G. Brisinda | Fondazione Policlinico A. Gemelli Roma (original) (raw)
Papers by G. Brisinda
British Journal of Surgery, 2020
Annali italiani di chirurgia
A case of papillary-cystic neoplasm of the pancreas is reported in a 22-year-old woman. The only ... more A case of papillary-cystic neoplasm of the pancreas is reported in a 22-year-old woman. The only symptom was a palpable pulsating mass in her upper left abdomen. A conservative surgical treatment was adopted, consisting of pancreatic body resection (meso-pancreatectomy) and pancreaticojejunostomy to distal pancreatic stump. These neoplasms are quite uncommon, and can be difficult to differentiate from other cystic lesions of the pancreas. Surgical excision is curative in these tumors and is the treatment of choice due to its low morbidity and good long-term survival.
British Journal of Surgery, 2020
Journal of Global Health, 2020
Screening policies, preventive measures and in-hospital infection of COVID-19 in global surgical ... more Screening policies, preventive measures and in-hospital infection of COVID-19 in global surgical practices Background In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic, and to clarify the international gaps on infection control policies among countries worldwide. Methods During April 2-8, 2020, a cross-sectional online survey on surgical practice was distributed to surgeons worldwide through international surgical societies, social media and personal contacts. Main outcome and measures included preventive measures and screening policies of COVID-19 in surgical practice and centers' experiences of in-hospital COVID-19 infection. Data were analyzed by country's cumulative deaths number by April 8, 2020 (high risk, >5000; intermediate risk, 100-5000; low risk, <100). Results A total of 936 centers in 71 countries responded to the survey (high risk, 330 centers; intermediate risk, 242 centers; low risk, 364 centers). In the majority (71.9%) of the centers, local guidelines recommended preoperative testing based on symptoms or suspicious radiologic findings. Universal testing for every surgical patient was recommended in only 18.4% of the centers. In-hospital COVID-19 infection was reported from 31.5% of the centers, with higher rates in higher risk countries (high risk, 53.6%; intermediate risk, 26.4%; low risk, 14.8%; P < 0.001). Of the 295 centers that experienced in-hospital COVID-19 infection, 122 (41.4%) failed to trace it and 58 (19.7%) reported the infection originating from asymptomatic patients/staff members. Higher risk countries adopted more preventive measures including universal testing, routine testing of hospital staff and use of dedicated personal protective equipment in operation theatres, but there were remarkable discrepancies across the countries. Conclusions This large international survey captured the global surgical practice under the COVID-19 pandemic and highlighted the insufficient preoperative screening of COVID-19 in the current surgical practice. More intensive screening programs will be necessary particularly in severely affected countries/institutions. Study registration Registered in ClinicalTrials.gov: NCT04344197
The International Journal of Artificial Organs, 1992
Results of cultured islet transplantation in the management of insulin-dependent diabetes are sti... more Results of cultured islet transplantation in the management of insulin-dependent diabetes are still unsatisfactory. The main problem preventing success is the swift and resolute host immune rejection. To obviate this we designed and experimented a model of bioartificial pancreas, made of polymeric hollow fibers, put into the blood circulation as an artero-venous bypass to immunoisolate endocrine tissue from leucocytes and immunoglobulins. We tested four different membrane bioreactors (BR1-4). BR1 and 2 had seven hollow fibers, the others more than 6,000 smaller fibers. In BR4 a connecting tube with a high-permeability membrane was inserted between the islet compartment and the bioreactor outlet to improve the ultrafiltration flow. In vitro, the islets inside the bioreactor perfused with glucose solutions (300 mg%) showed a rapid, high insulin secretory response, related to the glucose stimulation. The use of the outside connection allowed a twofold increase of insulin production.
The American journal of gastroenterology, 2006
Lateral internal sphincterotomy is widely used in the treatment of chronic anal fissure. However,... more Lateral internal sphincterotomy is widely used in the treatment of chronic anal fissure. However, it is associated with a high rate of irreversible incontinence. For this reason the botulinum toxin has become a medical means of reversible sphincterotomy. Indeed, this neurotoxin induces relaxation of the smooth internal anal sphincter lasting one to three months after one injection. We reviewed the published studies about the use of this technique in the management of chronic anal fissure. Healing occurred in more than 70% of fissures without irreversible incontinence. Although further studies are needed to determine the best modalities of administration, especially due to the remaining significant recurrence rate, this toxin may be a valuable treatment for chronic anal fissure in the future.
Clinical Uses of Botulinum Toxins
Botulinum neurotoxin (BoNT) inhibits neuromuscular transmission and it has become a drug with man... more Botulinum neurotoxin (BoNT) inhibits neuromuscular transmission and it has become a drug with many indications1À3. The range of clinical applications has grown to encompass several neurological and non-neurological conditions. Over the years, the number of ...
The Lancet, 1998
Relief by botulinum toxin of voiding dysfunction due to prostatitis. By - Giorgio Maria, Antonio ... more Relief by botulinum toxin of voiding dysfunction due to prostatitis. By - Giorgio Maria, Antonio Destito, Sergio Lacquaniti, Anna Rita Bentivoglio, Giuseppe Brisinda, Alberto Albanese.
Infection Control in the Intensive Care Unit, 2011
ABSTRACT Intra-abdominal infections (IAIs) are defined as an inflammatory response of the periton... more ABSTRACT Intra-abdominal infections (IAIs) are defined as an inflammatory response of the peritoneum to microorganisms and their toxins, which results in purulent exudate in the abdominal cavity. They have two major manifestations: generalized peritonitis and IA abscess. Mortality rates for peritonitis, regardless of diagnostic and therapeutic developments in recent years, remain unacceptably high and still represent one of the greatest challenges for surgeons. Drainage, debridement, and definitive surgical management are the usual consecutive steps to be carried out, but in many circumstances, the procedure has to be tailored to the individual patient. Successful source control and antibiotic management is associated with illness resolution. Progression or failure to resolve organ dysfunction suggests disease persistence and the need for further intervention. Particular interest has been given to severe acute pancreas and its diagnosis and management, as well as to mediastinitis and pleural infection disease. Furthermore, we discuss the two most important sources of infection in surgery: wound and urinary tract.
Surgery, 1999
Background. Recent studies demonstrate that chronic anal fissure can be the consequence of a loca... more Background. Recent studies demonstrate that chronic anal fissure can be the consequence of a local ischemic process. Thus hypothesizing that at the perianal level the interaction of immune component with endothelium could constitute a mechanism determining ischemia and hypertonia, the presence or absence of circulating anti-endothelial cell antibodies (AECAs) was determined in the serum of patients with anal fissure. Methods. The study was carried out on 30 patients: 10 with posterior chronic anal fissure (group 1), 10 with grades III and IV hemorrhoids (group 2), and 10 without previous or active anorectal disease, or both (group 3). An indirect immunofluorescence assay on sections of rat kidney tissue was used to identify AECA in the peripheral blood. Results. The assay result was positive for AECAs in 12 patients, all with anorectal disease when compared to the control group (P = .001). The basal anal tone was higher in the AECA-positive patients than in the AECA-negative patients (P = .001). Conclusions. Only the patients with anal fissure or hemorrhoids were AECA positive. All healthy controls tested negative for AECA. Although the number of subjects studied is small, the presence of autoantibodies directed against the endothelial cells in the serum of these patients supports the hypothesis that the endothelium is involved in the anal disease.
The Lancet, 2000
In the trials by M Rowsell and co-workers (March 4, p 779) 1 and Brian Mehigan and others (p 782)... more In the trials by M Rowsell and co-workers (March 4, p 779) 1 and Brian Mehigan and others (p 782), 2 the short-term results of the stapler procedure were compared with those of conventional haemorrhoidectomy. The studies suggest that stapled haemorrhoidectomy is ...
Gastroenterology, 2004
HG, and the German Antibiotics in Severe Acute Pancreatitis (ASAP) Study Group. Prophylactic anti... more HG, and the German Antibiotics in Severe Acute Pancreatitis (ASAP) Study Group. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double-blind trial. Gastroenterology 2004;126:997-1004. 2. Aly EA, Milne R, Johnson CD. Non-compliance with national guidelines in the management of acute pancreatitis in the United Kingdom.
… , clinical features, and …, 2004
... sive LES do not experience progressive symptoms or weight loss, and dilation carries an appre... more ... sive LES do not experience progressive symptoms or weight loss, and dilation carries an appreciable risk for esophageal perforation. ... Preliminary data in rats have shown a substantial loss of body weight associated with a reduction of dietary intake in ... 81 No side effects occurred ...
Diseases of the Colon & Rectum, 2000
Annals of Surgery, 2012
W e read with interest the systematic review and meta-analysis by Mirnezami et al.1 The aim of th... more W e read with interest the systematic review and meta-analysis by Mirnezami et al.1 The aim of the study is to investigate the long-term oncological influence of anastomotic leak (AL) after restorative surgery for colorectal cancer (CRC) using meta-analysis methods. Principal outcomes evaluated were local recurrence, distant recurrence, and longterm survival. We agree with the authors that the study is subject to a number of limitations. Adjuvant therapy may have a confusing effect on the results of the paper, and also fewer patients with advanced CRC who develop an AL receive adjuvant therapy, when compared with stage-matched groups of patients without an AL.2 It seems conceivable that failure to receive adjuvant treatment, or delays to the start of therapy due to development of an AL, may facilitate recurrence of CRC. Therefore, we agree with the authors that caution must also be exerted in overinterpretation of the reported findings; a statistical association between AL and increased local recurrence and reduced cancer specific survival does not imply a causative association. The impact of AL on the immediate postoperative morbidity and mortality is well known.3–5 However, it is controversial whether the AL itself is a prognostic factor for local recurrence and/or survival of patients with CRC. Although some investigators report that AL is an independent prognostic factor associated with local recurrence or survival, others do not support this point of view.5 One problem with this type of analysis is that usually the proportion of patients with AL is so small that it is difficult to identify it as a factor in long-term survival.3 Meta-analysis uses statistical methods to obtain a quantitative estimate of the effect of a particular intervention from the effects reported in many studies. Compared with traditional reviews and expert opinion, meta-analysis provides a more objective and quantitative summary of the evidence that is
Annals of Surgery, 2010
Objective: This study evaluates the effects of mechanical bowel preparation (MBP) on anastomosis ... more Objective: This study evaluates the effects of mechanical bowel preparation (MBP) on anastomosis below the peritoneal verge and questions the influence of MBP on anastomotic leakage in combination with a diverting ileostomy in lower colorectal surgery. Summary Background Data: In a previous large multicenter randomized controlled trial MBP has shown to have no influence on the incidence of anastomotic leakage in overall colorectal surgery. The role of MBP in lower colorectal surgery with or without a diverting ileostomy remains unclear. Methods: This study is a subgroup analysis of a prior multicenter (13 hospitals) randomized trial comparing clinical outcome of MBP versus no MBP. Primary end point was the occurrence of anastomotic leakage and secondary endpoints were septic complications and mortality. Results: Total of 449 Patients underwent a low anterior resection with a primary anastomosis below the peritoneal verge. The incidence of anastomotic leakage was 7.6% for patients who received MBP and 6.6% for patients who did not. Significant risk factors for anastomotic leakage were the American Society of Anesthesiologists-classification (P ϭ 0.005) and male gender (P ϭ 0.007). Of total, 48 patients received a diverting ileostomy during initial surgery; 27 patients received MBP and 21 patients did not. There were no significant differences regarding septic complications and mortality between both groups. Conclusion: MBP has no influence on the incidence of anastomotic leakage in low colorectal surgery. Furthermore, omitting MBP in combination with a diverting ileostomy has no influence on the incidence of anastomotic leakage, septic complications, and mortality rate.
The COVID‐19 pandemic required reorganization of surgical services, affecting patients with commo... more The COVID‐19 pandemic required reorganization of surgical services, affecting patients with common surgical diseases including acute appendicitis. No evidence is available on the topic. This study found global variation in screening policies, use of personal protective equipment and intraoperative directives. There has been increased adoption of non‐operative management and open appendicectomy. Hands off
British Journal of Surgery, 2021
British Journal of Surgery, 2020
Annali italiani di chirurgia
A case of papillary-cystic neoplasm of the pancreas is reported in a 22-year-old woman. The only ... more A case of papillary-cystic neoplasm of the pancreas is reported in a 22-year-old woman. The only symptom was a palpable pulsating mass in her upper left abdomen. A conservative surgical treatment was adopted, consisting of pancreatic body resection (meso-pancreatectomy) and pancreaticojejunostomy to distal pancreatic stump. These neoplasms are quite uncommon, and can be difficult to differentiate from other cystic lesions of the pancreas. Surgical excision is curative in these tumors and is the treatment of choice due to its low morbidity and good long-term survival.
British Journal of Surgery, 2020
Journal of Global Health, 2020
Screening policies, preventive measures and in-hospital infection of COVID-19 in global surgical ... more Screening policies, preventive measures and in-hospital infection of COVID-19 in global surgical practices Background In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic, and to clarify the international gaps on infection control policies among countries worldwide. Methods During April 2-8, 2020, a cross-sectional online survey on surgical practice was distributed to surgeons worldwide through international surgical societies, social media and personal contacts. Main outcome and measures included preventive measures and screening policies of COVID-19 in surgical practice and centers' experiences of in-hospital COVID-19 infection. Data were analyzed by country's cumulative deaths number by April 8, 2020 (high risk, >5000; intermediate risk, 100-5000; low risk, <100). Results A total of 936 centers in 71 countries responded to the survey (high risk, 330 centers; intermediate risk, 242 centers; low risk, 364 centers). In the majority (71.9%) of the centers, local guidelines recommended preoperative testing based on symptoms or suspicious radiologic findings. Universal testing for every surgical patient was recommended in only 18.4% of the centers. In-hospital COVID-19 infection was reported from 31.5% of the centers, with higher rates in higher risk countries (high risk, 53.6%; intermediate risk, 26.4%; low risk, 14.8%; P < 0.001). Of the 295 centers that experienced in-hospital COVID-19 infection, 122 (41.4%) failed to trace it and 58 (19.7%) reported the infection originating from asymptomatic patients/staff members. Higher risk countries adopted more preventive measures including universal testing, routine testing of hospital staff and use of dedicated personal protective equipment in operation theatres, but there were remarkable discrepancies across the countries. Conclusions This large international survey captured the global surgical practice under the COVID-19 pandemic and highlighted the insufficient preoperative screening of COVID-19 in the current surgical practice. More intensive screening programs will be necessary particularly in severely affected countries/institutions. Study registration Registered in ClinicalTrials.gov: NCT04344197
The International Journal of Artificial Organs, 1992
Results of cultured islet transplantation in the management of insulin-dependent diabetes are sti... more Results of cultured islet transplantation in the management of insulin-dependent diabetes are still unsatisfactory. The main problem preventing success is the swift and resolute host immune rejection. To obviate this we designed and experimented a model of bioartificial pancreas, made of polymeric hollow fibers, put into the blood circulation as an artero-venous bypass to immunoisolate endocrine tissue from leucocytes and immunoglobulins. We tested four different membrane bioreactors (BR1-4). BR1 and 2 had seven hollow fibers, the others more than 6,000 smaller fibers. In BR4 a connecting tube with a high-permeability membrane was inserted between the islet compartment and the bioreactor outlet to improve the ultrafiltration flow. In vitro, the islets inside the bioreactor perfused with glucose solutions (300 mg%) showed a rapid, high insulin secretory response, related to the glucose stimulation. The use of the outside connection allowed a twofold increase of insulin production.
The American journal of gastroenterology, 2006
Lateral internal sphincterotomy is widely used in the treatment of chronic anal fissure. However,... more Lateral internal sphincterotomy is widely used in the treatment of chronic anal fissure. However, it is associated with a high rate of irreversible incontinence. For this reason the botulinum toxin has become a medical means of reversible sphincterotomy. Indeed, this neurotoxin induces relaxation of the smooth internal anal sphincter lasting one to three months after one injection. We reviewed the published studies about the use of this technique in the management of chronic anal fissure. Healing occurred in more than 70% of fissures without irreversible incontinence. Although further studies are needed to determine the best modalities of administration, especially due to the remaining significant recurrence rate, this toxin may be a valuable treatment for chronic anal fissure in the future.
Clinical Uses of Botulinum Toxins
Botulinum neurotoxin (BoNT) inhibits neuromuscular transmission and it has become a drug with man... more Botulinum neurotoxin (BoNT) inhibits neuromuscular transmission and it has become a drug with many indications1À3. The range of clinical applications has grown to encompass several neurological and non-neurological conditions. Over the years, the number of ...
The Lancet, 1998
Relief by botulinum toxin of voiding dysfunction due to prostatitis. By - Giorgio Maria, Antonio ... more Relief by botulinum toxin of voiding dysfunction due to prostatitis. By - Giorgio Maria, Antonio Destito, Sergio Lacquaniti, Anna Rita Bentivoglio, Giuseppe Brisinda, Alberto Albanese.
Infection Control in the Intensive Care Unit, 2011
ABSTRACT Intra-abdominal infections (IAIs) are defined as an inflammatory response of the periton... more ABSTRACT Intra-abdominal infections (IAIs) are defined as an inflammatory response of the peritoneum to microorganisms and their toxins, which results in purulent exudate in the abdominal cavity. They have two major manifestations: generalized peritonitis and IA abscess. Mortality rates for peritonitis, regardless of diagnostic and therapeutic developments in recent years, remain unacceptably high and still represent one of the greatest challenges for surgeons. Drainage, debridement, and definitive surgical management are the usual consecutive steps to be carried out, but in many circumstances, the procedure has to be tailored to the individual patient. Successful source control and antibiotic management is associated with illness resolution. Progression or failure to resolve organ dysfunction suggests disease persistence and the need for further intervention. Particular interest has been given to severe acute pancreas and its diagnosis and management, as well as to mediastinitis and pleural infection disease. Furthermore, we discuss the two most important sources of infection in surgery: wound and urinary tract.
Surgery, 1999
Background. Recent studies demonstrate that chronic anal fissure can be the consequence of a loca... more Background. Recent studies demonstrate that chronic anal fissure can be the consequence of a local ischemic process. Thus hypothesizing that at the perianal level the interaction of immune component with endothelium could constitute a mechanism determining ischemia and hypertonia, the presence or absence of circulating anti-endothelial cell antibodies (AECAs) was determined in the serum of patients with anal fissure. Methods. The study was carried out on 30 patients: 10 with posterior chronic anal fissure (group 1), 10 with grades III and IV hemorrhoids (group 2), and 10 without previous or active anorectal disease, or both (group 3). An indirect immunofluorescence assay on sections of rat kidney tissue was used to identify AECA in the peripheral blood. Results. The assay result was positive for AECAs in 12 patients, all with anorectal disease when compared to the control group (P = .001). The basal anal tone was higher in the AECA-positive patients than in the AECA-negative patients (P = .001). Conclusions. Only the patients with anal fissure or hemorrhoids were AECA positive. All healthy controls tested negative for AECA. Although the number of subjects studied is small, the presence of autoantibodies directed against the endothelial cells in the serum of these patients supports the hypothesis that the endothelium is involved in the anal disease.
The Lancet, 2000
In the trials by M Rowsell and co-workers (March 4, p 779) 1 and Brian Mehigan and others (p 782)... more In the trials by M Rowsell and co-workers (March 4, p 779) 1 and Brian Mehigan and others (p 782), 2 the short-term results of the stapler procedure were compared with those of conventional haemorrhoidectomy. The studies suggest that stapled haemorrhoidectomy is ...
Gastroenterology, 2004
HG, and the German Antibiotics in Severe Acute Pancreatitis (ASAP) Study Group. Prophylactic anti... more HG, and the German Antibiotics in Severe Acute Pancreatitis (ASAP) Study Group. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double-blind trial. Gastroenterology 2004;126:997-1004. 2. Aly EA, Milne R, Johnson CD. Non-compliance with national guidelines in the management of acute pancreatitis in the United Kingdom.
… , clinical features, and …, 2004
... sive LES do not experience progressive symptoms or weight loss, and dilation carries an appre... more ... sive LES do not experience progressive symptoms or weight loss, and dilation carries an appreciable risk for esophageal perforation. ... Preliminary data in rats have shown a substantial loss of body weight associated with a reduction of dietary intake in ... 81 No side effects occurred ...
Diseases of the Colon & Rectum, 2000
Annals of Surgery, 2012
W e read with interest the systematic review and meta-analysis by Mirnezami et al.1 The aim of th... more W e read with interest the systematic review and meta-analysis by Mirnezami et al.1 The aim of the study is to investigate the long-term oncological influence of anastomotic leak (AL) after restorative surgery for colorectal cancer (CRC) using meta-analysis methods. Principal outcomes evaluated were local recurrence, distant recurrence, and longterm survival. We agree with the authors that the study is subject to a number of limitations. Adjuvant therapy may have a confusing effect on the results of the paper, and also fewer patients with advanced CRC who develop an AL receive adjuvant therapy, when compared with stage-matched groups of patients without an AL.2 It seems conceivable that failure to receive adjuvant treatment, or delays to the start of therapy due to development of an AL, may facilitate recurrence of CRC. Therefore, we agree with the authors that caution must also be exerted in overinterpretation of the reported findings; a statistical association between AL and increased local recurrence and reduced cancer specific survival does not imply a causative association. The impact of AL on the immediate postoperative morbidity and mortality is well known.3–5 However, it is controversial whether the AL itself is a prognostic factor for local recurrence and/or survival of patients with CRC. Although some investigators report that AL is an independent prognostic factor associated with local recurrence or survival, others do not support this point of view.5 One problem with this type of analysis is that usually the proportion of patients with AL is so small that it is difficult to identify it as a factor in long-term survival.3 Meta-analysis uses statistical methods to obtain a quantitative estimate of the effect of a particular intervention from the effects reported in many studies. Compared with traditional reviews and expert opinion, meta-analysis provides a more objective and quantitative summary of the evidence that is
Annals of Surgery, 2010
Objective: This study evaluates the effects of mechanical bowel preparation (MBP) on anastomosis ... more Objective: This study evaluates the effects of mechanical bowel preparation (MBP) on anastomosis below the peritoneal verge and questions the influence of MBP on anastomotic leakage in combination with a diverting ileostomy in lower colorectal surgery. Summary Background Data: In a previous large multicenter randomized controlled trial MBP has shown to have no influence on the incidence of anastomotic leakage in overall colorectal surgery. The role of MBP in lower colorectal surgery with or without a diverting ileostomy remains unclear. Methods: This study is a subgroup analysis of a prior multicenter (13 hospitals) randomized trial comparing clinical outcome of MBP versus no MBP. Primary end point was the occurrence of anastomotic leakage and secondary endpoints were septic complications and mortality. Results: Total of 449 Patients underwent a low anterior resection with a primary anastomosis below the peritoneal verge. The incidence of anastomotic leakage was 7.6% for patients who received MBP and 6.6% for patients who did not. Significant risk factors for anastomotic leakage were the American Society of Anesthesiologists-classification (P ϭ 0.005) and male gender (P ϭ 0.007). Of total, 48 patients received a diverting ileostomy during initial surgery; 27 patients received MBP and 21 patients did not. There were no significant differences regarding septic complications and mortality between both groups. Conclusion: MBP has no influence on the incidence of anastomotic leakage in low colorectal surgery. Furthermore, omitting MBP in combination with a diverting ileostomy has no influence on the incidence of anastomotic leakage, septic complications, and mortality rate.
The COVID‐19 pandemic required reorganization of surgical services, affecting patients with commo... more The COVID‐19 pandemic required reorganization of surgical services, affecting patients with common surgical diseases including acute appendicitis. No evidence is available on the topic. This study found global variation in screening policies, use of personal protective equipment and intraoperative directives. There has been increased adoption of non‐operative management and open appendicectomy. Hands off
British Journal of Surgery, 2021