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Boccatonda A, D’Ardes D, Tallarico V, Vicari S, Bartoli E, Vidili G, Guagnano MT, Cocco G, Cipollone F, Schiavone C, Accogli E. Gastrointestinal Ultrasound in Emergency Setting. J Clin Med 2023; 12:jcm12030799. [PMID: 36769448 PMCID: PMC9917741 DOI: 10.3390/jcm12030799] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Acute bowel diseases are responsible for more than one third of subjects who were referred to the emergency department for acute abdominal pain and gastrointestinal evaluation. Gastrointestinal ultrasound (GIUS) is often employed as the first imaging method, with a good diagnostic accuracy in the setting of acute abdomen, and it can be an optimal diagnostic strategy in young females due to the radiation exposure related to X-ray and computed tomography methods. The physician can examine the gastrointestinal system in the area with the greatest tenderness by ultrasound, thus obtaining more information and data on the pathology than the standard physical examination. In this comprehensive review, we have reported the most relevant indications and advantages to using ultrasound in the investigation of abdominal acute pain.
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Affiliation(s)
- Andrea Boccatonda
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, Bentivoglio (BO), 40010 Bologna, Italy
- Correspondence: ; Tel.: +39-051-664-4111
| | - Damiano D’Ardes
- Department of Medicine and Aging Science, Institute of “Clinica Medica”, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Viola Tallarico
- Department of Internal Medicine, Bologna University, 40138 Bologna, Italy
| | - Susanna Vicari
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, Bentivoglio (BO), 40010 Bologna, Italy
| | - Elena Bartoli
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, Bentivoglio (BO), 40010 Bologna, Italy
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Maria Teresa Guagnano
- Department of Medicine and Aging Science, Institute of “Clinica Medica”, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Giulio Cocco
- Internistic Ultrasound Unit, SS Annunziata Hospital, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging Science, Institute of “Clinica Medica”, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Cosima Schiavone
- Internistic Ultrasound Unit, SS Annunziata Hospital, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Esterita Accogli
- Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, 40133 Bologna, Italy
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Bandini G, Accogli E, Cometi L, Matucci-Cerinic M, Moggi Pignone A. Ultrasound assessment of splanchnic circulation in Systemic Sclerosis: a non-invasive approach for the study of bowel vasculopathy? Eur J Intern Med 2022; 103:120-121. [PMID: 35821193 DOI: 10.1016/j.ejim.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Giulia Bandini
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Florence, Italy.
| | - Esterita Accogli
- Department of Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, Bologna, Italy
| | - Laura Cometi
- Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC, Florence, Italy; Unit of Immunology, Rheumatology, Allergy and Rare diseases (unIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Alberto Moggi Pignone
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Florence, Italy
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Boccatonda A, Cocco G, Sofia S, Accogli E, Vicari S, Schiavone C. A New Type of Outpatient: Lung Ultrasound After COVID-19 Infection. J Ultrasound Med 2022; 41:2113-2114. [PMID: 34748228 PMCID: PMC8661862 DOI: 10.1002/jum.15871] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | - Giulio Cocco
- Internistic Ultrasound UnitSS Annunziata Hospital, “G. d'Annunzio” UniversityChietiItaly
| | - Soccorsa Sofia
- Emergency DepartmentMaggiore Hospital, AUSL BolognaBolognaItaly
| | - Esterita Accogli
- Internal MedicineCentre of Research and Learning in Ultrasound, Maggiore HospitalBolognaItaly
| | - Susanna Vicari
- Internal MedicineBentivoglio Hospital, AUSL BolognaBentivoglioItaly
| | - Cosima Schiavone
- Internistic Ultrasound UnitSS Annunziata Hospital, “G. d'Annunzio” UniversityChietiItaly
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Bandini G, Cometi L, Accogli E, Domanico A, Tofani L, Bruni C, Bellando-Randone S, Lepri G, Orlandi M, Guiducci S, El-Aoufy K, Ciuti G, Fabbri A, Matucci-Cerinic M, Moggi-Pignone A. Ultrasound evaluation of bowel vasculopathy in systemic sclerosis. Eur J Intern Med 2022; 100:62-68. [PMID: 35058148 DOI: 10.1016/j.ejim.2022.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/05/2022] [Accepted: 01/13/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastrointestinal (GI) manifestations are frequent in systemic sclerosis (SSc) with an impact on quality of life and morbidity. Bowel vasculopathy is a key pathogenetic factor responsible for GI involvement. OBJECTIVES To compare abdominal ultrasound (US) and Color Doppler Ultrasonography (CDU) features of splanchnic vessels of SSc patients with healthy controls. METHODS The charts of SSc patients who underwent an abdominal US and CDU study were retrospectively analyzed. For Superior Mesenteric Artery (SMA) and Inferior Mesenteric Artery (IMA) caliber, Peak Systolic Velocity (PSV), Reverse Velocity (RV), End-Diastolic Velocity (EDV), Mean Velocity (mV), Blood-flow, Resistive Index (RI) and Pulsatility Index (PI) were recorded. RESULTS 28 SSc patients and 28 controls were enrolled. In SSc, caliber of SMA was significantly smaller than in controls (5.75 ± 0.62 mm vs. 6.45 ± 0.60 mm, p < 0.0001 - p adj =0.0002). The flow study of SMA and IMA showed a significant reduction of RV (SMA: 7.25 ± 6.37 cm/s vs. 18.52 ± 6.16 cm/s, p < 0.0001 - p adj <0.0001; IMA: 2.69 ± 6.10 cm/s vs. 17.06 ± 5.75 cm/s, p < 0.0001 - p adj <0.0001) and PI (SMA: 3.33 ± 0.75 vs. 4.53 ± 1.03, p < 0.0001 - p adj =0.0002; IMA: 3.54 ± 0.95 vs. 6.08 ± 1.53, p < 0.0001 - p adj <0.0001) in SSc patients than controls. CONCLUSION involvement of splanchnic vessels in SSc may be non-invasively investigated with abdominal US and CDU. Morphological and functional changes of Doppler parameters observed in SMA and IMA clearly demonstrate that these vessels are affected by SSc vasculopathy.
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Affiliation(s)
- Giulia Bandini
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy.
| | - Laura Cometi
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Esterita Accogli
- Department of Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, Bologna, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Andrea Domanico
- Department of Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, Bologna, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Lorenzo Tofani
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Martina Orlandi
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Khadija El-Aoufy
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Gabriele Ciuti
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Alessia Fabbri
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
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Cometi L, Bandini G, El Aoufy K, Domanico A, Tofani L, Bruni C, Bellando Randone S, Guiducci S, Moggi Pignone A, Accogli E, Matucci-Cerinic M. OP0176 ULTRASOUND (US) EVALUATION OF BOWEL VASCULOPATHY IN SYSTEMIC SCLEROSIS (SSC). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.647] [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: 11/04/2022]
Abstract
Background:Gastrointestinal involvement is one of the most frequent features of SSc, affecting nearly 90% of patients, with a great impact on quality of life and morbidity. One of the key pathological factors of SSc bowel involvement is vasculopathy (1), although little is known about its pathophysiology and no treatments are currently available.Objectives:to assess with abdominal US the superior mesenteric artery (SMA) and the inferior mesenteric artery (IMA) vessel characteristics and blood flow in SSc, compared to healthy controls (HC).Methods:we performed fasting abdominal US in SSc patients fulfilling the ACR/EULAR 2013 classification criteria and HC. Patients with a history of peripheral /coronary arterial disease were excluded. For both SMA and IMA, caliber (mm), Peak Systolic Velocity – PSV (cm/sec), Reverse Velocity – RV (cm/sec), End-Diastolic Velocity – EDV (cm/sec), Mean Velocity – mV (cm/sec), Blood-flow (cm/sec), Resistive Index – RI and Pulsatility Index – PI were measured.Results:28 SSc patients [25 females (89.3%), mean age 48.75 ± 12.39 years; 6 (22.22%) anti-centromere and 19 (70.37%) positive for anti-topoisomerase I antibodies] and 28 HC [18 females (64.3%), mean age 36.25 ± 12.08 years] were evaluated. In SSc, the SMA caliber was significantly smaller than in HC (5.75 ± 0.62 vs. 6.45 ± 0.60 mm, p<0.0001), while IMA dimensions did not differ.The SMA study revealed SSc patients had a significant reduction of RV (7.25 ± 6.37 vs. 18.52 ± 6.16 cm/sec, p<0.0001) and PI (3.33 ± 0.75 vs. 4.53 ± 1.03, p<0.0001) when compared to HC. In addition, in SSc the mV of SMA was significantly lower than in HC (38.03 ± 13.90 vs. 28.32 ±9.25 cm/sec, p=0.0035), as well as the RI (0.88 ± 0.04 vs. 0.91 ± 0.03, p=0.0034); EDV was significantly increased (16.34 ± 7.03 vs. 12.64 ± 5.46 cm/sec, p=0.0321). Similarly to SMA, also in IMA RV and PI were significantly lower that controls (RV: 2.69 ± 6.10 vs. 17.06 ± 5.75 cm/sec, p<0.0001; PI: 3.54 ± 0.95 vs. 6.08 ± 1.53, p<0.0001). Moreover SSc patients presented a significant reduction of PSV and RI of IMA (PSV: 72.27 ± 27.23 vs. 93.81 ± 25.73 cm/sec, p=0.0084; RI: 0.88 ± 0.04 vs. 0.91 ± 0.03, p=0.0132) when compared to HC. Although the HC group was significantly younger than the SSc group (p=0.0003), all the results were confirmed after adjustment for age (Table 1).Table 1.comparison of the characteristics of SMA and IMA between SSc patients and HC.SScHCp-valueAge adjusted p-valueSMANMean ± SDNMean ± SDCaliber (mm)285.75 ± 0.62286.45 ± 0.60<0.00010.0002PSV (cm/sec)28137.50 ± 34.5028135.26 ± 33.810.80750.7297RV (cm/sec)287.25 ± 6.372818.52 ± 6.16<0.0001<0.0001EDV (cm/sec)2816.34 ± 7.032812.64 ± 5.460.03210.0650mV (cm/sec)2838.03 ± 13.902828.32 ±9.250.00350.0150Blood-flow (cm/sec)281073.1 ± 831.1628913.36 ± 272.870.34090.4781PI283.33 ± 0.75284.53 ± 1.03<0.00010.0002RI280.88 ± 0.04280.91 ± 0.030.00340.0141IMACaliber (mm)262.71 ± 0.47242.79 ± 0.370.48720.5385PSV (cm/sec)2372.27 ± 27.232393.81 ± 25.730.00840.0044RV (cm/sec)232.69 ± 6.102317.06 ± 5.75<0.0001<0.0001EDV (cm/sec)237.87 ± 2.01237.95 ± 2.100.89210.9250mV (cm/sec)2317.83 ± 5.332314.75 ± 5.080.05140.3938Blood-flow (cm/sec)23106.70 ± 47.992084.00 ± 30.130.06760.3056PI233.54 ± 0.95236.08 ± 1.53<0.0001<0.0001RI230.88 ± 0.04230.91 ± 0.030.01320.0205SMA=superior mesentheric artery, IMA=inferior mesentheric artery, PSV=Peak Systolic Velocity, RV=Reverse Velocity, EDV=End-Diastolic Velocity, mV=Mean Velocity, PI=Pulsatility Index, RI=Resistive Index.Conclusion:this preliminary study shows, for the first time, the presence of a significant reduction of RV, PI and RI in the intestinal arteries of SSc patients when compared to HC. These data show an increased stiffness of the gastrointestinal arterial wall, in agreement with the typical SSc vasculopathy. A larger cohort is needed to confirm the results and explore the possible relationship with other clinical features of the disease.References:[1]Sjogren, RW.Gastrointestinal features of scleroderma. Curr Opin Rheumatol 1996;8:569-75.Disclosure of Interests:None declared
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Giugno V, Di Marzio G, Domanico A, Accogli E. Lung Ultrasound (LUS) in COVID-19 Pneumonia: Usefulness in Two Atypical Cases. Eur J Case Rep Intern Med 2020; 7:001800. [PMID: 32789143 PMCID: PMC7417063 DOI: 10.12890/2020_001800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 11/26/2022] Open
Abstract
Clinical experience and scientific articles have shown that patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be paucisymptomatic or asymptomatic at the time of diagnosis. In this paper, we will discuss two paucisymptomatic patients with blood tests suggestive for SARS-CoV-2 infection but with repeated negative nasopharyngeal swabs and without typical features of COVID-19 pneumonia on chest high-resolution computed tomography. In these cases, lung ultrasound helped to raise clinical suspicion of COVID-19 pneumonia and facilitate diagnosis.
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Sofia S, Boccatonda A, Montanari M, Spampinato M, D'ardes D, Cocco G, Accogli E, Cipollone F, Schiavone C. Thoracic ultrasound and SARS-COVID-19: a pictorial essay. J Ultrasound 2020; 23:217-221. [PMID: 32297175 PMCID: PMC7159975 DOI: 10.1007/s40477-020-00458-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022] Open
Abstract
Thoracic ultrasound seems to adapt to the screening for lung involvement of patients with suspected or ascertained SARS-COVID-19 infection due to its characteristics of easy applicability. It can be also a relevant method in monitoring patients. B lines are early finding of COVID-19, even in mild-symptomatic subjects; in the most serious cases such as pre-ARDS or ARDS, the B lines end up filling the ultrasound image almost completely, until it merges, so as to create a single hyperechoic image named as "white lung", with distortion and irregularity of the pleural line. In advanced stage, lung consolidations are present, representing pulmonary pathological areas that are no longer normally ventilated.
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Affiliation(s)
- Soccorsa Sofia
- Emergency Department, Ospedale Maggiore AUSL Bologna, Bologna, Italy
| | - Andrea Boccatonda
- Internistic Ultrasound Unit, SS Annunziata Hospital, "G. d'Annunzio" University, via dei Vestini, 66100, Chieti, Italy.
| | | | | | - Damiano D'ardes
- Internistic Ultrasound Unit, SS Annunziata Hospital, "G. d'Annunzio" University, via dei Vestini, 66100, Chieti, Italy
| | - Giulio Cocco
- Internistic Ultrasound Unit, SS Annunziata Hospital, "G. d'Annunzio" University, via dei Vestini, 66100, Chieti, Italy
| | - Esterita Accogli
- Department of Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, Bologna, Italy
| | - Francesco Cipollone
- Clinica Medica Division and European Center of Excellence on Atherosclerosis, Hypertension and Dyslipidemia "SS. Annunziata" Hospital, Chieti, Italy
| | - Cosima Schiavone
- Internistic Ultrasound Unit, SS Annunziata Hospital, "G. d'Annunzio" University, via dei Vestini, 66100, Chieti, Italy
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Grizzi F, Fiorino S, Qehajaj D, Fornelli A, Russo C, de Biase D, Masetti M, Mastrangelo L, Zanello M, Lombardi R, Domanico A, Accogli E, Tura A, Mirandola L, Chiriva-Internati M, Bresalier RS, Jovine E, Leandri P, Di Tommaso L. Computer-aided assessment of the extra-cellular matrix during pancreatic carcinogenesis: a pilot study. J Transl Med 2019; 17:61. [PMID: 30819202 PMCID: PMC6393991 DOI: 10.1186/s12967-019-1817-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/21/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A hallmark of pancreatic ductal adenocarcinoma is the desmoplastic reaction, but its impact on the tumor behavior remains controversial. Our aim was to introduce a computer -aided method to precisely quantify the amount of pancreatic collagenic extra-cellular matrix, its spatial distribution pattern, and the degradation process. METHODS A series of normal, inflammatory and neoplastic pancreatic ductal adenocarcinoma formalin-fixed and paraffin-embedded Sirius red stained sections were automatically digitized and analyzed using a computer-aided method. RESULTS We found a progressive increase of pancreatic collagenic extra-cellular matrix from normal to the inflammatory and pancreatic ductal adenocarcinoma. The two-dimensional fractal dimension showed a significant difference in the collagenic extra-cellular matrix spatial complexity between normal versus inflammatory and pancreatic ductal adenocarcinoma. A significant difference when comparing the number of cycles necessary to degrade the pancreatic collagenic extra-cellular matrix in normal versus inflammatory and pancreatic ductal adenocarcinoma was also found. The difference between inflammatory and pancreatic ductal adenocarcinoma was also significant. Furthermore, the mean velocity of collagenic extra-cellular matrix degradation was found to be faster in inflammatory and pancreatic ductal adenocarcinoma than in normal. CONCLUSION These findings demonstrate that inflammatory and pancreatic ductal adenocarcinomas are characterized by an increased amount of pancreatic collagenic extra-cellular matrix and by changes in their spatial complexity and degradation. Our study defines new features about the pancreatic collagenic extra-cellular matrix, and represents a basis for further investigations into the clinical behavior of pancreatic ductal adenocarcinoma and the development of therapeutic strategies.
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Affiliation(s)
- Fabio Grizzi
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center—IRCCS, Rozzano, Milan, Italy
- Humanitas University, Rozzano, Milan, Italy
- Histology Core, Humanitas Clinical and Research Center—IRCCS, Rozzano, Milan, Italy
| | - Sirio Fiorino
- Internal Medicine Unit, Maggiore Hospital, Bologna, Italy
| | - Dorina Qehajaj
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center—IRCCS, Rozzano, Milan, Italy
| | - Adele Fornelli
- Anatomic Pathology Service, Maggiore Hospital, Bologna, Italy
| | - Carlo Russo
- “Michele Rodriguez” Foundation-Institute for Quantitative Measures in Medicine, Milan, Italy
| | - Dario de Biase
- Department of Pharmacy and Biotechnology (FaBiT), University of Bologna, Bologna, Italy
| | | | | | | | | | - Andrea Domanico
- Ultrasound Center Internal Medicine A, Maggiore Hospital, Bologna, Italy
| | - Esterita Accogli
- Ultrasound Center Internal Medicine A, Maggiore Hospital, Bologna, Italy
| | | | | | - Maurizio Chiriva-Internati
- Kiromic Biopharma, Inc., Houston, TX USA
- Department of Gastroenterology, Hepatology & Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer, Houston, TX USA
| | - Robert S. Bresalier
- Department of Gastroenterology, Hepatology & Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer, Houston, TX USA
| | - Elio Jovine
- Surgery Unit, Maggiore Hospital, Bologna, Italy
| | - Paolo Leandri
- Internal Medicine Unit, Maggiore Hospital, Bologna, Italy
| | - Luca Di Tommaso
- Humanitas University, Rozzano, Milan, Italy
- Department of Pathology, Humanitas Clinical and Research Center—IRCCS, Rozzano, Milano, Italy
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Fiorino S, Bacchi-Reggiani ML, Birtolo C, Acquaviva G, Visani M, Fornelli A, Masetti M, Tura A, Sbrignadello S, Grizzi F, Patrinicola F, Zanello M, Mastrangelo L, Lombardi R, Benini C, Di Tommaso L, Bondi A, Monetti F, Siopis E, Orlandi PE, Imbriani M, Fabbri C, Giovanelli S, Domanico A, Accogli E, Di Saverio S, Grifoni D, Cennamo V, Leandri P, Jovine E, de Biase D. Matricellular proteins and survival in patients with pancreatic cancer: A systematic review. Pancreatology 2018; 18:122-132. [PMID: 29137857 DOI: 10.1016/j.pan.2017.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/29/2017] [Accepted: 11/01/2017] [Indexed: 02/05/2023]
Abstract
Extracellular matrix (ECM) plays a fundamental role in tissue architecture and homeostasis and modulates cell functions through a complex interaction between cell surface receptors, hormones, several bioeffector molecules, and structural proteins like collagen. These components are secreted into ECM and all together contribute to regulate several cellular activities including differentiation, apoptosis, proliferation, and migration. The so-called "matricellular" proteins (MPs) have recently emerged as important regulators of ECM functions. The aim of our review is to consider all different types of MPs family assessing the potential relationship between MPs and survival in patients with pancreatic ductal adenocarcinoma (PDAC). A systematic computer-based search of published articles, according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) Statement issued in 2009 was conducted through Ovid interface, and literature review was performed in May 2017. The search text words were identified by means of controlled vocabulary, such as the National Library of Medicine's MESH (Medical Subject Headings) and Keywords. Collected data showed an important role of MPs in carcinogenesis and in PDAC prognosis even though the underlying mechanisms are still largely unknown and data are not univocal. Therefore, a better understanding of MPs role in regulation of ECM homeostasis and remodeling of specific organ niches may suggest potential novel extracellular targets for the development of efficacious therapeutic strategies.
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Affiliation(s)
- Sirio Fiorino
- Internal Medicine Unit C, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy.
| | - Maria Letizia Bacchi-Reggiani
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale), Cardiology Unit, Policlinico S. Orsola-Malpighi, University of Bologna, via Massarenti 9, Bologna, Italy
| | - Chiara Birtolo
- Internal Medicine Unit A, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Giorgia Acquaviva
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale), University of Bologna, Azienda USL di Bologna, Largo Nigrisoli 3, Bologna, Italy
| | - Michela Visani
- Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale), University of Bologna, Azienda USL di Bologna, Largo Nigrisoli 3, Bologna, Italy
| | - Adele Fornelli
- Anatomic Pathology Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Michele Masetti
- Surgery Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Andrea Tura
- CNR Institute of Neuroscience, Via Giuseppe Moruzzi 1, Padova, Italy
| | | | - Fabio Grizzi
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, Milano, Italy
| | - Federica Patrinicola
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, Milano, Italy
| | - Matteo Zanello
- Surgery Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Laura Mastrangelo
- Surgery Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Raffaele Lombardi
- Surgery Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Claudia Benini
- Surgery Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Luca Di Tommaso
- Department of Pathology, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, Milano, Italy
| | - Arrigo Bondi
- Anatomic Pathology Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Francesco Monetti
- Radiology Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Elena Siopis
- Radiology Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Paolo Emilio Orlandi
- Radiology Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Michele Imbriani
- Radiology Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Carlo Fabbri
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Silvia Giovanelli
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Andrea Domanico
- Internal Medicine Unit A, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Esterita Accogli
- Internal Medicine Unit A, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Salomone Di Saverio
- Surgical Emergency Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Daniela Grifoni
- Department of Pharmacy and Biotechnology, University of Bologna, via San Donato 15, Bologna, Italy
| | - Vincenzo Cennamo
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Paolo Leandri
- Surgical Emergency Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Elio Jovine
- Surgery Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy
| | - Dario de Biase
- Department of Pharmacy and Biotechnology, University of Bologna, via San Donato 15, Bologna, Italy.
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Zenobii MF, Accogli E, Domanico A, Arienti V. Update on ultrasound in bowel obstruction. Intern Emerg Med 2016; 11:1015-7. [PMID: 27503505 DOI: 10.1007/s11739-016-1518-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Maria Francesca Zenobii
- Department of Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, Bologna, Italy
| | - Esterita Accogli
- Department of Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, Bologna, Italy
| | - Andrea Domanico
- Department of Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, Bologna, Italy
| | - Vincenzo Arienti
- Department of Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, Bologna, Italy.
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Abstract
Acute cholecystitis (AC) represents a principal cause of morbidity worldwide and is one of the most frequent reasons for hospitalization due to gastroenteric tract diseases. AC should be suspected in presence of clinical signs and of gallstones on an imaging study. Upper abdominal US represents the first diagnostic imaging step in the case of suspected AC. Computed tomography (CT) with intravenous contrast (IV) or magnetic resonance imaging (MRI) with gadolinium contrast and technetium hepatobiliary iminodiacetic acid (Tc-HIDA) can be employed to exclude complications. US examination should be performed with right subcostal oblique, with longitudinal and intercostal scans. Normal gallbladder US findings and AC major and minor US signs are described. Polyps, sludge and gallbladder wall thickening represent the more frequent pitfalls and they must be differentiated from stones, duodenal artifacts and many other non-inflammatory conditions that cause wall thickening, respectively. By means of bedside ultrasound, the finding of gallstones in combination with acute pain, when the clinician presses the gallbladder with the US probe (the sonographic Murphy's sign), has a 92.2 % positive predictive value for AC. In our preliminary experience, bedside US-performed by echoscopy (ES) and/or point-of-care US (POCUS) demonstrated good reliability in detecting signs of AC, and was always integrated with physical examination and performed by a skilled operator.
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Affiliation(s)
- Maria Francesca Zenobii
- Centre of Research and Learning in Ultrasound, Department of Internal Medicine, Maggiore Hospital, Bologna, Italy
| | - Esterita Accogli
- Centre of Research and Learning in Ultrasound, Department of Internal Medicine, Maggiore Hospital, Bologna, Italy
| | - Andrea Domanico
- Centre of Research and Learning in Ultrasound, Department of Internal Medicine, Maggiore Hospital, Bologna, Italy
| | - Vincenzo Arienti
- Centre of Research and Learning in Ultrasound, Department of Internal Medicine, Maggiore Hospital, Bologna, Italy.
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12
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Cesario V, Accogli E, Domanico A, Di Lascio FML, Napoleone L, Gasbarrini A, Arienti V. Percutaneous real-time sonoelastography as a non-invasive tool for the characterization of solid focal liver lesions: A prospective study. Dig Liver Dis 2016; 48:182-8. [PMID: 26687030 DOI: 10.1016/j.dld.2015.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 10/23/2015] [Accepted: 11/07/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Real-time sonoelastography is currently used for the characterization of superficial solid lesions such as thyroid and breast masses. This study evaluates the usefulness of percutaneous sonoelastography for the characterization of solid focal liver lesions. METHODS 30 out of 43 patients with 38 known liver lesions were included in a prospective, diagnostic study. Qualitative analysis (pattern of deformation, elasticity type of liver tumour) and semi-quantitative measurements (strain ratio, hardness percentage, histogram) were evaluated. Sensitivity, specificity, positive and negative predictive values were calculated and the area under the receiver operating characteristics curve was constructed. RESULTS Patterns A and C-D are specific of benign lesions and metastases respectively. The patterns for haemangiomas, focal nodular hyperplasia and metastases were significantly different to each other in terms of strain ratio, hardness percentage and histogram (p<0.05). A statistically significant difference (p<0.001) was observed between the median values of the 3 measured parameters for benign (1.02; 12%; 47) and malignant lesions (1.66; 65%; 20.5) respectively. The area under the receiver operating characteristics curve values for strain ratio, hardness percentage and histogram were 0.88, 0.89, and 0.86 respectively for cut-off values of 1.2, 45, and 30. CONCLUSIONS By percutaneous sonoelastography it is possible to differentiate benign versus malignant focal liver lesions, metastases in particular, with good diagnostic performance.
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Affiliation(s)
- Valentina Cesario
- Internal Medicine and Gatroenterology Department, UCSC, Policlinico Gemelli, Rome, Italy.
| | - Esterita Accogli
- Internal Medicine A Department, Ospedale Maggiore, Bologna, Italy
| | - Andrea Domanico
- Internal Medicine A Department, Ospedale Maggiore, Bologna, Italy
| | - F Marta L Di Lascio
- Faculty of Economics and Management, Free University of Bozen, Bolzano, Italy
| | - Laura Napoleone
- Internal Medicine Department, Università La Sapienza, Rome, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gatroenterology Department, UCSC, Policlinico Gemelli, Rome, Italy
| | - Vincenzo Arienti
- Internal Medicine A Department, Ospedale Maggiore, Bologna, Italy
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13
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Arienti V, Di Giulio R, Cogliati C, Accogli E, Aluigi L, Corazza GR. Bedside ultrasonography (US), Echoscopy and US point of care as a new kind of stethoscope for Internal Medicine Departments: the training program of the Italian Internal Medicine Society (SIMI). Intern Emerg Med 2014; 9:805-14. [PMID: 25145290 DOI: 10.1007/s11739-014-1113-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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] [Received: 06/13/2014] [Accepted: 07/30/2014] [Indexed: 02/06/2023]
Abstract
In recent years, thanks to the development of miniaturized ultrasound devices, comparable to personal computers, tablets and even to smart phones, we have seen an increasing use of bedside ultrasound in internal medicine departments as a novel kind of ultrasound stethoscope. The clinical ultrasound-assisted approach has proved to be particularly useful in assessing patients with nodules of the neck, dyspnoea, abdominal pain, and with limb edema. In several cases, it has allowed a simple, rapid and precise diagnosis. Since 2005, the Italian Society of Internal Medicine and its Ultrasound Study Group has been holding a Summer School and training courses in ultrasound for residents in internal medicine. A national network of schools in bedside ultrasound was then organized for internal medicine specialists who want to learn this technique. Because bedside ultrasound is a user-dependent diagnostic method, it is important to define the limits and advantages of different new ultrasound devices, to classify them (i.e. Echoscopy and Point of Care Ultrasound), to establish appropriate different levels of competence and to ensure their specific training. In this review, we describe the point of view of the Italian Internal Medicine Society on these topics.
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Affiliation(s)
- Vincenzo Arienti
- Department of Internal Medicine, Internal Medicine A, Maggiore Hospital, Bologna, Italy,
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14
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Arienti V, Aluigi L, Pretolani S, Accogli E, Polimeni L, Domanico A, Violi F. Ultrasonography (US) and non-invasive diagnostic methods for non-alcoholic fatty liver disease (NAFLD) and early vascular damage. Possible application in a population study on the metabolic syndrome (MS). Intern Emerg Med 2012; 7 Suppl 3:S283-90. [PMID: 23073869 DOI: 10.1007/s11739-012-0824-7] [Citation(s) in RCA: 7] [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] [Indexed: 12/15/2022]
Abstract
Abdominal ultrasonography (US) represents the first-line imaging examination in chronic liver diseases; in most cases, US, laboratory findings and the clinical context are generally sufficient to guide the diagnosis. Thanks to the considerable diffusion of US, we have seen an increased diagnosis of NAFLD in recent years, although this condition is generally silent from a clinical point of view. We have to identify the metabolic syndrome in the general population and to promptly recognize NAFLD to prevent its development into non-alcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma. Among the non-invasive diagnostic techniques for NAFLD and for early vascular damage, ultrasonography represents the method of choice. In fact, besides the traditional semiotics of fundamental US of the liver, new US techniques have recently been proposed (contrast enhancement US, acoustic structure characterization), with respect to serum biomarkers and Fibroscan, for the study of liver fibrosis. Similarly, also as concerns the US measurement of carotid intima-media thickness, new automated methods with sophisticated software and radio-frequency signal have recently been introduced. Finally, we report the preliminary results of a personal experience on liver and carotid US in the epidemiology of the metabolic syndrome.
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Affiliation(s)
- Vincenzo Arienti
- Ultrasound Center, Internal Medicine A, Maggiore Hospital, Bologna, Italy.
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15
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Azzaroli F, Colecchia A, Colecchi A, Lodato F, Trerè D, Bacchi Reggiani ML, Festi D, Prati GM, Accogli E, Casanova S, Derenzini M, Roda E, Mazzella G. A statistical model predicting high hepatocyte proliferation index and the risk of developing hepatocellular carcinoma in patients with hepatitis C virus-related cirrhosis. Aliment Pharmacol Ther 2006; 24:129-36. [PMID: 16803611 DOI: 10.1111/j.1365-2036.2006.02955.x] [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: 12/27/2022]
Abstract
BACKGROUND Incidence of hepatocellular carcinoma in hepatitis C virus-related cirrhosis is 4% per year. Although cost-effective, current screening could be improved. AIM To develop a statistical model including non-invasive parameters able to identify patients at high risk of developing hepatocellular carcinoma. METHODS One hundred and fifty-eight patients (73F:85M) with compensated chronic hepatitis C virus liver disease underwent evaluation, including argyrophilic nucleolar organizer regions proliferation index, and were followed up for 56.18 +/- 1.44 months. RESULTS Fifty-six patients had chronic hepatitis without cirrhosis and low argyrophilic nucleolar organizer regions proliferation index (< or =25%), 65 had hepatitis C virus-related cirrhosis and low argyrophilic nucleolar organizer regions proliferation index and 37 had hepatitis C virus-related cirrhosis and high argyrophilic nucleolar organizer regions proliferation index (>25%). Groups were similar for gender and viral genotype distribution. None of the patients with chronic hepatitis without cirrhosis developed hepatocellular carcinoma, compared with 6.1% of low argyrophilic nucleolar organizer regions proliferation index and 30.6% of high argyrophilic nucleolar organizer regions proliferation index (P = 0.002). By multivariable logistic regression analysis, the following parameters were independently associated with hepatocellular carcinoma development and used for the development of the statistical model: platelets (OR 0.98), gamma-globulins (OR 0.111), alanine aminotransferase/aspartate aminotransferase ratio (OR 0.07), serum ferritin (OR 1.0) and ultrasonographic pattern (coarse OR 2.9, coarse nodular OR 10.12). The statistical model properly allocated 95.9% of patients with low argyrophilic nucleolar organizer regions proliferation index and 72.2% of patients with high argyrophilic nucleolar organizer regions proliferation index. CONCLUSIONS The model, to be validated in large prospective studies, may help tailoring screening according to the risk of hepatocellular carcinoma development.
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Affiliation(s)
- F Azzaroli
- Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy.
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16
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Azzaroli F, Accogli E, Nigro G, Trere D, Giovanelli S, Miracolo A, Lodato F, Montagnani M, Tamé M, Colecchia A, Mwangemi C, Festi D, Roda E, Derenzini M, Mazzella G. Interferon plus ribavirin and interferon alone in preventing hepatocellular carcinoma: A prospective study on patients with HCV related cirrhosis. World J Gastroenterol 2004; 10:3099-102. [PMID: 15457551 PMCID: PMC4611249 DOI: 10.3748/wjg.v10.i21.3099] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To determine the role of interferon (IFN) with or without ribavirin in preventing or delaying hepatocellular carcinoma (HCC) development in patients with hepatitis C virus (HCV) related cirrhosis. Data on the preventive effect of IFN plus ribavirin treatment are lacking.
METHODS: A total of 101 patients (62 males and 39 females, mean age 55.1 ± 1.4 years) with histologically proven HCV related liver cirrhosis plus compatible biochemistry and ultrasonography were enrolled in the study. Biochemistry and ultrasonography were performed every 6 mo. Ultrasound guided liver biopsy was performed on all detected focal lesions. Follow-up lasted for 5 years. Cellular proliferation, evaluated by measuring Ag-NOR proteins in hepatocytes nuclei, was expressed as AgNOR-Proliferative index (AgNOR-PI) (cut-off = 2.5). Forty-one patients (27 males, 14 females) were only followed up after the end of an yearly treatment with IFN-alpha2b (old treatment control group = OTCG). Sixty naive patients were stratified according to sex and AgNOR-PI and then randomized in two groups: 30 were treated with IFN-alpha2b + ribavirin (treatment group = TG), the remaining were not treated (control group = CG). Nonresponders (NR) or relapsers in the TG received further IFN/ribavirin treatments after a 6 mo of withdrawal.
RESULTS: AgNOR-PI was significantly lowered by IFN (P < 0.001). HCC incidence was higher in patients with AgNOR-PI > 2.5 (26% vs 3%, P < 0.01). Two NR in the OTCG, none in the TG and 9 patients in the CG developed HCC during follow-up. The Kaplan-Mayer survival curves showed statistically significant differences both between OTCG and CG (P < 0.004) and between TG and CG (P < 0.003).
CONCLUSION: IFN/ribavirin treatment associated with re-treatment courses of NR seems to produce the best results in terms of HCC prevention. AgNOR-PI is a useful marker of possible HCC development.
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Affiliation(s)
- Francesco Azzaroli
- Department of Internal Medicine, University of Bologna, Via Massarenti 9, 40138 Bologna.
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17
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Fabbri C, Jaboli MF, Giovanelli S, Azzaroli F, Pezzoli A, Accogli E, Liva S, Nigro G, Miracolo A, Festi D, Colecchia A, Montagnani M, Roda E, Mazzella G. Gastric autoimmune disorders in patients with chronic hepatitis C before, during and after interferon-alpha therapy. World J Gastroenterol 2003; 9:1487-90. [PMID: 12854147 PMCID: PMC4615488 DOI: 10.3748/wjg.v9.i7.1487] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the prevalence of autoimmune gastritis in chronic hepatitis C virus (HCV) patients and the influence of a-interferon (IFN) treatment on autoimmune gastritis.
METHODS: We performed a prospective study on 189 patients with positive anti-HCV and viral RNA enrolled in a 12-month IFN protocol. We evaluated: a) the baseline prevalence of autoimmune gastritis, b) the impact of IFN treatment on development of biochemical signs of autoimmune gastritis (at 3, 6 and 12 mo), c) the evolution after IFN withdrawal (12 mo) in terms of anti-gastric-parietal-cell antibodies (APCA), gastrin, anti-thyroid, and anti-non-organ-specific antibodies.
RESULTS: APCA positivity and 3-fold gastrin levels were detected in 3 (1.6%) and 9 (5%) patients, respectively, at baseline, in 25 (13%) and 31 (16%) patients at the end of treatment (both P < 0.001, vs baseline), and in 7 (4%) and 14 (7%) patients 12 mo after withdrawal (P = 0.002 and P = 0.01 respectively, vs baseline; P = not significant vs end of treatment). The development of autoimmune gastritis was strictly associated with the presence of autoimmune thyroiditis (P = 0.0001), no relationship was found with other markers of autoimmunity.
CONCLUSION: In HCV patients, IFN frequently precipitates latent autoimmune gastritis, particularly in females. Following our 12-month protocol, the phenomenon generally regressed. Since APCA positivity and high gastrin levels are associated with the presence of antithyroid antibodies, development of autoimmune thyroiditis during IFN treatment may provide a surrogate preliminary indicator of possible autoimmune gastritis to limit the need for invasive examinations.
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Affiliation(s)
- Carlo Fabbri
- Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy
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18
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Trevisani F, D'Intino PE, Morselli-Labate AM, Mazzella G, Accogli E, Caraceni P, Domenicali M, De Notariis S, Roda E, Bernardi M. Serum alpha-fetoprotein for diagnosis of hepatocellular carcinoma in patients with chronic liver disease: influence of HBsAg and anti-HCV status. J Hepatol 2001; 34:570-5. [PMID: 11394657 DOI: 10.1016/s0168-8278(00)00053-2] [Citation(s) in RCA: 475] [Impact Index Per Article: 20.7] [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: 02/07/2023]
Abstract
BACKGROUND It is not established whether virological status affects the efficiency of alpha-fetoprotein (AFP) as a hepatocellular carcinoma (HCC) marker among patients with chronic liver disease (CLD). METHODS We enrolled in a case-control study 170 HCC and 170 CLD patients, matched for age, sex, CLD and HBsAg/anti-HCV status. The AFP sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated. PPV and NPV were evaluated for three additional HCC prevalences (5, 10, and 20%). RESULTS The best discriminating AFP value was 16 ng/ml. A value of 20 ng/ml (above which investigations for HCC are recommended) had equivalent sensitivity (60.0 vs. 62.4%) and specificity (90.6 vs. 89.4%). PPV of 20 ng/ml was 84.6% but decreased to 25.1% at 5% tumor prevalence. NPV was 69.4% and rose to 97.7% at 5% prevalence. In the different groups of infected patients PPV ranged from 80.0 to 90.9%, falling to 17.4-34.5% at 5% prevalence. In noninfected patients PPV was 100% at any HCC prevalence. NPV ranged from 59.0 to 73.0%, reaching 96.5-98.1% at 5% prevalence. CONCLUSIONS In CLD patients, AFP monitoring misses many HCCs and inappropriately arouses suspicion of malignancy in many patients. Its usefulness is barely affected by the infection responsible for CLD. An AFP elevation could be more indicative of HCC in non-infected patients.
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Affiliation(s)
- F Trevisani
- Dipartimento di Medicina Interna, Cardioangiologia, Epatologia, University of Bologna, Italy.
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Perniola R, Falorni A, Clemente MG, Forini F, Accogli E, Lobreglio G. Organ-specific and non-organ-specific autoantibodies in children and young adults with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED). Eur J Endocrinol 2000; 143:497-503. [PMID: 11022196 DOI: 10.1530/eje.0.1430497] [Citation(s) in RCA: 66] [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: 11/08/2022]
Abstract
OBJECTIVE The aim of the study was to assess the complex of autoantibodies which can be detected in patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED), a rare autosomal recessive disease in which the extent of autoimmunity is still unknown. DESIGN Antibodies (A) to parathyroid glands, adrenal cortex (AC-A), ovary and testis (steroid cell antibodies, SC-A), pancreatic islet cells (IC-A), gastric parietal cells, and non-organ-specific antigens were investigated in 11 APECED patients living in the Salento region of southern Italy. Further measurements included antibodies to cytochrome P450 (CYP) enzymes: cholesterol side-chain cleavage enzyme (CYP11A), 21-hydroxylase (CYP21) and 17alpha-hydroxylase (CYP17); and to glutamic acid decarboxylase 65-kDa isoform (GAD65), tyrosine phosphatase-like protein IA2, thyroglobulin (TG), thyroperoxidase (TPO), thyrotropin receptor, liver CYP enzymes and intrinsic factor. METHODS Antibodies to organs and subcellular fractions were detected by immunofluorescence. Radiobinding, immunoradiometric, and immunoblotting assays were used for the other measurements. RESULTS AC-A and SC-A were positive in all sera; among antibodies to adrenal CYP enzymes, only CYP21-A were present in all the patients with Addison's disease of short-medium duration (<15 years). Of three patients with Addison's disease of long duration (>15 years), two tested positive for antibodies to all three CYP enzymes, and the other for only CYP11A-A. In all sera CYP11A-A and/or CYP17-A were found. Two patients tested positive for both IC-A and GAD65-A, one for both IC-A and IA2-A, and one for GAD65-A; the fasting C-peptide assay showed no statistical difference between these four subjects and the others. All four hypothyroid patients were positive for TPO-A, while two of them were positive and two were negative for TG-A; two euthyroid subjects had positivity for TG-A. Liver-kidney microsomal antibodies reacting against the CYP2A6 were detected in two patients with autoimmune hepatitis. All but one sera contained anti-nuclear antibodies at a titre ranging between 1:20 and 1:80; however, only two patients had a connective tissue disease (Sjögren's syndrome). CONCLUSIONS Several autoantibodies may be detected in any APECED patient. Our data confirm that CYP21-A and TPO-A are major autoantibodies involved in APECED-associated Addison's disease and hypothyroidism respectively, while CYP11A-A and CYP17-A correlate with positivity for SC-A. Markers of islet cell autoimmunity are frequent, but prevalence and modalities of progression to overt beta-cell failure have to be clarified. Low-titre non-organ-specific autoantibodies are a feature of autoimmunity in APECED, but their role has yet to be fully explained.
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Affiliation(s)
- R Perniola
- Paediatric Unit, Vito Fazzi Regional Hospital, Lecce, Italy.
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20
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Fabbri C, Marchetto S, Pezzoli A, Accogli E, Fusaroli P, Azzaroli F, Jaboli MF, Mazzeo C, Montagnani M, Festi D, Roda E, Mazzella G. Efficacy of ursodeoxycholic acid in association with alpha-interferon for chronic hepatitis C in alpha-interferon non-responder patients. Eur J Gastroenterol Hepatol 2000; 12:511-5. [PMID: 10833093 DOI: 10.1097/00042737-200012050-00006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate the effect of combined treatment with alpha-interferon (alpha-IFN) and ursodeoxycholic acid (UDCA) on liver function tests and serum HCV-RNA in patients with chronic hepatitis C who had not responded to alpha-IFN alone. METHOD One hundred and three patients (60 men, 43 women, mean age 49 +/- 1.3 years) who had not responded (both HCV-RNA positive and increased serum ALT levels) to 4 consecutive months of treatment with alpha-IFN (3 MU three times weekly) were randomly assigned to receive UDCA (IFN-UDCA, 53 patients, 600 mg/day) in addition to the same alpha-IFN dose, or to continue alpha-IFN alone (IFN-controls, 50 patients). After stopping alpha-IFN, patients who had received UDCA continued to receive UDCA for an additional 6-month period. The two groups were comparable for sex, basal ALT, basal yGT, genotype distribution and liver histology, while mean age was lower in controls (53 +/- 1.8 vs 46 +/- 1.8 years; P< 0.01). RESULTS Twenty (38%) out of 53 IFN-UDCA patients had normal ALT, compared with only six (12%) out of 50 IFN-control patients (P < 0.01). HCV-RNA became undetectable in four IFN-UDCA patients. Three months after withdrawal of alpha IFN, 15 IFN-UDCA responders, but none of the IFN-controls, had normal ALT values (P< 0.01); 6 months after withdrawal, nine IFN-UDCA responders still had normal ALT (P= NS) and HCV-RNA was still undetectable in four of them. Portal and periportal inflammation showed a statistically significant improvement (Fisher's exact test P< 0.01) in IFN-UDCA patients as compared with IFN-controls, while no effect was observed on portal fibrosis. CONCLUSIONS These data demonstrate that UDCA improves the response rate to alpha-IFN. Furthermore, in 8% of IFN-UDCA patients the response rate was sustained and associated with HCV-RNA clearance.
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Affiliation(s)
- C Fabbri
- Department of Internal Medicine and Gastroenterology, University of Bologna, Italy
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Perniola R, De Rinaldis C, Accogli E, Lobreglio G. Prevalence and clinical features of cryoglobulinaemia in multitransfused beta-thalassaemia patients. Ann Rheum Dis 1999; 58:698-702. [PMID: 10531074 PMCID: PMC1752797 DOI: 10.1136/ard.58.11.698] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The aim of the study was to determine the prevalence of cryoglobulinaemia and its clinical features among beta-thalassaemia patients. METHODS Eighty eight multitransfused beta-thalassaemia patients were studied. They were physically examined and asked about the presence of cryoglobulinaemia related symptoms. Hepatitis C virus (HCV) serology, HCV-RNA, HCV subtypes, viraemia, serum ferritin, liver and kidney function tests, rheumatoid factor (RF), circulating immune complexes (CIC), complement levels and autoantibodies were all evaluated. The patients were divided into four groups: HCV-RNA positive patients with and without cryoglobulinaemia (groups A and B), HCV-Ab positive/HCV-RNA negative patients (group C), HCV-Ab negative patients (group D). RESULTS Cryoglobulinaemia was present in 35 of 53 (66.0%) patients with chronic HCV infection. They had higher viraemia than non-cryoglobulinaemic viral carriers, but no statistical difference relating to sex or HCV subtypes was found. In comparison with the other groups, group A patients were older, had undergone transfusion therapy for a longer period, had received a higher number of transfusions, and had increased levels of RF and CIC, as well as consumption of C4; in addition, they had a higher prevalence of cirrhosis. Cutaneous lesions (purpura, Raynaud's phenomenon, nodules and leg rash), peripheral neuropathy and sicca syndrome symptoms were present only in group A. Musculoskeletal symptoms (bone pain, arthralgia and myalgia), weakness, splenomegaly, lymphadenopathy, skin ulcers and proteinuria were also commoner in group A, but the difference did not reach statistical significance, possibly because of partial overlap between cryoglobulinaemia and beta-thalassaemia syndromes. CONCLUSION Because of its high prevalence in multitransfused beta-thalassaemia patients, cryoglobulinaemia needs to be systematically studied and considered in the differential diagnosis of various beta-thalassaemia manifestations.
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Affiliation(s)
- R Perniola
- Paediatric Unit, Vito Fazzi Regional Hospital, Lecce, Italy
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Mazzella G, Accogli E, Sottili S, Festi D, Orsini M, Salzetta A, Novelli V, Cipolla A, Fabbri C, Pezzoli A, Roda E. Alpha interferon treatment may prevent hepatocellular carcinoma in HCV-related liver cirrhosis. J Hepatol 1996; 24:141-7. [PMID: 8907566 DOI: 10.1016/s0168-8278(96)80022-5] [Citation(s) in RCA: 223] [Impact Index Per Article: 8.0] [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: 02/06/2023]
Abstract
BACKGROUND/AIMS The aims of alpha-interferon treatment for chronic viral liver infections are clearance of the virus and healing of the disease. Hepatocellular carcinoma is a complication of viral cirrhosis; but it is not yet known whether treatment of viral cirrhosis with alpha-interferon prevents this complication. METHODS The incidence and the risk (Cox regression analysis) of developing hepatocellular carcinoma were calculated in 347 patients with hepatic cirrhosis; 227 (34 hepatitis B virus and 193 hepatitis C virus related) were treated with alpha-interferon and 120 (28 hepatitis B virus and 92 hepatitis C virus) did not receive this treatment, in order to evaluate the efficacy of alpha-interferon in the prevention of hepatocellular carcinoma. In all patients, the cirrhosis was well compensated (Child A). RESULTS Over mean follow-up periods of 49 months for hepatitis B virus and 32 months for hepatitis C virus, 20/347 patients (6/62 hepatitis B virus and 14/285 hepatitis C virus) developed hepatocellular carcinoma. The risk of developing this tumor was significantly greater in males (p < 0.007) and in patients not treated with alpha-interferon (p < 0.01). The Relative Risk of developing hepatocellular carcinoma increased significantly (p < 0.0002) with each passing year. In patients with hepatic cirrhosis secondary to hepatitis B virus infections, the risk did not seem to be modified by alpha-interferon treatment, even though a greater, but not significant risk (Relative Risk = 4.9; p = 0.3) was calculated for untreated patients; in contrast, in hepatitis C virus-related cirrhosis, this risk was reduced by a factor of 4.0 (p = 0.04). The tumor developed only in non-responder patients regardless of virus type. After adjustment for confounding factors (sex, age, alcohol consumption, cigarette smoking), a statistically significant (p < 0.025) effect of interferon treatment in preventing hepatocellular carcinoma was still demonstrated when responders were matched with controls, but not when responders were compared with non-responders. CONCLUSIONS These results show that, in addition to its ability to halt the progression of viral-induced liver disease, alpha-interferon is also of benefit in patients with hepatitis C virus cirrhosis who respond to this treatment by lowering their risk of developing hepatocellular carcinoma.
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Affiliation(s)
- G Mazzella
- Cattedra di Gastroenterologia, University of Bologna, Chieti, Italy
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Roda E, Cipolla A, Salzetta A, Marchetto S, Pezzoli A, Accogli E, Novelli V, Polimeni C, Cerrè C, Mazzella G. Influence of ursodeoxycholic acid on biliary lipids. Scand J Gastroenterol Suppl 1994; 204:16-8. [PMID: 7824872 DOI: 10.3109/00365529409103619] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The advent of bile acid therapy has shed some light on the mechanisms involved in determining bile lipid secretion. The administration of cholelytic bile acids results in a lowering of cholesterol percent molar and saturation index due to a reduction in cholesterol secretion. Studies carried out after administration of bile acids showed initially that biliary cholesterol secretion rates were dependent on the hydrophobic/hydrophilic balance of the prevailing bile acid present in bile. However, more detailed investigations showed that some bile acids (cholic and chenodeoxycholic acids) did not follow this rule because of the presence of other mechanisms involved in determining biliary cholesterol secretion and a possible link between cholesterol synthesis and biliary cholesterol secretion. Several different human models have been used in more recent studies to arrive at a better understanding of the mechanisms involved in determining bile lipid secretion: obese patients, obese patients in rapid weight loss, patients with non-familial hypercholesterolemia and primary biliary cirrhosis. The findings in these studies indicate how modifications in biliary lipid secretion can easily be induced when there are changes in the relative amounts of bile acids. These changes may bring about modifications in intestinal absorption, liver synthesis, and secretion of cholesterol and bile acids that could possibly lead to the formation of lithogenic bile and subsequently to cholesterol gallstones.
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Affiliation(s)
- E Roda
- Dept. of Gastroenterology, University of Bologna, Italy
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