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Dr. Alessandro Crocoli
Chief of Surgical Oncology Unit, Bambino Gesù Children Hospital IRCCS, Piazza S.Onofrio 4 00165, Rome, Italy

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0 Pediatric Surgery
0 neuroblastoma
0 Pediatric surgical Oncology
0 pediatric palliative care
0 pediatric oncology

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pediatric oncology
neuroblastoma
Pediatric surgical Oncology
Central venous catheter
Wilms tumor
PICC

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Research article
Published: 21 June 2021 in The Journal of Vascular Access
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Background: Central line-associated bloodstream infections (CLABSI) are significant cause of complications in pediatric intensive care units (PICUs). An emerging challenge are CLABSIs in children with medical complexity (CMC) admitted to PICU. CMC are patients with chronic conditions with or without neurological impairment needing for tracheostomy and/or home mechanical or non-invasive ventilation and/or gastrostomy/jejunostomy. We evaluate CLABSI incidence in a PICU with high prevalence of CMC. Methods: This was a retrospective study in the PICU of the Bambino Gesù Children Hospital from January 2017 to December 2020. The medical records were reviewed and demographic, clinical and microbiological data were extracted. CLABSI were defined according to the Center for Disease Control and Prevention’s National Healthcare Safety Networks (NHSN) surveillance. Results: A total of 101 children with 125 central lines (CLs) were included; 79/101 (78%) patients were CMC and 50/101 (50%) had a thracheostomy. CLABSI incidence was 2.75/1000 CL-days (9 cases/3269 CL-days); incidence was 0 in patients without underling conditions and 3.14/1000 in CMC ( p < 0.001). CLABSI were due to gram negative bacteria in five patients, Candida spp in three and Staphylococcus hominis in one. CLs were removed in eight cases while in the later one, with CLABSI due to Pseudomonas aeruginosa, a conservative strategy was adopted cause of unavailable alternative venous access and removed at discharge with negative culture. All patients recovered. Conclusions: A target 0% CLABSI was possible in critically ill children without underling condition while a high incidence was reported in CMC and sustained by a peculiar CLABSI ecology. This ecology should be considered when a CLABSI was suspected in CMC for prompt antibiotics stewardship.

ACS Style

Alessia Scarselli; Andrea Smarrazzo; Francesco De Sanctis; Lucilla Ravà; Michaela Carletti; Marta Ciofi Degli Atti; Marcella Aversa; Riccardo Drago; Alessandro Crocoli; Caterina Geremia; Andrea Guerricchio; Barbara Lucignano; Andrea Campana; Maria Antonietta De Ioris; Daniela Perrotta. The burden of central line-associated bloodstream infections in children with medical complexity. The Journal of Vascular Access 2021, 1 .

AMA Style

Alessia Scarselli, Andrea Smarrazzo, Francesco De Sanctis, Lucilla Ravà, Michaela Carletti, Marta Ciofi Degli Atti, Marcella Aversa, Riccardo Drago, Alessandro Crocoli, Caterina Geremia, Andrea Guerricchio, Barbara Lucignano, Andrea Campana, Maria Antonietta De Ioris, Daniela Perrotta. The burden of central line-associated bloodstream infections in children with medical complexity. The Journal of Vascular Access. 2021; ():1.

Chicago/Turabian Style

Alessia Scarselli; Andrea Smarrazzo; Francesco De Sanctis; Lucilla Ravà; Michaela Carletti; Marta Ciofi Degli Atti; Marcella Aversa; Riccardo Drago; Alessandro Crocoli; Caterina Geremia; Andrea Guerricchio; Barbara Lucignano; Andrea Campana; Maria Antonietta De Ioris; Daniela Perrotta. 2021. "The burden of central line-associated bloodstream infections in children with medical complexity." The Journal of Vascular Access , no. : 1.

Research article
Published: 04 June 2021 in The Journal of Vascular Access
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Background: Proper securement of central venous catheters plays an important role in onco-hematological pediatric patients. A new subcutaneously anchored securement device has been recently introduced in the clinical practice, and it has been extensively used in children. Method: In our study, we have retrospectively investigated the safety and the effectiveness of such device, reviewing the experience of three Italian pediatric oncological units. We have considered only tunneled catheters (cuffed or non-cuffed) inserted in children with malignancy; all types of tunneled central catheters were included in the analysis (both centrally and peripherally inserted) as long as they were secured with a subcutaneously anchored device. We investigated the incidence of dislodgment and of other catheter-related complications, with special attention to local adverse effects potentially related to the securement device. Results: We collected data from 311 tunneled catheters of different caliber: 80.4% were centrally inserted central catheters (CICC), 15.4% were peripherally inserted (PICC), and 4.2% were femorally inserted. Approximately half of the catheters (51%) were non-cuffed. Incidence of dislodgment was very low (2.6%) and the incidence of local pain or inflammation potentially related to the securement device was minimal (1.9%). Catheter related bacteremias were below 1 episode/1000 catheter days. No symptomatic catheter related thrombosis was reported. There was no significant difference in complications comparing cuffed versus non-cuffed catheters, or CICCs versus PICCs, or hematologic tumors versus solid tumors. Conclusion: In our retrospective analysis of a vast population of oncological pediatric patients with tunneled central catheters, the subcutaneously anchored securement device was tolerated very well, and it was highly effective in preventing dislodgment, both in cuffed and non-cuffed catheters.

ACS Style

Alessandro Crocoli; Cristina Martucci; Luca Sidro; Daniela Delle Donne; Giuseppe Menna; Mauro Pittiruti; Maria Debora De Pasquale; Luisa Strocchio; Gian Luigi Natali; Alessandro Inserra. Safety and effectiveness of subcutaneously anchored securement for tunneled central catheters in oncological pediatric patients: A retrospective study. The Journal of Vascular Access 2021, 1 .

AMA Style

Alessandro Crocoli, Cristina Martucci, Luca Sidro, Daniela Delle Donne, Giuseppe Menna, Mauro Pittiruti, Maria Debora De Pasquale, Luisa Strocchio, Gian Luigi Natali, Alessandro Inserra. Safety and effectiveness of subcutaneously anchored securement for tunneled central catheters in oncological pediatric patients: A retrospective study. The Journal of Vascular Access. 2021; ():1.

Chicago/Turabian Style

Alessandro Crocoli; Cristina Martucci; Luca Sidro; Daniela Delle Donne; Giuseppe Menna; Mauro Pittiruti; Maria Debora De Pasquale; Luisa Strocchio; Gian Luigi Natali; Alessandro Inserra. 2021. "Safety and effectiveness of subcutaneously anchored securement for tunneled central catheters in oncological pediatric patients: A retrospective study." The Journal of Vascular Access , no. : 1.

Review
Published: 11 February 2021 in The Journal of Vascular Access
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Purpose: To explore the clinical evidence available on mindful organizing (MO) that will improve teamwork for positioning and managing central venous catheters in patients admitted to neonatal intensive care and other pediatric intensive care units to decrease central-line-associated and catheter-related bloodstream infections (CLABSI and CRBSI). Methods: We searched several databases (PubMed, Embase, CINAHL, CENTRAL, SCOPUS, and Web of Science) up to June 2018. We included studies investigating the effectiveness of MO teamwork in reducing CLABSI and CRBSI. The systematic review followed the PRISMA guidelines. We used validated appraisal checklists to assess quality. Results: Seven studies were included: only one was a non-randomized case-controlled trial (CCT). All the others had a pre-post intervention design, one a time-series design and one an interrupted time-series design. The methodological heterogeneity precluded a meta-analysis. Despite the low certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, three studies including thousands of participants provided numerical data for calculating risk ratios (RR) and 95% confidence intervals (CI) comparing MO with no intervention for decreasing the CLABSI rate in neonatal and pediatric ICUs. The one CCT disclosed no significant difference in the CLABSI rate decrease between groups (RR = 0.96; 95%CI 0.47–1.97). Nor did the pre- and post-intervention interrupted time-series design disclose a significant decrease (RR = 0.80; 95%CI 0.36 1.77). In the study using a before-after study design, the GRADE system found that the CLABSI rate decrease differed significantly in favor of post-intervention (RR = 0.13; 95%CI 0.03 0.57; p = 0.007). Conclusions: Despite the decreased CLABSI rate, the available evidence is low in quality. To reduce the unduly high CLABSI rates in neonatal and pediatric intensive care settings, custom-designed clinical trials should further define the clinical efficacy of MO to include it in care bundles as a new international standard.

ACS Style

Paola Rosati; Rosella Saulle; Laura Amato; Zuzana Mitrova; Alessandro Crocoli; Matilde Brancaccio; Gaetano Ciliento; Valeria Alessandri; Fiammetta Piersigilli; Joseph Nunziata; Corrado Cecchetti; Alessandro Inserra; Marta Ciofi degli Atti; Massimiliano Raponi. Mindful organizing as a healthcare strategy to decrease catheter-associated infections in neonatal and pediatric intensive care units. A systematic review and grading recommendations (GRADE) system. The Journal of Vascular Access 2021, 1 .

AMA Style

Paola Rosati, Rosella Saulle, Laura Amato, Zuzana Mitrova, Alessandro Crocoli, Matilde Brancaccio, Gaetano Ciliento, Valeria Alessandri, Fiammetta Piersigilli, Joseph Nunziata, Corrado Cecchetti, Alessandro Inserra, Marta Ciofi degli Atti, Massimiliano Raponi. Mindful organizing as a healthcare strategy to decrease catheter-associated infections in neonatal and pediatric intensive care units. A systematic review and grading recommendations (GRADE) system. The Journal of Vascular Access. 2021; ():1.

Chicago/Turabian Style

Paola Rosati; Rosella Saulle; Laura Amato; Zuzana Mitrova; Alessandro Crocoli; Matilde Brancaccio; Gaetano Ciliento; Valeria Alessandri; Fiammetta Piersigilli; Joseph Nunziata; Corrado Cecchetti; Alessandro Inserra; Marta Ciofi degli Atti; Massimiliano Raponi. 2021. "Mindful organizing as a healthcare strategy to decrease catheter-associated infections in neonatal and pediatric intensive care units. A systematic review and grading recommendations (GRADE) system." The Journal of Vascular Access , no. : 1.

Journal article
Published: 01 February 2021 in Pediatric Blood & Cancer
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Background Extra‐appendicular neuroendocrine tumors (NETs) are very rare tumors. While diagnostic and therapeutic guidelines are well established for adults, data on children and adolescents are lacking. Patients and Methods Patients with a diagnosis of extra‐appendicular NET registered on the Tumori Rari in Età Pediatrica ‐ Rare Tumors in Pediatric Age (TREP) from 2000 to 2020 were analyzed. Clinical characteristics including patients’ presentation, tumor features, treatment, and outcome were reviewed. Results Twenty‐seven patients with extra‐appendicular NET registered on TREP with a median age of 173 months. The primary site was the pancreas (12) or bronchi (10) in the majority of cases. Other primary sites included the thymus, Meckel's diverticulum, and liver. Thirteen (48%) of tumors extended beyond the organ of origin: four invaded neighboring organs and/or regional nodes and nine involved distant metastases. The 3‐year event‐free survival (EFS) for those with localized disease was superior to those with metastatic disease (66.6% 95% CI 5‐95% vs 33% 95% CI 5‐68%, respectively; P = .005). A complete resection was feasible in 17 patients. The 3‐year EFS in these patients was superior to those with no or incomplete resection (R0 vs R1/R2, respectively; P = .007). Overall, 16 children had no evidence of disease at follow‐up, and one is alive with disease; five died, and five were lost to follow‐up. Conclusions Data from our experience demonstrated a wide heterogeneity of presentation and outcome of these tumors. Localized disease and complete surgical resection were the main prognostic factors of good outcome. Other therapies may have a role in prolonging survival in metastatic disease.

ACS Style

Calogero Virgone; Andrea Ferrari; Stefano Chiaravalli; Maria Debora De Pasquale; Alessandro Inserra; Paolo D'Angelo; Martina Funmilayo Ogunleye; Alessandro Crocoli; Stefano Vallero; Simone Cesaro; Rita Alaggio; Gianni Bisogno; Patrizia Dall'Igna. Extra‐appendicular neuroendocrine tumors: A report from the TREP project (2000‐2020). Pediatric Blood & Cancer 2021, 68, e28880 .

AMA Style

Calogero Virgone, Andrea Ferrari, Stefano Chiaravalli, Maria Debora De Pasquale, Alessandro Inserra, Paolo D'Angelo, Martina Funmilayo Ogunleye, Alessandro Crocoli, Stefano Vallero, Simone Cesaro, Rita Alaggio, Gianni Bisogno, Patrizia Dall'Igna. Extra‐appendicular neuroendocrine tumors: A report from the TREP project (2000‐2020). Pediatric Blood & Cancer. 2021; 68 (4):e28880.

Chicago/Turabian Style

Calogero Virgone; Andrea Ferrari; Stefano Chiaravalli; Maria Debora De Pasquale; Alessandro Inserra; Paolo D'Angelo; Martina Funmilayo Ogunleye; Alessandro Crocoli; Stefano Vallero; Simone Cesaro; Rita Alaggio; Gianni Bisogno; Patrizia Dall'Igna. 2021. "Extra‐appendicular neuroendocrine tumors: A report from the TREP project (2000‐2020)." Pediatric Blood & Cancer 68, no. 4: e28880.

Editorial
Published: 10 November 2020 in The Journal of Vascular Access
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Introduction: Central venous accesses devices (CVADs) have a fundamental importance for diagnostic and therapeutic purposes in pediatric onco-hematological patients. The treatment of pediatric onco-hematological diseases is complex and requires the use of integrated multimodal therapies. Long-lasting and safe central venous access is therefore a cornerstone for any successful treatment. Methods: The aim of this work is to define pediatric guidelines about the management of CVADs in onco-hematology. A panel of experts belonging to the working groups on Infections and Supportive Therapy, Surgery and Nursing of the Italian Pediatric Hematology Oncology Association (AIEOP) revised the scientific literature systematically, scored the level of evidence and prepared these guidelines. The content of the following guidelines was approved by the Scientific Board of AIEOP. Results and Conclusions: Important innovations have been developed recently in the field of CVADs, leading to new insertion methods, new materials and new strategy in the overall management of the device, especially in the adult population. These guidelines recommend how to apply these innovations in the pediatric population, and are directed to all physicians, nurses and health personnel active in the daily management of CVADs. Their aim is to update the knowledge on CVAD and improve the standard of care in pediatric patients with malignancies.

ACS Style

Monica Cellini; Anna Bergadano; Alessandro Crocoli; Clara Badino; Francesca Carraro; Luca Sidro; Debora Botta; Alessia Pancaldi; Francesca Rossetti; Federica Pitta; Simone Cesaro. Guidelines of the Italian Association of Pediatric Hematology and Oncology for the management of the central venous access devices in pediatric patients with onco-hematological disease. The Journal of Vascular Access 2020, 1 .

AMA Style

Monica Cellini, Anna Bergadano, Alessandro Crocoli, Clara Badino, Francesca Carraro, Luca Sidro, Debora Botta, Alessia Pancaldi, Francesca Rossetti, Federica Pitta, Simone Cesaro. Guidelines of the Italian Association of Pediatric Hematology and Oncology for the management of the central venous access devices in pediatric patients with onco-hematological disease. The Journal of Vascular Access. 2020; ():1.

Chicago/Turabian Style

Monica Cellini; Anna Bergadano; Alessandro Crocoli; Clara Badino; Francesca Carraro; Luca Sidro; Debora Botta; Alessia Pancaldi; Francesca Rossetti; Federica Pitta; Simone Cesaro. 2020. "Guidelines of the Italian Association of Pediatric Hematology and Oncology for the management of the central venous access devices in pediatric patients with onco-hematological disease." The Journal of Vascular Access , no. : 1.

Research article
Published: 02 July 2020 in The Journal of Vascular Access
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Background: Subcutaneously anchored securement devices (or subcutaneous engineered securement devices) have been introduced recently into the clinical practice, but the number of published studies is still scarce. The Italian Group of Long-Term Central Venous Access Devices (GAVeCeLT)—in collaboration with WoCoVA (World Congress on Vascular Access)—has developed a Consensus about the effectiveness, safety, and cost-effectiveness of such devices. Methods: After the definition of a panel of experts, a systematic collection and review of the literature on subcutaneously anchored securement devices was performed. The panel has been divided in two working groups, one focusing on adult patients and the other on children and neonates. Results: Although the quality of evidence is generally poor, since it is based mainly on non-controlled prospective studies, the panel has concluded that subcutaneously anchored securement devices are overall effective in reducing the risk of dislodgment and they appear to be safe in all categories of patients, being associated only with rare and negligible local adverse effects; cost-effectiveness is demonstrated—or highly likely—in specific populations of patients with long-term venous access and/or at high risk of dislodgment. Conclusion: Subcutaneously anchored securement is a very promising strategy for avoiding dislodgment. Further studies are warranted, in particular for the purpose of defining (a) the best management of the anchoring device so to avoid local problems, (b) the patient populations in which it may be considered highly cost-effective and even mandatory, (c) the possible benefit in terms of reduction of other catheter-related complications such as venous thrombosis and/or infection, and—last but not least—(d) their impact on the workload and stress level of nurses taking care of the devices.

ACS Style

Fulvio Pinelli; Mauro Pittiruti; Ton Van Boxtel; Giovanni Barone; Roberto Biffi; Giuseppe Capozzoli; Alessandro Crocoli; Stefano Elli; Daniele Elisei; Adam Fabiani; Cristina Garrino; Ugo Graziano; Luca Montagnani; Alessio Pini Prato; Giancarlo Scoppettuolo; Nicola Zadra; Clelia Zanaboni; Pietro Zerla; Evangelos Konstantinou; Matt Jones; Hervé Rosay; Liz Simcock; Marguerite Stas; Gilda Pepe. GAVeCeLT-WoCoVA Consensus on subcutaneously anchored securement devices for the securement of venous catheters: Current evidence and recommendations for future research. The Journal of Vascular Access 2020, 22, 716 -725.

AMA Style

Fulvio Pinelli, Mauro Pittiruti, Ton Van Boxtel, Giovanni Barone, Roberto Biffi, Giuseppe Capozzoli, Alessandro Crocoli, Stefano Elli, Daniele Elisei, Adam Fabiani, Cristina Garrino, Ugo Graziano, Luca Montagnani, Alessio Pini Prato, Giancarlo Scoppettuolo, Nicola Zadra, Clelia Zanaboni, Pietro Zerla, Evangelos Konstantinou, Matt Jones, Hervé Rosay, Liz Simcock, Marguerite Stas, Gilda Pepe. GAVeCeLT-WoCoVA Consensus on subcutaneously anchored securement devices for the securement of venous catheters: Current evidence and recommendations for future research. The Journal of Vascular Access. 2020; 22 (5):716-725.

Chicago/Turabian Style

Fulvio Pinelli; Mauro Pittiruti; Ton Van Boxtel; Giovanni Barone; Roberto Biffi; Giuseppe Capozzoli; Alessandro Crocoli; Stefano Elli; Daniele Elisei; Adam Fabiani; Cristina Garrino; Ugo Graziano; Luca Montagnani; Alessio Pini Prato; Giancarlo Scoppettuolo; Nicola Zadra; Clelia Zanaboni; Pietro Zerla; Evangelos Konstantinou; Matt Jones; Hervé Rosay; Liz Simcock; Marguerite Stas; Gilda Pepe. 2020. "GAVeCeLT-WoCoVA Consensus on subcutaneously anchored securement devices for the securement of venous catheters: Current evidence and recommendations for future research." The Journal of Vascular Access 22, no. 5: 716-725.

Editorial
Published: 27 June 2020 in The Journal of Vascular Access
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Central venous access devices have revolutioned the care of children affected by malignancies, facilitating management of complex and prolonged infusive therapies, reducing pain and discomfort related to repeated blood samples and indiscriminate venipunctures, thus reducing also psychological stress of both patients and families. In this respect, peripherally inserted central catheters have been disseminated for use, even in pediatric oncology patients, for their many advantages: easy and non-invasive placement with no risk of insertion-related complications, as well as easy removal; reduced need for general anesthesia both for insertion and removal; adequate prolonged performance also for challenging therapies (e.g. stem cell transplantation); and low rate of late complications. Nonetheless, concerns have been recently raised about use of such devices in children with cancer, especially regarding a presumed (but not demonstrated) high risk of catheter-related venous thrombosis. Are we facing a new witch (or peripherally inserted central catheter) hunt? The choice of the central venous access device—particularly in oncologic children—should be based on an evaluation of clinical advantages and risks, as provided by appropriate and scientifically accurate clinical studies.

ACS Style

Alessandro Crocoli; Simone Cesaro; Monica Cellini; Francesca Rossetti; Luca Sidro; Fulvio Pinelli; Mauro Pittiruti. In defense of the use of peripherally inserted central catheters in pediatric patients. The Journal of Vascular Access 2020, 22, 333 -336.

AMA Style

Alessandro Crocoli, Simone Cesaro, Monica Cellini, Francesca Rossetti, Luca Sidro, Fulvio Pinelli, Mauro Pittiruti. In defense of the use of peripherally inserted central catheters in pediatric patients. The Journal of Vascular Access. 2020; 22 (3):333-336.

Chicago/Turabian Style

Alessandro Crocoli; Simone Cesaro; Monica Cellini; Francesca Rossetti; Luca Sidro; Fulvio Pinelli; Mauro Pittiruti. 2020. "In defense of the use of peripherally inserted central catheters in pediatric patients." The Journal of Vascular Access 22, no. 3: 333-336.

Journal article
Published: 03 June 2020 in Pediatric Blood & Cancer
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Background Pheochromocytomas (PCs) are neuroendocrine tumors arising from the chromaffin cells of the adrenal gland, and paragangliomas (PGLs) are their extra‐adrenal counterparts arising from ganglia along the sympathetic/parasympathetic chain. Surgery is the cornerstone of treatment. A sporatic or inherited germline mutation is commonly associated. Materials and methods Among over 1000 patients registered into the Tumori Rari in Età Pediatrica—rare tumors in pediatric age project—from 2000 to 2019, 50 were affected by PC/PGL. All clinical and therapeutic data were evaluated. Results Twenty‐eight patients had PC and 22 had PGL. Age at diagnosis ranged between 5 and 17 years. Thirty‐five patients had symptoms related to catecholamine hypersecretion; in 7 of 50 patients, diagnosis was incidental or done during assessment of a familial syndrome. In all cases, conventional imaging was effective to assess the presence of a tumor. In addition, 18 of 38 functional imaging studies were positive (61%). Forty‐eight patients were eligible for surgery: a complete resection was more frequently achieved in PC than in PGL (26/28 vs 11/22). All relapses were treated with surgery alone, surgery plus medical treatment, or chemotherapy alone; one PC with metastasis at diagnosis received radiotherapy only. Forty‐four patients were in the first, second, or third complete remission (10/50 recurred; 8/10 carried a germline mutation). Five of 50 patients were alive with disease. One patient died of disease. Conclusions Surgery can be curative in most tumors but it may not be always effective in removing PGLs. Severe postsurgical sequelae may affect these patients. Genetic tests should always be considered in individuals affected, and genetic counseling should be offered to their families.

ACS Style

Calogero Virgone; Marina Andreetta; Stefano Avanzini; Stefano Chiaravalli; Maria Debora De Pasquale; Alessandro Crocoli; Alessandro Inserra; Paolo D'angelo; Rita Alaggio; Giuseppe Opocher; Giovanni Cecchetto; Andrea Ferrari; Gianni Bisogno; Patrizia Dall'igna. Pheochromocytomas and paragangliomas in children: Data from the Italian Cooperative Study (TREP). Pediatric Blood & Cancer 2020, 67, 1 .

AMA Style

Calogero Virgone, Marina Andreetta, Stefano Avanzini, Stefano Chiaravalli, Maria Debora De Pasquale, Alessandro Crocoli, Alessandro Inserra, Paolo D'angelo, Rita Alaggio, Giuseppe Opocher, Giovanni Cecchetto, Andrea Ferrari, Gianni Bisogno, Patrizia Dall'igna. Pheochromocytomas and paragangliomas in children: Data from the Italian Cooperative Study (TREP). Pediatric Blood & Cancer. 2020; 67 (8):1.

Chicago/Turabian Style

Calogero Virgone; Marina Andreetta; Stefano Avanzini; Stefano Chiaravalli; Maria Debora De Pasquale; Alessandro Crocoli; Alessandro Inserra; Paolo D'angelo; Rita Alaggio; Giuseppe Opocher; Giovanni Cecchetto; Andrea Ferrari; Gianni Bisogno; Patrizia Dall'igna. 2020. "Pheochromocytomas and paragangliomas in children: Data from the Italian Cooperative Study (TREP)." Pediatric Blood & Cancer 67, no. 8: 1.

Review
Published: 06 March 2020 in International Journal of Molecular Sciences
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Undifferentiated soft tissue sarcomas are a group of diagnostically challenging tumors in the pediatric population. Molecular techniques are instrumental for the categorization and differential diagnosis of these tumors. A subgroup of recently identified soft tissue sarcomas with undifferentiated round cell morphology was characterized by Capicua transcriptional receptor (CIC) rearrangements. Recently, an array-based DNA methylation analysis of undifferentiated tumors with small blue round cell histology was shown to provide a highly robust and reproducible approach for precisely classifying this diagnostically challenging group of tumors. We describe the case of an undifferentiated sarcoma of the abdominal wall in a 12-year-old girl. The patient presented with a voluminous mass of the abdominal wall, and multiple micro-nodules in the right lung. The tumor was unclassifiable with current immunohistochemical and molecular approaches. However, DNA methylation profiling allowed us to classify this neoplasia as small blue round cell tumor with CIC alterations. The patient was treated with neoadjuvant chemotherapy followed by complete surgical resection and adjuvant chemotherapy. After 22 months, the patient is disease-free and in good clinical condition. To put our experience in context, we conducted a literature review, analyzing current knowledge and state-of-the-art diagnosis, prognosis, and clinical management of CIC rearranged sarcomas. Our findings further support the use of DNA methylation profiling as an important tool to improve diagnosis of non-Ewing small round cell tumors.

ACS Style

Evelina Miele; Rita De Vito; Andrea Ciolfi; Lucia Pedace; Ida Russo; Maria Debora De Pasquale; Angela Di Giannatale; Alessandro Crocoli; Biagio De Angelis; Marco Tartaglia; Rita Alaggio; Giuseppe Maria Milano. DNA Methylation Profiling for Diagnosing Undifferentiated Sarcoma with Capicua Transcriptional Receptor (CIC) Alterations. International Journal of Molecular Sciences 2020, 21, 1818 .

AMA Style

Evelina Miele, Rita De Vito, Andrea Ciolfi, Lucia Pedace, Ida Russo, Maria Debora De Pasquale, Angela Di Giannatale, Alessandro Crocoli, Biagio De Angelis, Marco Tartaglia, Rita Alaggio, Giuseppe Maria Milano. DNA Methylation Profiling for Diagnosing Undifferentiated Sarcoma with Capicua Transcriptional Receptor (CIC) Alterations. International Journal of Molecular Sciences. 2020; 21 (5):1818.

Chicago/Turabian Style

Evelina Miele; Rita De Vito; Andrea Ciolfi; Lucia Pedace; Ida Russo; Maria Debora De Pasquale; Angela Di Giannatale; Alessandro Crocoli; Biagio De Angelis; Marco Tartaglia; Rita Alaggio; Giuseppe Maria Milano. 2020. "DNA Methylation Profiling for Diagnosing Undifferentiated Sarcoma with Capicua Transcriptional Receptor (CIC) Alterations." International Journal of Molecular Sciences 21, no. 5: 1818.

Case report
Published: 11 February 2020 in Cancers
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Background: Colorectal carcinoma (CRC) is very rare in the pediatric and adolescent age range and clinical management is performed according to adult protocols. We report, for the first time in the literature, a case of a child with metastatic CRC successfully treated with panitumumab associated to chemotherapy. Methods: A twelve-year-old male was diagnosed with CRC with nodal metastasis and peritoneal neoplastic effusion. After performing a genetic evaluation, in light of the absence of mutations in RAS family genes, anti-Epidermal Growth Factor Receptor (EGFR) monoclonal antibody, panitumumab, was added to chemotherapy FOLFOXIRI. Results: The child successfully responded to therapy with normalization of the Carbohydrate Antigen (CA) 19.9 value after the third cycle of treatment. After the sixth cycle, he underwent surgery that consisted in sigmoid resection with complete D3 lymphadenectomy. At histological evaluation, no residual neoplastic cells were detectable in the surgical specimen. He completed 12 cycles of chemotherapy plus panitumomab and he is alive without disease 14 months from diagnosis. Conclusions: Our results suggest performing mutational screening for colorectal cancer also in the pediatric setting, in order to orient treatment that should include targeted therapies.

ACS Style

Maria Debora De Pasquale; Alessandro Crocoli; Tamara Caldaro; Martina Rinelli; Gian Paolo Spinelli; Paola Francalanci; Raffaele Cozza; Alessandro Inserra; Evelina Miele. Targeting Epidermal Growth Factor Receptor (EGFR) in Pediatric Colorectal Cancer. Cancers 2020, 12, 414 .

AMA Style

Maria Debora De Pasquale, Alessandro Crocoli, Tamara Caldaro, Martina Rinelli, Gian Paolo Spinelli, Paola Francalanci, Raffaele Cozza, Alessandro Inserra, Evelina Miele. Targeting Epidermal Growth Factor Receptor (EGFR) in Pediatric Colorectal Cancer. Cancers. 2020; 12 (2):414.

Chicago/Turabian Style

Maria Debora De Pasquale; Alessandro Crocoli; Tamara Caldaro; Martina Rinelli; Gian Paolo Spinelli; Paola Francalanci; Raffaele Cozza; Alessandro Inserra; Evelina Miele. 2020. "Targeting Epidermal Growth Factor Receptor (EGFR) in Pediatric Colorectal Cancer." Cancers 12, no. 2: 414.

Journal article
Published: 11 December 2019 in Cancer Genetics
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Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and rarely occur in pediatric patients. 85% of pediatric GISTs and 15% of adult GISTs lack of KIT or PDGFRA mutations. 40% of these "wild-type" GISTs present loss of function mutations in genes encoding for the subunits of the succinate dehydrogenase (SDH) complex. Germline mutations in SDH complex genes have been described in patients with the Carney–Stratakis syndrome (CSS), a rare inherited condition that predisposes to GIST and paraganglioma. We report two pediatric patients with multifocal GIST, harboring respectively a novel and a previously reported loss-of-function germline variant, in SDHC and SDHB genes.

ACS Style

Martina Rinelli; Emanuele Agolini; Giuseppe Maria Milano; Ida Russo; Alessandro Crocoli; Rita De Vito; Angela Di Giannatale; Pier Luigi Di Paolo; Antonio Novelli. Pediatric gastrointestinal stromal tumor: Report of two novel patients harboring germline variants in SDHB and SDHC genes. Cancer Genetics 2019, 241, 61 -65.

AMA Style

Martina Rinelli, Emanuele Agolini, Giuseppe Maria Milano, Ida Russo, Alessandro Crocoli, Rita De Vito, Angela Di Giannatale, Pier Luigi Di Paolo, Antonio Novelli. Pediatric gastrointestinal stromal tumor: Report of two novel patients harboring germline variants in SDHB and SDHC genes. Cancer Genetics. 2019; 241 ():61-65.

Chicago/Turabian Style

Martina Rinelli; Emanuele Agolini; Giuseppe Maria Milano; Ida Russo; Alessandro Crocoli; Rita De Vito; Angela Di Giannatale; Pier Luigi Di Paolo; Antonio Novelli. 2019. "Pediatric gastrointestinal stromal tumor: Report of two novel patients harboring germline variants in SDHB and SDHC genes." Cancer Genetics 241, no. : 61-65.

Journal article
Published: 08 December 2019 in Pediatric Blood & Cancer
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Malignant germ cell tumors (GCTs) are a heterogeneous group of rare neoplasms in children. Optimal outcome is achieved with multimodal therapies for patients with both localized and advanced disease, especially after the introduction of platinum-based chemotherapy regimens. In this respect, data on salvage treatment for children with relapsed or platinum-refractory disease are still limited. Retrospective analysis of data regarding patients affected by malignant GCTs with platinum-refractory or relapsed disease after first-line treatment according to AIEOP TCGM 2004 protocol was conducted. Twenty-one patients, 15 females and 6 males, were considered for the analysis. All 21 patients received second-line conventional chemotherapy (SLCT), two of these immediately after surgery for local relapse removal. Two patients showed a progression of disease during SLCT and died of disease shortly thereafter, whereas 19 patients were in partial remission (PR) or complete remission (CR) after SLCT. Treatment after SLCT consisted in surgery on residual tumor mass (9/19) followed by high dose of chemotherapy (HDCT) with autologous hematopoietic stem cell support (16/19). The overall survival (OS) and event-free survival of the whole populations are 71% and 66.6%, respectively. Platinum-refractory patients OS is 54.5% compared with 91.5% of the relapsed group. There were no treatment-related deaths. SLCT followed or not by HDCT is an effective salvage treatment for children with relapsed/refractory GCTs. However, the role of HDCT following SLCT needs to be further investigated, especially regarding the identification of specific patient subgroups, which can benefit from this more intensive treatment.

ACS Style

Maria Debora De Pasquale; Paolo D'angelo; Alessandro Crocoli; Renata Boldrini; Massimo Conte; Gianni Bisogno; Filippo Spreafico; Alessandro Inserra; Davide Biasoni; Patrizia Dall'igna; Fortunato Siracusa; Evelina Miele; Monica Terenziani. Salvage treatment for children with relapsed/refractory germ cell tumors: The Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) experience. Pediatric Blood & Cancer 2019, 67, e28125 .

AMA Style

Maria Debora De Pasquale, Paolo D'angelo, Alessandro Crocoli, Renata Boldrini, Massimo Conte, Gianni Bisogno, Filippo Spreafico, Alessandro Inserra, Davide Biasoni, Patrizia Dall'igna, Fortunato Siracusa, Evelina Miele, Monica Terenziani. Salvage treatment for children with relapsed/refractory germ cell tumors: The Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) experience. Pediatric Blood & Cancer. 2019; 67 (3):e28125.

Chicago/Turabian Style

Maria Debora De Pasquale; Paolo D'angelo; Alessandro Crocoli; Renata Boldrini; Massimo Conte; Gianni Bisogno; Filippo Spreafico; Alessandro Inserra; Davide Biasoni; Patrizia Dall'igna; Fortunato Siracusa; Evelina Miele; Monica Terenziani. 2019. "Salvage treatment for children with relapsed/refractory germ cell tumors: The Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) experience." Pediatric Blood & Cancer 67, no. 3: e28125.

Commentary
Published: 11 March 2019 in Pediatric Blood & Cancer
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Alessandro Inserra; Alessandro Crocoli. Palliative care: A surgical perspective. Pediatric Blood & Cancer 2019, 66, e27817 .

AMA Style

Alessandro Inserra, Alessandro Crocoli. Palliative care: A surgical perspective. Pediatric Blood & Cancer. 2019; 66 (8):e27817.

Chicago/Turabian Style

Alessandro Inserra; Alessandro Crocoli. 2019. "Palliative care: A surgical perspective." Pediatric Blood & Cancer 66, no. 8: e27817.

Review
Published: 01 March 2019 in Journal of Pediatric Surgery
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Complete encasement of the inferior vena cava by retroperitoneal tumors is rare. Although replacement of the vena cava has been considered for various conditions in adults, it is rarely used in children except for challenging resections and as a last chance approach - often aiming more at debulking than cure. From January 2009 to February 2017, 4 patients (2 adrenal neuroblastomas, 1 renal cell carcinoma, 1 infantile fibrosarcoma) underwent elective en-bloc resection of tumor and of the infrahepatic portion of the inferior vena cava (IVC), with planned IVC prosthetic replacement. In three cases a portion of the left renal vein had to be resected as well, with the vein reanastomosed onto the prosthesis, and a concomitant auto-transplantation of the right kidney was associated in one neuroblastoma patient. All patients had an uncomplicated postoperative course. In one patient, the prosthetic conduit is patent at long-term (43 months), while the middle portion of the prosthesis did eventually thrombose at mid-term after surgery in the three others - with no related symptoms. Interestingly, all renal venous reconstructions remain patent. Three patients (2 neuroblastomas and 1 infantile fibrosarcoma) are alive and disease-free at 43, 74 and 108 months after surgery, respectively. One patient with renal cell carcinoma died of recurrence of the disease 21 months after surgery. Resection and reconstruction of the vena cava, including the renal vein portion, can be considered and planned electively in case of tumoral encasement. This strategy is associated with good tolerance of the operation, low morbidity and satisfactory long-term function, even in cases with progressive and/or secondary partial thrombosis. IV.

ACS Style

Chiara Grimaldi; Arianna Bertocchini; Alessandro Crocoli; Jean De Ville De Goyet; Aurora Castellano; Analisa Serra; Marco Spada; Alessandro Inserra. Caval replacement strategy in pediatric retroperitoneal tumors encasing the vena cava: a single-center experience and review of literature. Journal of Pediatric Surgery 2019, 54, 557 -561.

AMA Style

Chiara Grimaldi, Arianna Bertocchini, Alessandro Crocoli, Jean De Ville De Goyet, Aurora Castellano, Analisa Serra, Marco Spada, Alessandro Inserra. Caval replacement strategy in pediatric retroperitoneal tumors encasing the vena cava: a single-center experience and review of literature. Journal of Pediatric Surgery. 2019; 54 (3):557-561.

Chicago/Turabian Style

Chiara Grimaldi; Arianna Bertocchini; Alessandro Crocoli; Jean De Ville De Goyet; Aurora Castellano; Analisa Serra; Marco Spada; Alessandro Inserra. 2019. "Caval replacement strategy in pediatric retroperitoneal tumors encasing the vena cava: a single-center experience and review of literature." Journal of Pediatric Surgery 54, no. 3: 557-561.

Case report
Published: 16 November 2018 in The Journal of Vascular Access
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Exhaustion of vascular accesses is a major complication in patients undergoing hemodialysis, especially in pediatric setting. We report the case of a boy treated for loss of hemodialysis access after a combined liver–kidney transplantation and transient renal dysfunction. An interventional dilatation of calcific superior vena cava allowed to insert a stable central venous line for dialysis until full graft recovery. Careful management of central lines allows to spare the main vessels and reduces the need for unusual accesses.

ACS Style

Chiara Grimaldi; Alessandro Crocoli; Roberta Angelico; Maria Cristina Saffioti; Simona Gerocarni Nappo; Fabrizio Chiusolo; Francesca Tortora; Sergio Giuseppe Picardo; Luca Dello Strologo; Maria Sole Basso; Lidia Monti; Paolo Guccione; Massimo Rollo; Marco Spada. Life-saving vascular access after combined liver and kidney transplantation: A challenging access to the right atrium. The Journal of Vascular Access 2018, 20, 442 -445.

AMA Style

Chiara Grimaldi, Alessandro Crocoli, Roberta Angelico, Maria Cristina Saffioti, Simona Gerocarni Nappo, Fabrizio Chiusolo, Francesca Tortora, Sergio Giuseppe Picardo, Luca Dello Strologo, Maria Sole Basso, Lidia Monti, Paolo Guccione, Massimo Rollo, Marco Spada. Life-saving vascular access after combined liver and kidney transplantation: A challenging access to the right atrium. The Journal of Vascular Access. 2018; 20 (4):442-445.

Chicago/Turabian Style

Chiara Grimaldi; Alessandro Crocoli; Roberta Angelico; Maria Cristina Saffioti; Simona Gerocarni Nappo; Fabrizio Chiusolo; Francesca Tortora; Sergio Giuseppe Picardo; Luca Dello Strologo; Maria Sole Basso; Lidia Monti; Paolo Guccione; Massimo Rollo; Marco Spada. 2018. "Life-saving vascular access after combined liver and kidney transplantation: A challenging access to the right atrium." The Journal of Vascular Access 20, no. 4: 442-445.

Research article
Published: 26 October 2018 in Pediatric Blood & Cancer
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1 Background Solid pseudopapillary pancreatic tumors (SPPT) are an extremely rare entity in pediatric patients. Even if the role of radical surgical resection as primary treatment is well established, data about follow‐up after pancreatic resection in children are scant. 2 Methods A retrospective review of data from the Italian Pediatric Rare Tumor Registry (TREP) was performed. Short‐term (<30 days) and long‐term complications of different surgical resections, as well as long‐term follow‐up were evaluated. 3 Results From January 2000 to present, 43 patients (male:female = 8:35) were enrolled. The median age at diagnosis was 13.2 years (range, 7–18). Nine children had an incidental diagnosis, whereas 26 complained of abdominal pain and 4 of palpable mass. Tumors arose either from the head of pancreas (n = 14) or from body/tail (n = 29): only one patient presented with metastatic disease. Resection was complete in all patients (cephalic duodenopancreatectomy vs distal resection). At follow‐up (median, 8.4 years; range, 0–17 years), one recurrence occurred in a patient with intraoperative rupture. All patients are alive. Three pancreatic fistulas occurred in the body/tail group, whereas four complications occurred in the head group (one ileal ischemia, two stenosis of the pancreatic duct, and one chylous fistula). 4 Conclusion Surgery is the best therapeutic option for these tumors; hence, complete resection is mandatory. Extensive resections, including cephalic duodenopancreatectomy, are safe when performed in specialized centers. Long‐term follow‐up should be aimed to detect tumor recurrence and to evaluate residual pancreatic function.

ACS Style

Alessandro Crocoli; Chiara Grimaldi; Calogero Virgone; Maria Debora De Pasquale; Giovanni Cecchetto; Simone Cesaro; Gianni Bisogno; Valerio Cecinati; Alessandra Narciso; Daniele Alberti; Andrea Ferrari; Patrizia Dall'igna; Marco Spada; Alessandro Inserra. Outcome after surgery for solid pseudopapillary pancreatic tumors in children: Report from the TREP project-Italian Rare Tumors Study Group. Pediatric Blood & Cancer 2018, 66, e27519 .

AMA Style

Alessandro Crocoli, Chiara Grimaldi, Calogero Virgone, Maria Debora De Pasquale, Giovanni Cecchetto, Simone Cesaro, Gianni Bisogno, Valerio Cecinati, Alessandra Narciso, Daniele Alberti, Andrea Ferrari, Patrizia Dall'igna, Marco Spada, Alessandro Inserra. Outcome after surgery for solid pseudopapillary pancreatic tumors in children: Report from the TREP project-Italian Rare Tumors Study Group. Pediatric Blood & Cancer. 2018; 66 (3):e27519.

Chicago/Turabian Style

Alessandro Crocoli; Chiara Grimaldi; Calogero Virgone; Maria Debora De Pasquale; Giovanni Cecchetto; Simone Cesaro; Gianni Bisogno; Valerio Cecinati; Alessandra Narciso; Daniele Alberti; Andrea Ferrari; Patrizia Dall'igna; Marco Spada; Alessandro Inserra. 2018. "Outcome after surgery for solid pseudopapillary pancreatic tumors in children: Report from the TREP project-Italian Rare Tumors Study Group." Pediatric Blood & Cancer 66, no. 3: e27519.

Journal article
Published: 05 January 2018 in BMC Cancer
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The Intratumoral Microvessel Density (IMVD) is commonly used to quantify tumoral vascularization and is usually assessed by pan-endothelial markers, such as CD31. Endoglin (CD105) is a protein predominantly expressed in proliferating endothelium and the IMVD determined by this marker measures specifically the neovascularization. In this study, we investigated the CD105 expression in pediatric rhabdomyosarcoma and assessed the neovascularization by using the angiogenic ratio IMVD-CD105 to IMVD-CD31. Paraffin-embedded archival tumor specimens were selected from 65 pediatric patients affected by rhabdomyosarcoma. The expression levels of CD105, CD31 and Vascular Endothelial Growth Factor (VEGF) were investigated in 30 cases (18 embryonal and 12 alveolar) available for this study. The IMVD-CD105 to IMVD-CD31 expression ratio was correlated with clinical and pathologic features of these patients. We found a specific expression of endoglin (CD105) in endothelial cells of all the rhabdomyosarcoma specimens analyzed. We observed a significant positive correlation between the IMVD individually measured by CD105 and CD31. The CD105/CD31 expression ratio was significantly higher in patients with lower survival and embryonal histology. Indeed, patients with a CD105/CD31 expression ratio < 1.3 had a significantly increased OS (88%, 95%CI, 60%–97%) compared to patients with higher values (40%, 95%CI, 12%–67%). We did not find any statistical correlation among VEGF and EFS, OS and CD105/CD31 expression ratio. CD105 is expressed on endothelial cells of rhabdomyosarcoma and represent a useful tool to quantify neovascularization in this tumor. If confirmed by further studies, these results will indicate that CD105 is a potential target for combined therapies in rhabdomyosarcoma.

ACS Style

Virginia Di Paolo; Ida Russo; Renata Boldrini; Lucilla Ravà; Marco Pezzullo; Maria Chiara Benedetti; Angela Galardi; Marta Colletti; Rossella Rota; Domenico Orlando; Alessandro Crocoli; Héctor Peinado; Giuseppe Maria Milano; Angela Di Giannatale. Evaluation of Endoglin (CD105) expression in pediatric rhabdomyosarcoma. BMC Cancer 2018, 18, 31 .

AMA Style

Virginia Di Paolo, Ida Russo, Renata Boldrini, Lucilla Ravà, Marco Pezzullo, Maria Chiara Benedetti, Angela Galardi, Marta Colletti, Rossella Rota, Domenico Orlando, Alessandro Crocoli, Héctor Peinado, Giuseppe Maria Milano, Angela Di Giannatale. Evaluation of Endoglin (CD105) expression in pediatric rhabdomyosarcoma. BMC Cancer. 2018; 18 (1):31.

Chicago/Turabian Style

Virginia Di Paolo; Ida Russo; Renata Boldrini; Lucilla Ravà; Marco Pezzullo; Maria Chiara Benedetti; Angela Galardi; Marta Colletti; Rossella Rota; Domenico Orlando; Alessandro Crocoli; Héctor Peinado; Giuseppe Maria Milano; Angela Di Giannatale. 2018. "Evaluation of Endoglin (CD105) expression in pediatric rhabdomyosarcoma." BMC Cancer 18, no. 1: 31.

Journal article
Published: 01 September 2017 in Journal of Pediatric Surgery
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Alessandro Crocoli; Luca Sidro; Clelia Zanaboni; Francesca Rossetti; Mauro Pittiruti. Letter to the Editor. Journal of Pediatric Surgery 2017, 52, 1535 -1536.

AMA Style

Alessandro Crocoli, Luca Sidro, Clelia Zanaboni, Francesca Rossetti, Mauro Pittiruti. Letter to the Editor. Journal of Pediatric Surgery. 2017; 52 (9):1535-1536.

Chicago/Turabian Style

Alessandro Crocoli; Luca Sidro; Clelia Zanaboni; Francesca Rossetti; Mauro Pittiruti. 2017. "Letter to the Editor." Journal of Pediatric Surgery 52, no. 9: 1535-1536.

Journal article
Published: 24 May 2017 in The Journal of Vascular Access
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Introduction Children with special health-care needs are an emerging and consistent population. In a subset of children with medical complexity (CMC) a continuous access to the central vascular system is advisable to eliminate unnecessary pain and stress and to improve home management and palliative care. Methods The surgical registry of a tertiary hospital was checked in order to identify CMC who underwent totally implantable venous access device (VAD) placement. Medical records were reviewed. Results From October 2009 to August 2014, a totally implantable VAD was placed in 10 children. Seven out of 10 patients were affected by cerebral palsy while 3 presented a genetic syndrome. The median duration of the indwelling catheter was 31 months (range 5 to 77 months). Six catheters are still in place since the first placement. Infectious complications were observed in two patients, respectively, a Candida albicans and a Staphylococcus aureus colonization; in both cases the VAD was removed. In another two cases, removal was planned for reservoir dislodgment within the subcutaneous tissue. No other major complications were observed during the procedure and the follow-up period. Emergency admissions decreased from a median value of 0.4/month (range 0-1.5/month) to 0.2/month (range 0-0.6/month) after the VAD placement. Conclusions A totally implanted VAD in CMC is safe and manageable. As expected, infection seems to be the major complication with no infection-related death. Malnutrition and musculoskeletal deformities, which are frequent comorbidities in CMC, should be considered to reduce the risk of dislodgment/migration.

ACS Style

Caterina Geremia; Maria Antonietta De Ioris; Alessandro Crocoli; Ottavio Adorisio; Raffaella Scrocca; Mary Haywood Lombardi; Susanna Staccioli; Pietro Stella; Paola Amendola; Gaetano Ciliento; Francesco De Peppo; Andrea Campana. Totally Implantable Venous Access Devices in Children with Medical Complexity: Preliminary Data from a Tertiary Care Hospital. The Journal of Vascular Access 2017, 18, 426 -429.

AMA Style

Caterina Geremia, Maria Antonietta De Ioris, Alessandro Crocoli, Ottavio Adorisio, Raffaella Scrocca, Mary Haywood Lombardi, Susanna Staccioli, Pietro Stella, Paola Amendola, Gaetano Ciliento, Francesco De Peppo, Andrea Campana. Totally Implantable Venous Access Devices in Children with Medical Complexity: Preliminary Data from a Tertiary Care Hospital. The Journal of Vascular Access. 2017; 18 (5):426-429.

Chicago/Turabian Style

Caterina Geremia; Maria Antonietta De Ioris; Alessandro Crocoli; Ottavio Adorisio; Raffaella Scrocca; Mary Haywood Lombardi; Susanna Staccioli; Pietro Stella; Paola Amendola; Gaetano Ciliento; Francesco De Peppo; Andrea Campana. 2017. "Totally Implantable Venous Access Devices in Children with Medical Complexity: Preliminary Data from a Tertiary Care Hospital." The Journal of Vascular Access 18, no. 5: 426-429.

Journal article
Published: 21 March 2017 in The Journal of Vascular Access
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Alessandro Crocoli; Alessandra Narciso; Valerio Pardi; Antonella Accinni; Silvia Madafferi; Arianna Bertocchini; Alessandro Inserra. Removal of tunneled-cuffed catheters in children: is it safe to leave the cuff? The Journal of Vascular Access 2017, 18, e22 -e23.

AMA Style

Alessandro Crocoli, Alessandra Narciso, Valerio Pardi, Antonella Accinni, Silvia Madafferi, Arianna Bertocchini, Alessandro Inserra. Removal of tunneled-cuffed catheters in children: is it safe to leave the cuff? The Journal of Vascular Access. 2017; 18 (2):e22-e23.

Chicago/Turabian Style

Alessandro Crocoli; Alessandra Narciso; Valerio Pardi; Antonella Accinni; Silvia Madafferi; Arianna Bertocchini; Alessandro Inserra. 2017. "Removal of tunneled-cuffed catheters in children: is it safe to leave the cuff?" The Journal of Vascular Access 18, no. 2: e22-e23.