Marco Ghionzoli - Academia.edu (original) (raw)

Papers by Marco Ghionzoli

IFMBE Proceedings, 2019

The introduction of the vacuum bell (VB) for the conservative treatment of Pectus Excavatum (PE) ... more The introduction of the vacuum bell (VB) for the conservative treatment of Pectus Excavatum (PE) has led to a new non-invasive alternative to thoracic surgery. The VB works by elevating the chest as long as a negative differential pressure is internally assured. In recent years studies have been conducted to validate this type of treatment and to outline its correct use; results show a short-term PE improvement when the device is worn for a minimum of 30 min (twice a day) up to a maximum of several hours a day for 12–15 months. Although the worldwide diffusion of VB devices increases year after year, its ability to lift the chest during treatment with respect to the applied pressure has begun to be evaluated only recently. In this paper, a new instrument for measuring chest elevation during treatment is presented and validated. The proposed system consists of two measurement devices: a commercial instrument for the detection of the negative pressure inside the VB, and a specifically developed optical system for the detection of chest movement. The effectiveness of the proposed system, tested on five paediatric patients, paves the way to the objective definition of an optimised patient specific VB scheme of use.

Lecture Notes in Mechanical Engineering, 2019

Pectus Excavatum (PE) is a congenital anomaly of the thoracic cage, at the level of the sternal-c... more Pectus Excavatum (PE) is a congenital anomaly of the thoracic cage, at the level of the sternal-costal plane, which consists of an inward angle of the sternum, in the direction of the spine. Its incidence, equal to 1 in 300–400 people, makes it the most frequent among thoracic malformations. For a proper care of patients suffering from PE, it is essential to monitor the progression of the disease and estimate its severity, in order to follow the course of the pathology over time and define the correct treatment. To this end, over the years, severity indexes, or chest indexes, have been introduced. Among them, in recent years, the so-called optical indices, calculated on optical scans of the patient’s chest, are gaining ground. In fact, the optical scan is faster to apply and prevents the patient from being exposed to radiation. In this work the peculiar morphological features of PE have been examined by extracting various geometric parameters, in order to develop an outpatient support tool for the evaluation of the severity of the pathology and the monitoring of its progression over time. The extracted values have been compared against a ground truth obtained through five independent surveys collected from paediatric specialists. A Linear Discriminant Analysis was performed to determine the accuracy of the classification using the proposed geometric parameters, obtaining positive results.

Children, 2022

Retention of foreign bodies (FB) in the liver parenchyma is a rare event in children but it can b... more Retention of foreign bodies (FB) in the liver parenchyma is a rare event in children but it can bring a heavy burden in terms of immediate and long-term complications. Multiple materials can migrate inside the liver. Clinical manifestations may vary, depending on the nature of the foreign body, its route of penetration and timing after the initial event. Moreover, the location of the FB inside the liver parenchyma may pose specific issues related to the possible complications of a challenging surgical extraction. Different clinical settings and the need for highly specialized surgical skills may influence the overall management of these children. Given the rarity of this event, a systematic review of the literature on this topic was conducted and confirmed the pivotal role of surgery in the pediatric population.

2020 42nd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC), 2020

Pectus Arcuatum (PA) is a congenital chest wall deformity which produces a superior manubrial and... more Pectus Arcuatum (PA) is a congenital chest wall deformity which produces a superior manubrial and sternal protrusion, particularly at the sternal angle. PA surgical correction to reduce the angle of the sternum always includes the removal of bone portion by means of horizontal sternal osteotomies, resection of deformed rib cartilage and finally stabilization of the anterior thoracic wall. Within this process an incorrect assessment of the sternotomy angle during the procedure may lead to the need for bone or cartilage grafts to fill the left voids. This problem has been addressed with a patient-specific cutting template, realized with Reverse Engineering and Additive Manufacturing techniques, which proved to be a key element to simplify the procedure and avoid the occurrence of this type of complications. In this work is presented and validated a procedure that, through common CAD operations, realizes in a completely automatic way the CAD model of the custom cutting template, so as to make non-expert users independent in the realization of the medical device.

Pediatric Surgery International, 2021

Purpose The purpose of the study is to evaluate results and outcomes in a long-time follow-up per... more Purpose The purpose of the study is to evaluate results and outcomes in a long-time follow-up period, by performing a novel testicular fixation procedure, known as “fat anchor orchidopexy” (FAO), for the treatment of palpable low inguinal undescended testis. Materials and methods We retrospectively reviewed all patients who underwent scrotal orchiopexy technique, from May 2013 to May 2019, at the Pediatric Surgery Division of Department of Surgical Pathology, University of Pisa (Italy). FAO (Spinelli’s technique) consists in anchoring the testicles to sub-scrotal fat with a single trans-scrotal incision. All the patients enrolled had history of unilateral or bilateral undescended testis. Data collected included patient’s age, operative times and complications. Results A total of 150 children with cryptorchidism were treated using a single trans-scrotal orchiopexy. Of them, 130 patients (86.7%) had unilateral undescended testis and 20 (13.3%) bilateral cryptorchidism. Mean patient’s ...

IEEE Transactions on Medical Robotics and Bionics, 2019

This paper describes a sensorized orthosis used to objectively monitor the follow-up of pediatric... more This paper describes a sensorized orthosis used to objectively monitor the follow-up of pediatric patients affected by Pectus Carinatum and treated through compression therapy. The study reports an analysis made on 25 patients. The pressure exerted by the compression brace was monitored by means of a high-density sensing matrix at every outpatient check, over 150 days. The pressure maps derived from this analysis correlated with the clinical parameters indicating a successful outcome for the treatment of specific deformity types such as symmetric chondrogladiolous and rib flares. Results demonstrate that bracing is an effective tool in well-motivated patients in the previously mentioned deformity types. Pressure mapping emerged as a parameter to objectively assess treatment efficacy and may pave the way to a new generation of orthoses with high-density sensorized elements chronically embedded in their structure.

The Annals of Thoracic Surgery, 2018

Background. Current approaches to quantifying the severity of pectus excavatum require internal m... more Background. Current approaches to quantifying the severity of pectus excavatum require internal measurements based on cross-sectional imaging. The aim of this study is to exploit a novel index evaluated on the external surface of the chest with a three-dimensional (3D) optical scanner. Methods. Fifty-one children (41 male, 10 female) between 2 and 17 years of age were evaluated with a 3D optical scanner. Pectus excavatum severity was calculated by using an ad hoc instant 3D scanner and defining an automatic procedure to generate an optical 3D correction index (CI3D). For the latter, an ideal threshold was derived from a statistical analysis, and five blind surveys were collected from pediatric specialists on chest wall deformities. The CI3D was then correlated with blind clinical assessments of PE severity.

Journal of laparoendoscopic & advanced surgical techniques. Part A, 2017

Nuss bar removal after minimally invasive repair of pectus excavatum in patients where bar ends a... more Nuss bar removal after minimally invasive repair of pectus excavatum in patients where bar ends are not palpable, can be a challenging procedure for the surgeon; a blind dissection toward the bar edges may lead to intercostal vessels or deep intercostal muscle injuries. In this article, we describe a fast, repeatable, low-cost technique to detect bar edge and stabilizers. A perioperative scan is performed by means of a portable ultrasonograph a few minutes before the operation. The bar edge stabilizer is detected as a hyperechogenic image with a concentric crescent while the bar edge is detected as a hyperechogenic dashed line with net edges. The scan is performed, and the actual projection on the skin of the metal plaque bulk is then labeled on the patient's chest by an ink marker. We believe that this method may improve morbidity, operative time, and consequently, hospitalization length and costs.

Pediatric Reports, 2016

Bacterial growth of peritoneal fluid specimens obtained during surgical procedures for acute appe... more Bacterial growth of peritoneal fluid specimens obtained during surgical procedures for acute appendicitis may be useful to optimize further antibiotic therapy in complicated cases. DNA amplification represents a fast technique to detect microbial sequences. We aimed to compare the potential of DNA amplification versus traditional bacterial growth culture highlighting advantages and drawbacks in a surgical setting. Peritoneal fluid specimens were collected during surgery from 36 children who underwent appendectomy between May and December 2012. Real-time polymerase chain reaction (RT-PCR) and cultures were performed on each sample. RT-PCR showed an amplification of 16S in 18/36 samples, Escherichia coli (in 7 cases), Pseudomonas aeruginosa (3), Fusobacterium necrophorum (3), Adenovirus (2), E.coli (1), Klebsiella pneumoniae (1), Serratia marcescens/Enterobacter cloacae (1). Bacterial growth was instead observed only in four patients (3 E.coli and 1 P.aeruginosa and Bacteroides ovatus...

Pediatrics International, 2016

Thoraco-abdominal trauma can in rare cases involve diaphragmatic rupture and subsequent herniatio... more Thoraco-abdominal trauma can in rare cases involve diaphragmatic rupture and subsequent herniation of intra-abdominal contents. We report a case of this complication in a 5-year-old boy who was injured in a car crash, and who manifested respiratory distress and hemodynamic instability after 48 h of being monitored in the pediatric intensive care unit. Multiple radiologic investigations were inconclusive and the definite diagnosis was established only on thoracoscopic exploration.

The Annals of thoracic surgery, 2015

Congenital sternal cleft is a rare chest wall malformation. Because of the flexibility of the che... more Congenital sternal cleft is a rare chest wall malformation. Because of the flexibility of the chest in infants, surgical repair should be performed by primary closure in the neonatal period. In adolescents and adults, different techniques have been suggested to overcome the lack of sternal bone tissue. We describe a very rare case of an 18-year-old woman with a complete bifid sternum associated with pectus excavatum for whom a satisfactory cosmetic and functional result was obtained by adequate surgical planning, which entailed a combination of two standardized surgical techniques.

Archives of Disease in Childhood - Fetal and Neonatal Edition, 2014

ABSTRACT

The Korean Journal of Pain, 2012

The Nuss procedure for the correction of Pectus Excavatum (PE) is associated with intense postope... more The Nuss procedure for the correction of Pectus Excavatum (PE) is associated with intense postoperative pain. Our strategy to control early postoperative pain is to combine epidural with intravenous analgesia. Our aim was to analyse our pain control strategy by reviewing all the PE cases treated at our institution. Sixty consecutive patients, aged between 12 and 26 years old, received the PE operation at our institution from January, 2007 to September, 2010. The median age was 16 (12−27) with a male/female ratio of about 7/1. An epidural catheter was employed in all the cases, with 38 patients (63%) requiring additional drugs to control pain, which remained in place for 74 hours (72−96). The pain score was higher in male patients, but lower in those younger than 16 years old. Moreover, patients that consumed benzodiazepines had a significant decrease in cumulative opioid intake (P = 0.0408). Both gender and age had an impact on pain control, while we noticed a synergistic effect between opiates and tranquillizers.

Medical Science Case Reports, 2014

Aesthetic plastic surgery, Jan 12, 2015

The umbilicus has a paramount aesthetical function for the abdomen and when removed due to a surg... more The umbilicus has a paramount aesthetical function for the abdomen and when removed due to a surgical procedure, an umbilicoplasty is mandatory: indeed, its absence could contribute to the development of psychological disorders, especially in childhood. Herein, we describe a straightforward technique to obtain a seemingly natural umbilical scar. This technique, easily taught in a general pediatric surgery environment, may be amenable for any kind of umbilical reconstruction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Turkish journal of pediatrics

Congenital diaphragmatic hernia (CDH) presents a wide spectrum of anatomical variants and clinica... more Congenital diaphragmatic hernia (CDH) presents a wide spectrum of anatomical variants and clinical pictures depending on the topography and dimensions of the diaphragmatic defect and on the patient age. Most CDH cases acutely present with tachypnea, cyanosis, and respiratory failure within the first minutes to hours of life. Despite significant advances in neonatal medicine, this congenital anomaly still presents a high mortality rate, especially for associated malformations. On the other hand, there is a rare subset of CDH patients who present outside the neonatal period. The most common symptoms of late-presenting CDH include recurrent pulmonary infections, dyspnea, wheezing, abdominal pain, failure to thrive, vomiting, diarrhea and anorexia. Although late-presenting CDH generally presents good prognosis after early surgical correction, misdiagnosis is quite frequent because of its wide spectrum of clinical manifestations. The following case report describes a six-month-old infant...

Pediatric Reports, 2013

Pectus excavatum, the most frequent congenital chest wall deformity, may be rarely observed as a ... more Pectus excavatum, the most frequent congenital chest wall deformity, may be rarely observed as a sole deformity or as a sign of an underlying connective tissue disorder. To date, only few studies have described correlations between this deformity and heritable connective tissue disorders such as Marfan, Ehlers-Danlos, Poland, MASS (Mitral valve prolapse, not progressive Aortic enlargement, Skeletal and Skin alterations) phenotype among others. When concurring with connective tissue disorder, cardiopulmonary and vascular involvement may be associated to the thoracic defect. Ruling out the concomitance of pectus excavatum and connective tissue disorders, therefore, may have a direct implication both on surgical outcome and long term prognosis. In this review we focused on biological bases of connective tissue disorders which may be relevant to the pathogenesis of pectus excavatum, portraying surgical and clinical implication of their concurrence.

Fetal and Pediatric Pathology, 2014

Cervical thymic cysts are rare cervical masses which usually present in the first decade of life ... more Cervical thymic cysts are rare cervical masses which usually present in the first decade of life accounting for 0.3% - 1% of all congenital neck masses. Due to its rarity thymic cysts are seldom included in the differential diagnosis of cystic cervical mass and are often mistaken for more common conditions such as branchial cleft cyst or cystic hygroma. Herein we present a case of a 6-year-old girl with a right lateral cervical cystic mass with multiple septae extended from mandibular angle along the neurovascular bundle of the neck which revealed to be a thymic cyst at histopathology.