Robotically Assisted Mitral Valve Repair as the Treatment of Choice for Patients with Difficult Anatomies

Marco Russo,Hamed Ouda,Martin Andreas,Maurizio Taramasso,Stefano Benussi,Francesco Maisano,Alberto Weber 대한흉부외과학회 2019 Journal of Chest Surgery (J Chest Surg) Vol.52 No.1

Robotically assisted mitral valve repair has proven its efficacy during the last decade. The most suitable approach for patients with difficult anatomies, such as morbid obesity, sternal deformities, cardiac rotation, or vascular anomalies, represents a current challenge in cardiac surgery. Herein, we present the case of a 71-year-old patient affected by severe degenerative mitral valve regurgitation with pectus excavatum and a right aortic arch with an anomalous course of the left subclavian artery who was successfully treated using a Da Vinci–assisted approach.

The Prognostic Significance of Patient-Prosthesis Mismatch after Aortic Valve Replacement

Paolo Nardi,Marco Russo,Guglielmo Saitto,Giovanni Ruvolo 대한흉부외과학회 2018 Journal of Chest Surgery (J Chest Surg) Vol.51 No.3

Patient-prosthesis mismatch (PPM) is a controversial issue in current clinical practice. PPM has been reported to have a negative impact on patients’ prognosis after aortic valve replacement in several studies, showing increased all-cause and cardiac mortality. Moreover, a close relationship has recently been described between PPM and structural valve deterioration in biological prostheses. In patients at risk for PPM, several issues should be considered, and in the current era of cardiac surgery, preoperative planning should consider the different types of valves available and the various surgical techniques that can be used to prevent PPM. The present paper analyses the state of the art of the PPM issue.

Pectoralis Muscle Flap Repair Reduces Paradoxical Motion of the Chest Wall in Complex Sternal Wound Dehiscence

Jacob Zeitani,Marco Russo,Eugenio Pompeo,Gian Luigi Sergiacomi,Luigi Chiariello 대한흉부외과학회 2016 Journal of Chest Surgery (J Chest Surg) Vol.49 No.5

Background: The aim of the study was to test the hypothesis that in patients with chronic complex sternum dehiscence, the use of muscle flap repair minimizes the occurrence of paradoxical motion of the chest wall (CWPM) when compared to sternal rewiring, eventually leading to better respiratory function and clinical outcomes during follow-up. Methods: In a propensity score matching analysis, out of 94 patients who underwent sternal reconstruction, 20 patients were selected: 10 patients underwent sternal reconstruction with bilateral pectoralis muscle flaps (group 1) and 10 underwent sternal rewiring (group 2). Eligibility criteria included the presence of hemisternum diastases associated with multiple (≥3) bone fractures and radiologic evidence of synchronous chest wall motion (CWSM). We compared radiologically assessed (volumetric computed tomography) ventilatory mechanic indices such as single lung and global vital capacity (VC), diaphragm excursion, synchronous and paradoxical chest wall motion. Results: Follow-up was 100% complete (mean 85±24 months). CWPM was inversely correlated with single lung VC (Spearman R=−0.72, p=0.0003), global VC (R=−0.51, p=0.02) and diaphragm excursion (R=−0.80, p=0.0003), whereas it proved directly correlated with dyspnea grade (Spearman R=0.51, p=0.02) and pain (R=0.59, p=0.005). Mean CWPM and single lung VC were both better in group 1, whereas there was no difference in CWSM, diaphragm excursion and global VC. Conclusion: Our study suggests that in patients with complex chronic sternal dehiscence, pectoralis muscle flap reconstruction guarantees lower CWPM and greater single-lung VC when compared with sternal rewiring and it is associated with better clinical outcomes with less pain and dyspnea.

Liver transplantation for non-alcoholic fatty liver disease: indications and post-transplant management

Sara Battistella,Francesca D’Arcangelo,Marco Grasso,Alberto Zanetto,Martina Gambato,Giacomo Germani,Marco Senzolo,Francesco Paolo Russo,Patrizia Burra 대한간학회 2023 Clinical and Molecular Hepatology(대한간학회지) Vol.29 No.-

Non-alcoholic fatty liver disease (NAFLD) is currently the fastest growing indication to liver transplantation (LT) in Western Countries, both for end stage liver disease and hepatocellular carcinoma. NAFLD/non-alcoholic steatohepatitis (NASH) is often expression of a systemic metabolic syndrome; therefore, NAFLD/NASH patients require a multidisciplinary approach for a proper pre-surgical evaluation, which is important to achieve a post-transplant outcome comparable to that of other indications to LT. NAFLD/NASH patients are also at higher risk of post-transplant cardiovascular events, diabetes, dyslipidemia, obesity, renal impairment and recurrent NASH. Lifestyle modifications, included diet and physical activity, are key to improve survival and quality of life after transplantation. A tailored immunosuppressive regimen may be proposed in selected patients. Development of new drugs for the treatment of recurrent NASH is awaited.

Extracorporeal Shock Wave Therapy in Peyronie’s Disease: Clinical Efficacy and Safety from a Single-Arm Observational Study

Marina di Mauro,Giorgio Ivan Russo,Pier Andrea Della Camera,Fabrizio di Maida,Gianmartin Cito,Nicola Mondaini,Marco Capece,Marco Falcone,Francesco Sessa,Andrea Mari,Riccardo Campi,Carlotta Sabini,Serg 대한남성과학회 2019 The World Journal of Men's Health Vol.37 No.3

ItalyPurpose: In this study, we aimed to determine the role of extracorporeal shockwave therapy (ESWT) in the management of Peyronie’s disease (PD). Materials and Methods: A total of 325 patients suffering from PD were enrolled in this single-arm clinical study. All patients were received ESWT using a schedule of 1 treatment/wk. Penile curvature was measured by a goniometer after intracavernosal drug-induced erection using Alprostadil. Plaque size was measured with a ruler and sexual function assessed by the international index of erectile function (IIEF)-15 score. Severity of erectile dysfunction was classified as severe (IIEF-15 ≤10), moderate (IIEF-15 between 11 and 16), or mild (IIEF-15 between 17 and 25). Results were evaluated at baseline and 3 months after the treatment.Results: All the patients completed the study protocol. Median age was 59.0 years (55.0–64.0 years). After treatment, the median (interquartile range, IQR) plaque size reduced from 1.78 cm2 (1.43–2.17 cm2) to 1.53 cm2 (1.31–1.96 cm2) (p<0.001); the median (IQR) penile length in erection increased from 13.0 cm (12.0–14.0 cm) to 14 cm (13.0–15.0 cm) (p<0.001) and the median (IQR) penile curvature from 30.4° (22.2°–35.4°) to 25.0° (20.2°–30.4°) (p<0.001). We also observed a decrease in pain assessed by visual analogue scale (7 vs. 3; p<0.001), an improvement in each of the IIEF sub-domains (p<0.001) and an improvement in all three PD questionnaire domains (p<0.001). Conclusions: Based on our findings, ESWT could be considered a safe and efficient minimally invasive option for the management of the patients suffering from PD.

Photolysis of Br₂in CCl₄studied by time-resolved X-ray scattering

Kong, Qingyu,Lee, Jae Hyuk,Lo Russo, Manuela,Kim, Tae Kyu,Lorenc, Maciej,Cammarata, Marco,Bratos, Savo,Buslaps, Thomas,Honkimaki, Veijo,Ihee, Hyotcherl,Wulff, Michael International Union of Crystallography 2010 Acta crystallographica. Section A, Foundations of Vol.66 No.2

<P>A time-resolved X-ray solution scattering study of bromine molecules in CCl4is presented as an example of how to track atomic motions in a simple chemical reaction. The structures of the photoproducts are tracked during the recombination process, geminate and non-geminate, from 100 ps to 10 µs after dissociation. The relaxation of hot Br2<SUP>*</SUP>molecules heats the solvent. At early times, from 0.1 to 10 ns, an adiabatic temperature rise is observed, which leads to a pressure gradient that forces the sample to expand. The expansion starts after about 10 ns with the laser beam sizes used here. When thermal artefacts are removed by suitable scaling of the transient solvent response, the excited-state solute structures can be obtained with high fidelity. The analysis shows that 30% of Br2<SUP>*</SUP>molecules recombine directly along the<I>X</I>potential, 60% are trapped in the<I>A</I>/<I>A</I>′ state with a lifetime of 5.5 ns, and 10% recombine non-geminately<I>via</I>diffusive motion in about 25 ns. The Br-Br distance distribution in the<I>A</I>/<I>A</I>′ state peaks at 3.0 Å.</P>

Impact of Preoperative Patient Characteristics and Flow Rate on Failure, Early Complications, and Voiding Dysfunction After a Transobturator Tape Procedure: A Multicentre Study

Andrea Cocci,Giovanni E. Cacciamani,Giorgio Ivan Russo,Maria Angela Cerruto,Martina Milanesi,Luis G. Medina,Sebastiano Cimino,Walter Artibani,Giuseppe Morgia,Marco Carini,Vincenzo Li Marzi 대한배뇨장애요실금학회 2017 International Neurourology Journal Vol.21 No.4

Purpose: To evaluate the impact of preoperative patient characteristics and flow rate on failure, early postoperative complications, and voiding in patients who underwent transvaginal tension-free vaginal tape-obturator (TVT-O) treatment for uncomplicated stress urinary incontinence (SUI). Methods: We retrospectively reviewed patients who underwent TVT-O for SUI at 3 Italian centres. The exclusion criteria were predominant voiding and storage symptoms suggestive of detrusor overactivity, the presence of grade >1 urogenital prolapse, previous pelvic radiotherapy or other clinical contraindications for surgical procedures, neurogenic bladder dysfunction, and collagen diseases. Multivariate logistic regression models were constructed to identify predictors of early voiding dysfunction after TVT-O. Results: A total of 219 patients underwent TVT-O between January 2010 and December 2015. All patients received follow-up at 3, 6, and 12 months, and underwent a stress test, uroflowmetry, and bladder ultrasound to evaluate the postvoid residual volume. They also responded to the Urogenital Distress Inventory (UDI-6) questionnaire. The rates of persistent incontinence after TVT-O, postoperative complications, and satisfaction were 16.4% (36 of 219), 24.2% (53 of 219), and 86.3% (189 of 219), respectively. Nineteen patients (9.5%) experienced early voiding dysfunction. Based on an analysis of baseline characteristics, we determined that a cutoff value of 9.0 on the UDI-6 predicted postoperative SUI with 62% specificity, 72% sensitivity, and 66% accuracy. In the multivariate logistic regression analysis, a preoperative UDI-6≥9.0 was an independent predictor of postoperative SUI. The predictors of complications were menopause (P = 0.04) and the preoperative UDI-6 score (P = 0.01). Conclusions: Menopause and UDI-6 scores could be prognostic factors for persistent SUI after TVT-O. Well-designed prospective studies with a suitable number of patients are needed to corroborate our findings.

How Atypical Penile Curvature Influence Clinical Outcomes in Patients with Peyronie’s Disease Receiving Collagenase Clostridium Histolyticum Therapy?

Andrea Cocci,Fabrizio Di Maida,Giorgio Ivan Russo,Marina di Mauro,Gianmartin Cito,Marco Falcone,Andrea Minervini,Giovanni Cacciamani,Riccardo Campi,Andrea Mari,Francesco Sessa,Nicola Mondaini 대한남성과학회 2020 The World Journal of Men's Health Vol.38 No.1

Purpose: The aim of this study was to evaluate the efficacy of collagenase Clostridium histolyticum (CCH) in patients with Peyronie’s disease (PD) suffering from atypical deformities. Materials and Methods: We retrospectively collected data of patients with atypical penile curvature (PC) secondary to PD. All patients underwent a modified treatment protocol, consisting of 3 intralesional injections of 0.9 mg of CCH performed at 4-week intervals at the point of maximum PC. Patients were instructed to follow a strict routine, involving daily modeling of erect penis and stretching at the urinary toilette time, two minutes each. Success was defined as a decrease in PC of ≥20° from baseline. Results: Sixty-five patients were included in the analysis. Median age was 59.0 years (interquartile range [IQR], 53.0 to 63.0 years), median curvature 40.0° (IQR, 30.0° to 45.0°) median duration of the disease 12.0 years (IQR, 6.5 to 24.0 years). Fiftythree patients (81.54%) had ventral PC, 7 (10.77%) hourglass PC, and 5 (7.69%) shortening PC. Median changes of PC were -20.0 (IQR, -20.0 to -10.0; p<0.01) in ventral PC, -20.0 (IQR, -20.0 to 0; p<0.01) in hourglass and -15.0 (IQR, -15.0 to -15.0; p<0.01) in shortening PC. At Kruscal–Wallis test, significant differences between groups were not found. The rate of PC success was 56.60% (30/53) in ventral PC, 57.14% (4/7) in hourglass and 20.00% (1/5) in shortening PC (p=0.29). Treatment success was not influenced by characteristics of curvature (odds ratio=0.66; p=0.20). Conclusions: CCH intralesional injections could represent an effective therapeutic option for the conservative management of patients with atypical PC.

Spatiotemporal reaction kinetics of an ultrafast photoreaction pathway visualized by time-resolved liquid x-ray diffraction.

Kim, Tae Kyu,Lorenc, Maciej,Lee, Jae Hyuk,Lo Russo, Manuela,Kim, Joonghan,Cammarata, Marco,Kong, Qingyu,Noel, Sylvie,Plech, Anton,Wulff, Michael,Ihee, Hyotcherl National Academy of Sciences 2006 PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF Vol.103 No.25

<P>We have studied the reaction dynamics for HgI(2) in methanol by using time-resolved x-ray diffraction (TRXD). Although numerous time-resolved spectroscopic studies have provided ample information about the early dynamics of HgI(2), a comprehensive reaction mechanism in the solution phase spanning from picoseconds up to microseconds has been lacking. Here we show that TRXD can provide this information directly and quantitatively. Picosecond optical pulses triggered the dissociation of HgI(2), and 100-ps-long x-ray pulses from a synchrotron probed the evolving structures over a wide temporal range. To theoretically explain the diffracted intensities, the structural signal from the solute, the local structure around the solute, and the hydrodynamics of bulk solvents were considered in the analysis. The results in this work demonstrate that the determination of transient states in solution is strongly correlated with solvent energetics, and TRXD can be used as an ultrafast calorimeter. It also is shown that a manifold of structural channels can be resolved at the same time if the measurements are accurate enough and that global analysis is applied. The rate coefficients for the reactions were obtained by fitting our model against the experimental data in one global fit including all q-values and time delays. The comparison between all putative reaction channels confirms that two-body dissociation is the dominant dissociation pathway. After this primary bond breakage, two parallel channels proceed. Transient HgI associates nongeminately with an iodine atom to form HgI(2), and I(2) is formed by nongeminate association of two iodine atoms.</P>

Vitamin D and Male Fertility: An Updated Review

Gianmartin Cito,Andrea Cocci,Elisabetta Micelli,Alejandro Gabutti,Giorgio Ivan Russo,Maria Elisabetta Coccia,Giorgio Franco,Sergio Serni,Marco Carini,Alessandro Natali 대한남성과학회 2020 The World Journal of Men's Health Vol.38 No.2

To date, the key role of vitamin D in male reproductive system has been suggested, since the expression of vitamin D receptors and metabolizing enzymes was demonstrated in the testis and spermatozoa. Nevertheless, a general consensus about the role of vitamin D in male fertility is still debated. The aim of this review is to provide an updated systematic revision of the current available literature, discussing the experimental and clinical evidence on the role of vitamin D in the regulation of testis hormone production, seminal parameters and male fertility. The consequences of vitamin D deficiency on serum levels of testicular hormones have been analysed by several observational and interventional studies, with controversial results. Equally, the experimental researches not were able to state a certain relationship between vitamin D status and testis hormone production. Possible bias, including age, body mass index, and baseline vitamin D status justified the differences among studies. As well as concerning the effect of vitamin D on semen parameters, most of the studies agreed in the possibility that vitamin D might have a positive effect on human male fertility potential, particularly through better sperm motility. Regarding pregnancy outcomes, normal level of vitamin D seems to be related to better pregnancies. However, all the previous studies displayed a wide heterogeneity in study design, population, methodology, and cut off values used for the evaluation of vitamin D status. Future studies are needed to better clarify the exact role of vitamin D on hormonal and seminal panel in both fertile and infertile men.