Publications by authors named "Umberto Bracale"
Objective: To validate the ISGPS complexity grading system for minimally invasive pancreaticoduodenectomy (MIPD).
Background: Although concerns about patient safety persist, MIPD is gaining popularity. The ISGPS recently introduced a difficulty grading system to improve patient selection by aligning procedural complexity with surgeon and center expertise.
Background: The AFX unibody endograft offers advantages in treating abdominal aortic aneurysms (AAAs) with narrow aortic bifurcations due to its unique design, where the flow divider sits at the native aortic bifurcation. However, its limited length options may limit complete proximal neck utilization. As per device instruction for use, the implant should be completed with an aortic cuff.
View Article and Find Full Text PDFBackground: Carotid revascularization procedures, such as carotid endarterectomy (CEA) and carotid artery stenting (CAS), can lead to restenosis. Monitoring restenosis onset through biomarkers is crucial in clinical practice. This study aimed to evaluate inflammation biomarkers in CEA and CAS to determine their predictive value for restenosis risk postprocedure.
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- This study explored how different work activities relate to chronic venous disease (CVD) in the lower limbs by evaluating patients referred for assessment from January 2019 to December 2023.
- A total of 948 patients were analyzed, with 613 having CVD and the rest serving as control participants, indicating that sedentary jobs and those in hot environments increased the risk of developing CVD.
- The study concluded that certain work conditions, like prolonged sitting or standing and exposure to high temperatures, can negatively impact venous health in the lower limbs, potentially leading to CVD progression.
Article Synopsis
- The Manta Vascular Closure Device, designed for closing large-bore arterial accesses, was evaluated to see if it performs as well as the ProGlide device in terms of achieving hemostasis after endovascular procedures.
- A retrospective study was conducted on 524 cases of (T)EVAR procedures between January 2021 and April 2023, comparing outcomes of 355 procedures using Manta versus 169 using ProGlide.
- Results showed similar complication rates and effectiveness for both devices, although Manta had a statistically larger sheath size, indicating that both are viable options for vascular closure.
Carotid stenosis is characterized by the progressive narrowing of the carotid arteries due to the formation of atherosclerotic plaque, which can lead to stroke and death as major complications. Numerous biomarkers allow for its study and characterization, particularly those related to "omics" sciences. Through the most common research databases, we report representative studies about carotid stenosis biomarkers based on genomics, transcriptomics, proteomics, and metabolomics in a narrative review.
View Article and Find Full Text PDFPurpose: Endovascular aortic repair (EVAR) is currently expanding its feasibility thanks to design innovations, but hostile proximal necks and narrow iliac arteries are still a constraint, as expressed by the Instructions for Use (IFU) of most devices. Our aim is to report the preliminary results of the E-Tegra endograft in infrarenal abdominal aortic aneurysms (AAAs) performed in 15 high-volume centers.
Materials And Methods: The e-Tegra Italian endoGraft REgistry (TIGRE) is a prospectively maintained database of consecutive EVAR with the E-Tegra stent-graft across 15 participating centers between March 2021 and March 2023.
Article Synopsis
- Clinical guidelines are evidence-based recommendations created by experts to help healthcare providers and patients make informed decisions about health conditions, ultimately improving healthcare quality and tailored care.
- The European Hernia Society (EHS) guidelines specifically assist surgeons in managing abdominal wall defects with reliable answers to their clinical questions, traditionally developed through consensus among key opinion leaders.
- The GRADE method enhances the quality of these guidelines by providing a structured approach to evaluating evidence and making recommendations, addressing challenges in guideline production and advocating for dedicated research groups to improve adherence to this methodology.
Article Synopsis
- Acute limb ischemia (ALI) occurs when blood flow to a limb is suddenly reduced, leading to a lack of oxygen and nutrients in the tissues, which can cause severe complications even after treatment.
- The text reviews various molecular and cellular factors involved in ALI, focusing on arterial thrombosis, embolism, and the subsequent ischemia/reperfusion (I/R) syndrome that can occur after restoring blood flow.
- It highlights the significance of inflammation, apoptosis, and other tissue damage mechanisms in ALI, while also discussing potential novel biomarkers and targeted therapies for better management.
Buerger's disease is a segmental and inflammatory syndrome affecting relatively young individuals primarily and occurs with occlusion of small to medium-sized vessels in their extremities. The typical age for symptoms to appear is between 35 and 50 years in smoking patients. The disease is not manifested in children or the elderly.
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- The study examines the timing of protective loop ileostomy (PLI) closure after rectal cancer surgery and its effects on postoperative outcomes, dividing patients into two groups based on early (EC) or late (LC) closure.* -
- Data from 51 patients over two years showed no significant differences in complication rates or perioperative characteristics between the EC and LC groups, although the LC group had a higher incidence of requiring adjuvant therapy.* -
- While the timing of PLI did not predict complications, a higher Low-Anterior Resection Score (LARS) was observed in the LC group, indicating potential delays in recovery, which necessitates further randomized studies for confirmation.*
Endurant Stent Graft for Treatment of Abdominal Aortic Aneurysm Inside and Outside of the Instructions for Use for the Proximal Neck: A 14-Year, Single-Center Experience.
J Clin Med
April 2024
Article Synopsis
- A study was conducted to evaluate the performance of the Endurant stent graft in treating abdominal aortic aneurysms (AAAs) over a medium and long-term period, including patients treated both within and outside the device's instructions for use (IFU).
- The research involved 795 patients over 14 years, comparing two groups: those treated according to IFU guidelines and those who were not, noting significant differences in aneurysm neck characteristics and outcomes between the groups.
- Results showed a low aneurysm-related mortality rate (<1%) and a 10.5% endoleak rate, with larger AAAs and shorter prosthesis necks correlating with increased risks of complications and reintervention.
Article Synopsis
- The study investigated how chronic venous disease (CVD) affects sexual dysfunction (SD) and whether CVD treatments influence SD outcomes.
- A total of 649 patients were surveyed using the ASEX questionnaire, revealing that 18.8% experienced sexual dysfunction, with higher rates in women and those at advanced disease stages.
- The findings indicate that sexual dysfunction in CVD patients can improve following appropriate treatment for the condition.
Background: Colovesical fistulas (CVFs) pose a challenge in diverticulitis, affecting 4% to 20% of sigmoid colon cases. Complicated diverticular disease contributes significantly, accounting for 60%-70% of all CVFs. Existing studies on laparoscopic CVF management lack clarity on its effectiveness in diverticular cases compared to open surgery.
View Article and Find Full Text PDFAn aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysms (AAAs) and constitute <1% of all AAAs, which increases from 2% to 6.7% in ruptured AAAs. Unlike other aortic ruptures, most ACFs are not associated with significant blood loss on admission.
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- The study aimed to evaluate how effective prophylactic mesh is for preventing parastomal hernias in end colostomy patients, ultimately contributing to European clinical guidelines.* -
- The meta-analysis included 12 randomized trials, showing that while quality of life (QoL) was unaffected by the use of mesh, it significantly reduced the incidence of parastomal hernias (risk reduction OR = 0.33).* -
- No significant differences were found in surgery requirements or severe complications associated with mesh use, suggesting that while the mesh helps reduce hernia rates, it doesn’t impact QoL or lead to more serious surgical issues.*
Article Synopsis
- A new guideline has been developed for preventing parastomal hernias, prompted by evidence supporting the use of prophylactic mesh and advancements in guideline methods.
- An interdisciplinary panel, including surgeons, nurses, and patients, employed a systematic review and meta-analysis to create trustworthy recommendations based on GRADE standards.
- The guideline recommends using prophylactic mesh for patients with end colostomies, particularly those at high risk, while acknowledging moderate evidence certainty for parastomal hernia prevention and identifying areas for future research.
New advanced technologies have recently been developed and preliminarily applied to surgery, including virtual reality (VR), augmented reality (AR) and mixed reality (MR). We retrospectively review all colorectal cases in which we used holographic 3D reconstruction from February 2020 to December 2022. This innovative approach was used to identify vascular anomalies, pinpoint tumor locations, evaluate infiltration into neighboring organs and devise surgical plans for both training and educating trainee assistants.
View Article and Find Full Text PDFMetalloproteinases (MPs) are zinc-dependent enzymes with proteolytic activity and a variety of functions in the pathophysiology of human diseases. The main objectives of this review are to analyze a specific family of MPs, the matrix metalloproteinases (MMPs), in the most common chronic and complex diseases that affect patients' social lives and to better understand the nature of the associations between MMPs and the psychosocial environment. In accordance with the PRISMA extension for a scoping review, an examination was carried out.
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- Carotid artery stenting (CAS) with new-generation Roadsaver dual-layer stents aims to improve outcomes compared to traditional stenting methods, which have worse results in plaque issues and cerebral embolization.
- This study analyzed data from 353 patients who underwent CAS between 2017 and 2022 at three Italian centers, focusing on procedural success and adverse cerebrovascular events, including strokes and transient ischemic attacks.
- Results showed a high technical success rate of 96.9%, with a low incidence of complications, indicating that the Roadsaver stent may offer better midterm safety and effectiveness for patients undergoing this procedure.
Article Synopsis
- Lung cancer (LC) has a high mortality rate, and identifying metastases is crucial for understanding patients' conditions—this case describes a 67-year-old man with lung metastasis that spread to the colon, leading to significant complications.
- The patient underwent an initial radical resection after imaging and colonoscopy indicated an ulcerated neoplasm at the hepatic colic flexure, identified as poorly differentiated squamous carcinoma originating from lung cancer.
- After 8 months, the patient experienced a recurrence at the ileocolic anastomosis, necessitating a second surgery which again revealed the same type of cancer, reinforcing the diagnosis of metastatic squamous carcinoma from lung origin.
Article Synopsis
- Minimally invasive total gastrectomy (MITG) is an important surgical approach for treating gastric cancer, but there is currently no consensus on the best techniques for key processes like lymphadenectomy and anastomosis creation.
- An international panel of expert surgeons participated in a study using the Delphi method, which involved multiple rounds of voting to establish consensus on the technical steps of MITG, resulting in 41 key statements after three rounds.
- The consensus findings, showing high internal consistency, aim to improve surgical quality and outcomes for patients undergoing MITG by providing standardized techniques based on expert agreement.
Article Synopsis
- Peyronie's disease, affecting 9% of men, involves inflammation leading to fibrosis and is associated with pain and erectile dysfunction; there's a need for better understanding of its onset and progression.
- Researchers created a systemic immune-inflammation index (SII) and identified a neutrophil-to-eosinophil ratio (NER) as potential biomarkers to help evaluate the disease's inflammation.
- A study comparing 49 men with Peyronie's to 50 controls found significant differences in NER and eosinophil counts, with a higher prevalence of hypercholesterolemia, hyperglycemia, and hypertension in patients; the NER was most effective at distinguishing between groups.
A Randomized Phase III Trial of Complete Mesocolic Excision Compared with Conventional Surgery for Right Colon Cancer: Interim Analysis of a Nationwide Multicenter Study of the Italian Society of Surgical Oncology Colorectal Cancer Network (CoME-in trial).
Ann Surg Oncol
March 2024
Background: Although complete mesocolic excision (CME) is supposed to be associated with a higher lymph node (LN) yield, decreased local recurrence, and survival improvement, its implementation currently is debated because the evidence level of these data is rather low and still not supported by randomized controlled trials.
Method: This is a multicenter, randomized, superiority trial (NCT04871399). The 3-year disease-free survival (DFS) was the primary end point of the study.