Author
Stefano Siboni
Other affiliations: University of Southern California
Bio: Stefano Siboni is an academic researcher from University of Milan. The author has contributed to research in topics: Dysphagia & GERD. The author has an hindex of 16, co-authored 69 publications receiving 864 citations. Previous affiliations of Stefano Siboni include University of Southern California.
Topics: Dysphagia, GERD, Esophagectomy, Perforation (oil well), Esophagus
Papers
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Centre Hospitalier Universitaire de Grenoble1, University of Milan2, Radboud University Nijmegen3, Rambam Health Care Campus4, State University of Campinas5, University of Pavia6, University of Cambridge7, Royal Perth Hospital8, Scripps Health9, Sher-I-Kashmir Institute of Medical Sciences10, University of Brescia11
TL;DR: The esophagus traverses three body compartments (neck, thorax, and abdomen) and is surrounded at each level by vital organs and can be life-threatening either by digestive contamination of surrounding structures in case of esophageal wall breach or concomitant damage of surrounding organs.
Abstract: The esophagus traverses three body compartments (neck, thorax, and abdomen) and is surrounded at each level by vital organs. Injuries to the esophagus may be classified as foreign body ingestion, caustic ingestion, esophageal perforation, and esophageal trauma. These lesions can be life-threatening either by digestive contamination of surrounding structures in case of esophageal wall breach or concomitant damage of surrounding organs. Early diagnosis and timely therapeutic intervention are the keys of successful management.
127 citations
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TL;DR: Tourniquet use in the civilian sector is associated with a low rate of complications and with the low complication rate and high potential for benefit, aggressive use of this potentially lifesaving intervention is justified.
Abstract: Background Unlike in the military setting, where the use of tourniquets has been well established, in the civilian sector their use has been far less uniform. The purpose of this study was to examine the outcomes associated with the use of tourniquets for civilian extremity trauma. Study design Adult (≥18 years) patients admitted to our institution with an extremity injury requiring tourniquet application from January 2007 to June 2014 were retrospectively reviewed. The primary outcome analyzed was limb loss. Secondary outcomes included death, hospital length of stay, and complications. Results There were 87 patients who met inclusion criteria. Average age was 35.3 years, 90.8% were male, and 66.7% had penetrating injuries, with a median Injury Severity Score (ISS) of 6. Tourniquets were placed in the prehospital setting in 50.6%, in the emergency department in 39.1%, and in the operating room in 10.3% of patients. The windlass type Combat Application Tourniquet was the most commonly used type (67.8%), followed by a pneumatic system (24.1%) and self-made tourniquet (8.0%). The median duration of use was 75 minutes (interquartile range, 91) with no differences between groups (p = 0.547). Overall, 80.5% had a vascular injury (70.1% arterial), and a total of 99 limb operations were performed, including 15 amputations. Fourteen amputations (93.3%) occurred at the scene or were directly attributed to the extent of tissue damage with a median Mangled Extremity Severity Score (MESS) of 7 (interquartile range, 2). In the remaining patient, the tourniquet was lifesaving but likely contributed to limb loss. Seven patients sustained 13 other complications; however, none was directly attributed to tourniquet use. Conclusion Tourniquet use in the civilian sector is associated with a low rate of complications. With the low complication rate and high potential for benefit, aggressive use of this potentially lifesaving intervention is justified. Level of evidence Epidemiologic/prognostic study, level III.
117 citations
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Tulane University1, University of Texas Health Science Center at San Antonio2, University of Southern California3, University of Arizona4, University of Pittsburgh5, Uniformed Services University of the Health Sciences6, United States Department of the Army7, Oregon Health & Science University8, University of Texas Southwestern Medical Center9, Virginia Commonwealth University10
TL;DR: This study is the largest evaluation of prehospital tourniquet use in a civilian population to date and found that tournique was applied safely and effectively in the civilian population.
Abstract: BACKGROUNDRecent military studies demonstrated an association between prehospital tourniquet use and increased survival. The benefits of this prehospital intervention in a civilian population remain unclear. The aims of our study were to evaluate tourniquet use in the civilian population and to comp
78 citations
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TL;DR: Both anti-reflux procedures are safe and effective up to 1-year follow-up and MSA is associated with less gas/bloat symptoms and increased ability to vomit and belch.
62 citations
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TL;DR: Laroscopic removal of the Linx device can be safely performed as a 1-stage procedure and in conjunction with fundoplication even in patients presenting with device erosion.
Abstract: Objective:The aim of this study was to identify patients’ characteristics that may predict failure and removal of the Linx sphincter augmentation device, and to report the results of 1-stage laparoscopic removal and fundoplication.Background:The Linx device is a long-term magnetic implant that was d
58 citations
Cited by
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TL;DR: This guideline recommends the use of a MT/DCR protocol in hospitals that manage such patients and recommends that the protocol target a high ratio of PLAS and PLT to RBC, and conditionally recommend the in-hospital use of TXA early in the management of severely injured bleeding patients.
Abstract: BackgroundThe resuscitation of severely injured bleeding patients has evolved into a multi-modal strategy termed damage control resuscitation (DCR). This guideline evaluates several aspects of DCR including the role of massive transfusion (MT) protocols, the optimal target ratio of plasma (PLAS) and
295 citations
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Ewout W. Steyerberg1, Ewout W. Steyerberg2, Eveline J. A. Wiegers2, Charlie A. Sewalt2 +249 more•Institutions (15)
TL;DR: In this article, Peul et al. presented a study of the CENTER-TBI Participants and Investigators until 1 November 2019, which is free to read and download at: https://authors.elsevier.com/c/1ZjYd5FFzKkkIst
Abstract: Additional co-authors: Wilco Peul, Nino Stocchetti, Nicole von Steinbuchel, Thijs Vande Vyvere, Jan Verheyden, Andrew I R Maas, David K Menoni and the CENTER-TBI Participants and Investigators Until 1 November 2019, this article is free to read and download at: https://authors.elsevier.com/c/1ZjYd5FFzKkIst
253 citations
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TL;DR: It is demonstrated that allogeneic blood transfusion is a greater risk factor in the traumatically injured patient when compared with the elective surgical patient for the development of postoperative bacterial infection.
Abstract: BACKGROUND
Immunosuppression is a consequence of allogeneic (homologous) blood transfusion (ABT) in humans and is associated with an increased risk in cancer recurrence rates after potentially curative surgery as well as an increase in the frequency of postoperative bacterial infections. Although a meta-analysis has been reported demonstrating the relationship between ABT and colon cancer recurrence, no meta-analysis has been reported demonstrating the relationship of ABT to postoperative bacterial infection.
METHODS
Twenty peer-reviewed articles published from 1986 to 2000 were included in a meta-analysis. Criteria for inclusion included a clearly defined control group (nontransfused) compared with a treated (transfused) group and statistical analysis of accumulated data that included stepwise multivariate logistic regression analysis. In addition, a subgroup of publications that included only the traumatically injured patient was included in a separate meta-analysis. A fixed effects analysis was conducted with odds ratios obtained by using the conditional maximum likelihood method and 95% confidence intervals on the obtained odds ratios were determined using the mid-p technique.
RESULTS
The total number of subjects included in this meta-analysis was 13,152 (5,215 in the transfused group and 7,937 in the nontransfused group). The common odds ratio for all articles included in this meta-analysis evaluating the association of ABT to the incidence of postoperative bacterial infection was 3.45 (range, 1.43-15.15), with 17 of the 20 studies demonstrating a value of p < or = 0.05. These results provide overwhelming evidence that ABT is associated with a significantly increased risk of postoperative bacterial infection in the surgical patient. The common odds ratio of the subgroup of trauma patients was 5.263 (range, 5.03-5.43), with all studies showing a value of p < 0.05 (0.005-0.0001). These results demonstrate that ABT is associated with a greater risk of postoperative bacterial infection in the trauma patient when compared with those patients receiving ABT during or after elective surgery.
CONCLUSION
These results demonstrate that ABT is an associated and apparently significant and frequently overlooked risk factor for the development of postoperative bacterial infection in the surgical patient. Allogeneic blood transfusion is a greater risk factor in the traumatically injured patient when compared with the elective surgical patient for the development of postoperative bacterial infection.
239 citations
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TL;DR: In this article, a focused review provides updated knowledge regarding the effects of extreme environmental stressors on cognitive function and their biological underpinnings, including the potential mechanisms underpinning these alterations.
Abstract: Cognitive function defines performance in objective tasks that require conscious mental effort. Extreme environments, namely heat, hypoxia, and cold can all alter human cognitive function due to a variety of psychological and/or biological processes. The aims of this Focused Review were to discuss; 1) the current state of knowledge on the effects of heat, hypoxic and cold stress on cognitive function, 2) the potential mechanisms underpinning these alterations, and 3) plausible interventions that may maintain cognitive function upon exposure to each of these environmental stressors. The available evidence suggests that the effects of heat, hypoxia and cold stress on cognitive function are both task and severity dependent. Complex tasks are particularly vulnerable to extreme heat stress, whereas both simple and complex task performance appear to be vulnerable at even at moderate altitudes. Cold stress also appears to negatively impact both simple and complex task performance, however, the research in this area is sparse in comparison to heat and hypoxia. In summary, this focused review provides updated knowledge regarding the effects of extreme environmental stressors on cognitive function and their biological underpinnings. Tyrosine supplementation may help individuals maintain cognitive function in very hot, hypoxic, and/or cold conditions. However, more research is needed to clarify these and other postulated interventions.
189 citations
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TL;DR: Clinical characteristics of the patients, including post-surgical status, previous trauma, simplified acute physiologic score, APACHE II score, McCabe score, body temperature, white blood cell count, Po2, Pco2, and radiologic score were not able to distinguish patients with pneumonia from those without pneumonia.
Abstract: This is a prospective, postmortem study to determine the accuracy of various bronchoscopic and non-bronchoscopic techniques in the diagnosis of ventilator-associated pneumonia. The authors prospectively studied patients who died in their intensive care unit. Within 15 minutes of death, patients underwent first blind bronchial sampling (BBS), then mini-bronchoalveolar lavage, protected specimen brush (PBS), and bronchoalveolar lavage. The specimens obtained from each study were cultured in a similar way. Within 30 minutes of death, a pneumonectomy was performed at the bedside under sterile conditions while maintaining mechanical ventilation. Either the right or left lung was removed, depending on the area of infiltrate on chest film. Six to 10 specimens were obtained aseptically and cultured. Histologic examination was performed on the lung to look for histologic evidence of bronchopneumonia. Ventilator-associated pneumonia was considered definite if histology exhibited signs of bronchopneumonia and lung tissue culture was positive. Ventilator-associated pneumonia was considered histologic if the histology was positive but the lung culture was negative. During the 2-year period of the study, a total of 146 patients died in the intensive care unit, but only 38 were included in the study. The other 118 patients were excluded for a variety of reasons, including autopsy not available within 30 minutes of death, sampling techniques not performed within 15 minutes of death, and immunocompromised hosts. Of the 38 patients in the study, 21 were receiving antibiotics at the time of death. Four had been on antibiotics that had been discontinued for 72 hours or more before death, and 13 were on no antibiotics during the hospitalization or on no antibiotics during the 7 days preceding death. On histology, 18 of the 38 patients had evidence of bronchopneumonia. Half of these 18 patients had moderate pneumonia, and half had evidence of severe pneumonia. Twenty patients had no evidence of bronchopneumonia. Twelve of the 18 patients with evidence of bronchopneumonia had positive cultures from the lung tissue. None of the lung tissue from the 20 patients without histologic evidence of bronchopneumonia yielded bacteria. In comparing the results of the various sampling techniques with diagnoses of definite ventilator-associated pneumonia, BBS had the greatest sensitivity and acceptable specificity at ≥104 organisms per milliliter. PBS had a sensitivity of only 42% at the ≥103 level but a 95% specificity. When the sampling techniques were compared in the 18 patients with definite or histologic evidence of ventilator-associated pneumonia and the 20 patients without ventilator-associated pneumonia, BBS maintained very good sensitivity and specificity at ≥104 organisms. PBS had a sensitivity of only 33% at ≥103 organisms but a 95% specificity. Another interesting result of the study was that clinical characteristics of the patients, including post-surgical status, previous trauma, simplified acute physiologic score, APACHE II score, McCabe score, body temperature, white blood cell count, Po2, Pco2, and radiologic score were not able to distinguish patients with pneumonia from those without pneumonia. Interestingly, the duration of mechanical ventilation did appear to differ significantly; patients with pneumonia were ventilated for 12.7 ± 9 days versus those without pneumonia, who were actually ventilated longer, at 33.1 ± 34.6 days. The only clinical measure which appeared to be discriminatory was the clinical pulmonary infection score (CPIS). Patients with pneumonia had a CPIS significantly higher than did those without pneumonia. At a CPIS of 6, the overall accuracy of the measure for the diagnosis of pneumonia was 79%. The sensitivity of a CPIS ≥6 was 72%, and its specificity was 85%. When the sum of the CPIS and logarithmic concentration of the organisms obtained in culture from BBS samples was >10, the specificity was 95%, and the sensitivity was 67%.
168 citations