Italy

                                                         “INCREDIBLE”

“I want this therapy used in our Pisa Burn Center”

 In the 1975 - 85 decade, Dr. Saliba was invited to present his Heparin Effects in Burns and in Heart Attack studies in Florence Italy 3 times and in Rome once.

The 8th SBI International Heparin Therapy in Burn Symposium was held within the 13th ISBI Burn Congress in Fortaleza Brazil, September 2006.  Following presentations by Drs. Reyes from Mexico and Saliba from the USA, Pisa Italy Plastic Surgeon Marco Stabile approached and told Saliba, “I want this therapy used in our Burn Center.”  They talked then and at dinner.  Dr. Bruno Balmelli who later helped implement heparin into Paraguay listened.

Dr. Marco Stabile, M.D., S.I.C.P.R.E, Soc F.C.P.R.E, I.S.A.P.S, Plastic Surgeon. Born in Milano Italy, a graduate of Parma School of Medicine, and fluent in Italian, French, English, and Espanol languages, Dr. Stabile is an active member of the Italian and the French Society of Plastic and Reconstructive Surgery, and the International Society of Aesthetic Plastic Surgery.  His general medicine practice was at Privat Hospital in Cremona in 1988 and at Germani’s Cingia de Botti Hospital from 1990 to 1993. He performed General Surgery at Privat Hospital again from 1993 to 2001.  After Plastic Surgery training in Parma Italy and in Burns under Prof. JC Guimberteauin Bordeaux France, he has worked in the Plastic Surgery and Burns Unit of Cisanello Hospital in Pisa. He has authored  15 publications and participated in 70 congress workshops in and outside of Italy.  marcostabile@gmail.com  

Back in Italy, on October 22, Dr. Stabile e-mailed Dr. Saliba, “Best regards from Pisa.  I'm very interested to use heparin in our Burn Unit, but I don’t know the kind of heparin or where I can find it in Italy. Best regards, Marco.”

Dr. Saliba replied, “Dr. Stabile and Colleagues, Similar best regards from SBI. Meeting you and our planned cooperation is very important as your Pisa Burn Unit, that treats burned patients in the Northern Half of Italy, has high priority with our Institute now.  You will have SBI support to the extent you request it. The Sodium Aqueous Heparin Solution for Injection, USP you use now is the heparin that you can use in treating burned patients.  It is available worldwide in immediately usable 5000 International Units per milliliter (IU) and higher concentrations.  You can download free the Directions which are in the SBI Website Protocol Http://www.salibaburnsinstitute.org  At your request, SBI will send 1 or 2 doctors to Pisa for up to 7 days to present, discuss, and actively consult. SBI will provide the doctors and pay for their air travel if your Hospital provides accommodations.  You may NOT need our services – about half of the burn centers using heparin have learned from our Protocol and Website. However, you will have that option open. Professional regards, Michael.“

February 2007. Stabile replied: “Michael, Here I'm waiting for the Ethics Committee to approve our study.  My Chief’s name is Alessandro Messei. 

April 2007 Saliba wrote  “Pisa Burn Unit facilities, ultra-modern equipment, and the quality of your surgical treatment is truly impressive.  Yet, burns are still terrible and further improvements are needed. Adding heparin has favorably improved burn care and results in many countries.  You said your initial heparin use was good.  Please continue. Report your results.

In July Stabile informed Saliba: I announce (to) you, that the Ethic Committee accepted our Protocol. This is an informal notice, but is a great result. We are the first hospital to test heparin in a study in Italy!   However, to start, I need your contribution to buy the heparin, as this is a necessary condition for approval that was fixed by Ethics Committee.

The Saliba Burns Institute supplied the funds for the heparin. Stabile confirmed that the money was received, that the heparin was purchased, and that he had been designated to be the Principal Investigator.

October 22, 2007(1 year after the first e-mails)   Dr. Saliba, we are ready to start. I showed the Protocol to the staff. I am pleased to show you the Dose Tables.

December 2007. Dear Dr. Saliba, INCREDIBLE Results!  After a little discussion with anesthetist colleagues who work with us in our Burn Unit, we started with heparin in two cases.  

March 2008. Dr. Marco Stabile submitted the abstract of the Pisa Italy study to the 14th ISBI Burn Congress in MontrealCanadain September.  The abstract was accepted in June 2008.

A Prospective Study of Burns Treated With and Without Topical and Parenteral Heparin. Stabile M., Gatti G.L., Sansevero S., Murr C., Massei A. Unit of Plastic Surgery and Burns, Cisanello University Hospital, Pisa, Italy. Introduction: Heparin added to traditional burn treatment has been reported to be of value, this Ethics Committee Approved Study was performed in our Burn Centre within 12 months, 2007 into 2008. We wanted to test heparin effects on burn pain, restoration of blood in ischemic tissue, enhanced granulation, and smooth skin previously reported to be improved by heparin compared to controls not treated with heparin.  Method: In our Burn Centre Unit, a case-vs-control study of 30 continuous similar patients (ages 24-71), who had sustained predominantly superficial and deep second degree burns of 10-20% TBSA size was randomly prospectively performed, comparing the results using our traditional surgery-first treatment without heparin in 15 patients (Control Group, C) with 15 similar patients treated prior to any surgery with heparin administered both topically and parenterally (Heparin Group, H).  Results: Group H with heparin complained of significantly less pain than Group C, without use of heparin and received a significantly lesser amount of pain medicines. The experimental treatment Group H needed fewer antibiotics and had significantly fewer skin grafts than traditional treatment Group C.  For Group H, days in hospital were significantly less than for Group C. Burns required significantly less time to heal in the case Group H than in Controls C. Scars were absent and skin was smooth and satisfaction was much higher in heparin treated Group H. The p values were all p<0.05. We found evidence that the circulation was better, revascularization was faster, and granulations were enhanced in Group H.   Data quantities, statistics, and photographs will be presented.  Conclusions. Heparin added topically and parenterally significantly improved burn treatment and results in this preliminary limited prospective study in our burn centre. Burn care costs were much reduced.

 

 

 

 

 

 

 

 

 

August 11-13. By email Stabile and Saliba reviewed and discussed the study evidence that supported the study findings showing that heparin improved burn care and results.  Dr. Stabile wrote: Our presentation will show data quantities, serial dated photographs, and statistics which are all p<0.05 values.   

Dr. Saliba responded: Excellent. Italian doctors from medical centers like Pisa have contributed some of the most important medical advances in medical history.  You are and will be one of those. Best regards with much appreciation, Michael.”  

Early in September, Drs Saliba, Stabile and Gatti (a co-author with Stabile) met and presented their studies at the 14th ISBI Montreal Canada Burn Congress.

October 2008.  Michael, our study will be presented in Londonat the British Association of Plastic, Reconstruction, and Aesthetic Surgery (bapras) Winter Meeting, December 3-5.  Warm regards, Marco.

October 10. From Dr. Saliba: Dr. Marco Stabile, today I received an announcement of your study presentation in Londonfrom London Plastic Surgeon Mr. Mohammad Jawad. He wrote, “Dear Micheal, Hope you are well. Finally HEPARIN has arrived on London scene. The announcement is:  3 - 5 DECEMBER 2008. WINTER MEETING AT THE ROYAL COLLEGE OF SURGEONS BUILDING, LONDON. WEDNESDAY: SESSION on BURNS. 14:09 PM. A Comparative Study of Burns Treated with and without Topical and Parenteral Heparin. Dr. M Stabile, Dr B Balmelli, Dr G Gatti, and Professor A Massei (Pisa)  14:18 Discussion.  I thought you will be interested to come over and defend or enjoy it.  Best, M Jawad.”  Congratulations Marco. SBI has tried unsuccessfully since 1999 to introduce heparin therapy in burn into England. It (your presentation) is good news!  Dr. Saliba.

Monday, October 27.  Dear Michael, I have news. I have been in Madridin the First European Congress of the Societies of Plastic Surgery, and I have met my friend Dr. Orlando, who is now the Chief of Plastic Surgery Centre and Burn unit in Bristol England.  He said it was very important that I present in London. He is interested (too). Best regards, Marco

October 2008. Michael, I'm very happy that British plastic surgeons may witness how effective adding heparin is in burn treatment!   Best regards, Marco

Dr. Marco continued to make presentations and communicate with his surgical colleagues.

 April 2009  Malta is a wonderful place!  I showed my plastic surgery work, and the study about heparin.  Everyone was surprised about the results. I would like to publish my work.

June 18, 2009, Dr. Stabile took a sabbatical leave from the Plastic Surgery Unit of Cisanello University Hospital in PisaItalyfor 8 months to develop his personal work and studies.

October 22, 2009 (3 years after the 1st e-mails) Dr. Stabile e-mailed “NEW FRONTIERE IN FRANCE.  I'm happy because my work with heparin burn therapy is accepted for presentation in the National Congress of French Society of Plastic and Reconstructive Surgery in Paris.  Yes, is a great goal in Europe!  I met also in a Congress in Berlin. The President of the Italian Society of Burns and I spoke about heparin therapy...He said the Italian society of Burns wants to know more about heparin in burns. We can organize a Congress with him I think.

May 2010.  Stabile to Saliba:  I was in Finland and I made a private heparin therapy presentation to colleagues in Finlandand from France and Germany.  They were SURPRISED at the results. I will soon present in Paris. 

Summer 2010 Stabile submitted a heparin study abstract to the 4th Pan African Burn Society Meeting February 2011 in Cape Town, South Africa.  Doctors from all the African Countries would attend. Stabile and Saliba discussed.out SBI’s participation in the upcoming Lima, Peru Burn Meeting in November 2010.

.

 February 2008.  Dr Stabile and Dr. Saliba met in Rome and made heparin presentations to Prof. Dr. Palumbo, the Director of Rome Burn Center.

 

 

USA, INDIA, RUSSIA, BULGARIA, EL SALVADOR, BRAZIL, MEXICO, HAITI, OMAN, CHINA, SOUTH KOREA, NEPAL, ITALY, PARAGUAY, BELGIUM, PERU, CHILE, SOUTH AFRICA