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Valerii G, Ormando VM, Cellini C, Sacco L, Barbera C. Endoscopic management of intramural spontaneous duodenal hematoma: A case report. World J Gastroenterol 2022; 28:2243-2247. [PMID: 35721883 PMCID: PMC9157618 DOI: 10.3748/wjg.v28.i20.2243] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/12/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intramural duodenal hematoma is a rare condition described for the first time in 1838. This condition is usually associated with blunt abdominal trauma in children. Other non-traumatic risk factors for spontaneous duodenal haematoma include several pancreatic diseases, coagulation disorders, malignancy, collagenosis, peptic ulcers, vasculitis and upper endoscopy procedures. In adults the most common risk factor reported is anticoagulation therapy. The clinical presentation may vary from mild abdominal pain to acute abdomen and intestinal obstruction or gastrointestinal bleeding.
CASE SUMMARY The aim of this case summary is to show a case of intramural spontaneous hematoma with symptoms of intestinal obstruction that was properly drained endoscopically by an innovative system lumen-apposing metal stent Hot AXIOS™ stent (Boston Scientific Corp., Marlborough, MA, United States).
CONCLUSION Endoscopic lumen-apposing metal stent Hot AXIOS™ stent is a safe and feasible treatment of duodenal intramural hematoma in our case.
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Affiliation(s)
- Giorgio Valerii
- Gastroenterology and Endoscopy Unit, Ospedale G. Mazzini, Teramo 64100, Italy
| | | | - Carlo Cellini
- Gastroenterology and Endoscopy Unit, Ospedale G. Mazzini, Teramo 64100, Italy
| | - Luca Sacco
- Surgery Unit, Ospedale G. Mazzini, Teramo 64100, Italy
| | - Carmelo Barbera
- Gastroenterology and Endoscopy Unit, Ospedale G. Mazzini, Teramo 64100, Italy
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Merli F, Luminari S, Salvi F, Cavallo F, Gini G, Musuraca G, Gaidano G, Cellini C, Merli M, Ferrari A, Molinari A, Liberati A, Conconi A, Matteucci P, Pozzi S, Musso M, Mammi C, Monaco F, Ferrero S, Tucci A. OBINUTUZUMAB-MINICHOP FOR THE TREATMENT OF ELDERLY UNFIT PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA. A STUDY OF THE FONDAZIONE ITALIANA LINFOMI. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_44] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- F. Merli
- Hematology; Arcispedale Santa Maria Nuova-IRCCS; Reggio Emilia Italy
| | - S. Luminari
- Hematology; Arcispedale Santa Maria Nuova-IRCCS and University of Modena and Reggio Emilia; Reggio Emilia Italy
| | - F. Salvi
- Hematology Unit; Antonio e Biagio e Cesare Arrigo Hospital; Alessandria Italy
| | - F. Cavallo
- Division of Hematology; University of Torino; Torino Italy
| | - G. Gini
- Division of Hematology; Ospedali Riuniti; Ancona Italy
| | - G. Musuraca
- Hematology Unit; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS; Meldola (FC) Italy
| | - G. Gaidano
- Division of Hematology, Department of Translational Medicine; Amedeo Avogadro University of Eastern Piedmont; Novara Italy
| | - C. Cellini
- Hematology Unit; Santa Maria delle Croci Hospital; Ravenna Italy
| | - M. Merli
- Division of Hematology; University Hospital “Ospedale di Circolo e Fondazione Macchi-ASST Sette Laghi”; Varese Italy
| | - A. Ferrari
- Hematology; Arcispedale Santa Maria Nuova-IRCCS; Reggio Emilia Italy
| | - A. Molinari
- Hematology; Ospedale degli Infermi; Rimini (FC) Italy
| | - A.M. Liberati
- Department of Oncohematology; S.Maria Hospital; Terni Italy
| | - A. Conconi
- Unit of Hematology; Department of Internal Medicine, Ospedale degli Infermi; Ponderano (BI) Italy
| | - P. Matteucci
- Haematology and Bone Marrow Transplantation Unit; Fondazione IRCCS Istituto Nazionale dei Tumori; Milan Italy
| | - S. Pozzi
- Department of Diagnostic, Clinical and Public Health Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - M. Musso
- Division of Hematology; La Maddalena Hospital; Palermo Italy
| | - C. Mammi
- GRADE onlus; Gruppo Amici dell'Ematologia; Reggio Emilia Italy
| | - F. Monaco
- Hematology Unit; Antonio e Biagio e Cesare Arrigo Hospital; Alessandria Italy
| | - S. Ferrero
- Division of Hematology; University of Torino; Torino Italy
| | - A. Tucci
- Hematology; Spedali Civili Hospital; Brescia Italy
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Manta R, Caruso A, Cellini C, Sica M, Zullo A, Mirante VG, Bertani H, Frazzoni M, Mutignani M, Galloro G, Conigliaro R. Endoscopic management of patients with post-surgical leaks involving the gastrointestinal tract: A large case series. United European Gastroenterol J 2016; 4:770-777. [PMID: 28408994 DOI: 10.1177/2050640615626051] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 08/04/2015] [Accepted: 12/13/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Post-surgical anastomotic leaks often require a re-intervention, are associated with a definite morbidity and mortality, and with relevant costs. We described a large series of patients with different post-surgical leaks involving the gastrointestinal tract managed with endoscopy as initial approach. METHODS This was a retrospective analysis of prospectively collected cases with anastomotic leaks managed with different endoscopic approaches (with surgical or radiological drainage when needed) in two endoscopic centres during 5 years. Interventions included: (1) over-the-scope clip (OTSC) positioning; (2) placement of a covered self-expanding metal stent (SEMS); (3) fibrin glue injection (Tissucol); and (4) endo-sponge application, according to both the endoscopic feature and patient's status. RESULTS A total of 76 patients underwent endoscopic treatment for a leak either in the upper (47 cases) or lower (29 cases) gastrointestinal tract, and the approach was successful in 39 (83%) and 22 (75.9%) patients, respectively, accounting for an overall 80.3% success rate. Leak closure was achieved in 84.9% and 78.3% of patients managed by using a single or a combination of endoscopic devices. Overall, leak closure failed in 15 (19.7%) patients, and the surgical approach was successful in all 14 patients who underwent re-intervention, whilst one patient died due to sepsis at 7 days. CONCLUSIONS Our data suggest that an endoscopic approach, with surgical or radiological drainage when needed, is successful and safe in the majority of patients with anastomotic gastrointestinal leaks. Therefore, an endoscopic treatment could be attempted before resorting to more invasive, costly and risky re-intervention.
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Affiliation(s)
- Raffaele Manta
- Surgical Digestive Diagnostic and Interventional Endoscopy, "Niguarda-Cà Granda" Hospital, Milan, Italy
| | - Angelo Caruso
- Gastroenterology and Endoscopy Unit, "Nuovo S. Agostino" Hospital, Modena, Italy
| | - Carlo Cellini
- Gastroenterology and Endoscopy Unit, "Nuovo S. Agostino" Hospital, Modena, Italy
| | - Mariano Sica
- Gastroenterology and Endoscopy Unit, "Nuovo S. Agostino" Hospital, Modena, Italy
| | - Angelo Zullo
- Gastroenterology and Digestive Endoscopy, "Nuovo Regina Margherita" Hospital, Rome, Italy
| | | | - Helga Bertani
- Gastroenterology and Endoscopy Unit, "Nuovo S. Agostino" Hospital, Modena, Italy
| | - Marzio Frazzoni
- Digestive Physiopathology Unit, Baggiovara Hospital, Modena, Italy
| | - Massimiliano Mutignani
- Surgical Digestive Diagnostic and Interventional Endoscopy, "Niguarda-Cà Granda" Hospital, Milan, Italy
| | - Giuseppe Galloro
- Department of Clinical Medicine and Surgery, Unit of Surgical Digestive Endoscopy, Federico II University of Naples, Naples, Italy
| | - Rita Conigliaro
- Gastroenterology and Endoscopy Unit, "Nuovo S. Agostino" Hospital, Modena, Italy
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D'Amario D, Leone AM, Iaconelli A, Luciani N, Gaudino M, Kannappan R, Manchi M, Severino A, Shin SH, Graziani F, Biasillo G, Macchione A, Smaldone C, Cellini C, Siracusano A, Ottaviani L, Massetti M, Goichberg P, Leri A, Anversa P, Crea F. Response to letter regarding article, "growth properties of cardiac stem cells are a novel biomarker of patients' outcome after coronary bypass surgery". Circulation 2015; 130:e118-9. [PMID: 25245852 DOI: 10.1161/circulationaha.114.010924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/16/2022]
Affiliation(s)
- Domenico D'Amario
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio M Leone
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Iaconelli
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Nicola Luciani
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Mario Gaudino
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Ramaswamy Kannappan
- Departments of Anesthesia and Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Melissa Manchi
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Severino
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Sang Hun Shin
- Departments of Anesthesia and Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Francesca Graziani
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Gina Biasillo
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Macchione
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Costantino Smaldone
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Cellini
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Siracusano
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Lara Ottaviani
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Polina Goichberg
- Departments of Anesthesia and Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Annarosa Leri
- Departments of Anesthesia and Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Piero Anversa
- Departments of Anesthesia and Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Pragliola C, Chello M, Gaudino M, Mazza A, Cellini C, Spadaccio C, Covino E. Long-term results of an open flexible prosthetic band for mitral insufficiency. Asian Cardiovasc Thorac Ann 2014; 22:811-5. [PMID: 24585286 DOI: 10.1177/0218492314520747] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND use of a prosthetic ring is an integral part of any mitral valve repair and can influence the long-term stability of the results. We evaluated the long-term results of the AnnuloFlex ring implanted as an open flexible band in patients affected by degenerative mitral disease. METHODS between 2001 and 2010, 82 patients (52 women, 30 men) with a mean age of 62 years, underwent repair of a prolapsing mitral valve with an AnnuloFlex band. One patient was reoperated on for a technical error and received a mechanical prosthesis, 3 were missing at follow-up, and the other 78 were prospectively followed up with clinical interviews and transthoracic echocardiography. RESULTS the mean follow-up was 7.0 ± 1.8 years. Six patients died; 2 deaths were considered valve-related. The overall survival estimate at 10 years was 88.6% (95% confidence interval: 76.1%-94.8%). Freedom from endocarditis was 97.1% (95% confidence interval: 89.1%-98.5%). Freedom from thrombosis or hemorrhage was 93.7% (95% confidence interval: 81.6%-97.9%). Freedom from new or increased regurgitation was 93.1% (95% confidence interval: 87.3%-97.3%). The cumulative freedom from any valve-related event was 78.6% (95% confidence interval: 69.7%-97.1%). A single case of systolic anterior motion occurred before hospital discharge. CONCLUSION the long-term results of the AnnuloFlex band are excellent and stable.
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Affiliation(s)
- Claudio Pragliola
- Department of Cardiovascular Science, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Chello
- Division of Cardiac Surgery, Università Campus Biomedico, Rome, Italy
| | - Mario Gaudino
- Department of Cardiovascular Science, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Mazza
- Department of Cardiovascular Science, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Cellini
- Department of Cardiovascular Science, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Elvio Covino
- Division of Cardiac Surgery, Università Campus Biomedico, Rome, Italy
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Offidani M, Corvatta L, Maracci L, Liberati AM, Ballanti S, Attolico I, Caraffa P, Alesiani F, Caravita di Toritto T, Gentili S, Tosi P, Brunori M, Derudas D, Ledda A, Gozzetti A, Cellini C, Malerba L, Mele A, Andriani A, Galimberti S, Mondello P, Pulini S, Coppetelli U, Fraticelli P, Olivieri A, Leoni P. Efficacy and tolerability of bendamustine, bortezomib and dexamethasone in patients with relapsed-refractory multiple myeloma: a phase II study. Blood Cancer J 2013; 3:e162. [PMID: 24270324 PMCID: PMC3880441 DOI: 10.1038/bcj.2013.58] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 09/25/2013] [Indexed: 11/25/2022] Open
Abstract
Bendamustine demonstrated synergistic efficacy with bortezomib against multiple myeloma (MM) cells in vitro and seems an effective treatment for relapsed-refractory MM (rrMM). This phase II study evaluated bendamustine plus bortezomib and dexamethasone (BVD) administered over six 28-day cycles and then every 56 days for six further cycles in patients with rrMM treated with ⩽4 prior therapies and not refractory to bortezomib. The primary study end point was the overall response rate after four cycles. In total, 75 patients were enrolled, of median age 68 years. All patients had received targeted agents, 83% had 1–2 prior therapies and 33% were refractory to the last treatment. The response rate⩾partial response (PR) was 71.5% (16% complete response, 18.5% very good PR, 37% partial remission). At 12 months of follow-up, median time-to-progression (TTP) was 16.5 months and 1-year overall survival was 78%. According to Cox regression analysis, only prior therapy with bortezomib plus lenalidomide significantly reduced TTP (9 vs 17 months; hazard ratio=4.5; P=0.005). The main severe side effects were thrombocytopenia (30.5%), neutropenia (18.5%), infections (12%), neuropathy (8%) and gastrointestinal and cardiovascular events (both 6.5%). The BVD regimen is feasible, effective and well-tolerated in difficult-to-treat patients with rrMM.
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Affiliation(s)
- M Offidani
- Clinica di Ematologia, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
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7
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D'Amario D, Leone AM, Iaconelli A, Luciani N, Gaudino M, Kannappan R, Manchi M, Severino A, Shin SH, Graziani F, Biasillo G, Macchione A, Smaldone C, De Maria GL, Cellini C, Siracusano A, Ottaviani L, Massetti M, Goichberg P, Leri A, Anversa P, Crea F. Growth properties of cardiac stem cells are a novel biomarker of patients' outcome after coronary bypass surgery. Circulation 2013; 129:157-72. [PMID: 24249720 DOI: 10.1161/circulationaha.113.006591] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [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] [Indexed: 12/21/2022]
Abstract
BACKGROUND The efficacy of bypass surgery in patients with ischemic cardiomyopathy is not easily predictable; preoperative clinical conditions may be similar, but the outcome may differ significantly. We hypothesized that the growth reserve of cardiac stem cells (CSCs) and circulating cytokines promoting CSC activation are critical determinants of ventricular remodeling in this patient population. METHODS AND RESULTS To document the growth kinetics of CSCs, population-doubling time, telomere length, telomerase activity, and insulin-like growth factor-1 receptor expression were measured in CSCs isolated from 38 patients undergoing bypass surgery. Additionally, the blood levels of insulin-like growth factor-1, hepatocyte growth factor, and vascular endothelial growth factor were evaluated. The variables of CSC growth were expressed as a function of the changes in wall thickness, chamber diameter and volume, ventricular mass-to-chamber volume ratio, and ejection fraction, before and 12 months after surgery. A high correlation was found between indices of CSC function and cardiac anatomy. Negative ventricular remodeling was not observed if CSCs retained a significant growth reserve. The high concentration of insulin-like growth factor-1 systemically pointed to the insulin-like growth factor-1-insulin-like growth factor-1 receptor system as a major player in the adaptive response of the myocardium. hepatocyte growth factor, a mediator of CSC migration, was also high in these patients preoperatively, as was vascular endothelial growth factor, possibly reflecting the vascular growth needed before bypass surgery. Conversely, a decline in CSC growth was coupled with wall thinning, chamber dilation, and depressed ejection fraction. CONCLUSIONS The telomere-telomerase axis, population-doubling time, and insulin-like growth factor-1 receptor expression in CSCs, together with a high circulating level of insulin-like growth factor-1, represent a novel biomarker able to predict the evolution of ischemic cardiomyopathy following revascularization.
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Affiliation(s)
- Domenico D'Amario
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy (D.D'A., A.M.L., A.I., N.L., M.G., M. Manchi, A. Severino, F.G., G.B., A.M., C.S., G.L.D.M., C.C., A. Siracusano, L.O., M. Massetti, F.C.); and Departments of Anesthesia and Medicine, and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.D'A., R.K., S.H.S., P.G., A.L., P.A.)
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Cellini C, Deeb AP, Sharma A, Monson JRT, Fleming FJ. Association between operative approach and complications in patients undergoing Hartmann's reversal. Br J Surg 2013; 100:1094-9. [PMID: 23696424 DOI: 10.1002/bjs.9153] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Complications following reversal of Hartmann's procedure are common, with morbidity rates of up to 50 per cent, and a mortality rate as high as 10 per cent. This is based on case series with heterogeneous data collection and analysis. This study determined risk factors for complications following Hartmann's reversal. METHODS Patients who underwent elective open and laparoscopic Hartmann's reversal were identified from the American College of Surgeons National Surgical Quality Improvement Program database (2005-2010). The programme collects patient demographics, preoperative medical history, clinical findings and laboratory investigations. Postdischarge data were obtained by a certified reviewer. Complications were categorized as major, septic or incisional. Risk-adjusted 30-day outcomes were assessed by univariable and multivariable analyses, adjusting for patient characteristics, co-morbidity and operative approach. RESULTS During the study period 7996 patients had a Hartmann's procedure and 2567 cases of Hartmann's reversal were identified, including 336 laparoscopic procedures (13·1 per cent). Major, septic and incisional complication rates were 13·3, 8·5 and 15·7 per cent respectively, with a mortality rate of 0·5 per cent. A laparoscopic approach was found to be independently associated with fewer major (odds ratio (OR) 0·53, 95 per cent confidence interval 0·34 to 0·81), septic (OR 0·48, 0·27 to 0·83) and incisional (OR 0·54, 0·37 to 0·80) complications. A history of chronic obstructive pulmonary disease (OR 1·78-2·00), steroid use (OR 1·75), body mass index at least 30 kg/m² (OR 1·48), diabetes (OR 1·40), smoking (OR 1·33-1·40), American Society of Anesthesiologists fitness grade III and IV (OR 1·46-1·48) and prolonged operating time (OR 1·02) were other factors associated with complications. CONCLUSION A laparoscopic approach to Hartmann's reversal was associated with fewer complications than open surgery in this highly selected group of patients.
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Affiliation(s)
- C Cellini
- Division of Colorectal Surgery and Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, NY 14642, USA
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9
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Costantini R, Caldaralo F, Palmieri C, Napolitano L, Aceto L, Cellini C, Innocenti P. Risk factors for conversion of laparoscopic cholecystectomy. Ann Ital Chir 2012; 83:245-252. [PMID: 22610122] [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]
Abstract
BACKGROUND Conversion during laparoscopic cholecystectomy has adverse effects on operating time, postoperative morbidity and hospital costs. Identifying risk factors for conversion is thus important to help surgeons to plan and counsel the patient and arranging operating schedules accordingly. This study evaluated retrospectively preoperative and intraoperative risk factors for conversion in 906 laparoscopic cholecystectomies for gallbladder calculosis. METHODS Examined preoperative variables were: age, sex, obesity, arterial hypertension, diabetes, previous acute myocardial infarction, chronic obstructive pulmonary disease, non-ischemic heart disease, chronic hepatitis, hepatic cirrhosis, previous pancreatitis, biliary colics, endoscopic retrograde cholangiopancreatography (ERCP) and abdominal or cardiac surgery,as well as pain, fever, a high white blood cell count, ultrasound signs of cholecystitis at hospitalization. Intraoperative variables were: adhesiolysis, associated hepatic biopsy. RESULTS Twenty-five operations were converted (conversion rate: 2.76%). Factors significantly associated with conversion were: age over 60 years, diabetes, previous supramesocolic abdominal surgery, ultrasound signs of cholecystitis, white cell count over 9x10(3)/dl, previous acute myocardial infarction and preoperative ERCP, intraoperative adhesiolysis (0.001<p<0.05). CONCLUSION Systematic evaluation of these factors in patients scheduled for laparoscopic cholecystectomy may help predict difficulties of the procedure, allow patients to be better informed about possible conversion, and optimize the planning of interventions for cases at risk.
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10
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Pompei A, Toniato E, Innocenti P, D Alimonte I, Cellini C, Mattoscio D, Cotellese R, Bosco D, Ciccarelli R, Dadorante V, D Orazio N, Martinotti S, Robuffo I. Cyanidin reduces preadipocyte differentiation and relative ChREBP expression. J BIOL REG HOMEOS AG 2012; 26:253-264. [PMID: 22824753] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Adipogenesis is a continuous process even in adult adipose tissue for the presence of preadipocytes that, when subjected to appropriate stimuli can proliferate and differentiate. ChREBP, the essential transcription factor for lipogenesis, is expressed in all tissues, but mainly in lipogenic organs. In this study, we focused on ChREBP expression during preadipocytes differentiation. Since it was found that cyanidin-3 reduces body weight in mice even in the presence of a high-fat diet, by decreasing levels of blood glucose and by improving insulin sensitivity, we studied the effect of this substance on adipogenic differentiation. For this purpose we used preadipocytes obtained from subcutaneous and visceral human adipose explant tissue, characterized and stimulated to differentiate in selective media. On cytofluorimetric analysis these cells showed mesenchymal markers (CD29, CD90, CD44), whereas they were negative for hematopoietic markers (CD45, CD10, CD117,CD31). ChREBP expression levels were quantified by immunoelectron-microscopy and western blotting analysis. In this report we show that ChREBP is expressed in preadipocytes (both nuclear and cytoplasmic compartments); the cytoplasmic level of ChREBP increased by 50 percent on day seven of differentiation into mature adipocytes. Cyanidin reduced differentiation by 20 percent (as evaluated by red oil O staining) and the expression of ChREBP. In addition, cyanidin-treated cells showed abnormal morphology, a square shape with irregular size, probably due to the fact that cyanidin may interfere with the extracellular matrix. These findings suggest that dietary cyanidin, may have inhibitory effects on adipogenesis.
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Affiliation(s)
- A Pompei
- Institute of Molecular Genetics, National Research Council, Chieti, Italy
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11
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Napolitano L, Cellini C, Iacovetta D, Waku M, Innocenti P. [Low rectal cancer: therapeutic options and clinical experience of a single center]. G Chir 2011; 32:123-127. [PMID: 21453590] [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
INTRODUCTION Currently the therapeutic gold standard for medium and low rectal tumours is the "en-bloc" excision of the rectum and total mesorectal excision (TME) preserving the autonomous nerve plexus. In very distal tumours, complex procedures such as very low anterior resections and intersphincteric resections are used where possible. These procedures can avoid incapacitating operations such as abdominoperineal amputation. The possibilities to perform these procedures even by laparoscopic means, with regard to it's advantages, are still under evaluation. The authors describe their own clinical experiences using such methods. PATIENTS AND METHODS From 2005 to 2010, we performed by laparoscopic procedure 3 anterior resections and 3 inter-sphincteric resections for cancer of the low rectum . Medium age of patients was 70 years (range 52-80 years) and male to female ratio was 4/2. Mean operative time was 260 min ( range 220 - 360 min). No laparoscopic procedure was converted to the traditional open surgery. We noted 2 anastomotic leakages of which one required re-operation. Two patients were classified T2 (1 N0 and 1 N1); four patients T3 (3 N0 and 1 N2). In all the cases, resection margins were free. The mean distance from the anal verge was 3,8 cm (range 2,8 - 6 cm). In a mean followup of 48 months ( range 6-54 months), 1 patient developed hepatic metastasis and no local recurrence was noted. Two patients had urinary retention, resolved spontaneously. One patient presented erectile dysfunction. At 12 months from the operation, one patient had slight incontinence for gas and liquids. CONCLUSIONS We believe that total mesorectal resection, even associated with sphincter preserving procedures, such as intersphincteric resection, in case of very low rectal tumours, can also be performed by laparoscopic approach with the same oncological and surgical principles of open surgery. However it is necessary to have broad based studies and randomised clinical trials in order to confirm the safety of such procedure and the results obtained.
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Affiliation(s)
- L Napolitano
- Dipartimento di Scienze Chirurgiche, Universita G.D'Annunzio, Italy
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Madonna R, Renna FV, Cellini C, Cotellese R, Picardi N, Francomano F, Innocenti P, De Caterina R. Age-dependent impairment of number and angiogenic potential of adipose tissue-derived progenitor cells. Eur J Clin Invest 2011; 41:126-33. [PMID: 20874854 DOI: 10.1111/j.1365-2362.2010.02384.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [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: 02/06/2023]
Abstract
BACKGROUND Adipose tissue-derived stromal cells (ADSCs) are being recognized as a source of stem cells potentially useful for cardiovascular repair. We analysed the abundance and angiogenic activity of adipose tissue-derived progenitor cells (PCs) in elderly patients most likely to benefit from this novel source of stem cells. MATERIALS AND METHODS Fifty-two subjects (aged 68 ± 13 years) with variable degrees of cardiovascular risk underwent abdominal surgery for intercurrent diseases. Visceral adipose tissue (3 ± 1 g visceral fat per patient) was processed with type-1 collagenase to obtain ADSCs from the stromal-vascular fraction. Adipose tissue-derived PCs were quantified by flow cytometry as %CD45(-)/CD34(+)/CD133(+) cells of total ADSCs. Matrigel angiogenesis assay was used to analyse the ability of ADSCs to form tubes or networks. RESULTS We found no correlations between number of CD45(-)/CD34(+)/CD133(+) or total ADSCs and quantitative risk parameters including total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, waist circumference, body mass index, and systolic and diastolic arterial pressure. However, increasing age (r = -0·31, P < 0·05) significantly and inversely correlated with levels of adipose tissue-derived CD45(-)/CD34(+)/CD133(+) cells in Matrigel angiogenesis assays; increasing age (r = -0·29, P < 0·05) was related to a reduction of ADSC-derived tubulization. CONCLUSIONS Ageing may alter the availability of adipose tissue-derived CD45(-)/CD34(+)/CD133(+) cells and their angiogenic functional capacity. Such changes may impair the use of adipose tissue as source of autologous PCs in elderly patients.
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Affiliation(s)
- Rosalinda Madonna
- Department of Cardiology and Center of Excellence on Aging, G. d'Annunzio University-Chieti, Chieti, Italy
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Marino M, Cellini C, Tsiopoulos V, Pavoni N, Zamparelli R, Corrado M, Cosentino N, Lombardo A, Belloni F, Niccoli G. Erratum to A case of myocardial infarction effectively treated by emergency coronary stenting soon after a Bentall-De Bono aortic surgery (Cardiovasc Revasc Med 2010;11(4):263). Cardiovascular Revascularization Medicine 2011. [DOI: 10.1016/j.carrev.2010.11.008] [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: 11/30/2022]
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Selvaggi F, Risio D, Dimalio R, Cellini C, Simo D, Cotellese R, Legnini M, Innocenti P. Results of surgical and percutaneous ablative therapy for hepatocellular carcinoma in elderly patients. BMC Geriatr 2010. [PMCID: PMC3290177 DOI: 10.1186/1471-2318-10-s1-a35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Napolitano LM, Iacovetta D, Cellini C, Waku M, Innocenti P. [Laparoscopic surgery of adrenal tumours: indications and techniques]. G Chir 2010; 31:336-338. [PMID: 20646387] [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
Laparoscopic adrenalectomy is a gold standard in the treatment of the majority of adrenal lesions. In fact, laparoscopic technique reduces post-operative morbidity, hospital stay, the necessity of blood transfusions, post-operative pain and complications. We examined the data of patients who were operated by laparoscopic technique from April 2000 to April 2010. The following data were evaluated: demographic data of the patients, type of operation, the operative time, the rate of conversion to laparotomic procedure, post-operative complications, histologic diagnosis and the dimensions of the lesions. A total of 41 patients underwent to laparoscopic procedure. Two patients developed complications which got resolved through medical treatment. No patient died after surgery. The time of laparoscopic procedure was 95 min in average. No patient was converted to laparotomy. The total average hospital stay was 4.18 days. Average diameter of the lesions was 4.43 cm (range 1.2-8.5 cm). The data we obtained from our studies confirm the safety and the feasibility of laparoscopic adrenalectomy and it's application can be considered even in case of malignant lesions. The only contraindication to laparoscopic procedure is the involvement of surrounding tissue and vascular invasion by tumour cells.
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Affiliation(s)
- L M Napolitano
- P.O. SS Annunziata, Chieti, Dipartmento di Scienze Chirurgiche Sperimentali e Cliniche, U.O. di Patologia Chirurgica e Chirurgia Laparoscopica
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Cellini C, Schutz AC, Gegenfurtner KR. Saccadic eye movements to Gaussian luminance and color blobs. J Vis 2010. [DOI: 10.1167/9.8.438] [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: 11/24/2022] Open
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Selvaggi F, Simo D, Cellini C, Iacovetta D, Dimalio R, Cotellese R, D'Aulerio A, Francomano F, Innocenti P. Colorectal cancer surgery in the elderly: oncologic results from our experience. BMC Geriatr 2009. [PMCID: PMC4290835 DOI: 10.1186/1471-2318-9-s1-a20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Iacovetta D, Cellini C, Selvaggi F, Kechoud ES, Legnini M, Francomano F, Innocenti P. Multimodal approach to liver neoplasm in elderly patients. A single center experience. BMC Geriatr 2009. [PMCID: PMC4291012 DOI: 10.1186/1471-2318-9-s1-a68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Vanier MC, Lachance-Demers H, Cellini C, Beaulieu N, Garneau M, Turpin-Lavallée O, Turcotte A, Lalonde L. Developing a Liaison Role for Pharmacists in a Family Medicine Clinic. Can Pharm J (Ott) 2009. [DOI: 10.3821/1913-701x-142.1.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: To develop a pharmacist liaison service in a family medicine teaching clinic in order to optimize and facilitate community pharmacists' interventions. Target groups: Community pharmacists involved in the care of patients registered at the family medicine clinic (FMC) of Cité de la Santé de Laval and clinical pharmacists working at this clinic. Activities: The FMC is a medical teaching clinic located in a general care hospital. The FMC operates as a multidisciplinary group of GPs, nurses and pharmacists providing care to enlisted patients. Due to their clinical experience, proximity to the medical team and direct access to FMC patients' charts, FMC pharmacists (FMC-PH) are in a key position to support community pharmacists (COM-PH) in order to optimize the quality of pharmaceutical care dispensed to their common patients. The liaison pharmacist service was created within a larger study of COM-PH interventions and their impact on medication when receiving a doctor request for medication profile analysis and a standard prescription or a prescription enriched with additional clinical information. Forty-nine COM-PH interested in participating in the larger study attended one of 3 workshops offered by pharmacy residents, FMC-PH and a physician. Information on the clinic and the new service of liaison as well as case studies on medication adjustment and laboratory monitoring were presented and discussed. A decision aid tool was also provided to participants. A FMC-PH is available from Monday to Friday (9 a.m. to 4 p.m.) to answer questions by telephone from COM-PH directly related to FMC's patients' care and links with the medical team when necessary. Liaison tasks were added to other clinical duties and responsibilities of the FMC-PH. Communications with COM-PH were documented by FMC-PH between November 2007 and April 2008. Deliverables: Fifty-eight communications involving 27 COM-PH and 49 patients have been documented. Among 78 drug-related issues discussed with FMC-PH, the most frequent were obtaining results or suggesting laboratory monitoring (35%), discordance between pharmacy medication chart and FMC chart (18%), dose too high (8%), additional medication needed (8%), dose too low (5%) and inappropriate medication. Among the 93 actions taken by FMC-PH in response to contact with COM-PH, the most frequent were transferring additional laboratory results (29%) or additional information related to treatment (22%) to COM-PH, transferring new information and recommendations to the medical team via case discussion with treating physician and/or writing a note in the FMC patient's chart (22%), revising medication history (14%) and correcting patient's medication profile in the FMC chart (11%). The mean time per action was 9.5 ± 8.9 minutes. Conclusion: The liaison pharmacist service was used regularly by the community pharmacists and was easily integrated in the FMC-pharmacists' tasks. Community pharmacists' calls resulted in additional information or correction of available information to the FMC team in 33% of cases. Community pharmacists were very interested in obtaining laboratory results and additional clinical information to optimize their patient follow-up. This model of liaison succeeded in increasing collaboration and improving flow of information between pharmacists.
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Cellini C, Tazzari V, Grafone T, Conti M, Baccini C, Zamagni E, Cangini D, Tacchetti P, Tosi P, Zaccaria A, Cavo M. PO-03 bFGF, IL-6, TNF-α and VEGF serum levels in newly diagnosed multiple myeloma patients treated with thalidomide, dexamethasone and autologous transplantation. Thromb Res 2007. [DOI: 10.1016/s0049-3848(07)70156-1] [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: 10/22/2022]
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Gaudino M, Luciani N, Glieca F, Cellini C, Pragliola C, Trani C, Burzotta F, Schiavoni G, Anselmi A, Possati G. Patients With In-Stent Restenosis Have an Increased Risk of Mid-Term Venous Graft Failure. Ann Thorac Surg 2006; 82:802-4. [PMID: 16928486 DOI: 10.1016/j.athoracsur.2006.04.084] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 03/24/2006] [Revised: 04/23/2006] [Accepted: 04/25/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study was designed to evaluate if patients in whom in-stent restenosis developed had an higher risk of early venous graft failure compared with normal patients. METHODS The study cohort comprised 120 patients (60 with previous in-stent restenosis and 60 controls) who received a total of 165 complementary venous grafts on the circumflex or right coronary artery system (84 in the restenosis group and 81 in the control group). All patients were prospectively followed-up and underwent reangiography at 5-years follow-up. RESULTS In the restenosis group, 28 venous grafts (33.%) were perfectly patent, 10 showed major irregularities, and 46 were occluded. In the control patients, 50 grafts (61.7%) were perfectly patent (p < 0.001 compared with the restenosis series), 12 showed major irregularities (p = .74), and 19 were occluded (p < 0.0001). In contrast, the 5-year outcome of internal thoracic artery grafts was not affected by history of in-stent restenosis. CONCLUSIONS Patients who developed in-stent restenosis have an higher risk of early venous graft failure compared with the control patients. Arterial grafts should probably be preferred in these patients.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiac Surgery, Catholic University, Rome, Italy.
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Boncompagni G, Incandela L, Bechini A, Giannini D, Cellini C, Trezzi M, Ciofi degli Atti ML, Ansaldi F, Valle L, Bonanni P. Measles outbreak in Grosseto, central Italy, 2006. ACTA ACUST UNITED AC 2006; 11:E060803.4. [PMID: 16966773 DOI: 10.2807/esw.11.31.03015-en] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 11/20/2022]
Abstract
From 2003 to 2007, Italy is implementing a national plan to eliminate measles and congenital rubella
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Affiliation(s)
- G Boncompagni
- Local Health Agency 9 - Hygiene and Public Health (zone 4) - Grosseto, Italy
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Gaudino M, Cellini C, Pragliola C, Trani C, Burzotta F, Schiavoni G, Nasso G, Possati G. Arterial versus venous bypass grafts in patients with in-stent restenosis. Circulation 2006; 112:I265-9. [PMID: 16159829 DOI: 10.1161/circulationaha.104.512905] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients who develop in-stent restenosis, successful revascularization can be difficult to achieve using percutaneous methods. This study was designed to verify the surgical results in this setting and to evaluate the potential beneficial role of arterial bypass conduits. METHODS AND RESULTS Sixty consecutive coronary artery bypass patients with previous in-stent restenosis and 60 control cases were randomly assigned to receive an arterial conduit (either right internal thoracic or radial artery; study group) or a great saphenous vein graft (control group) on the first obtuse marginal artery to complete the surgical revascularization procedure. At a mean follow-up of 52+/-11 months, patients were reassessed clinically and by angiography. Freedom from clinical and instrumental evidence of ischemia recurrence was found in 19 of 60 subjects in the study group versus 45 of 60 in the control series (P=0.01). The results of the arterial grafts were excellent in both the study and control groups (right internal thoracic artery patency rate, 19 of 20 for both, and radial artery patency rate, 20 of 20 versus 19 of 20; P=0.99). Saphenous vein grafts showed lower patency rate than arterial grafts in both series and had extremely high failure rate in the study group (patency rate, 10 of 20 in the study group versus 18 of 20 in the control group; P=0.001). Use of venous graft was an independent predictor of failure in the study group, whereas hypercholesterolemia was associated with graft failure in both series. CONCLUSIONS Venous grafts have an high incidence of failure among cases who previously developed in-stent restenosis, whereas the use of arterial conduits can improve the angiographic and clinical results. Arterial grafts should probably be the first surgical choice in this patient population.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiac Surgery, Catholic University, Rome, Italy.
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Gaudino M, Alessandrini F, Glieca F, Luciani N, Cellini C, Pragliola C, Morelli M, Canosa C, Nasso G, Possati G. Survival after aortic valve replacement for aortic stenosis: does left ventricular mass regression have a clinical correlate? Eur Heart J 2004; 26:51-7. [PMID: 15615799 DOI: 10.1093/eurheartj/ehi012] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [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] [Indexed: 11/13/2022] Open
Abstract
AIM The effects of post-operative left ventricular mass regression (LVMR) on clinical outcome after aortic valve surgery remains to be established. This study was intended to establish the impact of patient characteristics on post-operative survival in patients referred for aortic valve replacement (AVR), with particular regard to LVMR. METHODS AND RESULTS Two hundred and sixty consecutive cases submitted to aortic valve replacement for valvular stenosis were prospectively followed for a mean of 28+/-9 months. Baseline, characteristics and extent of LVMR were tested for association with survival by uni- and multivariable analysis. Ten deaths occurred during hospital stay and 52 during out-of-hospital follow-up. Mean left ventricular mass decreased from 190+/-43 to 158+/-70 g/m2 (P<0.001). Older age, advanced functional class, hypertension, reduced left ventricle ejection fraction, and high pre-operative left ventricular mass index were associated with reduced survival. Overall the extent of LVMR did not influence the clinical results, while only early (<6 months) LVMR was weakly associated with mid-term outcome. CONCLUSION Survival after aortic valve surgery is mainly determined by the pre-operative functional cardiac and systemic status. The extent of LVMR does not correlate with clinical outcome, whereas aggressive treatment of hypertension may improve post-operative survival.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiac Surgery, Catholic University, Largo A Gemelli 8, 00168 Rome, Italy.
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Cellini C, Hollenbeck ST, Christos P, Martins D, Carson J, Kemper S, Lavigne E, Chan E, Simmons R. Factors Associated With Residual Breast Cancer After Re-excision for Close or Positive Margins. Ann Surg Oncol 2004; 11:915-20. [PMID: 15383425 DOI: 10.1245/aso.2004.12.037] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [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: 11/18/2022]
Abstract
BACKGROUND Successful breast conservation surgery (BCS) requires complete tumor excision. Margin status of the initial specimen determines the need for additional surgery. We explored factors associated with residual cancer (RC) upon follow-up surgery in patients with close, positive, or undetermined margins following BCS. METHODS A retrospective analysis of 276 patients with initial close, positive, or undetermined margins who underwent re-excision (RE) or mastectomy was conducted. All initial excisions were intended as definitive procedures. Chi-square analysis was used to identify factors that may predict RC. RESULTS Of 276 patients, 87 had close, 168 had positive, and 21 had undetermined margins on initial excision. Of this group, 63% (175/276) had RC upon RE or mastectomy. Of positive-margin patients, 68% had RC, compared with 53% of close-margin and 67% of undetermined-margin patients (P = .006). Tumors >/=2 cm were more often associated with RC than smaller tumors (70.8% vs. 56.5%; P = .07). This association was strongest in positive-margin patients (P = .04). High tumor grade was associated with RC in all groups. RC linearly increased with the number of involved margins (P = .02). Specimen inking with multiple colors was associated with decreased risk of RC (P = .004). CONCLUSIONS Over half of patients with involved or undetermined margins had RC upon RE or mastectomy. Positive and undetermined margins were more often associated with RC than close margins. Larger tumor size was associated with RC in patients with positive. Increasing tumor grade suggests a greater chance of detecting RC in all groups. Multiple involved margins led to a greater risk of RC.
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Affiliation(s)
- C Cellini
- Weill Cornell Breast Center, 425 East 61st Street, 8th Floor, New York, NY 10021, USA
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Cellini C, Xu J, Buchmiller-Crair T. Ontogeny of Epidermal Growth Factor Receptor (EGFR) in a fetal rabbit model of Intrauterine Growth Retardation (IUGR). J Surg Res 2004. [DOI: 10.1016/j.jss.2004.07.173] [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: 10/26/2022]
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Gaudino M, Glieca F, Luciani N, Cellini C, Morelli M, Girola F, Guarini G, Possati G. Left ventricular mass regression after aortic valve replacement for aortic stenosis: time course and determinants. J Heart Valve Dis 2004; 13 Suppl 1:S55-8. [PMID: 15225004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Mario Gaudino
- Department of Cardiac Surgery, Catholic University, Rome, Italy.
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Gaudino M, Alessandrini F, Pragliola C, Cellini C, Glieca F, Luciani N, Girola F, Possati G. Effect of target artery location and severity of stenosis on mid-term patency of aorta-anastomosed vs. internal thoracic artery-anastomosed radial artery grafts. Eur J Cardiothorac Surg 2004; 25:424-8. [PMID: 15019672 DOI: 10.1016/j.ejcts.2003.11.027] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [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: 10/07/2003] [Revised: 11/11/2003] [Accepted: 11/24/2003] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To verify the effect of location and severity of stenosis of the target coronary artery (TCA) on mid-term patency of aorta-anastomosed vs. internal thoracic artery (ITA)-anastomosed radial artery (RA) graft. METHODS During a 3-year period 228 consecutive patients received an RA graft at our institution. In 131 cases the RA was anastomosed to the aorta whereas in 97 the proximal anastomosis was performed on a mammary graft. The two groups were comparable in terms of preoperative variables and TCA characteristics. At a mean follow-up of 6.5 years 128 cases of the aorta-anastomosed and 95 of the mammary-anastomosed group were submitted to control angiography. RESULTS Mid-term patency and perfect patency rates were 92.1 and 89.8% (118/128 and 115/128) for aorta-anastomosed RA vs. 86.3 and 84.2% for mammary-anastomosed grafts (82/95 and 80/95; P=0.81 and 0.82). The location of TCA did not influence graft patency in the two groups. The severity of the TCA stenosis strongly influenced graft patency in both groups but the threshold for failure was clearly higher in the mammary-anastomosed group. CONCLUSIONS ITA-anastomosed RA grafts are more vulnerable to the detrimental effect of chronic native competitive flow and should be used only for target vessel with subocclusive stenosis. The location of the distal anastomosis does not influence long-term RA patency.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiac Surgery, Catholic University, Rome, Italy.
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Gaudino M, Alessandrini F, Glieca F, Luciani N, Cellini C, Pragliola C, Morelli M, Girola F, Possati G. Effect of surgical revascularization of a right coronary artery tributary of an infarcted nonischemic territory on the outcome of patients with three-vessel disease: a prospective randomized trial. J Thorac Cardiovasc Surg 2004; 127:435-9. [PMID: 14762352 DOI: 10.1016/j.jtcvs.2003.08.026] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We evaluated the in-hospital and long-term effects of surgical grafting of a dominant graftable right coronary artery tributary of an infarcted nonischemic territory in patients with triple-vessel disease who were undergoing coronary artery bypass grafting. METHODS Of 303 consecutive patients undergoing coronary artery bypass grafting with 3-vessel coronary disease and a dominant right coronary artery tributary of an infarcted nonischemic territory, 154 were randomized to right coronary artery revascularization and 149 to no right coronary artery grafting. In all cases, standard on-pump surgical myocardial revascularization was performed. RESULTS Overall hospital mortality was 2 of 154 versus 1 of 149 (P =.97); no difference in in-hospital outcome was observed between the 2 groups. At follow-up, cardiac event-free survival was 84 of 152 in the right coronary artery grafting series and 62 of 148 in the non-right coronary artery grafting group (P =.20). However, when the analysis was limited to surviving patients without new scintigraphic evidence of ischemia (to avoid confounding factors derived from ischemia in the left coronary system or right coronary artery graft malfunction), we found that patients who received a right coronary artery graft had fewer cardiac events, a lower incidence of arrhythmia, and less left ventricular dilatation than did the non-right coronary artery revascularized series. CONCLUSIONS Surgical grafting of a right coronary artery tributary of an infarcted nonischemic territory in patients with 3-vessel coronary artery disease submitted to coronary artery bypass grafting improved late electric stability, ventricular geometry, and event-free survival but did not affect in-hospital or 10-year survival.
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Affiliation(s)
- Mario Gaudino
- Department of Cardia Surgery, Catholic University, Rome, Italy.
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Hollenbeck ST, Cellini C, Christos P, Varnado-Rhodes Y, Martins D, Nussbaum M, Osborne MP, Simmons RM. Breast cancer in patients with residual invasive carcinoma is more accurately staged with additive tumor size assessment. Ann Surg Oncol 2004; 11:59-64. [PMID: 14699035 DOI: 10.1007/bf02524347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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 Accurate assessment of tumor size for patients with breast cancer undergoing re-excision following breast-conserving therapy is important for appropriate staging and adjuvant treatment. We investigated the accuracy of additive vs. nonadditive size assessment in determining final tumor stage. METHODS Patients with infiltrating carcinoma in the initial excision and in at least one additional re-excision (re-excision positive; n = 89) had tumor size assessed with additive and nonadditive techniques. This group was compared with patients undergoing re-excision but without identifiable residual carcinoma (re-excision negative; n = 105) regarding rates of lymph node (LN) metastasis. RESULTS The re-excision positive patients had a different median final tumor size depending on the size assessment technique used (nonadditive: 1.8 cm; additive: 3.0 cm; P <.0001). Both groups of patients had a median tumor size consistent with T1c staging in nonadditive size assessment. However, re-excision positive patients had a significantly higher incidence of LN metastasis (P <.05) than did re-excision negative patients. Both groups were then separated into T1 and T2 stages and the LN metastasis rates were assessed. Compared with nonadditive size assessment, additive size assessment distributed re-excision positive patients into T stages whereby the LN metastasis rates more closely approximated those of re-excision negative patients (T1, 3% vs. 6% difference; T2, 4% vs. 13% difference). CONCLUSIONS With regard to LN metastasis, staging for patients with residual invasive carcinoma in re-excision specimens is more accurate with additive tumor size assessment.
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Affiliation(s)
- S T Hollenbeck
- Department of Surgery, Weill Medical College of Cornell University, New York, NY 10021, USA
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Tosi P, Zamagni E, Cellini C, Ronconi S, Patriarca F, Ballerini F, Musto P, Di Raimondo F, Ledda A, Lauria F, Masini L, Gobbi M, Vacca A, Ria R, Cangini D, Tura S, Baccarani M, Cavo M. Salvage Therapy With Thalidomide In Patients With Advanced Relapsed/Refractory Multiple Myeloma. J Peripher Nerv Syst 2002. [DOI: 10.1046/j.1529-8027.2002.02026_15.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gaudino M, Glieca F, Luciani N, Cellini C, Morelli M, Spatuzza P, Di Mauro M, Alessandrini F, Possati G. Should severe monolateral asymptomatic carotid artery stenosis be treated at the time of coronary artery bypass operation? Eur J Cardiothorac Surg 2001; 19:619-26. [PMID: 11343942 DOI: 10.1016/s1010-7940(01)00665-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [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] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The optimal treatment of severe monolateral asymptomatic carotid artery stenosis (SMACS) in patients undergoing coronary artery bypass grafting (CABG) is still controversial. MATERIALS AND METHODS This study is based on the in-hospital and mid-term (>5 years) clinical results of a cohort of 139 consecutive CABG patients with SMACS operated at our Institution between January 1989 and December 1995. In the first 73 patients (no carotid surgery group), the SMACS was left untouched at the time of coronary surgery, whereas in the remaining 66 (carotid endoarterectomy group), the carotid stenosis was treated either immediately before or concomitantly with the CABG procedure (depending on the severity of the anginal symptoms). RESULTS The overall preoperative characteristics of the patients were comparable. The in-hospital results were similar between the two groups with regard to mortality, stroke and major postoperative complications. However, at mid-term follow-up, significantly more patients of the no carotid surgery group suffered cerebral events (transient or permanent) ipsilateral to the SMACS or the lesion had to be operated on. CONCLUSIONS The concomitant treatment (either staged or simultaneous) of SMACS at the time of CABG does not influence the in-hospital results, but confers significant neurological protection during the years after the operation.
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Affiliation(s)
- M Gaudino
- Department of Cardiac Surgery, Catholic University, Rome, Italy.
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Tosi P, Ronconi S, Zamagni E, Cellini C, Grafone T, Cangini D, Pileri SA, Baccarani M, Tura S, Cavo M. Salvage therapy with thalidomide in multiple myeloma patients relapsing after autologous peripheral blood stem cell transplantation. Haematologica 2001; 86:409-13. [PMID: 11325648] [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: 02/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The introduction of high-dose therapy with stem cell support has significantly improved the outcome of patients with multiple myeloma (MM) in terms of increased complete remission (CR) rate and extended survival, both disease-free and overall. Few options, however, are presently available for patients who relapse after single or double autologous stem cell transplantation (SCT). Thalidomide, a glutamic acid derivative with anti-angiogenetic properties, has been recently proposed as salvage treatment for such patients. The present study was aimed at evaluating thalidomide as single agent therapy for patients who had previously received autologous peripheral blood stem cell transplantation. DESIGN AND METHODS From October 1999 to August 2000, 11 patients (7 males/4 females) who had relapsed after single (n = 4) or double (n = 7) autologous peripheral blood SCT were enrolled in the trial. Thalidomide, always employed as a single agent, was initially administered at a dose of 100 mg/day; if well tolerated, the dose was increased serially by 200 mg every other week to a maximum of 800 mg/day. RESULTS The median administered dose was 600 mg/day. WHO grade > II toxic effects were constipation, lethargy, and leukopenia. Four patients (36%) showed > 50% reduction in serum M protein concentration and 4 showed > 25% reduction, for a total response rate averaging 72%. After a median follow-up of 5 months, 3 out of 8 responding patients are alive and progression-free and 5 patients have relapsed. INTERPRETATION AND CONCLUSIONS; These data confirm that thalidomide is active in poor-prognosis MM patients such as those relapsing after autologous SCT, and could thus deserve further testing in combination therapy.
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Affiliation(s)
- P Tosi
- Institue of Hematology and Medical Oncology, Seràgnoli, University of Bologna, Italy.
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Ruo L, Cellini C, La-Calle JP, Murray M, Thaler HT, Quan SH, Guillem JG. Limitations of family cancer history assessment at initial surgical consultation. Dis Colon Rectum 2001; 44:98-103; discussion 103-4. [PMID: 11805570 DOI: 10.1007/bf02234829] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [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] [Indexed: 02/08/2023]
Abstract
PURPOSE Although important for the diagnosis of familial clustering of colorectal cancer and hereditary nonpolyposis colorectal cancer, the accuracy of familial cancer history assessment in the office setting has been questioned. Furthermore, there are few publications describing the optimal method for accurately capturing a family cancer history. The purpose of this study was to determine how well family cancer history is assessed in patients with early age-of-onset colorectal cancer at initial surgical consultation compared with a telephone interview and mailed questionnaire. METHODS Medical records of patients 40 years old or younger at the time of colorectal cancer surgery were reviewed for documentation of family cancer history at initial surgical consultation. In addition, family cancer history was solicited from surviving patients or their next of kin by telephone and a mailed questionnaire. The kappa coefficient was used to measure degree of correlation between family cancer history obtained at initial surgical consultation and subsequent telephone interview and questionnaire. RESULTS One hundred twenty-five patients were available for analysis. Family cancer history was documented on the initial surgical consultation report in 78 percent of cases. Although 31.2 percent were identified as having no family cancer history at initial surgical consultation, this proportion decreased to 13.5 percent after telephone interviews and questionnaires. Family history assessment at initial surgical consultation also failed to identify 7 of 11 individuals meeting Amsterdam criteria for hereditary nonpolyposis colorectal cancer and 10 of 16 individuals meeting modified clinical criteria for hereditary nonpolyposis colorectal cancer. CONCLUSIONS Although family cancer history was commonly obtained during the initial surgical consultation of patients with colorectal cancer, there was a tendency to underestimate the extent of familial cancer. A telephone interview and questionnaire conducted at a later date may reveal a more comprehensive family cancer history. This is an important observation, because individuals identified as high-risk for hereditary nonpolyposis colorectal cancer or familial clustering of colorectal cancer require special consideration with respect to screening, surveillance, and surgical management.
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Affiliation(s)
- L Ruo
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Gaudino M, Glieca F, Alessandrini F, Luciani N, Cellini C, Pragliola C, Possati G. The unclampable ascending aorta in coronary artery bypass patients: A surgical challenge of increasing frequency. Circulation 2000; 102:1497-502. [PMID: 11004139 DOI: 10.1161/01.cir.102.13.1497] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [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] [Indexed: 12/21/2022]
Abstract
BACKGROUND The unclampable ascending aorta (UAA) is a condition increasingly encountered during CABG procedures. We report our experience with CABG patients with UAA and place particular emphasis on the preoperative diagnosis and surgical management. METHODS AND RESULTS UAA was diagnosed in 211 of 4812 consecutive CABG patients (4.3%). On the basis of the chest radiograph, echocardiogram, and coronary angiograph, a preoperative diagnosis was achieved in only 58 patients (27.4%). An age of >70 years, diabetes, smoking, unstable angina, diffuse coronaropathy, and peripheral vasculopathy were all predictors of UAA. Patients were treated with hypothermic ventricular fibrillation (no-touch technique n=129) or beating heart revascularization (no-pump technique n=82) depending on the possibility of founding an arterial cannulation site. The overall in-hospital mortality rate was 2.8% (6 of 211) with no differences between the 2 surgical strategies. The no-touch technique was associated with a greater incidence of neurological complications (stroke and transient ischemic attack), renal insufficiency, and stay in the intensive care unit and hospital. However, at midterm follow-up, more patients of the no-pump group had ischemia recurrence. CONCLUSIONS A preoperative diagnosis of UAA is achievable only in a minority of patients, which highlights the necessity revising the current diagnostic protocols. The use of the no-touch technique is associated with an high perioperative risk but a superior possibility of complete revascularization, whereas adoption of the no-pump strategy ensures a smoother postoperative course at the expense of an higher incidence of ischemia recurrence.
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Affiliation(s)
- M Gaudino
- Department of Cardiac Surgery, Catholic University, Rome, Italy.
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Zinzani PL, Magagnoli M, Bendandi M, Tani M, Stefoni V, Cellini C, Poggi S, Piccioli M, Pileri S, Tura S. Long-term follow-up of hairy cell leukemia patients treated with 2-chlorodeoxyadenosine. Haematologica 2000; 85:922-5. [PMID: 10980629] [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: 02/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The management of patients with hairy cell leukemia (HCL) has evolved significantly over the past two decades. In fact, both 2'-deoxycoformycin (DCF) and 2-chlorodeoxyadenosine (2-CdA) induce complete response (CR) in the majority of the patients with HCL. However, fewer data exist on the long-term follow-up of patients who have undergone the characteristically brief exposure to 2-CdA therapy. Thus, it is important to evaluate such long-term outcome data in order to increase understanding of the efficacy of this agent in the management of HCL. DESIGN AND METHODS We reviewed the long-term follow-up data of 23 HCL patients pretreated with a-interferon and then treated with 2-CdA administered as a single continuous IV infusion for 7 days at the dose of 0.1 mg/kg/day in our institute between January 1991 and February 1992. RESULTS Of 23 patients, 19 (83%) achieved a CR and 4 (17%) a partial response (PR), with an overall response rate of 100%. After a median follow-up of 102 months (range: 96-108), there have been 9 (39%) relapses. In the PR subset 100% of patients relapsed within the first 45 months of follow-up. In the group of patients who obtained a CR, 26% relapsed; all these relapses occurred between 54 and 86 months. Overall, the median time to relapse was 54 months (range: 16-86). All relapsed patients were re-treated with 2-CdA at the dose of 0.15 mg/kg/day for 5 days in a 2-hour infusion, and 67% and 22% then obtained CR or PR, respectively. The median duration of this second response was 48 months (range: 22-80). All but one of these patients are still maintaining the second response to 2-CdA. The 9-year overall and the relapse-free survivals are 91% and 70%, respectively. INTERPRETATION AND CONCLUSIONS In HCL patients a single dose of 2-CdA induces a long-term CR with a 9-year survival > 90%. Over 50% of patients appear to be clinically cured by this procedure, but the lack of a long-term plateau in the relapse-free survival curve means caution on this point is still warranted.
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Affiliation(s)
- P L Zinzani
- Istituto di Ematologia e Oncologia Medica "Seràgnoli", Policlinico S.Orsola, Via Massarenti 9, 40138 Bologna, Italy.
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Zinzani PL, Magagnoli M, Bendandi M, Gherlinzoni F, Orcioni GF, Cellini C, Stefoni V, Pileri SA, Tura S. Efficacy of fludarabine and mitoxantrone (FN) combination regimen in untreated indolent non-Hodgkin's lymphomas. Ann Oncol 2000; 11:363-5. [PMID: 10811507 DOI: 10.1023/a:1008388824069] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [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: 11/12/2022] Open
Abstract
PURPOSE In the last years, fludarabine (FLU) alone or in combination with other drugs has been reported to be effective in the treatment of previously treated low-grade non-Hodgkin's lymphomas (LG-NHL). The aim of this study was to define the therapeutic efficacy and toxicity of a combination of FLU and mitoxantrone (FN regimen) in untreated LG-NHL. PATIENTS AND METHODS We used a two-drug combination of FLU (25 mg/m2 i.v. on days 1 to 3) and mitoxantrone (10 mg/m2 i.v. on day 1) to treat 27 previously untreated patients with LG-NHL, Chemotherapy was repeated every four weeks for a total of six cycles. Among 27 patients, 17 (63%) were diagnosed with follicular, 6 (22%) with small lymphocytic, and 4 (15%) with immunocytoma subtypes. RESULTS Of the 27 patients, 18 (67%) achieved complete response (CR) and 6 (22%) partial response, while the remaining 3 (11%) showed no benefit from the treatment. Regarding histology, in the follicular subtype we observed an overall response rate of 94%, with a 76.5% CR rate. The estimated two-year relapse-free survival was 83%, and overall survival was 92%. Hematologic grade 3-4 toxicity was seen in only five (3.3%) patients; no opportunistic infections or deaths were associated with the administration of the FN regimen. CONCLUSIONS These preliminary data show that the FN regimen is a very active, well-tolerated combination chemotherapy for untreated patients with advanced LG-NHL.
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Affiliation(s)
- P L Zinzani
- Institute of Hematology and Medical Oncology Seràgnoli, University of Bologna, Italy.
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Zinzani PL, Magagnoli M, Moretti L, De Renzo A, Battista R, Zaccaria A, Guardigni L, Mazza P, Marra R, Ronconi F, Lauta VM, Bendandi M, Gherlinzoni F, Gentilini P, Ciccone F, Cellini C, Stefoni V, Ricciuti F, Gobbi M, Tura S. Randomized trial of fludarabine versus fludarabine and idarubicin as frontline treatment in patients with indolent or mantle-cell lymphoma. J Clin Oncol 2000; 18:773-9. [PMID: 10673518 DOI: 10.1200/jco.2000.18.4.773] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [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: 11/20/2022] Open
Abstract
PURPOSE A first comparative trial of fludarabine (FLU) alone versus FLU plus idarubicin (FLU-ID) for indolent or mantle-cell lymphomas. PATIENTS AND METHODS From September 1995 to July 1998, 199 patients aged 25 to 65 years (median, 54 years) with newly diagnosed stages II to IV indolent or mantle-cell lymphomas (standard risk according to the International Prognostic Index) were enrolled onto a multicenter, 1:1 randomized study. Of the 199 patients who were able to be assessed, 101 were assigned to the FLU group (six monthly cycles of FLU 25 mg/m(2)/d on days 1 through 5) and 98 to the FLU-ID group (six monthly cycles of FLU 25 mg/m(2)/d on days 1 through 3 and idarubicin 12 mg/m(2) on day 1). RESULTS In the FLU group, complete response (CR) and partial response rates were 47% and 37%, respectively, whereas in the FLU-ID group, they were 39% and 42%, respectively. In-depth analysis of the CR rate with respect to histologic type showed that FLU seemed to be superior to FLU-ID in treating follicular lymphomas (60% v 40%, respectively), whereas FLU-ID seemed to be more effective than FLU in treating nonfollicular lymphomas (small lymphocytic, 43% v 29%, respectively; immunocytoma, 38% v 23%, respectively; P = not significant), excluding the mantle-cell subset (in which there was no difference between the two groups). No striking differences were observed between the two protocols in terms of overall response or toxicity, which was generally mild. However, with a median follow-up of 19 months, only 29 patients (62%) who received FLU alone have maintained their initial CR, compared with 32 (84%) of those who received FLU-ID therapy (P =.021). CONCLUSION Although the FLU-ID regimen may not significantly improve the induction of CR in most indolent-lymphoma patients, our preliminary data do suggest that, with respect to FLU alone, it may be capable of conferring a longer-lasting CR and that it might be superior in terms of CR rate in small lymphocytic and immunocytoma subtypes.
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Affiliation(s)
- P L Zinzani
- Institute of Hematology and Medical Oncology and University of Bologna, Bologna, Italy.
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Zinzani PL, Martelli M, Magagnoli M, Zaja F, Storti S, Pavone E, Lauta VM, De Renzo A, Gobbi M, Bocchia M, Ronconi F, Scaramucci L, Gherlinzoni F, Palombi F, Bendandi M, Stefoni V, Anticoli Borza P, Cellini C, Mandelli F, Tura S. How do patients with aggressive non-Hodgkin's lymphoma treated with third-generation regimens (MACOP-B and F-MACHOP) fare in the long-term? Haematologica 1999; 84:996-1001. [PMID: 10553159] [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: 02/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVE To examine the long-term clinical course and prognostic factors of patients with advanced aggressive non-Hodgkin's lymphoma (NHL) treated with third-generation regimens as front-line chemotherapy. DESIGN AND METHODS A total of 348 patients aged <60 years received MACOP-B or F-MACHOP regimen between September 1988 and August 1993 for advanced stage aggressive NHL. RESULTS Of these, 249 (71.5%) obtained a complete response (CR); 65/249 (26%) subsequently relapsed. The CR rates for MACOP-B and F-MACHOP were 70.5% and 72%, respectively, while the relapse-free survival rates (RFS) at 9 years were 66% and 74%, respectively. The overall survival rate at 9 years was 61% for MACOP-B and 67% for F-MACHOP patients. Of the relapses, 78.5% were early (<24 months) and 21.5% late. Eleven out of 65 (17%) patients are in continuous second CR with a median follow-up of 45 months; most of them have been salvaged with high-dose therapies. The validity of the International Prognostic Index was confirmed in long-term analysis. INTERPRETATION AND CONCLUSIONS With a 9-year RFS, it is possible to consider cured 50% of the patient with aggressive NHL treated with a third-generation regimen. About a quarter of the CRs relapse and late relapse occurs in roughly 20% of all relapsed patients. In these patients high-dose chemotherapy followed by autologous bone marrow or hematopoietic stem cell transplantation seems to be a very reliable approach in terms of long-term second CR. Finally, the IPI score maintains its pivotal role in terms of stratifying patients according to different risk subsets also in long-term analysis.
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Affiliation(s)
- P L Zinzani
- Istituto di Ematologia e Oncologia Medica "Seràgnoli", Policlinico S.Orsola, via Massarenti 9, 40138 Bologna, Italy
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Zinzani PL, Magagnoli M, Moretti L, Battista R, Ronconi F, De Renzo A, Zaccaria A, Gentilini P, Guardigni L, Gherlinzoni F, Cellini C, Fattori PP, Bendandi M, Bocchia M, Aitini E, Tura S. Fludarabine-based chemotherapy in untreated mantle cell lymphomas: an encouraging experience in 29 patients. Haematologica 1999; 84:1002-6. [PMID: 10553160] [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: 02/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVE A prospective study to evaluate the role of fludarabine alone or in combination with idarubicin in untreated patients with mantle cell lymphoma (MCL). DESIGN AND METHODS Twenty-nine untreated patients with mantle cell lymphoma were stochastically treated with intravenous fludarabine at a dose of 25 mg/m(2)/day for 5 days (11 patients) or with a combination of fludarabine and idarubicin (FLU-ID) (fludarabine 25 mg/m(2) i.v. on days 1 to 3 and idarubicin 12 mg/m(2) i.v. on day 1 (18 patients). For both regimens, cycles were given at three-week intervals for a total of six courses. According to the International Prognostic Index, the most part of high-intermediate and high risk factor patients were in the FLU-ID subset: 7 (39%) patients vs. 2 (18%) in the fludarabine alone subset. RESULTS Of the 29 patients, 8 (28%) obtained a complete response and 10 (35%) a partial response, with an overall response rate of 63%. The remaining 11 (37%) patients did not respond to the therapy. The overall response rates were 64% (7 patients) in the fludarabine group and 61% (11 patients) in the FLU-ID group. The complete response rate was 27% (3 patients) for fludarabine and 28% (5 patients) for FLU-ID. The toxicity was mild in terms of neutropenia and infections, and no fatalities occurred due to drug-induced side effects. INTERPRETATION AND CONCLUSIONS These results suggest the efficacy of fludarabine alone or in combination with idarubicin in MCL patients. It will be important to increase this experience and to assess other fludarabine-containing regimens, in particular with cyclophosphamide plus idarubicin and with mitoxantrone and or cyclophosphamide, to test the true role of this approach in MCL.
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Affiliation(s)
- P L Zinzani
- Istituto di Ematologia e Oncologia Medica "Seràgnoli", Policlinico S.Orsola, via Massarenti 9, 40138 Bologna, Italy
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Zinzani PL, Magagnoli M, Chierichetti F, Zompatori M, Garraffa G, Bendandi M, Gherlinzoni F, Cellini C, Stefoni V, Ferlin G, Tura S. The role of positron emission tomography (PET) in the management of lymphoma patients. Ann Oncol 1999; 10:1181-4. [PMID: 10586334 DOI: 10.1023/a:1008327127033] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.4] [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: 11/12/2022] Open
Abstract
BACKGROUND Treatment of both Hodgkin's disease (HD) and aggressive non-Hodgkin's lymphoma (NHL) with abdominal presentation at the time of diagnosis is often followed by detection of residual masses by computed tomography (CT). However, CT is usually unable to discriminate between residual tumor and fibrosis/necrosis. We investigated the ability of fluorine-18 fluorodeoxyglucose positron emission tomography (PET) to differentiate between residual active tumor tissue and fibrosis. PATIENTS AND METHODS Forty-four patients with HD or aggressive NHL presenting abdominal involvement (41% with bulky mass) were studied with CT and PET at the end of chemotherapy +/- radiation therapy. RESULTS After treatment, seven patients had negative PET and CT, and none of them relapsed. The remaining 37 patients all had positive CT (abnormalities < or = 10%). All of the 13 who also had positive PET relapsed (100%). By contrast, there was only 1 (4%) relapse among the 24 patients who were positive at CT but negative at PET. The two-year actuarial relapse-free survival rate was 95% for those with negative PET compared with 0% for positive PET patients (P < 0.000000). CONCLUSIONS In lymphoma patients with abdominal masses who present CT positivity at restaging, PET should be considered the noninvasive imaging modality of choice for differentiating early recurrences or residual disease from fibrosis.
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Affiliation(s)
- P L Zinzani
- Institute of Hematology and Medical Oncology Seràgnoli, University of Bologna, Italy.
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Frustaci A, Magnavita N, Chimenti C, Caldarulo M, Sabbioni E, Pietra R, Cellini C, Possati GF, Maseri A. Marked elevation of myocardial trace elements in idiopathic dilated cardiomyopathy compared with secondary cardiac dysfunction. J Am Coll Cardiol 1999; 33:1578-83. [PMID: 10334427 DOI: 10.1016/s0735-1097(99)00062-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.8] [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] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We sought to investigate the possible pathogenetic role of myocardial trace elements (TE) in patients with various forms of cardiac failure. BACKGROUND Both myocardial TE accumulation and deficiency have been associated with the development of heart failure indistinguishable from an idiopathic dilated cardiomyopathy. METHODS Myocardial and muscular content of 32 TE has been assessed in biopsy samples of 13 patients (pts) with clinical, hemodynamic and histologic diagnosis of idiopathic dilated cardiomyopathy (IDCM), all without past or current exposure to TE. One muscular and one left ventricular (LV) endomyocardial specimen from each patient, drawn with metal contamination-free technique, were analyzed by neutron activation analysis and compared with 1) similar surgical samples from patients with valvular (12 pts) and ischemic (13 pts) heart disease comparable for age and degree of LV dysfunction; 2) papillary and skeletal muscle surgical biopsies from 10 pts with mitral stenosis and normal LV function, and 3) LV endomyocardial biopsies from four normal subjects. RESULTS A large increase (>10,000 times for mercury and antimony) of TE concentration has been observed in myocardial but not in muscular samples in all pts with IDCM. Patients with secondary cardiac dysfunction had mild increase (< or = 5 times) of myocardial TE and normal muscular TE. In particular, in pts with IDCM mean mercury concentration was 22,000 times (178,400 ng/g vs. 8 ng/g), antimony 12,000 times (19,260 ng/g vs. 1.5 ng/g), gold 11 times (26 ng/g vs. 2.3 ng/g), chromium 13 times (2,300 ng/g vs. 177 ng/g) and cobalt 4 times (86,5 ng/g vs. 20 ng/g) higher than in control subjects. CONCLUSIONS A large, significant increase of myocardial TE is present in IDCM but not in secondary cardiac dysfunction. The increased concentration of TE in pts with IDCM may adversely affect mitochondrial activity and myocardial metabolism and worsen cellular function.
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Affiliation(s)
- A Frustaci
- Department of Cardiology, Catholic University, Rome, Italy
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Gaudino M, Glieca F, Alessandrini F, Cellini C, Luciani N, Pragliola C, Schiavello R, Possati G. Individualized surgical strategy for the reduction of stroke risk in patients undergoing coronary artery bypass grafting. Ann Thorac Surg 1999; 67:1246-53. [PMID: 10355391 DOI: 10.1016/s0003-4975(99)00151-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [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] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study was designed to evaluate the efficacy of a protocol of systematic screening of the ascending aorta and internal carotid arteries and individualization of the surgical strategy to the ascending aorta and internal carotid arteries status in reducing the stroke incidence among patients undergoing coronary artery bypass grafting. METHODS On the basis of a pre- and intraoperative screening of the ascending aorta and internal carotid arteries, 2,326 consecutive patients undergoing coronary artery bypass grafting were divided in low, moderate, and high neurologic risk groups. In the high-risk group dedicated surgical techniques were always adopted and the reduction of the neurologic risk was considered more important than the achievement of total revascularization. RESULTS The incidence of perioperative stroke in the high-risk group was similar to those of the other two groups (1.1 versus 1.3 and 1.1%, respectively; p = not significant); however, angina recurrence was significantly more frequent in the high-risk group. CONCLUSIONS The described strategy allows a low rate of perioperative stroke in high-risk patients undergoing coronary artery bypass grafting. Whether the reduction of the neurologic risk outweighs the benefits of complete revascularization remains to be determined.
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Affiliation(s)
- M Gaudino
- Department of Cardiac Surgery, Catholic University, Rome, Italy.
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Paterson ES, Moré MI, Pillay G, Cellini C, Woodgate R, Walker GC, Iyer VN, Winans SC. Genetic analysis of the mobilization and leading regions of the IncN plasmids pKM101 and pCU1. J Bacteriol 1999; 181:2572-83. [PMID: 10198024 PMCID: PMC93686 DOI: 10.1128/jb.181.8.2572-2583.1999] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The conjugative IncN plasmids pKM101 and pCU1 have previously been shown to contain identical oriT sequences as well as conserved restriction endonuclease cleavage patterns within their tra regions. Complementation analysis and sequence data presented here indicate that these two plasmids encode essentially identical conjugal DNA-processing proteins. This region contains three genes, traI, traJ, and traK, transcribed in the same orientation from a promoter that probably lies within or near the conjugal transfer origin (oriT). Three corresponding proteins were visualized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and complementation analysis confirmed that this region contains three tra complementation groups. All three proteins resemble proteins of the IncW plasmid R388 and other plasmids thought to have roles in processing of plasmid DNA during conjugation. The hydropathy profile of TraJ suggests a transmembrane topology similar to that of several homologous proteins. Both traK and traI were required for efficient interplasmid site-specific recombination at oriT, while traJ was not required. The leading region of pKM101 contains three genes (stbA, stbB, and stbC), null mutations in which cause elevated levels of plasmid instability. Plasmid instability was observed only in hosts that are proficient in interplasmid recombination, suggesting that this recombination can potentially lead to plasmid loss and that Stb proteins somehow overcome this, possibly via site-specific multimer resolution.
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Affiliation(s)
- E S Paterson
- Department of Biology, Carleton University, Ottawa, Ontario, Canada K1S 5B6
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45
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Possati G, Gaudino M, Santarelli F, Morelli M, Cellini C, Di Sciascio G, Trani C, Serricchio M, Tondi P. [The radial artery in coronary surgery: the midterm clinical and angiographic results and the variation in vasoreactivity over time]. G Ital Cardiol 1999; 29:135-42. [PMID: 10088068] [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: 02/11/2023]
Abstract
OBJECTIVE To evaluate the mid-term angiographic results of radial artery grafts used for myocardial revascularization. METHODS The first 68 consecutive surviving patients who received a radial artery graft proximally anastomosed to the aorta at our institution were restudied in a five-year follow-up (mean 59 +/- 6.5 months); 48 of these patients had already undergone an early angiographic examination. The response of the radial artery to the endovascular infusion of serotonin was evaluated one and five years after surgery and the mid-term status of the radial artery grafts was correlated with the degree of stenosis of the target vessel and with the Ca(++)-channel-blocker therapy. RESULTS The patency and perfect patency rates of the radial artery five years after the operation were 91.9 and 87.0% respectively. All radial artery grafts that were patent early after surgery remained patent at mid-term follow-up and in seven patients early parietal irregularities disappeared after five years. The early propensity to graft spasm after serotonin challenge decreased markedly at mid-term follow-up. The continued use of Ca(++)-antagonists after the first postoperative year did not affect the status of the radial artery graft, whereas the severity of target-vessel stenosis markedly influenced the angiographic results. CONCLUSIONS The mid-term angiographic results of RA grafts used for myocardial revascularization are excellent. A correct surgical indication is essential, whereas continued therapy with Ca(++)-antagonists after the first year does not influence the mid-term angiographic results.
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Affiliation(s)
- G Possati
- Cattedra di Cardiochirurgia, Università Cattolica del Sacro Cuore, Roma
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Guillem JG, Puig-La Calle J, Cellini C, Murray M, Ng J, Fazzari M, Paty PB, Quan SH, Wong WD, Cohen AM. Varying features of early age-of-onset "sporadic" and hereditary nonpolyposis colorectal cancer patients. Dis Colon Rectum 1999; 42:36-42. [PMID: 10211518 DOI: 10.1007/bf02235180] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [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] [Indexed: 02/08/2023]
Abstract
PURPOSE Although the criteria for clinical diagnosis of hereditary nonpolyposis colorectal cancer are not fully agreed on, young age seems to be a common trait. The purpose of this study is to identify clinicopathologic features of hereditary nonpolyposis colorectal cancer in early age-of-onset colorectal cancer patients stratified as a function of family cancer history. METHODS Two hundred thirty consecutive colorectal cancer patients 40 years or older at time of diagnosis were registered into an ongoing database during a ten-year period. Accurate family history was obtained via medical records, telephone calls, and questionnaires on 146 patients. According to extent of family history of cancer, patients were stratified into seven groups: 1) fulfilling Amsterdam criteria, 2) fulfilling less strict criteria, 3) having at least one first-degree relative with colorectal cancer, 4) having at least one distant relative with colorectal cancer, 5) having at least one first-degree relative with any cancer, 6) having at least one distant relative with any cancer, 7) having no family history of cancer. RESULTS Twenty-two of 146 patients fulfilled Amsterdam and less strict hereditary nonpolyposis colorectal cancer criteria (15 percent). These hereditary nonpolyposis colorectal cancer patients were significantly younger (31 vs. 35 years; P = 0.0003) and had more metachronous colorectal cancer (27 percent vs. 2 percent; P = 0.007) and less colorectal cancer with nodal or metastatic spread than the non-hereditary nonpolyposis colorectal cancer patients (35 percent vs. 65 percent; P = 0.01). CONCLUSION Precise familial cancer assessment in early age-of-onset colorectal cancer increases the yield of hereditary nonpolyposis colorectal cancer diagnosis. Because of the frequent development of metachronous colorectal cancer and favorable prognosis, extensive rather than segmental surgery should be considered in early age-of-onset colorectal cancer patients belonging to hereditary nonpolyposis colorectal cancer families.
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Affiliation(s)
- J G Guillem
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Possati G, Gaudino M, Alessandrini F, Luciani N, Glieca F, Trani C, Cellini C, Canosa C, Di Sciascio G. Midterm clinical and angiographic results of radial artery grafts used for myocardial revascularization. J Thorac Cardiovasc Surg 1998; 116:1015-21. [PMID: 9832694 DOI: 10.1016/s0022-5223(98)70054-6] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.2] [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] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the midterm angiographic results of the use of radial artery grafts for myocardial revascularization. METHODS The first 68 consecutive surviving patients who received a radial artery graft proximally anastomosed to the aorta at our institution were studied again at 5 years (mean 59 +/- 6.5 months) of follow-up; 48 of these patients had previously undergone an early angiographic examination. The response of the radial artery to the endovascular infusion of serotonin was evaluated 1 and 5 years after the operation, and the midterm status of the radial artery graft was correlated with the degree of preoperative stenosis of the target vessel and with calcium-channel blocker therapy. RESULTS The patency and perfect patency rates of the radial artery grafts 5 years after the operation were 91.9% and 87.0%, respectively. All radial artery grafts that were patent early after the operation remained patent at midterm follow-up, and early parietal irregularities in 7 patients were seen to have disappeared after 5 years. The early propensity toward graft spasm after serotonin challenge was markedly decreased at midterm follow-up. The continued use of calcium-channel antagonists after the first postoperative year did not influence the radial artery graft status, whereas the preoperative severity of the target-vessel stenosis markedly influenced the angiographic results. CONCLUSIONS The midterm angiographic results of radial artery grafts used for myocardial revascularization are excellent. The correct surgical indication is essential. Continued therapy with calcium-channel antagonists after the first year does not influence the midterm angiographic results.
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Affiliation(s)
- G Possati
- Departments of Cardiac Surgery and Cardiology, Catholic University, and the Department of Cardiology, Campus Biomedico University, Rome, Italy
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Abstract
We report two cases in which combined beating heart revascularization of the left anterior descending artery (LAD) and percutaneous angioplasty of the non-LAD target arteries were adopted after the intraoperative detection of porcelain aorta and impossibility to complete surgical revascularization. This type of strategy preserves the benefits of surgical LAD grafting and complete revascularization and results in a simple and low-risk technical procedure in an otherwise challenging setting.
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Affiliation(s)
- M Gaudino
- Department of Cardiac Surgery, Catholic University, Rome, Italy
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Cellini C, Kalogeraki VS, Winans SC. The hydrophobic TraM protein of pKM101 is required for conjugal transfer and sensitivity to donor-specific bacteriophage. Plasmid 1997; 37:181-8. [PMID: 9200221 DOI: 10.1006/plas.1997.1291] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
pKM101 is a self-transmissible plasmid of the IncN incompatibility group. Analysis of the DNA sequences of the genes required for conjugal transfer suggested the existence of a previously uncharacterized open reading frame, designated traM, that might be required for conjugation. Merodiploid strains containing transposon insertion mutations either in traM or in neighboring tra genes were used to demonstrate that traM constitutes a new complementation group essential for conjugation and donor phage sensitivity. The hydrophobicity profile of TraM suggests that it contains a signal sequence. The remainder of TraM is also composed predominantly of hydrophobic amino acids but contains one possible surface exposed loop. TraM-alkaline phosphatase and TraM-beta-galactosidase fusion proteins supported the hypothesis that TraM has a small cytoplasmic loop. We were unable to detect heterologous complementation between any tra mutation and its homolog from the virB operon of Agrobacterium tumefaciens.
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Affiliation(s)
- C Cellini
- Section of Microbiology, Cornell University, Ithaca, New York 10021, USA
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Falappa PG, Danza FM, Cotroneo AR, Cellini C, Baruffi E. Percutaneous removal of a Kirschner wire from the thoracic aorta. Rays 1989; 14:65-8. [PMID: 2520857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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