Biomedical subjects

Nicola Rotolo

Publications and source records attributed to Nicola Rotolo.

5 recordsLinked to original sources

PubMed2006

Prospective study of infection risk factors in 988 lung resections.

PURPOSE: To evaluate the incidence of surgical site infections (SSI), as related to risk factors, in patients undergoing lung resections (LR). METHODS: We evaluated 988 consecutive patients prospectively who underwent LR between 1996 and 2005 at the Center for Thoracic Surgery of the University of Insubria, Varese, Italy. Patients were divided into four groups: Pneumonectomy (n=104), lobectomy/bi-lobectomy (n=438), wedge resection by thoracotomy (n=155), and wedge resection by video-thoracoscopy (VATS) (n=291). The recorded risk factors for SSI were hemoglobin concentration, serum albumin concentration, lymphocyte count, percentage of predicted forced expiratory volume in 1 sec (FEV1), duration of surgery, blood transfusion, age>70 years, and comorbidity. The postoperative SSIs (superficial and deep incisional SSI, pneumonia, empyema) were recorded in they occurred within 30 days, and the final outcome was recorded. RESULTS: Postoperative infections were found in 141 patients (14.3%) and included 166 thoracic infections, among them 32 incisional SSIs (3.2%), 103 cases of pneumonia (10.4%); and 24 empyemas (2.4%). The overall incidence of SSI was significantly lower in patients having wedge resections by VATS (5.5%) than in the other three groups (17.9%) (p<0.001). The overall mortality rate was 1.2% (12/988), of which six deaths (0.6%) were caused by complications of infection. The infection rate correlated with duration of surgery>180 min, age>70 years, serum albumin<3.5 g/dL, and the presence of any comorbidity. Moreover, 18% of patients with FEV1>70% had postoperative pneumonia, a significant increase (p<0.01) compared with patients with FEV1>or=70%. CONCLUSIONS: In this prospective study, the SSI rate after LR was 14.3%, and the 30-day operative mortality rate was 1.2%, with most of the deaths caused by pneumonia. After VATS LR procedures, the incidence of SSI was lower at 5.5%. Finally, SSI correlated with the duration of surgery, serum albumin, concurrent comorbidity, age, and FEV1.

Aged↗

PubMed2006

Risk factors for surgical infections.

BACKGROUND: Many risk factors for postoperative infections have been identified that can be used individually or in combination as scoring indices. METHODS: Infection risk scores can be applied in clinical practice to identify high-risk surgical patients, to indicate the need to implement risk-reduction strategies, and to stratify risk for comparison of outcome among different patient series. RESULTS: In the hierarchy of patient-related risk factors, serum albumin concentration and advanced age rank at the top of the list. Among the treatment-related factors, the quality of the surgical technique is a most important determinant, although most surgical site infections are attributable to patient-related risk factors rather than to flawed surgical care. Scoring systems can identify the patients at highest risk, thus prompting the implementation of therapy to improve modifiable conditions, but most clinicians outside the academic and research setting do not use them. Risk assessment also can be performed by expert clinical judgment. Discussion with the patient and informed consent are essential. CONCLUSIONS: Carefully collected scores of patient risk factors may be valuable to document the relations between the risk and the outcome of surgery. Ideally, each institution should select a validated scoring system to audit postoperative infectious morbidity and surgical performance in the various specialties.

Aged↗

PubMed2005

Molecular mechanisms of hexavalent chromium-induced apoptosis in human bronchoalveolar cells.

Hexavalent chromium (Cr[VI]) is classified by the International Agency for Research on Cancer as a group I carcinogen. Although the U.S. Occupational Safety and Health Administration was obliged to reduce the permissible exposure limit (PEL), it was reported that U.S. workers continue to be exposed to dangerously high Cr(VI) levels. In this study, we examined the role of p53 and target genes in a bronchoalveolar carcinoma isogenic cell line system and in primary human bronchial epithelial cells. p53-Negative parental H358 cell line, the same line in which the wild-type p53 expression vector (pC53-SN3) was introduced, and cells obtained from biopsies of human bronchus were exposed to chromate. Induction of DNA strand breaks were evaluated by alkaline elution assay, and apoptosis was analyzed by gel ladder, annexin V-PI staining, and ELISA, whereas p53 and target genes were evaluated by Western blots. Although Cr(VI) induced DNA strand breaks in both H358 cell clones, apoptosis was present only in the p53-transfected cells (H358p53(+/+)). In these cells, Cr(VI)-induced apoptosis is mediated by p53 upregulation of p53-upregulated modulator of apoptosis (PUMA), BAX translocation to mitochondria, cytochrome c release, and caspase-3 activation. In primary human bronchial epithelial cells expressing functional p53, Cr(VI) induced expression of PUMA and Noxa, which promote apoptosis through BAX. This result establishes p53 as the "necessary" player in Cr(VI)-induced apoptosis. To the best of our knowledge, this is the first report indicating strict correlation of Cr(VI) apoptosis to PUMA induction on primary human bronchoalveolar cells in short-term cultures.

Adenocarcinoma, Bronchiolo-Alveolar↗

PubMed2003

Traumatic diaphragmatic rupture: personal experience.

402 thoracoabdominal traumas have been observed since November 1998 and seven of these patients (1.7%) showed a diaphragmatic rupture. Four patients showed a right diaphragm rupture and three a left diaphragm rupture. Road traffic accidents were the main cause of trauma. Early diagnosis was performed in three patients (43%), a delayed diagnosis was made to the other patients (57%): one case was an intraoperative diagnosis (14.2%). Everyone had chest X rays and chest and upper abdomen CT scan. One patient had MRI on a late diagnosis. Thoracotomy was performed in all patients and one case (14.2%) of morbility and one (14.2%) of mortality were observed.

Adult↗

PubMedDate not supplied

Resection of small indeterminate lung nodules by video-assisted thoracoscopic surgery (VTS). Implications for the early diagnosis of lung cancer.

Small indeterminate lung nodules are increasingly detected because of the extensive use of chest x-rays and of computed tomography scans. In evaluating a small solitary pulmonary nodule the main concern is whether the nodule is benign or malignant. Resection by video-assisted thoracic surgery is the standard treatment for solitary pulmonary nodules, especially if they are small and not accessible by bronchoscopy or by percutaneous transthoracic needle aspiration. In this prospective study the personal experience in the diagnosis and treatment of lung nodules by video-assisted thoracic surgery and its implications in early diagnosis of lung cancer, are illustrated In the reported series video-assisted lung wedge resection was carried out successfully in (94%) of lung nodules, with low morbidity and no mortality. A definitive pathologic diagnosis was achieved in all cases. These findings indicate that indeterminate lung nodules > 1 cm in diameter have a high probability (65%) of being malignant and therefore need to be resected to establish a definitive diagnosis.

Adult↗