Italian recommendations on enzymatic debridement in burn surgery.

Abstract Introduction Nexobrid®, a bromelain-based type of enzymatic debridement, has become more prevalent in recent years. We present the recommendations on enzymatic debridement (Nexobrid®)'s role based on the practice knowledge of expert Italian users. Methods The Italian recommendations, endorsed by SIUST (Italian Society of Burn Surgery), on using enzymatic debridement to remove eschars for burn treatment were defined. The definition followed a process to evaluate the level of agreement (a measure of consensus) among selected experts, representing Italian burn centers, concerning defined clinical aspects of enzymatic debridement. The consensus involved a multi-phase process based on the Delphi method. Results The consensus panel included experts from Italy with a combined experience of 1068 burn patients treated with enzymatic debridement. At the end of round 3 of the Delphi method, the panel reached 100% consensus on 26 out of 27 statements. The panel achieved full, strong consensus (all respondents strongly agreed on the statement) on 24 out of 27 statements. Discussion The statements provided by the Italian consensus panel represent a "ready to use" set of recommendations for enzymatic debridement in burn surgery that both draw from and complete the existing scientific literature on the topic. These recommendations are specific to the Italian experience and are neither static nor definitive. As such, they will be updated periodically as further quality evidence becomes available

Classic Kaposi's sarcoma in morocco: clinico -epidemiological study at the national institute of oncology

<p>Abstract</p> <p>Background</p> <p>Classic Kaposi's sarcoma (CKS) is a rare disease likely associated with human herpes virus 8 (HHV-8) infection, and occurs predominantly in Jewish, Mediterranean and middle eastern men .There is a dearth of data in Moroccan patients with CKS regarding epidemiology, clinical characteristics and outcomes. This report examines a cohort of patients with CKS evaluated at the national institute of oncology over 11-year period.</p> <p>Methods</p> <p>A retrospective analysis of patients referred to the national institute of oncology with classical Kaposi sarcoma, between January 1998 and February 2008, was performed. Reviewed information included demographics, clinical and pathological staging, death or last follow-up.</p> <p>Results</p> <p>During the study period, 56 patients with a diagnosis of CKS have been referred to our hospital. There were 11(19,7%) females and 45 (80,3%) males (male-to-female ratio: 4:1). Mean age at diagnosis was 61,7 ± 15 (range: 15- 86 years). Nodules and/or plaques were the most frequent type of lesion. The most common location was the lower limbs, particularly the distal lower extremity (90%). In addition to skin involvement, visceral spread was evident in 9 cases. The most common visceral involvement sites were lymph nodes (44%), lung (22%), and gastrointestinal tract (22%). Associated lymphoedema was seen in 24 (42%) of the patients. There were 18 stage I patients (32,14%), 8: stage II (14,28%), 21 stage III(37,5%) and 9 stage IV (16,07%). A second primary malignancy was diagnosed in 6 cases (10,7%), none of the reticuloendothelial system.</p> <p>With a median follow-up of 45 months, 38 (67,8) patients are alive, of whom 25 (65,78%) patients with stable disease, five with progressive disease currently under systemic chemotherapy and 8(21,05%) are alive and free of disease, over a mean interval of 5 years.</p> <p>Conclusion</p> <p>This is the largest reported series in our context. In Morocco, CKS exhibits some special characteristics including a disseminated skin disease at diagnosis especially in men, a more common visceral or lymph node involvement and a less frequent association with second malignancies.</p

Bilateral Internal Thoracic Artery Grafting Concomitant With Other Cardiac Operations ― Insights From a European Multicenter Retrospective Study on 1,123 Consecutive Patients ―

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An integrated approach to investigate the seismotectonics of northern Sicily and southern Tyrrhenian

This paper deals with a comparison among recent structure and seismicity in the hinge zone between northern Sicily and southern Tyrrhenian, corresponding to both emerged and submerged northern portion of the Maghrebian chain. This hinge zone is part of a wider W–E trending right-lateral shear zone, mainly characterized by both a synthetic NW-SE/W–E oriented, and antithetic left-lateral N–S/NE-SW fault systems, which has been affecting the tectonic edifice, since the Pliocene. The inland structures have been mapped using aerial-photo interpretation, geological mapping and mesostructural analysis to reconstruct the stress regime in the study area. On the contrary, the offshore structures have been inferred from the available morpho-bathymetric and geological maps of the southern Tyrrhenian basin. A seismological analysis was carried out on a data set of about 11,000 seismic events occurred between January 1981 and December 2005 in the study area. The observed local magnitude is mainly comprised between 2.0 and 2.3, reaching in places peak values greater than 5.5. The distribution of the hypocenters allowed to recognize three major seismogenic zones. The deepest events (down to about 600 km) of the easternmost area are related to the Ionian lithospheric slab subducting beneath the Calabrian arc. A set of events is substantially depending by the Etna volcano activity. The third set of events is heterogeneously distributed mainly in the southern Tyrrhenian and in the eastern Sicily. This latter seismogenic zone is strictly connected to the deformation field active within the hinge zone. A statistical analysis of the seismological data allowed to individuate several clusters of events occurred in the hinge zone, which have been subsequently relocated with a relative location method. Furthermore, the seismogenic processes, relative to the most numerous clusters, were characterized in the space, time and magnitude domains with statistical techniques. The collected focal mechanisms, even if highlight the complexity of the relationships between seismogenic volumes of the clusters and single dislocations, also showsomespatial trends useful to the seismotectonic analysis. On the whole, both structural and seismological data seem to be consistent with a neotectonic model related to NW-SE trending maximum compressional stress axis producing a non-coaxial strain, even if in particular areas different seismogenic conditions are possible, due to the accommodation of rock volumes leading a marked mechanical heterogeneity

Oncoplastic and reconstructive surgery in SENONETWORK Italian breast centers: lights and shadows

: • Despite the significance of oncoplastic procedure, an italian database is lacking. • Senonetwork established a multidisciplinary survey to assess their safety and efficacy. • Reconstructive outcomes were positive across low and high-volume centers. • After mastectomy, implant-based techniques are common. DTI reconstruction is advantageuos. • This contributes to the global understanding of effective strategies against breast cancer