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Calò L, Crescenzi C, Martino A, Casella M, Romeo F, Cappelletto C, Bressi E, Panattoni G, Stolfo D, Targetti M, Toso E, Musumeci MB, Tini G, Ciabatti M, Stefanini M, Silvetti E, Stazi A, Danza ML, Rebecchi M, Canestrelli S, Fedele E, Lanzillo C, Fusco A, Sangiuolo FC, Oliviero G, Radesich C, Perotto M, Pieroni M, Golia P, Mango R, Gasperetti A, Autore C, Merlo M, de Ruvo E, Russo AD, Olivotto I, Sinagra G, Gaita F. The Diagnostic Value of the 12-Lead ECG in Arrhythmogenic Left Ventricular Cardiomyopathy: Novel ECG Signs. JACC Clin Electrophysiol 2023; 9:2615-2627. [PMID: 37768253 DOI: 10.1016/j.jacep.2023.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/27/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Electrocardiographic (ECG) findings in arrhythmogenic left ventricular cardiomyopathy (ALVC) are limited to small case series. OBJECTIVES This study aimed to analyze the ECG characteristics of ALVC patients and to correlate ECG with cardiac magnetic resonance and genotype data. METHODS We reviewed data of 54 consecutive ALVC patients (32 men, age 39 ± 15 years) and compared them with 84 healthy controls with normal cardiac magnetic resonance. RESULTS T-wave inversion was often noted (57.4%), particularly in the inferior and lateral leads. Low QRS voltages in limb leads were observed in 22.2% of patients. The following novel ECG findings were identified: left posterior fascicular block (LPFB) (20.4%), pathological Q waves (33.3%), and a prominent R-wave in V1 with a R/S ratio ≥0.5 (24.1%). The QRS voltages were lower in ALVC compared with controls, particularly in lead I and II. At receiver-operating characteristic analysis, the sum of the R-wave in I to II ≤8 mm (AUC: 0.909; P < 0.0001) and S-wave in V1 plus R-wave in V6 ≤12 mm (AUC: 0.784; P < 0.0001) effectively discriminated ALVC patients from controls. It is noteworthy that 4 of the 8 patients with an apparently normal ECG were recognized by these new signs. Transmural late gadolinium enhancement was associated to LPFB, a R/S ratio ≥0.5 in V1, and inferolateral T-wave inversion, and a ringlike pattern correlated to fragmented QRS, SV1+RV6 ≤12 mm, low QRS voltage, and desmoplakin alterations. CONCLUSIONS Pathological Q waves, LPFB, and a prominent R-wave in V1 were common ECG signs in ALVC. An R-wave sum in I to II ≤8 mm and SV1+RV6 ≤12 mm were specific findings for ALVC phenotypes compared with controls.
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Affiliation(s)
- Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Rome, Italy.
| | | | | | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Cardiology Hospital Ospedali Riuniti, Ancona, Italy
| | - Fabiana Romeo
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | - Chiara Cappelletto
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Edoardo Bressi
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | | | - Davide Stolfo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Mattia Targetti
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Elisabetta Toso
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Maria Beatrice Musumeci
- Cardiology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Giacomo Tini
- Cardiology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | | | | | - Elisa Silvetti
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | | | | | - Marco Rebecchi
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | | | - Elisa Fedele
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | | | - Armando Fusco
- Division of Radiology, Policlinico Casilino, Rome, Italy
| | | | - Giada Oliviero
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | - Cinzia Radesich
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Maria Perotto
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | | | - Paolo Golia
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | - Ruggiero Mango
- Cardiology Unit, Department of Emergency and Critical Care, Policlinico Tor Vergata, Rome, Italy
| | | | - Camillo Autore
- Cardiology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Marco Merlo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | | | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Cardiology Hospital Ospedali Riuniti, Ancona, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Cardiology Unit, Meyer University Children Hospital IRCCS, University of Florence, Florence, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
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Calò L, Panattoni G, Tatangelo M, Brunetti G, Graziano F, Monzo L, Danza ML, Fedele E, Grieco D, Crescenzi C, Rebecchi M, Stazi A, Bressi E, De Ruvo E, Golia P, Gaita F, Corrado D, Zorzi A. Electrocardiographic characteristics of right-bundle-branch-block premature ventricular complexes predicting absence of left ventricular scar in athletes with apparently structural normal heart. Europace 2023; 25:euad217. [PMID: 37466354 PMCID: PMC10374981 DOI: 10.1093/europace/euad217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/29/2023] [Indexed: 07/20/2023] Open
Abstract
AIMS Left ventricular scar is an arrhythmic substrate that may be missed by echocardiography and diagnosed only by cardiac magnetic resonance (CMR), which is a time-consuming and expensive imaging modality. Premature ventricular complexes (PVCs) with a right-bundle-branch-block (RBBB) pattern are independent predictors of late gadolinium enhancement (LGE) but their positive predictive value is low. We studied which electrocardiographic features of PVCs with an RBBB pattern are associated with a higher probability of the absence of an underlying LGE. METHODS The study included 121 athletes (36 ± 16 years; 48.8% men) with monomorphic PVCs with an RBBB configuration and normal standard clinical investigations who underwent CMR. LGE was identified in 35 patients (29%), predominantly in those with PVCs with a superior/intermediate axis (SA-IntA) compared to inferior axis (IA) (38% vs. 10%, P = 0.002). Among patients with SA-IntA morphology, the contemporary presence of qR pattern in lead aVR and V1 was exclusively found in patients without LGE at CMR (51.0% vs. 0%, P < 0.0001). Among patients with IA, the absence of LGE correlated to a narrow ectopic QRS (145 ± 16 vs. 184 ± 27 msec, P < 0.001). CONCLUSIONS Among athletes with apparently idiopathic PVCs with a RBBB configuration, the presence of a concealed LGE at CMR was documented in 29% of cases, mostly in those with a SA-IntA. In our experience, the contemporary presence of qR pattern in lead aVR and V1 in PVCs with RBBB/SA-IntA morphology or, on the other hand, a relatively narrow QRS in PVCs with an IA, predicted absence of LGE.
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Affiliation(s)
- Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Germana Panattoni
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Mario Tatangelo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Giulia Brunetti
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Francesca Graziano
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Luca Monzo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
- Université de Lorraine INSERM, Centre d’ Investigations Cliniques Plurithématique, Nancy, France
| | - Maria Ludovica Danza
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Elisa Fedele
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Domenico Grieco
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Cinzia Crescenzi
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Marco Rebecchi
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Alessandra Stazi
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Edoardo Bressi
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Ermenegildo De Ruvo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Paolo Golia
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
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Crescenzi C, Silvetti E, Romeo F, Martino A, Bressi E, Panattoni G, Stefanini M, Stazi A, Danza ML, Rebecchi M, Canestrelli S, Fedele E, Lanza O, Lanzillo C, Fusco A, Golia P, De Ruvo E, Calò L. The electrocardiogram in non-ischaemic-dilated cardiomyopathy. Eur Heart J Suppl 2023; 25:C179-C184. [PMID: 37125290 PMCID: PMC10132560 DOI: 10.1093/eurheartjsupp/suad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This article summarizes the main electrocardiogram (ECG) findings in dilated cardiomyopathy (DCM) patients. Recent reports are described in the great 'pot' of DCM peculiar ECG patterns that are typical of specific forms of DCM. Patients with late gadolinium enhancement on CMR, who are at greatest arrhythmic risk, have also distinctive ECG features. Future studies in large DCM populations should evaluate the diagnostic and prognostic value of the ECG.
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Affiliation(s)
- Cinzia Crescenzi
- Corresponding author. Tel: +39 06 23188406, Fax: +39 06 23188410,
| | - Elisa Silvetti
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Fabiana Romeo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Annamaria Martino
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Edoardo Bressi
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Germana Panattoni
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Matteo Stefanini
- Division of Radiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Alessandra Stazi
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Maria Ludovica Danza
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Marco Rebecchi
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Stefano Canestrelli
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Elisa Fedele
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Oreste Lanza
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Chiara Lanzillo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Armando Fusco
- Division of Radiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Paolo Golia
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Ermenegildo De Ruvo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
| | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Roma, Italy
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Russo V, Papa AA, Rago A, Ciardiello C, Martino AM, Stazi A, Golino P, Calò L, Nigro G. Arrhythmic CArdiac DEath in MYotonic dystrophy type 1 patients (ACADEMY 1) study: the predictive role of programmed ventricular stimulation. Europace 2022; 24:1148-1155. [PMID: 35861549 DOI: 10.1093/europace/euab282] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/05/2021] [Indexed: 09/13/2023] Open
Abstract
AIMS Myotonic dystrophy type 1 (DM1) predisposes to the development of life-threatening arrhythmias and sudden cardiac death. Our study aimed to evaluate the prognostic value of programmed ventricular stimulation (PVS) in DM1 patients with conduction system disease. METHODS AND RESULTS Arrhythmic CArdiac DEath in MYotonic dystrophy type 1 patients (ACADEMY 1) is a double-arm non-randomized interventional prospective study. Myotonic dystrophy type 1 patients with permanent cardiac pacing indication were eligible for the inclusion. The study population underwent to pacemaker (PM) or implantable cardioverter-defibrillator (ICD) implantation according to the inducibility of ventricular tachyarrhythmias at PVS. Primary endpoint of the study was a composite of appropriate ICD therapy and cardiac arrhythmic death. The secondary study endpoint was all-cause mortality. Seventy-two adult-onset DM1 patients (51 ± 12 years; 39 male) were enrolled in the study. A ventricular tachyarrhythmia was induced in 25 patients (34.7%) at PVS (PVS+) who underwent dual chambers ICD implantation. The remaining 47 patients (65.3%) without inducible ventricular tachyarrhythmia (PVS-) were treated with dual-chamber PM. During an average observation period of 44.7 ± 10.2 months, nine patients (12.5%) met the primary endpoint, four in the ICD group (16%) and five (10.6%) in the PM group. Thirteen patients died (18.5%), 2 in the ICD group (8%) and 11 in PM group (23.4%). The Kaplan-Meier analysis did not show a significantly different risk of both primary and secondary endpoint event rates between the two groups. CONCLUSIONS The inducibility of ventricular tachyarrhythmias has shown a limited value in the arrhythmic risk stratification among DM1 patients.
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Affiliation(s)
- Vincenzo Russo
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania 'Luigi Vanvitelli', Monaldi Hospital, Naples 80131, Italy
| | | | - Anna Rago
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | | | | | - Alessandra Stazi
- Department of Cardiology, Policlinico Casilino Hospital, Rome, Italy
| | - Paolo Golino
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania 'Luigi Vanvitelli', Monaldi Hospital, Naples 80131, Italy
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino Hospital, Rome, Italy
| | - Gerardo Nigro
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania 'Luigi Vanvitelli', Monaldi Hospital, Naples 80131, Italy
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5
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Crescenzi C, Panattoni G, Stazi A, Martino A, Sgueglia M, De Ruvo E, Calò L. Ventricular arrhythmias and risk stratification of cardiac sudden death in athletes. Minerva Cardioangiol 2020; 68:110-122. [PMID: 32429629 DOI: 10.23736/s0026-4725.20.05178-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sudden cardiac death (SCD) of young athletes is an unexpected and tragic event that could occur during sport activities and is frequently related to ventricular arrhythmias. Identifying athletes at risk of SCD remains a major challenge. While specific characteristics of premature ventricular contractions are considered common and benign, other "uncommon" features should require more accurate investigations, in order to determine eligibility for competitive sports. The most common type of idiopathic premature ventricular contractions originates from ventricular outflow tract and is characterized by an ECG pattern with left bundle branch block and inferior QRS axis (infundibular pattern). Another pattern associated with a good prognosis is the "fascicular" morphology, characterized by a typical right bundle branch block, superior QRS axis morphology and QRS duration <130 ms. Conversely, other morphological features (such as left bundle branch block /intermediate or superior axis or right bundle branch block/intermediate or superior axis and wide QRS) correlate to an underlying substrate. In risk stratification setting, cardiac magnetic resonance plays a key role allowing an accurate identification of myocardial tissue abnormalities, which could affect athletes' prognosis. This review focuses on characteristics of premature ventricular contractions characteristics in terms of morphology, distribution, complexity and response to exercise and describes the possible underlying myocardial substrates. This review also critically analyzes the evaluation process of athletes with premature ventricular contractions necessary for an accurate risk stratification.
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Affiliation(s)
| | | | | | | | | | | | - Leonardo Calò
- Division of Cardiology, Casilino Polyclinic, Rome, Italy -
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6
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Cristiano E, De Vita A, Villano A, Mencarelli E, Melita V, Manfredonia L, Stazi A, Bisignani A, Lanza GA, Crea F. P1696Effect of remote ischemic preconditioning on vascular dilator function in patient undergoing invasive coronary procedure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- E Cristiano
- Catholic University of the Sacred Heart, Rome, Italy
| | - A De Vita
- Catholic University of the Sacred Heart, Rome, Italy
| | - A Villano
- Catholic University of the Sacred Heart, Rome, Italy
| | - E Mencarelli
- Catholic University of the Sacred Heart, Rome, Italy
| | - V Melita
- Catholic University of the Sacred Heart, Rome, Italy
| | - L Manfredonia
- Catholic University of the Sacred Heart, Rome, Italy
| | - A Stazi
- Catholic University of the Sacred Heart, Rome, Italy
| | - A Bisignani
- Catholic University of the Sacred Heart, Rome, Italy
| | - G A Lanza
- Catholic University of the Sacred Heart, Rome, Italy
| | - F Crea
- Catholic University of the Sacred Heart, Rome, Italy
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7
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Villano A, Manfredonia L, Mencarelli E, Melita V, De Vita A, Stazi A, Rizzi A, Pitocco D, Lanza GA, Crea F. P4484Prognostic value of endothelial dysfunction in asymptomatic type 2 diabetic patients with no evidence of cardiac disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Villano
- Catholic University of the Sacred Heart, Rome, Italy
| | - L Manfredonia
- Catholic University of the Sacred Heart, Rome, Italy
| | - E Mencarelli
- Catholic University of the Sacred Heart, Rome, Italy
| | - V Melita
- Catholic University of the Sacred Heart, Rome, Italy
| | - A De Vita
- Catholic University of the Sacred Heart, Rome, Italy
| | - A Stazi
- Catholic University of the Sacred Heart, Rome, Italy
| | - A Rizzi
- Catholic University of the Sacred Heart, Rome, Italy
| | - D Pitocco
- Catholic University of the Sacred Heart, Rome, Italy
| | - G A Lanza
- Catholic University of the Sacred Heart, Rome, Italy
| | - F Crea
- Catholic University of the Sacred Heart, Rome, Italy
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8
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Meinero P, Stazi A, Carbone A, Fasolini F, Regusci L, La Torre M. Endoscopic pilonidal sinus treatment: a prospective multicentre trial. Colorectal Dis 2016; 18:O164-70. [PMID: 26946340 DOI: 10.1111/codi.13322] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/11/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pilonidal disease (PD) is a common inflammatory disease of the gluteal fold, resulting in recurrent acute/chronic infection at the level of the natal cleft. In this study, endoscopic pilonidal sinus treatment (EPSiT), a new endoscopic minimally invasive procedure, was evaluated for its effectiveness in treating PD. METHODS Two hundred and fifty prospective patients with chronic PD were enrolled in a prospective multicentre study conducted at a secondary and tertiary colorectal surgery centre. The primary end-point of this study was wound healing, and the short-/long-term outcomes such as healing time, morbidity rate and recurrence rate were analysed. The secondary end-point of this study was quality of life (QoL). RESULTS The complete wound healing rate was 94.8%, and the mean complete wound healing time was 26.7 ± 10.4 days. The incomplete healing rate (5.2%) was significantly related to the number of external openings (P = 0.01). There was no difference in the failure rate when EPSiT was performed as the first-line treatment for PD or when it was used after unsuccessful procedures (P = n.s.). Recurrence occurred in 12 cases (5%). The QoL significantly increased from preoperative levels 15 days after the EPSiT procedure (45.3 vs 7.9; P < 0.0001). CONCLUSIONS The EPSiT procedure is a safe and effective technique for treating PD. It provides better short- and long-term outcomes than various other techniques that are more invasive. EPSiT is a minimally invasive outpatient procedure, which is associated with a quick recovery and a good QoL outcome.
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Affiliation(s)
- P Meinero
- Colorectal Unit Sanatrix Clinic, Rome and Sestri Levante Hospital, Genova, Italy.,Department of Surgery, EOC Hospital, Mendrisio, Switzerland
| | - A Stazi
- Pelvic Care Center, Madonna delle Grazie Hospital, Velletri, Rome, Italy
| | - A Carbone
- Colorectal Unit Sanatrix Clinic, Rome and Sestri Levante Hospital, Genova, Italy.,Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - F Fasolini
- Department of Surgery, EOC Hospital, Mendrisio, Switzerland
| | - L Regusci
- Department of Surgery, EOC Hospital, Mendrisio, Switzerland
| | - M La Torre
- Colorectal Unit Sanatrix Clinic, Rome and Sestri Levante Hospital, Genova, Italy.,Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
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9
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Lanza GA, Stazi A, Villano A, Torrini F, Milo M, Laurito M, Flego D, Aurigemma C, Liuzzo G, Crea F. Effect of Remote Ischemic Preconditioning on Platelet Activation Induced by Coronary Procedures. Am J Cardiol 2016; 117:359-65. [PMID: 26739396 DOI: 10.1016/j.amjcard.2015.10.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 10/30/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Abstract
In this study, we aim to assess whether remote ischemic preconditioning (RIPC) reduces platelet activation during coronary angiography (CA) and/or percutaneous coronary interventions. We studied 30 patients who underwent CA because of a suspect of stable angina. Patients were randomized to RIPC (3 short episodes of forearm ischemia) or sham RIPC (controls) before the procedure. Blood samples were collected at baseline, at the end of the procedure, and 24 hours later. Monocyte-platelet aggregate (MPA) formation and platelet CD41 in the MPA gate and CD41 and CD62 expression in the platelet gate were assessed by flow cytometry, in the absence and in the presence of adenosine diphosphate (ADP) stimulation. A significant increase in platelet activation occurred during the invasive procedure in controls, which persisted at 24 hours. However, compared with controls, RIPC group showed no or a lower increase in platelet variables, including MPA formation (p <0.0001) and CD41 (p = 0.002) in the MPA gate and CD41 (p <0.0001) and CD62 (p = 0.002) in the platelet gate. ADP increased platelet activation at baseline, but did not further increase platelet reactivity during the invasive procedure in either groups. Percutaneous coronary interventions, performed in 10 patients (6 in the RIPC group and 4 in controls), did not have any further significant effect on platelet activation and reactivity compared with CA alone. In conclusion, RIPC reduces platelet activation occurring during CA. In contrast, no effects were observed on platelet response to ADP stimulation, probably related to the administration of an ADP antagonist in all patients.
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10
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Lanza GA, Careri G, Stazi A, Villano A, De Vita A, Aurigemma C, Crea F. Clinical Spectrum and Outcome of Patients With Non-ST-Segment Elevation Acute Coronary Syndrome and No Obstructive Coronary Atherosclerosis. Circ J 2016; 80:1600-6. [DOI: 10.1253/circj.cj-16-0145] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Giulia Careri
- Institute of Cardiology, Università Cattolica del Sacro Cuore
| | | | - Angelo Villano
- Institute of Cardiology, Università Cattolica del Sacro Cuore
| | - Antonio De Vita
- Institute of Cardiology, Università Cattolica del Sacro Cuore
| | | | - Filippo Crea
- Institute of Cardiology, Università Cattolica del Sacro Cuore
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Figliozzi S, Stazi A, Pinnacchio G, Laurito M, Parrinello R, Villano A, Russo G, Milo M, Mollo R, Lanza GA, Crea F. Use of T-wave alternans in identifying patients with coronary artery disease. J Cardiovasc Med (Hagerstown) 2016; 17:20-5. [DOI: 10.2459/jcm.0000000000000080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Wu M, Villano A, Russo G, Di Franco A, Stazi A, Lauria C, Sestito A, Lanza GA, Crea F. Poor Tolerance and Limited Effects of Isosorbide-5-Mononitrate in Microvascular Angina. Cardiology 2015; 130:201-6. [DOI: 10.1159/000370027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/18/2014] [Indexed: 11/19/2022]
Abstract
Objectives: To assess the effects of isosorbide-5-mononitrate (ISMN) in patients with microvascular angina (MVA). Methods: We randomized 20 MVA patients, treated with a β-blocker or a calcium antagonist, to 60 mg slow-release ISMN (halved to 30 mg if not tolerated) or placebo once a day for 4 weeks; the patients were then switched to the other treatment for another 4 weeks. Their clinical status was assessed with the Seattle Angina Questionnaire (SAQ) and the EuroQoL score for quality of life. The exercise stress test (EST), coronary blood flow (CBF) response to nitrate and the cold pressor test (CPT), brachial artery flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) were also assessed. Results: Nine patients (45%) did not complete the ISMN phase due to side effects; 2 patients refused a follow-up. Nine patients completed the study. The SAQ and EuroQoL scores were significantly better with ISMN than with placebo, although the differences were small. No differences were found between the treatments in the EST results, CBF response to nitroglycerin (p = 0.55) and the CPT (p = 0.54), FMD (p = 0.26) and NMD (p = 0.35). Conclusions: In this study, a high proportion of MVA patients showed an intolerance to ISMN; in those tolerating the drug, significant effects on their angina status were observed, but the benefit appeared to be modest and independent of effects on coronary microvascular function.
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Pinnacchio G, Lanza GA, Stazi A, Careri G, Coviello I, Mollo R, Crea F. Determinants of heart rate turbulence in individuals without apparent heart disease and in patients with stable coronary artery disease. Europace 2015; 17:1855-61. [PMID: 25564548 DOI: 10.1093/europace/euu338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 11/03/2014] [Indexed: 01/09/2023] Open
Abstract
AIMS To assess the characteristics and determinants of heart rate turbulence (HRT) in individuals without any apparent heart disease and in patients with coronary artery disease (CAD). METHODS AND RESULTS Heart rate turbulence parameters, turbulence onset (TO), and turbulence slope (TS) were calculated on 24 h electrocardiogram recordings in 209 individuals without any heart disease (group 1) and in 157 CAD patients (group 2). In group 1, only age independently predicted abnormal TO (≥0%) [odds ratio (OR), 1.05; P<0.001], while predictors of abnormal TS (≤2.5 ms/RR) were age (OR, 0.85; P < 0.001) and hypertension (OR, 0.19; P = 0.028). In group 2 patients, only age independently predicted TO (OR, 1.03; P = 0.038), while age (OR, 0.90; P = 0.001) and left ventricular ejection fraction (LVEF; OR, 1.07; P = 0.008) predicted TS. Heart rate turbulence values were different in groups 1 and 2. Turbulence onset was (mean, standard deviation) -1.80 ± 2.24 vs. -0.73 ± 1.61%, respectively (P < 0.001), whereas TS was (median, interquartile interval) 5.83 (3.25-10.55) vs. 2.93 (1.73-5.81) ms/RR, respectively (P < 0.001). Coronary artery disease group, however, did not predict abnormal HRT parameters in multivariable analyses, both in the whole population and when comparing two subgroups matched for age and gender. Age and (for TS) LVEF, indeed, were the only independent predictors of abnormal HRT. CONCLUSIONS Age is a major HRT determinant both in subjects without any apparent heart disease and in stable CAD patients. Hypertension and LVEF contribute independently to HRT in these two groups, respectively. Coronary artery disease group was not by itself associated with abnormal HRT parameters in multivariable analyses.
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Affiliation(s)
- Gaetano Pinnacchio
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Alessandra Stazi
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giulia Careri
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Ilaria Coviello
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Roberto Mollo
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Crea
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
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Parrinello R, Sestito A, Di Franco A, Russo G, Villano A, Figliozzi S, Nerla R, Tarzia P, Stazi A, Lanza GA, Crea F. Peripheral Arterial Function and Coronary Microvascular Function in Patients with Variant Angina. Cardiology 2014; 129:20-4. [DOI: 10.1159/000362380] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 03/21/2014] [Indexed: 11/19/2022]
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Di Franco A, Villano A, Di Monaco A, Lamendola P, Russo G, Stazi A, Scavone G, Nerla R, Sestito A, Lanza GA, Crea F. Correlation between coronary microvascular function and angina status in patients with stable microvascular angina. Eur Rev Med Pharmacol Sci 2014; 18:374-379. [PMID: 24563437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Classical anti-ischemic drugs are the first-line form of treatment in patients with microvascular angina (MVA), but they often fail to achieve a satisfactory control of angina symptoms. It is unknown whether there is any relation between improvement of angina status and changes in microvascular function induced by classical anti-ischemic drugs in MVA patients. AIM To assess whether, in MVA patients, the effects of classical anti-ischemic drugs on symptoms and quality of life (QoL) are related to changes in coronary microvascular function. PATIENTS AND METHODS We studied 51 patients (59±10 years; 15 men) with MVA. Coronary blood flow (CBF) response to adenosine (ADO) and to cold pressor test (CPT), Seattle Angina Questionnaire (SAQ) and EuroQoL scale were assessed at baseline, in pharmacological washout, and after 12 months under anti-ischemic therapy. Patients were divided into 2 groups: (1) Group 1 included patients with no improvement of QoL (EuroQoL score change < 10 points); (2) Group 2 included patients with QoL improvement (increase in EuroQoL score ≥ 10 points). RESULTS At baseline, the 2 groups were similar in age, gender, cardiovascular risk factors, CBF response to ADO and to CPT, SAQ and EuroQoL scores. At follow-up the 2 groups differed only for beta blockers use (27% vs. 88% in group 1 and 2, respectively; p < 0.001). A significant improvement in SAQ score was observed only in group 2. CBF response to both ADO and CPT showed a similar improvement in the 2 groups. No relation was found between changes in coronary microvascular function and in angina status. CONCLUSIONS In MVA patients beta-blockers are more effective than other anti-ischemic drugs in improving angina symptoms. The improvement of angina status does not seem to be mediated by changes in coronary microvascular function.
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Affiliation(s)
- A Di Franco
- Institute of Cardiology, and Diabetes Unit; School of Medicine, Catholic University of the Sacred Heart, Rome, Italy.
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Russo G, Di Franco A, Lamendola P, Tarzia P, Nerla R, Stazi A, Villano A, Sestito A, Lanza GA, Crea F. Lack of effect of nitrates on exercise stress test results in patients with microvascular angina. Cardiovasc Drugs Ther 2013; 27:229-34. [PMID: 23338814 DOI: 10.1007/s10557-013-6439-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To assess the effects of short-acting nitrates on exercise stress test (EST) results and the relation between EST results and coronary blood flow (CBF) response to nitrates in patients with microvascular angina (MVA). METHODS We completed 2 symptom/sign limited ESTs on 2 separate days, in a random sequence and in pharmacological washout, in 29 MVA patients and in 24 patients with obstructive coronary artery disease (CAD): one EST was performed without any intervention (control EST, C-EST), and the other after sublingual isosorbide dinitrate, 5 mg (nitrate EST, N-EST). CBF response to nitroglycerin (25 μg) was assessed in the left anterior descending coronary artery by transthoracic Doppler-echocardiography. RESULTS At C-EST. ST-segment depression ≥1 mm (STD) was induced in 26 (90 %) and 23 (96 %) MVA and CAD patients, respectively (p=0.42), whereas at N-EST, STD was induced in 25 (86 %) and 14 (56 %) MVA and CAD patients, respectively (p=0.01). Time and rate pressure product at 1 mm STD increased during N-EST, compared to C-EST, in CAD patients (475±115 vs. 365±146 s, p<0.001; and 23511±4352 vs. 20583±6234 bpm∙mmHg, respectively, p=0.01), but not in MVA patients (308±160 vs. 284±136 s; p=0.19; and 21290±5438 vs. 20818±4286 bpm∙mmHg, respectively, p=0.35). In MVA patients, a significant correlation was found between heart rate at STD during N-EST and CBF response to nitroglycerin (r=0.40, p=0.04). CONCLUSIONS Short-acting nitrates improve EST results in CAD, but not in MVA patients. In MVA patients a lower nitrate-dependent coronary microvascular dilation may contribute to the lack of effects of nitrates on EST results.
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Affiliation(s)
- Giulio Russo
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy
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Aurigemma C, Scalone G, Tomai F, Altamura L, De Persio G, Stazi A, Lanza GA, Crea F. Persistent enhanced platelet activation in patients with acute myocardial infarction and coronary microvascular obstruction: clinical implications. Thromb Haemost 2013; 111:122-30. [PMID: 24085158 DOI: 10.1160/th13-02-0166] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 08/30/2013] [Indexed: 11/05/2022]
Abstract
About 30% of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing recanalisation of the infarct-related coronary artery do not achieve valid myocardial reperfusion (no-reflow phenomenon or coronary microvascular obstruction [MVO]). The mechanisms of MVO are incompletely understood. In this study we investigated the role platelet activation in the pathogenesis of coronary MVO in STEMI patients. We enrolled 48 STEMI patients (age 56.2 ± 11 years; 31 men), treated by primary percutaneous coronary intervention (PCI) followed by double anti-platelet treatment, and 20 control patients with stable coronary artery disease (CAD) on single anti-platelet treatment (age 57.5 ± 6 years, 12 men). STEMI patients were divided into two groups: 35 patients with complete myocardial reperfusion (MR) and 13 patients with coronary MVO despite successful PCI. Platelet activation was assessed on admission and at one-month follow-up by measuring platelet receptor expression and monocyte-platelet aggregates (MPAs). Platelet receptor expression, platelet receptor conformational change for fibrinogen binding availability and MPA formation were increased in STEMI patients with MVO compared to both STEMI patients with MR and stable CAD patients, both on admission and at one-month follow-up (p<0.05 for all).Among STEMI patients, platelet activation is greater in those who display coronary MVO, compared to those with MR, after successful PCI, both on admission and one month after STEMI, suggesting that enhanced platelet activation might be involved in the pathogenesis of MVO. The persistence of enhanced platelet activation despite double classical anti-platelet therapy suggests that new anti-platelet strategies should be considered in patients with coronary MVO.
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Affiliation(s)
| | | | | | | | | | | | - Gaetano A Lanza
- Gaetano A. Lanza, MD, Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma, Italy, Tel.: +39 06 30154187, E-mail:
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Laurito M, Stazi A, Delogu AB, Milo M, Battipaglia I, Scalone G, Infusino F, Villano A, Russo G, Iannotta R, Saracino A, Parrinello R, Figliozzi S, Sestito A, Romagnoli C, Lanza GA, Crea F. Endothelial and platelet function in children with previous Kawasaki disease. Angiology 2013; 65:716-22. [PMID: 24019084 DOI: 10.1177/0003319713502392] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We investigated whether children with a previous Kawasaki disease (KD) have evidence of abnormal vascular and/or platelet function. We included 14 patients with previous KD and 14 matched controls. We assessed endothelial function by flow-mediated dilation (FMD), carotid intima-media thickness (cIMT), coronary microvascular function by coronary blood flow response (CBFR) to cold pressor test, and platelet reactivity by measuring monocyte-platelet aggregates (MPAs) and CD41-platelet expression by flow cytometry. No differences were found between the groups in FMD, cIMT, or CBFR to cold pressor test. The MPAs were similar in patients with KD and controls. CD41-platelet expression, however, was significantly increased in patients with KD compared with controls, both at rest (14.3 ± 1.9 vs 12.4 ± 1.9 mean fluorescence intensity [mfi], P = .01) and after adenosine diphosphate stimulation (19.3 ± 1.3 vs 17 ± 1.7 mfi, P < .001). In conclusion, children with a previous episode of KD showed increased platelet activation, compared with healthy participants despite no apparent vascular abnormality at follow-up.
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Affiliation(s)
- Marianna Laurito
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandra Stazi
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelica B Delogu
- Institute of Pediatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Milo
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Irma Battipaglia
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giancarla Scalone
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabio Infusino
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Villano
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulio Russo
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rossella Iannotta
- Institute of Pediatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Annalisa Saracino
- Institute of Pediatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Stefano Figliozzi
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alfonso Sestito
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Gaetano A Lanza
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Crea
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
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Stazi A, Scalone G, Laurito M, Milo M, Pelargonio G, Bencardino G, Narducci ML, Perna F, Lanza GA, Crea F. Effect of peripheral ischemic preconditioning on platelet activation related ablation of atrial fibrillation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mollo R, Cosenza A, Coviello I, Stazi A, Russo G, Villano A, Sestito A, Bencardino G, Lanza GA, Crea F. A novel electrocardiographic predictor of clinical response to cardiac resynchronization therapy. Europace 2013; 15:1615-21. [DOI: 10.1093/europace/eut151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Giuratrabocchetta S, Pecorella G, Stazi A, Tegon G, De Fazio M, Altomare DF. Safety and short-term effectiveness of EEA stapler vs PPH stapler in the treatment of degree III haemorrhoids: prospective randomized controlled trial. Colorectal Dis 2013; 15:354-8. [PMID: 22776142 DOI: 10.1111/j.1463-1318.2012.03172.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM Stapled haemorrhoidopexy has gained wide acceptance due to less postoperative pain although postoperative bleeding and prolapse recurrence are among the major drawbacks of this technique compared with the standard Milligan-Morgan hemorrhoidectomy. The aim was to investigate a new stapler device designed to overcome these side effects. METHOD In all, 135 patients (71 men, mean age 42 years) with degree III haemorrhoids were randomly allotted to stapled haemorrhoidopexy with PPH® staplers (Ethicon EndoSurgery) (63 patients) or with an EEA® stapler (Covidien) (72 patients) in four referral colorectal centres. The number of haemostatic overstitches apposed on the stapled suture, the area of the resected mucosa (in square centimetres) and any postoperative bleeding within 30 days were recorded. RESULTS The mean area of the resected mucosa was significantly wider in EEA than PPH patients (35.75 ± 17.51 vs 28.05 ± 10.23 cm(2), P = 0.002). The median number of haemostatic stitches apposed in the EEA group was significantly lower than in the PPH groups (median value 1, vs 3, interquartile range 0-2, vs 2-5, P < 0.0001). Intraoperative haemostasis was better in the EEA group compared with the PPH01 and PPH03 groups. Postoperative bleeding occurred only in two PPH patients. CONCLUSION Data suggest that the EEA stapler has better haemostatic properties than the PPH stapler and allows resection of a larger area of mucosal prolapse with potential benefits over the recurrence rate of haemorrhoid prolapse.
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Affiliation(s)
- S Giuratrabocchetta
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
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Coviello I, Pinnacchio G, Laurito M, Stazi A, Battipaglia I, Barone L, Mollo R, Russo G, Villano A, Sestito A, Lanza GA, Crea F. Prognostic role of heart rate variability in patients with ST-segment elevation acute myocardial infarction treated by primary angioplasty. Cardiology 2013; 124:63-70. [PMID: 23328532 DOI: 10.1159/000345779] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 10/31/2012] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The aim of our study was to assess the prognostic value of heart rate variability (HRV) in ST-segment elevation acute myocardial infarction (STEMI) patients treated by percutaneous transluminal coronary angioplasty (PTCA) and optimal medical therapy. METHODS We enrolled 182 consecutive patients with a first STEMI (59.1 ± 11 years; 82.4% men) treated by primary PTCA. HRV was assessed on 24-hour Holter ECG recordings before discharge and 1 and 6 months after discharge. The primary end point was the occurrence of major clinical events (MCE), defined as death or new acute myocardial infarction (AMI). RESULTS At a follow-up of 42 ± 23 months, MCE occurred in 14 patients (7.6%; 3 deaths and 11 re-AMIs). HRV parameters before discharge were significantly lower in patients with MCE, with standard deviation of all RR intervals (SDNN) and very low frequency and low frequency (LF) amplitude being the most predictive variables. HRV assessed at follow-up instead did not significantly predict MCE. At multivariate analysis, only SDNN (HR 0.97; p = 0.02) and LF (HR 0.90; p = 0.04) remained significantly associated with MCE. Lower tertile SDNN and LF values were associated with a multivariate HR of 3.91 (p = 0.015) and of 2.92 (p = 0.048), respectively. Similar results were observed considering re-AMI only as the end point. CONCLUSIONS In STEMI patients treated by PTCA, HRV assessed before discharge was an independent predictor of MCE and re-AMI.
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Affiliation(s)
- Ilaria Coviello
- Cardiology Institute, Catholic University of the Sacred Heart, Rome, Italy
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Careri G, Nerla R, Di Monaco A, Russo G, Stazi A, Villano A, Sestito A, Lanza GA, Crea F. Clinical correlates and prognostic value of flow mediated dilation in patients with non-ST segment elevation acute coronary syndromes. Am J Cardiol 2013; 111:51-7. [PMID: 23062313 DOI: 10.1016/j.amjcard.2012.08.049] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 08/21/2012] [Accepted: 08/21/2012] [Indexed: 01/07/2023]
Abstract
Endothelial dysfunction can predict cardiovascular outcomes in several populations of patients. The aim of this study was to assess the severity, time course, and clinical implications of endothelial dysfunction in patients with non-ST-segment elevation (NSTE) acute coronary syndromes (ACS). Sixty patients with NSTE ACS (mean age 62 ± 8 years, 44 men) and 40 controls with stable coronary artery disease (CAD) (mean age 63 ± 10 years, 27 men) were studied. In patients with NSTE ACS and in those with stable CAD, endothelial function was assessed <12 hours after admission and at 3-month follow-up by measuring right brachial artery dilation after 5 minutes of forearm ischemia (flow-mediated dilation [FMD]). Clinical outcomes were assessed after a median follow-up period of 32 months (range 14 to 36). The primary end point was a combination of cardiac death or readmission for new ACS or recurrence of angina pectoris. FMD on admission was significantly lower in patients with NSTE ACS compared to those with stable CAD (2.1 ± 1.2% vs 4.8 ± 1.9%, p <0.001). FMD improved significantly at 3-month follow-up in patients with NSTE ACS, becoming comparable to that in patients with stable CAD (5.7 ± 2.6% vs 5.5 ± 1.7%, p = 0.93). During follow-up, 14 cardiac events (23%) occurred in patients with NSTE ACS. On multivariate analysis, only diabetes (hazard ratio 18.1, 95% confidence interval 3.9 to 83.9, p <0.001) and FMD at 3 months (hazard ratio 0.78, 95% confidence interval 0.61 to 0.99, p = 0.04) were independent predictors of the primary end point in patients with NSTE ACS. In conclusion, endothelial function is markedly impaired in the acute phase of NSTE ACS but improves significantly at 3-month follow-up. In patients with NSTE ACS, FMD at 3 months after the acute event is a significant independent predictor of cardiac outcomes.
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Lamendola P, Nerla R, Pitocco D, Villano A, Scavone G, Stazi A, Russo G, Di Franco A, Sestito A, Ghirlanda G, Lanza GA, Crea F. Effect of ranolazine on arterial endothelial function in patients with type 2 diabetes mellitus. Atherosclerosis 2012; 226:157-60. [PMID: 23146293 DOI: 10.1016/j.atherosclerosis.2012.10.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 10/16/2012] [Accepted: 10/22/2012] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the effect of ranolazine on systemic vascular function in patients with type II diabetes mellitus (T2DM). METHODS We randomized 30 consecutive T2DM patients with no evidence of cardiovascular disease and no insulin therapy to receive one of the following 3 forms of treatment in a blinded fashion: ranolazine, 375 mg bid for 3 weeks (group 1); ranolazine, 375 mg bid for 2 weeks, followed by placebo bid for 1 week (group 2); placebo bid for 3 weeks (group 3). Flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) of the right brachial artery were assessed at baseline and after 48 h, and 2 and 3 weeks. RESULTS FMD and NMD were similar among groups at baseline. Compared to the basal value, FMD significantly improved after 2 weeks in group 1 and in group 2 (p < 0.01 for both), but not in group 3. At 3 weeks, FMD remained improved, compared to baseline, in group 1 (p < 0.05), whereas returned to basal values in group 2 (p = 0.89 vs. baseline). No changes in NMD were observed in any group. CONCLUSIONS In this controlled study, ranolazine was able to improve endothelial function in T2DM patients.
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Nerla R, Di Franco A, Milo M, Pitocco D, Zaccardi F, Tarzia P, Sarullo FM, Villano A, Russo G, Stazi A, Ghirlanda G, Lanza GA, Crea F. Differential effects of heart rate reduction by atenolol or ivabradine on peripheral endothelial function in type 2 diabetic patients. Heart 2012; 98:1812-6. [PMID: 23086971 DOI: 10.1136/heartjnl-2012-302795] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess whether reduction of heart rate (HR) has beneficial effects on endothelial function in patients with type 2 diabetes mellitus (T2DM). DESIGN Randomised, double-blind, placebo-controlled study. SETTING University hospital. PATIENTS 66 T2DM patients without overt cardiovascular disease. INTERVENTIONS Patients were randomised to receive for 4 weeks, in addition to their standard therapy, one of the following treatments: atenolol (25 mg twice daily), ivabradine (5 mg twice daily) or placebo (1 tablet twice daily). MAIN OUTCOME MEASURES Systemic endothelial function, assessed by flow-mediated dilation (FMD); endothelium-independent vasodilation, assessed by nitrate-mediated dilation (NMD); cardiac autonomic function, assessed by HR variability (HRV). RESULTS 61 patients completed the study (19, 22 and 20 patients in atenolol, ivabradine and placebo groups, respectively). Compared with baseline, HR was similarly reduced by atenolol (87±13 vs 69±9 bpm) and ivabradine (86±12 to 71±9 bpm), but not by placebo (82±10 vs 81±9 bpm) (p<0.001). FMD improved at follow-up in the atenolol group (4.8±1.7 vs 6.4±1.9%), but not in the ivabradine group (5.2±2.5 vs 4.9±2.2%) and in the placebo group (4.8±1.5 vs 4.7±1.7%) (p<0.01). NMD did not change significantly in any group. HRV parameters did not change in the placebo group; they, instead, consistently increased in the atenolol, whereas a mild increase in SDNNi was only observed in the ivabradine group. A significant correlation was found in the atenolol group between HR and FMD changes (r=-0.48; p=0.04). CONCLUSIONS Despite a comparable reduction in HR, atenolol, but not ivabradine, improved FMD in T2DM patients suggesting that changes in HR are by themselves unlikely to significantly improve endothelial function.
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Affiliation(s)
- Roberto Nerla
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma, Italy
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Tarnoki D, Tarnoki A, Stazi A, Medda E, Cotichini R, Baracchini C, Meneghetti G, Fanelli F, Littvay L, Metneki J, Molnar A, Garami Z, Berczi V, Lazar Z, Horvath I. P188 ASSOCIATION BETWEEN ATHEROSCLEROSIS AND LUNG FUNCTION – RESULTS FROM INTERNATIONAL TWIN STUDY 2009. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70255-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tarnoki A, Tarnoki D, Stazi A, Medda E, Cotichini R, Fagnani C, Nisticò L, Lucatelli P, Boatta E, Zini C, Meneghetti G, Baracchini C, Osztovits J, Jermendy G, Littvay L, Metneki J, Karlinger K, Molnar A, Fanelli F, Garami Z, Berczi V. P205 ATHEROSCLEROSIS AND BODY COMPOSITION. FINDINGS OF INTERNATIONAL TWIN STUDY 2009. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70272-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Papi C, Festa V, Fagnani C, Stazi A, Antonelli G, Moretti A, Koch M, Capurso L. Evolution of clinical behaviour in Crohn's disease: predictive factors of penetrating complications. Dig Liver Dis 2005; 37:247-53. [PMID: 15788208 DOI: 10.1016/j.dld.2004.10.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2004] [Accepted: 10/09/2004] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Crohn's disease is a heterogeneous entity. The Vienna Classification defines three different clinical patterns: 'non-stricturing, non-penetrating', 'stricturing' and 'penetrating'. Aim of this study was to assess the change in clinical behaviour over time and to evaluate whether an evolution towards penetrating complications can be predicted. METHODS A total of 139 patients with non-penetrating behaviour at the time of diagnosis were included. The mean follow-up was 4.84 years (range 1-23.2 years). The clinical behaviour, according to the Vienna Criteria, was assessed at the diagnosis and at the end of follow up. Statistical analysis was performed by means of the Kaplan-Meier method and standard logistic regression analysis. RESULTS The cumulative probability of a change in clinical behaviour was 22, 38 and 63% at 3, 6 and 12 years, respectively, and the cumulative probability of developing penetrating complications was 22, 33 and 55% at 3, 6 and 12 years, respectively. Young age at diagnosis (<40 years) and a stricturing behaviour are independent risk factors of developing major penetrating complications (internal fistula, mass or abscess): OR=6.0, 95% CI 1.1-30.5; OR=4.0, 95% CI 1.5-10.9, respectively, but not perianal disease. CONCLUSIONS The behavioural classification of Crohn's disease is a dynamic model in which each status should be considered as not fixed but evolutive. Perianal disease should be considered a distinct pattern of penetrating behaviour.
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Affiliation(s)
- C Papi
- Gastroenterology Unit, S. Filippo Neri Hospital, Via Martinotti 20, 00135 Rome, Italy.
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Indinnimeo M, Cicchini C, Stazi A, Ghini C, Laghi A, Memeo L, Iannaccone R, Teneriello FL, Mingazzini PL. Duodenal pancreatic heterotopy diagnosed by magnetic resonance cholangiopancreatography: report of a case. Surg Today 2002; 31:928-31. [PMID: 11759893 DOI: 10.1007/s005950170038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We describe herein the case of a heterotopic pancreas that caused stenosis in the second portion of the duodenum. A 46-year-old man presented with upper abdominal pain and a 12-month history of intermittent vomiting. There was no history of melena, hematochezia, hematemesis, clay-colored stools, jaundice, or hepatitis and he did not describe any food dyscrasias, although fatty foods and alcohol seemed to make the symptoms worse. No specific medication or change in position relieved the pain. An initial diagnosis of chronic pancreatitis with multiple pseudocysts was made on the basis of elevated serum amylase and lipase levels, and abdominal ultrasonography and computed tomography (CT) findings. Medical treatment with octreotide was given for 8 weeks, but without any marked effect. Double-contrast barium examination and esophagogastroduodenoscopy were not diagnostic. Magnetic resonance (MR) cholangiopancreatography revealed findings indicative of cystic dystrophy of a heterotopic pancreas (CDHP), and an endoscopy supported this diagnosis. A pancreatoduodenectomy was performed and pathological examination confirmed a diagnosis of CDHP. In our opinion, MR cholangiopancreatography is the diagnostic tool of choice when CDHP is suspected.
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Affiliation(s)
- M Indinnimeo
- Department of Surgery, University of Rome La Sapienza, Italy
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Indinnimeo M, Cicchini C, Memeo L, Stazi A, Ghini C, Ricci F, Reale MG, Mingazzini P. Plasma and tissue prolactin detection in colon carcinoma. Oncol Rep 2001; 8:1351-3. [PMID: 11605064 DOI: 10.3892/or.8.6.1351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Serum concentrations of prolactin, a trophic hormone produced by the pituitary gland, have been shown to be raised in certain group of patients with cancer. Prolactin was detected in 0-20% of the colon cancer by immunohistochemistry and in plasma in 6-53% of the patients. These conflicting results do not support the hypothesis of an ectopic prolactin production by colon carcinoma. The aim of this study was to confirm the reported incidence of hyper-prolactinemia in colorectal cancer and to find further evidence for an ectopic prolactin production by the tumor. Thirty consecutive patients with colon carcinoma were studied. Before surgery all the patients underwent blood sample collection to assay plasma prolactin levels. All patients underwent colectomy. All the neoplastic specimens were tested with antiprolactin antibody. In none of the patients were significantly high preoperative levels of plasma prolactin found. Prolactin immunostaining was not identified in any of the tumor specimens. We could not confirm previous reports of frequent hyperprolactinemia in patients with cancer. This is the first report in which the incidence of both hyperprolactinemia and prolactin positive immunostaining was 0%. Our study was unable to demonstrate the synthesis of prolactin by colorectal cancers. The tumor is unlikely to be the source of hormone production. Our results suggest that circulating prolactin levels cannot be used as prognostic marker in patients with colon cancer.
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Affiliation(s)
- M Indinnimeo
- Dipartimento di Chirurgia Pietro Valsoni, University of Rome La Sapienza, I-00161 Rome, Italy.
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Indinnimeo M, Cicchini C, Stazi A, Limiti MR, Ghini C, Mingazzini PL, Vecchione A. Prognostic impact of CD31 antigen expression in anal canal carcinoma. Hepatogastroenterology 2001; 48:1355-8. [PMID: 11677963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND/AIMS CD31 is a platelet endothelial cell adhesion molecule. Thus CD31 immunostaining of vascular endothelial cells can be used to measure degree of angiogenesis. As angiogenesis is necessary for tumor growth and metastasis, microvessels density could be a predictor of prognosis. The purpose of this study was to examine the relationship between CD31 value and standard pathologic parameters and prognosis of anal canal carcinoma. METHODOLOGY Twenty-four patients with anal canal carcinoma were evaluated. Five-micron sections of formalin-fixed, paraffin-embedded tissue were tested with monoclonal anti-CD31 antibody. CD31 value is considered positive if more than 185 vessels/mm2 were counted. Pearson's chi 2 test was employed to test for association between CD31 value and clinicopathological variables. RESULTS We found no correlation between CD31 value and histologic type, lymph node involvement, patients age and neoplastic relapse. Significant correlation was found between CD31 score and depth of parietal invasion. CONCLUSIONS The relapse type could strengthen the hypothesis that increased vascularity promotes neoplastic dissemination. As angiogenesis could be used as prognostic indicator to determine patients who may be at higher risk for relapse, our results warrant further confirmation. Development of markers of angiogenic activity in anal canal carcinoma must be an integral part of proper clinical trials.
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Affiliation(s)
- M Indinnimeo
- Department of Surgery Pietro Valdoni, Università di Roma La Sapienza, via del Policlinico, 155, 00161 Rome, Italy.
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Indinnimeo M, Cicchini C, Stazi A, Ghini C, Mingazzini P, Laghi A. Analysis of a follow-up program for anal canal carcinoma. J Exp Clin Cancer Res 2001; 20:199-203. [PMID: 11484975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The ideal follow-up program for anal canal cancer remains unclear and controversial. We hereby describe an extensive follow-up program for anal canal carcinoma in order to evaluate which examinations and which diagnostic techniques really had impact on survival and management. We evaluated 25 patients with anal canal carcinoma. Local excision (LE) was performed in 5 patients, radiochemotherapy (RCT) in 13, radiochemotherapy and local excision (RCTE) in 7. Mean follow-up time was 6.3 years (range 20 months-11 years). The follow-up program included clinical examination, serum tumor markers evaluation, transrectal ultrasonography (TRUS), anoscopy with either mucosal or by Tru-cut needle multiple biopsies, standard chest X-ray and hepatic-inguinal ultrasonography, endoanal magnetic resonance imaging and in some cases total-body skeletal scintigraphy. A large multicentered randomized and prospective trial is surely lacking and should be undertaken as soon as possible. Our results suggest that an effective local control, rather than a higher survival is the reachable goal at present for anal canal carcinomas. However, further steps should be made to achieve better results. After this experience we propose a more semplified follow-up protocol which consists in performing only rectal examination, endoscopy, Tru-cut needle biopsies and TRUS for local control and inguinal ultrasound and TC to evidence distant metastases.
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Affiliation(s)
- M Indinnimeo
- Dept. of Surgery Pietro Valdoni, University of Rome La Sapienza, Italy
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Indinnimeo M, Cicchini C, Stazi A, Limiti MR, Ghini C, Mingazzini P, Vecchione A. Immunohistochemical assessment of Ki-67 as prognostic cellular proliferation marker in anal canal carcinoma. J Exp Clin Cancer Res 2000; 19:471-5. [PMID: 11277325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
In order to define new prognostic factors useful for therapeutic decision-making, the Authors conducted a study on anal canal carcinomas in which Ki-67 proliferation index is correlated with pathological variables and clinical outcome. The Ki-67-detectable antigen is expressed in all stages of the cells cycle except G0. Thus, Ki-67 index can measure cell proliferation and it could be considered an indicator of prognosis. Thirty-one patients with anal canal carcinoma were evaluated. The specimens were formalin-fixed, paraffin-embedded and used for immunostaining of Ki-67 antigen. We found a significant correlation between Ki-67 score and depth of invasion and lymph node involvement. No correlation was found between high Ki-67 value and neoplastic relapse. These results suggest that Ki-67 positivity carries different significance in different cancers. Additional studies are required to ascertain whether more aggressive therapeutic procedures should be applied in the subset of patients with a high growth fraction.
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Affiliation(s)
- M Indinnimeo
- Dept. of Surgery Pietro Valdoni, University of Rome La Sapienza, Italy
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Abstract
BACKGROUND AND OBJECTIVES Anatomic extent is not the sole axis of classification of tumors and of tumor patients relevant to treatment planning and estimation of prognosis. This results in the need to demonstrate an improvement in prognostic assessment and choice of therapy achieved by consideration of factors other than TNM. nm23 protein does prevent tumor from metastasizing and may also play a role in the control of growth and development. The purpose of this study was to elucidate the clinical significance of nm23 expression in human anal canal carcinoma and to evaluate its influence on the outcome of patients after surgery or radiochemotherapy. METHODS Twenty-two patients affected by anal canal carcinoma were evaluated. Each section was incubated with monoclonal antibody nm23 NDPK-A. Immunostaining was considered positive when at least 10% of the tumor cells were immunostained. RESULTS nm23 immunoreactivity was detected in 6/22 (27.3%) tumors. No significant association was found between nm23 expression and prognosis. CONCLUSIONS The mechanisms causing enhanced nm23-H1 expression in anal canal carcinoma are unknown. Although the level and expression were not correlated with prognosis, activation of nm23-H1 gene might be a prerequisite for oncogenesis in this type of tumor, while an alternate possibility is the modification of cellular characteristics in relation to proliferation and/or differentiation as a consequence of oncogenesis.
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Affiliation(s)
- M Indinnimeo
- 1st Department of Surgery, University of Rome La Sapienza, Italy
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Abstract
We herein describe an unusual late radiation-related complication requiring surgery in a 60-year-old male affected by anal epidermoid carcinoma. The patient presented with obstructed defecation and ulcerated perianal lesions. The perianal biopsies were positive for anal squamous carcinoma. Transanal diagnostic investigations could not be performed because of anal stenosis. Computed tomography detected left inguinal lymphadenopathy and a nonhomogeneous presacral mass, infiltrating the rectal wall, the coccyx, and the sacrum. The patient underwent a colostomy, infusion of cisplatin and 5-fluorouracil, and irradiation of the pelvis, perianal region, and inguinal lymph nodes. In June 1997 the patient complained of the onset of continuous pain at the genitalia, and for penis necrosis he underwent penis amputation. The histologic examination was conclusive for postradiotherapy thrombosis. This complication could strengthen the hypothesis of vasculoconnective damage as the origin of long-term effects of radiotherapy. Probably the minimal dose in transit volume could not be achieved. Careful evaluation in choosing the treatment scheme is necessary if different options are available.
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Affiliation(s)
- C Cicchini
- 1st Department of Surgery, University of Rome La Sapienza, Italy
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36
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Teneriello FL, Della Casa U, Teneriello GF, Alessandrini G, Cicchini C, Stazi A, Ghini C, Indinnimeo M. [Annular pancreas in adults: diagnostic considerations on a case]. G Chir 2000; 21:243-7. [PMID: 10862461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Annular Pancreas (AP) is a rare congenital anomaly that usually presents in childhood with symptoms referable to duodenal obstruction; nonetheless, this condition can manifest in adulthood with abdominal pain, pancreatitis, duodenal ulcer, pancreatic head mass. The Authors hereby discuss a case of AP observed in a 63 year-old patient in which EUS played a decisive role in achieving a certain diagnosis.
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Affiliation(s)
- F L Teneriello
- Istituto di l'Clinica Chirurgica, Università degli Studi La Sapienza, Roma
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Indinnimeo M, Cicchini C, Stazi A, Alessandrini G, Ghini C, Fanelli F, Pavone P. Magnetic resonance imaging using endoanal coil in anal canal tumors after radiochemotherapy or local excision. Int Surg 2000; 85:143-6. [PMID: 11071332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
The ideal method for evaluation of anal canal tumors after radiochemotherapy and/or local excision remains controversial. Endoanal magnetic resonance imaging (EMRI) is a new, promising technique. The effectiveness of EMRI is reported in a study of 24 patients. Axial SET1-weighted and TSET2-weighted, sagittal and coronal T2-weighted sequences using Fat-suppression were acquired. In 4 cases, the low signal/noise ratio did not allow a diagnosis. In 6 cases, the lesion was not detected. Parietal hypo-intense thickening was detected in 14 patients, but it was not diagnostic for disease recurrence. In this study, EMRI showed 58.3% sensitivity and 41.6% specificity, thus it was not useful in the follow-up of anal tumors.
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Affiliation(s)
- M Indinnimeo
- First Department of Surgery, School of Medicine, University La Sapienza, Rome, Italy.
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Indinnimeo M, Cicchini C, Stazi A, Giarnieri E, French D, Ghini C, Vecchione A. Coexistence of anal and genital human papilloma virus infection in patients with anal canal carcinoma. Tech Coloproctol 1999. [DOI: 10.1007/s101510050004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Indinnimeo M, Cicchini C, Stazi A, Giarnieri E, French D, Limiti MR, Ghini C, Vecchione A. Human papillomavirus infection and p53 nuclear overexpression in anal canal carcinoma. J Exp Clin Cancer Res 1999; 18:47-52. [PMID: 10374676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The product of HPV E6 and E7 genes is able to inactivate both the p53 and pRb proteins. The aim of this study was to evaluate the correlation among anal HPV infection and nuclear p53 overexpression. The Authors evaluated HPV DNA by PCR and p53 nuclear expression by immunohistochemistry in 12 cloacogenic and 6 squamocellular carcinoma. HPV DNA was detected in 71.4% of the squamocellular tumors and in 57.1% of the cloacogenic tumors. In squamocellular tumors HPV types 31-33 and 16 were found; in cloacogenic tumors type 16 alone was detected. Nuclear accumulation of p53 was found to be associated with the presence of HPV. There was no significant difference in parietal infiltration, lymph nodes involvement and prognosis between HPV+p53+ patients and HPV-p53- patients. Tumor aggressiveness is likely to be enhanced by factors other than HPV infection and p53 overexpression.
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Affiliation(s)
- M Indinnimeo
- First Department of Surgery, University La Sapienza, Rome, Italy
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Pulsoni A, Stazi A, Cotichini R, Allione B, Cerri R, Di Bona E, Nosari AM, Pagano L, Recchia A, Ribersani M, Rocchi L, Veneri D, Visani G, Mandelli F, Mele A. Acute promyelocytic leukaemia: epidemiology and risk factors. A report of the GIMEMA Italian archive of adult acute leukaemia. GIMEMA Cooperative Group. Eur J Haematol 1998; 61:327-32. [PMID: 9855248 DOI: 10.1111/j.1600-0609.1998.tb01096.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute promyelocytic leukaemia (APL) exhibits peculiar epidemiological, clinical, cytogenetic and molecular features, compared to the other acute myeloid leukaemias (AML). Data on epidemiology and occupational risk factors for APL desumed from the GIMEMA archive are reported and compared with those of the other AML. An exploratory case-case study was designed on AML patients from 56 haematology centres in Italy. Overall, 4296 patients older than 15 yr with a new diagnosis of acute leukaemia were recorded between July 1992 and July 1997. Of these, 335 were classified as APL, and 2894 as other AML. The median age of APL patients was 43 compared to 59 yr for the other AML (p < 0.00001). In order to identify peculiar risk factors for APL development, different parameters were compared in the 2 groups. After adjusting by age no significant differences were observed with regard to education, lifetime prevalence of cancer among siblings and previous diseases in the patient's history. Occupational exposure as a possible risk factor for APL showed no increased risk compared to other AML among farmers, builders and leather workers. A significant association was found in electricians (OR=4.4, 95% CI=2.0-9.7) and a weak association was found in wood workers (OR=3.2, 95% CI=0.8-10.8). The proportion of APL with respect to other AML was significantly higher in the north east of Italy compared to the rest of the country (OR=1.7, 95% CI=1.3-2.2). These data confirm the younger age of APL patients compared to the other AML. A possible role of electromagnetic fields is suggested by the higher risk of APL in electrical workers and in the more industrialized areas of the country.
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Affiliation(s)
- A Pulsoni
- Department of Cellular Biotechnology and Haematology, University La Sapienza Roma, Italy.
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Indinnimeo M, Cicchini C, Stazi A, Limiti MR, Giarnieri E, Ghini C, Vecchione A. The prevalence of p53 immunoreactivity in anal canal carcinoma. Oncol Rep 1998; 5:1455-7. [PMID: 9769387 DOI: 10.3892/or.5.6.1455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We examined the relationship between p53 expression and clinicopathologic parameters in anal carcinoma. p53 immunoreactivity was detected in 14/18 (77.7%) tumors. Significant association was found between p53 expression and depth of invasion. There was no significant association between p53 expression and histologic type, lymph node metastasis, age and prognosis. Possibly the genetic pathway to anal carcinoma involving p53 gene overexpression confer aggressive growth pattern, but it does not result in worse prognosis. The absence of correlation between p53 overexpression and prognosis could be explained by tumors negative for mutations having an excess of wild-type p53 protein.
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Affiliation(s)
- M Indinnimeo
- I Clinica Chirurgica - Policlinico Umberto I, Universita di Roma "La Sapienza", 00161 Rome, Italy
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Indinnimeo M, Cicchini C, Stazi A, Limiti MR, Ghini C. An unusual location of cloacogenic carcinoma. Int Surg 1998; 83:343-6. [PMID: 10096758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
A 61 year-old female presented with abdominal pain, rectal bleeding, mucus discharge, tenesmus and constipation. Rectal examination and proctoscopy demonstrated rectal stenosis at 5 cm from the anal verge. Transrectal ultrasonography detected a capsulated lesion as a mesenchymal rectal tumor. Computed tomography and endorectal magnetic resonance detected a mesenchymal lesion in the lower-middle rectal thirds. Serum TPA, GICA, SCC and CYFRA were pathological. At surgery the tumour was fixed to the levator ani muscle with rectal folding. Frozen sections of the levator ani muscle biopsies revealed cloacogenic tumour. Abdominoperineal resection was performed. The rectal lesion was cloacogenic carcinoma at 9 cm from the dentate line (pT4 pN0; Ki67 35%; CD31 181 vessels/mm2). Adjuvant radio-chemotherapy was performed. The patient is alive and disease free at 19 months. Extra-anal cloacogenic tumours are an unusual finding. Perhaps cloacal cells were originally present in the rectal wall, but secondary rectal involvement by cloacal remnant from the levator ani muscle cannot be excluded.
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Affiliation(s)
- M Indinnimeo
- First Department of Surgery, University of Rome La Sapienza, Roma, Italy
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Indinnimeo M, Cicchini C, Stazi A, Mingazzini P, Caligo MA, Ghimenti C, Bevilacqua G. Genetic instability, p53 and nm23 mutation and clinicopathological features in rectal carcinoma. Anticancer Res 1998; 18:989-93. [PMID: 9615752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Defective DNA mismatch repair proteins fail to correct replication errors (RERs). These defects may lead to secondary, mutation of oncogenes and tumor suppressor genes. Microsatellite instability might be a marker of such replication errors. Eighteen rectal tumors were examined to evaluate genetic instability, in sporadic rectal cancer by PCR. RERs were observed in 27.8% of the cases. No significant difference was noticed between RER+ and RER- patients as far as prognosis, clinicopathological features and p53 gene mutation are concerned. The incidence of nm23 gene mutation was the only statistically significant difference between the 2 groups. Three patients with only one altered microsatellite showed advanced tumor and nm23 gene mutation. Two cases with 5 altered microsatellites and nm23 gene mutated are disease-free: in one of them the p53 gene was also mutated. Probably more than one altered microsatellite is necessary to protect from the effects of secondary mutations.
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Affiliation(s)
- M Indinnimeo
- First Department of Surgery, University of Rome La Sapienza, Rome, Italy
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Indinnimeo M, Cicchini C, Stazi A, Mingazzini P, Ghini C, Pavone P. Trans anal full thickness tru-cut needle biopsies in anal canal tumors after conservative treatment. Oncol Rep 1998; 5:325-7. [PMID: 9468550 DOI: 10.3892/or.5.2.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
After conservative treatment anal mucosal biopsies enable exclusion of neoplastic cells only on the endoluminal surface. We used transanal full thickness tru-cut needle biopsies in the follow-up of 11 anal tumors. Full thickness tru-cut needle biopsies showed malignant cells in the fibrous tissue in 3 patients and few cells with atypical nuclear features in another 2. All diagnostic exams resulted negative. Therefore, needle biopsies were helpful to diagnose neoplastic remainder. Multiple samples are necessary to reduce the false negative number. This method is simple, relatively inexpensive, easily repeatable and not burdened with complications.
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MESH Headings
- Aged
- Anus Neoplasms/metabolism
- Anus Neoplasms/pathology
- Anus Neoplasms/surgery
- Biomarkers, Tumor/metabolism
- Biopsy, Needle/methods
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Carcinoma, Transitional Cell/metabolism
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/surgery
- Chemotherapy, Adjuvant
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Proctoscopy
- Radiotherapy, Adjuvant
- Ultrasonography
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Affiliation(s)
- M Indinnimeo
- I Clinica Chirurgica Policlinico, Universita di Roma, via del Policlinico 155, Rome, 00161, Italy
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Brozzetti S, Gialloreti A, Cicchini C, Stazi A, Indinnimeo M. [Transpyloric prolapse of a gastric carcinoma arising from a pedunculated hyperplastic polyp]. G Chir 1998; 19:19-21. [PMID: 9567490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A case of gastric carcinoma developed on a large pedunculated hyperplastic polyp prolapsed into duodenum is reported. The cases of transpyloric prolapsed primary pedunculated gastric carcinoma are rare, only 34 cases have been described in Japan during the past 35 years, including the sessile forms. These gastric polyps should be considered in the differential diagnosis of intraluminar filling defects of the duodenal bulb. Endoscopy and biopsy are essential for a correct diagnostic evaluation. Large hyperplastic polyps, especially if prolapsed, require a surgical excision.
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Affiliation(s)
- S Brozzetti
- I Clinica Chirurgica, Università degli Studi La Sapienza, Roma
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Indinnimeo M, Reale MG, Cicchini C, Stazi A, Fiori E, Izzo P. CEA, TPA, CA 19-9, SCC and CYFRA at diagnosis and in the follow-up of anal canal tumors. Int Surg 1997; 82:275-9. [PMID: 9372374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The authors evaluated serum CEA, TPA, CA19-9, SCC and CYFRA at diagnosis and in the follow-up of 18 anal canal tumors. Sensitivity at diagnosis was 38.8% for CEA, 55.5% for TPA, 16.6% for CA19-9, 50% for SCC and 5.5% for CYFRA. In the follow-up CEA showed 0% sensitivity and 73.3% specificity, TPA 33.3% sensitivity and 86.6% specificity, CA19-9 0% sensitivity and 80% specificity, SCC 0% sensitivity and 93.3% specificity, CYFRA 0% sensitivity and 100% specificity. The authors consider the usefulness of serum SCC and TPA at diagnosis of squamocellular anal cancer and of CEA in the diagnosis of cloacogenic tumors. Nevertheless these serum markers did not detect recurrences in the follow-up.
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Affiliation(s)
- M Indinnimeo
- I Department of Surgery, University of Rome La Sapienza, Rome, Italy
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Affiliation(s)
- M Indinnimeo
- First Department of Surgery, University La Sapienza Rome, Italy
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Indinnimeo M, Cicchini C, French D, Limiti M, Stazi A, Giarnieri E, Vecchione A. Correlation between human papillomavirus infection and clinicopathological parameters in anal canal carcinoma. Oncol Rep 1997; 4:307-10. [DOI: 10.3892/or.4.2.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Indinnimeo M, Giarnieri E, Stazi A, Cicchini C, Brozzetti S, Valli C, Carreca I, Vecchione A. Early stage human colorectal cancer: prognostic value of nm23-H1 protein overexpression. Cancer Lett 1997; 111:1-5. [PMID: 9022121 DOI: 10.1016/s0304-3835(96)04472-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Nm23 gene codifies for a nucleoside diphosphate kinase allowing the intracellular transduction of the signals. In colorectal cancer nm23 protein expression seems related to the progression of the disease. By immunohistochemistry we have studied the intracytoplasmatic nm23 H1 protein expression in 20 patients affected by colorectal cancer at initial stage. In 12 cases it resulted elevated and in four the disease recurred. The overexpression was not correlated with other prognostic factors. Nm23 H1-positive patients affected by colorectal cancer at initial stage could be considered at risk for disease recurrence and included in a more frequent follow-up protocol.
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Affiliation(s)
- M Indinnimeo
- I Clinica Chirurgica, Università degli Studi di Roma La Sapienza, Rome, Italy
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