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Stampanoni Bassi M, Gilio L, Galifi G, Buttari F, Dolcetti E, Bruno A, Belli L, Modugno N, Furlan R, Finardi A, Mandolesi G, Musella A, Centonze D, Olivola E. Mood disturbances in newly diagnosed Parkinson's Disease patients reflect intrathecal inflammation. Parkinsonism Relat Disord 2024; 122:106071. [PMID: 38432021 DOI: 10.1016/j.parkreldis.2024.106071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/16/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
In Parkinson's disease (PD), neuroinflammation may be involved in the pathogenesis of mood disorders, contributing to the clinical heterogeneity of the disease. The cerebrospinal fluid (CSF) levels of interleukin (IL)-1β, IL-2, IL-6, IL-7, IL-8, IL-9, IL-12, IL-17, interferon (IFN)γ, macrophage inflammatory protein 1-alpha (MIP-1a), MIP-1b, granulocyte colony stimulating factor (GCSF), eotaxin, tumor necrosis factor (TNF), and monocyte chemoattractant protein 1 (MCP-1), were assessed in 45 newly diagnosed and untreated PD patients and in 44 control patients. Spearman's correlations were used to explore possible associations between CSF cytokines and clinical variables including mood. Benjamini-Hochberg (B-H) correction for multiple comparisons was applied. Linear regression was used to test significant associations correcting for other clinical variables. In PD patients, higher CSF concentrations of the inflammatory molecules IL-6, IL-9, IFNγ, and GCSF were found (all B-H corrected p < 0.02). Significant associations were found between BDI-II and the levels of IL-6 (Beta = 0.438; 95%CI 1.313-5.889; p = 0.003) and IL-8 (Beta = 0.471; 95%CI 0.185-0.743; p = 0.002). Positive associations were also observed between STAI-Y state and both IL-6 (Beta = 0.452; 95%CI 1.649-7.366; p = 0.003), and IL-12 (Beta = 0.417; 95%CI 2.238-13.379; p = 0.007), and between STAI-Y trait and IL-2 (Beta = 0.354; 95%CI 1.923-14.796; p = 0.012), IL-6 (Beta = 0.362; 95%CI 0.990-6.734; p = 0.01), IL-8 (Beta = 0.341; 95%CI 0.076-0.796; p = 0.019), IL-12 (Beta = 0.328; 95%CI 0.975-12.135; p = 0.023), and IL-17 (Beta = 0.334; 95CI 0.315-4.455; p = 0.025). An inflammatory CSF milieu may be associated with depression and anxiety in the early phases of PD, supporting a role of neuroinflammation in the pathogenesis of mood disturbances.
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Affiliation(s)
| | - Luana Gilio
- Unit of Neurology, IRCCS Neuromed, Pozzilli, IS, Italy; Faculty of Psychology, Uninettuno Telematic International University, Rome, Italy
| | | | - Fabio Buttari
- Unit of Neurology, IRCCS Neuromed, Pozzilli, IS, Italy
| | | | - Antonio Bruno
- Unit of Neurology, IRCCS Neuromed, Pozzilli, IS, Italy
| | - Lorena Belli
- Unit of Neurology, IRCCS Neuromed, Pozzilli, IS, Italy
| | | | - Roberto Furlan
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Annamaria Finardi
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Georgia Mandolesi
- Synaptic Immunopathology Lab, IRCCS San Raffaele Roma, Italy; Department of Human Sciences and Quality of Life Promotion, University of Rome San Raffaele, Italy
| | - Alessandra Musella
- Synaptic Immunopathology Lab, IRCCS San Raffaele Roma, Italy; Department of Human Sciences and Quality of Life Promotion, University of Rome San Raffaele, Italy
| | - Diego Centonze
- Unit of Neurology, IRCCS Neuromed, Pozzilli, IS, Italy; Laboratory of Synaptic Immunopathology, Department of Systems Medicine, Tor Vergata University, Rome, Italy.
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Romani F, Sansalone CV, Rimoldi P, Rondinara G, de Carlis L, Belli LS, Riolo F, Pitotta V, Belli L. Liver transplantation for small HCC in cirrhosis. Transpl Int 2018. [DOI: 10.1111/tri.1992.5.s1.215] [Citation(s) in RCA: 6] [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] [Indexed: 01/22/2023]
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Canale M, Camerini A, Magnacca M, Del Meglio J, Lilli A, Donati S, Belli L, Lencioni S, Amoroso D, Casolo G. High cumulative anthracycline dose without cardiac toxicity: a study on outlier patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx435.010] [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: 11/14/2022] Open
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Chiaravalloti A, Fiorentini A, Francesco U, Martorana A, Koch G, Belli L, Torniolo S, Di Pietro B, Motta C, Schillaci O. Is cerebral glucose metabolism related to blood-brain barrier dysfunction and intrathecal IgG synthesis in Alzheimer disease?: A 18F-FDG PET/CT study. Medicine (Baltimore) 2016; 95:e4206. [PMID: 27631200 PMCID: PMC5402543 DOI: 10.1097/md.0000000000004206] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The aim of this study was to investigate the relationships between blood-brain barrier (BBB) dysfunction, intrathecal IgG synthesis, and brain glucose consumption as detectable by means of serum/cerebrospinal fluid (CSF) albumin index (Qalb) and IgG index [(CSF IgG/serum IgG) × Serum albumin/CSF albumin)] and 2-deoxy-2-(F) fluoro-D-glucose (F-FDG) positron emission tomography/computed tomography (PET/CT) in a selected population affected by Alzheimer disease (AD). The study included 134 newly diagnosed AD patients according to the NINCDS-ADRDA criteria. The mean (±SD) age of the patients was 70 (±6) years; 60 were male and 64 were female. Mini mental State Examination was equal to 18.9 (±7.2). All patients underwent a CSF assay and magnetic resonance before F-FDG PET scanning. The relationships were evaluated by means of statistical parametric mapping (SPM8). We found a significant negative correlation between the increase of Qalb and F-FDG uptake in the Brodmann Area 42 and 22 that corresponds to the left superior temporal gyrus, with higher Qalb values being related to a reduced glucose consumption in these areas. No significant relationships have been found between brain glucose consumption and IgG index. The results of our study suggest that BBB dysfunction is related to reduction of cortical activity in the left temporal cortex in AD subjects.
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Affiliation(s)
- Agostino Chiaravalloti
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
- Correspondence: Agostino Chiaravalloti, Department of Biomedicine and Prevention, University Tor Vergata, Viale Oxford 81, 00133 Rome, Italy (e-mail: )
| | | | - Ursini Francesco
- Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | - Alessandro Martorana
- Department of Neurosciences, University Tor Vergata, Rome, Italy
- IRCCS Santa Lucia, Rome, Italy
| | - Giacomo Koch
- Department of Neurosciences, University Tor Vergata, Rome, Italy
- IRCCS Santa Lucia, Rome, Italy
| | - Lorena Belli
- Department of Neurosciences, University Tor Vergata, Rome, Italy
| | - Sofia Torniolo
- Department of Neurosciences, University Tor Vergata, Rome, Italy
| | - Barbara Di Pietro
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Caterina Motta
- Department of Neurosciences, University Tor Vergata, Rome, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
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Semprini R, Koch G, Belli L, D. Lorenzo F, Ragonese M, Manenti G, P. Sorice G, Martorana A. Insulin and the Future Treatment of Alzheimer's Disease. CNSNDDT 2016; 15:660-4. [DOI: 10.2174/1871527315666160518123049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/01/2015] [Accepted: 09/01/2015] [Indexed: 11/22/2022]
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Chiaravalloti A, Koch G, Toniolo S, Belli L, Lorenzo FD, Gaudenzi S, Schillaci O, Bozzali M, Sancesario G, Martorana A. Comparison between Early-Onset and Late-Onset Alzheimer's Disease Patients with Amnestic Presentation: CSF and (18)F-FDG PET Study. Dement Geriatr Cogn Dis Extra 2016; 6:108-19. [PMID: 27195000 PMCID: PMC4868930 DOI: 10.1159/000441776] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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] [Indexed: 12/14/2022] Open
Abstract
Background/Aims To investigate the differences in brain glucose consumption between patients with early onset of Alzheimer's disease (EOAD, aged ≤65 years) and patients with late onset of Alzheimer's disease (LOAD, aged >65 years). Methods Differences in brain glucose consumption between the groups have been evaluated by means of Statistical Parametric Mapping version 8, with the use of age, sex, Mini-Mental State Examination and cerebrospinal fluid values of AΒ1-42, phosphorylated Tau and total Tau as covariates in the comparison between EOAD and LOAD. Results As compared to LOAD, EOAD patients showed a significant decrease in glucose consumption in a wide portion of the left parietal lobe (BA7, BA31 and BA40). No significant differences were obtained when subtracting the EOAD from the LOAD group. Conclusions The results of our study show that patients with EOAD show a different metabolic pattern as compared to those with LOAD that mainly involves the left parietal lobe.
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Affiliation(s)
| | - Giacomo Koch
- Department of Non-Invasive Brain Stimulation Unit, Department of Behavioural and Clinical Neurology, Rome, Italy
| | - Sofia Toniolo
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Lorena Belli
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Sara Gaudenzi
- Department of Non-Invasive Brain Stimulation Unit, Department of Behavioural and Clinical Neurology, Rome, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Department of IRCCS Neuromed, Pozzilli, Italy
| | - Marco Bozzali
- Department of Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
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Martorana A, Di Lorenzo F, Belli L, Sancesario G, Toniolo S, Sallustio F, Sancesario GM, Koch G. Cerebrospinal Fluid Aβ42 Levels: When Physiological Become Pathological State. CNS Neurosci Ther 2015; 21:921-5. [PMID: 26555572 DOI: 10.1111/cns.12476] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/07/2015] [Accepted: 10/08/2015] [Indexed: 12/31/2022] Open
Abstract
Impaired amyloid beta (Aβ) metabolism is currently considered central to understand the pathophysiology of Alzheimer's disease (AD). Measurements of cerebrospinal fluid Aβ levels remain the most useful marker for diagnostic purposes and to individuate people at risk for AD. Despite recent advances criticized the direct role in neurodegeneration of cortical neurons, Aβ is considered responsible for synaptopathy and impairment of neurotransmission and therefore remains the major trigger of AD and future pharmacological treatment remain Aβ oriented. However, experimental and clinical findings showed that Aβ peptides could have a wider range of action responsible for cell dysfunction and for appearance of clinico-pathological entities different from AD. Such findings may induce misunderstanding of the real role played by Aβ in AD and therefore strengthen criticism on its centrality and need for CSF measurements. Aim of this review is to discuss the role of CSF Aβ levels in light of experimental, clinical pathologic, and electrophysiological results in AD and other pathological entities to put in a correct frame the value of Aβ changes.
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Affiliation(s)
- Alessandro Martorana
- Clinica Neurologica, Sytem Medicine Department, University of Rome "Tor Vergata", Rome, Italy
| | - Francesco Di Lorenzo
- Clinica Neurologica, Sytem Medicine Department, University of Rome "Tor Vergata", Rome, Italy.,Non-Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Lorena Belli
- Clinica Neurologica, Sytem Medicine Department, University of Rome "Tor Vergata", Rome, Italy
| | - Giuseppe Sancesario
- Clinica Neurologica, Sytem Medicine Department, University of Rome "Tor Vergata", Rome, Italy
| | - Sofia Toniolo
- Clinica Neurologica, Sytem Medicine Department, University of Rome "Tor Vergata", Rome, Italy
| | - Fabrizio Sallustio
- Clinica Neurologica, Sytem Medicine Department, University of Rome "Tor Vergata", Rome, Italy
| | | | - Giacomo Koch
- Non-Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
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Cillo U, Burra P, Mazzaferro V, Belli L, Pinna AD, Spada M, Nanni Costa A, Toniutto P. A Multistep, Consensus-Based Approach to Organ Allocation in Liver Transplantation: Toward a "Blended Principle Model". Am J Transplant 2015; 15:2552-61. [PMID: 26274338 DOI: 10.1111/ajt.13408] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 05/01/2015] [Accepted: 05/09/2015] [Indexed: 02/06/2023]
Abstract
Since Italian liver allocation policy was last revised (in 2012), relevant critical issues and conceptual advances have emerged, calling for significant improvements. We report the results of a national consensus conference process, promoted by the Italian College of Liver Transplant Surgeons (for the Italian Society for Organ Transplantation) and the Italian Association for the Study of the Liver, to review the best indicators for orienting organ allocation policies based on principles of urgency, utility, and transplant benefit in the light of current scientific evidence. MELD exceptions and hepatocellular carcinoma were analyzed to construct a transplantation priority algorithm, given the inequity of a purely MELD-based system for governing organ allocation. Working groups of transplant surgeons and hepatologists prepared a list of statements for each topic, scoring their quality of evidence and strength of recommendation using the Centers for Disease Control grading system. A jury of Italian transplant surgeons, hepatologists, intensivists, infectious disease specialists, epidemiologists, representatives of patients' associations and organ-sharing organizations, transplant coordinators, and ethicists voted on and validated the proposed statements. After carefully reviewing the statements, a critical proposal for revising Italy's current liver allocation policy was prepared jointly by transplant surgeons and hepatologists.
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Affiliation(s)
- U Cillo
- Hepatobiliary Surgery and Liver Transplant Center, Padova University Hospital, Padova, Italy
| | - P Burra
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
| | - V Mazzaferro
- Hepato-Pancreatic-Biliary Surgery and Oncology National Cancer Institute (Istituto Nazionale Tumori), Milan, Italy
| | - L Belli
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - A D Pinna
- Department of General Surgery and Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - M Spada
- Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center in Italy, Palermo, Italy
| | | | - P Toniutto
- Medical Liver Transplant Section, Department of Medical Sciences Experimental and Clinical, University of Udine, Udine, Italy
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Civati G, Busnach G, Brando B, Broggi ML, Seveso M, Belli LS, Brunati C, Del Favero E, Forti D, Belli L. Low doses of ciclosporin in renal transplantation. A single center experience. Contrib Nephrol 2015; 51:84-7. [PMID: 3552425 DOI: 10.1159/000413100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Ponticelli C, Minetti L, Quarto di Palo F, Vegeto A, Belli L, Corbetta G. The Milano clinical trial of ciclosporin in cadaveric renal transplantation. Contrib Nephrol 2015; 51:51-4. [PMID: 3552420 DOI: 10.1159/000413094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Jordan P, Quadrelli S, Heres M, Belli L, Ruhl N, Colt H. Examining patients' preferences for participation in clinical decision-making: the experience in a Latin American chronic obstructive pulmonary disease and cancer outpatient population. Intern Med J 2014; 44:281-7. [PMID: 24373195 DOI: 10.1111/imj.12351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 02/04/2013] [Accepted: 12/16/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS It is generally accepted that patients prefer to be told the truth by their physicians; however, the practice of partial truth-telling is frequent with an existing 'norm of nondisclosure.' Our primary objective was to determine what patients wanted to be told about their illness, and whether there might be differences between patients with either cancer or advanced chronic obstructive pulmonary disease (COPD). A second objective was to determine how these patients envisioned their participation, or lack thereof, in the treatment decision-making process. METHODS Subjects were eligible for this prospective study if they were attending the oncology or pulmonary outpatient consultation services at the British Hospital or the Sanatorio Güemes Private Hospital in Buenos Aires, Argentina between June 2009 and May 2010. RESULTS Ninety-nine patients were recruited. Forty-four had a diagnosis of COPD, and 55 patients had cancer. Seventeen of the patients expected their health to improve in the future, but a significantly higher proportion of patients with malignant disorders expected to get better in the near future as compared with those with COPD (98.2% vs 62.8%, P < 0.001). Most study participants expressed a desire to receive all the information available about their condition. A majority of the participants expressed a preference for making treatment decisions in collaboration with their physician (40.4%) CONCLUSIONS While they considered the role of their families relevant and wanted information to be shared so that family members might participate in decision-making, they did not want their families to have a right to withhold information, make final decisions.
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Affiliation(s)
- P Jordan
- Buenos Aires British Hospital and Buenos Aires Sanatorio Güemes, Buenos Aires, Argentina
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Ponziani FR, Viganò R, Iemmolo RM, Donato MF, Rendina M, Toniutto P, Pasulo L, Morelli MC, Burra P, Miglioresi L, Merli M, Di Paolo D, Fagiuoli S, Gasbarrini A, Pompili M, Belli L, Gerunda GE, Marino M, Montalti R, Di Benedetto F, De Ruvo N, Rigamonti C, Colombo M, Rossi G, Di Leo A, Lupo L, Memeo V, Bringiotti R, Zappimbulso M, Bitetto D, Vero V, Colpani M, Fornasiere E, Pinna AD, Morelli MC, Bertuzzo V, De Martin E, Senzolo M, Ettorre GM, Visco-Comandini U, Antonucci G, Angelico M, Tisone G, Giannelli V, Giusto M. Long-term maintenance of sustained virological response in liver transplant recipients treated for recurrent hepatitis C. Dig Liver Dis 2014; 46:440-5. [PMID: 24635906 DOI: 10.1016/j.dld.2014.01.157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 01/13/2014] [Accepted: 01/25/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The recurrence of hepatitis C viral infection is common after liver transplant, and achieving a sustained virological response to antiviral treatment is desirable for reducing the risk of graft loss and improving patients' survival. AIM To investigate the long-term maintenance of sustained virological response in liver transplant recipients with hepatitis C recurrence. METHODS 436 Liver transplant recipients (74.1% genotype 1) who underwent combined antiviral therapy for hepatitis C recurrence were retrospectively evaluated. RESULTS The overall sustained virological response rate was 40% (173/436 patients), and the mean follow-up after liver transplantation was 11±3.5 years (range, 5-24). Patients with a sustained virological response demonstrated a 5-year survival rate of 97% and a 10-year survival rate of 93%; all but 6 (3%) patients remained hepatitis C virus RNA-negative during follow-up. Genotype non-1 (p=0.007), treatment duration >80% of the scheduled period (p=0.027), and early virological response (p=0.002), were associated with the maintenance of sustained virological response as indicated by univariate analysis. Early virological response was the only independent predictor of sustained virological response maintenance (p=0.008). CONCLUSIONS Sustained virological response achieved after combined antiviral treatment is maintained in liver transplant patients with recurrent hepatitis C and is associated with an excellent 5-year survival.
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Koch G, Belli L, Giudice T, Lorenzo F, Sancesario G, Sorge R, Bernardini S, Martorana A. Frailty Among Alzheimer’s Disease Patients. CNSNDDT 2013; 12:507-11. [DOI: 10.2174/1871527311312040010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 03/22/2013] [Accepted: 03/25/2013] [Indexed: 11/22/2022]
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Esposito Z, Belli L, Toniolo S, Sancesario G, Bianconi C, Martorana A. Amyloid β, glutamate, excitotoxicity in Alzheimer's disease: are we on the right track? CNS Neurosci Ther 2013; 19:549-55. [PMID: 23593992 DOI: 10.1111/cns.12095] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 02/07/2013] [Accepted: 02/08/2013] [Indexed: 12/11/2022] Open
Abstract
Alzheimer's disease (AD) has a devastating impact on aged people worldwide. Although sophisticated and advanced molecular methods have been developed for its diagnosis since early phases, pharmacological treatment still represents an unresolved topic. The more the disease progresses, the more the uneffectiveness of antidementia drugs emerges. New and encouraging results from experimental works indicate that glutamate pathway may play a substantial role in the pathogenesis since early stages of the disease. Several experimental data together with the clinical use of the uncompetitive N-methyl-d-aspartate (NMDA) antagonist memantine strengthen this idea. Unfortunately, definitive data on the glutamatergic transmission involvement in AD are still incomplete. Moreover, clinical results indicate only temporarily limited effects of memantine. Currently, memantine is indicated for moderate-to-severe cases of AD, an indication that may limit its efficacy and impact on Alzheimer's dementia. The association of memantine with the acetylcholinesterase inhibitor drugs used to treat dementia symptoms appears to be beneficial, in both experimental and clinical studies. Because cholinergic and glutamatergic dysfunction occurs early in AD, the coadministration of appropriate treatment in early stages of the disease might represent a valid option from the beginning of cognitive decline. Moreover, to better evaluate drug efficacy, the association of the recently introduced biomarkers with a clinical AD profile should be considered an aim to pursue.
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Affiliation(s)
- Zaira Esposito
- Centro per il Decadimento Cognitivo, Sacro Cuore Don Calabria, Negrar-Verona, Italy
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Baggiani A, Ierardi AM, Caspani B, Motta F, Toniolo D, Belloni P, Setola E, Campagnoli E, Tempini S, Crocchiolo R, Bregni M, Belli L. Hypoxic liver perfusion with mitomycin-C for treating multifocal metastases and unresectable primary tumours: a single-centre series of 42 patients. Radiol Med 2011; 116:1239-49. [DOI: 10.1007/s11547-011-0724-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 12/15/2010] [Indexed: 01/02/2023]
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Bregni M, Bagliani A, Toniolo D, Belloni P, Caspani B, Motta F, Mastore M, Campagnoli E, Setola E, Belli L. Hypoxic perfusion with mitomycin-C in the treatment of multifocal liver metastases and primary tumors: A mono-institutional series of 42 patients. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14100] [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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Bauchiero L, Demarie A, Belli L, Brogliatti B. Deep sclerectomy and viscocanalostomy: critical revision of the results obtained during the learning curve. Acta Ophthalmol Scand Suppl 2003; 236:64-6. [PMID: 12390152 DOI: 10.1034/j.1600-0420.80.s236.41.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rolle T, Brogliatti B, Fea A, Borasio E, Fornero A, Belli L, Manea M. Structural glaucomatous damage vs. visual field defects: longitudinal study in patients with ocular hypertension or early primary open-angle glaucoma. Acta Ophthalmol Scand Suppl 2003; 236:45-6. [PMID: 12390135 DOI: 10.1034/j.1600-0420.80.s236.26.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- T Rolle
- Eye Clinic, University of Turin
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Belli LS, De Carlis L, Rondinara GF, Romani F, Alberti A, Pirotta V, Sansalone CV, Riolo F, Rossetti O, Slim OA, Aseni P, Ideo G, Belli L. Prospective randomized trial of steroid withdrawal in liver transplant patients: preliminary report. Transpl Int 2001; 7 Suppl 1:S88-90. [PMID: 11271343 DOI: 10.1111/j.1432-2277.1994.tb01317.x] [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: 11/30/2022]
Abstract
Although steroid withdrawal has been successfully performed in heart and kidney transplant recipients, no controlled studies of SW have been carried out in liver transplant patients. To evaluate this possibility a prospective controlled study was carried out in 46 liver transplant recipients operated on after may 1991. They all received a sequential quadruple immunosuppression consisting of 3 mg/kg antithymocyte globulins (RATG) for the first 5 postoperative days, cyclosporin A (starting from day 3-5 and maintaining parenteral whole-blood trough levels at 200-300 ng/ml during the first month and at 150-250 thereafter), azathioprine (1 mg/kg per day for the first month) and steroids. Prednisone was started at a dose of 200 mg per day 1 and then tapered to 20 mg/day over the first posteroperative week; this dose was maintained until day 90 when the patients were randomly allocated either to long-term steroid therapy (0.1 mg/kg per day) or to steroid withdrawal. Minimum follow-up after randomization was 6 months (6-27 months). Liver biochemistry was checked at regular intervals throughout the follow-up period. Liver biopsies were performed whenever clinically indicated and also in the first 19 patients during readmission for annual review. The incidence ot acute and chronic rejection 90 days from liver transplantation was 2.5% in patients maintained on long-term therapy. No patient in the steroid-withdrawal group had experienced either an acute or a chronic rejection episode so far. Steroid-related complications did not differ significantly between the two groups. The most recent interim analysis showed that steroid withdrawal is a safe undertaking in liver transplant recipients and may be successfully accomplished in almost all patients.
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Affiliation(s)
- L S Belli
- Liver Transplantation Unit, Niguarda Hospital, Milan, Italy
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20
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Famiglietti A, Garcia SD, de Mier CA, Casco R, Belli L, Marcenac F, Vay C, de Torres RA. Evolution of Neisseria gonorrhoeae drug susceptibility in Buenos Aires, Argentina, 1985-99. Sex Transm Infect 2001; 77:142. [PMID: 11287699 PMCID: PMC1744279 DOI: 10.1136/sti.77.2.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- A Famiglietti
- Clinical Microbiology Division, Department of Clinical Biochemistry, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, Argentina
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21
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Canevascini R, Quadri P, Belli L, Pellegata A, Bianchi F, Locchette L, Phebani L. [The elderly person at home. Multidimensional geriatric evaluation]. Krankenpfl Soins Infirm 1999; 92:36-40. [PMID: 10401386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- R Canevascini
- Servizio di geriatria Ospedale regionale Beata Vergine, Mendrisio
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22
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Le Chevalier T, Monnier A, Douillard JY, Ruffie P, Sun XS, Belli L, Ibrahim N, Bougon N, Bérille J. Docetaxel (Taxotere) plus cisplatin: an active and well-tolerated combination in patients with advanced non-small cell lung cancer. Eur J Cancer 1998; 34:2032-6. [PMID: 10070306 DOI: 10.1016/s0959-8049(98)00287-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [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: 11/23/2022]
Abstract
The activity of the combination of intravenous docetaxel 75 mg/m2 plus cisplatin 100 mg/m2 administered every 3 weeks for 3 cycles then every 6 weeks was investigated in 51 chemotherapy naive patients with locally advanced or metastatic non-small cell lung cancer (NSCLC). The population was 92% male, with a median age of 54 years and median performance status of 1; 80% of patients had metastatic disease, including 37% with bone involvement. All patients received prophylactic premedication (ondansetron, dexamethasone plus cetirizine) and standard hyperhydration. With a median of 4 treatment cycles (range 1-9), 14 of 42 evaluable patients responded (overall response rate 33.3%, 95% CI 19.6-49.6%); the median response duration was 7.3 months, median survival 8.4 months, and 1-year survival rate 35%. The most common adverse event was neutropenia, occurring in two-thirds of patients. Neurosensory effects were cumulative but generally mild. No treatment-related deaths occurred. This combination of docetaxel/cisplatin showed activity in advanced NSCLC. While it was not clearly superior to single-agent docetaxel, due to differences in prognostic factors among the patients in open trials, a randomised study would be needed to demonstrate definitively whether cisplatin adds to the activity of docetaxel or not.
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23
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Andreone P, Caraceni P, Grazi GL, Belli L, Milandri GL, Ercolani G, Jovine E, D'Errico A, Dal Monte PR, Ideo G, Forti D, Mazziotti A, Cavallari A, Bernardi M. Lamivudine treatment for acute hepatitis B after liver transplantation. J Hepatol 1998; 29:985-9. [PMID: 9875646 DOI: 10.1016/s0168-8278(98)80127-x] [Citation(s) in RCA: 58] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIMS Acute hepatitis caused by recurrent or de novo hepatitis B virus (HBV) infection after liver transplantation frequently induces aggressive disease leading to liver failure. The aim of this study was to determine the efficacy and safety of lamivudine treatment in post-transplant acute hepatitis B. METHOD Twelve patients with acute hepatitis B were started on lamivudine 100 mg p.o. daily within 8 weeks of the appearance of HBsAg. One patient was excluded after 1 month because of hepatocellular carcinoma recurrence. Patients were followed for an average of 68.6 weeks (range 32-108), and were clinically and biochemically evaluated on a monthly basis. They had a histological assessment at baseline, after at least 6 months, and whenever clinically indicated. RESULTS Basal HBV-DNA ranged between 13 and 1288 pg/ml and serum alanine aminotransferase between 97 and 1036 U/l. HBV-DNA became undetectable within 8 weeks and transaminases normalized within 24 weeks in all cases. At the last visit, eight patients (73%) remained HBV-DNA negative by liquid hybridization and had normal or close to normal alanine aminotransferase. Five patients (45%) were also HBsAg negative and HBV-DNA negative by polymerase chain reaction. HBV-DNA and transaminase breakthrough occurred in three patients (27%). Histology after 6-9 months showed chronic hepatitis in seven patients. Lamivudine was well tolerated without serious adverse reactions. CONCLUSIONS These results indicate that lamivudine treatment induces sustained inhibition of viral replication and normalization of transaminases in the majority of post-transplant patients with acute hepatitis B. HBsAg loss may be achieved in a considerable number of cases. Although viral resistance is relatively frequent, early initiation of lamivudine appears to be effective and safe.
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Affiliation(s)
- P Andreone
- Dipartimento di Medicina Interna, Cardioangiologia ed Epatologia, University of Bologna, Italy
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24
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Silini E, Belli L, Alberti AB, Asti M, Cerino A, Bissolati M, Rondinara G, De Carlis L, Forti D, Mondelli MU, Ideo G. HGV/GBV-C infection in liver transplant recipients: antibodies to the viral E2 envelope glycoprotein protect from de novo infection. J Hepatol 1998; 29:533-40. [PMID: 9824261 DOI: 10.1016/s0168-8278(98)80147-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIMS Liver transplantation for endstage liver cirrhosis provides a useful model to investigate the pathogenetic role of hepatotropic viral agents. Recently, a new member of the Flaviviridae family, provisionally named HGV/GBV-C virus, has been associated with acute and chronic non A-E hepatitis. We studied 136 patients with cirrhosis consecutively transplanted at our institution for evidence of hepatitis G virus infection and correlation with the patients' clinical course. METHODS All patients survived for at least 6 months after transplantation (median follow-up 44 months) and underwent routine liver biopsies. Hepatitis G virus infection was studied using both direct viral RNA identification by RT-PCR and indirect detection of antibodies to the E2 glycoprotein. RESULTS There was a high frequency of the hepatitis G virus among patients undergoing liver transplantation, with HGV RNA and anti-E2 prevalence rates of 18.4% and 26.5%, respectively. HGV RNA prevalences significantly increased after transplantation (47.8%), with 47.3% rate of new infections in susceptible subjects. Anti-E2 antibodies were significantly more prevalent among patients transplanted for HCV-related cirrhosis and represented a strong protective factor against hepatitis G virus reinfection or recurrent infection. No correlation was found between HGV RNA or anti-E2 prevalences and survival after transplantation or rates of recurrent liver damage. CONCLUSIONS All available evidence suggests that, although liver transplant patients are heavily exposed to hepatitis G virus both before and after transplantation, hepatitis G virus does not induce liver disease in this setting. Most infections appear to be self-limited and induce a protective immunity which is marked by the presence of anti-E2 antibodies.
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Affiliation(s)
- E Silini
- Department of Pathology and Infectious Diseases, University of Pavia and IRCCS Policlinico S. Matteo, Italy
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25
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Belli L, Arrondello C, Antronaco R, Curzio D, Morosi E, Fugazzola C. [Venography of postoperative recurrence of symptomatic varicocele in males]. Radiol Med 1998; 95:470-3. [PMID: 9687923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION We report the results of our experience with venography in patients with postoperative recurrent varicocele. The study was carried out to detect the causes of this condition. MATERIAL AND METHODS Forty-four patients with postoperative recurrent varicocele, examined in our department from June, 1993, to June, 1996, were submitted to selective spermatic venography after clinical examination and color Doppler sonography. Thirty-six patients had been treated with high surgical ligation of the spermatic vein and 8 with inguinal ligation. Thirty-two patients were treated percutaneously, after diagnostic angiography, with coils and/or sclerotizing agents. RESULTS In our study, the persistence of patent collateral veins, missed at surgical ligation, was the main cause of recurrence (68%): this was due either to a double or triple spermatic vein, mostly in the pelvic tract (50%), venous bridges crossing the surgical ligation (11%), or to retroperitoneal anastomoses (7%). A smaller group of patients showed ineffective ligation of the vein (27%); in the remaining 5% of cases incompetence of the extrafunicular plexus was detected. DISCUSSION AND CONCLUSIONS Our experience, supported by a literature review, demonstrates that the anatomic variants, not detected preoperatively because phlebography had not been performed, were the most frequent causes of recurrence. Spermatic venography is the most accurate imaging modality for vascular mapping in postoperative recurrences; it often allows to treat the patients simultaneously by a percutaneous approach.
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Affiliation(s)
- L Belli
- Cattedra di Radiologia, Università di Pavia, Varese VA
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26
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Griemberg G, Pizzimenti MC, Famiglietti AM, Belli L, Vay C, García S, Cardinalli A, Costa MA, Marcenac F, Casco RH. [The impact of HIV infection on the incidence of syphilis and gonorrhea at a university hospital (1985-1994)]. Medicina (B Aires) 1998; 57:1-6. [PMID: 9435362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Syphilis and gonorrhea are two sexually transmitted diseases (STD) which still persist in spite of the existence of effective treatment. In this paper the incidence of these two diseases was evaluated between 1985-1994, a decade during which the problem of HIV infection arose. Every patient who attended the STD Program at the Hospital and was suspected of having syphilis and/or gonorrhea was clinically evaluated and was subjected to the following tests: a) search for Neisseria gonorrhoeae (Ng) and penicinilase producers (PPNG) identification, b) search for Treponema pallidum (Tp) by darkfield microscopy, c) serological studies for syphilis. From 1985 to 1991 the average of positive cases for Ng was 14.8% while from 1992 to 1994 it was 4.0% (p < 0.0001) showing a dramatic decrease between 1991 and 1992. PPNG increased from 8.7% in 1985 to 44.6% in 1988 and then slowly decreased down to 26.9% in 1994. From 1985 to 1990 the average of positive darkfield examinations was 20.7% while from 1991 to 1994 it was 12.2% (p < 0.0001). Between 1985 to 1988 syphilis serological studies showed 45.7% positive cases dropping to 34.3% between 1989 and 1994 (p < 0.0001). HIV infection appearance had a wide repercussion throughout the world generating behavioral and sexual habit changes which have probably helped to prevent these two STD. Gonorrhea incidence was also influenced by the appearance of new effective treatments, even against PPNG, such as fluorated quinolones and third generation cephalosporines. The population studied belongs to the most crowded area in Argentina, so that these observations should not be extrapolated to the rest of the country.
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Affiliation(s)
- G Griemberg
- Laboratorio de Inmunología Clínica, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires
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27
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Ferrario F, Spriano G, Belli L, Roselli R, Piantanida R. [Idiopathic thrombosis of the internal jugular vein]. Rev Laryngol Otol Rhinol (Bord) 1997; 118:125-8. [PMID: 9297921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The venous thrombosis represents a vascular disorder usually involving the low limbs. The manifestation at the level of the upper limbs and the neck is much more rare, particularly as a consequence of a central venous catheterization of an infectious disease or of a trauma. The authors report an unusual case of spontaneous thrombosis of the internal jugular vein and analyze the most salient nosologic, diagnostic and therapeutic aspects.
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Affiliation(s)
- F Ferrario
- Ospedale di Circolo e Fondazione Macchi, Service O.R.L., Varese, Italie
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28
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Bretel J, Arriagada R, Le Chevalier T, Baldeyrou P, Belli L, Grunenwald D, Le Pechoux C, Ruffié P, De Jaeger K. 290 Thymic carcinoma: Outcome of a retrospective series of 56 patients. Lung Cancer 1997. [DOI: 10.1016/s0169-5002(97)89672-9] [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: 11/25/2022]
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29
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De Carlis L, Zurleni F, Ballabio A, Pirotta V, Rondinara G, Sansalone CV, Colella G, Slim AO, Meroni A, Belli L, Forti D. Left thoracic approach for cancer of cardia: early and late results. Int Surg 1997; 82:137-40. [PMID: 9331840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The surgical treatment of cancer of the cardia is controversial and results are often disappointing. Concern exists not only with regards to the surgical approach but also to the extent of the resection. The authors analyze their experience over a 20-year period adopting almost exclusively a "limited" esophagogastrectomy with a wide regional lymphadenectomy through a left thoracotomy. The aim of the study is to determine if this approach actually plays a role in the treatment of this tumor. METHODS 148 patients were evaluated for cardial cancer. Of these 22 (14.8%) were not resectable and 6 (4%) received other types of resections for technical reasons. 120 patients are the basis of the present analysis. More than 75% of patients were in stage III or IV. Follow-up was completed in 92.5% of cases; all surviving patients had at least 5 years of follow-up. RESULTS Four (3.3%) patients died in the postoperative period. In 6 cases (5%) an anastomotic leakage occurred and this caused the death of 2 patients. Nine (7.5%) patients had severe pulmonary complications. Dysphagia was relieved in all non complicated patients. 13 (10.8%) patients had anastomotic recurrence. Overall survival rate after 5 years was 25.62 +/- 6.1%. A significant difference in survival was noted in patients at stages II and III after 5 years (61.3% vs 18.6, p < 0.02). CONCLUSIONS This operation has proved to be a good option providing satisfying long-term results and a lower incidence of complications if compared with more extended procedures. It can be performed in the majority of patients with carcinoma of the cardia with a low mortality and morbidity and with excellent palliation of dysphagia. In our opinion it remains an optimum treatment for cardial cancer.
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Affiliation(s)
- L De Carlis
- Department of Surgery and Transplantation, Pizzamiglio II, Niguarda Hospital, Milan, Italy
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30
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De Carlis L, Pirotta V, Rondinara GF, Sansalone CV, Colella G, Maione G, Slim AO, Rampoldi A, Cazzulani A, Belli L, Forti D. Hepatic adenoma and focal nodular hyperplasia: diagnosis and criteria for treatment. Liver Transpl Surg 1997; 3:160-5. [PMID: 9346730 DOI: 10.1002/lt.500030209] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
UNLABELLED Focal nodular hyperplasia (FNH) and adenoma are rare benign hepatic tumors, and the standards for diagnosis and treatment still remain controversial. Usually adenoma is an indication for resection, due to its tendency to bleed and to degenerate; FNH, on the contrary, may be treated conservatively. Preoperation differential diagnosis is, however, difficult, often impossible. MATERIALS AND METHODS Thirty-eight patients with presumed hepatic adenoma and/or FNH were studied at our department from 1984 to 1996. Preoperative assessment included clinical evaluation and symptoms, laboratory tests, liver biopsy, ultrasound scan, computed tomography scan, magnetic resonance imaging, scintigraphy, and angiography. Thirteen patients had a presumed diagnosis of FNH, 16 of adenoma, and 9 of undetermined benign lesions; 27 had hepatic resections (3 with laparoscopic technique), and 11 were not operated on and are actually under a strict follow-up observation. RESULTS The final diagnosis was 19 FNH and 19 adenomas (2 of which contained areas of hepatocarcinoma). Presumed diagnosis was confirmed in 71% of cases. Use of oral contraceptives, abdominal symptoms, and pathologic liver test results were frequent in patients with adenomas. There were no deaths after surgery. All resected patients were tumor free during the follow-up, and in 10 of the 11 nonoperated cases, the size of the nodules remained unchanged. We conclude that precise diagnosis of these benign liver tumors remains difficult and sometimes impossible, despite new imaging techniques. Hepatic resections can be performed under very safe conditions; laparoscopic surgery may play a role in selected cases. Adenomas and uncertain cases are clear indications for surgery. Only when a diagnosis of FNH can be firmly confirmed in asymptomatic patients is strict observation without surgery recommended.
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Affiliation(s)
- L De Carlis
- Department of Surgery and Abdominal Transplantation, Niguarda Hospital, Milan, Italy
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31
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Grazioli L, Stanga C, Olivetti L, Belli L, Viola G, Fugazzola C. [Magnetic resonance angiography with TOF-TONE tridimensional sequences in the study of steno-occlusive diseases of the renal arteries. Comparison with digital angiography]. Radiol Med 1997; 93:77-82. [PMID: 9380874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The authors examined 32 patients (68 renal arteries in all) with suspected renovascular hypertension with MRA (3D TOF-TONE sequences) and DSA. MRA visualization of the renal vessels was considered good in 96.8%, 91.6%, 76.6% and 16.6% of cases for the ostium, the proximal third, the distal third and the hilum, respectively. MRA correctly assessed the 4 occlusions in our series and 19/20 atherosclerotic stenoses, all in proximal site. In proximal stenosis detection, MRA had 100% sensitivity and 98% specificity in atherosclerotic sclerosis-occlusion grading considering a 50% caliber reduction as the cut-off value. The two techniques were in agreement in 68% of cases; MRA overestimated stenosis grade in 25% of cases. The 3D TOF-TONE sequence is a reliable diagnostic tool in the study of the proximal tract of the renal arteries, but its major limitation remains in distal tract studies. Nevertheless, this technique has elective indications in a selected group of patients, namely the elderly with hypertension and impaired renal function.
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Affiliation(s)
- L Grazioli
- Cattedra di Radiologia dell'Universià, Brescia
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32
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Abstract
Primary and metastatic tumors of the liver can be treated successfully with transcatheter chemoembolization (TACE) during selective arterial catheterism. Arteritis is a possible referred side effect which can lead to tortuosity of the arteries, stenosis and occlusion of vessels. In our hospitals 117 consecutive patients were treated with TACE from January 1990 to December 1992; 61 patients were affected by hepatocellular carcinoma (HCC) and 56 were affected by metastases from colorectal carcinoma. Each patient received from 1 to 4 treatments at monthly intervals using epirubicin/Lipiodol ultrafluid (E/LUF) or a mixture of epirubicin and mitomicin C (MC)/LUF and followed by gelatine sponge injection in the hepatic artery. Selective angiography performed 30-62 days after the first chemoembolization showed artery stenosis in 7 patients and thrombosis in 2 cases related to toxic arteritis due to chemoembolization. Reports about arteritis during TACE treatments are discussed.
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Affiliation(s)
- L Belli
- Department of Radiology, Ospedale Multizonale, Viale Borri 57, I-21100 Varese, Italy
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Ponticelli C, Civati G, Tarantino A, Quarto di Palo F, Corbetta G, Minetti L, Vegeto A, Belli L. Randomized study with cyclosporine in kidney transplantation: 10-year follow-up. J Am Soc Nephrol 1996; 7:792-7. [PMID: 8738816 DOI: 10.1681/asn.v75792] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
This study presents the 10-yr follow-up results of a multicenter controlled trial on 108 recipients of cadaveric renal transplantation, randomized to receive cyclosporine (N = 55) or azathioprine (N = 53), both in combination with steroids. The 10-yr patient survival rate was 89% in the cyclosporine group and 83% in the azathioprine group (P = not significant [NS]); the 10-yr graft survival was 56% and 35%, respectively (log-rank test, P = 0.009). The half-life of grafts functioning after 1 yr was 15.4 +/- 3.9 versus 10.6 +/- 3.6, P = NS). The rate of early rejection in the cyclosporine group was significantly lower than that in the azathioprine group (0.30 versus 1.4, P < 0.01). Although the mean creatinine clearance rate was always higher in the azathioprine group, the decline in graft function from the first to the tenth yr was not significantly different between the two groups (-13.0 +/- 16.4 versus -12.3 +/- 19 mL/min, P = NS). In cadaveric renal transplantation, cyclosporine allows better graft survival than azathioprine, not only in the short term but also in the long term, with similar attrition of graft function for up to 10 yr.
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Affiliation(s)
- C Ponticelli
- Divisione di Nefrologia e Dialisi, IRCCS Ospedale Maggiore, Milan, Italy
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34
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Leocata P, Corbacelli A, Chiominto A, Cutilli T, Belli L, Ventura L. Unicentric angiofollicular hyperplasia (Castleman's disease) of the parotid: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 81:328-32. [PMID: 8653467 DOI: 10.1016/s1079-2104(96)80333-7] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Angiofollicular lymph node hyperplasia, or Castleman's disease, is a condition of uncertain cause usually presenting with mediastinal lymphadenopathy. Occasionally other lymph node groups may be involved with or without associated systemic manifestations. A case of Castleman's disease involving parotid lymph nodes is reported in a 16-year-old female patient who presented with a painless swelling that initially was noticed at the age of 3 years. Diagnosis was established by histopathologic examination of the respected specimen. Histologic and clinical features of Castleman's disease are also discussed.
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Affiliation(s)
- P Leocata
- Dipartimento di medicina sperimentale, Universitá dell'Aquila, Italy
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35
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Belli L, LeChevalier T, Gottfried M, Adams D, Ruffie P, LeCesne A, Tete L, Pellae-Cosset B. Phase I/II study of paclitaxel plus cisplatin as first-line chemotherapy for advanced non-small cell lung cancer: preliminary results. Semin Oncol 1995; 22:29-33. [PMID: 8643967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
From March 1993 to May 1994, 32 chemotherapy-naive patients with advanced non-small cell lung cancer entered a phase I/II study to determine the maximum tolerated dose and the activity of the paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ)/cisplatin combination. The 21 men and 11 women had a median age of 59 years (range, 25 to 72 years) and a median performance status of 1 (range, 0 to 2). Histologic types were adenocarcinoma (13 cases), squamous cell carcinoma (10), and large cell carcinoma (nine). Nine patients had stage IIIB disease and 23 had stage IV disease. The first four dose levels of paclitaxel were 135, 175, 200, and 225 mg/m2 given with a fixed cisplatin dose of 100 mg/m2; at level 5, paclitaxel 225 mg/m2 was again given, and the cisplatin dose was increased to 120 mg/m2. Cycles were given every 3 weeks. Paclitaxel was administered as a 3-hour infusion followed by cisplatin, with standard premedication and hyperhydration. The maximum tolerated dose for the first cycle was not reached. Grades 3 and 4 neutropenia occurred in 24% and 16% of cycles (two cases with fever), respectively. Grades 2 and 3 peripheral axonal neurotoxicity occurred in two and 16 patients, respectively; the neurotoxicity appeared to be dose dependent and cumulative after a median total paclitaxel dose of 1,300 mg/m2. Of the 29 patients evaluable for efficacy, 11 (38%) had a partial response; efficacy was superior at paclitaxel doses of at least 200 mg/m2, with eight (47%) of 17 evaluable patients responding at these levels. In conclusion, at these doses of paclitaxel and cisplatin, the dose-limiting neurologic toxicity is dose dependent and cumulative after a total paclitaxel dose of approximately 1,300 mg/m2. This combination is highly active, with a total objective response rate of 38% and an objective response rate of 47% at paclitaxel doses of 200 mg/m2 or higher. Further evaluation is warranted.
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Affiliation(s)
- L Belli
- Comité de Pathologie Thoracique, Institut Gustave-Roussy, Villejuif, France
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Douillard J, Monnier A, Ibrahim N, Belli L, Sun X, Soulas F, Boyer R, Bérille J, Le Chevalier T. 1096 Preliminary report of a phase II study of docetaxel (taxotere® and cisplatin in advanced non small cell lung cancer (NSCLC). Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)96342-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Caccamo L, Belli LS, Mazzaferro V, Colledan M, Alberti A, Regalia E, Fassati LR, Ideo G, Rubino A, Belli L. Milan multicenter experience in 96 liver transplants for hepatitis B virus-related cirrhosis. Transplant Proc 1994; 26:3585-7. [PMID: 7998283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- L Caccamo
- Ospedale Maggiore IRCCS, Milan, Italy
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Sterzi R, Santilli I, Donato MF, Erminio F, Belli LS, Belli L, Guarino M, D'Alessandro R, Stracciari A, Pazzaglia F. Neurologic complications following orthotopic liver transplantation. Transplant Proc 1994; 26:3679-80. [PMID: 7998320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- R Sterzi
- Division Neurologia, Ospedale Niguarda Cà Granda, Milano, Italy
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Regalia E, Sansalone C, Mazzaferro V, Reggiani P, Rondinara GF, Lucianetti A, Pulvirenti A, De Carlis L, Paone G, Belli L. Pattern of recurrence of hepatocellular carcinoma after liver transplantation: Milan multicenter experience. Transplant Proc 1994; 26:3579-80. [PMID: 7998280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- E Regalia
- Liver Transplantation Unit, National Cancer Institute, Milan, Italy
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Sansalone CV, Colella G, Rondinara GF, Rossetti O, De Carlis L, Belli LS, Meroni A, Della Volpe A, Trojsi C, Belli L. Iliac artery graft interposition in liver transplantation: our experience in 72 cases. Transplant Proc 1994; 26:3535-6. [PMID: 7998264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- C V Sansalone
- Department of Surgery, Niguarda Hospital, Milan, Italy
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Fiaccadori E, Tortorella G, Gonzi G, Pincolini S, Belli L, Albertini D, Beghi C, Avogar A. Hemodynamic, respiratory, and metabolic effects of medium-chain triglyceride-enriched lipid emulsions following valvular heart surgery. Chest 1994; 106:1660-7. [PMID: 7988181 DOI: 10.1378/chest.106.6.1660] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
STUDY A lipid emulsion containing 10 percent medium-chain triglycerides (MCT) and 10 percent long-chain triglycerides (LCT) was infused at a rate of 1 ml/kg/h (3.3 mg/kg/min) for 2 h, in 12 patients (2 males, 10 females; mean age, 54 +/- 3 (SEM) years; range, 34 to 67 years) 24 h after open-heart surgery (mitral valve replacement). METHODS Hemodynamic factors (pulmonary and radial artery indwelling catheters), oxygen and carbon dioxide partial pressures, oxygen saturation, oxygen delivery and consumption, and intrapulmonary shunt fraction were obtained before, during, and after lipid infusion (for 2 h), at 30-s intervals, along with some metabolic indexes (triglycerides, free fatty acids, glucose, insulin, lactate, acetoacetate). RESULTS No statistically significant changes in heart rate, cardiac index, systemic and pulmonary pressures and resistances, central venous and pulmonary capillary pressures, or arterial oxygen partial pressure were observed during infusion. Arterial carbon dioxide partial pressure values were constantly reduced throughout and after the end of lipid infusion, as compared with baseline values, while oxygen consumption was increased significantly without any change in oxygen delivery. No adverse effects on intrapulmonary shunt fraction were observed. Statistically significant increases of triglycerides, free fatty acids, acetoacetate and insulin (peak values at end of the lipid infusion) were found in comparison with baseline values. Plasma glucose increased significantly during lipid infusion and remained higher than baseline values until the end of the study. Lactate levels were unchanged except for a slight decrease at the end of the study, without any derangement of acid-base equilibrium. Neither arrhythmias nor adverse clinical reactions were observed as a consequence of lipid infusion. CONCLUSIONS Fat emulsions containing both MCT and LCT, when given at 3.3 mg/kg/min for 120 min following valvular heart surgery, do not exert negative cardiopulmonary effects, and could represent a source of rapidly metabolized substrates.
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Affiliation(s)
- E Fiaccadori
- Istituto di Clinica Medica e Nefrologia, Università di Parma, Italy
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Romani F, Belli LS, Rondinara GF, DeCarlis L, Rimoldi P, Riolo F, Bellati G, Ideo G, Belli L. The role of transplantation in small hepatocellular carcinoma complicating cirrhosis of the liver. J Am Coll Surg 1994; 178:379-84. [PMID: 8149037] [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: 01/29/2023]
Abstract
Of 176 hepatic transplants performed from 1986 to December 1992, 27 patients had small hepatocellular carcinoma (< or = 5 centimeters) complicating cirrhosis of the liver. All patients were asymptomatic for the hepatic malignancy and the diagnosis was established in each instance preoperatively by means of serial sonographic scans and alpha-fetoprotein levels. Cirrhosis was classified as Child's A in eight instances, as Child's B in 16 and Child C's in three. The cause was alcoholic in three patients, posthepatitic in 21 patients (eight hepatitis B virus [HBV] positive and 13 hepatitis C virus [HCV] positive) and undetermined in three. The in-hospital mortality rate was 11 percent (three of 27). Additionally, five patients died at different intervals after transplantation: only two died of neoplastic recurrence at 12 and 32 months, respectively (7.4 percent rate). Actuarial survival rates were 82 percent at one year and 71 percent at three years, with a mean follow-up period of 32 months (range six to 78 months). Morbidity related to the procedure was a relevant problem: 21 percent of the patients had prompt resumption of normal life while 37 percent required repeated hospitalization and 42 percent required strict control on an outpatient basis. The most frequent problem was HBV or HCV reinfection of the grafted liver, which occurred in 42 percent. Based on this experience, transplantation of the liver has shown an excellent oncologic accuracy for small hepatocellular carcinoma in cirrhosis of the liver, thus representing the most rational surgical procedure for patients with Child's B and Child's C cirrhosis classification. The relevant mortality and morbidity rates, strictly related to this procedure, suggest other options as more appropriate in those with Child A cirrhosis at this time.
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Affiliation(s)
- F Romani
- Department of Surgery Transplantation Unit Pizzamiglio 11, Niguarda Hospital, Milan, Italy
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Belli L, Masini MC, Della Chiesa D, Galli F, Marcolli M, Frattini GM, Puricelli G, Caresano A. [Percutaneous angioplasty of arterio-venous fistulae with Zijlstra catheters]. Radiol Med 1993; 86:865-9. [PMID: 8296009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Brescia-Cimino arteriovenous fistulas are the most common vascular accesses in hemodialysis patients. Arterial blood pressure inside the vein and repeated punctures cause progressive sclerosis of the vessel wall and stenosis or occlusion are the final outcome. Percutaneous dilatation is an effective method to preserve arteriovenous fistulas function. From January 1991 through December 1992, eleven dilatations were performed in 10 patients (7 women and 3 men, mean age: 55 years) using a Zijlstra dedicated catheter provided with multiple infusion holes, which allows long dilatation times and therefore progressive wall distention. A high-pressure balloon yields better results in case of stiff and diffuse stenosis. The immediate results of the maneuver were good in all patients. One acute thrombosis of the fistula was observed a few hours after the procedure, and a second dilatation was performed in a patient 8 months after the first one. Mean arteriovenous fistula patency time was 6 months. Finally, a critical review of the international literature on the subject is made and the value of dilatation in the treatment of fistula stenosis is reported; the necessity to use new dedicated catheters in also stressed.
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Affiliation(s)
- L Belli
- Servizio di Radiologia, Ospedale Multizonale, Varese
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Belli L, Carlis LDE, Romani F, Rondinara G, Rimoldi P, AIberti A, Bettale G, Dughetti L, Ideo G, Sberna M, Belli L. Dysarthria and cerebellar ataxia: late occurrence of severe neurotoxicity in a liver transplant recipient. Transpl Int 1993. [DOI: 10.1111/j.1432-2277.1993.tb00642.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Broggini P, Puricelli G, Goddi A, Belli L, Pozzi E, Malvestiti G, Leoni O, Marandola P, Roggia A, Jallous M. Percutaneous Sclerotherapy of Varicocele: Personal Experience. Urologia 1993. [DOI: 10.1177/039156039306000212] [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: 11/16/2022]
Abstract
The Authors describe their experience regarding 80 cases of selective phlebography of the spermatic vein in men with varicocele. Percutaneous transvenous retrograde sclerotherapy of the internal spermatic vein was performed in 78 patients (type 1 and type 3 according to Coolsaet). Follow-up colour-doppler 1 month after sclerotherapy revealed a persistent varicocele in only 3% of cases. The Authors present the advantages of percutaneous sclerotherapy.
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Affiliation(s)
- P. Broggini
- Scuola di Specializzazione in Urologia - Università degli Studi di Pavia
| | - G.P. Puricelli
- Divisione di Radiologia - Ospedale Multizonale di Circolo - Varese
| | - A. Goddi
- Divisione di Radiologia - Ospedale Multizonale di Circolo - Varese
| | - L. Belli
- Divisione di Radiologia - Ospedale Multizonale di Circolo - Varese
| | - E. Pozzi
- Divisione Urologica - Ospedale S. Antonio Abate - Gallarate
| | | | - O. Leoni
- Divisione Urologica - Ospedale S. Antonio Abate - Gallarate
| | - P. Marandola
- Scuola di Specializzazione in Urologia - Università degli Studi di Pavia
| | - A. Roggia
- Divisione Urologica - Ospedale S. Antonio Abate - Gallarate
| | - M. Jallous
- Scuola di Specializzazione in Urologia - Università degli Studi di Pavia
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Belli L, Limborgh Meyer H. Outpatient nursing clinic (ONC) in Italy: Still a dream? Eur J Cancer 1993. [DOI: 10.1016/0959-8049(93)92143-g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Baudo F, DeGasperi A, deCataldo F, Caimi TM, Cattaneo D, Redaelli R, Pannacciulli E, Corti A, Mazza E, Belli L. Antithrombin III supplementation during orthotopic liver transplantation in cirrhotic patients: a randomized trial. Thromb Res 1992; 68:409-16. [PMID: 1290169 DOI: 10.1016/0049-3848(92)90099-v] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Severe intraoperative bleeding is one of the main problems during liver transplantation. Acquired hemostatic defects, namely primary or secondary hyperfibrinolysis, are considered significant pathogenetic events. Antithrombin III (ATIII), the main physiological serine protease inhibitor, has a critical role in the regulation of hemostasis. 29 patients with post necrotic cirrhosis undergoing liver transplantation were randomized to receive or not ATIII replacement therapy before the induction of anaesthesia and thereafter throughout surgery. Activation of both coagulation and fibrinolysis (increase of thrombin-antithrombin complexes, fibrin and fibrinogen degradation products) were demonstrated in both groups. Blood loss and transfusion requirements were not affected by ATIII administration.
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Affiliation(s)
- F Baudo
- Department of Hematology, Ospedale Niguarda Cà Granda, Milano, Italy
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Lassus A, Abath Filho L, Santos Júnior MF, Belli L. Comparison of fleroxacin and penicillin G plus probenecid in the treatment of acute uncomplicated gonococcal infections. Genitourin Med 1992; 68:317-20. [PMID: 1427804 PMCID: PMC1195987 DOI: 10.1136/sti.68.5.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the activity of fleroxacin in acute uncomplicated infections with N. gonorrhoeae in comparison with conventional penicillin G plus probenecid treatment. DESIGN Multicentre open label randomised parallel group study. SUBJECTS Male patients aged 18 years or over from university departments of urology, epidemiology and dermatology and a clinic for sexually transmitted diseases. INTERVENTIONS Two hundred and sixty male patients were randomly assigned to treatment with either a single oral dose of fleroxacin 400 mg (130 patients) or a single intramuscular dose of penicillin G (2.4 or 5.0 mega units) plus a single oral dose of probenecid 1 gram (130 patients). Efficacy and safety assessments were undertaken at follow-up (3-14 days after treatment). Efficacy was assessed as bacteriological outcome of treatment. Safety was assessed by evaluation of adverse events, laboratory abnormalities and changes in vital signs. RESULTS Two hundred and twenty four patients (114 in the fleroxacin group and 110 in the penicillin plus probenecid group) were evaluated for efficacy. Bacteriological cures were achieved in 100% of patients in the fleroxacin group and 97% of patients in the penicillin plus probenecid group. There was no statistically significant difference between the two groups in this respect (Fisher exact test, p = 0.25). Clinical cures were achieved in 100% of patients receiving fleroxacin and 95% of patients receiving penicillin plus probenecid. Safety analyses were undertaken on 255 patients (126 in the fleroxacin group and 129 in the penicillin plus probenecid group). No adverse events were reported for either treatment group, and no clinically relevant laboratory abnormalities were apparent. Thus, there appeared to be no difference in the efficacy or safety of these two treatments when used to treat acute, uncomplicated urethral gonorrhoea in males. CONCLUSIONS In this study fleroxacin proved to be highly effective therapy for uncomplicated gonococcal urethritis in males and may provide a favourable alternative to standard treatment.
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Affiliation(s)
- A Lassus
- Dermatology Department, Helsinki University Central Hospital, Finland
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Belli L, De Carlis L, Beati C, Rondinara G, Sansalone V, Brambilla G. Surgical treatment of symptomatic giant hemangiomas of the liver. Surg Gynecol Obstet 1992; 174:474-8. [PMID: 1595024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cavernous hemangiomas are the most common benign tumors of the liver. Twenty-four patients who had hepatic resections for giant symptomatic hepatic hemangiomas during a six year period at a single institute were retrospectively reviewed to analyze indications for surgical treatment and evaluate operative mortality and morbidity. There were 18 women and six men varying in age from 41 to 69 years with an average age of 52.5 years. Moderate to severe pain, discomfort, feeling of fullness, bloating and sensation of an abdominal mass were the most commonly reported symptoms. Ten patients had moderate anemia and two had severe anemia. Tumors were visualized by ultrasonography in all patients and by computed tomography in 18. Angiography was performed in all patients with diagnostic confirmation of a benign hemangioma in all but one patient in whom an angiosarcoma was suspected. The resection was feasible in each patient: 20 minor hepatic resections (three wedge, 11 segmentectomies, six bisegmentectomies) and four right hepatic lobectomies were carried out. There were no surgical deaths. Two patients had postoperative complications: one patient had a pneumonia on the right side and one had wound infection. The benign nature of the tumors was confirmed in all. The lesions varied in size from 5.6 to 26 centimeters in diameter. Symptoms and hematologic disorders were relieved in all patients in the follow-up. The results of our experience confirm that resection for giant symptomatic hepatic hemangioma represents a safe radical curative procedure. Medical treatment is justified in smaller lesions or in asymptomatic patients.
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Affiliation(s)
- L Belli
- Department of Surgery, Pizzamiglio 2 Niguarda Hospital, Milan, Italy
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