Italian journal of gastroenterology and hepatology
A retrospective study was conducted to determine incidence and predisposing factors of incisional... more A retrospective study was conducted to determine incidence and predisposing factors of incisional hernia after an emergency midline laparotomy. The study population consisted in 197 patients of whom 138 were followed-up for 2 years after surgery. An incisional hernia developed in 25 (18.1%) patients at a mean follow-up of 11.2 months. Multivariate analysis showed the importance of age (> 60 years, p < 0.004), obesity (p < 0.008) and occurrence of post-operative wound infection (p < 0.00001) for the development of an incisional hernia. Univariate analysis showed that intestinal occlusion (p < 0.02), peritonitis (p < 0.006), upper abdominal access (p < 0.04) and post-operative wound infection (p < 0.003) in older patients and obesity (p < 0.003) and the presence of a neoplasm (p < 0.006) in younger patients, played a significant role. The comparison between young and old patients showed that upper abdominal access (p < 0.007), interrupted and layered w...
Small bowel intussusception in adults is a rare surgical disease which almost always occurs as a ... more Small bowel intussusception in adults is a rare surgical disease which almost always occurs as a complication of either benign or malignant lesion of the bowel that is working as a leading point. In adults, the surgical approach consists of the resection of the bowel involved to ensure the excision of the lesion below. The authors report a case of ileocecal intussusception occurred in a young woman, 35 years old, observed for abdominal pain and signs of small bowel occlusion. She underwent surgical resection of the ileocecal segment with laparoscopic approach. The authors discuss the feasibility of the laparoscopic approach in this rare surgical disease and its benefits in terms of patient's postoperative comfort and outcome.
A case of grade IV renal trauma is reported and the literature reviewed. A 29-year-old man was ad... more A case of grade IV renal trauma is reported and the literature reviewed. A 29-year-old man was admitted in an emergency setting for a grade IV renal and splenic trauma as a result of a motorcycle accident. Since the patient was haemodynamically stable and the retroperitoneal haematoma was neither expanding nor pulsating, a conservative approach was adopted and the renal trauma was managed with interventional radiology. The case shows that major renal traumas can be usefully managed by non-operative treatment, necessarily consisting in a mutidisciplinary approach
Italian journal of gastroenterology and hepatology
A retrospective study was conducted to determine incidence and predisposing factors of incisional... more A retrospective study was conducted to determine incidence and predisposing factors of incisional hernia after an emergency midline laparotomy. The study population consisted in 197 patients of whom 138 were followed-up for 2 years after surgery. An incisional hernia developed in 25 (18.1%) patients at a mean follow-up of 11.2 months. Multivariate analysis showed the importance of age (> 60 years, p < 0.004), obesity (p < 0.008) and occurrence of post-operative wound infection (p < 0.00001) for the development of an incisional hernia. Univariate analysis showed that intestinal occlusion (p < 0.02), peritonitis (p < 0.006), upper abdominal access (p < 0.04) and post-operative wound infection (p < 0.003) in older patients and obesity (p < 0.003) and the presence of a neoplasm (p < 0.006) in younger patients, played a significant role. The comparison between young and old patients showed that upper abdominal access (p < 0.007), interrupted and layered w...
Small bowel intussusception in adults is a rare surgical disease which almost always occurs as a ... more Small bowel intussusception in adults is a rare surgical disease which almost always occurs as a complication of either benign or malignant lesion of the bowel that is working as a leading point. In adults, the surgical approach consists of the resection of the bowel involved to ensure the excision of the lesion below. The authors report a case of ileocecal intussusception occurred in a young woman, 35 years old, observed for abdominal pain and signs of small bowel occlusion. She underwent surgical resection of the ileocecal segment with laparoscopic approach. The authors discuss the feasibility of the laparoscopic approach in this rare surgical disease and its benefits in terms of patient's postoperative comfort and outcome.
A case of grade IV renal trauma is reported and the literature reviewed. A 29-year-old man was ad... more A case of grade IV renal trauma is reported and the literature reviewed. A 29-year-old man was admitted in an emergency setting for a grade IV renal and splenic trauma as a result of a motorcycle accident. Since the patient was haemodynamically stable and the retroperitoneal haematoma was neither expanding nor pulsating, a conservative approach was adopted and the renal trauma was managed with interventional radiology. The case shows that major renal traumas can be usefully managed by non-operative treatment, necessarily consisting in a mutidisciplinary approach
Background: Rome hosts thousands of sensible targets. Healthcare reaction has been guaranteed by ... more Background: Rome hosts thousands of sensible targets. Healthcare reaction has been guaranteed by 6 advanced Emergency Departments (EDs) and 7 basic ones. Everyday Rome hosts 6 millions of people/die, ± 2 million in particular occasions. About National Stockpile Antidotes (SNA), Rome hosts 3 warehouses. In case of events, stockpiles are activated with a long-time call; then stockpiles are charged in delivering trucks. Methods: Study analyzes PEIMAF (State of emergency plans for massive influx of injures) of advanced EDs in Rome and their adequacy in a possible CBRNe attack. Hypothesis of C/N attack on Saint Peter’s Square during Angelus on Wednesday (at 12.00 AM) or E attack in Trastevere on Saturday (at 9.00 PM). Analysis of activation of SNA and travel times between SNA warehouse and EDs. Comparison with French EDs during Paris attacks. Finding: EDs are chronically undermanned in ordinary conditions already, and would have issues in hosting a very large number of critical patients all at once. Some hospitals do not inform their workers about PEIMAF or they do not consider CBRNe emergencies in their PEIMAF, and even if it has been considered, hardly any simulation/exercitation is ever performed. Moreover, news of the CBRNe attack may not reach immediately the healthcare personal already at work in EDs; this is extremely problematic since they could be at major risk of contamination in case of CBRNe attacks. Furthermore, without a standardize protocol active in the whole city, no cross-hospital organization can be performed.
Conclusion: All data point towards the weakness and fragmentation of actual organizative system. Time of activation and charging are crucials for first aid efficacy and efficiency; a smart call system can reduce the activation time of SNA. A better organization of SNA in major Rome hospitals can reduce delivering time and help save more lives.
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Papers by Claudio Modini
About National Stockpile Antidotes (SNA), Rome hosts 3 warehouses. In case of events, stockpiles are activated with a long-time call; then stockpiles are charged in delivering trucks.
Methods: Study analyzes PEIMAF (State of emergency plans for massive influx of injures) of advanced EDs in Rome and their adequacy in a possible CBRNe attack.
Hypothesis of C/N attack on Saint Peter’s Square during Angelus on Wednesday (at 12.00 AM) or E attack in Trastevere on Saturday (at 9.00 PM).
Analysis of activation of SNA and travel times between SNA warehouse and EDs.
Comparison with French EDs during Paris attacks.
Finding: EDs are chronically undermanned in ordinary conditions already, and would have issues in hosting a very large number of critical patients all at once.
Some hospitals do not inform their workers about PEIMAF or they do not consider CBRNe emergencies in their PEIMAF, and even if it has been considered, hardly any simulation/exercitation is ever performed.
Moreover, news of the CBRNe attack may not reach immediately the healthcare personal already at work in EDs; this is extremely problematic since they could be at major risk of contamination in case of CBRNe attacks.
Furthermore, without a standardize protocol active in the whole city, no cross-hospital organization can be performed.
Conclusion: All data point towards the weakness and fragmentation of actual organizative system. Time of activation and charging are crucials for first aid efficacy and efficiency; a smart call system can reduce the activation time of SNA. A better organization of SNA in major Rome hospitals can reduce delivering time and help save more lives.