nose, focusing on its diagnosis and treatment. Full article

(This article belongs to the Special Issue Skin Disorders in Hematological Disease)

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10 pages, 5036 KiB

Open AccessCase Report

Primary Extra-Nodal DLBCL of Glands: Our Experiences outside Guidelines of Treatment

by Antonello Sica, Mario Santagata, Caterina Sagnelli, Piero Rambaldi, Renato Franco, Massimiliano Creta, Paola Vitiello, Stefano Caccavale, Vincenzo Tammaro, Evangelista Sagnelli and Andrea Ronchi

Healthcare 2021, 9(3), 286; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9030286 - 05 Mar 2021

Cited by 1 | Viewed by 1692

Abstract

Lymphomas usually involve lymph nodes and other lymphoid tissues, but sometimes occur in non-lymphoid organs, called extra-nodal sites. Primary diffuse extra-lymph node large B-cell lymphoma (DLBCL) of the thyroid and parotid gland have been observed rarely. According to the most accredited guidelines, primary [...] Read more.

Lymphomas usually involve lymph nodes and other lymphoid tissues, but sometimes occur in non-lymphoid organs, called extra-nodal sites. Primary diffuse extra-lymph node large B-cell lymphoma (DLBCL) of the thyroid and parotid gland have been observed rarely. According to the most accredited guidelines, primary extra-nodal DLBCL of the parotid and thyroid glands should be treated with three cycles of R-CHOP followed by radiotherapy of the involved site (ISRT). Surgery alone is not enough to treat DLBCL. We describe two unusual cases of primary extra-nodal DLBCL in elderly patients treated exclusively with surgical resection, given the inability to apply chemotherapy. Both patients achieved clinical recovery, which was maintained after a follow-up of more than 18 months, despite not having performed the indicated chemotherapy protocol. The two cases presented here, and a few others reported in the literature, should be considered exceptions to the rule, and do not allow the conclusion that surgery alone might be sufficient for complete remission. Full article

(This article belongs to the Special Issue Skin Disorders in Hematological Disease)

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8 pages, 566 KiB

Open AccessCase Report

How Fear of COVID-19 Can Affect Treatment Choices for Anaplastic Large Cell Lymphomas ALK+ Therapy: A Case Report

by Antonello Sica, Caterina Sagnelli, Beniamino Casale, Gino Svanera, Massimiliano Creta, Armando Calogero, Renato Franco, Evangelista Sagnelli and Andrea Ronchi

Healthcare 2021, 9(2), 135; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9020135 - 31 Jan 2021

Cited by 5 | Viewed by 2234

Abstract

Background: The t (2; 5) chromosomal rearrangement of the ALK gene with nucleophosmin 1 gene (NPM1), resulting in an NPM1–ALK fusion, was first demonstrated in 1994 in anaplastic large cell lymphoma, (ALCL), a T-cell lymphoma responsive to cyclophosphamide, abriblastine, vincristine and prednisone in [...] Read more.

Background: The t (2; 5) chromosomal rearrangement of the ALK gene with nucleophosmin 1 gene (NPM1), resulting in an NPM1–ALK fusion, was first demonstrated in 1994 in anaplastic large cell lymphoma, (ALCL), a T-cell lymphoma responsive to cyclophosphamide, abriblastine, vincristine and prednisone in approximately 80% of cases; refractory cases usually respond favorably to brentuximab vedotin. These treatments are regarded as a bridge to allogeneic hematopoietic stem cell transplantation (allo-SCT). Nowadays, transplant procedures and the monitoring of chemotherapy patients proceed very slowly because the SARS-CoV-2 pandemic has heavily clogged the hospitals in all countries. Results: A 40-year-old Caucasian woman was first seen at our clinical center in June 2020. She had ALCL ALK+, a history of failure to two previous therapeutic lines and was in complete remission after 12 courses of brentuximab, still pending allo-SCT after two failed donor selections. Facing a new therapeutic failure, we requested and obtained authorization from the Italian drug regulatory agency to administer 250 mg of crizotinib twice a day, a drug incomprehensibly not registered for ALCL ALK +. Conclusions: The response to crizotinib was optimal since no adverse event occurred, and CT-PET scans persisted negative; this drug has proved to be a valid bridge to allo-SCT. Full article

(This article belongs to the Special Issue Skin Disorders in Hematological Disease)

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