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Comparabilità e valutazione dei servizi sanitari

  • Nerina Agabiti1

  1. Dipartimento di epidemiologia del servizio sanitario regionale, Lazio
Nera Agabiti -

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Ricerca bibliografica periodo dal 16 marzo 2012 al 31 maggio 2012

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1. Chiò A, Calvo A, Moglia C, Gamna F, Mattei A, Mazzini L, Mora G; PARALS. (Collaborators: Chiò A, Cammarosano S, Canosa A, Gallo S, Cocito D, Mutani R, Durelli L, Ferrero B, Bertolotto A, Mauro A, Leone M, Monaco F, Nasuelli N, Giobbe D, Sosso L, Gionco M, Leotta D, Appendino L, Imperiale D, Cavallo R, Oddenino E, Geda C, Geda C, Poglio F, Doriguzzi Bozzo C, Santimaria P, Massazza U, Villani A, Conti R, Pisano F, Palermo M, Ursino E, Vergnano F, Sassone O, Provera P, Penza MT, Aguggia M, Di Vito N, Meineri P, Pastore I, Ghiglione P, Seliak D, Cavestro C, Astegiano G, Corso G, Bottacchi E. ) Non-invasive ventilation in amyotrophic lateral sclerosis: a 10 year population based study. J Neurol Neurosurg Psychiatry. 2012 Apr;83(4):377-81. Epub 2011 Oct 19
ALS Centre, Department of Neuroscience, University of Torino, Via Cherasco 15, Torino 10126, Italy. achio@usa.net Comment in J Neurol Neurosurg Psychiatry. 2012 Apr;83(4):368-9.
Abstract
OBJECTIVE To evaluate the clinical characteristics and outcome of non-invasive ventilation (NIV) in an epidemiological based series of amyotrophic lateral sclerosis (ALS) patients. METHODS The study was performed using data from the Piemonte and Valle d'Aosta Register for ALS, a prospective epidemiological register enrolling all ALS incident cases in two Italian regions. RESULTS Among the 1260 patients incident in the period 1995-2004, 259 (20.6%) underwent NIV. Young male patients and subjects attending the tertiary ALS centres were more likely to undergo NIV. There was a progressive significant increase in the use of NIV during the study but was limited to patients attending the ALS tertiary centres. Median survival after NIV was 289 days (95% CI 255 to 333). CONCLUSIONS In an epidemiological setting, NIV represents an increasingly utilised option for the treatment of respiratory disturbances in ALS and has favourable effects on survival, in particular among patients followed by tertiary ALS centres. Sociocultural factors, such as age, gender and marital status, strongly influence the probability of undergoing NIV. Efforts should be made to remove these obstacles in order to spread the use of NIV in all ALS patients with respiratory failure. PMID: 22013242 [PubMed - indexed for MEDLINE]

Breve commento a cura di Nerina Agabiti
La Sclerosi Laterale Amiotrofica (SLA) è una malattia neurologica di estrema gravità sulla cui eziologia ci sono ancora punti oscuri e per la quale le terapie disponibili attualmente non riescono a modificare sostanzialmente la prognosi infausta. Una recente revisione sistematica Cochrane ha concluso che la ventilazione meccanica non-invasiva è il trattamento di scelta dei problemi respiratori nella SLA, i quali rappresentano generalmente la causa finale di decesso. Nell’interessante articolo di Chiò et al vengono presentati i dati relativi ad uno studio longitudinale di popolazione basato sui dati del Registro SLA della Valle d’Aosta e del Piemonte attivo dal 1995. Sono stati raccolti prospetticamente dati su 1260 pazienti nell’arco di 10 anni. Circa il 21% ha utilizzato la ventilazione meccanica non-invasiva. L’uso di questa terapia era favorita dall’essere ricoverati in centri attrezzati per l’assistenza specialistica dedicata alla SLA. Nel tempo si è assistito ad un aumento dell’uso di tale terapia ma solo nei centri specializzati. Il tempo mediano di sopravvivenza dall’inizio della terapia con ventilazione meccanica non-invasiva è stato di 289 giorni. L’età giovanile, il genere maschile e l’essere sposato influenza positivamente l’accesso alla terapia. La sopravvivenza è migliore tra i pazienti giovani, sposati, con nutrizione enterale e seguiti presso i centri specializzati dedicati alla SLA. Gli autori sottolineano l’importanza della diffusione delle linee guida sul trattamenti in modo da migliorare in generale la cura della SLA nella popolazione, anche se è evidente da questo studio il beneficio della cure effettuate in centri di alta specializzazione dedicati alla malattia rispetto a cure in altre strutture.

2. Antonelli A, Ficarra V, Bertini R, Carini M, Carmignani G, Corti S, Longo N, Martorana G, Minervini A, Mirone V, Novara G, Serni S, Simeone C, Simonato A, Siracusano S, Volpe A, Zattoni F, Cunico SC; members of the SATURN Project - LUNA Foundation. Elective partial nephrectomy is equivalent to radical nephrectomy in patients with clinical T1 renal cell carcinoma: results of a retrospective, comparative, multi-institutional study. BJU Int. 2012 Apr;109(7):1013-8. doi: 10.1111/j.1464-410X.2011.10431.x. Epub 2011 Aug 24
University of Brescia, Brescia, Italy.
Abstract
OBJECTIVE To compare the oncological outcomes of patients who underwent elective partial nephrectomy (PN) or radical nephrectomy (RN) for clinically organ-confined renal masses ≤7 cm in size (cT1). PATIENTS AND METHODS The records of 3480 patients with cT1N0M0 disease were extracted from a multi-institutional database and analyzed retrospectively. RESULTS In patients who underwent PN, the risk of clinical understaging was 3.2% in cT1a cases and 10.6% in cT1b cases. With regard to the cT1a patients, the 5- and 10-year cancer-specific survival (CSS) estimates were 94.7% and 90.4%, respectively, after RN and 96.1% and 94.9%, respectively, after PN (log-rank test: P = 0.01). With regard to cT1b patients, the 5-year CSS probabilities were 92.6% after RN and 90% after PN, respectively (log-rank test: P = 0.89). Surgical treatment failed to be an independent predictor of CSS on multivariable analysis, both for cT1a and cT1b patients. Interestingly, PN was oncologically equivalent to RN also in patients with pT3a tumours (log-rank test: P = 0.91). CONCLUSIONS Elective PN is not associated with an increased risk of recurrence and cancer-specific mortality in both cT1a and cT1b tumours. Data from the present study strongly support the use of partial nephrectomy in patients with clinically T1 tumours, according to the current recommendations of the international guidelines. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL. PMID: 21883829 [PubMed - indexed for MEDLINE]
3. Tarantini G, Facchin M, Capodanno D, Musumeci G, Saia F, Menozzi A, Meliga E, Mancone M, Lettieri C, Tamburino C. Paclitaxel versus sirolimus eluting stents in diabetic patients: does stent type and/or stent diameter matter? Long-term clinical outcome of 2429-patient multicenter registry. Catheter Cardiovasc Interv. 2012 Apr 18. doi: 10.1002/ccd.24445. [Epub ahead of print]
Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy. giuseppe.tarantini.1@unipd.it.
Abstract
BACKGROUND Drug-eluting stents (DES) are more effective in reducing restenosis than bare-metal stents. Less certain is the relative performance of the 2 widely used DES- sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES)-in diabetic patients undergoing percutaneous coronary intervention (PCI). OBJECTIVES: We studied the long-term effectiveness and safety of SES versus PES in diabetic patients, overall and grouped by the size of the stent placed in the native stented vessel. METHODS Data were obtained from an observational, multicenter registry of 2,429 consecutive patients with DM who underwent PCI between August 2003 and August 2009 with SES (n=1370) or PES (n=1059). Data were analyzed separately for patients with small stents (<3.0 mm, n= 1274) vs only large (≥3.0 mm, n=1155). RESULTS At Cox adjusted analysis of the overall cohort, there was no significant difference between SES and PES with regard to death/myocardial infarction (D/MI) (p=0.6) or target lesion revascularization (TLR) (p=0.3) either in 'small-stent' (D/MI, p=0.8; TLR, p=0.2) or 'large stent' group (D/MI, p=0.8; TLR, p=0.4) throughout 1 to 5-year follow-up. These results were confirmed by sensitivity, propensity-score matched analysis (717 matched pairs) that failed to find differences in the safety and efficacy between SES and PES. CONCLUSIONS In this large observational study, PES and SES were equally safe and efficacious in diabetic patients undergoing PCI in clinical practice, regardless of the stent size. © 2012 Wiley Periodicals, Inc. Copyright © 2012 Wiley Periodicals, Inc. PMID: 22511311 [PubMed - as supplied by publisher]
4. Rombolà G, Londrino F, Corbani V, Falqui V, Ardini M, Zattera T, Lanthanum Experience Litolae Group OB. Lanthanum carbonate: a postmarketing observational study of efficacy and safety J Nephrol. 2012 Apr 4:0. doi: 10.5301/jn.5000118. [Epub ahead of print]
Nephrology and Dialysis Unit, S. Andrea Hospital, La Spezia - Italy.
Abstract
BACKGROUND Hyperphosphatemia is associated with morbidity and mortality in hemodialysis patients. The use of calcium chelators is restricted by the risk of hypercalcemia and vascular calcifications. Sevelamer, a non-calcium chelator, is associated with risks of metabolic acidosis and poor compliance. Lanthanum carbonate is a non-calcium chelator not associated with these issues. However, accumulation in liver and bone has been a reason for concern. METHODS Adult patients (n=112) from 9 hemodialysis centers, with serum phosphorus >5.5 mg/dL and on hemodialysis for >1 year, were selected to switch to lanthanum carbonate (mean dosage: 2,189 ± 491 mg/day); 103 completed the study. Laboratory assays for serum phosphate, calcium, parathyroid hormone, alkaline phosphatase, gamma-glutamyl transpeptidase (gammaGT), aspartate transaminase, alanine transaminase and plasma bicarbonate were performed monthly. Seven patients underwent a bone biopsy for evaluation of lanthanum bone content. RESULTS Switching to lanthanum carbonate led to a reduction in mean serum phosphate levels (-18.2%; p<0.001) and calcium × phosphorus product (-17.6%; p<0.0001). There were no important changes in other variables, except for an increase in transaminases in 2 patients with preexisting liver disease, who discontinued therapy. An increase in plasma bicarbonate concentration was observed (p=0.001). Although some lanthanum was detected in bone, its distribution did not follow the mineralization front. CONCLUSIONS Lanthanum carbonate is effective and well tolerated, provided that recipients do not have preexisting liver disease. After 8 months of treatment, lanthanum was not detected in the mineralization front of bone. In hemodialysis patients, lanthanum carbonate does not seem to be involved in metabolic bone disease. PMID: 22476966 [PubMed - as supplied by publisher]
5. Cucchetti A, Ercolani G, Cescon M, Bigonzi E, Peri E, Ravaioli M, Pinna AD. Impact of subcentimeter margin on outcome after hepatic resection for colorectal metastases: a meta-regression approach. Surgery. 2012 May;151(5):691-9. Epub 2012 Jan 18.
Liver and Multiorgan Transplant Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. aleqko@libero.it
Abstract
BACKGROUND The optimal margin width and its influence on outcomes after hepatic resection for colorectal liver metastases is still controversial: a meta-analysis was conducted to analyze the impact of subcentimeter margin width on patient and disease-free survival after resection. METHODS A systematic search was performed, covering the last decade, following the Meta-analysis Of Observational Studies in Epidemiology guidelines. Relative risks (RRs) for patient and disease-free survival (DFS) were calculated after resection in relationship to a margin width >1 cm (R0 > 1 cm) and between 1 mm and 1 cm (R0 < 1 cm) using the DerSimonian and Laird random-effects model. Meta-regression was applied for covariate adjustment. RESULTS Eleven observational studies were identified involving 2823 patients. Overall, 59.1% of patients were R0 < 1 cm and 40.9% were R0 > 1 cm. Meta-analysis showed that compared with patients with margins R0 > 1 cm, a R0 < 1 cm margin lead to decreased 1-, 3-, and 5-year DFS with a RR of 1.17 (95% confidence interval [CI] 1.07-1.27), 1.38 (95% CI 1.16-1.65), and 1.55 (95% CI 1.25-1.91), respectively, but patient survival was obviously affected (P > .05 in all cases). Patients with margins of R0 < 1 cm differ from those with R0 > 1 cm for greater proportions of multiple metastases (RR 1.43; 95% CI 0.25-1.61) and synchronous bowel disease (RR 1.42; 95% CI 0.8-1.92). Meta-regression showed that these two covariates had a significant impact on DFS but not on patient survival. CONCLUSION A resection margin width >1 cm is desirable even if patient survival is at best only slightly affected by subcentimeter margin as a consequence of a decreased DFS. The presence of multiple metastases and synchronous bowel neoplasm represent potential study selection biases that significantly decrease DFS; well-conducted, matched analyses consequently are essential to clarify the issue. Copyright © 2012 Mosby, Inc. All rights reserved. PMID: 22261294 [PubMed - in process]
6. Frigerio S, Di Giulio P, Gregori D, Gavetti D, Ballali S, Bagnato S, Guidi G, Foltran F, Renga G. Managing peripheral venous catheters: an investigation on the efficacy of a strategy for the implementation of evidence-based guidelines. J Eval Clin Pract. 2012 Apr;18(2):414-9. doi: 10.1111/j.1365-2753.2010.01590.x. Epub 2010 Nov 30.
Quality Office, CTO-CRF-M. Adelaide Hospital, Torino, Italy
Abstract
RATIONALE, AIMS AND OBJECTIVES Until now, the evaluation of the effectiveness of guideline implementation in nursing and allied health professions has received relatively little attention. The aims of this study were (i) to describe the development process of guidelines concerning the management of peripheral venous catheters (PVCs) implemented in an Italian hospital; and (ii) to evaluate the effectiveness of guideline dissemination in terms of both clinical outcomes (signs of infection) and process outcomes (measures of appropriateness of PVC management). METHODS An observational study was conducted before and after the adoption of a new protocol in the CTO-CRF-Maria Adelaide Hospital. Data from 306 PVCs (153 before and 153 after) were collected. For each PVC, a wide range of outcome measures was collected, including: data on fixation system type of dressing; visibility of the insertion site; registration of the insertion date; duration of catheter insertion; presence of connectors, taps and needles; and signs of infection. The effect of guideline implementation was evaluated using a logistic regression model to adjust for the confounding variable represented by the nurses' average years of working experience. RESULTS The risk of using inappropriate dressing was significantly reduced [odds ratio (OR) 0.43; 95% confidence interval (CI) 0.27-0.70], while the use of transparent dressing increased (OR 2.39; 95% CI 1.46-3.89). CONCLUSION Our study shows significant improvement in practices relevant to the correct management of PVCs 2 months after guideline implementation. A second survey (after a minimum of 6 months) is necessary to assess persistence of improvement in clinical practices. © 2010 Blackwell Publishing Ltd. PMID: 21114722 [PubMed - in process]
7. Filingeri V, Bellini MI, Gravante G. The role of radiofrequency surgery in the treatment of hemorrhoidal disease. Eur Rev Med Pharmacol Sci. 2012 Apr;16(4):548-53.
Department of Surgical Sciences, University of Rome "Tor Vergata", Rome, Italy. v.filingeri@tiscali.it
Abstract
BACKGROUND In this article we reported results obtained in our previous studies concerning application of Radiofrequency (RF) in proctology and in particular for hemorrhoids treatment. METHODS We compared Radiofrequency Submucosal Hemorrhoidectomy (RSH) and Conventional Parks' Hemorrhoidectomy (CPH) (group 1), Radiofrequency Open Hemorroidectomy (ROH) and Milligan-Morgan Hemorrhoidectomy (MMH) (group 2), Radiofrequency Closed Hemorrhoidectomy (RCH) and Ferguson Hemorrhoidectomy (FH) (group 3), Combined Hemorrhoidal Radiocoagulation (CHR) and Rubber Band Ligation (RBL) (group 4). In this work primary endpoints were determined as evaluation of the grade of pain felt immediately after the procedure and at the first evacuation, bleeding, operation time, readmission to work, incidence of failures and patient's satisfaction. RESULTS Group 1 - In comparison to Parks' technique, use of radiofrequency scalpel reduced mean operation time (61.2 min, range 50-75, vs. 37.4 min, range 30-51; p < 0.05), first postoperative day pain score (5.9, range 3-10, vs. 4.0, range 1-10; p < 0.05), pain score at first evacuation (5.7, range 2-10, vs 4.2, range 1-8; p < 0.05) and pain score on postoperative days (3.6, range 1-9, vs. 2.8, range 1-8; p < 0.05). Group 2 - Results show a substantial similarity between these techniques, however the procedure lasted 7 minutes less with RF scalpel (18.6 min, range 16-21, vs. 25.55 min, range 20-30; p < 0.05). Group 3 - Patients treated with RF showed significant reduction in surgical time (23 min, range 21-31, vs. 33 min, range 24-35; p < 0.01), in pain at 1st post-operative day (VAS score 3.4 +/- 1.3 vs. 4.8 +/- 1.0; p < 0.05) and at the first evacuation (3.4 +/- 1.0 vs. 5.0 +/- 0.8; p < 0.05). Group 4 - The study confirmed validity of both the used techniques, however CHR seems to allow a reduction in incidence of failures. CONCLUSIONS Results obtained from radiofrequency surgery compared with those achieved with classic surgery for hemorrhoidal disease show in the majority of cases that radiosurgery facilitates, accelerates and improves surgical procedures. PMID: 22696885 [PubMed - in process]
8. Lees T, Troëng T, Thomson IA, Menyhei G, Simo G, Beiles B, Jensen LP, Palombo D, Venermo M, Mitchell D, Halbakken E, Wigger P, Heller G, Björck M. International Variations in Infrainguinal Bypass Surgery - A VASCUNET Report. Eur J Vasc Endovasc Surg. 2012 May 31. [Epub ahead of print]
Northern Vascular Centre, Newcastle Upon Tyne Hospitals NHS Trust, UK.
Abstract
OBJECTIVES To compare practice in lower limb bypass surgery in nine countries. DESIGN A prospective study amalgamating and analysing data from national and regional vascular registries. METHODS A table of data fields and definitions was agreed by all member countries of the Vascunet Collaboration. Data from January 2005 to December 2009 was submitted to a central database. RESULTS 32,084 cases of infrainguinal bypass (IIB) in nine countries were analysed. Procedures per 100,000 population varied between 2.3 in the UK and 24.6 in Finland. The proportion of women varied from 25% to 43.5%. The median age for all countries was 70 for men and 76 for women. Hungary treated the youngest patients. IIB was performed for claudication for between 15.7% and 40.8% of all procedures. Vein grafts were used in patients operated on for claudication (52.9%), for rest pain (66.7%) and tissue loss (74.1%). Italy had the highest use of synthetic grafts. Among claudicants 45% of bypasses were performed to the below knee popliteal artery or more distally. Graft patency at 30 days varied between 86% and 99%. CONCLUSIONS Significant variations in practice between countries were demonstrated. These results should be interpreted alongside the known limitations of such registry data with respect to quality and completeness of the data. Variation in data completeness and data validation between countries needs to be improved for useful international comparison of outcomes. Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved. PMID: 22658613 [PubMed - as supplied by publisher]

Breve commento a cura di Nerina Agabiti
I dati dello studio VASCUNET pubblicati da Lees et al forniscono un interessante quadro comparativo dell’uso della chirurgia vascolare degli arti inferiori (bypass sotto-inguinale) utilizzando i dati provenienti da registri di 9 paesi. Il lavoro è interessante proprio per la possibilità di confrontare l’occorrenza di questa chirurgia e la variabilità delle tecniche tra regioni e paesi. Il data base è centralizzato e riguarda un quinquennio (2005-2009). Sono oggetto di studio 23.084 casi. Si è osservata una notevole variabilità sia nell’offerta di procedure, nelle tecniche e nelle popolazioni. Infatti, il tasso di procedura varia tra 2.3 x 100.000 in UK e 24.6 in Finlandia, la proporzione di donne varia tra 25 e 43%. L’Ungheria è lo stato con maggio numero di pazienti giovani operati. La variabilità tra centri deve tuttavia – dicono gli Autori – essere interpretata con cautela data la disomogenea completezza e qualità dei dati dei registri. Studi di questo genere forniscono interessanti informazioni sull’andamento dell’offerta di tecniche o terapie nel tempo e tra aree, ed insieme sottolineano la necessità dell’uso di metodologie standardizzate e validate di raccolta dati.

9. Pelliccia F, Trani C, Biondi-Zoccai GG, Nazzaro M, Berni A, Patti G, Patrizi R, Pironi B, Mazzarotto P, Gioffrè G, Speciale G, Pristipino C; Prospective Registry of Vascular Access in Interventions in Lazio Region (prevail) Study Group. Comparison of the Feasibility and Effectiveness of Transradial Coronary Angiography Via Right Versus Left Radial Artery Approaches (from the PREVAIL Study). Am J Cardiol. 2012 May 30. [Epub ahead of print]
Dipartimento Universitario del Cuore e Grossi Vasi "A. Reale", 1(a) Facoltà di Medicina e Chirurgia, Università degli Studi di Roma "La Sapienza", Rome Italy.
Abstract
It remains undefined if transradial coronary angiography from a right or left radial arterial approach differs in real-world practice. To address this issue, we performed a subanalysis of the PREVAIL study. The PREVAIL study was a prospective, multicenter, observational survey of unselected consecutive patients undergoing invasive cardiovascular procedures over a 1-month observation period, specifically aimed at assessing the outcomes of radial approach in the contemporary real world. The choice of arterial approach was left to the discretion of the operator. Prespecified end points of this subanalysis were procedural characteristics. Of 1,052 patients consecutively enrolled, 509 patients underwent transradial catheterization, 304 with a right radial and 205 with a left radial approach. Procedural success rates were similar between the 2 groups. Compared to the left radial group, the right radial group had longer procedure duration (46 ± 29 vs 33 ± 24 minutes, p <0.0001) and fluoroscopy time (765 ± 787 vs 533 ± 502, p <0.0001). At multivariate analysis, including a parsimonious propensity score for the choice of left radial approach, duration of procedure (beta coefficient 11.38, p <0.001) and total dose-area product (beta coefficient 11.38, p <0.001) were independently associated with the choice of the left radial artery approach. The operator's proficiency in right/left radial approach did not influence study results. In conclusion, right and left radial approaches are feasible and effective to perform percutaneous procedures. In the contemporary real world, however, the left radial route is associated with shorter procedures and lower radiologic exposure than the right radial approach, independently of an operator's proficiency. Copyright © 2012 Elsevier Inc. All rights reserved. PMID: 22651876 [PubMed - as supplied by publisher]
10. Vikatmaa P, Mitchell D, Jensen LP, Beiles B, Björck M, Halbakken E, Lees T, Menyhei G, Palombo D, Troëng T, Wigger P, Venermo M. Variation in Clinical Practice in Carotid Surgery in Nine Countries 2005-2010. Lessons from VASCUNET and Recommendations for the Future of National Clinical Audit. Eur J Vasc Endovasc Surg. 2012 Jul;44(1):11-7. Epub 2012 May 24.
Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland.
Abstract
OBJECTIVES The aim of the study was to analyse variation in carotid surgical practice, results and effectiveness in nine countries. PATIENTS AND METHODS A total of 48,185 carotid endarterectomies (CEAs) and 4602 carotid artery stenting (CAS) procedures were included in the comparison. A theoretical effectiveness of CEA provision for each country was estimated. RESULTS 92.6% of the CEAs were performed according to the inclusion criteria based on the current European recommendations and had a theoretical benefit for the patient. The indication for surgery was symptomatic stenosis in 60.1% and this proportion varied between 31.4% in Italy and 100% in Denmark. The overall combined stroke and death rate in symptomatic patients was 2.3%. This varied between rates of 0.9% in Italy and 3.8% in Norway. The overall combined stroke and death rate in asymptomatic patients was 0.9%. It was lowest in Italy at 0.5%, and highest in Sweden at 2.7%. We estimated that the stroke prevention rate per 1000 CEAs varied from 72.9 in Italy to 130.8 in Denmark. CONCLUSIONS There is significant variation in clinical practice across the participating countries. The theoretical stroke prevention potential of CEA seems to vary between participating countries due to differences in the inclusion criteria. Copyright © 2012 European Society for Vascular Surgery. All rights reserved. PMID: 22633072 [PubMed - in process]
11. Abdollah F, Schmitges J, Sun M, Jeldres C, Tian Z, Briganti A, Shariat SF, Perrotte P, Montorsi F, Karakiewicz PI. Comparison of mortality outcomes after radical prostatectomy versus radiotherapy in patients with localized prostate cancer: A population-based analysis. Int J Urol. 2012 May 10. doi: 10.1111/j.1442-2042.2012.03052.x. [Epub ahead of print]
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada Department of Urology, Vita Salute San Raffaele University, Milan, Italy Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany Department of Urology, Weill Medical College of Cornell University, New York, New York, USA.
Abstract
To compare the mortality outcomes of radical prostatectomy and Objectives: radiotherapy as treatment modalities for patients with localized prostate cancer. 665 patients with localized prostate cancer,  Our cohort consisted of 68 Methods: treated with radical prostatectomy or radiotherapy, between 1992 and 2005. Propensity-score matching was used to minimize potential bias related to treatment assignment. Competing-risks analyses tested the effect of treatment type on cancer-specific mortality, after accounting for other-cause mortality. All analyses were stratified according to prostate cancer risk groups, baseline For patients treated with radical Charlson Comorbidity Index and age. Results: prostatectomy versus radiotherapy, the 10-year cancer-specific mortality rates were 1.4 versus 3.9% in low-intermediate risk prostate cancer and 6.8 versus 11.5% in high-risk prostate cancer, respectively. Rates were 2.4 versus 5.9% in patients with Charlson Comorbidity Index of 0, 2.4 versus 5.1% in patients with Charlson Comorbidity Index of 1, and 2.9 versus 5.2% in patients with Charlson years, Comorbidity Index of ≥2. Rates were 2.1 versus 5.0% in patients aged 65-69 2.8 versus 5.5% in patients aged 70-74 years, and 2.9 versus 7.6% in patients  years (all P aged 75-80<0.001). At multivariable analyses, radiotherapy was  associated with less favorable cancer-specific mortality in all categories (all  P< Patients treated with radical prostatectomy fare 0.001). Conclusions:  substantially better than those treated with radiotherapy. Patients with high-risk prostate cancer benefit the most from radical prostatectomy. Conversely, the lowest benefit was observed in patients with low-intermediate risk prostate cancer and/or multiple comorbidities. An intermediate benefit was observed in the other examined categories. © 2012 The Japanese Urological Association. PMID: 22574746 [PubMed - as supplied by publisher]
12. Bussu F, Paludetti G, Almadori G, De Virgilio A, Galli J, Miccichè F, Tombolini M, Rizzo D, Gallo A, Giglia V, Greco A, Valentini V, De Vincentiis M. Comparison of total laryngectomy with surgical (cricohyoidopexy) and nonsurgical organ-preservation modalities in advanced laryngeal squamous cell carcinomas: A multicenter retrospective analysis. Head Neck. 2012 Apr 12. doi: 10.1002/hed.22994. [Epub ahead of print]
Institute of Otorhinolaryngology, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy. francescobussu@yahoo.it.
Abstract
BACKGROUND Functional outcome and quality of life (QOL) have become relevant endpoints in the field of laryngeal oncology, leading to the emergence of organ-preserving strategies. METHODS The medical records of 166 patients with advanced (stages III and IV) laryngeal squamous cell carcinoma (SCC) who were treated with a total laryngectomy, radiochemotherapy, or cricohyoidopexy (CHP) were reviewed. RESULTS In the whole series, no statistically significant differences among the 3 treatment arms with respect to the overall survival (OS) and disease-specific survival (DSS) rates were observed. The organ-preservation rate was 45% for radiotherapy and 76.7% for CHP (p = .0002). Among the cT4a cases, a longer survival was observed for the patients treated with total laryngectomy (3 yr-OS = 78% vs 68% for CHP and 54% for radiochemotherapy, p = .031). CONCLUSIONS In advanced laryngeal SCC, CHP shows survival rates comparable to those of radiochemotherapy and a higher larynx-preservation rate, although it may not replace radiochemotherapy because it can be recommended only in selected cases. © 2012 Wiley Periodicals, Inc. Head Neck, 2012. Copyright © 2012 Wiley Periodicals, Inc. PMID: 22495830 [PubMed - as supplied by publisher]
13. Tamburino C, Barbanti M, Capodanno D, Mignosa C, Gentile M, Aruta P, Pistritto AM, Bonanno C, Bonura S, Cadoni A, Gulino S, Di Pasqua MC, Cammalleri V, Scarabelli M, Mulè M, Immè S, Del Campo G, Ussia GP. Comparison of complications and outcomes to one year of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis. Am J Cardiol. 2012 May 15;109(10):1487-93. Epub 2012 Feb 21.
Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy.
Abstract
Comparisons of transcatheter aortic valve implantation (TAVI) to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis remain sparse or limited by a short follow-up. We sought to evaluate early and midterm outcomes of consecutive patients (n = 618) undergoing successful TAVI (n = 218) or isolated SAVR (n = 400) at 2 centers. The primary end point was incidence of Valvular Academic Research Consortium-defined major adverse cerebrovascular and cardiac events (MACCEs) up to 1 year. Control of potential confounders was attempted with extensive statistical adjustment by covariates and/or propensity score. In-hospital MACCEs occurred in 73 patients (11.8%) and was more frequent in patients treated with SAVR compared to those treated with TAVI (7.8% vs 14.0%, p = 0.022). After addressing potential confounders using 3 methods of statistical adjustment, SAVR was consistently associated with a higher risk of MACCEs than TAVI, with estimates of relative risk ranging from 2.2 to 2.6 at 30 days, 2.3 to 2.5 at 6 months, and 2.0 to 2.2 at 12 months. This difference was driven by an adjusted increased risk of life-threatening bleeding at 6 and 12 months and stroke at 12 months with SAVR. Conversely, no differences in adjusted risk of death, stroke and myocardial infarction were noted between TAVI and SAVR at each time point. In conclusion, in a large observational registry with admitted potential for selection bias and residual confounding, TAVI was not associated with a higher risk of 1-year MACCEs compared to SAVR. Copyright © 2012 Elsevier Inc. All rights reserved. PMID: 22356793 [PubMed - in process]
14. Piazza M, Ricotta JJ 2nd. Open surgical repair of thoracoabdominal aortic aneurysms. Ann Vasc Surg. 2012 May;26(4):600-5. Epub 2011 Dec 20
Clinica di Chirurgia Vascolare ed Endovascolare, Universita' degli Studi di Padova, Padova, Italy.
Abstract
Despite much advancement in preoperative evaluation and perioperative care of patients with thoracoabdominal aortic aneurysms (TAAA), open surgical repair of TAAAs remains a formidable challenge for the vascular surgeon. It requires extensive dissection and mobilization of the aorta and its branches, as well as cross-clamping of the aorta above intercostal and visceral arteries. Over the past decade, the mortality and morbidity associated with open TAAA repair have improved significantly. However, it remains one of the most complex, extensive surgical procedures performed in the field of vascular surgery. Recently, there has been much attention directed at less invasive methods such as the so-called "hybrid" or "debranching" procedure, or complete endovascular repair with fenestrated and branched endografts for repairing TAAAs. However, the gold standard for repair of TAAA remains open surgery, and this article summarizes the clinical outcomes of open surgical repair of TAAAs during the past decade (2000-2010) to provide a benchmark for comparison with results from previous decades and also with which to compare the results of modern-day hybrid and/or complete endovascular techniques. Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. PMID: 22188939 [PubMed - in process]
15. Zaffagnini S, Marcheggiani Muccioli GM, Giordano G, Bonanzinga T, Grassi A, Nitri M, Bruni D, Ravazzolo G, Marcacci M. Long-term outcomes after repair of recurrent post-traumatic anterior shoulder instability: comparison of arthroscopic transglenoid suture and open Bankart reconstruction. Knee Surg Sports Traumatol Arthrosc. 2012 May;20(5):816-21. Epub 2011 Sep 20.
Laboratorio di Biomeccanica, Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10, 40136, Bologna, Italy. s.zaffagnini@biomec.ior.it
Abstract
PURPOSE The purpose of this study is to report long-term outcomes of the arthroscopic modified Caspari technique compared to an open capsular shift surgery to treat post-traumatic anterior shoulder recurrent instability. The hypothesis was that the open surgery group would show higher degenerative changes than to the modified Caspari technique group after a follow-up from 10 to 17 years. METHODS One hundred and ten nonrandomized consecutive patients who underwent a surgical repair of recurrent unilateral anterior shoulder instability between 1990 and 1999 were retrospectively analyzed. Eighty-two patients were available for long-term follow-up. In particular, 49 patients (59.8%) (group A) were treated with arthroscopic transglenoid modified Caspari suturing technique (mean follow-up 13.7 ± 2.2 years), whereas 33 patients (40.2%) (group B) were treated with combined open capsular shift and Bankart repair (mean follow-up 15.7 ± 2.2 years). Patients were evaluated according to the failure rate (re-dislocation), Rowe, UCLA, and Constant scores. Radiological osteoarthritis changes were ranked according to Samilson score. RESULTS There were no statistically significant differences between the two groups concerning the failure rate (n.s.), Rowe (n.s.), UCLA (n.s.), and Constant (n.s.) scores. Group A: re-dislocation rate 12.5% (6 re-dislocations), Rowe 85.0 ± 22.6, UCLA 26.4 ± 4.8, and Constant 86.3 ± 16.7. Group B: re-dislocation rate 9% (3 re-dislocations), Rowe 83.2 ± 24.4, UCLA 26.9 ± 4.2, and Constant 87.4 ± 14.1. Radiographic findings of osteoarthritis: 2 severe (4%), 4 moderate (8%), and 12 mild (25%) in group A; 2 severe (6%), 4 moderate (12%), and 9 mild (27%) in group B; differences between groups were not statistically significant (n.s). CONCLUSIONS The results after both techniques were good in majority of patients, with no significant differences in terms of re-dislocation and osteoarthritis development. Compared to the current literature, the recurrence rate was high in both groups. The modified Caspari technique could be an arthroscopic alternative for older, non-athletic shoulders. LEVEL OF EVIDENCE Therapeutic Study-Retrospective Comparative Study, Level III. PMID: 21932077 [PubMed - in process]

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