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Vestito A, Dajti E, Cortellini F, Montagnani M, Bazzoli F, Zagari RM. Can Liver Ultrasound Elastography Predict the Risk of Hepatocellular Carcinoma Recurrence After Radiofrequency Ablation? A Systematic Review and Meta-Analysis. Ultraschall Med 2023; 44:e139-e147. [PMID: 34758491 DOI: 10.1055/a-1657-8825] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE The role of liver stiffness (LS) on ultrasound elastography in the prediction of hepatocellular carcinoma (HCC) recurrence after treatment with radiofrequency ablation (RFA) is still unclear. Our aim was to perform a systematic review and meta-analysis to assess whether LS can predict the recurrence of HCC after RFA. MATERIALS AND METHODS Medline via PubMed, Embase, Scopus, and Cochrane Library databases, and abstracts of international conference proceedings were searched up to June 30, 2020. Cohort studies were included if they assessed the association between LS values measured by ultrasound elastography before RFA and HCC recurrence. RESULTS 9 studies including 1373 patients with HCC treated by RFA, 643 of whom developed HCC recurrence, were identified. The mean value of LS before RFA was significantly higher in patients who developed HCC recurrence than in those who did not (weighted mean difference=11.98 kPa, 95%CI: 7.60-16.35, I2=63.8%). There was a significant positive association between LS value and HCC recurrence both at univariate (unadjusted HR=1.03, 95%CI: 1.00-1.07, I2=72.7%) and multivariate analysis (adjusted HR=1.03, 95%CI: 1.02-1.04, I2=0). Patients with LS value ≥13-14 kPa or >1.5 m/s have a higher risk of both HCC recurrence (unadjusted HR=2.18, 95%CI: 1.46-3.25, I2=49.7%; adjusted HR=2.41, 95%CI: 1.53-3.79, I2=0) and overall mortality (adjusted HR=4.38; 95%CI: 2.33-8.25, I2=0) in comparison with those with LS below these cutoffs. CONCLUSION Liver ultrasound elastography appears to be a reliable tool to predict HCC recurrence and overall survival after RFA. This technique may be useful for the management of patients with HCC treated by RFA.
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Affiliation(s)
- Amanda Vestito
- Gastroenterology Unit, IRCCS S. Orsola Hospital, Bologna, Italy
| | - Elton Dajti
- Gastroenterology Unit, IRCCS S. Orsola Hospital, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Fabio Cortellini
- Gastroenterology Unit, IRCCS S. Orsola Hospital, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Marco Montagnani
- Gastroenterology Unit, IRCCS S. Orsola Hospital, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Franco Bazzoli
- Gastroenterology Unit, IRCCS S. Orsola Hospital, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Rocco Maurizio Zagari
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Gastroenterology Unit, IRCCS S. Orsola Hospital, Bologna, Italy
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Torresan F, Cortellini F, Azzaroli F, Ioannou A, Mularoni C, Shoshan D, Mandolesi D, De Giorgio R, Karamanolis G, Bazzoli F. Graded pneumatic dilation in subtype I and II achalasia: long-term experience in a single center. Ann Gastroenterol 2022; 35:28-33. [PMID: 34987285 PMCID: PMC8713348 DOI: 10.20524/aog.2021.0683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/25/2021] [Indexed: 11/11/2022] Open
Abstract
Background The efficacy of pneumatic dilation (PD) in the management of achalasia has yielded variable results. The availability of high-resolution manometry led to the identification of 3 clinically relevant subtypes of achalasia, revealing the poor efficacy of PD in subtype III. Furthermore, PD showed a lower response rate in patients with subtype III compared to laparoscopic Heller myotomy and peroral endoscopic myotomy. This study aimed to investigate the short- and long-term efficacy, safety profile and side effects of PD with a "graded approach" in subtypes I and II achalasia. Methods We enrolled 141 patients (male 67, mean age=66±16.26 years) with achalasia (n=27 subtype I, n=74 subtype II and n=40 subtype III) between January 2010 and July 2020 at St. Orsola University Hospital, Bologna, Italy. We analyzed the data of patients with subtypes I and II, who underwent a graded-protocol PD. Short- and long-term clinical efficacy, complications and gastroesophageal reflux disease (GERD) were recorded. Results One month after graded protocol PD, 100% subtype I and 96.2% subtype II achalasia patients showed clinical remission. The PD procedure was completed without major complications in all patients. In the long-term follow up (median time: 56 months), 95.5% subtype I and 90% subtype II achalasia patients had an Eckardt score ≤3. GERD occurred in 27.7% of all patients. Conclusion A graded-protocol PD applied in the appropriate achalasia subtypes was shown to be a safe and highly effective approach, in both the short- and long-term.
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Affiliation(s)
- Francesco Torresan
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Francesco Torresan, Fabio Cortellini, Francesco Azzaroli, Daniele Mandolesi, Franco Bazzoli)
| | - Fabio Cortellini
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Francesco Torresan, Fabio Cortellini, Francesco Azzaroli, Daniele Mandolesi, Franco Bazzoli).,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy (Fabio Cortellini, Francesco Azzaroli, Cecilia Mularoni, Dikla Shoshan, Franco Bazzoli)
| | - Francesco Azzaroli
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Francesco Torresan, Fabio Cortellini, Francesco Azzaroli, Daniele Mandolesi, Franco Bazzoli).,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy (Fabio Cortellini, Francesco Azzaroli, Cecilia Mularoni, Dikla Shoshan, Franco Bazzoli)
| | - Alexandros Ioannou
- 2 Department of Surgery, Gastroenterology Unit, "Aretaieio" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (Alexandros Ioannou, George Karamanolis)
| | - Cecilia Mularoni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy (Fabio Cortellini, Francesco Azzaroli, Cecilia Mularoni, Dikla Shoshan, Franco Bazzoli)
| | - Dikla Shoshan
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy (Fabio Cortellini, Francesco Azzaroli, Cecilia Mularoni, Dikla Shoshan, Franco Bazzoli)
| | - Daniele Mandolesi
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Francesco Torresan, Fabio Cortellini, Francesco Azzaroli, Daniele Mandolesi, Franco Bazzoli)
| | - Roberto De Giorgio
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy (Roberto De Giorgio)
| | - George Karamanolis
- 2 Department of Surgery, Gastroenterology Unit, "Aretaieio" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece (Alexandros Ioannou, George Karamanolis)
| | - Franco Bazzoli
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Francesco Torresan, Fabio Cortellini, Francesco Azzaroli, Daniele Mandolesi, Franco Bazzoli).,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy (Fabio Cortellini, Francesco Azzaroli, Cecilia Mularoni, Dikla Shoshan, Franco Bazzoli)
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Cortellini F, Carrara S, Fusaroli P. EUS-guided fine-needle biopsy for gastric submucosal tumors: Does one size fit all? Endosc Ultrasound 2021; 11:151-152. [PMID: 34755708 PMCID: PMC9059798 DOI: 10.4103/eus-d-21-00095] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Fabio Cortellini
- Department of Medical and Surgical Sciences, University of Bologna Faculty of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Silvia Carrara
- Department of Gastroenterology, Endoscopic Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Pietro Fusaroli
- Gastrointestinal Unit, Hospital of Imola, University of Bologna, Bologna, Italy
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Cortellini F, Marasco G, Renzulli M, Vasuri F, Ricciardiello L. Gastric Melanoma of Unknown Primary. J Gastrointestin Liver Dis 2021; 30:14. [PMID: 33723546 DOI: 10.15403/jgld-3420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/03/2021] [Indexed: 11/01/2022]
Abstract
We describe a case of a patient with anemia referring to our Digestive Endoscopy Unit. Upper GI endoscopy revealed a polypoid lesion with an ulcerated central depression. Histopathological examination of the biopsy specimen taken during endoscopy revealed a gastric metastatic melanoma. The dermatologic inspection failed in finding the primary melanoma. The importance of endoscopic examination in the diagnostic process of metastatic patients with unknown primaries is highlited by this case.
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Affiliation(s)
- Fabio Cortellini
- Azienda Ospedaliero-Universitaria di Bologna, Bologna; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. .
| | - Giovanni Marasco
- Azienda Ospedaliero-Universitaria di Bologna, Bologna; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. .
| | - Matteo Renzulli
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Luigi Ricciardiello
- Azienda Ospedaliero-Universitaria di Bologna, Bologna; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
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Frazzoni L, Spada C, Radaelli F, Mussetto A, Laterza L, La Marca M, Piccirelli S, Cortellini F, Rondonotti E, Paci V, Bazzoli F, Fabbri C, Manno M, Aragona G, Manes G, Occhipinti P, Cadoni S, Zagari RM, Hassan C, Fuccio L. 1L- vs. 4L-Polyethylene glycol for bowel preparation before colonoscopy among inpatients: A propensity score-matching analysis. Dig Liver Dis 2020; 52:1486-1493. [PMID: 33250131 DOI: 10.1016/j.dld.2020.10.006] [Citation(s) in RCA: 6] [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] [Received: 07/05/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Inpatients are at risk for inadequate colon cleansing. Experts recommend 4L-polyethylene-glycol (PEG) solution. A higher colon cleansing adequacy rate for a hyperosmolar 1L-PEG plus ascorbate prep has been recently reported. AIMS We aimed to determine whether 1L-PEG outperforms 4L-PEG among inpatients. METHODS post-hoc analysis of a large Italian multicenter prospective observational study among inpatients (QIPS study). We performed a propensity score matching between 1L-PEG and 4L-PEG group. The primary outcome was the rate of adequate colon cleansing as assessed by unblinded endoscopists through Boston scale. Secondary outcome was the safety profile. RESULTS Among 1,004 patients undergoing colonoscopy, 724 (72%) were prescribed 4L-PEG and 280 (28%) 1L-PEG. The overall adequate colon cleansing rate was 69.2% (n = 695). We matched 274 pairs of patients with similar distribution of confounders. The rate of patients with adequate colon cleansing was higher in 1L-PEG than in 4L-PEG group (84.3% vs. 77.4%, p = 0.039). No different shift in serum concentration of electrolytes (namely Na+, K+, Ca2+), creatinine and hematocrit were observed for both preparations. CONCLUSION We found a higher rate of adequate colon cleansing for colonoscopy with the 1L-PEG bowel prep vs. 4L-PEG, with apparent similar safety profile, among inpatients. A confirmatory randomized trial is needed. (ClinicalTrials.gov no: NCT04310332).
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Affiliation(s)
- Leonardo Frazzoni
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Liboria Laterza
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Marina La Marca
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Fabio Cortellini
- Gastroenterology Unit, S. Maria delle Croci Hospital, Ravenna, Italy
| | | | - Valentina Paci
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Franco Bazzoli
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Carlo Fabbri
- Unit of Gastroenterology and Digestive Endoscopy, Forli-Cesena Hospital, AUSL Romagna, Forli-Cesena, Italy
| | - Mauro Manno
- UOSD Gastroenterologia ed Endoscopia Digestiva, Azienda USL di Modena, Italy
| | - Giovanni Aragona
- Department of Internal Medicine, Gastroenterology and Hepatology Unit, "Guglielmo da Saliceto" Hospital, Via Taverna 49, Piacenza, Italy
| | - Gianpiero Manes
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate Milanese Hospital, Milan, Italy
| | - Pietro Occhipinti
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Maggiore della Carità, Novara, Italy
| | - Sergio Cadoni
- Digestive Endoscopy Unit, Centro Traumatologico-Ortopedico Hospital, Iglesias, Italy
| | - Rocco Maurizio Zagari
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Lorenzo Fuccio
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Bologna, Italy.
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Cortellini G, Lippolis D, Amati S, Piovaccari G, Cortellini F, Ballardini G. Effective Ibuprofen Desensitization in a Patient with Myopericarditis. Pharmacology 2018; 103:111-113. [PMID: 30544105 DOI: 10.1159/000495692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022]
Abstract
To date, aspirin desensitization is employed with patients with nonsteroidal anti-inflammatory drugs (NSAIDs) exacerbated respiratory diseases (NERD) or with aspirin or NSAIDs hypersensitive patients needing a stent procedure for coronary artery disease. On the other hand, few data exist regarding aspirin desensitization in other cardiological features and particularly we haven't data on different NSAIDs desensitization. Only for NERD patients we have data on ketorolac use. We report an efficacious desensitization procedure for ibuprofen in urticaria/angioedema patient with pericarditis and myocarditis associated.
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Affiliation(s)
- Gabriele Cortellini
- Internal Medicine, Allergy Unit, Rimini Hospital, Azienda Sanitaria Romagna, Rimini, Italy,
| | - Domenico Lippolis
- Internal Medicine, Allergy Unit, Rimini Hospital, Azienda Sanitaria Romagna, Rimini, Italy
| | - Silvia Amati
- Cardiology Unit, Rimini Hospital, Azienda Sanitaria Romagna, Rimini, Italy
| | | | - Fabio Cortellini
- Internal Medicine, Allergy Unit, Rimini Hospital, Azienda Sanitaria Romagna, Rimini, Italy
| | - Giorgio Ballardini
- Internal Medicine, Allergy Unit, Rimini Hospital, Azienda Sanitaria Romagna, Rimini, Italy
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Cortellini G, Rossi F, Lippolis D, Cortellini F, Gavioli B, Ballardini G. Delayed hypersensitivity to new oral anticoagulants. Demonstration of cross reactivity for the drug category and definition of non-irritant concentrations for patch tests. Eur Ann Allergy Clin Immunol 2018; 51:38-40. [PMID: 30066999 DOI: 10.23822/eurannaci.1764-1489.71] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary The current therapy with direct trombin inhibitors (DTI) is indicated for the prevention of stroke in non-valvular atrial fibrillation. Side effects are reported, particularly skin hypersensitivity, for this whole category of drugs as well as for other modern antiplatelet and anticoagulant drugs. For their clinical features, these reactions appear as delayed T-cell mediated drug hypersensitivity, but at present there are no diagnostic methods of investigation. We reported a case of delayed skin reaction to edoxaban and we found the non-irritant concentration for patch test in the whole category of drugs. The patch test resulted positive for edoxaban. A successive challenge with alternative DTIs and/or a switch to warfarin is proposed as alternative therapy.
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Affiliation(s)
- G Cortellini
- Internal Medicine Department, Allergy Unit, Rimini Hospital, Rimini, Italy
| | - F Rossi
- Pharmacy Unit, Ravenna Hospital, Ravenna, Italy
| | - D Lippolis
- Internal Medicine Department, Allergy Unit, Rimini Hospital, Rimini, Italy
| | - F Cortellini
- Internal Medicine Department, Allergy Unit, Rimini Hospital, Rimini, Italy
| | - B Gavioli
- Pharmacy Unit, Rimini Hospital, Rimini, Italy
| | - G Ballardini
- Internal Medicine Department, Allergy Unit, Rimini Hospital, Rimini, Italy
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Cortellini G, Mascella F, Simoncelli M, Lippolis D, Focherini M, Cortellini F, Cherubini C, Gavioli B, Ballardini G. Effective Desensitization to Tocilizumab in Delayed Hypersensitivity Reaction. Pharmacology 2018; 102:114-116. [DOI: 10.1159/000490419] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/27/2018] [Indexed: 11/19/2022]
Abstract
We present tocilizumab desensitization of a 47-year-old woman affected by rheumatoid arthritis with full body delayed erythematous urticarial reaction. Skin test for tocilizumab gave cutaneous reaction after 6 h at 20 mg/mL. The schedule of desensitization was then adapted for non-immediate reaction. We prepared a desensitization procedure reaching the cumulative dose of 516 mg in 5 weeks. After 6 months, the repetition of skin tests had a negative result, with demonstration of tolerance induction. Today the patient has good control of the disease.
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