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Metovic J, Gallino C, Zanon E, Bussone R, Russo R, Vissio E, Annaratone L, Conti L, Papotti M, Cassoni P, Castellano I. Eccrine spiradenoma of the nipple: Case report, differential diagnosis and literature review. Histol Histopathol 2019; 34:909-915. [PMID: 30806477 DOI: 10.14670/hh-18-094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Eccrine spiradenoma is a rare lesion originating from eccrine sweat glands, with only few cases reported in breast tissue: we here describe for the first time, an eccrine spiradenoma arising in the nipple. An 84 year-old woman with a lesion enlarging her right nipple, showing ulcerations and eczema-like changes of the covering skin, was admitted to our hospital. Surgical excision of the central quadrant with nipple-areola complex was performed, followed by histopathological evaluation which revealed an adenoma with predominantly basaloid epithelial cells. The lesion was composed of tightly packed small and large groups of cells, arranged in diffuse alveolar/pseudorosette formations. The small cells expressed p63 and calponin, while a positive expression of CK7 and CD117 was detected in large cells. After careful and detailed examination, excluding various similar entities, a diagnosis of eccrine spiradenoma has been rendered. Although extremely rare, eccrine spiradenoma should be taken into account in the differential diagnosis of subcutaneous primary breast tumors.
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Affiliation(s)
- Jasna Metovic
- Department of Oncology, University of Turin, Turin, Italy
| | - Chiara Gallino
- Breast Unit, Department of Radiology, Cottolengo Hospital, Turin, Italy
| | - Eugenio Zanon
- Breast Unit, Department of Radiology, Cottolengo Hospital, Turin, Italy
| | - Riccardo Bussone
- Breast Unit, Department of Surgery, Cottolengo Hospital, Turin, Italy
| | - Roberto Russo
- Department of Public Health Sciences and Pediatrics, University of Turin, Cottolengo Hospital, Turin, Italy
| | - Elena Vissio
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Laura Annaratone
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luca Conti
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mauro Papotti
- Department of Oncology, University of Turin, Turin, Italy
| | - Paola Cassoni
- Department of Medical Sciences, University of Turin, Turin, Italy
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Pasca S, Ambaglio C, Rocino A, Santoro C, Cantori I, Zanon E. Combined use of antifibrinolytics and activated prothrombin complex concentrate (aPCC) is not related to thromboembolic events in patients with acquired haemophilia A: data from FAIR Registry. J Thromb Thrombolysis 2018; 47:129-133. [PMID: 30267246 DOI: 10.1007/s11239-018-1750-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Antifibrinolytics combined with aPCC are not routinely administered to patients with acquired hemophilia A due to increased thrombotic risk. This association normalizes clot stability, and improves the efficacy of therapy, but can increase the risk of severe side effects. Due to these premises it has always raised doubts and perplexities in the clinics. We now report the data of the "FEIBA® on acquired haemophilia A Italian Registry (FAIR Registry)", a retrospective-prospective study that included 56 patients. This is the first study that assessed the clinical response of the combination of aPCC and antifibrinolytic agents in patients with acquired haemophilia A. A total of 101 acute bleeds were treated with aPCC. Antifibrinolytic agents were used in the treatment of 39.6% of total bleeds, based on both, a clinical assessment and an evaluation of bleeding. Twenty-five of the 30 patients (57.1%) treated with antifibrinolytic drugs showed serious co-morbidity. Among them, 40% presented severe cardiovascular diseases. All bleeds treated with combined therapy had a shorter duration of treatment (mean reduction 16.3%). All the treated patients presented a good tolerability and no arterial or venous thromboembolic events were reported. In our retrospective registry the combination of antifibrinolytics and aPCC appears safe and effective in the treatment of patients with AHA, especially in the case of severe and life-threatening bleeding, but this hypothesis needs to be confirmed in adequate, larger clinical trials.
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Affiliation(s)
- S Pasca
- Haemophilia Centre, University Hospital of Padua, Via Giustiniani, 35128, Padua, Italy.
| | - C Ambaglio
- Haemophilia Centre, S.Matteo Hospital of Pavia, Pavia, Italy
| | - A Rocino
- Haemophilia and Thrombosis Centre, S.Giovanni Bosco Hospital of Neaples, Naples, Italy
| | - C Santoro
- Cellular Biotecnology and Haematology Department, Umberto I University Hospital of Rome, Rome, Italy
| | - I Cantori
- Centre of Coagulation Diseases, Hospital of Macerata, Macerata, Italy
| | - E Zanon
- Haemophilia Centre, University Hospital of Padua, Via Giustiniani, 35128, Padua, Italy
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Galletta E, Daidone V, Zanon E, Casonato S. Type 3 von Willebrand disease mistaken for moderate haemophilia A: a lesson still to be learned. Haemophilia 2018; 24:e154-e157. [PMID: 29665224 DOI: 10.1111/hae.13490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- E Galletta
- Thrombotic and Hemorrhagic Disorders Unit, University of Padua Medical School, Padua, Italy
| | - V Daidone
- Thrombotic and Hemorrhagic Disorders Unit, University of Padua Medical School, Padua, Italy
| | - E Zanon
- Thrombotic and Hemorrhagic Disorders Unit, University of Padua Medical School, Padua, Italy
| | - S Casonato
- Thrombotic and Hemorrhagic Disorders Unit, University of Padua Medical School, Padua, Italy
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Bagnasco S, Bottigli U, Cheran SC, Delogu P, Fantacci ME, Fauci F, Forni G, Lauria A, Lopez Torres E, Magro R, Masala GL, Oliva P, Palmiero R, Ramello L, Raso G, Retico A, Sitta M, Stumbo S, Tangaro S, Zanon E, Cerello P. GPCALMA: a Grid-based Tool for Mammographic Screening. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1633955] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Objectives:
The next generation of high energy physics (HEP) experiments requires a GRID approach to a distributed computing system: the key concept is the Virtual Organisation (VO), a group of distributed users with a common goal and the will to share their resources.
Methods:
A similar approach, applied to a group of hospitals that joined the GPCALMA project (Grid Platform for Computer Assisted Library for MAmmography), will allow common screening programs for early diagnosis of breast and, in the future, lung cancer. The application code makes use of neural networks for the image analysis and is useful in improving the radiologists' diagnostic performance. GRID services allow remote image analysis and interactive online diagnosis, with a potential for a relevant reduction of the delays presently associated with screening programs.
Results and Conclusions:
A prototype of the system, based on AliEn GRID Services [1], is already available, with a central server running common services [2] and several clients connecting to it. Mammograms can be acquired in any location; the related informatio required to select and access them at any time is stored in a common service called Data Catalogue, which can be queried by any client. Thanks to the PROOF facility [3], the result of a query can be used as input for analy-sis algorithms, which are executed on the nodes where the input images are stored,. The selected approach avoids data transfers for all the images with a negative diagnosis and allows an almost real time diagnosis for the set of images with high cancer probability.
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Marchesini E, Oliovecchio E, Coppola A, Santagostino E, Radossi P, Castaman G, Valdrè L, Santoro C, Tagliaferri A, Ettorre C, Zanon E, Barillari G, Cantori I, Caimi TM, Sottilotta G, Iorio A, Mannucci PM. Comorbidities in persons with haemophilia aged 60 years or more compared with age-matched people from the general population. Haemophilia 2017; 24:e6-e10. [PMID: 29271531 DOI: 10.1111/hae.13379] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2017] [Indexed: 01/04/2023]
Affiliation(s)
- E Marchesini
- Hemophilia Centre-SC Vascular and Emergency Department, University of Perugia, Perugia, Italy
| | - E Oliovecchio
- Hemophilia Centre-SC Vascular and Emergency Department, University of Perugia, Perugia, Italy
| | - A Coppola
- Regional Reference Centre for Coagulation Disorders, Federico II University Hospital, Naples, Italy.,Regional Reference Centre for inherited bleeding disorders, University Hospital of Parma, Parma, Italy
| | - E Santagostino
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - P Radossi
- Transfusion Service, Haemophilia Centre and Haematology, Castelfranco Veneto Hospital, Castelfranco Veneto, Italy
| | - G Castaman
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - L Valdrè
- Unit of Angiology and Coagulation Disorders, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - C Santoro
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - A Tagliaferri
- Regional Reference Centre for inherited bleeding disorders, University Hospital of Parma, Parma, Italy
| | - C Ettorre
- Hemophilia and Thrombosis Center, Policlinico Giovanni XXIII, Bari, Italy
| | - E Zanon
- Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Padua, Italy
| | - G Barillari
- Center for Haemorrhagic and Thrombotic Disorders, Udine General and University Hospital, Udine, Italy
| | - I Cantori
- Haemophilia Center, Regional Reference Center for inherited bleeding and thrombophilic disorders, Civil Hospital, Macerata, Italy
| | - T M Caimi
- A De Gasperis Cardiovascular Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | - G Sottilotta
- Hemostasis and Thrombosis Unit, "Bianchi-Melacrino-Morelli" Metropolitan Hospital, Reggio Calabria, Italy
| | - A Iorio
- Department of Clinical Epidemiology and Biostatistics, Department of Medicine, McMaster University, Hamilton, Canada
| | - P M Mannucci
- Scientific Direction, IRCCS Ca' Granda Maggiore Hospital Foundation and University of Milan, Milan, Italy
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Affiliation(s)
- E Zanon
- Hemophilia Center, University Hospital of Padua, Padua, Italy
| | - M Milan
- Hemophilia Center, University Hospital of Padua, Padua, Italy
| | - L Sarolo
- Hemophilia Center, University Hospital of Padua, Padua, Italy
| | - S Pasca
- Hemophilia Center, University Hospital of Padua, Padua, Italy
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Iorio A, Barbara AM, Makris M, Fischer K, Castaman G, Catarino C, Gilman E, Kavakli K, Lambert T, Lassila R, Lissitchkov T, Mauser-Bunschoten E, Mingot-Castellano ME, Ozdemir N, Pabinger I, Parra R, Pasi J, Peerlinck K, Rauch A, Roussel-Robert V, Serban M, Tagliaferri A, Windyga J, Zanon E. Natural history and clinical characteristics of inhibitors in previously treated haemophilia A patients: a case series. Haemophilia 2017; 23:255-263. [PMID: 28205285 DOI: 10.1111/hae.13167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Development of inhibitors is the most serious complication in haemophilia A treatment. The assessment of risk for inhibitor formation in new or modified factor concentrates is traditionally performed in previously treated patients (PTPs). However, evidence on risk factors for and natural history of inhibitors has been generated mostly in previously untreated patients (PUPs). The purpose of this study was to examine cases of de novo inhibitors in PTPs reported in the scientific literature and to the EUropean HAemophilia Safety Surveillance (EUHASS) programme, and explore determinants and course of inhibitor development. METHODS We used a case series study design and developed a case report form to collect patient level data; including detection, inhibitor course, treatment, factor VIII products used and events that may trigger inhibitor development (surgery, vaccination, immune disorders, malignancy, product switch). RESULTS We identified 19 publications that reported 38 inhibitor cases and 45 cases from 31 EUHASS centres. Individual patient data were collected for 55/83 (66%) inhibitor cases out of 12 330 patients. The median (range) peak inhibitor titre was 4.4 (0.5-135.0), the proportion of transient inhibitors was 33% and only two cases of 12 undergoing immune tolerance induction failed this treatment. In the two months before inhibitor development, surgery was reported in nine (22%) cases, and high intensity treatment periods reported in seven (17%) cases. CONCLUSIONS By studying the largest cohort of inhibitor development in PTPs assembled to date, we showed that inhibitor development in PTPs, is on average, a milder event than in PUPs.
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Affiliation(s)
- A Iorio
- Department of Clinical Epidemiology and Biostastics, McMaster University, Hamilton, ON, Canada
| | - A M Barbara
- Department of Clinical Epidemiology and Biostastics, McMaster University, Hamilton, ON, Canada
| | - M Makris
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - K Fischer
- Van Creveldkliniek University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - C Catarino
- Congenital Coagulopathies Centre, Santa Maria Hospital, Lisbon, Portugal
| | - E Gilman
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - K Kavakli
- Department of Pediatric Hematology, Ege University Children's Hospital, Izmir, Turkey
| | - T Lambert
- Centre de traitement des Hemophiles de Bicetre, Paris, France
| | - R Lassila
- Department of Hematology, Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | | | - E Mauser-Bunschoten
- Van Creveldkliniek University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - N Ozdemir
- Istanbul University Haemophilia Centre, Istanbul, Turkey
| | - I Pabinger
- Department of Medicine I, Haemophilia Centre, Medical University of Vienna, Vienna, Austria
| | - R Parra
- Hospital Vall d'Hebron, Barcelona, Spain
| | - J Pasi
- Barts and the London School of Medicine, London, UK
| | - K Peerlinck
- Haemophilia Center, Universitaire Ziekenhuis Gasthuisberg, Leuven, Belgium
| | - A Rauch
- Département d'Hématologie Transfusion, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - V Roussel-Robert
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy
| | | | - A Tagliaferri
- European Haemophilia Center, Paediatric Clinical Emergency Hospital Louis Turcanu, Timisoara, Romania
| | - J Windyga
- Department of Disorders of Haemostasis and Internal Medicine, Institute of Haematology & Transfusion Medicine, Warsaw, Poland
| | - E Zanon
- Haemophilia Centre, Azienda Universitaria Ospedaliera di Padova, Padova, Italy
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8
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Zanon E, Saracino M, Simioni P, Cogo A, Fadin M, Gavasso S, Girolami A. Prevalence of Antiphospholipid Antibodies and Lupus Anticoagulant in Juvenile Patients with Objectively Documented Deep-vein Thrombosis. Clin Appl Thromb Hemost 2016. [DOI: 10.1177/107602969600200114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The prevalence of lupus anticoagulant (LA) and antiphospholipid antibodies (APA) in young patients (<45 years) with deep-vein thrombosis (DVT) is not clearly defined yet. We studied 93 consecutive patients (36 males, 57 females; aged 15 to 45) with objectively documented DVT. A control group consisting of 100 nor mal, sex- and age-matched individuals was also investi gated. In all subjects, we evaluated prothrombin time (PT), partial thromboplastin time (PTT), AT III antigen and activity, protein C antigen and activity, free and total protein S antigen and protein S activity, fibrinogen, plas minogen, heparin cofactor II, plasminogen activator in hibitor (PAI), lupus anticoagulant (LA), and APA. For the assessment of LA, we used the PTT-LA kit (Boeh ringer Mannheim, Milan, Italy) as a screening test, with mixing studies with the Staclot-PNP kit and the Staclot- LA kit (Boehringer Mannheim, Milan, Italy) as confirma tory procedures. For the detection of APA, we used a commercially available enzyme-linked immunoassay (ELISA) (Asserachrom APA, Boehringer Mannheim, Mi lan, Italy). History was elicited in all patients to deter mine if the thrombotic episode was idiopathic or the re sult of a well-identified risk factor. LA was found in 11 (11.8%) patients. APA were positive in 13 (14%) and bor derline in 19 (20.4%) patients. In the control group, no patients were positive for LA or APA, but five exhibited borderline APA levels. LA was significantly more fre quent (p = 0.05) in patients with idiopathic DVT than in patients with secondary DVT; no difference was found for APA (p > 0.5). An inherited coagulation defect was found in seven (7.5%) patients. Our data suggest that the presence of LA or APA is associated with an increased incidence of thrombotic manifestation in young patients. Moreover LA is more frequent in patients with idiopathic DVT. Because the incidence of recurrent thrombotic manifestations in patients with LA or APA is estimated to be ∼50% within 2 years from the first thrombotic episode, the tests should be performed in all patients with juvenile thrombosis.
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Affiliation(s)
- E. Zanon
- Institute of Medical Semeiotics, University of Padua Medical School, Padua, Italy
| | - M.A. Saracino
- Institute of Medical Semeiotics, University of Padua Medical School, Padua, Italy
| | - Paolo Simioni
- Institute of Medical Semeiotics, University of Padua Medical School, Padua, Italy
| | - Alberto Cogo
- Institute of Medical Semeiotics, University of Padua Medical School, Padua, Italy
| | - M.A. Fadin
- Institute of Medical Semeiotics, University of Padua Medical School, Padua, Italy
| | - S. Gavasso
- Institute of Medical Semeiotics, University of Padua Medical School, Padua, Italy
| | - Antonio Girolami
- Institute of Medical Semeiotics, University of Padua Medical School, Padua, Italy
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Oldenburg J, Zimmermann R, Katsarou O, Zanon E, Kellermann E, Lundin B, Ellinghaus P. Potential biomarkers of haemophilic arthropathy: correlations with compatible additive magnetic resonance imaging scores. Haemophilia 2016; 22:760-4. [DOI: 10.1111/hae.12936] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2016] [Indexed: 12/28/2022]
Affiliation(s)
| | - R. Zimmermann
- Kurpfalz Hospital and Haemophilia Centre for Children and Adults Heidelberg Germany
| | | | - E. Zanon
- University of Padua Medical School Padua Italy
| | | | - B. Lundin
- Lund University and Skåne University Hospital Lund Sweden
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10
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Oldenburg J, Zimmermann R, Katsarou O, Theodossiades G, Zanon E, Niemann B, Kellermann E, Lundin B. Controlled, cross-sectional MRI evaluation of joint status in severe haemophilia A patients treated with prophylaxis vs. on demand. Haemophilia 2014; 21:171-179. [PMID: 25470205 PMCID: PMC4359687 DOI: 10.1111/hae.12539] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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] [Accepted: 08/08/2014] [Indexed: 01/06/2023]
Abstract
In patients with haemophilia A, factor VIII (FVIII) prophylaxis reduces bleeding frequency and joint damage compared with on-demand therapy. To assess the effect of prophylaxis initiation age, magnetic resonance imaging (MRI) was used to evaluate bone and cartilage damage in patients with severe haemophilia A. In this cross-sectional, multinational investigation, patients aged 12-35 years were assigned to 1 of 5 groups: primary prophylaxis started at age <2 years (group 1); secondary prophylaxis started at age 2 to <6 years (group 2), 6 to <12 years (group 3), or 12-18 years (group 4); or on-demand treatment (group 5). Joint status at ankles and knees was assessed using Compatible Additive MRI scoring (maximum and mean ankle; maximum and mean of all 4 joints) and Gilbert scores in the per-protocol population (n = 118). All prophylaxis groups had better MRI joint scores than the on-demand group. MRI scores generally increased with current patient age and later start of prophylaxis. Ankles were the most affected joints. In group 1 patients currently aged 27-35 years, the median of maximum ankle scores was 0.0; corresponding values in groups 4 and 5 were 17.0 and 18.0, respectively [medians of mean index joint scores: 0.0 (group 1), 8.1 (group 2) and 13.8 (group 4)]. Gilbert scores revealed outcomes less pronounced than MRI scores. MRI scores identified pathologic joint status with high sensitivity. Prophylaxis groups had lower annualized joint bleeds and MRI scores vs. the on-demand group. Primary prophylaxis demonstrated protective effects against joint deterioration compared with secondary prophylaxis.
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Morfini M, Marchesini E, Paladino E, Santoro C, Zanon E, Iorio A. Pharmacokinetics of plasma-derived vs. recombinant FVIII concentrates: a comparative study. Haemophilia 2014; 21:204-209. [PMID: 25274155 DOI: 10.1111/hae.12550] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2014] [Indexed: 11/26/2022]
Abstract
Only very few pharmacokinetic (PK) studies comparing plasma derived FVIII (pd-FVIII) against recombinant FVIII (rFVIII) concentrates are available. The studies have been generally conducted to demonstrate the bioequivalence of a new product with an old one. The switch from a plasma-derived FVIII (pd-FVIII) to a rFVIII concentrate is a good moment to enrol the patients in a comparative PK study. To achieve information on the PK characteristics of two different classes of FVIII concentrates, according to two different designs: a 10 FVIII concentration/time point design and a reduced 4-point design. A single dose PK comparing pd- and rFVIII concentrates has been performed in four Haemophilia Centres of Italy. Seventeen haemophilia A patients underwent two subsequent single dose PK studies at the moment of switching. Two-compartment- and Non-compartment-analysis did not show significant differences between the outcomes of PK of pd-FVIII and rFVIII, due to inter-patient variability. In vivo recovery (IVR) of rFVIII was slightly higher than that of pd-FVIII and rFVIII/pd-FVIII AUC ratio was 1.37 in 11/17 patients. The difference is only due to the initial distribution phase because after the first 10 h from the end of the infusion, the two decay curves are overlapping. The elimination half-life of the concentrates was very similar even though a complete bioequivalence was not demonstrated because of a higher AUC of rFVIII concentrates, limited to the distribution phase. The higher Cmax and IVR of rFVIII may be due to the presence of heterodimers activated forms of the recombinant molecules.
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Affiliation(s)
- M Morfini
- Agency for Haemophilia, University Hospital of Florence, Florence, Italy
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12
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Franchini M, Coppola A, Rocino A, Zanon E, Morfini M. Perceived challenges and attitudes to regimen and product selection from Italian haemophilia treaters: the 2013 AICE survey. Haemophilia 2014; 20:e128-35. [DOI: 10.1111/hae.12334] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2013] [Indexed: 12/23/2022]
Affiliation(s)
- M. Franchini
- Department of Transfusion Medicine and Haematology; Carlo Poma Hospital; Mantova Italy
| | - A. Coppola
- Regional Reference Centre for Coagulation Disorders; Federico II University Hospital; Naples Italy
| | - A. Rocino
- Haemophilia and Thrombosis Centre; San Giovanni Bosco Hospital; Naples Italy
| | - E. Zanon
- Haemophilia Centre; Department of Cardiologic, Thoracic and Vascular Sciences; University of Padua Medical School; Padua Italy
| | - M. Morfini
- Agency for Haemophilia; Department of Emergency and Reception; Azienda Ospedaliero-Universitaria Careggi; Firenze Italy
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Zanon E, Milan M, Brandolin B, Barbar S, Spiezia L, Saggiorato G, Simioni P, Baudo F. High dose of human plasma-derived FVIII-VWF as first-line therapy in patients affected by acquired haemophilia A and concomitant cardiovascular disease: four case reports and a literature review. Haemophilia 2012; 19:e50-3. [PMID: 23051581 DOI: 10.1111/hae.12033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2012] [Indexed: 11/29/2022]
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Castaman G, Coppola A, Zanon E, Boeri E, Musso M, Siragusa S, Federici AB, Mancuso G, Barillari G, Biasoli C, Feola G, Franchini M, Moratelli S, Gamba G, Schinco P, Valdrè L, Dragani A, Mazzucconi G, Tagliaferri A, Morfini M. Efficacy and safety during formulation switch of a pasteurized VWF/FVIII concentrate: results from an Italian prospective observational study in patients with von Willebrand disease. Haemophilia 2012; 19:82-8. [DOI: 10.1111/hae.12005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2012] [Indexed: 11/27/2022]
Affiliation(s)
| | - A. Coppola
- Federico II University Hospital; Naples; Italy
| | - E. Zanon
- University Hospital; Padua; Italy
| | | | - M. Musso
- University Hospital Catania; Catania; Italy
| | | | - A. B. Federici
- IRCCS Cà Granda Maggiore Policlinico Hospital Foundation and Department of Internal Medicine; AB Bonomi Hemophilia Thrombosis Center; University of Milan; Milan; Italy
| | | | | | | | - G. Feola
- San Luca Hospital; Vallo della Lucania; Italy
| | | | | | - G. Gamba
- San Matteo Hospital; Pavia; Italy
| | - P. Schinco
- San Giovanni Battista Hospital; Torino; Italy
| | - L. Valdrè
- S. Orsola-Malpighi Hospital; Bologna; Italy
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Bortolini M, Genta F, Biacchiardi CP, Zanon E, Camanni M, Deltetto F. Axillary dissection in breast cancer patients with metastatic sentinel node: to do or not to do? Suggestions from our series. ISRN Oncol 2011; 2011:527904. [PMID: 22084733 PMCID: PMC3195778 DOI: 10.5402/2011/527904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 05/20/2011] [Indexed: 11/26/2022]
Abstract
Several studies have put to question and evaluated the indication and prognosis of sentinel lymph node biopsy (SNLB) as sole treatment in human breast cancer. We reviewed 1588 patients who underwent axillary surgery. In 239 patients, axillary lymph node dissection (ALND) was performed following positive fine needle aspiration cytology (FNAC), and, in 299 cases, ALND was executed after positive SNLB. The most dramatic result from our data is that patients with either micrometastasis of the sentinel lymph node (SLN) or only metastatic SLN have, respectively, an 84.5% and a 75.0% chance of having no other nodal involvement. We believe a more refined patient selection is neccessary when considering ALND. Where the primary tumor is larger than 5 cm, where radio or adjuvant therapies are not indicated, in cases of FNAC+ nodes, and in cases presenting more than one metastatic sentinel node, we prefer to carry out ALND. Having thus said, however, our data suggests that it is wise not to perform ALND in almost all cases presenting positive SLNs.
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Affiliation(s)
- M Bortolini
- Ginteam, Mini-Invasive Gynaecological and Breast Unit, Evangelical Hospital, ASL TO1, Corso Marconi 35, 10125 Torino, Italy
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16
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Perono Biacchiardi C, Brizzi D, Genta F, Zanon E, Camanni M, Deltetto F. Breast cancer preoperative staging: does contrast-enhanced magnetic resonance mammography modify surgery? Int J Breast Cancer 2011; 2011:757234. [PMID: 22295233 PMCID: PMC3262586 DOI: 10.4061/2011/757234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 03/31/2011] [Indexed: 11/20/2022] Open
Abstract
Women with newly diagnosed breast cancer may have lesions undetected by conventional imaging. Recently contrast-enhanced magnetic resonance mammography (CE-MRM) showed higher sensitivity in breast lesions detection. The present analysis was aimed at evaluating the benefit of preoperative CE-MRM in the surgical planning. From 2005 to 2009, 525 consecutive women (25-75 years) with breast cancer, newly diagnosed by mammography, ultrasound, and needle-biopsy, underwent CE-MRM. The median invasive tumour size was 19 mm. In 144 patients, CE-MRM identified additional lesions. After secondlook, 119 patients underwent additional biopsy. CE-MRM altered surgery in 118 patients: 57 received double lumpectomy or wider excision (41 beneficial), 41 required mastectomy (40 beneficial), and 20 underwent contra lateral surgery (18 beneficial). The overall false-positive rate was 27.1% (39/144). CE-MRM contributed significantly to the management of breast cancer, suggesting more extensive disease in 144/525 (27.4%) patients and changing the surgical plan in 118/525 (22.5%) patients (99/525, 18.8% beneficial).
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Affiliation(s)
- Chiara Perono Biacchiardi
- Ginteam, Mini-Invasive Gynaecological and Breast Surgery Unit, Evangelical Hospital, ASL TO1, Via Silvio Pellico 19, 10125 Torino, Italy
| | - Davide Brizzi
- Breast Radiology Unit, Evangelical Hospital, ASL TO1, Via Silvio Pellico 19, 10125 Torino, Italy
| | - Franco Genta
- Ginteam, Mini-Invasive Gynaecological and Breast Surgery Unit, Evangelical Hospital, ASL TO1, Via Silvio Pellico 19, 10125 Torino, Italy
| | - Eugenio Zanon
- Breast Radiology Unit, Evangelical Hospital, ASL TO1, Via Silvio Pellico 19, 10125 Torino, Italy
| | - Marco Camanni
- Ginteam, Mini-Invasive Gynaecological and Breast Surgery Unit, Evangelical Hospital, ASL TO1, Via Silvio Pellico 19, 10125 Torino, Italy
| | - Francesco Deltetto
- Ginteam, Mini-Invasive Gynaecological and Breast Surgery Unit, Evangelical Hospital, ASL TO1, Via Silvio Pellico 19, 10125 Torino, Italy
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17
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Siboni SM, Zanon E, Sottilotta G, Consonni D, Castaman G, Mikovic D, Biondo F, Tagliaferri A, Iorio A, Mannucci PM, Peyvandi F. Central nervous system bleeding in patients with rare bleeding disorders. Haemophilia 2011; 18:34-8. [PMID: 21539694 DOI: 10.1111/j.1365-2516.2011.02545.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Central nervous system (CNS) bleeding is one of the most severe and debilitating manifestations occurring in patients with rare bleeding disorders (RBDs). The aim of this study was to retrospectively collect data on patients affected with RBDs who had CNS bleeding, to establish incidence of recurrence, death rate, neurological sequences, most frequent location, type of bleeding and efficacy of treatments. Results pertained to 36 CNS bleeding episodes in 24 patients with severe deficiency except one with moderate factor VII (FVII) deficiency. Six patients (25%) experienced a recurrence and two had more than one recurrence. Seven patients (29%) had an early onset of CNS bleeding before the first 2 years of life, others (71%) later in life. In 76% of cases, CNS bleeding was spontaneous. CNS bleeding was intracerebral in 19 cases (53%), extracerebral in 10 (28%) and both intracerebral and extracerebral in two cases (6%). Neurosurgery was performed in 11 cases, in association with replacement therapy in seven cases. Seizures were noted in four patients. Residual psychomotor abnormalities were seen in two patients. No death was recorded. To prevent recurrence, 17/24 patients (71%) were put on secondary prophylaxis. In conclusion, recurrence of CNS bleeding was confirmed to be relatively frequent in patients with severe FV, FX, FVII and FXIII deficiencies. Most patients were managed with replacement therapy alone, surgery being reserved for those with worsening neurological conditions. Our results indicate that some RBDs require early prophylactic treatment to prevent CNS bleeding. Optimal dosage and frequency of treatment need further evaluation.
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Affiliation(s)
- S M Siboni
- Centro Emofilia e Trombosi A Bianchi Bonomi, Dipartimento di Medicina Interna e Specialità Mediche, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Università degli Studi di Milano, Milano, Italy.
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18
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Tagliaferri A, Rivolta GF, Iorio A, Oliovecchio E, Mancuso ME, Morfini M, Rocino A, Mazzucconi MG, Franchini M, Ciavarella N, Scaraggi A, Valdrè L, Tagariello G, Radossi P, Muleo G, Iannaccaro PG, Biasoli C, Vincenzi D, Serino ML, Linari S, Molinari C, Boeri E, La Pecorella M, Carloni MT, Santagostino E, Di Minno G, Coppola A, Rocino A, Zanon E, Spiezia L, Di Perna C, Marchesini M, Marcucci M, Dragani A, Macchi S, Albertini P, D'Incà M, Santoro C, Biondo F, Piseddu G, Rossetti G, Barillari G, Gandini G, Giuffrida AC, Castaman G. Mortality and causes of death in Italian persons with haemophilia, 1990-2007. Haemophilia 2010; 16:437-46. [PMID: 20148978 DOI: 10.1111/j.1365-2516.2009.02188.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although a number of studies have analysed so far the causes of death and the life expectancy in haemophilic populations, no investigations have been conducted among Italian haemophilia centres. Thus, the aim of this study was to investigate mortality, causes of deaths, life expectancy and co-morbidities in Italian persons with haemophilia (PWH). Data pertaining to a total of 443 PWH who died between 1980 and 2007 were retrospectively collected in the 30 centres who are members of the Italian Association of Haemophilia Centres that chose to participate. The mortality rate ratio standardized to the male Italian population (SMR) was reduced during the periods 1990-1999 and 2000-2007 such that during the latter, death rate overlapped that of the general population (SMR 1990-1999: 1.98 95% CI 1.54-2.51; SMR 2000-2007: 1.08 95% CI 0.83-1.40). Similarly, life expectancy in the whole haemophilic population increased in the same period (71.2 years in 2000-2007 vs. 64.0 in 1990-1999), approaching that of the general male population. While human immunodeficiency virus infection was the main cause of death (45%), 13% of deaths were caused by hepatitis C-associated complications. The results of this retrospective study show that in Italian PWH improvements in the quality of treatment and global medical care provided by specialized haemophilia centres resulted in a significantly increased life expectancy.
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Affiliation(s)
- A Tagliaferri
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital, Parma, Italy
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19
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Mazzer M, Zanon E, Foltran L, De Pauli F, Cardellino G, Iaiza E, Ermacora P, Aprile G, Fasola G. Second-line pemetrexed–oxaliplatin combination for advanced pancreatic adenocarcinoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15597 Background: Few regimens showed efficacy in advanced pancreatic cancer patients (pts) who had failed a first-line gemcitabine-based therapy. However, there is growing evidence suggesting that second-line treatment may provide further disease control in selected pts. Both pemetrexed and oxaliplatin demonstrated activity in this setting, and their combination resulted safe and tolerable.Methods: Pancreatic cancer pts with advanced disease, PS>60, age>18 years, who progressed after a gemcitabine-based therapy were enrolled in a phase II trial, and treated with pemetrexed 500 mg/mq followed by oxaliplatin 120 mg/mq, day 1 every 3 weeks, together with adequate oral folinic acid and intramuscular vitamin B12 supplementation. Accordingly to the Simon Minimax two-stage study design, an accrual of 31 patients was planned, with a minimum response rate considered of interest of 25%, α level 0.10 and β level 0.10. Results: To date, 16 patients have been treated. Of them, 12 progressed during or shortly after gemcitabine (13) or gemcitabine-cisplatin combination (3), with a median time to progression of 186 days. 62 cycles were delivered, with a median of 4 cycles per patient (range 2–8). Overall, the regimen was well tolerated: most common adverse events were mild-to-moderate sensory neurotoxicity and gastrointestinal disturbances. We reported grade 3 anemia, grade 3 thrombocytopenia, and grade 3 fatigue in 1 patient each. Three among the treated patients died within 30 days from last delivered cycle due to progressive disease. Confirmed partial (3) or minor responses (6) were observed in 9 out of 15 evaluable pts, with a median decrease in the Ca 19.9 value of 43% among those who responded. Median progression-free survival was 99 days. At the time of analysis, 3 out of 16 patients are still on treatment.Conclusions: The preliminary results suggest that second-line pemetrexed-oxaliplatin combination is well tolerated and reasonably active, and allow the continuation of the study until the full sample of 31 pts. No significant financial relationships to disclose.
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Affiliation(s)
| | - E. Zanon
- University Hospital, Udine, Italy
| | | | | | | | - E. Iaiza
- University Hospital, Udine, Italy
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20
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Tagliaferri A, Franchini M, Coppola A, Rivolta GF, Santoro C, Rossetti G, Feola G, Zanon E, Dragani A, Iannaccaro P, Radossi P, Mannucci PM. Effects of secondary prophylaxis started in adolescent and adult haemophiliacs. Haemophilia 2008; 14:945-51. [PMID: 18540895 DOI: 10.1111/j.1365-2516.2008.01791.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- A Tagliaferri
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital, Parma, Italy.
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21
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Tangaro S, Bellotti R, De Carlo F, Gargano G, Lattanzio E, Monno P, Massafra R, Delogu P, Fantacci ME, Retico A, Bazzocchi M, Bagnasco S, Cerello P, Cheran SC, Lopez Torres E, Zanon E, Lauria A, Sodano A, Cascio D, Fauci F, Magro R, Raso G, Ienzi R, Bottigli U, Masala GL, Oliva P, Meloni G, Caricato AP, Cataldo R. MAGIC-5: an Italian mammographic database of digitised images for research. Radiol Med 2008; 113:477-85. [DOI: 10.1007/s11547-008-0282-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Accepted: 09/21/2007] [Indexed: 10/22/2022]
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22
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Aprile G, Iaiza E, De Pauli F, Zanon E, Foltran L, Mazzer M, Cardellino G, Miscoria M, Fasola G, Sonis S. Geographical differences in acute treatment-related toxicity frequencies: A comparative analysis of 503 colorectal cancer (CRC) patients receiving chemotherapy. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20561] [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: 11/20/2022] Open
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23
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Salviato R, Belvini D, Radossi P, Sartori R, Pierobon F, Zanotto D, Zanon E, Castaman G, Gandini G, Tagariello G. F8 gene mutation profile and ITT response in a cohort of Italian haemophilia A patients with inhibitors. Haemophilia 2008; 13:361-72. [PMID: 17610549 DOI: 10.1111/j.1365-2516.2007.01437.x] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Anti factor VIII (FVIII) antibodies represent the main complication of replacement therapy in severe cases of haemophilia and most patients with inhibitor have gross gene rearrangements or point mutations that hamper the production of normal circulating FVIII. In this study we have investigated 82 haemophilia A patients with inhibitors. Seventy six were severe, three were moderate and three were mild. We screened the patients for the causative mutations using long range PCR for the recurrent intron 22 inversion (invint22), multiplex PCR for intron 1 inversion (invint1) and conformation sensitive gel electrophoresis followed by DNA sequencing for all other mutation types in the F8 gene. Diverse genetic defects were detected in the severe cases (with a predominance of severe molecular defects): F8 gene inversions, large deletions and non-sense mutations account for 71% of the mutations. Only missense and splicing mutations were identified in the non-severe patients and we confirmed that the presence of inhibitors correlates well with the presence of severe mutations, but a proportion of severe patients develops inhibitors despite the presence of diverse less severe mutations. When we have analysed the subgroup of patients who underwent immunetolerance, we have found that F8 gene large deletions are likely to be a high risk factor also for immunetolerance therapy unresponsiveness, while no clear evidence has been demonstrated for other mutation types.
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Affiliation(s)
- R Salviato
- Dipartimento di Laboratorio, Servizio Trasfusionale, Centro Regionale per le Malattie del Sangue e Servizio di assistenza agli Emofilici di Castelfranco Veneto (Treviso), Castelfranco Veneto (TV), Italy
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24
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Bracci R, Zanon E, Cellerino R, Gesuita R, Puglisi F, Aprile G, Barbieri V, Misuraca D, Venuta S, Carle F, Piga A. Information to cancer patients: a questionnaire survey in three different geographical areas in Italy. Support Care Cancer 2008; 16:869-77. [DOI: 10.1007/s00520-007-0375-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Accepted: 12/06/2007] [Indexed: 01/03/2023]
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25
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Bottos AM, Zanon E, Sartori MT, Girolami A. Psychological aspects and coping styles of parents with Haemophilic child undergoing a programme of counselling and psychological support. Haemophilia 2007; 13:305-10. [PMID: 17498080 DOI: 10.1111/j.1365-2516.2006.01428.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [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: 11/30/2022]
Abstract
Parents of children affected by haemophilia must face, often without prior knowledge, the difficult challenge imposed by such a pathology. To satisfy the need of information, guideline and psychological support for a better quality of life, 30 parents with haemophiliac children have participated in a programme of counselling and psychological support. Such a programme has the aim of guiding the group trough a process of discovery, comparison and personal growth and stimulating adaptive processes of problem-solving and decision-making. The aim of this paper was to verify how the programme influenced coping strategies and other psychological constructs such as depression and anxiety. Subjects of this study were administered the following psychological tests: COPE (coping, orientation to problems experienced), BDI (beck depression inventory), STAI-Y form (state-trait anxiety inventory) at the beginning and at the end of the programme. The results show that by the end of the programme subjects are characterized by a greater use of problem-focused coping strategies, typical of individuals who think that the situation is susceptible to change, and a minor use of emotion-focused coping strategies, related to individuals who regard the situation as immutable. The use of avoidance -focused coping strategies seems to remain at the same level even if it was low. Also the other psychological aspects investigated, namely depression and anxiety, did receive a positive influence. The results show how significant such programme has been for parents.
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Affiliation(s)
- A M Bottos
- Department of Medical and Surgical Sciences, Haemophilia Centre, Second Chair of Medicine, University of Padua Medical School, Padua, Italy
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26
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Zanon E, Aprile G, Tuniz F, De Pauli F, Iaiza E, Pella N, Saman M, Skrap M, Fasola G, Piga A. Outcome of colorectal cancer (CRC) patients resected for brain metastases (BM). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.14530] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14530 Background: Advances in systemic treatment for metastatic CRC confer survival advantage, allowing patients to reach a median survival of almost 2 years. As a consequence of this remarkable life extension, the incidence of BM from CRC, though still low, is increasing over time. The presence of BM is considered an index of poor prognosis, even when surgical resection is possible. Methods: To determine if an aggressive approach to BM from CRC could provide patients with clinical benefit or survival advantage, we retrospectively collected data from 29 CRC patients who underwent neurosurgical resection of BM between March 1998 and July 2006. Results: The median age at the time of surgical procedure was 65 years, median ECOG PS was 1, and the majority of patients (26 out of 29) had concomitant metastases at other sites. Lung and liver metastases were both common. Median number of previous chemotherapy regimens was two, with almost all of the patients being exposed both to oxaliplatinum and irinotecan-based regimens. After resection, 30 Gy of external whole-brain radiotherapy were administered to the majority of the patients. At the time of the analysis, 26 out of 29 patients had died, with a median survival time after brain metastasectomy of 210 days (8–682). Only 2 patients died within a month from surgery. We did observe prolonged survival for patients who received post-surgical radiotherapy (Kaplan Maier, p=0.033). Although death due to encephalic progression was reported for the patients with brain as the sole metastatic site, intracranial disease progression was not a clear predictor for poor survival in the whole cohort (p>0.05). Conclusions: Surgical resection of BM from CRC, whether followed by radiotherapy or not, is a feasible and safe technique, offering a chance of prolonged survival. Patients who received radiotherapy after complete neurosurgical resection have a better outcome. No significant financial relationships to disclose.
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Affiliation(s)
- E. Zanon
- University Hospital, Udine, Italy; School of Medicine, University of Texas, TX
| | - G. Aprile
- University Hospital, Udine, Italy; School of Medicine, University of Texas, TX
| | - F. Tuniz
- University Hospital, Udine, Italy; School of Medicine, University of Texas, TX
| | - F. De Pauli
- University Hospital, Udine, Italy; School of Medicine, University of Texas, TX
| | - E. Iaiza
- University Hospital, Udine, Italy; School of Medicine, University of Texas, TX
| | - N. Pella
- University Hospital, Udine, Italy; School of Medicine, University of Texas, TX
| | - M. Saman
- University Hospital, Udine, Italy; School of Medicine, University of Texas, TX
| | - M. Skrap
- University Hospital, Udine, Italy; School of Medicine, University of Texas, TX
| | - G. Fasola
- University Hospital, Udine, Italy; School of Medicine, University of Texas, TX
| | - A. Piga
- University Hospital, Udine, Italy; School of Medicine, University of Texas, TX
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27
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Piga A, Miscoria M, Aprile G, Cozzi M, Iaiza E, De Pauli F, Zanon E, Fasola G, Sacco C. Treatment of colorectal cancer in elder patients. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.19595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
19595 Background: Tumor-related mortality is higher in elder patients worldwide. This may be due to comorbidities associated with age but also, at least in part, to a cautious approach by the attending physician(s) which might result in inadequate or even denied treatment. This approach is purportedly justified by scarcity of literature reports on effectiveness, tolerance and side effects of chemotherapy and other treatments on this category of patients. Methods: We have reviewed clinical records of patients of 70 years of age or older with colorectal cancer who came to our first observation between January 2004 and April 2006. We have correlated the appropriateness of therapeutic decisions, based on adherence to clinical standards, to the clinical characteristics of the patients and in particular to number and degree of coexisting morbidities. Chi square test was used for analysing the association between variables. Results: We have reviewed the records of 193 patients with colorectal cancer, to a total of 215 events, including 22 relapses in the same patients, in which a new therapeutic decision was involved. Adjuvant treatment was omitted in 40% of patients with stage III colon cancer, and 38% of patients with stage III rectal cancer. Chemotherapy was also omitted in 34% of patients with stage IV colon cancer and 35% of patients with stage IV rectal cancer. Even when patients received treatment, preference was given to drugs and regimens of low toxicity. Therapeutic decisions appeared in most cases based on age rather than number and severity of comorbidities. On the other hand, once the decision to treat was taken, the treatment was given as programmed, although 21% of patients received drug doses lower than 75% of projected dose; reasons for abandoning the treatment were progression and toxicity in stage IV, and more often patient's refusal in stage III. Conclusions: In a disease where standards of treatment are well defined, elder patients often receive inadequate treatment or no therapy at all. Although the justification for inadequate treatment is or should be poor clinical conditions of patients, this is not apparent from review of clinical records. Efforts should be made to have in elder patients standardised evaluation of physical status and comorbidities on a regular basis. No significant financial relationships to disclose.
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Affiliation(s)
- A. Piga
- University of Udine, Udine, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy
| | - M. Miscoria
- University of Udine, Udine, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy
| | - G. Aprile
- University of Udine, Udine, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy
| | - M. Cozzi
- University of Udine, Udine, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy
| | - E. Iaiza
- University of Udine, Udine, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy
| | - F. De Pauli
- University of Udine, Udine, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy
| | - E. Zanon
- University of Udine, Udine, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy
| | - G. Fasola
- University of Udine, Udine, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy
| | - C. Sacco
- University of Udine, Udine, Italy; Azienda Ospedaliero-Universitaria, Udine, Italy
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28
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Genta F, Zanon E, Camanni M, Deltetto F, Drogo M, Gallo R, Gilardi C. Cost/Accuracy Ratio Analysis in Breast Cancer Patients Undergoing Ultrasound-Guided Fine-Needle Aspiration Cytology, Sentinel Node Biopsy, and Frozen Section of Node. World J Surg 2007; 31:1155-63. [PMID: 17464539 DOI: 10.1007/s00268-007-9009-3] [Citation(s) in RCA: 51] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We evaluated the effectiveness and the cost of axillary staging in breast cancer patients by ultrasound-guided fine-needle aspiration cytology (US-FNAC), sentinel node biopsy (SNB), and frozen sections of the sentinel node to achieve the target of the highest number of immediate axillary dissections. From January 2003 through October 2005, a total of 404 consecutive eligible breast cancer patients underwent US-FNAC of suspicious axillary lymph nodes. If tumor cells were found, immediate axillary dissection was proposed (33% of node-positive cases). If US or cytology was negative, SNB was performed. Frozen sections of the sentinel node allowed immediate axillary dissection in 31% of node-positive cases. The remaining 36% underwent delayed axillary dissection. We compared our policy with clinical evaluation of the axilla, showing better specificity of US-FNAC, the cost balanced by a 12% reduction of SNBs, and a marked reduction of unnecessary axillary dissections resulting from false-positive clinical staging. Moreover, the comparison between our policy and permanent histology of the sentinel node showed an 8% cost saving, mainly associated with the immediate axillary dissections. US-FNAC of axillary lymph nodes in breast cancer patients reliably predicts the presence of metastases and therefore refers a significant number of patients to the appropriate surgical treatment, avoiding an SNB. As cost saving to the health care system in our study is mainly related to one-step axillary surgery, US-FNAC of axillary lymph nodes and frozen section of the sentinel node generate significant cost saving for patients who have metastatic nodes.
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MESH Headings
- Axilla
- Biopsy, Fine-Needle/economics
- Breast/pathology
- Breast Neoplasms/economics
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/economics
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/economics
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Cost Savings
- Female
- Frozen Sections/economics
- Humans
- Italy
- Lymph Node Excision/economics
- Lymph Nodes/pathology
- Mastectomy, Segmental/economics
- National Health Programs/economics
- Neoplasm Staging
- Reoperation/economics
- Sensitivity and Specificity
- Sentinel Lymph Node Biopsy/economics
- Ultrasonography, Interventional/economics
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Affiliation(s)
- Franco Genta
- Ginteam, Mini-Invasive Gynaecological and Breast Surgery Unit, Evangelical Hospital, ASL 1, Torino, Italy.
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Bellotti R, De Carlo F, Tangaro S, Gargano G, Maggipinto G, Castellano M, Massafra R, Cascio D, Fauci F, Magro R, Raso G, Lauria A, Forni G, Bagnasco S, Cerello P, Zanon E, Cheran SC, Lopez Torres E, Bottigli U, Masala GL, Oliva P, Retico A, Fantacci ME, Cataldo R, De Mitri I, De Nunzio G. A completely automated CAD system for mass detection in a large mammographic database. Med Phys 2006; 33:3066-75. [PMID: 16964885 DOI: 10.1118/1.2214177] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [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: 11/07/2022] Open
Abstract
Mass localization plays a crucial role in computer-aided detection (CAD) systems for the classification of suspicious regions in mammograms. In this article we present a completely automated classification system for the detection of masses in digitized mammographic images. The tool system we discuss consists in three processing levels: (a) Image segmentation for the localization of regions of interest (ROIs). This step relies on an iterative dynamical threshold algorithm able to select iso-intensity closed contours around gray level maxima of the mammogram. (b) ROI characterization by means of textural features computed from the gray tone spatial dependence matrix (GTSDM), containing second-order spatial statistics information on the pixel gray level intensity. As the images under study were recorded in different centers and with different machine settings, eight GTSDM features were selected so as to be invariant under monotonic transformation. In this way, the images do not need to be normalized, as the adopted features depend on the texture only, rather than on the gray tone levels, too. (c) ROI classification by means of a neural network, with supervision provided by the radiologist's diagnosis. The CAD system was evaluated on a large database of 3369 mammographic images [2307 negative, 1062 pathological (or positive), containing at least one confirmed mass, as diagnosed by an expert radiologist]. To assess the performance of the system, receiver operating characteristic (ROC) and free-response ROC analysis were employed. The area under the ROC curve was found to be Az = 0.783 +/- 0.008 for the ROI-based classification. When evaluating the accuracy of the CAD against the radiologist-drawn boundaries, 4.23 false positives per image are found at 80% of mass sensitivity.
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Affiliation(s)
- R Bellotti
- Dipartimento di Fisica, Università di Bari, Sezione INFN di Bari, Italy
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30
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Piga A, Zanon E, Bracci R, Barbieri V, Puglisi F, Aprile G, Gesuita R, Carle F, Venuta S, Cellerino R. Information to cancer patients: A questionnaire survey in three different geographical areas in Italy. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.18593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
18593 Background: The way information to cancer patients is delivered widely varies among different countries. In Italy, as in other Mediterranean countries, the traditional approach has been of partial disclosure of the truth. Methods: We asked 200 cancer patients in 3 different Centres form Northern, Central and Southern Italy (Udine, Ancona, Catanzaro) to answer a 26-item questionnaire on communication aspects, in order to verify if information received was correct and adequate, and dependent on geographical variations. Statistics included univariate and multiple correspondence analysis, which studies relations between all variables, and provides a graphical representation in which associated variables tend to aggregate spatially. Results: Questionnaires were completed by 587 patients, of median age 60 yrs, 57% females, mainly with gastrointestinal (32%) or breast cancer (30%); 63% had active disease at time of interview. 77% of patients interviewed had a correct knowledge of their diagnosis, with no difference between different Centres. More informed were patients of female gender (p = 0.004), young age, better education, and with breast cancer (all p < 0.001). Patients appropriately informed on prognosis were 41%. More informed were those with good prognosis, breast cancer, and not receiving treatment; less informed patients from Southern Italy and those with advanced disease. Degree of information was not directly related to desire for information, which was more pronounced for patients from Central and Southern Italy. Satisfaction for information received was higher for patients from Northern Italy, not on treatment, with limited disease. Multiple correspondence analysis identified clusters of patients such as those of old age, lower education, male sex, advanced disease, preferred paternalistic approach, characterized by poor level of information; and young age, female sex, high scholarity, breast cancer, patient-centered relationship with their doctor, characterized by high level of information. Conclusions: The cultural attitude towards communication aspects in oncology is changing in Italy. There are still significant differences at different latitudes, but there is a general trend to improving awareness about cancer. No significant financial relationships to disclose.
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Affiliation(s)
- A. Piga
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
| | - E. Zanon
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
| | - R. Bracci
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
| | - V. Barbieri
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
| | - F. Puglisi
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
| | - G. Aprile
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
| | - R. Gesuita
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
| | - F. Carle
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
| | - S. Venuta
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
| | - R. Cellerino
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
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Aprile Esq. G, Sponza M, Vit A, Pella N, Gasparini D, Zanon E, Iaiza E, De Pauli F, Marzio A, Piga A. Impact of the size of metatases on the outcome of patients with non-resectable colorectal liver metastases treated with percutaneous laser-induced thermoablation (pLIT). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.13556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
13556 Background: whenever surgical resection of liver metastases from colorectal cancer is not possible, thermal ablation is a mini-invasive local treatment that can be considered as an alternative approach. Complete thermal ablation can be achieved by laser treatment. When thermoablation is obtained by radiofrequency, patients treated for a small dominant lesion (less than 3 cm) experience a better outcome. This evidence is less clear when pLIT is used. Patients and Methods: 30 patients (22 with a single lesion, 8 with up to three metastases) were consecutively treated. Maximum diameter of the dominant lesion was less than 3 cm in 20 pts and more than 3 cm in ten. With mild sedation and local anaesthesia, optical fibers were inserted directly into the tumor with echo-guided percutaneous needle placement. Each optical fiber was connected to a neodymium:yttrium-aluminium-garnet (ND:YAG) laser, which delivers concentrated light at a wave-length of 1064 nm, with a 5-Watt power and a 1800-Joule energy per single fiber. A minimum of two and a maximum of four needles were used, with a 5 to 8 mm distance from one needle to another. Results: all patients tolerated LIT procedure well, without major complications. Post-treatment CT-scan demonstrated complete thermonecrosis in 39 out of 44 (87%) of the treated lesions, and almost complete in the remaining 5, 4 of which of diameter larger than 3 cm. Local failure was reported in 12% of the lesions at six-month follow-up. The median Kaplan-Meier survival for all patients was 607 days, with survival rate of 82% at one year and 55% at three years. Patients treated for a smaller dominant lesion had a significantly better survival than the others (850 vs 420 days, p=0.04, logrank). Conclusions: pLIT permitted in most cases a complete ablation of liver metastases with a high local tumor control rate and a low complication rate. Patients with a smaller dominant lesion do best after pLIT procedure. Local treatment coupled with systemic chemotherapy offers a chance of prolonged survival in patients not amenable to hepatic surgery. No significant financial relationships to disclose.
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Affiliation(s)
- G. Aprile Esq.
- Policlinico Universitario, Udine, Italy; Azienda Ospedaliera, Udine, Italy
| | - M. Sponza
- Policlinico Universitario, Udine, Italy; Azienda Ospedaliera, Udine, Italy
| | - A. Vit
- Policlinico Universitario, Udine, Italy; Azienda Ospedaliera, Udine, Italy
| | - N. Pella
- Policlinico Universitario, Udine, Italy; Azienda Ospedaliera, Udine, Italy
| | - D. Gasparini
- Policlinico Universitario, Udine, Italy; Azienda Ospedaliera, Udine, Italy
| | - E. Zanon
- Policlinico Universitario, Udine, Italy; Azienda Ospedaliera, Udine, Italy
| | - E. Iaiza
- Policlinico Universitario, Udine, Italy; Azienda Ospedaliera, Udine, Italy
| | - F. De Pauli
- Policlinico Universitario, Udine, Italy; Azienda Ospedaliera, Udine, Italy
| | - A. Marzio
- Policlinico Universitario, Udine, Italy; Azienda Ospedaliera, Udine, Italy
| | - A. Piga
- Policlinico Universitario, Udine, Italy; Azienda Ospedaliera, Udine, Italy
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Girolami A, Randi ML, Ruzzon E, Zanon E, Girolami B. Myocardial infarction, other arterial thrombosis and invasive coronary procedures, in hemaophilia B: a critical evaluation of reported cases. J Thromb Thrombolysis 2005; 20:43-6. [PMID: 16133895 DOI: 10.1007/s11239-005-2227-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Myocardial infarction and other arterial thrombosis are commonly maintained to be rare in hemophilia patients. This, in general, seems true but the occurrence of a thrombotic event in hemophilia B is not exceptional. A thorough search of the literature has yielded 13 patients with myocardial infarction and 1 patient with a cerebrovascular accident. There were three fatalities. In five cases MI occurred after infusion of Prothrombin Complex Concentrates. In three additional patients the event occurred after infusion of plasma, Feiba or cryoprecipitate supernatant. Four patients had an antero-lateral infarction. Two had a non-Q infarction and one each showed a multiple or a posterior-inferior form. Several therapeutic coronary procedures (GABG and PTCA) were carried out in hemophilia B patients without undue complication providing adequate level of FIX were maintained. Heparin prophilaxis was used in all patients but one. The analysis of the literature indicates that (1) MI may occur in hemophilia B patients and (2) that invasive coronary artery therapeutic procedures may be carried out without complications.
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Affiliation(s)
- A Girolami
- Department of Medical and Surgical Sciences & Northeastern Italy Association for Hemophilia and other coagulation disorders, University of Padua Medical School, via Opsedale 105, 35128 Padua, Italy
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33
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Girolami A, Vettore S, Bortoletto E, Zanon E. Mild factor VII deficiency due to heterozygosis is not associated with a bleeding tendency. Blood Coagul Fibrinolysis 2005; 16:459-60; author reply 460. [PMID: 16093739 DOI: 10.1097/01.mbc.0000179910.34914.fb] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Girolami A, Scandellari R, Lombardi AM, Girolami B, Bortoletto E, Zanon E. Pregnancy and oral contraceptives in factor V deficiency: a study of 22 patients (five homozygotes and 17 heterozygotes) and review of the literature. Haemophilia 2005; 11:26-30. [PMID: 15660985 DOI: 10.1111/j.1365-2516.2005.01056.x] [Citation(s) in RCA: 25] [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: 11/28/2022]
Abstract
Information on the effect of pregnancy or oral contraceptives (OC) in congenital factor V (FV) deficiency is scanty. The personal investigation of five homozygous and 17 female heterozygous showed that patients with severe deficiency bleed considerably at the time of delivery. However, bleeding can be controlled properly by administration of fresh frozen plasma with excellent foetal outcome. The safe level for adequate haemostasis seems around 25% of normal. On the contrary, heterozygote patients show no significant postpartum bleeding and therefore need no substitution therapy. Oral contraceptives were taken and well tolerated by four of our homozygous patients and appear to be beneficial because they cause a decrease in menometrorrhagies thereby improving the anaemia and decreasing transfusional needs. One patient took hormonal replacement therapy with no undue effects. No thrombosis was noted in the propositae during oral contraceptive therapy. The review of the literature has allowed the gathering of information on 20 additional pregnancies. The foetal outcome was satisfactory in every instance. Excessive bleeding was noted in 11 pregnancies. In seven of the remaining pregnancies, no undue bleeding was noted thanks to appropriate substitution therapy. In the remaining two pregnancies no bleeding was noted and no substitution therapy was given. No data are apparently available in the literature about the use of OCs in FV deficiency.
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Affiliation(s)
- A Girolami
- Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy.
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35
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Cerello P, Bagnasco S, Bottigli U, Cheran SC, Delogu P, Fantacci ME, Fauci F, Forni G, Lauria A, Lopez Torres E, Magro R, Masala GL, Oliva P, Palmiero R, Ramello L, Raso G, Retico A, Sitta M, Stumbo S, Tangaro S, Zanon E. GPCALMA: a Grid-based tool for mammographic screening. Methods Inf Med 2005; 44:244-8. [PMID: 15924184] [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: 05/02/2023]
Abstract
OBJECTIVES The next generation of high energy physics (HEP) experiments requires a GRID approach to a distributed computing system: the key concept is the Virtual ORGANISATION (VO), a group of distributed users with a common goal and the will to share their resources. METHODS A similar approach, applied to a group of hospitals that joined the GPCALMA project (Grid Platform for Computer Assisted Library for MAmmography), will allow common screening programs for early diagnosis of breast and, in the future, lung cancer. The application code makes use of neural networks for the image analysis and is useful in improving the radiologists' diagnostic performance. GRID services allow remote image analysis and interactive online diagnosis, with a potential for a relevant reduction of the delays presently associated with screening programs. RESULTS AND CONCLUSIONS A prototype of the system, based on AliEn GRID Services [1], is already available, with a central server running common services [2] and several clients connecting to it. Mammograms can be acquired in any location; the related information required to select and access them at any time is stored in a common service called Data Catalogue, which can be queried by any client. Thanks to the PROOF facility [3], the result of a query can be used as input for analysis algorithms, which are executed on the nodes where the input images are stored,. The selected approach avoids data transfers for all the images with a negative diagnosis and allows an almost real time diagnosis for the set of images with high cancer probability.
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Affiliation(s)
- P Cerello
- INFN, Sezione di Torino, via P. Giuria 1, 10125 Turin, Italy.
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36
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Romagnolo C, Burati S, Ciaffoni S, Fattori E, Franchi M, Zanon E, Girolami A. Severe factor X deficiency in pregnancy: case report and review of the literature. Haemophilia 2004; 10:665-8. [PMID: 15357794 DOI: 10.1111/j.1365-2516.2004.01012.x] [Citation(s) in RCA: 26] [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: 11/25/2022]
Abstract
Isolate factor X deficiency is an extremely rare clotting factor disorder inherited in autosomal recessive fashion and pregnancy in a homozygous patient is frequently complicated by recurrent miscarriage, uterine bleeding and premature labour. Eleven pregnancies in seven patients affected by FX deficiency have been reported in the literature. Two additional pregnancies have been reported in a FX variant (FX Friuli). We present a new case of successful at term pregnancy in a homozygous patient.
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Affiliation(s)
- C Romagnolo
- Obstetric Gynecology Department, Sacro Cuore Hospital Negrar, Verona, Italy.
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38
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Aprile G, Zanon E, Perlazzi R, Puglisi F, Belvedere O, Bracci R, Cellerino R, Piga A. A questionnaire survey on information to cancer patients in Northern Italy. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.8252] [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: 11/20/2022] Open
Affiliation(s)
- G. Aprile
- University of Udine, UDINE, Italy; University of Ancona, ANCONA, Italy
| | - E. Zanon
- University of Udine, UDINE, Italy; University of Ancona, ANCONA, Italy
| | - R. Perlazzi
- University of Udine, UDINE, Italy; University of Ancona, ANCONA, Italy
| | - F. Puglisi
- University of Udine, UDINE, Italy; University of Ancona, ANCONA, Italy
| | - O. Belvedere
- University of Udine, UDINE, Italy; University of Ancona, ANCONA, Italy
| | - R. Bracci
- University of Udine, UDINE, Italy; University of Ancona, ANCONA, Italy
| | - R. Cellerino
- University of Udine, UDINE, Italy; University of Ancona, ANCONA, Italy
| | - A. Piga
- University of Udine, UDINE, Italy; University of Ancona, ANCONA, Italy
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39
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Abstract
Although enormous progress has been made in recent years in the field of haemophilia, some problems still await solution, such as the risk of sudden haemorrhage, the sequelae of haemophilic arthropathy and social activities. We, therefore, carried out a case-control study in which some psychological dimensions (social expectations, tendency to depression, state of anxiety and self-esteem) were evaluated in a group of 60 haemophiliacs. A control group was formed of 78 healthy subjects matched for age, socio-economic class and level of education. The methodology used was the administration of self-assessment questionnaires which investigate and provide a quantitative measure of psychological dimensions. The results can be subjected to statistical analysis. Three self-assessment questionnaires were used: (i) the Marlowe-Crowne scale, (ii) the Beck Inventory version modified by Cusinato and (iii) the S.T.A.I.-form. Our aim was to evaluate: (i) whether there are significant differences in the considered psychological aspects between haemophiliacs and healthy subjects; (ii) whether there is a significant correlation between the psychological dimensions considered in the haemophiliacs and in the healthy subjects. The results showed that the haemophiliacs have a good psychological adaptation to their disease with the exception of their greater tendency to have less self-esteem than do the healthy subjects. As far as concerns the second aim, we found than self-esteem correlated with all the psychological variables investigated. This information could indicate the enormous importance that the psychological variable 'self-esteem' plays in haemophiliacs with respect to whether or not they develop depressive disorders and/or anxiety states.
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Affiliation(s)
- M Canclini
- Department of General Psychology, University of Padua, Italy
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40
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Sapino A, Cassoni P, Zanon E, Fraire F, Croce S, Coluccia C, Donadio M, Bussolati G. Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management. Br J Cancer 2003; 88:702-6. [PMID: 12618878 PMCID: PMC2376348 DOI: 10.1038/sj.bjc.6600744] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [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] [Indexed: 11/15/2022] Open
Abstract
The knowledge of the status of axillary lymph nodes (LN) of patients with breast cancer is a fundamental prerequisite in the therapeutic decision. In the present work, we evaluated the impact of fine-needle aspiration cytology (FNAC) of ultrasonographically (US) selected axillary LN in the diagnosis of LN metastases and subsequently in the treatment of patients with breast cancer. Axillary US was performed in 298 patients with diagnosed breast cancer (267 invasive carcinomas and 31 ductal carcinoma in situ DCIS), and in 95 patients it was followed by FNAC of US suspicious LN. Smears were examined by routine cytological staining. Cases of uncertain diagnosis were stained in immunocytochemistry (ICC) with a combination of anticytokeratin and anti-HMFG2 antibodies. Eighty-five FNAC were informative (49 LN were positive for metastases, 36 were negative). In 49 of 267 patients with invasive breast carcinoma (18%), a preoperative diagnosis of metastatic LN in the axilla could be confirmed. These patients could proceed directly to axillary dissection. In addition, US-guided FNAC presurgically scored 49 out of 88 (55%) metastatic LN. Of all others, with nonsuspicious LN on US (203 cases including 31 DCIS), in which no FNAC examination was performed, 28 invasive carcinomas (16%) turned out to be LN positive on histological examination. Based on these data, US examination should be performed in all patients with breast cancer adding ICC-supported FNAC only on US-suspect LN. This presurgical protocol is reliable for screening patients with LN metastases that should proceed directly to axillary dissection or adjuvant chemotherapy, thus avoiding sentinel lymph node biopsy.
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Affiliation(s)
- A Sapino
- Department of Biomedical Sciences and Human Oncology, University of Turin, Italy.
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41
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Abstract
Oral contraceptive therapy is associated with a fourfold increased risk of venous thromboembolism as compared with age-matched non-users. The composition of oral contraceptives has varied considerably during the past two to three decades. The estrogen content (ethinylestradiol) has decreased and is now less than 0.03 mg/pill. This was done on the assumption that estrogen was the main culprit for thrombotic complications. Subsequently it was found that the progestins contained in the pill could also play a thrombogenic role. This was particularly maintained to be so for the third-generations progestins, namely gestodene or desogestrel. These gonane progestins have been widely used since the early 1990s, because they appeared to have a lesser androgenic effect. A careful and impartial evaluation of the literature seems to indicate that third-generation progestins are associated with a slight increase in thrombotic risk. However, the significance of this difference remains to be proven. In fact, a relative risk of only two in retrospective studies may have limited effect and disappear in prospectives studies. The role of associated risk factors, both congenital and acquired, has been often overlooked in most of the papers dealing with the subject. This may be important. Preparations containing third-generation progestins are probably associated with a slight increase in thrombosis risk. It is the responsibility of the physician to select the preparation most suited for a given patient. As a general rule it may be safe to start with a preparation containing second-generation progestins. However there is no need for "a pill scare" and it does not seem justified to have women already taking pills containing third-generation progestins to switch to other preparations. If a woman taking preparations containing third-generation progestins experience symptoms, it is probably safe to advise that patient not to take any oral contraceptive pill in the future, regardless of the type. The same is true for women who experience symptoms while taking second-generation progestins preparations.
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Affiliation(s)
- A Girolami
- University of Padua Medical School, Department of Medical and Surgical Sciences, Second Chair of Medicine, Italy
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42
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Bilora F, Boccioletti V, Zanon E, Petrobelli F, Girolami A. Hemophilia A, von Willebrand disease, and atherosclerosis of abdominal aorta and leg arteries: factor VIII and von Willebrand factor defects appear to protect abdominal aorta and leg arteries from atherosclerosis. Clin Appl Thromb Hemost 2001; 7:311-3. [PMID: 11697715 DOI: 10.1177/107602960100700411] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We hypothesized that patients with hemophilia or von Willebrand disease might be protected from atherosclerosis because of their coagulation defect. We studied 40 subjects affected by these two coagulation diseases using echocolor Doppler of the abdominal aorta and leg arteries, and compared the results with those obtained in 40 control patients who were homogenous with study patients in terms of sex, age, and risk factors for atherosclerosis. The probands presented a lower number of plaques than the 40 control subjects in the aorta and in the leg arteries. The most serious hemophilic patients had fewer plaques than controls or than patients with mild hemophilia. Both hemophilia and von Willebrand disease seem to protect against atherosclerosis.
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Affiliation(s)
- F Bilora
- Department of Medical and Surgery Sciences, University of Padua Medical School, Italy
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43
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Vianello F, Belvini D, Dal Bello F, Tagariello G, Zanon E, Lombardi AM, Zerbinati P, Girolami A. Mild bleeding diathesis in a boy with combined severe haemophilia B (C(10400)-->T) and heterozygous factor V Leiden. Haemophilia 2001; 7:511-4. [PMID: 11554942 DOI: 10.1046/j.1365-2516.2001.00551.x] [Citation(s) in RCA: 24] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Haemophilia B patients with factor IX (FIX) activity < 1% are usually characterized by severe bleeding episodes early in life. We report a case of sporadic severe haemophilia B, clinically characterized by mild bleeding diathesis. The presence of anamnestic thrombophlebitis in the patient's mother prompted us to investigate a possible associated hypercoagulable condition. Resistance to activated protein C due to factor V R506Q mutation was present in the mother and in the propositus, in the homozygous and heterozygous form, respectively. Molecular analysis of the FIX gene led to the identification of a nonsense mutation resulting in a stop codon at position 50, previously described and usually responsible for a severe pattern of haemophilia B. The implications of this unusual association are discussed.
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Affiliation(s)
- F Vianello
- Department of Medical and Surgical Sciences, University of Padua Medical School, Italy.
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44
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Zanon E, Vianello F, Casonato A, Girolami A. Early transfusion of factor VIII/von Willebrand factor concentrates seems to be effective in the treatment of gastrointestinal bleeding in patients with von Willebrand type III disease. Haemophilia 2001; 7:500-3. [PMID: 11554939 DOI: 10.1046/j.1365-2516.2001.00543.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The association between gastrointestinal angiodysplasia and von Willebrand disease was reported 30 years ago. The clinical course of patients with von Willebrand disease and angiodysplasia is characterized by numerous admissions to hospital for gastrointestinal bleeding necessitating transfusion with packed red cells, factor VIII and plasma. The management of these patients is problematic. Numerous treatments for the gastrointestinal bleeding have been proposed: surgery, electrocoagulation, laser photocoagulation, sclerotherapy, arteriography with embolization, immunoglobulins, oestrogens, and octreotide, but no treatment modality has been successful in all cases. We report a 66-year-old-female with small bowel angiodysplasia and von Willebrand type III disease in whom prompt administration of factor VIII/vWF concentrates was effective. Education of patients to recognize minimal gastrointestinal bleeding manifestations, periodical clinical visits and early infusion of factor VIII/vWF seems to be fundamental for the success of this therapy. A longer follow-up and the study of other patients are needed to confirm our observation.
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Affiliation(s)
- E Zanon
- Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy.
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Girolami A, Tormene D, Simioni P, Zanon E. Long-Term Use of Oral Contraceptive Therapy in Women With the Prothrombin 20210 G-A Polymorphism Without Thrombotic Complications: A Study of 13 Women (12 Heterozygotes and 1 Homozygote). Thromb Res 2001; 102:205-10. [PMID: 11369413 DOI: 10.1016/s0049-3848(01)00239-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 10/18/2022]
Abstract
Thirteen female patients with the prothrombin 20210 G-A abnormality (twelve heterozygotes and one homozygote) were selected out of 551 patients admitted to our Department of Medicine or to our Outpatient Hemostasis Units between January 1999 and October 2000. The selection was based on the fact that all patients had taken or were still taking oral contraceptives (OC) for a period of 3 years or longer than 3 years. None of these patents as gathered from history, physical examination, private physician records and our records has shown any DVT during or immediately after OC intake. Physical and compression ultrasonography examinations at the time of study were all negative. The average length of oral contraceptives therapy (OCT) was 10 years (range 3-23). The average age of patients at the time of oral contraception was 30 years. The 13 women had also 17 pregnancies without any venous thrombosis. The observations casts several doubt about the prothrombotic effect of this polymorphism. Since DVT has been shown to occur occasionally even in normal women, it is likely that the same may occur in women with this polymorphism regardless of the existence or not of any pathogenetic relationship between the two phenomena. Occasional reports suggesting a link between this polymorphism and oral contraception-related venous thrombosis should be carefully evaluated in order to avoid premature and incorrect conclusions.
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Affiliation(s)
- A Girolami
- Department of Medical and Surgical Sciences, Second Chair of Medicine, University of Padua Medical School, Padua, Italy
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Prandoni P, Sabbion P, Tanduo C, Errigo G, Zanon E, Bernardi E. Prevention of Venous Thromboembolism in High-Risk Surgical and Medical Patients. ACTA ACUST UNITED AC 2001; 1:61-70. [PMID: 15199515 DOI: 10.1055/s-2001-14542] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 10/16/2022]
Abstract
Although pharmacologic prophylaxis against venous thromboembolism has become the standard of care following total hip and knee replacement, prophylaxis among patients undergoing surgery for hip fracture and other lower extremity trauma remains underutilized. Available experience consistently supports the view that low-molecular-weight heparins are more effective than unfractionated heparin for prevention of proximal deep vein thrombosis (DVT) with no additional hemorrhagic risk and more effective than oral anticoagulants for prevention of in-hospital (mostly distal) venous thrombosis at the price of a higher surgical site bleeding and wound hematoma. The choice between low-molecular-weight heparin and warfarin should be tailored to the individual patients based on the clinical assessment of postoperative thrombosis and bleeding risk as well as the prophylaxis-specific cost and convenience. Whether thromboprophylaxis should be continued for a few additional weeks after hospital discharge is controversial. The overall incidence of postoperative DVT in patients with cancer is about twice as high as that of patients free of malignancy. Accordingly, they require prophylactic measures comparable with those usually recommended for major orthopedic surgery. In this setting, dermatan sulfate shows promise. In contrast to surgical patients, prevention of venous thromboembolism is less well studied in hospitalized medical patients. In a recent controlled randomized trial, enoxaparin in high prophylactic doses was an effective and safe measure of thromboprophylaxis in ordinary bedridden patients.
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Affiliation(s)
- P Prandoni
- Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy
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Vianello F, Zanon E, Zerbinati P, Innella B, Girolami A. Disappearance of FVIII inhibitors in a severe hemophilia A neonate after steroid treatment correlated with a cytokine shift toward a T-helper 2 pattern. Haematologica 2000; 85:1114-5. [PMID: 11025617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Zanon E, Martinelli F, Bacci C, Zerbinati P, Girolami A. Proposal of a standard approach to dental extraction in haemophilia patients. A case-control study with good results. Haemophilia 2000; 6:533-6. [PMID: 11012698 DOI: 10.1046/j.1365-2516.2000.00423.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We found no case-control studies on dental extraction in haemophilia patients in the literature even though the use of antifibrinolytic agents following a single infusion of factor VIII or IX has been accompanied by a lower number of bleeding complications in dental extractions. In this study we verified the incidence of bleeding complications after dental extraction in a group of 77 haemophilia patients. One hundred and eighty-four male patients requiring dental extraction represented the control group. All haemophilia patients received 20 mg kg-1 of tranexamic acid and a single infusion of factor VIII or IX to achieve a peak level about 30% of factor VIII or IX in vivo prior to dental extraction. Forty-five of 98 (45.9%) dental extractions in haemophilia patients and 110 of 239 (46%) dental extractions in the control group were surgical ones. We registered two bleeding complications in the group of haemophilia patients (one late bleeding and one haematoma in the site of the anaesthetic injection) and one (a late bleeding) in the control group. The difference of bleeding complications in the two groups of patients were not statistically significant (P=0.2; OR 0.2; CI 0.01-2.22). The protocol proposed in this study, characterized by the feasibility and the number of haemorrhagic complications not different from normal population, make dental extractions in haemophilia patients possible on an out-patient basis with a cost reduction for the community and minor discomfort for the patients.
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Affiliation(s)
- E Zanon
- Department of Medical and Surgical Sciences, University of Padua Medical School, Italy
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Abstract
The patients' movement in bed, is a procedure that demand great physical effort and use of good corporal mechanics for the nursing personnel, relative of preventing them back pain problems. Recognizing the importance of the movement and positioning, to promote safety and comfort to the patient, and before the professionals' complaints, described in the literature, this work has for objectives: to identify and analyzer the postures assumed by the nursing workers and identify the means and difficulties found during the execution of the referred activity. Through the technique of direct observation they were filmed, through videotapes, thirty procedures of patient's movement in the bed executed by nursing workers of an orthopedic clinic of an university hospital. The results evidence that the thirty procedures were executed along 197.41 minutes and that the corporal postures more frequently assumed they were, in respect to back, arms and legs, back inclined/arms with elbow down of row of seats/legs extension (53.76%). In agreement with the beginnings of the corporal mechanics and of the ergonomics, such postures are considered painful to the man, due to the muscle-skeletal aggressions and to the physical overload that they cart. The workers aimed the aspects little space (58.82%), physical load (52.94%) and absence of the personal (47.06%), as the main difficulties found in the execution of patient's movement in the bed, corroborating with the discoveries of the literature, characterizing that activity as painful. They pointed: the adequate technique (36.29%), used of sheet (35.29%) and space adequate (23.52%), as aspects that would facilitate the execution of the procedure.
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Girolami A, Prandoni P, Zanon E, Bagatella P, Girolami B. Venous thromboses of upper limbs are more frequently associated with occult cancer as compared with those of lower limbs. Blood Coagul Fibrinolysis 1999; 10:455-7. [PMID: 10636455 DOI: 10.1097/00001721-199912000-00001] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [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: 11/25/2022]
Abstract
Three hundred and forty-three consecutive patients with deep vein thrombosis (DVT) were investigated for the possible presence of occult or undiagnosed cancer, of whom 305 patients had DVT of the lower limbs whereas 38 had DVT of the upper limbs. Cancer was diagnosed during a 12-month follow-up in nine patients with DVT of the upper limbs (23.7%) and in 34 patients with DVT of the lower limbs (11.1%). The difference was statistically significant. Furthermore, it was shown that the majority of cancers (seven of nine) in the case of DVT of the upper limbs were discovered during the first week of hospital admission. In contrast, in the case of DVT of lower limbs, only eight of 34 cancers were discovered during the initial investigation. Lung cancer and lymphomas represented the majority of cancers associated with upper limb venous thrombosis (seven of nine). In the case of DVT of the lower limbs, cancers were heterogeneous; however, 12 of 34 were cancers of the colon or prostate.
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Affiliation(s)
- A Girolami
- Institute of Medical Semeiotics, Padova, Italy
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