Fieschi Dott. Stefano
Pubblicazioni su PubMed
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Management of COVID-19-related post-intubation tracheal stenosis.
Front Surg2023 ;10():1129803. doi: 1129803.
Conforti Serena, Licchetta Gloria, Reda Marco, Astaneh Arash, Pogliani Luca, Fieschi Stefano, Rinaldo Alessandro, Torre Massimo
Abstract
INTRODUCTION:
The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic has affected Italy since the beginning of 2020. Endotracheal intubation, prolonged mechanical ventilation, and tracheostomy are frequently required in patients with severe COVID-19. Tracheal stenosis is a potentially severe condition that can occur as a complication after intubation. The aim of this study was to evaluate the utility and safety of endoscopic and surgical techniques in the treatment of tracheal stenosis related to COVID-19.
MATERIALS AND METHODS:
Between June 2020 and May 2022, consecutive patients with tracheal stenosis who were admitted to our surgical department were considered eligible for participation in the study.
RESULTS:
A total of 13 patients were included in the study. They consisted of nine women (69%) and four men (31%) with a median age of 57.2 years. We included seven patients with post-tracheostomy tracheal stenosis. Bronchoscopy was performed to identify the type, location, and severity of the stenosis. All patients underwent bronchoscopic dilation and surveillance bronchoscopy at 7 and 30 days after the procedure. We repeated endoscopic treatment in eight patients. Three patients underwent tracheal resection anastomosis. Final follow-up bronchoscopy demonstrated no residual stenosis.
CONCLUSIONS:
The incidence of and risk factors associated with tracheal stenosis in critically ill patients with COVID-19 are currently unknown. Our experience confirms the efficacy and safety of endoscopic management followed by surgical procedures in cases of relapsed tracheal stenosis.
© 2023 Conforti, Licchetta, Reda, Astaneh, Pogliani, Fieschi, Rinaldo and Torre.
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Mid-term outcomes of first metatarsophalangeal arthroplasty using the Primus FGT double-stemmed silicone implants.
Foot Ankle Surg2017 Sep;23(3):142-147. doi: 10.1016/j.fas.2016.11.009.
Fieschi Stefano, Saffarini Mo, Manzi Luigi, Fieschi Arrigo
Abstract
BACKGROUND:
Silicone implants for first metatarsophalangeal (MTP-1) arthroplasty are regaining popularity, though most studies have long inclusion periods, or short follow-up. The authors aimed to report mid-term outcomes of a cohort that received a third-generation MTP-1 implant at minimum follow-up of 5 years.
METHODS:
The authors evaluated 70 MTP-1 arthroplasties performed in 64 patients using the Primus? Flexible Great Toe implant. The indications were hallux rigidus of grade II (10%) and grade III (87.1%) or revision surgery (2.9%).
RESULTS:
All patients completed clinical and radiographic assessments at 83.5 months (range, 62-114). There were no revisions or reoperations and the AOFAS-HMI score was 88.9±9.1 (median, 90; range, 67-100). Metatarsalgia was 'absent' in 47.1%, 'mild' in 41.1%, 'moderate' in 7.1% and 'severe' in 1.4%.
CONCLUSION:
This study reported excellent mid-term clinical outcomes and survival rates of a third generation MTP-1 arthroplasty design and confirmed findings of recent studies regarding efficacy of silicone double-stemmed implants.
LEVEL OF EVIDENCE:
Level IV case series.
Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.
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Cardiac metastatic melanoma: Imaging diagnostic clues.
J Cardiol Cases2015 Aug;12(2):33-36. doi: 10.1016/j.jccase.2015.03.001.
Pedrotti Patrizia, Musca Francesco, Torre Massimo, Pirola Roberto, De Biase Anna Maria, Fieschi Stefano, Quattrocchi Giuseppina, Roghi Alberto, Giannattasio Cristina
Abstract
A 47-year-old male was admitted to hospital for severe pericardial effusion; he had undergone surgical removal of cutaneous melanoma 10 years before. Echocardiography-guided pericardiocentesis revealed the presence of intramyocardial masses, which were better defined and characterized, together with pericardial involvement, by cardiac magnetic resonance. Pericardial fluid drained was negative for malignant cells, so video-assisted thoracoscopy was performed and pathologic tissue was biopsied, leading to the diagnosis of metastatic melanoma. Multidisciplinary approach and multimodality imaging played a key role in allowing the diagnostic workup in this complex case. .
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Lung transplantation and pulmonary vein thrombosis: a possible role of epicardial echocardiography.
J Cardiothorac Vasc Anesth2008 Feb;22(1):167-8. doi: 10.1053/j.jvca.2007.02.006.
Catena Emanuele, Paino Roberto, Fieschi Stefano, Rinaldo Alessandro, Milazzo Filippo, Dejuli Emanuela, Ravini Mario
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Inflammatory pseudotumor of the lung in adults.
Ann Thorac Surg2005 Feb;79(2):426-32.
Melloni Giulio, Carretta Angelo, Ciriaco Paola, Arrigoni Gianluigi, Fieschi Stefano, Rizzo Nathalie, Bonacina Edgardo, Augello Giuseppe, Belloni Pier Angelo, Zannini Piero
Abstract
BACKGROUND:
Thoracic surgeons have limited experience of inflammatory pseudotumors of the lung owing to their rare occurrence in routine clinical practice.
METHODS:
We retrospectively investigated the clinicopathologic features of 18 patients with inflammatory pseudotumor of the lung observed between 1992 and 2002.
RESULTS:
There were 13 men and 5 women. Median age was 57 years. Eight patients (44%) were symptomatic. Computed tomographic scan showed a solitary nodule (
CONCLUSIONS:
This series shows that a significant number of patients with inflammatory pseudotumor of the lung have a poor prognosis and confirms the need for radical resection in the treatment of this unusual entity.
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A new safe and stable spiral wire needle for thoracoscopic resection of lung nodules.
Chest2004 Jun;125(6):2289-93.
Torre Massimo, Ferraroli Giorgio M, Vanzulli Angelo, Fieschi Stefano
Abstract
BACKGROUND:
To show the safety and stability of a spiral wire needle (Somatex; Rietzneuendorf, Germany) in the detection and subsequent thoracoscopic resection of subpleural and/or small nodules of the lung.
METHODS:
Under local anesthesia and CT control, 13 patients underwent the positioning of a spiral wire needle into the lung, with the spiral located close to or inside the nodule to be resected. Then the patients underwent video-assisted thoracoscopic surgery resection of the nodules with only two thoracoscopic accesses.
RESULTS:
All the nodules were identified due to the precise location of the spiral wire needle. The presence of a stable spiral wire inside the parenchyma has allowed us to put under tension the overlying parenchyma, which had previously been excluded from ventilation. The external traction on the needle facilitates the detection of the nodule and simplifies thoracoscopic resection with a stapler. With this new tool, we have always reached an adequate diagnosis and observed no cases of dislodgment of the needle during the traction maneuvers, nor cases of conversion from thoracoscopy to thoracotomy.
CONCLUSIONS:
Although our initial experience is limited, the use of this spiral wire needle has been shown to be extremely advantageous in identifying subpleural and/or small nodules of the lung, even sparing the classic third thoracoscopic access for their resection. The presence of a wire needle with a spiral terminal portion (which is placed firmly inside the lung parenchyma) is very useful for the thoracoscopic resection of pulmonary nodules.
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