Raffaele Macarone Palmieri - Academia.edu (original) (raw)

Papers by Raffaele Macarone Palmieri

Biology and Life Sciences Forum, Oct 20, 2021

Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection affecting immunocompromised ... more Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection affecting immunocompromised patients. Patients with acute myeloid leukemia (AML) are not considered at high risk of PJP, thus, prophylaxis is not recommended. Between 2010 and 2020 we retrospectively analyzed 251 AML patients. We performed molecular diagnosis and genotyping of Pneumocystis jirovecii in 67 bronchoalveolar lavage samples. Eleven cases of PJP were diagnosed, with a prevalence of 4.3%. Our study confirms that the most widespread genotype in Europe is genotype 1; in our patients, 70% presented with genotype 1 and 30% the genotype 3.

Background: Cloud computing is a new paradigm that is changing how enterprises, institutions and ... more Background: Cloud computing is a new paradigm that is changing how enterprises, institutions and people understand, perceive and use current software systems. With this paradigm, the organizations have no need to maintain their own servers, nor host their own software. Instead, everything is moved to the cloud and provided on demand, saving energy, physical space and technical staff. Cloud-based system architectures provide many advantages in terms of scalability, maintainability and massive data processing. Methods: We present the design of an e-health cloud system, modelled by an M/M/m queue with QoS capabilities, i.e. maximum waiting time of requests. Results: Detailed results for the model formed by a Jackson network of two M/M/m queues from the queueing theory perspective are presented. These results show a significant performance improvement when the number of servers increases. Conclusions: Platform scalability becomes a critical issue since we aim to provide the system with ...

Surgical Endoscopy, 2021

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Updates in Surgery, 2020

Purpose of the present study is to analyze risk factors for adverse events after elective colorec... more Purpose of the present study is to analyze risk factors for adverse events after elective colorectal resection. A wide range of adverse events after elective colorectal surgery was reported, anastomotic leakage (AL) and related morbidity and mortality being the most feared ones. Clear definition of risk factors is crucial to limit the related mortality. Prospective, 1-year multicenter enrollment of 1546 elective colorectal resections with anastomosis. Endpoints were anastomotic leakage (AL), overall morbidity, major morbidity and mortality rates (ClinicalTrials.gov; Identifier: NCT03560180). AL rate was 4.92%. Overall morbidity, major morbidity and mortality rates were 30.20%, 9.76% and 1.29%, respectively. Intra-and/or postoperative blood transfusion(s) was the only variable independently influencing all the endpoints: Odds ratios (OR) were 8.15 for AL, 19.33 for overall morbidity, 10.17 for major morbidity and 3.70 for mortality); overall morbidity rates were also independently influenced by American Society of Anesthesiologists class III vs I-II and extra-vs intra-corporeal anastomosis (OR 1.57 and 1.49, respectively); major morbidity rates were also independently influenced by female vs male gender and by the length of the procedure (OR 0.60 and 1.004, respectively); mortality rates were also independently influenced by increasing age (OR 1.16). This study clearly identifies intra-and/or postoperative blood transfusion(s) as an independent risk factor for all adverse events after elective colorectal surgery.

International Journal of Colorectal Disease, 2020

Purpose To analyze different types of management and one-year outcomes of anastomotic leakage (AL... more Purpose To analyze different types of management and one-year outcomes of anastomotic leakage (AL) after elective colorectal resection. Methods All patients with anastomotic leakage after elective colorectal surgery with anastomosis (76/1,546; 4.9%), with the exclusion of cases with proximal diverting stoma, were followed-up for at least one year. Primary endpoints were as follows: composite outcome of one-year mortality and/or unplanned intensive care unit (ICU) admission and additional morbidity rates. Secondary endpoints were as follows: length of stay (LOS), one-year persistent stoma rate, and rate of return to intended oncologic therapy (RIOT). Results One-year mortality rate was 10.5% and unplanned ICU admission rate was 30.3%. Risk factors of the composite outcome included age (aOR = 1.08 per 1-year increase, p = 0.002) and anastomotic breakdown with end stoma at reoperation

The American Surgeon, 2012

Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online... more Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 4 double-spaced pages with no Abstract or sub-headings, with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.

Anticancer Research, 2019

Parasitology Research, 2018

Pneumocystis jirovecii is an opportunistic fungus occurring in human lungs. The group at highest ... more Pneumocystis jirovecii is an opportunistic fungus occurring in human lungs. The group at highest risk consists of HIV-infected and non-HIV-infected immunosuppressed individuals. In these patients, P. jirovecii infection may lead to Pneumocystis pneumonia; it may, however, persist also in an asymptomatic form. This study aimed to determine the prevalence of P. jirovecii and potential risk factors for infection in a group of renal transplant recipients and to characterize the genetic diversity of this fungus in the studied population. Sputum specimens from 72 patients were tested for presence of P. jirovecii using immunofluorescence microscopy, as well as nested PCR targeting the mtLSU rRNA gene. Genotyping involving analysis of four loci-mtLSU rRNA, CYB, DHPS, and SOD-was used to characterize the diversity of the detected organisms. Pneumocystis DNA was detected in eight (11.11%) patients. It has been shown that low eosinophil count and dual immunosuppressive treatment combining prednisone and calcineurin inhibitors are potential risk factors for colonization. Analysis of genotype distribution showed an association of the wild-type genotype of mtLSU rRNA with lower average age of patients and shorter time after kidney transplantation. Furthermore, CYB 2 genotype was detected only in patients with the ongoing prophylaxis regimen. In conclusion, renal transplant recipients are at risk of Pneumocystis colonization even a long time after transplantation. The present preliminary study identifies specific polymorphisms that appear to be correlated with certain patient characteristics and highlights the need for deeper investigation of these associations in renal transplant recipients.

Journal of Minimally Invasive Gynecology, 2017

Journal of Investigative Surgery, 2016

Pancreaticoduodenectomy (PD) is the surgical treatment of choice for cephalopancreatic cancer rep... more Pancreaticoduodenectomy (PD) is the surgical treatment of choice for cephalopancreatic cancer representing the only hope of cure. Since its first description in 1935 by Allan Whipple, several modifications have been proposed. The execution of the Cattell-Braasch maneuver of intestinal derotation (ID) in the course of PD, by restoring the entire bowel to its embryological position, could represent a further and multiexpedient variant. We retrospectively studied 45 consecutive pancreatic cancer patients treated with Whipple-Child PD in which the Cattell-Braasch procedure of ID was performed as integrative part of the intervention. Additionally, we compared our results with the ones of conventional PD performed through open, laparoscopy, and robotic surgery. Continuous variables of ID-PD were calculated using Student's t-test whereas Mantel-Haenszel method was used for comparison with other non-ID PD techniques. The average operative time was 342 min (range 250-435 min). The median estimated intraoperative blood loss was 460 ml (range 350-570 ml) (p < .0001); no intraoperative blood transfusion was required. The average number of lymph nodes harvested per specimen was 19.4 (range 17-25) (p < .0001). Morbidity and mortality rate was 28.8% and 4.4% (respectively p < .0001 and p = .1596). Our data are in keeping with the classical PDs performed without ID. The association of the maneuver of ID with PD seems to bring some important advantages such as wider exposure of the operative field, safer dissection of anatomical structures, less intraoperative blood loss and higher number of sampled lymph nodes.

SpringerPlus, 2016

The enhanced recovery after surgery (ERAS) program aims to attenuate the surgical stress response... more The enhanced recovery after surgery (ERAS) program aims to attenuate the surgical stress response and decrease postoperative complications. It has increasingly replaced conventional approaches in surgical care. To evaluate the benefits and harms of the ERAS program compared to conventional care in patients undergoing liver surgery. We searched the MEDLINE, PubMed, EMBASE and Cochrane databases. All RCTs that compared the ERAS program with conventional care were selected. Four RCTs were eligible for analysis, which included 634 patients (309 ERAS vs. 325 conventional). Overall morbidity (RR 0.67; 95 % CI 0.48-0.92; p = 0.01), primary length of stay (WMD -2.71; 95 % CI -3.43 to -1.99; p < 0.00001), total length of stay (WMD -2.10; 95 % CI -3.96 to -0.24; p = 0.03), time of functional recovery (WMD -2.30; 95 % CI -3.77 to -0.83; p = 0.002), and time to first flatus (SMD, -0.52; 95 % CI -0.69 to -0.35; p < 0.00001) were significantly shortened in the ERAS group. Quality of life wa...

Clinical and Experimental Medicine, 2015

We commend Giannini et al. [1] on their interesting article about two rare cases of gallbladder m... more We commend Giannini et al. [1] on their interesting article about two rare cases of gallbladder metastasis from malignant cutaneous melanoma. As for us, we would like to pique interest in another particular and very rare disease involving both melanoma and cholecyst, which is primary malignant melanoma of the gallbladder. A 59-year-old man was submitted to laparoscopic cholecystectomy. Four months before, he underwent a neurosurgical removal of a solitary brain metastasis from unknown primary melanoma. With this histological diagnosis, a whole body F-FDG PET scan was arranged revealing a significant uptake only in the gallbladder (GB). Concomitant CT scan showed a mildly hyperdense nodule in the lumen of the GB (Fig. 1). Macroscopic evaluation found a brownish polyp of 2 cm in diameter. The microscopy revealed a malignant melanoma with junctional activity staining positive for protein melan A (Fig. 2). Considering this feature and the absence of other lesions on PET scan, the conclusive diagnosis was primary malignant melanoma of GB. Adjuvant chemoimmunotherapy was given; at 15-month follow-up, no metastasis has been detected. Primary malignant melanoma of the GB (PMMG) is an extremely rare cancer with an ominous prognosis. The first case was described by Weiting and Hamdi in 1907. Since then, as of 2015, only 36 instances have been published in the world literature [2]. Histogenesis is still under debate: Melanocytes could follow an ectopic migration from the neural crest or originate from precursor cells resident in GB [3]. Assessing the clinicopathologic features of PMMG is not a simple task for the low number of patients: Both sexes are equally affected and the peak incidence is between 40 and 60 years [2]. A preoperative diagnosis of PMMG is substantially impossible to achieve: postoperatively, the exclusion of other primary sites and the finding of a solitary polypoid melanoma arising from the mucosa of GB showing junctional activity represent its incontestable prerequisites [2–4]. Prognosis is ominous, although PMMG demonstrated the longest median survival (41 months) among the other primary gastrointestinal Fig. 1 Contrast-enhanced CT scan of the abdomen showing a mildly hyperdense nodule in the lumen of the gallbladder (GB) without any gallstone

PloS one, Jan 5, 2010

We have previously shown that serum/glucocorticoid regulated kinase 1 (SGK1) is down-regulated in... more We have previously shown that serum/glucocorticoid regulated kinase 1 (SGK1) is down-regulated in colorectal cancers (CRC) with respect to normal tissue. As hyper-methylation of promoter regions is a well-known mechanism of gene silencing in cancer, we tested whether the SGK1 promoter region was methylated in colonic tumour samples.

BJOG: An International Journal of Obstetrics and Gynaecology, 1997

Faught W, Fung Kee Fung M. Port site recurrences following laparoscopically managed early stage e... more Faught W, Fung Kee Fung M. Port site recurrences following laparoscopically managed early stage endometrial cancer.

BMC Infectious Diseases, 2011

Background: Anisakiasis is an important fish-borne zoonosis provoked by larval stages of nematode... more Background: Anisakiasis is an important fish-borne zoonosis provoked by larval stages of nematodes belonging to the genus Anisakis. The detection and identification of human infections is difficult. This is due to: a) the low specificity of the clinical features and symptomatology related to human infections; b) the paucity of diagnostic features of larvae found in granulomatous lesions characteristic of "invasive anisakiasis"; and c) the lack morphological characters diagnostic at the specific level when larvae of Anisakis are detected. Thus, molecularbased diagnostic approaches are warranted. Method: We have developed a PCR method that amplifies the DNA of Anisakis spp. in fixed paraffin-embedded tissues. This method was applied to a granuloma removed from a human case of intestinal anisakiasis in Italy. Specific primers of the mtDNA cox2 gene were used and sequence analysis was performed according to the procedures already established for species of Anisakis. Results: The sequence obtained (629 bp) was compared with those of the other species of Anisakis which have so far been genetically characterized and with sequences obtained from larval stages of Anisakis collected from the Mediterranean fish Engraulis encrasicolus. This enabled the genetic identification of the larva in the human tissue as A. pegreffii. This is the first instance of human intestinal anisakiasis diagnosed using PCR of DNA purified from a fixed eosinophilic granuloma embedded in paraffin. Conclusion: The case of human anisakiasis presented reinforces the pathological significance of the species A. pegreffii to humans. The molecular/genetic methodological approach based on mtDNA cox2 sequence analysis, described here, can allow easy and rapid identification of Anisakis spp. in formalin-fixed and paraffin embedded tissues removed from cases of either gastric or intestinal human anisakiasis.

Chirurgia italiana

Perforation is one of the most serious complications of endoscopic sphincterotomy. In the last de... more Perforation is one of the most serious complications of endoscopic sphincterotomy. In the last decade, the management has shifted towards a more selective approach. Three cases are reported here involving three different treatments. In one case, the patient was submitted to a surgical procedure, while a conservative strategy was preferred in the other two, consisting in a naso-biliary drain and endoscopic clip placement, respectively. In this way, the safety of surgical and nonsurgical management of ERCP-related duodenal perforations was tested.

Il Giornale di chirurgia, 2012

Routine use of nasogastric tubes (NGT) after abdominal operations is intended to hasten the retur... more Routine use of nasogastric tubes (NGT) after abdominal operations is intended to hasten the return of bowel function, diminish the risk of anastomotic leakage and prevent pulmonary complications. The aim of our study was to prospectively assess the tolerability and the safety of the non use of NGT after elective colorectal open operations. Between March 2009 and December 2010, 110 consecutive patients underwent colo-rectal elective open surgery for neoplasm without nasogastric decompression. We analyzed the incidence of nausea and vomiting, the pulmonary complications, the return of bowel function the deep wound breakdown (fascial dehiscence) and the anastomotic leakage. Only 15 patients (13,6%) reported nausea without vomiting immediately after surgery and 9 cases of vomiting were observed (8%), requiring the insertion of the NGT (nasogastric tube) in 5 (4,5%). A total of 105 patients (96,3%) were NGT free. No deep wound dehiscence was observed and only one real pneumonia occurred....

Clinical Nutrition ESPEN, 2019

Objectives: The current study aims to investigate which components of ERAS protocol have the larg... more Objectives: The current study aims to investigate which components of ERAS protocol have the largest impact on recovery for gastric cancer patients undergoing gastrectomy.