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

SURVIVAL RATE IN PATIENTS WITH MALIGNANT MELANOMA VARIABLES AND RESULTS

SURVIVAL RATE IN PATIENTS WITH MALIGNANT MELANOMA VARIABLES AND RESULTS Dott.ssa Jasminka Minic Introduzione: Le linee guida per i pazienti con melanoma maligno e con linfonodo sentinella positivo, suggerisce svuotamento linfonodale. Meno del 20% degli svuotamenti sono risultati positivi e quindi la questione del beneficio terapeutico \ue8 ancora aperto. Questo studio retrospettivo \ue8 stato disegnato per identificare il gruppo dei pazienti con linfonodo sentinella positivo, che potrebbero beneficiare o essere risparmiati dallo svuotamento linfonodale, considerando analisi dei biomarcatori clinici e le caratteristiche istologiche micromorfometriche del linfonodo sentinella in termini di recidiva e mortalit\ue0. Materiale e Metodi: In questo studio retrospettivo (2000-2014) sono stati analizzati 1615 pazienti con melanoma primario, di cui 583 \ue8 stato sottoposto alla biopsia del linfonodo sentinella. Sono stati presi in considerazione 80 pazienti con linfonodo sentinella positivo, che sono stati sottoposti allo svuotamento linfonodale, considerando l\u2019analisi delle caratteristiche del materiale metastatico applicando la classificazione Rotterdam e Dewar. Chi-square test, Student-test, Analisi di varianza, Hazard ratio e Kaplan-Meier curve sono state utilizzate per analisi statistiche. Risultati: Questo studio ha dimostrato che confrontando dati demografici, biomarcatori clinici e analisi istologica del materiale metastatico applicando la classificazione Rotterdam, ha suggerito uno dei fattori prognostici eccellenti. D\u2019altra parte metastasi linfonodale valutato con Classificazione Dewar dimostra meno significativit\ue0 nel comparsa della recidiva e mortalit\ue0. Conclusioni: I nostri dati, ancora limitati, suggeriscono che non c\u2019\ue8 una significativit\ue0 nella ricomparsa della recidiva e mortalit\ue0 dopo lo svuotamento linfonodale. Metastasi nel linfonodo sentinella sembra di avere significato prognostico importante nella recidiva e nella mortalit\ue0. L\u2019indice Breslow sembra di non avere pi\uf9 l\u2019importanza come fattore prognostico nei pazienti con linfonodo sentinella positivo.SURVIVAL RATE IN PATIENTS WITH MALIGNANT MELANOMA VARIABLES AND RESULTS Dr Jasminka Minic Introduction: International guidelines for patients with malignant melanoma and a positive sentinel node biopsy, (SNB) suggests a complete lymph node dissection (CLND). Less than 20% of CLNDs show additional nodal metastases and its therapeutic benefit is still discussed. This retrospective study was designed to identify the group of patients with positive sentinel lymph node, who could benefit or could be spare of CLND, according to the analysis of clinical biomarkers and histological micromorphometric characteristic of SLN, in terms of recurrence (disease free survival, DFS) and mortality (overall survival). Material and Methods: In this long term retrospective study (2000-2014), was analyzed 1615 patients with primary melanoma, out of which 583 underwent SLN biopsy. We selected 80 (out of 125) patients with positive sentinel lymph node who underwent CLND, in order to analyze tumor burden according to Rotterdam and Dewar classification, Chi-square test,Student Test, analysis of variance, Hazard ratio and Kaplan-Meier survival curves were used to compare the incidence of recurrent/metastatic disease and mortality. Results: This study showed that among demographic data, clinical biomarkers and micromorphometric histological findings, tumor burden according to the Rotterdam classification seams to be an excellent prognostic factor. On the other had location of the metastasis according to the Dewar classification is to be less significant prognostic factor in DFS and OS in metastasis patients. Conclusions: Our data, although still limited, suggest there is not a significant increase in OS and DFS after CLND performance. SNB tumor burden seems to be the most important prognostic value in OS and DFS and Breslow index appears to have no further significance as a prognostic index in SNB positive patients