Renato Finazzi
Vita-Salute San Raffaele University
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Featured researches published by Renato Finazzi.
Liver Transplantation | 2006
Luca Aldrighetti; Carlo Pulitano; Marcella Arru; Renato Finazzi; Marco Catena; Laura Soldini; Laura Comotti; Gianfranco Ferla
Hepatic injury secondary to warm ischemia‐reperfusion (I/R) injury and alterations in haemostatic parameters are often unavoidable events after major hepatic resection. The release of inflammatory mediator is believed to play a significant role in the genesis of these events. It has been suggested that preoperative steroid administration may reduce I/R injury and improve several aspects of the surgical stress response. The aim of this prospective randomized study was to investigate the clinical benefits on I/R injury and systemic responses of preoperatively administered corticosteroids. Seventy‐six patients undergoing liver resection were randomized either to a steroid group or to a control group. Patients in the steroid group received preoperatively 500 mg of methylprednisolone. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, coagulation parameters, and inflammatory mediators, interleukin 6 and tumor necrosis factor alpha were compared between the 2 groups. Length of stay, and type and number of complications were recorded as well. Postoperative serum levels of ALT, AST, total bilirubin, and inflammatory cytokines were significantly lower in the steroid than in the control group at postoperative days 1 and 2. Changes in hemostatic parameters were also significantly attenuated in the steroid group. In conclusion, the incidence of postoperative complications in the steroid group tended to be significantly lower than the control group. It is of clinical interest that preoperative steroids administration before major surgery may reduce I/R injury, maintain coagulant/anticoagulant homeostasis, and reduce postoperative complications by modulating the inflammatory response. Liver Transpl 12:941–949, 2006.
World Journal of Surgery | 2003
Luca Aldrighetti; Marcella Arru; Roberto Caterini; Renato Finazzi; Laura Comotti; Torri G; Gianfranco Ferla
The aim of this retrospective study was to evaluate the influence of age on the outcome of liver resection. A total of 129 consecutive liver resections were divided into two groups: ≥ 70 years old [old group (O-group)] and < 70 years old [young group (Y-group)]. The two groups were first compared for the variables potentially affecting the postoperative course, including diagnosis, concomitant diseases, previous abdominal surgery, type of operation (major or minor resection), associated procedures, presence and length of portal clamping, intraoperative blood losses and transfusions, and length of operation. The outcome of liver resections was evaluated in terms of postoperative mortality, morbidity, transfusions, and length of hospitalization. The Y-group included 97 resections in 95 patients, aged 55.9 ± 10.5 years (mean ± SD; range: 23–69 years), and the O-group included 32 resections in 32 patients, aged 73.7 ± 3.2 years (mean ± SD; range: 70–82 years. The O-group included more hepatocellular carcinomas (46.9% versus 20.6%, p = 0.002) and cardiovascular diseases (15.2% versus 1.0%, p = 0.004). The two groups were comparable (p > 0.05) when evaluated for all other listed variables. As regards the postoperative outcome, the length of hospitalization was similar (median, range: 9.5 days, 5–60 days in the Y-group and 9 days, 5–48 days in the O-group) and the need for postoperative transfusions were not statistically different. Mortality included one case among young patients, while no deaths were recorded among elderly patients. Postoperative morbidity was higher in Y-group than in O-group (21.6% versus 9.4%, p = 0.2). In conclusion, the age factor does not negatively affect the outcome of liver resections.
Annals of The Royal College of Surgeons of England | 2006
Marco Catena; Luca Aldrighetti; Renato Finazzi; Giandomenico Arzu; Marcella Arru; Carlo Pulitano; Gianfranco Ferla
INTRODUCTION The aim of this study was to assess the safety and the efficacy of hepatic resective surgery in the treatment of single lobe hepatolithiasis. PATIENTS AND METHODS Retrospective analysis and comparison between hepatic resections in patients with hepatolithiasis (hepatolithiasis group [HG]) and liver masses (control group [CG]). Seventeen consecutive Caucasian patients with single lobe hepatolithiasis (HG) and 30 patients with liver masses without chronic liver disease and previous chemotherapy (CG), were operated during the 5-year period 2000-2005, inclusive. Major hepatic resections including 4 right hepatectomies, 10 left hepatectomies, and 3 left lateral sectionectomy in HG, and 12 right hepatectomies, 3 extended right hepatectomy, 5 left hepatectomies, 4 left lateral sectionectomy, 5 bisegmentectomy, and 1 mesohepatectomy in CG. The main outcome measures were: type and length of surgical procedures, intra- and postoperative blood losses and transfusions (packed red blood cells [PRBC] and fresh frozen plasma [FFP]), intra- and postoperative course and complications (within 30 days of the operation), length of hospitalisation, histopathology, and recurrence of hepatolithiasis. RESULTS Mean operation time was 6.21 +/- 2.38 h in HG versus 7.10 +/- 2.21 h in CG (P = 0.33). Mean intra-operative blood loss in CG was higher than in HG (1010 +/- 550 ml versus 560 +/- 459 ml; P = 0.035). The other variables considered in the two groups were not statistically different. Intra-operative transfusion were 0.50 +/- 0.85 units in HG versus 1.35 +/- 2.25 units of PRBC in CG (P = 0.06), and 0.66 +/- 1.34 units in HG versus 0.68 +/- 1.20 units of FFP in CG (P = 0.44), respectively. No cases of death were registered. Postoperative complications occurred in 12 patients (25.5%) - 5 cases (10.6%) in HG and 7 cases (14.8%) in CG (P = 0.18). Mean postoperative transfusions were 0.47 +/- 1.24 units in HG versus 1.10 +/- 1.18 units of PRBC in CG (P = 0.35), and 0.65 +/- 1.40 units in HG versus 0.46 +/- 0.82 units of FFP in CG (P = 0.25), respectively. Difference in median hospitalisation was not statistically significant (14 +/- 10 days versus 12 +/- 9 days; P = 0.28). Histopathology showed cholangiocarcinoma in 2 cases (11.7%). During the follow-up period (range, 5-127 months; mean, 50.4 +/- 41.9 months), 1 patient had lithiasis recurrence and 1 patient died for the co-existing cholangiocarcinoma. CONCLUSIONS Hepatic resection is the treatment of choice in patients with single lobe hepatolithiasis. An early indication for surgery may reduce the mortality/morbidity rates of hepatic resection for hepatolithiasis.
Journal of Gastrointestinal Surgery | 2006
Luca Aldrighetti; Carlo Pulitano; Marcella Arru; Marco Catena; Renato Finazzi; Gianfranco Ferla
We evaluated the feasibility and effectiveness of combining two different electronic devices, the ultrasonic dissector (UD) and the harmonic scalpel (HS), during hepatic resection. One hundred consecutive patients underwent liver resection using UD plus HS between January and December 2004 (UD + HS group). The ultrasonic dissector was used to fracture liver parenchyma and the uncovered vessel was sealed using the HS. Surgical outcomes were compared with 100 consecutive patients who underwent liver resection using the clamp crushing method. Operative variables, postoperative liver function, hospital stay, and type and number of complications were compared. The two groups were equivalent in term of demographic and pathologic variables. The UD + HS group had a decreased blood loss (500 ml versus 700 ml, P=0.005), number of patients transfused (22 versus 39, P=0.009), tumor exposure at the transection surface (4 versus 12, P=00.012), and hospital stay (7 versus 8.5 days, P=0.020). Postoperative major complications, in particular, fluid collection and biliary fistula, were significantly less frequent in the UD+HS group (2 versus 9, P=0.030). A longer operative time was recorded in the UD+HS group (385 versus 330 minutes, P=0.001). The combined use of UD with HS allows liver resection to be safely performed, with the advantage of reducing blood losses and surgery-related complications. The only major disadvantage may be a longer transection time.
Hpb | 2007
Carlo Pulitano; Luca Aldrighetti; Marcella Arru; Renato Finazzi; Laura Soldini; Marco Catena; Gianfranco Ferla
BACKGROUND Hepatic injury secondary to warm ischemia and reperfusion (I/R) remains an important clinical issue following liver surgery. The aim of this prospective, randomized study was to determine whether steroid administration may reduce liver injury and improve short-term outcome. PATIENTS AND METHODS Forty-three patients undergoing liver resection were randomized to a steroid group or a control group. Patients in the steroid group received 500 mg of methylprednisolone preoperatively. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, anti-thrombin III (AT-III), prothrombin time (PT), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-alpha) were compared between the two groups. Length of stay and type and number of complications were recorded. RESULTS Postoperative serum levels of ALT, AST, total bilirubin, and inflammatory cytokines were significantly lower in the steroid group than in controls. The postoperative level of AT-III in the control group was significantly lower than in the steroid group (ANOVA p < 0.01). The incidence of postoperative complications in the control group tended to be significantly higher than that in the steroid group. CONCLUSION These results suggest that steroid pretreatment represents a potentially important biologic modifier of I/R injury and may contribute to maintenance of coagulant/anticoagulant homeostasis.
Journal of Surgical Oncology | 2008
Eleonora Guzzetti; Carlo Pulitano; Marco Catena; Marcella Arru; Francesca Ratti; Renato Finazzi; Luca Aldrighetti; Gianfranco Ferla
Wedge resection (WR) for colorectal liver metastases (CLM) has become more common in an attempt to preserve liver parenchyma. However, some investigator have reported that WR is associated with a higher incidence of positive margin and an inferior survival compared with anatomic resection (AR) 1 .
Shock | 2007
Carlo Pulitano; Luca Aldrighetti; Marcella Arru; Renato Finazzi; Marco Catena; Eleonora Guzzetti; Laura Soldini; Laura Comotti; Gianfranco Ferla
Alterations in hemostatic parameters are a common finding after major hepatic resection. There is growing evidence that inflammation has a significant role in inducing coagulation disarrangement that follows major surgery. To determine whether preoperative methylprednisolone administration has a protective effect against the development of coagulation disorders, we evaluated the effect of preoperative steroids administration on changes in hemostatic parameters and plasma levels of inflammatory cytokines in patients undergoing liver surgery. Seventy-three patients undergoing liver resection were randomized to a steroid group or to a control group. Patients in the steroid group received 500 mg of methylprednisolone preoperatively. Serum levels of coagulation parameters (prothrombin time, platelets, fibrinogen, plasma fibrin degradation products [D-dimer], antithrombin III) and inflammatory mediators (IL-6 and TNF-&agr;) were measured before and immediately after the operation and on postoperative days 1, 2, and 5. Multivariate analysis was performed to identify factors related to the characteristics of the patients and surgery affecting coagulation parameters between the two groups. Decreases in antithrombin III, platelet count and fibrinogen levels, prolongation of prothrombin time, and increases in the plasma fibrin degradation products were significantly suppressed by the administration of methylprednisolone. Cytokines production was also significantly suppressed by the administration of methylprednisolone, and there was significant correlation between plasma levels of cytokines and coagulation alterations. These findings suggest that preoperative methylprednisolone administration inhibits the development of coagulation disarrangements in patients undergoing liver resection, possibly through suppressing the production of inflammatory cytokines.
Thrombosis and Haemostasis | 2005
Carlo Pulitano; Luca Aldrighetti; Renato Finazzi; Marcella Arru; Marco Catena; Gianfranco Ferla
Inihibition of cytokine response by methylprednisolone attenuates antithrombin reduction following hepatic resection -
International Journal of Infectious Diseases | 2002
Roberto Novati; Maria Grazia Viganò; Anna De Bona; Benedetta Nocita; Renato Finazzi; Adriano Lazzarin
Neurologic manifestations of brucellosis occur in 2-5% of patients.l.* The clinical pictures of neurobrucellosis are characteristically protean: they include meningoencephalitis, meningovascular complications, parenchymatous dysfunctions, peripheral neuropathy/radiculopathy and various degrees of behavioral abnormalities, sometimes leading to acute psychosis. From the clinical series available, meningitis has been referred as the most frequent presentation of neurobrucellosis, occurring in at least the 50% of cases;‘,” meningitis is most often acute, but subacute or chronic presentations are not rare and may lead to disseminated encephalomyelitis with diffuse central nervous system (CNS) demyelinization.3*4 In contrast, Bruceh abscess formation within the CNS has been described up to now in just one child with multiple brain abscesses.’ We here report the first case of neurobrucellosis with intramedullary abscess in an adult. A 24-year-old man from Sicily was admitted to the regional Hospital for high degree continuous fever and night sweats; fever had lasted for about two months and had been treated with a one-week course of oral prednisolone, before the patient was admitted to hospital. The patient remembered eating some fresh goat’s cheese in the recent past. Thus, brucellosis was suspected and the Brucella melitensis serum agglutination test (SAT) was performed. This was positive at a 1:SOO titer. A six-week cycle of rifampin 600 mglday and doxycycline 100 mg b.i.d. was given; both the fever and the agglutinins normalized. Six months later he complained of abrupt onset of fever, hypostenia of the left leg, and paresthesias of the right leg, with consequent impaired walking. A contrast-enhanced magnetic resonance imaging (MRI) of the brain and the spinal cord showed a focal lesion of 15 mm diameter within the dorsal tract of the spinal cord, near to the third intervertebral space; the abscess was surrounded by perilesional edema, had a partially liquid core and a ring enhancement was evident after Gadolinium in-
Hiv Clinical Trials | 2006
Amanda Mocroft; Andrzej Horban; Nathan Clumeck; H. J. Stellbrink; A d'Arminio Monforte; Kai Zilmer; Ole Kirk; Josep M. Gatell; Andrew N. Phillips; Jens D. Lundgren; M. Losso; A. Duran; N. Vetter; Igor Karpov; A. Vassilenko; S De Wit; B. Poll; R. Colebunders; Ladislav Machala; H. Rozsypal; D. Sedlacek; Jens Ole Nielsen; Thomas Benfield; Jan Gerstoft; T. Katzenstein; A. B E Hansen; P. Skinhøj; Court Pedersen; C. Katlama; J. P. Viard
BACKGROUND Few published studies have considered both the short- and long-term virologic or immunologic response to combination antiretroviral therapy (cART) and the impact of different cART strategies. PURPOSE To compare time to initial virologic (<500 copies/mL) or immunologic (>200/mm3 cell increase) response in antiretroviral-naïve patients starting either a single protease inhibitor (PI; n = 183), a ritonavir-boosted PI regimen (n = 197), or a nonnucleoside reverse transcriptase inhibitor (NNRTI)-based cART regimen (n = 447) after January 1, 2000, and the odds of lack of virologic or immunologic response at 3 years after starting cART. METHOD Cox proportional hazards models and logistic regression. RESULTS After adjustment, compared to patients taking an NNRTI-regimen, patients taking a single-PI regimen were significantly less likely to achieve a viral load (VL) <500 copies/mL (relative hazard [RH] 0.74, 95% CI 0.54-0.84, p = .0005); there was no difference between the boosted-PI regimen and the NNRTI regimen (p = .72). There were no differences between regimens in the risk of >200/mm3 CD4 cell increase after starting cART (p > .3). At 3 years after starting cART, patients taking a single-PI-based regimen were more likely to not have virologic suppression (<500 copies/mL; odds ratio [OR] 1.60, 95% CI 1.06-2.40, p = .024), while there were no differences in the odds of having an immunologic response (>200/mm3 increase; p > .15). This model was adjusted for CD4 and VL at starting cART, age, prior AIDS diagnosis, year of starting cART, and region of Europe. CONCLUSION Compared to patients starting an NNRTI-based regimen, patients starting a single-PI regimen were less likely to be virologically suppressed at 3 years after starting cART. These results should be interpreted with caution, because of the potential biases associated with observational studies. Ultimately, clinical outcomes, such as new AIDS diagnoses or deaths, will be the measure of efficacy of cART regimens, which requires the follow-up of a very large number of patients over many years.