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Fidanza A, Necozione S, Garagnani L. Does anterior plus posterior interosseus neurectomy lead to better outcomes than isolated posterior interosseus denervation in the treatment of chronic wrist pain? A systematic review of the literature and meta-analysis. EFORT Open Rev 2023; 8:110-116. [PMID: 36916712 PMCID: PMC10026062 DOI: 10.1530/eor-22-0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Purpose Partial wrist denervation can be performed by isolated posterior interosseous nerve (PIN) or combined PIN plus (+) anterior interosseous nerve (AIN) neurectomy procedures. The purpose of the current systematic review is to investigate any differences in clinical outcomes and failures in patients undergoing AIN + PIN vs isolated PIN neurectomy. Methods A review of the English Literature was performed on Medline, WOS and Scopus according to PRISMA protocol combining 'wrist denervation', 'PIN neurectomy', 'AIN neurectomy', anterior interosseous nerve neurectomy' and 'posterior interosseous nerve neurectomy'. Studies were assessed with a modified Coleman Methodology Score (CMS). The primary outcome for meta-analysis was 'Failures', including all patients who have required a second surgery or those who are left with pain (defined as 'bad'). Results Overall, 10 studies totalling 347 wrists were included in this systematic review, with a 'moderate' CMS. The isolated PIN neurectomy technique showed a 15.1% pooled failure rate at a median follow-up of 22 months, while the combined AIN+PIN denervation had a pooled failure rate of 23.6% at a follow-up with a median of 29 months. The combined analysis of both procedures did not show significantly better results in favour of either technique, with a general failure rate of 21.6% (P = 0.0501). Conclusion Partial denervation for chronic wrist pain is a salvage procedure that leads to an overall success of 78.4% for pain relief, with no substantial complications. Apparently, performing the neurectomy also of the AIN does not offer greater advantages compared to the isolated PIN neurectomy.
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Affiliation(s)
- Andrea Fidanza
- Unit of Orthopaedics and Traumatology - Department of life, Health & Environmental Sciences, University of L'Aquila, Italy
- Hand Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stefano Necozione
- Unit of Clinical Epidemiology - Department of life, Health & Environmental Sciences, University of L'Aquila, Italy
| | - Lorenzo Garagnani
- Hand Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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2
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Leti Acciaro A, Garagnani L, Lando M, Cataldo G, Adani R. Retrospective study of radial dome osteotomy with volar plate fixation versus K-wires in Madelung's deformity: long-term follow-up. Int Orthop 2021; 46:281-289. [PMID: 34850246 DOI: 10.1007/s00264-021-05266-0] [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] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/05/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The emerging role of the locking plate improved the technique also in corrective osteotomies in Madelung's deformity, but there is a lack of analyses between the fixation techniques, as well as little information in functional outcomes and long-term follow-up. The current study compared the outcomes, pitfalls, and advantages of volar plate and screws fixation versus K-wires fixation in a long-term follow-up. METHODS Twenty-eight children presenting the "distal radius" variant of Madelung's deformity underwent Vickers ligament release and distal radial dome osteotomy between 2009 and 2015. Twenty-three children (20 females and 3 males, mean age 15 years and 7 months at surgery and 24 years and 8 moths at follow-up), with 26 operatively treated wrists, were available for follow-up. A retrospective two-cohort study, evaluating clinically and radiologically results, has been conducted with a mean eight years and seven months follow-up. RESULTS Bone union and pain relief were obtained in all cases, as well as improvements in wrist motion and radiographic indices. A statistically significant correlation was identified between the volar plate fixation and an improved lunate subsidence on X-ray, and a trend towards an improved DASH score in the cohort with plate and screws, as well as significant improvement in wrist extension and supination always in the plate fixation cohort. CONCLUSIONS The long-term follow-up enabled the patients to report on more definitive outcomes in terms of functional and cosmetic improvements. Volar plate fixation is an effective technique allowing for simple post-operative management and earlier rehabilitation program with improved clinical and radiographic outcomes.
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Affiliation(s)
- Andrea Leti Acciaro
- Department of Hand Surgery and Microsurgery, AOU Policlinico, L.go del Pozzo, 71, 41124, Modena, Italy.
| | - Lorenzo Garagnani
- Hand Unit/Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mario Lando
- Department of Hand Surgery and Microsurgery, AOU Policlinico, L.go del Pozzo, 71, 41124, Modena, Italy
| | - Giacomo Cataldo
- Department of Orthopaedic and Traumatology, University of Modena and Reggio Emilia, AOU Policlinico, Modena, Italy
| | - Roberto Adani
- Department of Hand Surgery and Microsurgery, AOU Policlinico, L.go del Pozzo, 71, 41124, Modena, Italy
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3
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Leti Acciaro A, Garagnani L, Lando M, Lana D, Sartini S, Adani R. Modified dome osteotomy and anterior locking plate fixation for distal radius variant of Madelung deformity: a retrospective study. J Plast Surg Hand Surg 2021; 56:121-126. [PMID: 34106811 DOI: 10.1080/2000656x.2021.1934845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Dome osteotomy of the distal radius with Vickers ligament release is an established method of treatment for Madelung deformity. Many different surgical procedures have been proposed in literature but techniques, patient inclusion and efficacy evaluations are heterogeneous. MATERIALS AND METHODS A retrospective review of children affected by 'distal radius' Madelung deformity and treated with a standardized surgical procedure (modified reverse dome osteotomy of the distal radius and volar fixation with a small locking plate) between 2010 and 2018 at a single center was performed. The technique used in this study, reversing the shape of the classical dome osteotomy, allowed for an improved three-planar correction of the distal radial epiphysis and volar plate fixation allowed for an increased stability and reduced soft tissue morbidity. A structured follow-up including a prompt post-operative rehabilitation program (without wrist immobilization) was established. Pain relief, functional outcome and cosmetic appearance were assessed with a structured clinical assessment, DASH Score and radiographic assessment, accordingly. RESULTS A total of 15 wrists in 13 children (12 females, mean age of 15.6 years, range 11-19) were included. The mean follow-up time was 3.8 years. Bone union and pain relief were obtained in all cases. Improvement in the range of motion was detected in extension, supination and flexion of the wrist. Radial inclination was increased by 15.3° and lunate subsidence by 4.1 mm. CONCLUSIONS The use of volar fixation with a small locking plate and immediate post-operative rehabilitation for reverse dome osteotomy of the distal radius in pediatric patients affected by 'distal radius' Madelung's deformity is stable and effective.
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Affiliation(s)
- Andrea Leti Acciaro
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Lorenzo Garagnani
- Hand Unit/Department of Orthopedics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mario Lando
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Debora Lana
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Silvana Sartini
- Hand Rehabilitation Unit, University Hospital of Modena, Modena, Italy
| | - Roberto Adani
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
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Berber O, Gidwani S, Garagnani L, Spiteri M, Riley N, McNab I, Little C. Salvage of the Failed Total Wrist Arthroplasty: A Systematic Review. J Wrist Surg 2020; 9:446-456. [PMID: 33042649 PMCID: PMC7540651 DOI: 10.1055/s-0040-1713728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/28/2019] [Accepted: 05/07/2020] [Indexed: 10/23/2022]
Abstract
Background Although the performance of total wrist arthroplasty systems has improved, failure is encountered and is a major challenge to manage. Questions Does physical function improve with surgical management of the failed wrist arthroplasty? Is there an improvement in secondary outcome measures including pain, grip strength, and range of motion? What are the reasons for failure in primary total wrist arthroplasty? What are the complications associated with revision of the failed total wrist arthroplasty? What are the survival profiles of the different revision strategies? Methods A systematic review of available literature was performed. Studies were systematically assessed, and data extracted from suitable studies for review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were adhered to. The study protocol was modified from a previous protocol published on the PROSPERO database. Results Fourteen studies were identified considering 218 patients/214 index operations with a follow-up duration following revision surgery of 2 months to 21 years (silicone wrist arthroplasty-42 cases; nonsilicone wrist arthroplasty-172 cases). The functional outcome of revision surgery was infrequently recorded and documented with only short-term assessments undertaken. Complications were seen in 1:2 revision procedures, with re-revision surgeries required in 21.6% of revised primary nonsilicone arthroplasties. Re-revision rate following a revision arthrodesis was 21.4% (15/70 cases) compared with revision arthroplasty of 34.8% (32/92 cases). Revision arthrodesis nonunion rate was 17.5% (22 cases). Conclusion This review has confirmed the high level of surgical complexity and the likelihood of a complicated postoperative outcome when salvaging a failed wrist replacement. Level of Evidence This is a Level 3, systematic review study.
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Affiliation(s)
- Onur Berber
- Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, England, United Kingdom
- Whittington Health NHS Trust, London, United Kingdom
| | - Sam Gidwani
- Guy's and St Thomas' Hospitals NHS Foundation Trust, Great Maze Pond, London, England, United Kingdom
| | - Lorenzo Garagnani
- Guy's and St Thomas' Hospitals NHS Foundation Trust, Great Maze Pond, London, England, United Kingdom
| | - Michelle Spiteri
- Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, England, United Kingdom
| | - Nicholas Riley
- Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, England, United Kingdom
| | - Ian McNab
- Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, England, United Kingdom
| | - Christopher Little
- Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, England, United Kingdom
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5
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Rollo G, Luceri F, Pasquino A, Pichierri P, Tomarchio A, Bisaccia M, Garagnani L, Biserni M, Agnoletto M, Marmotti A, Mangiavini L, Meccariello L. Bone grafiting combined with Sauvé-Kapandji Procedures for the treatment of aseptic distal radius non-union. J BIOL REG HOMEOS AG 2020; 34:213-218. Congress of the Italian Orthopaedic Research Society. [PMID: 33261280] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Distal radius fractures are the most common type of upper limb fractures in adults. Non-union after distal radius fracture is rare, serious and unpredictable. The aim of our paper is to analyse the clinical and radiological outcomes of bone grafting and Sauvé-Kapandji Procedures for the treatment of aseptic distal radius non-union. We enrolled 13 patients with distal radius aseptic non-union. The following parameters were evaluated: The surgical time, elbow, forearm and wrist range of motion, the subjective quality of life and the wrist function measured by Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Pain Visual Analogic Score (VAS) and the complication rate. Bone union was measured using the radiographic union score as described by Radiographic Union Score (RUS). The evaluation endpoint was set at 24 months after surgery. All patients achieved fracture union. Grip strength improved by 12.4 kg. There was also improvement in wrist flexion, in wrist extension, and forearm pronosupination. These ranges of motion and grip strength improvements were statistically significant. Only 6 patients returned to full activity. This surgical technique represents a reliable alternative for treatment of distal radius aseptic non-unions. Further studies are needed to assess the long-term clinical results of this surgical procedure.
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Affiliation(s)
- G Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - F Luceri
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - A Pasquino
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - P Pichierri
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - A Tomarchio
- Department of Orthopedics and Traumatology, S. Croce e Carle Cuneo Hospital, Cuneo, Italy
| | - M Bisaccia
- Orthopaedics and Traumatology Unit, Department of Surgical and Biomedical Science, S.M. Misericordia Hospital, University of Perugia, Sant'Andrea delle Fratte, Perugia, Italy
| | - L Garagnani
- Hand and Wrist Unit, Department of Orthopaedics, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - M Biserni
- Department of Orthopedics and Traumatology, Santa Maria della Stella, Orvieto, Terni, Italy
| | - M Agnoletto
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - A Marmotti
- Department of Orthopaedics and Traumatology, University of Turin, Turin, Italy
| | - L Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - L Meccariello
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
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6
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Berber O, Garagnani L, Gidwani S. Systematic Review of Total Wrist Arthroplasty and Arthrodesis in Wrist Arthritis. J Wrist Surg 2018; 7:424-440. [PMID: 30349758 PMCID: PMC6196084 DOI: 10.1055/s-0038-1646956] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [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: 10/29/2017] [Accepted: 03/20/2018] [Indexed: 12/19/2022]
Abstract
Background End-stage wrist arthritis has traditionally been treated with a total wrist fusion. There is a recent trend toward motion preserving surgery in the form of total wrist replacement. Questions Is there a functional benefit to performing a total wrist replacement instead of a total wrist fusion in patients with end-stage wrist arthritis? Is there any difference in secondary outcome measures including pain, grip strength, and range of motion? Does the risk of adverse events and treatment failure differ between the two techniques? Methods A systematic literature search was performed to identify studies reporting either total wrist arthrodesis or arthroplasty for end-stage wrist arthritis. Studies were systematically screened and assessed for risk of bias and quality. Data were extracted and reviewed. Results A total of 43 studies were included in the review: 17 on arthrodesis, 24 on arthroplasty, and 2 matched cohort studies. This represented 669 index arthrodesis operations in 603 patients, and 1,371 index arthroplasty operations in 1,295 patients. A significant improvement in functional outcome was seen with both interventions. Similar improvements were seen in pain scores, and modest improvements were seen in grip strength. Range of motion following arthroplasty improved to a functional level in two studies. Complication rates were higher after arthroplasty (range: 0.2-9.5%) than those after arthrodesis (range: 0.1-6.1%; p = 0.06). Fourth-generation implants (range 0.1-2.9%) performed better than earlier designs (range: 0.2-8.1%; p = 0.002). Implant revision rates ranged from 3.5 to 52.6%. Fourth-generation prostheses survival rates were 78% at 15 years (Universal 2), 86% at 10 years (Motec), 90% at 9 years (Re-Motion), and 95% at 8 years (Maestro). Conclusion The newer fourth-generation wrist implants appear to be performing better than earlier designs. Both wrist arthrodesis and wrist arthroplasty improve function, pain, and grip strength. The risk of complication following wrist replacements is higher than that after total wrist arthrodesis.
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Affiliation(s)
- Onur Berber
- Hand and Wrist Unit, Department of Orthopaedics, Guy's and St Thomas' Hospitals, London, United Kingdom
- University of Brighton, Brighton, United Kingdom
| | - Lorenzo Garagnani
- Hand and Wrist Unit, Department of Orthopaedics, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Sam Gidwani
- Hand and Wrist Unit, Department of Orthopaedics, Guy's and St Thomas' Hospitals, London, United Kingdom
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Abstract
UNLABELLED The classical definition of 'Palmer Type IB' triangular fibrocartilage complex tear, includes a spectrum of clinical conditions. This review highlights the clinical and arthroscopic criteria that enable us to categorize five classes on a treatment-oriented classification system of triangular fibrocartilage complex peripheral tears. Class 1 lesions represent isolated tears of the distal triangular fibrocartilage complex without distal radio-ulnar joint instability and are amenable to arthroscopic suture. Class 2 tears include rupture of both the distal triangular fibrocartilage complex and proximal attachments of the triangular fibrocartilage complex to the fovea. Class 3 tears constitute isolated ruptures of the proximal attachment of the triangular fibrocartilage complex to the fovea; they are not visible at radio-carpal arthroscopy. Both Class 2 and Class 3 tears are diagnosed with a positive hook test and are typically associated with distal radio-ulnar joint instability. If required, treatment is through reattachment of the distal radio-ulnar ligament insertions to the fovea. Class 4 lesions are irreparable tears due to the size of the defect or to poor tissue quality and, if required, treatment is through distal radio-ulnar ligament reconstruction with tendon graft. Class 5 tears are associated with distal radio-ulnar joint arthritis and can only be treated with salvage procedures. This subdivision of type IB triangular fibrocartilage complex tear provides more insights in the pathomechanics and treatment strategies. LEVEL OF EVIDENCE II.
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Affiliation(s)
- A Atzei
- 1 Fenice Hand Surgery, Policlinico "San Giorgio", Pordenone, Italy.,2 Hand Surgery Unit, Casa di Cura 'Giovanni XXIII', Treviso, Italy
| | - R Luchetti
- 3 Rimini Hand Surgery and Rehabilitation Center, Rimini, Italy
| | - L Garagnani
- 4 Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, UK
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8
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Garagnani L, Weber MA, Smith GD. Twin born with a skeletonized hand in twin-to-twin transfusion syndrome treated with laser ablation in pregnancy. J Hand Surg Eur Vol 2016; 41:346-7. [PMID: 24835476 DOI: 10.1177/1753193414535348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- L Garagnani
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children, London, UK
| | - M A Weber
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - G D Smith
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children, London, UK
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9
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Ferrando PM, Garagnani L, Eckersley R, Weir J, Katsarma E. Lipomatous tumours of the hand and wrist A series of 25 cases and review of the literature. Ann Ital Chir 2014; 85:587-592. [PMID: 25711957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED consequently reports in the international literature are mainly of individual cases and small series. MATERIAL OF STUDY This is a retrospective review of a series of 25 patients with lipomatous tumours of the hand and wrist treated between 2001 and 2009. All patients underwent clinical and radiological assessment and a marginal excisional biopsy. 23 lipomas, 1 fibrolipomatous hamartoma (FLH) and 1 well differentiated lipoma-like liposarcoma/atypical lipomatous tumour (WDLLL/ALT) were identified. CONCLUSION Choosing the most appropriate investigations is mandatory for a correct diagnosis and planning. Ultrasound should always be considered as the first line investigation. MRI helps delineating the anatomy of the lesions and their relationships with the surrounding structures in the hand and wrist, enabling more accurate surgical planning. Histological examination of the excised specimen remains the gold standard for the formulation of the definitive diagnosis and should be performed in every case. KEY WORDS Digits tumours, Fibrolipomatous hamartoma, Hand tumours, Lipoma, Lipoma-like liposarcoma, Wrist tumours.
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10
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Landi A, Garagnani L, Leti Acciaro A, Lando M, Ozben H, Gagliano MC. Hyaluronic acid scaffold for skin defects in congenital syndactyly release surgery: a novel technique based on the regenerative model. J Hand Surg Eur Vol 2014; 39:994-1000. [PMID: 24664163 DOI: 10.1177/1753193414529046] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Syndactyly release may require skin grafting to fill the skin defects, which might lead to complications or poor cosmetic outcomes. A simple graftless technique for syndactyly release with a hyaluronic acid (HA) scaffold used to cover the bare areas is described. Between 2008 and 2011, release of 26 webs in 23 patients was performed. All skin defects were covered with Hyalomatrix(®) PA. One patient was excluded due to early post-operative infection that required HA scaffold removal before its integration. Web creep, secondary deformities, scar quality, and patient and parental satisfaction were assessed. Mean follow-up of the group of 22 patients was 24 months. There were no secondary deformities and minimal degree of web creep. All patients had close to normal pigmentation and good pliability at the sites of scaffold application. The results confirm the use of a HA scaffold as a promising alternative to skin grafting in syndactyly release surgery.
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Affiliation(s)
- A Landi
- Department of Hand Surgery and Microsurgery, University Hospital Policlinico di Modena, Modena, Italy
| | - L Garagnani
- Department of Hand Surgery and Microsurgery, University Hospital Policlinico di Modena, Modena, Italy
| | - A Leti Acciaro
- Department of Hand Surgery and Microsurgery, University Hospital Policlinico di Modena, Modena, Italy
| | - M Lando
- Department of Hand Surgery and Microsurgery, University Hospital Policlinico di Modena, Modena, Italy
| | - H Ozben
- Department of Hand Surgery and Microsurgery, University Hospital Policlinico di Modena, Modena, Italy
| | - M C Gagliano
- Department of Hand Surgery and Microsurgery, University Hospital Policlinico di Modena, Modena, Italy
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Abstract
The Rolando fracture is classically a Y pattern intra-articular fracture of the base of the thumb metacarpal. Due to the fracture’s inherent instability and difficultly in achieving and maintaining accurate reduction, management remains challenging. This article explores Silvio Rolando’s background, summarizes his classic paper from 1910 and reviews the current literature regarding optimal fixation techniques.
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Affiliation(s)
- M Mahoney
- Trauma and Orthopaedics, Queen Alexandra Hospital, Portsmouth, UK
| | - D Marsland
- Trauma and Orthopaedics, Queen Alexandra Hospital, Portsmouth, UK
| | - L Garagnani
- Department of Hand Surgery and Microsurgery, University Hospital, Policlinico di Modena, Modena, Italy
| | - P Sauvé
- Trauma and Orthopaedics, Queen Alexandra Hospital, Portsmouth, UK
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Carli D, Fairplay T, Ferrari P, Sartini S, Lando M, Garagnani L, Di Gennaro GL, Di Pancrazio L, Bianconi G, Elmakky A, Bernasconi S, Landi A, Percesepe A. Genetic Basis of Congenital Upper Limb Anomalies: Analysis of 487 Cases of a Specialized Clinic. ACTA ACUST UNITED AC 2013; 97:798-805. [DOI: 10.1002/bdra.23212] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 10/28/2013] [Accepted: 11/04/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Diana Carli
- Medical Genetics, Department of Medical and Surgical Sciences; University Hospital of Modena; Italy
| | - Tracy Fairplay
- Hand Rehabilitation, Department of Locomotor System Diseases; University Hospital of Modena; Italy
| | - Paola Ferrari
- Pediatrics, Department of Medical and Surgical Sciences; University Hospital of Modena; Italy
| | - Silvana Sartini
- Hand Rehabilitation, Department of Locomotor System Diseases; University Hospital of Modena; Italy
| | - Mario Lando
- Hand Surgery and Microsurgery, Department of Locomotor System Diseases; University Hospital of Modena; Italy
| | - Lorenzo Garagnani
- Hand Surgery and Microsurgery, Department of Locomotor System Diseases; University Hospital of Modena; Italy
| | - Giovanni Luigi Di Gennaro
- Department of Paediatric Orthopaedics and Traumatology; Rizzoli Orthopaedic Institute; Bologna Italy
| | | | - Giorgia Bianconi
- Center for Clinical Psychology Services, Department of Mental Health; University of Modena; Italy
| | - Amira Elmakky
- Medical Genetics, Department of Medical and Surgical Sciences; University Hospital of Modena; Italy
| | - Sergio Bernasconi
- Pediatrics, Department of Mother and Child; University Hospital of Parma; Italy
| | - Antonio Landi
- Hand Surgery and Microsurgery, Department of Locomotor System Diseases; University Hospital of Modena; Italy
| | - Antonio Percesepe
- Medical Genetics, Department of Medical and Surgical Sciences; University Hospital of Modena; Italy
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13
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Schirosi L, Nannini N, Nicoli D, Cavazza A, Valli R, Buti S, Garagnani L, Sartori G, Calabrese F, Marchetti A, Buttitta F, Felicioni L, Migaldi M, Rea F, Di Chiara F, Mengoli MC, Rossi G. Activating c-KIT mutations in a subset of thymic carcinoma and response to different c-KIT inhibitors. Ann Oncol 2012; 23:2409-2414. [PMID: 22357254 DOI: 10.1093/annonc/mdr626] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [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: 10/06/2023] Open
Abstract
BACKGROUND To analyze a multi-institutional series of type C thymic carcinomas (TCs) (including neuroendocrine tumors), focusing on the expression and mutations of c-KIT. MATERIALS AND METHODS Immunohistochemical expression of c-KIT/CD117, p63, CD5 and neuroendocrine markers, as well as mutational analysis of c-KIT exons 9, 11, 13, 14, 17 by direct sequencing of 48 cases of TCs. Immunohistochemical and molecular data were statistically crossed with clinicopathological features. RESULTS Overall, 29 tumors (60%) expressed CD117, 69% were positive for CD5 and 85% (41 cases) for p63. Neuroendocrine markers stained all six atypical carcinoids and five poorly-differentiated thymic squamous cell carcinomas. Overall, six CD117-positive cases (12.5%) showed c-KIT mutation. No mutation was detected in CD117-negative tumors and carcinoids. All the mutations were found in poorly-differentiated thymic squamous cell carcinomas expressing CD117, CD5, p63 and lacking neuroendocrine markers (6 of 12 cases with these features). Mutations involved exon 11 (four cases: V559A, L576P, Y553N, W557R), exon 9 (E490K) and exon 17 (D820E). CONCLUSIONS All TCs need an immunohistochemical screening with CD117, while c-KIT mutation analysis is mandatory only in CD117-positive cases, particularly when coexpressing CD5 and p63, lacking neuroendocrine differentiation. The finding of c-KIT mutation can predict efficacy with different c-KIT inhibitors.
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Affiliation(s)
- L Schirosi
- Section of Pathologic Anatomy, University Clinic Policlinico of Modena, Modena
| | - N Nannini
- Department of Diagnostic Medical Sciences and Special Therapies, Special Pathological Anatomy Section, University of Padua Medical School, Padova
| | - D Nicoli
- Laboratory of Molecular Biology, Hospital St. Maria Nuova, Reggio Emilia
| | - A Cavazza
- Section of Pathologic Anatomy, Hospital St. Maria Nuova, Reggio Emilia
| | - R Valli
- Section of Pathologic Anatomy, Hospital St. Maria Nuova, Reggio Emilia
| | - S Buti
- Oncology Division, Hospital of Cremona, Cremona
| | - L Garagnani
- Section of Pathologic Anatomy, University Clinic Policlinico of Modena, Modena
| | - G Sartori
- Section of Pathologic Anatomy, University Clinic Policlinico of Modena, Modena
| | - F Calabrese
- Department of Diagnostic Medical Sciences and Special Therapies, Special Pathological Anatomy Section, University of Padua Medical School, Padova
| | - A Marchetti
- Center of Predictive Molecular Medicine, Center of Excellence on Aging, University of Chieti, Chieti
| | - F Buttitta
- Center of Predictive Molecular Medicine, Center of Excellence on Aging, University of Chieti, Chieti
| | - L Felicioni
- Center of Predictive Molecular Medicine, Center of Excellence on Aging, University of Chieti, Chieti
| | - M Migaldi
- Section of Pathologic Anatomy, University Clinic Policlinico of Modena, Modena
| | - F Rea
- Division of Thoracic Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padova, Italy
| | - F Di Chiara
- Division of Thoracic Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padova, Italy
| | - M C Mengoli
- Section of Pathologic Anatomy, University Clinic Policlinico of Modena, Modena
| | - G Rossi
- Section of Pathologic Anatomy, University Clinic Policlinico of Modena, Modena.
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14
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Ferrando PM, Garagnani L. [A year of fellowship abroad: comparative analysis of specialized training and role of the surgical specialist in Italy and the United Kingdom]. Ann Ital Chir 2012; 83:455-460. [PMID: 23064309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM To compare the Italian and UK specialist training programmes and the role of the specialist in a surgical discipline. BACKGROUNDS Italian postgraduate medical and surgical trainees have the opportunity to spend up to 12 months in accredited foreign health facilities as part of their training programme. MATERIALS AND METHODS A comparison between the Italian and the UK specialist training programmes structure, training methods, trainees assessments, board examinations and clinical duties and research opportunities of the specialist trainees is performed. Also the role of the specialist surgeon working within the Italian and the UK National Health Service is discussed. RESULTS Several differences between the Italian and the UK training programmes and specialist surgeon role have been identified. Training programmes mainly differ in general structure and organization, duration, trainees' assessments and examinations. The Specialist surgeon in Italy is effectively a member of a team of specialists, led by a Director who has managerial and organizational duties and responsibilities, which include among the others the supervision and organization of the clinical activities of the other specialists. The specialist surgeon who works as a Consultant in the UK manages autonomously his own activities and duties, this resulting in a more independent approach to the profession. Each national system presents with unique and interesting characteristics. CONCLUSION A mutual exchange of experience, information and methods between different countries with different specialist training programmes and career paths would be auspicable in order to aid the further growth and development of a more integrated and homogeneous European health system.
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15
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Wang TT, Bashir MA, Garagnani L. Bilateral exertional rhabdomyolysis of the upper limb. J Hand Surg Eur Vol 2012; 37:472-3. [PMID: 22357332 DOI: 10.1177/1753193412439272] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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16
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Garagnani L, Gibson M, Smith PJ, Smith GD. Long-term donor site morbidity after free nonvascularized toe phalangeal transfer. J Hand Surg Am 2012; 37:764-74. [PMID: 22305432 DOI: 10.1016/j.jhsa.2011.12.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 12/05/2011] [Accepted: 12/06/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Free nonvascularized toe phalangeal transfer is an established surgical option for the reconstruction of hypoplastic digits. This study assessed long-term morbidity in the feet using this technique. METHODS We reviewed 40 children treated between 1991 and 2007 by free nonvascularized toe phalangeal transfer. The diagnosis was digital hypoplasia resulting from symbrachydactyly in 33 cases, constriction ring syndrome in 3 cases, thumb hypoplasia in 3 cases, and perinatal subclavian venous thrombosis in 1 case. The patients were followed up after surgery for a mean of 10 years (range, 3-19 y). The Oxford Ankle Foot Questionnaire was administered to patients and families to assess patient symptoms and patient and parental satisfaction. We assessed toe length ratio, the presence of visible deformity, and distal hypoplasia of the donor toes clinically and radiographically. RESULTS Emotional problems related to foot appearance were common. We also found functional problems with footwear in some patients. All patients had floppy unstable toes with visible deformity. Increasing foot deformity was seen with growth, which led to deterioration in foot aesthetics, particularly where multiple donor toes had been harvested. We identified distal and middle phalangeal and metatarsal hypoplasia in the donor toes. CONCLUSIONS Donor site morbidity for free toe phalangeal transfer is greater than previously documented. This should be considered during surgical decision making for reconstruction of hypoplastic digits. Preoperative counseling should include discussion regarding possible consequences of phalangeal harvest on donor toes and options for donor site reconstruction. Long-term follow-up of the donor site is essential to accurately assess results. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Lorenzo Garagnani
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children, London, UK.
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17
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Sammut D, Garagnani L. Obtaining maximum exsanguination of the hand, preserving sterility, and avoiding trauma to the digits: a simple technique. J Hand Surg Eur Vol 2012; 37:177-8. [PMID: 22131326 DOI: 10.1177/1753193411427832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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18
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Stohr KK, Fageur M, Bremner-Smith A, Garagnani L. Reduction with a temporary intrafocal K-wire during internal fixation of distal radius fractures. Ann R Coll Surg Engl 2010. [PMID: 20626985 DOI: 10.1308/003588410x12699663903719l] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- K K Stohr
- Chelsea and Westminster Hospital, London, UK.
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Toni A, Traina F, De Fine M, Garagnani L, Cervini A, Tassinari E. Anterolateral soft tissue sparing approach to the hip. Surgical technique. ACTA ACUST UNITED AC 2008; 92:23-7. [DOI: 10.1007/s12306-008-0040-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Accepted: 11/27/2007] [Indexed: 11/24/2022]
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20
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Rivasi F, Curatola C, Garagnani L, Negri G. Detection of Mycobacterium tuberculosis DNA by polymerase chain reaction from paraffin samples of chronic granulomatous endometritis. Histopathology 2007; 51:574-8. [PMID: 17880545 DOI: 10.1111/j.1365-2559.2007.02811.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sudanese A, Giardina F, Garagnani L, Traina F, Paderni S, Malaguti MC, Toni A. Intrapelvic migration of the prosthetic acetabular component. Chir Organi Mov 2004; 89:223-32. [PMID: 15751589] [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: 05/02/2023]
Abstract
The authors propose a preoperative evaluation protocol for cases of dislocation of the prosthetic cup complicated by intrapelvic migration, obtained by studying 20 cases of prosthetic loosening with protrusion of the acetabular component in the pelvis, treated by reimplantation or explantation. In all of the patients, accurate preoperative planning was carried out, because of the considerable frequency of dislocation, compression or damage to the vascular and nervous structures deriving from migration inside the pelvis of the acetabular component. The authors suggest that in all cases of acetabular loosening evaluation involve standard X-rays, bone scan with technethium99 and with marked granulocytes, CT scan. When the cup protrudes in the pelvis, prior to surgery, CT scan with contrast medium will be required, and if the risk of vascular involvement exists, angiography should also be carried out.
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Affiliation(s)
- A Sudanese
- 1 Divisione di Ortopedia e Traumatologia - Istituto Ortopedico Rizzoli, Bologna
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22
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Migaldi M, Sgambato A, Garagnani L, Ardito R, Ferrari P, De Gaetani C, Cittadini A, Trentini GP. Loss of p21Waf1 expression is a strong predictor of reduced survival in primary superficial bladder cancers. Clin Cancer Res 2000; 6:3131-8. [PMID: 10955794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
p21Waf1 is a downstream effector of p53 and belongs to the Cip1/Kip1 family of cyclin-dependent kinase inhibitors. Thus, it is a potential tumor suppressor gene and likely plays an important role in tumor development. Moreover, reduced expression of p21Waf1 has been reported to have prognostic value in several human malignancies. In this study, we evaluated the prognostic value of p21Waf1 in bladder cancer compared with other clinicopathological features and with p27Kip1 and p53 expression. A total of 96 superficial (pTa-1) human bladder carcinomas were immunohistochemically stained for p21Waf1 protein expression. Positive p21Waf1 staining (> or =5% positive nuclei) was observed in 68 of the 96 (71%) tumors. p21Waf1 expression was neither associated with tumor stage (P = 0.9) nor with tumor grade (P = 0.18) but was significantly associated with both p53 protein expression (> or =20% positive nuclei; P = 0.007) and with p53 gene mutations (P = 0.017). A significant correlation was also observed between positivity for p21Waf1 and high (>50% positive cells) p27Kip1 expression (P = 0.04). With regard to prognosis, patients whose tumors showed absence of p21Waf1 staining displayed a significantly shorter overall survival (P = 0.01 by log-rank test). However, p21Waf1 expression did not correlate with disease-free survival (P = 0.15 by log-rank test). On a multivariate analysis that also included p53 and p27Kip1 expression, negative p21Waf1 staining was an independent predictor of reduced overall survival (P = 0.004; relative risk, 5.32), stronger than age and tumor stage. These data indicate that expression of p21Waf1 protein strongly correlates with survival and might represent a useful prognostic marker in primary superficial bladder carcinomas.
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Affiliation(s)
- M Migaldi
- Dipartimento di Scienze Morfologiche e Medico Legali, Sezione di Anatomia Patologica, University of Modena, Italy
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23
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Romano G, Garagnani L, Boninsegna A, Ferrari P, Flamini G, De Gaetani C, Sgambato A, Giovanni F, Curigliano G, Ferretti G, Cittadini A, Trentini G. Analysis of 4-ABP-DNA adducts and p53 alterations in urinary bladder carcinoma. Anticancer Res 1999; 19:4571-6. [PMID: 10650812] [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: 02/15/2023]
Abstract
BACKGROUND Activated intermediates of 4-aminobiphenyl (4-ABP) are able to covalently interact with DNA to form adducts. There is a large body of evidence indicating that carcinogen-DNA adduct formation can be one of the cancer initiating mechanisms. MATERIALS AND METHODS (4-ABP)-induced DNA damage in association with p53 overexpression and mutations were evaluated in specimens of urothelial bladder cancers from 106 patients. RESULTS 4-ABP-DNA adduct levels resulted higher in smokers compared to non smokers, with a borderline statistical value. p53 nuclear overexpression was related to tumor grading, while no significant correlation with stage, 4-ABP-DNA adducts, smoking habit, and disease recurrence could be observed. Concerning molecular analysis, p53 point mutations were found in 17 of 106 cases (16%) and mutational pattern was significantly associated both with higher grade and stage, but no correlation was found with disease recurrence. CONCLUSIONS These results suggest that other sources, in addition to tobacco smoke, may contribute to 4-ABP-DNA adducts formation in bladder tissue and that p53 expression/mutation cannot be considered a prognostic factor in bladder cancer.
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Affiliation(s)
- G Romano
- Giovanni XXIII Research Cancer Center, Institute of General Pathology, Catholic University School of Medicine, Rome, Italy.
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Sgambato A, Migaldi M, Faraglia B, Garagnani L, Romano G, De Gaetani C, Ferrari P, Ardito R, Trentini G, Cittadini A. Loss of p27Kip1 expression correlates with tumor grade and with reduced disease-free survival in primary superficial bladder cancers. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81814-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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25
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Sgambato A, Migaldi M, Faraglia B, Garagnani L, Romano G, De Gaetani C, Ferrari P, Capelli G, Trentini GP, Cittadini A. Loss of P27Kip1 expression correlates with tumor grade and with reduced disease-free survival in primary superficial bladder cancers. Cancer Res 1999; 59:3245-50. [PMID: 10397272] [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: 02/13/2023]
Abstract
p27Kip1 is a member of the Cip1/Kip1 family of cyclin-dependent kinase inhibitors and is a potential tumor suppressor gene. We previously reported a deregulated expression of p27Kip1 in a series of human cancer cell lines and in primary breast and colon cancers. Moreover, p27Kip1 has been reported as an important prognostic factor in primary lung, breast, colon, and prostate cancers. In this study, we evaluated the prognostic value of p27Kip1 in a series of 96 superficial (pTa-1) human bladder carcinomas. High (>50% positive cells), moderate (25-50%), and low (<25%) p27Kip1 staining was observed in 39 (41%), 19 (20%), and 38 (39%) of the 96 primary superficial bladder cancers, respectively. No significant association was found between the expression level of p27Kip1 and tumor stage. Decreased p27Kip1 staining correlated with higher tumor grade (P = 0.001). Interestingly, a significant association was observed between increased expression of p27Kip1 and positivity for p53 (>20% positive cells; P < 0.001). A significant correlation was also observed between low expression of p27Kip1 and decreased disease-free survival (P = 0.0003 by log-rank test) and overall survival (P = 0.01 by log-rank test). Furthermore, on multivariate analysis, low p27Kip1 protein expression was an independent predictor of reduced disease-free survival (P = 0.018; relative risk = 1.95) second only to tumor stage. These data indicate that p27Kip1 protein is frequently expressed at low level in poorly differentiated tumors and suggest that this protein might represent a useful prognostic marker for disease recurrence and overall survival in superficial bladder carcinomas.
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Affiliation(s)
- A Sgambato
- Centro di Ricerche Oncologiche Giovanni XXIII-Istituto di Patologia Generale, Catholic University, Rome, Italy.
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Bensi L, Longo R, Vecchi A, Messora C, Garagnani L, Bernardi S, Tamassia MG, Sacchi S. Bcl-2 oncoprotein expression in acute myeloid leukemia. Haematologica 1995; 80:98-102. [PMID: 7628759] [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: 01/26/2023] Open
Abstract
BACKGROUND In lymphoproliferative diseases the expression of Bcl-2, a mitochondrial oncoprotein capable of blocking apoptosis, is well-documented, while little research has been carried out on its distribution in myeloproliferative conditions. METHODS Using immunocytochemical methods, 63 cases of acute myeloid leukemia (AML) at onset and 10 relapses were studied to investigate Bcl-2 expression and any possible correlations with subtypes of the FAB classification, sex, age or white cell peripheral blood count at onset. RESULTS Bcl-2 is present in 87.3% of AML cases at onset and in 100% of relapses. In 68.3% of cases at onset and in 90% of relapses the protein is present in more than 20% of the blasts. Relapses always show higher percentages of positive expression than those seen at onset. Our results demonstrate no statistical correlations between the expression of the oncoprotein Bcl-2 and FAB subtypes, sex, age, or white cell peripheral blood count. CONCLUSIONS The majority of blasts from AML patients express the oncoprotein Bcl-2, which is able to protect leukemic cells from apoptosis. Since numerous chemotherapies are cytotoxic in that they induce apoptosis, we feel that in vitro studies of cells from AML patients are necessary in order to broaden our knowledge about the effects of the most common therapeutic drugs and of those substances which, alone or in association, can modulate Bcl-2 expression.
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Affiliation(s)
- L Bensi
- Dipartimento di Science Mediche, Oncologiche e Radiologiche, Università di Modena, Italy
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27
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Garagnani L. [Critical period: the first 3 months]. Attual Dent 1985; 1:50-3. [PMID: 3867389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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