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Bacchini PL, Sammartano A, Manfredi P, Bidetti ML, Malpeli M, Magliani M, Maradini F, Ippolito L. Is SARS-CoV-2 vertical transmission still a current problem? A case report on a diagnosed SARS-CoV-2 infection with a positive sample of urines. Acta Biomed 2023; 94:e2023234. [PMID: 37850765 PMCID: PMC10644935 DOI: 10.23750/abm.v94i5.14864] [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] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/02/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND AND AIM Current data suggest little to no possibility of original COVID-19 transmission in pregnant women to the fetus during pregnancy or childbirth. Warning with Omicron new variants has decreased. CASE REPORT A clinical case of a SARS-CoV-2 virus transplacental infection of a newborn, born at the end of 2022, from a mother who tested positive for Sars-covid-2 and positive IgM SARS-CoV-2 anti-virus. The newborn tested positive for SARS-CoV-2 12 hours after birth, and was clinically symptomatic after three days, an increase in IgM antibodies was not found, although the virus was identified in the urine samples through molecular tests. The insufficient time to determine the presence of antibodies and the immune system's state of immaturity can explain the lack of IgM in the newborn's blood at 14 days after birth. CONCLUSIONS The Omicron SARS-CoV-2 keeps provoking infections among newborns, especially if the mother contracts it during the third trimester. The host response is most likely influenced by the newborn's peculiar state of immune immaturity. Just before birth, a positive nasal swab and the presence of a positive urine examination confirmed the diagnosis of intraplacental exposure. Research on the virus through molecular tests of urines can represent an additional technique when an aetiological framework of the infection is necessary and a distinction between congenital and post-natal forms.
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Affiliation(s)
| | | | - Piera Manfredi
- Pediatrics, Fidenza Hospital, 43036, Fidenza (PR), Italy.
| | | | - Monica Malpeli
- Clinical Pathology Unit, Medical and Diagnostic Department, Fidenza Hospital, Fidenza (PR), Italy.
| | - Magda Magliani
- Clinical Pathology Unit, Medical and Diagnostic Department, Fidenza Hospital, Fidenza (PR), Italy.
| | - Fabio Maradini
- Clinical Pathology Unit, Medical and Diagnostic Department, Fidenza Hospital, Fidenza (PR), Italy.
| | - Luigi Ippolito
- Clinical Pathology Unit, Medical and Diagnostic Department, Fidenza Hospital, Fidenza (PR), Italy.
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Sammartano A, Bertoncini L, Barbuti A, Ippolito L. A suspected hypervitaminosis A. Acta Biomed 2023; 94:e2023098. [PMID: 37326274 PMCID: PMC10308465 DOI: 10.23750/abm.v94i3.14041] [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] [Received: 12/07/2022] [Accepted: 02/09/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIM Vitamin A toxicity is uncommon, but when it occurs can be serious and even fatal. A case vitamin A intoxication with high levels in liver tests, thrombocytopenia and appearance virosis. Laboratory testing is one of the most widely used diagnostic interventions supporting medical decisions of this phenomenon are necessary. CASE REPORT Here, we report a case vitamin A intoxication with high levels in liver tests, thrombocytopenia and appearance virosis. The patient showed several clinical signs abdominal pain, including mild anemia and thrombocytopenia. CONCLUSIONS We believe that Laboratory testing is one of the most widely used diagnostic interventions supporting medical decisions, and further investigations regarding the etiology and prevalence of this phenomenon are necessary. (www.actabiomedica.it).
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Affiliation(s)
| | - Luca Bertoncini
- Clinical Patology Unit, Medical and Diagnostic Department, Borgotaro, Italy.
| | - Arianna Barbuti
- Clinical Patology Unit, Medical and Diagnostic Department, Borgotaro, Italy.
| | - Luigi Ippolito
- Clinical Patology Unit, Medical and Diagnostic Department, Fidenza, Italy.
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Sammartano A, Migliari S, Serreli G, Scarlattei M, Baldari G, Ruffini L. Validation of the HPLC Analytical Method for the Determination of Chemical and Radiochemical Purity of Ga-68-DOTATATE. Indian J Nucl Med 2023; 38:1-7. [PMID: 37180199 PMCID: PMC10171759 DOI: 10.4103/ijnm.ijnm_11_22] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/18/2022] [Accepted: 04/04/2022] [Indexed: 02/25/2023] Open
Abstract
Purpose of the Study Ga-68-DOTA-peptides targeting somatostatin receptors have been assessed as a valuable tool in neuroendocrine tumors imaging using positron emission tomography (PET). A new selective and sensitive high-pressure liquid chromatography (HPLC) method was developed for determining chemical and radiochemical purity of Ga-68-DOTATATE (PET) tracer. The identification of peaks was achieved on a symmetry C18 column 3 μm 120Å (3.0 mm × 150 mm spherical particles) using (A) water + 0.1% trifluoroacetic acid (TFA) and (B) acetonitrile + 0.1% TFA, as the mobile phases at a flow rate of 0.600 mL/min and monitored at 220 nm. The run time was 16 min. Materials and Methods The method was validated to fulfill International Conference on Harmonization requirements and EDQM guidelines, and it included specificity, linearity, limit of detection (LOD), limit of quantification (LOQ), accuracy, and precision. Results The calibration curve was linear over the concentration range from 0.5 to 3 μg/ml, with a correlation coefficient (r2) equal to 0.999, average coefficient of variation (CV%) 2%, and average bias% did not deviate more than 5% for all concentrations. The LOD and LOQ for DOTATATE were 0.5 and 0.1 μg/mL, respectively. The method was considered precise, obtaining coefficients of variation between 0.22% and 0.52% for intraday and 0.20% and 0.61% for interday precision. Accuracy of method was confirmed with average bias% that did not deviate more than 5% for all concentrations. Conclusion All results were acceptable and this confirmed that the method is suitable for its intended use in routine quality control of Ga-68-DOTATATE to guarantee the high quality of the finished product before release.
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Affiliation(s)
- Antonino Sammartano
- Department of Nuclear Medicine and Molecular Imaging, University Hospital of Parma, Via Gramsci, Italy
| | - Silvia Migliari
- Department of Nuclear Medicine and Molecular Imaging, University Hospital of Parma, Via Gramsci, Italy
| | - Giulio Serreli
- Department of Diagnostic, Medical Physics Unit, University Hospital of Parma, Via Gramsci, Parma, Italy
| | - Maura Scarlattei
- Department of Nuclear Medicine and Molecular Imaging, University Hospital of Parma, Via Gramsci, Italy
| | - Giorgio Baldari
- Department of Nuclear Medicine and Molecular Imaging, University Hospital of Parma, Via Gramsci, Italy
| | - Livia Ruffini
- Department of Nuclear Medicine and Molecular Imaging, University Hospital of Parma, Via Gramsci, Italy
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Gasparro D, Scarlattei M, Manuguerra R, Guglielmo P, Migliari S, Sammartano A, Baldari G, Maestroni U, Ruffini L. Synergic role of dual tracer PET/CT with 18F-FDG and 68Ga-PSMA in the detection of papillary renal cell carcinoma recurrence. Rev Esp Med Nucl Imagen Mol 2022; 41:322-324. [DOI: 10.1016/j.remnie.2021.05.004] [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] [Received: 01/31/2021] [Accepted: 04/18/2021] [Indexed: 11/17/2022]
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Gasparro D, Scarlattei M, Manuguerra R, Guglielmo P, Migliari S, Sammartano A, Baldari G, Maestroni U, Ruffini L. Papel sinérgico con doble trazador PET/TC con18F-FDG y68GA-PSMA en la detección de recurrencia del carcinoma papilar de células renales. Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2021.04.007] [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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Sammartano A, Migliari S, Scarlattei M, Baldari G, Serreli G, Lazzara C, Garau L, Ghetti C, Ruffini L. Performance and long-term consistency of five Galliform 68Ge/68Ga generators used for clinical Ga-68 preparations over a 4 year period. Nucl Med Commun 2022; 43:568-576. [PMID: 35190517 DOI: 10.1097/mnm.0000000000001545] [Citation(s) in RCA: 1] [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: 11/26/2022]
Abstract
BACKGROUND Gallium-68 is a positron emitter for PET applications that can be produced without cyclotron by a germanium (Ge-68) chloride/gallium (Ga-68) chloride generator. Short half-life (67.71 min) of Ga-68, matching pharmacokinetic properties of small biomolecules, facilitates isotope utilization in compounding radiopharmaceuticals for PET imaging. The increasing cost of good manufacturing practice-compliant generators has strengthened the need for radionuclide efficient use by planning specific radiopharmaceutical sessions during the week, careful maintenance of the generator and achievement of high labeling yield and radiochemical purity (RCP) of the radiolabeled molecules. METHODS The aim of this study was to evaluate the annual performance of five consecutive 68Ge/68Ga generators used for small-scale preparations of 68Ga-radiopharmaceuticals. To assess the long-term efficiency of isotope production we measured the weekly elution yield. To assess process efficiency we measured elution yield, labeling yield and RCP of four radiopharmaceutical preparations (68Ga-DOTATOC, 68Ga-PSMA-HBED-CC, 68Ga-PENTIXAFOR and 68Ga-DOTATATE). RESULTS The annual mean elution yield of the generators was 74.7%, higher than that indicated by the manufacturer, and it never went below 65%. The Ge-68 level in the final products was under the detection limits in all the produced batches (mean value 0.0000048%). The RCP of radiopharmaceuticals determined by high-performance liquid chromatography was 98 ± 0.22%. The mean yield of radiolabelling was 64.68, 68.71, 57 and 63.68% for 68Ga-DOTATOC, 68Ga-PSMA-HBED-CC, 68GaPENTIXAFOR and 68Ga-DOTATATE. CONCLUSION The ability to prepare in the hospital radiopharmacy high-purity and pharmaceutically acceptable 68Ga-radiolabeled probes on a routine basis facilitates patient access to precision imaging for clinical and research aims.
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Affiliation(s)
| | | | | | | | - Giulio Serreli
- Diagnostic Department, Medical Physics Unit, Azienda Ospedaliero-Universitaria di Parma, Gramsci, Parma, Italy
| | | | | | - Caterina Ghetti
- Diagnostic Department, Medical Physics Unit, Azienda Ospedaliero-Universitaria di Parma, Gramsci, Parma, Italy
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Migliari S, Sammartano A, Boss M, Gotthardt M, Scarlattei M, Baldari G, Silva C, Bonadonna RC, Ruffini L. Development and Validation of an Analytical HPLC Method to Assess Chemical and Radiochemical Purity of [ 68Ga]Ga-NODAGA-Exendin-4 Produced by a Fully Automated Method. Molecules 2022; 27:543. [PMID: 35056858 PMCID: PMC8778103 DOI: 10.3390/molecules27020543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/03/2022] [Accepted: 01/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Glucagon-like peptide 1 receptor (GLP-1R) is preferentially expressed in pancreatic islets, especially in β-cells, and highly expressed in human insulinomas and gastrinomas. In recent years several GLP-1R-avid radioligands have been developed to image insulin-secreting tumors or to provide a tentative quantitative in vivo biomarker of pancreatic β-cell mass. Exendin-4, a 39-amino acid peptide with high binding affinity to GLP-1R, has been labeled with Ga-68 for imaging with positron emission tomography (PET). Preparation conditions may influence the quality and in vivo behavior of tracers. Starting from a published synthesis and quality controls (QCs) procedure, we have developed and validated a new rapid and simple UV-Radio-HPLC method to test the chemical and radiochemical purity of [68Ga]Ga-NODAGA-exendin-4, to be used in the clinical routine. Methods: Ga-68 was obtained from a 68Ge/68Ga Generator (GalliaPharma®) and purified using a cationic-exchange cartridge on an automated synthesis module (Scintomics GRP®). NODAGA-exendin-4 contained in the reactor (10 µg) was reconstituted with HEPES and ascorbic acid. The reaction mixture was incubated at 100 °C. The product was purified through HLB cartridge, diluted, and sterilized. To validate the proposed UV-Radio-HPLC method, a stepwise approach was used, as defined in the guidance document released by the International Conference on Harmonization of Technical Requirements of Pharmaceuticals for Human Use (ICH), adopted by the European Medicines Agency (CMP/ICH/381/95 2014). The assessed parameters are specificity, linearity, precision (repeatability), accuracy, and limit of quantification. Therefore, a range of concentrations of Ga-NODAGA-exendin-4, NODAGA-exendin-4 (5, 4, 3.125, 1.25, 1, and 0.75 μg/mL) and [68Ga]Ga-NODAGA-exendin-4 were analyzed. To validate the entire production process, three consecutive batches of [68Ga]Ga-NODAGA-exendin-4 were tested. Results: Excellent linearity was found between 5-0.75 μg/mL for both the analytes (NODAGA-exendin-4 and 68Ga-NODAGA-exendin-4), with a correlation coefficient (R2) for calibration curves equal to 0.999, average coefficients of variation (CV%) < 2% (0.45% and 0.39%) and average per cent deviation value of bias from 100%, of 0.06% and 0.04%, respectively. The calibration curve for the determination of [68Ga]Ga-NODAGA-exendin-4 was linear with a R2 of 0.993 and CV% < 2% (1.97%), in accordance to acceptance criteria. The intra-day and inter-day precision of our method was statistically confirmed using 10 μg of peptide. The mean radiochemical yield was 45 ± 2.4% in all the three validation batches of [68Ga]Ga-NODAGA-exendin-4. The radiochemical purity of [68Ga]Ga-NODAGA-exendin-4 was >95% (97.05%, 95.75% and 96.15%) in all the three batches. Conclusions: The developed UV-Radio-HPLC method to assess the radiochemical and chemical purity of [68Ga]Ga-NODAGA-exendin-4 is rapid, accurate and reproducible like its fully automated production. It allows the routine use of this PET tracer as a diagnostic tool for PET imaging of GLP-1R expression in vivo, ensuring patient safety.
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Affiliation(s)
- Silvia Migliari
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy; (A.S.); (M.S.); (G.B.); (L.R.)
| | - Antonino Sammartano
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy; (A.S.); (M.S.); (G.B.); (L.R.)
| | - Marti Boss
- Department of Medical Imaging, Radboudumc, 6500 HB Nijmegen, The Netherlands; (M.B.); (M.G.)
| | - Martin Gotthardt
- Department of Medical Imaging, Radboudumc, 6500 HB Nijmegen, The Netherlands; (M.B.); (M.G.)
| | - Maura Scarlattei
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy; (A.S.); (M.S.); (G.B.); (L.R.)
| | - Giorgio Baldari
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy; (A.S.); (M.S.); (G.B.); (L.R.)
| | - Claudia Silva
- Food and Drug Sciences Department, University of Parma, Parco Area delle Scienze 27/A, 43126 Parma, Italy;
| | - Riccardo C. Bonadonna
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
- Division of Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy
| | - Livia Ruffini
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy; (A.S.); (M.S.); (G.B.); (L.R.)
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Sammartano A, Testa G, Ippolito L. Maintainance of diagnostic Laboratory during pandemic emergency (SARS-CoV-2) in a Small Hospital. Acta Biomed 2022; 93:e2022325. [PMID: 36533760 PMCID: PMC9828908 DOI: 10.23750/abm.v93i6.13418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/02/2022] [Indexed: 01/21/2023]
Affiliation(s)
| | - Giulia Testa
- Clinical Patology Unit, Medical and Diagnostic Department, Fidenza, Italy.
| | - Luigi Ippolito
- Clinical Patology Unit, Medical and Diagnostic Department, Fidenza, Italy.
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Graziani T, Cidda C, Serra W, Mattioli M, Sammartano A, Migliari S, Ruffini L. 373 Utility of the early phase of DPD scintigraphy in the diagnosis of correlated TT-R cardiac amyloidosis. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab142.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
The importance of cardiac scan with phosphonate-based radiotracers in the diagnosis of cardiac amyloidosis is now well established. Standard imaging is performed 3 h after tracer injection with a planar view on the cardiac region. This study sought to evaluate the predictive role of early-phase myocardial uptake (10 min after injection) of 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) compared compared with standard late acquisition, in patients with suspected hereditary transthyretin-related cardiac amyloidosis (TTR-CA).
Methods and results
Fifty five patients with suspected of TTR-CA with typical aspects of the relative apical sparing at two-dimensional speckle-tracking echocardiography, reported as a specific pattern for cardiac amyloidosis, were enrolled after having signed informed written consent. They have been subjected to a 99mTc-DPD cardiac scintigraphy with planar acquisition at 10 min and 3 h after tracer injection (13 Mbq/Kg). Patients with cardiac uptake on the planar images concluded the examination with a SPECT-CT (cardiac protocol) to assess the affected myocardial segments. On planar images the heart-to-mediastinum-ratio was measured. Subsequently, the diagnosis of amyloidosis has to be confirmed with morphologic examinations such as biopsy and genetic tests. Of the enrolled patients with clinical and echocardiographic aspect of TTR-CA, 22 were positive for cardiac amyloidosis. All of them showed tracer uptake in both early and late images. In patients with positive results, the early-phase showed a Heart-to-mediastinum-ratio >1.2. SPECT/CT showed involvement of almost two myocardial segments: in all patients the ventricular septum showed significant tracer uptake.
Conclusions
Our small group of patients showed that 99mTc-DPD myocardial uptake intensity on early-phase scintigraphy can be used to anticipate the results of late images in diagnosis of TTR cardiac amyloidosis.
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Affiliation(s)
- Tiziano Graziani
- S.C. Medicina Nucleare Azienda Ospedaliera Universitaria di Parma, Italy
| | - Carla Cidda
- S.C. Medicina Nucleare Azienda Ospedaliera Universitaria di Parma, Italy
| | - Walter Serra
- U.O.C Cardiologia, Azienda Ospedaliera Universitaria di Parma, Italy
| | - Maria Mattioli
- U.O.C Cardiologia, Azienda Ospedaliera Universitaria di Parma, Italy
| | - A. Sammartano
- S.C. Medicina Nucleare Azienda Ospedaliera Universitaria di Parma, Italy
| | - S. Migliari
- S.C. Medicina Nucleare Azienda Ospedaliera Universitaria di Parma, Italy
| | - Livia Ruffini
- S.C. Medicina Nucleare Azienda Ospedaliera Universitaria di Parma, Italy
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Gasparro D, Scarlattei M, Manuguerra R, Guglielmo P, Migliari S, Sammartano A, Baldari G, Maestroni U, Silini EM, Ruffini L. 18F-FDG and 68GA-Prostate-Specific Membrane Antigen PET/CT Perform Better Than CT Alone in Restaging Papillary Renal Cell Carcinoma Recurrence. Clin Nucl Med 2021; 46:e458-e460. [PMID: 34374683 DOI: 10.1097/rlu.0000000000003660] [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: 10/21/2022]
Abstract
ABSTRACT Renal cell carcinoma (RCC) shows variable FDG uptake; recently, PET/CT with prostate-specific membrane antigen (PSMA)-target radiotracers was demonstrated to be a promising tool in staging and restaging of RCC patients. We describe the case of a 77-year-old man with a lung metastasis of papillary RCC missed by CT scan who successfully underwent [18F]FDG PET/CT restaging. Targeted therapy with sunitinib was administered. A [68Ga]PSMA PET/CT performed during follow-up demonstrated, among the already known lesions, also a bone marrow metastasis, missed by previous CT scans. This case demonstrates that PET/CT molecular imaging with [18F]FDG and [68Ga]PSMA is superior to conventional imaging in RCC restaging and in assessing therapy response.
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Affiliation(s)
| | | | | | | | | | | | | | - Umberto Maestroni
- Urology Division, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
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Palumbo VD, Palumbo VD, Damiano G, Sammartano A, Messina M, Fazzotta S, Curione F, Cudia BM, Lo Monte AI. Colour Doppler-guided Haemorrhoidal Artery Ligation: a possible evolution of Transanal Haemorrhoidal Dearterialisation. Clin Ter 2021; 172:329-335. [PMID: 34247216 DOI: 10.7417/ct.2021.2337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction Haemorrhoids are a very common disease, with a great economic burden. Many treatments have been developed for trying to solve the problem, being the standard not yet found. In 1995, Doppler-guided haemorrhoidal artery ligation was introduced, aiming to reduce postoperative pain and complications. In this work, an evolu-tion of the aforementioned surgical technique was described. Materials and Methods 183 patients treated with standard Doppler-Guided Haemorrhoidal Artery Ligation were statistically compared with 225 patients dealt with Colour Doppler-Guided Haemorrhoidal Artery Ligation. The procedures were performed under local anaes-thesia with patients in lithotomy position. A special proctoscope and a dedicated Colourdoppler US probe were employed in the second group. Superior haemorrhoidal artery terminal branches were con-secutively ligated according to provided technique in the first group and under vision in the second. In all cases, each ligation was followed by mucopexy. Results No significant differences between the two groups, in terms of post-operative pain, early complications (bleeding, urinary retention, incontinence) or patient satisfaction, were demonstrated. Recurrence rate was significantly higher in patients treated with stan-dard DG-HAL. No late complications (after one-year follow-up) were registered in both groups. Conclusions Colour Doppler-Guided Haemorrhoidal Artery Li-gation represents an ideal management for 1-day surgery, and fulfils the requirements of minimally invasive surgery in patients with III-IV grade haemorrhoids. The absence of complications and the evidence of significant wellness of patients are the best advantages. Colour Doppler-Guided Haemorrhoidal Artery Ligation is a safe and easy procedure with good results and a very short-time training. It could be considered an easy and reliable method to treat symptomatic haemorrhoids.
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Affiliation(s)
- V D Palumbo
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - V D Palumbo
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - G Damiano
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - A Sammartano
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - M Messina
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Italy
| | - S Fazzotta
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - F Curione
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - B M Cudia
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - A I Lo Monte
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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Guglielmo P, Gasparro D, Scarlattei M, Baldari G, Bola S, Migliari S, Sammartano A, Maestroni U, Ruffini L. [ 68Ga]Ga-PSMA-HBED-CC PET/CT demonstrates to be superior to ceCT in detecting early treatment response in metastatic clear cell renal cell carcinoma. Eur J Nucl Med Mol Imaging 2021; 48:3337-3339. [PMID: 33754194 DOI: 10.1007/s00259-021-05250-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/07/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Priscilla Guglielmo
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy.
| | - Donatello Gasparro
- Oncology Division, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Maura Scarlattei
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Giorgio Baldari
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Stefano Bola
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Silvia Migliari
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Antonino Sammartano
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Umberto Maestroni
- Urology Division, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Livia Ruffini
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
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Migliari S, Sammartano A, Scarlattei M, Baldari G, Janota B, Bonadonna RC, Ruffini L. Feasibility of a scale-down production of [68Ga]Ga-NODAGA-Exendin-4 in a hospital based radiopharmacy. Curr Radiopharm 2021; 15:63-75. [PMID: 33687908 DOI: 10.2174/1874471014666210309151930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/23/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Glucagon-like peptide 1 receptor (GLP-1R) is preferentially expressed in β-cells, but it is highly expressed in human insulinomas and gastrinomas. Several GLP-1 receptor-avid radioligands have been developed to image insulin-secreting tumors or to provide a quantitative in vivo biomarker of pancreatic β-cell mass. Exendin-4 is a high affinity ligand of the GLP1-R, which is a candidate for being labeled with a PET isotope and used for imaging purposes. OBJECTIVE Here, we report the development and validation results of a semi manual procedure to label [Lys40,Nle14(Ahx-NODAGA)NH2]exendin-4, with Ga-68. METHODS A 68Ge/68Ga Generator (GalliaPharma®,Eckert and Ziegler) was eluted with 0.1M HCl on an automated synthesis module (Scintomics GRP®). The peptide contained in the kit vial (Radioisotope Center POLATOM) in different amounts (10-20-30 µg) was reconstituted with 2-[4-(2-hydroxyethyl)piperazin-1-yl]ethansulfonic acid (HEPES) solution and 68GaCl3 (400-900 MBq), followed by 10 min incubation at 95°C. The reaction solution was then purified through an Oasis HLB column. The radiopharmaceutical product was tested for quality controls (CQs), in accordance with the European Pharmacopoeia standards. RESULTS The synthesis of 68Ga]Ga-NODAGA-Exendin-4 provided optimal results with 10 µg of peptide, getting the best radiochemical yield (23.53 ± 2.4 %), molar activity (100 GBq/µmol) and radiochemical purity (91.69 %). CONCLUSION The study developed an imaging tool [68Ga]Ga-NODAGA-Exendin-4, avoiding pharmacological effects of exendin-4, for the clinical community.
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Affiliation(s)
- Silvia Migliari
- Nuclear Medicine and Molecular Imaging Department, University Hospital of Parma, via Gramsci 14, 43126 Parma. Italy
| | - Antonino Sammartano
- Nuclear Medicine and Molecular Imaging Department, University Hospital of Parma, via Gramsci 14, 43126 Parma. Italy
| | - Maura Scarlattei
- Nuclear Medicine and Molecular Imaging Department, University Hospital of Parma, via Gramsci 14, 43126 Parma. Italy
| | - Giorgio Baldari
- Nuclear Medicine and Molecular Imaging Department, University Hospital of Parma, via Gramsci 14, 43126 Parma. Italy
| | - Barbara Janota
- National Centre for Nuclear Research Radioisotope Centre POLATOM, Otwock. Poland
| | - Riccardo C Bonadonna
- Division of Endocrinology and Metabolic Diseases, Department of Medicine and Surgery, University of Parma School of Medicine and University Hospital of Parma, Parma. Italy
| | - Livia Ruffini
- Nuclear Medicine and Molecular Imaging Department, University Hospital of Parma, via Gramsci 14, 43126 Parma. Italy
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Leonetti A, Bola S, Minari R, Scarlattei M, Buti S, Bordi P, Baldari G, Gnetti L, Sammartano A, Migliari S, Cosenza A, Ferri L, Bonatti F, Mastrodomenico L, Ruffini L, Tiseo M. P76.52 Liquid Biopsy and PET Parameters as Predictive Factors of Osimertinib Treatment in Advanced EGFR-Mutated NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sammartano A, Migliari S, Scarlattei M, Baldari G, Ruffini L. Validation of Quality Control Parameters of Cassette-Based Gallium-68-DOTA-Tyr3-Octreotate Synthesis. Indian J Nucl Med 2020; 35:291-298. [PMID: 33642752 PMCID: PMC7905293 DOI: 10.4103/ijnm.ijnm_66_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 04/09/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose of the Study: Gallium (Ga)-68-DOTA peptides targeting somatostatin receptors have been assessed as a valuable tool in neuroendocrine tumor imaging using positron emission tomography. However, at the moment, a specific monograph in the European Pharmacopoeia (Ph. Eur.) does exist only for Ga-68-edotreotide (DOTATOC) injection. Here, we report on the validation process of Ga-68-DOTA-Tyr3-octreotate (DOTATATE) cassette-based production and quality control (QC). Materials and Methods: Preparation of Ga-68-DOTATATE was performed according to the current European Union-good manufacturing practices, the current good radiopharmacy practice, the Ph. Eur., and the guidelines on validation of analytical methods for radiopharmaceuticals. Process was validated via three consecutive production runs to ensure that the methods are reproducible and reliable in routine use. The QC tests for Ga-68-DOTATATE were radiochemical purity (RCP – high-pressure liquid chromatography [HPLC]), radiochemical impurities 68Ga3+ (HPLC and instant thin layer chromatography [ITLC]), chemical purity (HPLC and gas chromatography [GC]), pH (pH-strips), radionuclidic purity (principal γ-photon), germanium-breakthrough (68Ge-content), Ga-68 half-life (γ-ray spectrometry), and sterility/endotoxin assay. Results: Radiolabeling procedure of Ga-68-DOTATATE fits all the applicable Ph. Eur. specifications. RCP measured via ITLC was >99% in the three validation batches. HPLC-measured RCP resulted 99.45%, 99.78%, and 99.75%. Germanium-breakthrough was far below the recommended level established in the Ph. Eur. Ga-68-DOTATOC injection (#2482). Residual ethanol tested with GC was less than 10%. All the batches were tested for endotoxin content, which always resulted lower than 17.5 EU/ml. All preparations passed the sterility tests. pH of the final product was 7 in all samples. Conclusion: Ga-68-DOTATATE fulfilled all the pre-set QCs and release criteria in the batches considered for this validation study. The results demonstrated a batch-to-batch reproducibility, ensuring that synthesis process leads to the expected final product in terms of yield, quality, reliability, safety, and efficacy.
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Affiliation(s)
- Antonino Sammartano
- Department of Nuclear Medicine and Molecular Imaging, University Hospital of Parma, Parma, Italy
| | - Silvia Migliari
- Department of Nuclear Medicine and Molecular Imaging, University Hospital of Parma, Parma, Italy
| | - Maura Scarlattei
- Department of Nuclear Medicine and Molecular Imaging, University Hospital of Parma, Parma, Italy
| | - Giorgio Baldari
- Department of Nuclear Medicine and Molecular Imaging, University Hospital of Parma, Parma, Italy
| | - Livia Ruffini
- Department of Nuclear Medicine and Molecular Imaging, University Hospital of Parma, Parma, Italy
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Migliari S, Sammartano A, Scarlattei M, Baldari G, Silva C, Ruffini L. A Rapid and Specific HPLC Method to Determine Chemical and Radiochemical Purity of [ 68Ga]Ga-DOTA-Pentixafor (PET) Tracer: Development and Validation. Curr Radiopharm 2020; 14:121-130. [PMID: 32990551 DOI: 10.2174/1874471013666200929125102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/06/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Due to its overexpression in a variety of tumor types, the chemokine receptor 4 (CXCR4) represents a highly relevant diagnostic and therapeutic target in nuclear oncology. Recently, [68Ga]Ga-DOTA-Pentixafor has emerged as an excellent imaging agent for positron emission tomography (PET) of CXCR4 expression in vivo. Preparation conditions may influence the quality and in vivo behaviour of this tracer and no standard procedure for the quality controls (QCs) is available. OBJECTIVE The developed analytical test method was validated because a specific monograph in the Pharmacopoeia is not available for [68Ga]Ga-DOTA-Pentixafor. METHOD A stepwise approach was used based on the quality by design (QbD) concept of the ICH Q2 (R1) and Q8 (Pharmaceutical Development) guidelines in accordance with the regulations and requirements of EANM, SNM, IAEA and WHO. RESULTS The purity and quality of the radiopharmaceutical obtained according to the proposed method were found to be high enough to safely administrate it to patients. Excellent linearity was found between 0.5 and 4 μg/mL, with a correlation coefficient (r2) for calibration curves being equal to 0.999, the average coefficient of variation (CV%) < 2% and average bias% that did not deviate more than 5% for all concentrations. CONCLUSION This study developed a new rapid and simple HPLC method of analysis for the routine QCs of [68Ga]Ga-DOTA-Pentixafor to guarantee the high quality of the finished product before release.
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Affiliation(s)
- Silvia Migliari
- Nuclear Medicine and Molecular Imaging Department, Azienda Ospedaliero-Universitaria di Parma, via Gramsci 14, 43126Parma, Italy
| | - Antonino Sammartano
- Nuclear Medicine and Molecular Imaging Department, Azienda Ospedaliero-Universitaria di Parma, via Gramsci 14, 43126Parma, Italy
| | - Maura Scarlattei
- Nuclear Medicine and Molecular Imaging Department, Azienda Ospedaliero-Universitaria di Parma, via Gramsci 14, 43126Parma, Italy
| | - Giorgio Baldari
- Nuclear Medicine and Molecular Imaging Department, Azienda Ospedaliero-Universitaria di Parma, via Gramsci 14, 43126Parma, Italy
| | - Claudia Silva
- Food and Drug Sciences Department, Parco Area delle Scienze 27/A, University of Parma- 43124Parma, Italy
| | - Livia Ruffini
- Nuclear Medicine and Molecular Imaging Department, Azienda Ospedaliero-Universitaria di Parma, via Gramsci 14, 43126Parma, Italy
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Graziani T, Baldari G, Sammartano A, Scarlattei M, Migliari S, Pescarenico MG, Cidda C, Bola S, Ruffini L. SPECT/CT with 99mTc labelled heat-denatured erythrocyte to detect thoracic and abdominal splenosis. Acta Biomed 2020; 91:e2020098. [PMID: 33525300 PMCID: PMC7927460 DOI: 10.23750/abm.v91i4.9270] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/07/2020] [Indexed: 11/23/2022]
Abstract
Scintigraphy with 99mTc labelled heat-denatured erythrocyte (DRBC) allows non invasive diagnosis of heterotopic splenic tissue implantation (splenosis) following splenic trauma or surgery. Single-photon emission computed tomography (SPECT) combined with computed tomography (CT) improves diagnostic accuracy of planar imaging through a more precise localization of functional findings. We report about two cases of splenosis occurring many years after splenectomy. 99MTc-DCRBC scintigraphy was used for differential diagnosis of metastatic disease in one case and to assess an incidental finding at bone scan in the second one. SPECT/CT increased specificity of planar imaging, expecially revealing combined (thoracic and abdominal) splenosis. (www.actabiomedica.it)
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Affiliation(s)
- Tiziano Graziani
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Giorgio Baldari
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Antonino Sammartano
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Maura Scarlattei
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Silvia Migliari
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | | | - Carla Cidda
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Stefano Bola
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Livia Ruffini
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
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Sammartano A, Migliari S, Scarlattei M, Baldari G, Ruffini L. Synthesis, validation and quality controls of [68Ga]-DOTA-Pentixafor for PET imaging of chemokine receptor CXCR4 expression. Acta Biomed 2020; 91:e2020097. [PMID: 33525262 PMCID: PMC7927511 DOI: 10.23750/abm.v91i4.9106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 12/13/2022]
Abstract
Chemokine receptor-4 (CXCR4) is involved in tumor growth and progression in several types of human cancer. Recently, [68Ga]-DOTA-Pentixafor has been assessed as an excellent imaging probe targeting CXCR4-expression using positron emission tomography (PET). Here we report on the entire production cycle of [68Ga]-DOTA-Pentixafor, including quality control development and process validation.
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Affiliation(s)
- Antonino Sammartano
- Nuclear Medicine and Molecular Imaging Department, Azienda Ospedaliero-Universitaria di Parma, Italy.
| | - Silvia Migliari
- Nuclear Medicine and Molecular Imaging Department, Azienda Ospedaliero-Universitaria di Parma, Italy.
| | - Maura Scarlattei
- Nuclear Medicine and Molecular Imaging Department, Azienda Ospedaliero-Universitaria di Parma, Italy.
| | - Giorgio Baldari
- Nuclear Medicine and Molecular Imaging Department, Azienda Ospedaliero-Universitaria di Parma, Italy.
| | - Livia Ruffini
- Nuclear Medicine and Molecular Imaging Department, Azienda Ospedaliero-Universitaria di Parma, Italy.
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Scarlattei M, Baldari G, Silva M, Bola S, Sammartano A, Migliari S, Graziani T, Cidda C, Sverzellati N, Ruffini L. Unknown SARS-CoV-2 pneumonia detected by PET/CT in patients with cancer. Tumori 2020; 106:325-332. [PMID: 32567505 PMCID: PMC7308791 DOI: 10.1177/0300891620935983] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: In January 2020, the coronavirus disease 2019 (COVID-19) outbreak in Italy
necessitated rigorous application of more restrictive safety procedures in
the management and treatment of patients with cancer to ensure patient and
staff protection. Identification of respiratory syndrome coronavirus 2
(SARS-CoV-2) infection was a challenge during the pandemic owing to a large
number of asymptomatic or mildly symptomatic patients. Methods: We report 5 patients with unknown SARS-CoV-2 infection undergoing positron
emission tomography (PET)/computed tomography (CT) with radiopharmaceuticals
targeting different tumor processes: 18F-FDG,
18F-choline (FCH), and 68Ga-PSMA. Results: In all patients, PET/CT showed increased tracer uptake in the lungs
corresponding to CT findings of SARS-CoV-2 pneumonia. Quantitative
assessment of tracer uptake showed more elevated values for the glucose
analogue 18F-FDG (mean SUVmax 5.4) than for the other tracers
(mean SUVmax 3.5). Conclusions: Our findings suggest that PET/CT is a sensitive modality to hypothesize
SARS-CoV-2 pneumonia in patients with cancer, even when asymptomatic. More
data are needed to verify the correlation among immune response to
SARS-CoV-2 infection, clinical evolution, and PET results. Under the strict
safety measures implemented at the PET center, the number of potentially
SARS-CoV-2–positive patients undergoing PET/CT was very low (1.6%), and no
staff member has been diagnosed with infection as of April 30, 2020.
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Affiliation(s)
- Maura Scarlattei
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Giorgio Baldari
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Mario Silva
- Unit of "Scienze Radiologiche," Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Stefano Bola
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Antonino Sammartano
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Silvia Migliari
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Tiziano Graziani
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Carla Cidda
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Nicola Sverzellati
- Unit of "Scienze Radiologiche," Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Livia Ruffini
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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Sammartano A, Scarlattei M, Migliari S, Baldari G, Ruffini L. Validation of in vitro labeling method for human use of heat-damage red blood cells to detect splenic tissue and hemocateretic function. Acta Biomed 2019; 90:275-280. [PMID: 31580314 PMCID: PMC7233735 DOI: 10.23750/abm.v90i3.7767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM Selective imaging of the splenic tissue is obtained with heat-damaged, or heat-denatured, red blood cells (RBCs) of the patient labeled with 99mTc in a variety of clinical scenarios. Aim of the study was to validate the process used for labelling heat-damaged red blood cells "totally in vitro", after blood sample collection, before re-inject labeled RBCs to the patient. Moreover, we assessed efficacy of the staff training programme in order to guarantee repeatibility and method standardization in the clinical routine. METHODS The validation process of the labeling procedure was performed in three different patients during three consecutive days. After collection of a blood sample using a heparinized syringe, we isolated erythrocytes from other blood components by centrifugation and washing steps. Then, we added the stannous pyrophosphate (PYP) to the erythrocytes pellet, after pH control. The 'pretinning' of RBCs was necessary to reduce Tc-99m once pertechnetate was entered them. After the labeling reaction with 130 MBq of 99mTc-pertechnetate, the erythrocytes were denatured in a water bath at a temperature of 49°-50°C, for 10 min. Radioactivity of blood aliquotes was measured with a dose calibrator and labelling efficiency (LE%) was determined. The labelling purity was measured using a gamma counter and calculated using the formula: counts of pellet/counts of pellet+(counts of surnatant)*100.Training program was evaluated using a Learning Questionnaire (LQ). with a grading score from 6 ("") to 1 ("nothing") for each operator (n=3). RESULTS We didn't observed the presence of macroaggregates during the entire process, until the final sample. The labelling efficiency resulted at very high values in the three consecutive measured aliquotes (mean value 73.67%) as well as the labelling purity (>95.22%). In our instituion, we use splenic imaging with labelled heat-damaged RBCs to detect ectopic spleen, splenosis, extramedullary hematopoiesis. We performed 3 procedures with heat-damaged labeled RBCs with a mean labelling efficiency 73.67%.Training and learning programmes were scored by key objective areas with a mean value of 5. CONCLUSIONS Our in vitro labeling process of heat-damaged RBCs is simple and safe, providing a useful technique easy to implement in clinical routine for splenic imaging Learning outcome of the training programme was scored as effective by all the operators with evidence of high-efficiency-reproducible procedure mantained over time.
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Migliari S, Sammartano A, Cidda C, Baldari G, Scarlattei M, Serreli G, Ghetti C, Pipitone S, Lippi G, Ruffini L. Novel approach for quality assessment and improving diagnostic accuracy in cell-based infection imaging using 99mTc-HMPAO labeled leukocytes. Acta Biomed 2018; 89:355-364. [PMID: 30333459 PMCID: PMC6502120 DOI: 10.23750/abm.v89i3.7064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/27/2018] [Indexed: 01/06/2023]
Abstract
Background and aim: Labeled leukocytes with 99mTc-HMPAO are routinely used for infection imaging. Although cell labeling with 99mTc-HMPAO represents an imaging probe to detect infection sites, the diagnostic efficiency of the probe is largely influenced by cell manipulation, multidisciplinary interventions (i.e., biologist, technicians) and available technology (i.e., SPECT, SPECT/CT). The aim of the study was to assess in vitro and in vivo accuracy of a comprehensive approach for quality assessment (QA) of all steps of the procedure. Methods: Radiochemical purity (RCP), pH, labeling efficiency (LE) were measured in 320 procedures. White Cell Viability Factor (WVF) was determined in consecutive blood samples. Images (490 studies) were scored using a 5-point scale. Training program was evaluated using a Learning Questionnaire and a score system. Results: Pre/post-labelling WVF was 0.99% (max value 1%) in all blood samples. LE (mean value 72%) and RCP (>80% until 55 minutes) yielded considerably high values. The vast majority of images were scored as diagnostic by three independent observer (90% with score ≥4). Conclusions: This method appears highly reproducible and easy to use in clinical routine for leukocyte labeling, especially when standardized training and total QA system are implemented. (www.actabiomedica.it)
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Migliari S, Sammartano A, Scarlattei M, Serreli G, Ghetti C, Cidda C, Baldari G, Ortenzia O, Ruffini L. Development and Validation of a High-Pressure Liquid Chromatography Method for the Determination of Chemical Purity and Radiochemical Purity of a [ 68Ga]-Labeled Glu-Urea-Lys(Ahx)-HBED-CC (Positron Emission Tomography) Tracer. ACS Omega 2017; 2:7120-7126. [PMID: 29520394 PMCID: PMC5837251 DOI: 10.1021/acsomega.7b00677] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/16/2017] [Indexed: 10/15/2023]
Abstract
Background: Prostate-specific membrane antigen (PSMA) has gained high attention as a useful biomarker in the imaging evaluation of prostate cancer with positron emission tomography (PET) during recent years. [68Ga]-labeled Glu-urea-Lys(Ahx)-HBED-CC ([68Ga]-PSMA-HBED-CC) is a novel PSMA inhibitor radiotracer which has demonstrated its suitability in detecting prostate cancer. Preparation conditions may influence the quality and in vivo behavior of this tracer, and no standard procedure for the quality control (QC) is available. The aim of this study was to develop a new rapid and simple high-pressure liquid chromatography method of analysis for the routine QCs of [68Ga]-PSMA-HBED-CC to guarantee the high quality of the radiopharmaceutical product before release. Methods: A stepwise approach was used based on the quality by design concept of the International Conference of Harmonisation Q2 (R1) and Q8 (Pharmaceutical Development) guidelines in accordance with the regulations and requirements of European Association of Nuclear Medicine, Society of Nuclear Medicine, International Atomic Energy Agency, World Health Organization, and Italian Association of Nuclear Medicine and Molecular Imaging. The developed analytical test method was validated because a specific monograph in the pharmacopoeia is not available for [68Ga]-PSMA-HBED-CC. Results: The purity and quality of the radiopharmaceutical obtained according to the proposed method resulted high enough to safely administrate it to patients. An excellent linearity was found between 0.8 and 5 μg/mL, with a detection limit of 0.2 μg/mL. Assay imprecision (% CV) was <2%. Conclusions: The developed method to assess the radiochemical and chemical purity of [68Ga]-PSMA-HBED-CC is rapid, accurate, and reproducible, allowing routinely the use of this PET tracer as a diagnostic tool for imaging prostate cancer and also assuring patient safety.
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Affiliation(s)
- Silvia Migliari
- Nuclear Medicine and Molecular Imaging Department and Medical Physics
Unit, University Hospital of Parma, via Gramsci 14, 43126 Parma, Italy
| | - Antonino Sammartano
- Nuclear Medicine and Molecular Imaging Department and Medical Physics
Unit, University Hospital of Parma, via Gramsci 14, 43126 Parma, Italy
| | - Maura Scarlattei
- Nuclear Medicine and Molecular Imaging Department and Medical Physics
Unit, University Hospital of Parma, via Gramsci 14, 43126 Parma, Italy
| | - Giulio Serreli
- Nuclear Medicine and Molecular Imaging Department and Medical Physics
Unit, University Hospital of Parma, via Gramsci 14, 43126 Parma, Italy
| | - Caterina Ghetti
- Nuclear Medicine and Molecular Imaging Department and Medical Physics
Unit, University Hospital of Parma, via Gramsci 14, 43126 Parma, Italy
| | - Carla Cidda
- Nuclear Medicine and Molecular Imaging Department and Medical Physics
Unit, University Hospital of Parma, via Gramsci 14, 43126 Parma, Italy
| | - Giorgio Baldari
- Nuclear Medicine and Molecular Imaging Department and Medical Physics
Unit, University Hospital of Parma, via Gramsci 14, 43126 Parma, Italy
| | - Ornella Ortenzia
- Nuclear Medicine and Molecular Imaging Department and Medical Physics
Unit, University Hospital of Parma, via Gramsci 14, 43126 Parma, Italy
| | - Livia Ruffini
- Nuclear Medicine and Molecular Imaging Department and Medical Physics
Unit, University Hospital of Parma, via Gramsci 14, 43126 Parma, Italy
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Bellavia M, Damiano G, Palumbo VD, Spinelli G, Tomasello G, Marrazzo A, Ficarella S, Bruno A, Sammartano A, Fiorentini T, Scio A, Maione C, Lo Monte AI. Granulomatous Mastitis during Chronic Antidepressant Therapy: Is It Possible a Conservative Therapeutic Approach? J Breast Cancer 2012; 15:371-2. [PMID: 23091553 PMCID: PMC3468794 DOI: 10.4048/jbc.2012.15.3.371] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 08/23/2012] [Indexed: 01/09/2023] Open
Abstract
Granulomatous mastitis is a rare benign inflammatory disease of the breast with multiple etiologies such as tuberculosis, sarcoidosis, foreign body reaction, and mycotic and parasitic infections. In contrast, idiopathic granulomatous mastitis (IGM) is characterized by the presence of chronic granulomatous lobulitis in the absence of an obvious etiology. Clinically and radiologically it may mimic breast carcinoma and so awareness of surgeons, pathologists, and radiologists is essential to avoid unnecessary mastectomies. Cases of IGM are reported during antidepressant therapy in patients also showing high levels of prolactinemia. In these cases, we believe that surgical excision must be avoided being replaced with a conservative management of the pathological condition based on a corticosteroid treatment.
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Affiliation(s)
- Maurizio Bellavia
- University Hospital "P. Giaccone", University of Palermo School of Medicine, Palermo, Italy
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Spinelli G, Damiano G, Palumbo VD, Sammartano A, Maione C, Marrazzo A, Bellavia M, Barone R, Buscemi G, Lo Monte AI. Ileus following spontaneous jejunum intramural hematoma: case report and review of the literature. Acta Clin Croat 2012; 51:435-439. [PMID: 23330410] [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: 06/01/2023] Open
Abstract
Anticoagulant therapy may cause the onset of a spontaneous intramural hematoma of the small bowel, in the jejunum, ileum or duodenum. A 53-year-old woman on therapy with heparin for previous pulmonary embolism was admitted for abdominal pain and vomit. Computed tomography scan visualized an intramural hematoma of the jejunum causing subtotal obstruction of the intestinal lumen. The patient underwent resection of a part of the jejunum, securing intestinal continuity by a mechanical side-to-side anastomosis. The postoperative course was regular, but the initial anticoagulant therapy was reduced to prevent recurrence. In conclusion, spontaneous hematoma of small bowel can occur as a complication of anticoagulant therapy. The clinical picture and rapid diagnosis indicate medical or surgical therapy.
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Affiliation(s)
- Gabriele Spinelli
- Facoltà di Medicina e Chirurgia, Universita degli Studi di Palermo, Palermo, Italy
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Lo Monte AI, Bellavia M, Damiano G, Concetta Gioviale M, Maione C, Palumbo VD, Spinelli G, Tripodo C, Cacciabaudo F, Sammartano A, Buscemi S, De Luca S, Di Ganci S, Buscemi G. A complex case of fatal calciphylaxis in a female patient with hyperparathyroidism secondary to end stage renal disease of graft and coexistence of haemolytic uremic syndrome. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 156:262-5. [DOI: 10.5507/bp.2012.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 01/31/2012] [Indexed: 11/23/2022] Open
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Lo Monte AI, Bellavia M, Maione C, Damiano G, Gioviale MC, Palumbo V, Spinelli G, Tripodo C, Cacciabaudo F, Sammartano A, Buscemi G. Sistemic calciphylaxis and thrombotic microangiopathy in a kidney transplant patient: two mixing fatal syndromes? Med Hypotheses 2012; 79:74-5. [PMID: 22541862 DOI: 10.1016/j.mehy.2012.04.004] [Citation(s) in RCA: 6] [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] [Received: 09/01/2011] [Accepted: 04/01/2012] [Indexed: 10/28/2022]
Abstract
Abnormalities in calcium and phosphorus metabolism are common and metabolic bone diseases develop often in patients with chronic renal failure (CRF). Effective clinical management includes measures to control phosphorus retention and prevent hyperphosphataemia, to maintain serum calcium concentrations within the normal range and to prevent excess parathyroid hormone (PTH) secretion by the judicious use of vitamin D sterols. Certain of these interventions, however, appear to increase the risk of soft tissue and vascular calcification in patients with End Stage Renal Disease (ESRD), so current therapeutic approaches are thus being re-evaluated in an effort to limit these risks. Patients with calciphylaxis have an extremely high mortality rate, diagnosis requires a high degree of clinical suspicion and the role and extent of parathyroidectomy in the management of this condition remain controversial. In some cases renal transplant patients could suffer from a comorbidity in which vascular function is compromised not only by secondary hyperparathyroidism-related calcification but also by other pathological condition as haemolytic uremic syndrome (HUS), leading to a fatal clinical outcome. We postulate that in these cases a secondary hyperparathyroidism not properly diagnosed in an early phase of the renal disease (probably before the kidney transplant) could cause a vascular calcification which, adding to the pre-existing HUS-related vascular compromission, gave rise to catastrophic clinical consequences. In the management of ESRD patients, in particular in the cases of pre-existing angiopathies, could be therefore crucial the early and proper diagnosis of an alteration of calcium-posphorus metabolism and effort of medicine could be oriented in these cases also towards identification of screening methodologies to undoubtedly assess such a diagnosis.
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Affiliation(s)
- Attilio Ignazio Lo Monte
- Department of Surgical and Oncological Disciplines, University of Palermo, School of Medicine, Palermo, Italy.
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Lo Monte AI, Damiano G, Palumbo VD, Zumbino C, Spinelli G, Sammartano A, Bellavia M, Buscemi G. Eight-point Compass Rose Underlay Technique in 72 Consecutive Elderly Patients with Large Incisional Hernia. INT J GERONTOL 2011. [DOI: 10.1016/j.ijge.2011.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Frazzetta M, Tornambè A, Barrera T, Sciortino A, Lucania M, Frazzetta F, Sammartano A, Bonventre S, Vetri R. [Adrenal incidentaloma: case report and synthesis of indication and thresholds of surgery therapy]. G Chir 2010; 31:534-536. [PMID: 21232199] [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: 05/30/2023]
Abstract
With the term of incidental mass, any mass is identified, occasionally discovered with imaging techniques, in the absence of specific symptoms. In 1982, the term "incidentaloma" was introduced to indicate lesions detected on adrenal regions, found unexpectedly. The incidence percentages vary from 0.6%-3% in CT followed by other indications , to 10% and 25% in all patients who underwent an ultrasound, CT or MRI. An appropriate diagnostic protocol is mandatory to identify and to choose the proper treatment for the functioning lesions, as well as the malignant or potentially malignant lesions (1, 2). Incidentalomas with diameters under 1 cm seem to not have a pathologic significance, and are considered like manifestation of the gland involution in advanced-age subjects, and can remain unseen for a long time. The use of diagnostic imaging techniques has made it possible to identify these masses, even those of small size, in the course of diagnostic surveys done under various guidelines. The mass dimensions are a fundamental parameter used to distinguish benign lesions from malign ones (2, 3). Most Authors suspect malignity in masses above 5-6 cm, while considering those with a diameter under 3 cm to be benign. Whereas the rest remain undefined, thereby valued and treated according to criteria not perfectly established.
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Frazzetta M, Raimondo D, Furgiuele G, Sammartano A, Romito F, Frazzetta F, Lucania M, Piccolo CL, Bonventre S. Gastric polypoid lesions. Our experience. G Chir 2010; 31:162-166. [PMID: 20444334] [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: 05/29/2023]
Abstract
BACKGROUND AND AIM The Authors report the results of their experience on polypoids lesions of the stomach and on endoscopic polypectomies. PATIENTS AND METHODS A study on 2000 OGD (oesophagogastroduodenoscopy) has been carried out on 95 patients with polypoid lesions. The authors have analysed the associations existing between histological type and symptomatology and localisation of the lesion and the status of the Helicobacter pylori and the risk of cancerization. The data were confronted with the ones already available. RESULTS In the majority of the cases, the polypoid lesions were asymptomatic, the localization changed according to the histological type, with the antrum as the most affected area. The presence of Helicobacter pylori does not seem to be correlated to the lesion, except in the case of hyperplastic polyps. The percentage of risks of cancerization increased in case of adenomatous polyps. In one patient signet ring cell carcinoma within a gastric polyp was found. Gastric signet ring cell carcinomas are peculiar for their rarity as well as for the growth in polypoid lesions. CONCLUSION We confirm the higher frequency of hyperplastic polyps and the correlation between histological type and localization. Endoscopic polipectomy is the first approach in gastric polyps, with lower risk of developing cancer. Only in selected cases, as in one in ours, it is advisable the surgery.
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Affiliation(s)
- M Frazzetta
- Department of Surgical and Oncological Sciences, University of Palermo, Italy
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Arcara M, Sammartano A, Patti R, Vitello G, Di Vita G. [Bilateral testicular lymphoma. Case report]. G Chir 2008; 29:493-495. [PMID: 19068187] [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: 05/27/2023]
Abstract
A case of bilateral testicular lymphoma with involvement of skin and oropharynx was described. After a review of literature, the Authors underline the clinical features focusing the diagnostic approaches and the therapeutics options.
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Affiliation(s)
- M Arcara
- Università degli Studi di Palermo, Dipartimento di Discipline Chirurgiche ed Oncologiche, Cattera di Chirurgia Generale
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Bonventre S, Frazzetta M, Sammartano A, Di Trapani B, Tavormina A, Sciortino AS, Frazzetta F, Lucania M, Di Gesù G. [Infected pancreatic pseudocysts: technical notes]. G Chir 2008; 29:265-270. [PMID: 18544262] [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: 05/26/2023]
Abstract
INTRODUCTION Starting from the observation of 9 cases of giant infected pancreatic cysts, which occurred from 1994 to 2004 at the Department of Oncological and Surgical Studies, the Authors' aim has been to evaluate whether a more thorough necrosectomy, carried-out under video-endoscopic control, associated with a nose-gastro-cavity tube, which ensures a continuous cleansing of the newly-formed cavity, and an appropriate positioning of the drainages, could reduce the morbidity and allow a shorter recovery of the infected pseudocysts. PATIENTS AND METHODS Of 73 cases of acute pancreatitis, observed from 1994 to 2004, 9 showed severe and acute pancreatitis, which included giant pseudocysts, as revealed by the abdomen angio-TC. Our nine septic patients underwent cysto-gastro-anastomosis, necrosectomy, intraoperative cleansing of the cavity with an antibiotic solution and positioning of multiple drainages. Three of these patients also underwent a thorough and targeted necrosectomy, assisted by a trans-anastomotic video-endoscopy. A nose-gastro-cavity tube has been placed in all the patients. RESULTS The disappearance of the septic state in our three patients who underwent a targeted video-assisted necrosectomy occurred after three days of treatment; moreover, the abdomen angio-TC on the 5th postoperative day showed the disappearance of the necrotic areas. The recovery of these three patients was significantly shorter, compared to those undergoing traditional treatment (cysto-gastro-anastomosis, standard necrosectomy and positioning of abdominal drainages). CONCLUSIONS Our surgical video-assisted technique demonstrated that, with a slight increase in the operative time, a better control over sepsis may be accomplished, as well as a reduction of the post-operative morbidity, which leads to shorter hospitalisation of patients with infected pancreatic pseudocysts.
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Affiliation(s)
- S Bonventre
- Università degli Studi di Palermo, Dipartimento di Discpline Chirurgiche e Oncologiche, Cattedra di Chirurgia Generale e Fisiopatologia Chirurgica, Italy
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Sammartano A, Frazzetta M, Furgiuele G, Frazzetta F, De Simone G, Vetri G, Di Gesù G. [Gallstone ileus: diagnosis and treatment. Case report]. G Chir 2006; 27:363-7. [PMID: 17147848] [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: 05/12/2023]
Abstract
The authors present a case of gallstone intermittent ileus caused by the passage of a big gallstone (about 4 cm in diameter) in the intestinal lumen, through a cholecystoduodenal fistula. They emphasize the peculiarity of the case for the characteristics of symptoms and for casual diagnostic check-up with a ultrasonography. The disease is not frequently diagnosed; today it has a safe recognition by modern imaging. The symptoms can be intermittent and, even when there are the classic signs of intestinal occlusion, the site of the occlusion is various. With a timely endoscopical or surgical approach (open or laparoscopic) it is possible to reduce mortality of patients treated in emergency.
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Affiliation(s)
- A Sammartano
- Università degli Studi di Palermo, Dipartimento di Discipline Chirurgiche ed Oncologiche
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Frazzetta M, Furgiuele G, Raimondo D, Sammartano A, Mannino E, De Simone G, Vetri G, Bonventre S, Di Gesú G. [Ultrasonic dissector for total thyroidectomy: results of prospective randomized study]. G Chir 2005; 26:295-301. [PMID: 16329770] [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: 05/05/2023]
Abstract
In the last years, the introduction and employment in surgery of the dissectors of last generation (ultrasounds, radiofrequency, etc.) have contributed to a remarkable improvement and simplification of the performances and the surgical techniques. The present study has the aim to verify, on the basis of the experience made in the last two years and through a careful comparisons with operations performed in the usual way, the advantages of employment of ultrasonic dissector in thyroid surgery and if besides such advantages it is possible to obtain real and substantial reductions of the complications. To such aim a randomized perspective study has been lead, confronting two groups of 60 patients, submitted to total thyroidectomy in Chair of General Surgery and Surgical Physiopathology of the University of Palermo-Complex Operating Unit of General Surgery. In all patients have been considered age, sex, histological diagnosis, length of the incision, time (from the incision until suture of skin), entity of the bleeding, hospital stay, post-operative consequences and total costs of thyroidectomy. The elaboration of the obtained data shows the advantages following to the use of the dissectors of last generation: reduction of the times, reduction of the complications, better tolerance of the operation by patients, better rationalization of the resources.
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Affiliation(s)
- M Frazzetta
- Università degli Studi di Palermo, Dipartimento di Discipline Chirurgiche ed Oncologiche Cattedra di Chirurgia Generale e di Fisiopatologia Chirurgica
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Franzetta M, Raimondo D, Giammanco M, Di Trapani B, Passariello P, Sammartano A, Di Gesù G. Prognostic factors of cirrhotic patients in extra-hepatic surgery. MINERVA CHIR 2003; 58:541-4. [PMID: 14603166] [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: 04/27/2023]
Abstract
BACKGROUND The surgical approach to a cirrhotic patient is conditioned by a number of variables depending on the emergency and kind of the intervention. It is also related to the evolutionary stage of the liver pathology (evaluated following Child-Pugh score). The present study will explore the physiopathologic mechanisms which should be correlated with the preoperative risk factors responsible for the variation of morbidity and mortality of the hepatopathic patient addressed to an extrahepatic surgical intervention. METHODS This study includes a retrospective analysis (from 1992 to 1999) of 40 patients with cirrhosis (80% HCV correlated cirrhosis, 15.5% alcoholic cirrhosis, 2.5% cryptogenic cirrhosis), who underwent such procedures as: colon resection (5), gastrectomy (4), hernioplasty (11), cholecystectomy (14), ulcorraphy (3), laparotomy (3). Patients with hepatic resection and portal shunt are excluded from this study. A pre- and postoperative evaluation of ascites, PT, APTT, albumin, bilirubin and protein value, number of leukocytes and Child-Pugh score was performed on all patients. Their follow-up was 30 days. RESULTS The presence of tensive ascites, low albumin value, PT, APTT, together with the emergency of the operation, proved to be significant (p<0.001), in correlation with a mortality of 7.1% in Child's class A, of 23% in class B, and of 84% in class C. CONCLUSIONS Cirrhotic patients undergoing elective or emergency surgery can incur significant preoperative risks and postoperative complications, increasing their mortality rate. An accurate preoperative predictive factor is Child's class.
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Affiliation(s)
- M Franzetta
- Department of Surgery, Anatomy and Oncology, University of Palermo, Palermo, Italy.
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Giammanco M, Caldiero G, Raimondo D, Sammartano A, Frazzetta M, Vetri G, Di Gesù G. Artificial nutrition for the treatment of short bowel syndrome. MINERVA CHIR 2003; 58:545-9. [PMID: 14603167] [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: 04/27/2023]
Abstract
BACKGROUND In the short bowel syndromes (SBS) it is often difficult to grant a correct and sufficient alimentary supply only by ordinary natural nutrition. In the present research, we will study the prospective possibilities of integrating the nutritional supply making resort to artificial nutrition techniques in patients with SBS. METHODS We have treated 7 patients with SBS, 6 males and 1 female, whose age was ranging from 29 and 70 years. They all underwent wide intestinal resection, 2 of them for massive infarct, 4 for Crohn's disease, 1 for bowel volvolus. An evaluation of nutritional and immunological conditions was performed on all of them, determining: albumin, transferrin, C-reactive protein, prealbumin, leukocyte count, skin test. In a second time, a protocol was implemented, based on total parenteral nutrition for the first 5 days, with scalar calorie supply up to a total of 35 kcal/kg/die; on day 6 after the operation, the parenteral caloric supply was reduced of 500 kcal/die, being compensated by the introduction of an equal caloric ration by nasointestinal tube with peristaltic pump having a flow of 20 mL/h. In the following days, the parenteral caloric supply was reduced of 500 cal each 48 hours, being substituted with an equal enteral supply in order to progressively reach a complete abandonment of parenteral nutrition. RESULTS All the patients have a follow-up of 2 to 5 years; today they follow a high-calorie hyperglycidic, hypolipidic diet; no signs of malnutrition are shown by clinical and laboratory analysis. CONCLUSIONS In the light of the data in our possession, it can be understood that nutritional therapy is the main treatment for SBS; parenteral subministration has to be abandoned during the postoperatory course to give way to enteral nutrition, in order to create a physiological stimulus able to make the digestive system rapidly adapt to the new situation.
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Affiliation(s)
- M Giammanco
- Unit of Surgical Pathophysiology, Division of General Surgery, Department of Surgery, Anatomy and Oncological Science, University of Palermo, Palermo, Italy
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