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De Vincentis A, Vespasiani-Gentilucci U, Costanzo L, Novella A, Cortesi L, Nobili A, Mannucci PM, Incalzi RA, Mannucci PM, Nobili A, Pietrangelo A, Perticone F, Licata G, Violi F, Corazza GR, Corrao S, Marengoni A, Salerno F, Cesari M, Tettamanti M, Pasina L, Franchi C, Franchi C, Cortesi L, Tettamanti M, Miglio G, Tettamanti M, Cortesi L, Ardoino I, Novella A, Prisco D, Silvestri E, Emmi G, Bettiol A, Mattioli I, Biolo G, Zanetti M, Bartelloni G, Vanoli M, Grignani G, Pulixi EA, Lupattelli G, Bianconi V, Alcidi R, Girelli D, Busti F, Marchi G, Barbagallo M, Dominguez L, Beneduce V, Cacioppo F, Corrao S, Natoli G, Mularo S, Raspanti M, Zoli M, Matacena ML, Orio G, Magnolfi E, Serafini G, Simili A, Palasciano G, Modeo ME, Gennaro CD, Cappellini MD, Fabio G, De Amicis MM, De Luca G, Scaramellini N, Cesari M, Rossi PD, Damanti S, Clerici M, Leoni S, Di Mauro AD, Di Sabatino A, Miceli E, Lenti MV, Pisati M, Dominioni CC, Pontremoli R, Beccati V, Nobili G, Leoncini G, Anastasio L, Carbone M, Cipollone F, Guagnano MT, Rossi I, Mancuso G, Calipari D, Bartone M, Delitala G, Berria M, Delitala A, Muscaritoli M, Molfino A, Petrillo E, Giorgi A, Gracin C, Zuccalà G, D'Aurizio G, Romanelli G, Marengoni A, Volpini A, Lucente D, Picardi A, Gentilucci UV, Bellelli G, Corsi M, Antonucci C, Sidoli C, Principato G, Arturi F, Succurro E, Tassone B, Giofrè F, Serra MG, Bleve MA, Brucato A, De Falco T, Fabris F, Bertozzi I, Bogoni G, Rabuini MV, Prandini T, Manfredini R, Fabbian F, Boari B, De Giorgi A, Tiseo R, Paolisso G, Rizzo MR, Catalano C, Borghi C, Strocchi E, Ianniello E, Soldati M, Schiavone S, Bragagni A, Sabbà C, Vella FS, Suppressa P, De Vincenzo GM, Comitangelo A, Amoruso E, Custodero C, Fenoglio L, Falcetta A, Fracanzani AL, Tiraboschi S, Cespiati A, Oberti G, Sigon G, Peyvandi F, Rossio R, Colombo G, Agosti P, Monzani V, Savojardo V, Ceriani G, Salerno F, Pallini G, Montecucco F, Ottonello L, Caserza L, Vischi G, Liberato NL, Tognin T, Purrello F, Di Pino A, Piro S, Rozzini R, Falanga L, Pisciotta MS, Bellucci FB, Buffelli S, Montrucchio G, Peasso P, Favale E, Poletto C, Margaria C, Sanino M, Violi F, Perri L, Guasti L, Castiglioni L, Maresca A, Squizzato A, Campiotti L, Grossi A, Diprizio RD, Bertolotti M, Mussi C, Lancellotti G, Libbra MV, Galassi M, Grassi Y, Greco A, Sciacqua A, Perticone M, Battaglia R, Maio R, Stanghellini V, Ruggeri E, del Vecchio S, Salvi A, Leonardi R, Damiani G, Capeci W, Mattioli M, Martino GP, Biondi L, Pettinari P, Ghio R, Col AD, Minisola S, Colangelo L, Cilli M, Labbadia G, Afeltra A, Pipita ME, Castellino P, Zanoli L, Gennaro A, Gaudio A, Saracco V, Fogliati M, Bussolino C, Mete F, Gino M, Vigorito C, Cittadini A, Moreo G, Prolo S, Pina G, Ballestrero A, Ferrando F, Gonella R, Cerminara D, Berra S, Dassi S, Nava MC, Graziella B, Baldassarre S, Fragapani S, Gruden G, Galanti G, Mascherini G, Petri C, Stefani L, Girino M, Piccinelli V, Nasso F, Gioffrè V, Pasquale M, Sechi L, Catena C, Colussi G, Cavarape A, Da Porto A, Passariello N, Rinaldi L, Berti F, Famularo G, Tarsitani P, Castello R, Pasino M, Ceda GP, Maggio MG, Morganti S, Artoni A, Grossi M, Del Giacco S, Firinu D, Costanzo G, Argiolas G, Montalto G, Licata A, Montalto FA, Corica F, Basile G, Catalano A, Bellone F, Principato C, Malatino L, Stancanelli B, Terranova V, Di Marca S, Di Quattro R, Malfa LL, Caruso R, Mecocci P, Ruggiero C, Boccardi V, Meschi T, Ticinesi A, Nouvenne A, Minuz P, Fondrieschi L, Imperiale GN, Pirisi M, Fra GP, Sola D, Bellan M, Porta M, Riva P, Quadri R, Larovere E, Novelli M, Scanzi G, Mengoli C, Provini S, Ricevuti L, Simeone E, Scurti R, Tolloso F, Tarquini R, Valoriani A, Dolenti S, Vannini G, Volpi R, Bocchi P, Vignali A, Harari S, Lonati C, Napoli F, Aiello I, Landolfi R, Montalto M, Mirijello A, Purrello F, Di Pino A, del Primario NEC, Ghidoni S, Salvatore T, Monaco L, Ricozzi C, Pilotto A, Indiano I, Gandolfo F. The multifaceted spectrum of liver cirrhosis in older hospitalised patients: analysis of the REPOSI registry. Age Ageing 2021; 50:498-504. [PMID: 32926127 DOI: 10.1093/ageing/afaa150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Knowledge on the main clinical and prognostic characteristics of older multimorbid subjects with liver cirrhosis (LC) admitted to acute medical wards is scarce. OBJECTIVES To estimate the prevalence of LC among older patients admitted to acute medical wards and to assess the main clinical characteristics of LC along with its association with major clinical outcomes and to explore the possibility that well-distinguished phenotypic profiles of LC have classificatory and prognostic properties. METHODS A cohort of 6,193 older subjects hospitalised between 2010 and 2018 and included in the REPOSI registry was analysed. RESULTS LC was diagnosed in 315 patients (5%). LC was associated with rehospitalisation (age-sex adjusted hazard ratio, [aHR] 1.44; 95% CI, 1.10-1.88) and with mortality after discharge, independently of all confounders (multiple aHR, 2.1; 95% CI, 1.37-3.22), but not with in-hospital mortality and incident disability. Three main clinical phenotypes of LC patients were recognised: relatively fit subjects (FIT, N = 150), subjects characterised by poor social support (PSS, N = 89) and, finally, subjects with disability and multimorbidity (D&M, N = 76). PSS subjects had an increased incident disability (35% vs 13%, P < 0.05) compared to FIT. D&M patients had a higher mortality (in-hospital: 12% vs 3%/1%, P < 0.01; post-discharge: 41% vs 12%/15%, P < 0.01) and less rehospitalisation (10% vs 32%/34%, P < 0.01) compared to PSS and FIT. CONCLUSIONS LC has a relatively low prevalence in older hospitalised subjects but, when present, accounts for worse post-discharge outcomes. Phenotypic analysis unravelled the heterogeneity of LC older population and the association of selected phenotypes with different clinical and prognostic features.
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Affiliation(s)
| | | | - Luisa Costanzo
- Unit of Geriatrics, University Campus Bio-Medico, Rome, Italy
| | - Alessio Novella
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Laura Cortesi
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessandro Nobili
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Carlotta F, Raffaella R, Ilaria A, Alessandro N, Mannuccio MP, Mannucci PM, Nobili A, Pietrangelo A, Perticone F, Licata G, Violi F, Corazza GR, Corrao S, Marengoni A, Salerno F, Cesari M, Tettamanti M, Pasina L, Franchi C, Franchi C, Cortesi L, Tettamanti M, Miglio G, Tettamanti M, Cortesi L, Ardoino I, Novella A, Prisco D, Silvestri E, Emmi G, Bettiol A, Caterina C, Biolo G, Zanetti M, Guadagni M, Zaccari M, Chiuch M, Zaccari M, Vanoli M, Grignani G, Pulixi EA, Bernardi M, Bassi SL, Santi L, Zaccherini G, Lupattelli G, Mannarino E, Bianconi V, Paciullo F, Alcidi R, Nuti R, Valenti R, Ruvio M, Cappelli S, Palazzuoli A, Girelli D, Busti F, Marchi G, Barbagallo M, Dominguez L, Cocita F, Beneduce V, Plances L, Corrao S, Natoli G, Mularo S, Raspanti M, Cavallaro F, Zoli M, Lazzari I, Brunori M, Fabbri E, Magalotti D, Arnò R, Pasini FL, Capecchi PL, Palasciano G, Modeo ME, Gennaro CD, Cappellini MD, Maira D, Di Stefano V, Fabio G, Seghezzi S, Mancarella M, De Amicis MM, De Luca G, Scaramellini N, Cesari M, Rossi PD, Damanti S, Clerici M, Conti F, Bonini G, Ottolini BB, Di Sabatino A, Miceli E, Lenti MV, Pisati M, Dominioni CC, Murialdo G, Marra A, Cattaneo F, Pontremoli R, Beccati V, Nobili G, Secchi MB, Ghelfi D, Anastasio L, Sofia L, Carbone M, Cipollone F, Guagnano MT, Valeriani E, Rossi I, Mancuso G, Calipari D, Bartone M, Delitala G, Berria M, Pes C, Delitala A, Muscaritoli M, Molfino A, Petrillo E, Zuccalà G, D’Aurizio G, Romanelli G, Marengoni A, Zucchelli A, Manzoni F, Volpini A, Picardi A, Gentilucci UV, Gallo P, Dell’Unto C, Annoni G, Corsi M, Bellelli G, Zazzetta S, Mazzola P, Szabo H, Bonfanti A, Arturi F, Succurro E, Rubino M, Tassone B, Sesti G, Interna M, Serra MG, Bleve MA, Gasbarrone L, Sajeva MR, Brucato A, Ghidoni S, Fabris F, Bertozzi I, Bogoni G, Rabuini MV, Cosi E, Scarinzi P, Amabile A, Omenetto E, Prandini T, Manfredini R, Fabbian F, Boari B, Giorgi AD, Tiseo R, De Giorgio R, Paolisso G, Rizzo MR, Borghi C, Strocchi E, Ianniello E, Soldati M, Sabbà C, Vella FS, Suppressa P, Schilardi A, Loparco F, De Vincenzo GM, Comitangelo A, Amoruso E, Fenoglio L, Falcetta A, Bracco C, Fracanzani AL, Fargion S, Tiraboschi S, Cespiati A, Oberti G, Sigon G, Peyvandi F, Rossio R, Ferrari B, Colombo G, Agosti P, Monzani V, Savojardo V, Folli C, Ceriani G, Salerno F, Pallini G, Dallegri F, Ottonello L, Liberale L, Caserza L, Salam K, Liberato NL, Tognin T, Bianchi GB, Giaquinto S, Purrello F, Di Pino A, Piro S, Rozzini R, Falanga L, Spazzini E, Ferrandina C, Montrucchio G, Petitti P, Peasso P, Favale E, Poletto C, Salmi R, Gaudenzi P, Violi F, Perri L, Landolfi R, Montalto M, Mirijello A, Guasti L, Castiglioni L, Maresca A, Squizzato A, Campiotti L, Grossi A, Bertolotti M, Mussi C, Lancellotti G, Libbra MV, Dondi G, Pellegrini E, Carulli L, Galassi M, Grassi Y, Perticone F, Perticone M, Battaglia R, FIlice M, Maio R, Stanghellini V, Ruggeri E, del Vecchio S, Salvi A, Leonardi R, Damiani G, Capeci W, Gabrielli A, Mattioli M, Martino GP, Biondi L, Pettinari P, Ghio R, Col AD, Minisola S, Colangelo L, Cilli M, Labbadia G, Afeltra A, Marigliano B, Pipita ME, Castellino P, Zanoli L, Pignataro S, Gennaro A, Blanco J, Saracco V, Fogliati M, Bussolino C, Mete F, Gino M, Cittadini A, Vigorito C, Arcopinto M, Salzano A, Bobbio E, Marra AM, Sirico D, Moreo G, Gasparini F, Prolo S, Pina G, Ballestrero A, Ferrando F, Berra S, Dassi S, Nava MC, Graziella B, Baldassarre S, Fragapani S, Gruden G, Galanti G, Mascherini G, Petri C, Stefani L, Girino M, Piccinelli V, Nasso F, Gioffrè V, Pasquale M, Scattolin G, Martinelli S, Turrin M, Sechi L, Catena C, Colussi G, Passariello N, Rinaldi L, Berti F, Famularo G, Tarsitani P, Castello R, Pasino M, Ceda GP, Maggio MG, Morganti S, Artoni A, Del Giacco S, Firinu D, Losa F, Paoletti G, Costanzo G, Montalto G, Licata A, Malerba V, Montalto FA, Lasco A, Basile G, Catalano A, Malatino L, Stancanelli B, Terranova V, Di Marca S, Di Quattro R, La Malfa L, Caruso R, Mecocci P, Ruggiero C, Boccardi V, Meschi T, Lauretani F, Ticinesi A, Nouvenne A, Minuz P, Fondrieschi L, Pirisi M, Fra GP, Sola D, Porta M, Riva P, Quadri R, Larovere E, Novelli M, Scanzi G, Mengoli C, Provini S, Ricevuti L, Simeone E, Scurti R, Tolloso F, Tarquini R, Valoriani A, Dolenti S, Vannini G, Tedeschi A, Trotta L, Volpi R, Bocchi P, Vignali A, Harari S, Lonati C, Cattaneo M, Napoli F. Prevalence of use and appropriateness of antidepressants prescription in acutely hospitalized elderly patients. Eur J Intern Med 2019; 68:e7-e11. [PMID: 31405773 DOI: 10.1016/j.ejim.2019.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/25/2019] [Indexed: 11/29/2022]
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Buccheri M, Grassi M, Bianchi G, Lovati F, Vanoli M, Rizzolo A, Croce D. POSTHARVEST PHYSIOLOGY, NUTRITIONAL QUALITY AND AROMA PROFILE OF 'TAROCCO' BLOOD ORANGE FRUIT (CITRUS SINENSIS L. OSBECK). ACTA ACUST UNITED AC 2015. [DOI: 10.17660/actahortic.2015.1079.35] [Citation(s) in RCA: 2] [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: 11/17/2022]
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Taraborelli M, Ramoni V, Brucato A, Airò P, Bajocchi G, Bellisai F, Biasi D, Blagojevic J, Canti V, Caporali R, Caramaschi P, Chiarolanza I, Codullo V, Cozzi F, Cuomo G, Cutolo M, De Santis M, De Vita S, Di Poi E, Doria A, Faggioli P, Favaro M, Ferraccioli G, Ferri C, Foti R, Gerosa A, Gerosa M, Giacuzzo S, Giani L, Giuggioli D, Imazio M, Iudici M, Iuliano A, Leonardi R, Limonta M, Lojacono A, Lubatti C, Matucci-Cerinic M, Mazzone A, Meroni M, Meroni PL, Mosca M, Motta M, Muscarà M, Nava S, Padovan M, Pagani G, Paolazzi G, Peccatori S, Ravagnani V, Riccieri V, Rosato E, Rovere-Querini P, Salsano F, Santaniello A, Scorza R, Tani C, Valentini G, Valesini G, Vanoli M, Vigone B, Zeni S, Tincani A. Brief Report: Successful pregnancies but a higher risk of preterm births in patients with systemic sclerosis: An Italian multicenter study. ACTA ACUST UNITED AC 2012; 64:1970-7. [DOI: 10.1002/art.34350] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Vanoli M, Traisci G, Franchini A, Benetti G, Serra P, Monti MA. A program of professional accreditation of hospital wards by the Italian Society of Internal Medicine (SIMI): self- versus peer-evaluation. Intern Emerg Med 2012; 7:27-32. [PMID: 21833771 DOI: 10.1007/s11739-011-0684-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 07/22/2011] [Indexed: 10/17/2022]
Abstract
The Italian Society of Internal Medicine has developed a voluntary program of professional accreditation of the medical units run by its constituency. Participation in the program, which is meant to foster staff involvement in clinical governance, includes all the medical personnel and nurses. Accreditation is awarded provided the candidate unit is able to adhere to a pre-established set of quality standards, meet a number of clinical and organizational requirements and monitor specific indicators. Self-evaluation is the first step in the program, followed by a site visit by a team of peer internists experienced in quality auditing. The program, which has involved so far 19 units, has considered a number of clinical requirements related to the three most frequent diseases in Italian internal medicine wards: chronic heart failure (CHF), exacerbation of chronic obstructive pulmonary disease (COPD) and hepatic cirrhosis with ascites (HCA). The comparison between self- and peer-evaluation witnessed less discrepancies for disease-related than for organizational requirements, the latter being met to a smaller degree by most units. In particular, concordance was higher for requirements and indicators pertaining to CHF and HCA than to COPD. This program of professional accreditation developed by the Italian Society of Internal Medicine has the potential to describe, monitor and improve clinical and organizational performances in internal medicine. It should also be seen as a contribution to implement the strategy of professional governance in hospitals.
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Affiliation(s)
- Massimo Vanoli
- Internal Medicine Unit, Azienda Ospedaliera della Provincia di Lecco, Ospedale di Merate, Merate (LC), Italy.
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Vanoli M, Zerbini PE, Spinelli L, Torricelli A, Rizzolo A. Polyuronide content and correlation to optical properties measured by time-resolved reflectance spectroscopy in ‘Jonagored’ apples stored in normal and controlled atmosphere. Food Chem 2009. [DOI: 10.1016/j.foodchem.2009.01.081] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vanoli M, Jacob S, Eccher Zerbini P, Rizzolo A, Spinelli L, Torricelli A. TIME-RESOLVED REFLECTANCE SPECTROSCOPY AS A TOOL FOR SELECTING AT-HARVEST 'AMBRA' NECTARINES FOR AROMA QUALITY. ACTA ACUST UNITED AC 2008. [DOI: 10.17660/actahortic.2008.796.31] [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] [Indexed: 11/17/2022]
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Cappellari A, Origgi L, Spina MF, Yiannopoulou KG, Meola G, Vanoli M, Ciammola A, Gregorini F, Scorza R, Bresolin N. Central nervous system involvement in HCV-related mixed cryoglobulinemia. Electromyogr Clin Neurophysiol 2006; 46:149-58. [PMID: 16918199] [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: 05/11/2023]
Abstract
An involvement of the peripheral nervous system is frequent in patients with HCV-related mixed cryoglobulinemia (HCV-MC), whereas central nervous system (CNS) impairment has been rarely reported. To investigate the possible CNS involvement in MC, we evaluated 18 patients by neurophysiological, neuroradiological and neuropsychological methods. Three patients (16.7%) had clinically evident neurological central signs, ten (55.5%) complained of mild symptoms, possibly indicative of CNS impairment, and five (27.8%) did not have any CNS symptom. Evoked potentials (EPs) were abnormal in 83% of the cases (SSEPs in 72%, VEPs in 44%, MEPs in 39% and BAERs in 22%). Brain magnetic resonance imaging (MRI) showed abnormal findings in 83% (small T2-weighted hyperintense lesions in 72%, focal or diffuse atrophy in 50%). Cognitive impairment was detected in 22% of the patients. A mild or subclinical CNS involvement is frequent in MC patients. Neuropsychological, neurophysiological and neuroradiological examination are useful to detect CNS involvement also in asymptomatic subjects.
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Affiliation(s)
- A Cappellari
- Service of Clinical Neurophysiology, Department of Neurological Sciences, IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, and University of Milan, Italy.
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Tijskens L, Zerbini PE, Vanoli M, Jacob S, Grassi M, Cubeddu R, Spinelli L, Torricelli A. Effects of maturity on chlorophyll-related absorption in nectarines, measured by non-destructive time-resolved reflectance spectroscopy. ACTA ACUST UNITED AC 2006. [DOI: 10.1504/ijpti.2006.011660] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Salvarani C, Vanoli M, Daina E, Rossi C, Baldissera E, Bertolini G. OP15. TAKAYASU ARTERITIS: A STUDY OF 104 ITALIAN PATIENTS. Rheumatology (Oxford) 2005. [DOI: 10.1093/rheumatology/keh740] [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: 11/13/2022] Open
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Vanoli M, Eccher Zerbini P, Grassi M, Rizzolo A, Fibiani M, Zanella A, Pifferi A, Spinelli S, Torricelli A, Cubeddu R. THE QUALITY AND STORABILITY OF APPLES CV. ´JONAGORED´ SELECTED AT-HARVEST BY TIME-RESOLVED REFLECTANCE SPECTROSCOPY. ACTA ACUST UNITED AC 2005. [DOI: 10.17660/actahortic.2005.682.199] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Eccher Zerbini P, Vanoli M, Grassi M, Rizzolo A, Fibiani M, Biscotti G, Pifferi A, Torricelli A, Cubeddu R. TIME-RESOLVED REFLECTANCE SPECTROSCOPY AS A NON-DESTRUCTIVE TOOL TO ASSESS THE MATURITY AT HARVEST AND TO MODEL THE SOFTENING OF NECTARINES. ACTA ACUST UNITED AC 2005. [DOI: 10.17660/actahortic.2005.682.195] [Citation(s) in RCA: 5] [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] [Indexed: 11/17/2022]
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Vanoli M, Daina E, Salvarani C, Sabbadini MG, Rossi C, Bacchiani G, Schieppati A, Baldissera E, Bertolini G. Takayasu's arteritis: A study of 104 Italian patients. ACTA ACUST UNITED AC 2005; 53:100-7. [PMID: 15696576 DOI: 10.1002/art.20922] [Citation(s) in RCA: 194] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Takayasu's arteritis (TA) is a rare vasculitis. The Italian Takayasu's Arteritis study group was established with the aim to describe a large cohort of patients. METHODS Data were collected by means of an ad hoc form. Demographic information, clinical history, vascular findings, treatment, risk factors, and comorbidities were analyzed. RESULTS Data of 104 patients were collected. The median delay in diagnosis was 15.5 months (range 0-325 months). Age at onset <15 years was associated with a higher probability, whereas elevated erythrocyte sedimentation rate with a lower probability, of a delay in diagnosis. The majority of patients experienced nonspecific signs and symptoms indicative of an inflammatory disease in the early phase. Among vascular involvement, stenosis was the most frequent lesion, being present in 93% of patients, followed by occlusion (57%), dilatation (16%), and aneurysm (7%). Glucocorticoids were the mainstay of treatment in our series; however, treatment with cytotoxic agents was required in about half of the patients. Fifty-two patients underwent at least 1 surgical procedure. The main indications for intervention were renal vascular hypertension, cerebral hypoperfusion, and limb claudication. CONCLUSION As with many rare diseases, delay in diagnosis is an important issue for patients with TA. The increasing occurrence of vascular lesions along with the disease progression put to question the long-term effectiveness of contemporary treatment. These data may be helpful in increasing physicians' awareness to prevent diagnosis delay, update guidelines, and plan future research projects.
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Affiliation(s)
- M Vanoli
- IRCCS Ospedale Maggiore, Milan, Italy
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Mannucci PM, Vanoli M, Forza I, Canciani MT, Scorza R. Von Willebrand factor cleaving protease (ADAMTS-13) in 123 patients with connective tissue diseases (systemic lupus erythematosus and systemic sclerosis). Haematologica 2003; 88:914-8. [PMID: 12935979] [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: 03/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Autoantibodies inactivating the von Willebrand factor (VWF) cleaving protease, ADAMTS-13, are among the most frequent causes of thrombotic thrombocytopenic purpura (TTP). We evaluated whether or not ADAMTS-13 deficiency and autoantibodies inactivating the protease prevalent in patients with the prototypic autoimmune diseases systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). DESIGN AND METHODS We measured, in parallel, the protease and VWF antigen (VWF:Ag) in 123 patients, 36 of whom had SLE and 87 of whom had SSc. In 14 patients with either disease who had low plasma protease levels (below 40%) we also looked for anti-ADAMTS-13 inactivating antibodies. RESULTS ADAMTS-13 levels were significantly lower in SLE (p=0.0013) and in SSc (p=0.0002) than in normal controls. No anti-ADAMTS activity was measurable in patients with low ADAMTS-13 levels. VWF:Ag was high in both SLE and SSc (p=0.001). INTERPRETATION AND CONCLUSIONS Systemic connective tissue diseases are other conditions besides TTP that are associated in some instances with low but detectable levels of ADAMTS-13. Autoantibodies inactivating protease activity are not the cause of the low plasma levels of ADAMTS-13.
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Affiliation(s)
- Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Department of Internal Medicine, IRCCS maggiore Hospital and University of Milan, Milan, Italy.
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Marchini M, Antonioli R, Lleò A, Barili M, Caronni M, Origgi L, Vanoli M, Scorza R. HLA class II antigens associated with lupus nephritis in Italian SLE patients. Hum Immunol 2003; 64:462-8. [PMID: 12651073 DOI: 10.1016/s0198-8859(03)00017-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [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: 02/03/2023]
Abstract
Human leukocyte antigen DR2 (HLA-DR2), namely the allelic variant HLA-DR15, have been associated with lupus nephritis (LN) in Caucasians. The study investigated the relationships between HLA class II alleles and lupus nephritis in Italian patients. Two hundred forty-four patients fulfilling the American Rheumatism Association criteria for systemic lupus erythematosus (SLE) were typed for HLA-DRB1*, -DQA1*, -DQB1*, and -DPB1* alleles by polymerase chain reaction-sequence-specific oligonucleotide and polymears chain reaction-single-strand polymorphism; 71 patients had renal damage assessed by renal biopsy. Glomerulonephritis was classified using WHO criteria. Significance was tested by X(2) on 2x2 tables. HLA-DQA1*0101 was strongly associated with LN (OR = 2.72 [1.43-5.19]; p = 0.002), whereas HLA-DRB1*1501 was only marginally associated (OR = 1.94 [0.88-4.26]; p = not significant). HLA-DQA1*0102 demonstrated a significant protective effect (OR = 0.31 [0.14-0.86]; p = 0.002). On analyzing the distribution of HLA-DRB1*1501 bearing haplotypes in our SLE patients we found that the HLA-DRB1*1501 greatly enhanced the risk of developing LN conferred by the DQA1*0101 allele (OR = 65.96 [9.35-1326.25]), whereas DQA1*0102 suppressed the nephritogenic effect of DRB1*1501. At renal biopsy, 80% of DRB1*15 positive patients were classified as having class IV LN with the remaining 20% having class III LN. The figures were 19% and 21%, respectively, among the HLA-DR15 negative patients. In the Italian population HLA-DQA and HLA-DR alleles interact in conferring susceptibility to or protection against lupus nephritis, the diffuse proliferative glomerulonephritis (i.e., the most severe form of nephritis) is associated with the HLA-DR15 bearing haplotypes.
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Affiliation(s)
- Maurizio Marchini
- Clinical Immunology, University of Milan, and IRCCS Ospedale Maggiore, Milan, Italy.
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16
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Gerli R, Caponi L, Tincani A, Scorza R, Sabbadini MG, Danieli MG, De Angelis V, Cesarotti M, Piccirilli M, Quartesan R, Moretti P, Cantoni C, Franceschini F, Cavazzana I, Origgi L, Vanoli M, Bozzolo E, Ferrario L, Padovani A, Gambini O, Vanzulli L, Croce D, Bombardieri S. Clinical and serological associations of ribosomal P autoantibodies in systemic lupus erythematosus: prospective evaluation in a large cohort of Italian patients. Rheumatology (Oxford) 2002; 41:1357-66. [PMID: 12468814 DOI: 10.1093/rheumatology/41.12.1357] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To verify the association of ribosomal anti-P antibodies (anti-P), as detected by a sensitive ELISA, with serological findings and clinical manifestations, including neuropsychiatric involvement evaluated according to the American College of Rheumatology (ACR) nomenclature, in a large cohort of patients with systemic lupus erythematosus (SLE). METHODS Anti-P were evaluated in the serum of 149 consecutive Italian SLE patients by an ELISA using a multiple antigen peptide carrying four copies of a common P0, P1 and P2 epitope. A complete laboratory evaluation and clinical examination were performed in each patient. In addition, all patients underwent an accurate neuropsychiatric and neuropsychological assessment performed by trained specialists according to the 1999 ACR suggestions. RESULTS Serum anti-P were detected in 18/149 patients (12.1%). The anti-P prevalence was similar (11.7%) when the analysis was performed in a larger series of sera including 82 additional SLE patients, who were not included in the clinical study. The age of anti-P-positive patients at disease onset was less than 33 yr and, in comparison with the anti-P-negative patients, these patients showed more active disease activity and a higher prevalence of photosensitivity and malar and discoid rash. A strong association between IgG anticardiolipin antibodies and anti-P was also found. However, anti-P were associated with neither neuropsychiatric syndromes nor cognitive impairment. CONCLUSION This study does not seem to confirm the described association of anti-P with SLE neuropsychiatric manifestations. However, it supports the anti-P association with different skin manifestations as well as the presence of anticardiolipin in a subset of patients with SLE characterized by early disease onset.
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Affiliation(s)
- R Gerli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia, Italy
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Scorza R, Caronni M, Bazzi S, Nador F, Beretta L, Antonioli R, Origgi L, Ponti A, Marchini M, Vanoli M. Post-menopause is the main risk factor for developing isolated pulmonary hypertension in systemic sclerosis. Ann N Y Acad Sci 2002; 966:238-46. [PMID: 12114278 DOI: 10.1111/j.1749-6632.2002.tb04221.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.6] [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: 11/29/2022]
Abstract
In scleroderma patients, isolated pulmonary hypertension (PHT) has been associated with selected HLA haplotypes, severe impairment of the diffusing capacity for carbon monoxide and the diagnosis of CREST. Most patients with CREST have a late-age onset of the disease, corresponding to the perimenopausal or postmenopausal period. We conducted a retrospective cohort study to determine the role of post-menopause and of the other known clinical and biological markers in the development of isolated pulmonary hypertension in Italian patients with systemic sclerosis. 189 female patients with scleroderma who had no ecographic signs of pulmonary hypertension (PHT) and radiographic signs of lung fibrosis at the first visit and did not develop significant pulmonary fibrosis during the observation time were included. Sixty-three out of 189 patients (33.3%) presented isolated pulmonary hypertension. A severe impairment of diffusing capacity for carbon monoxide at admission was found to be an early predictive element for its development. An increased risk was associated with postmenopausal condition (RR = 5.2, p = 0.000), CREST syndrome (RR = 2.8, p = 0.001) and haplotype HLA-B35 (RR = 2.8; p = 0.002). A significant positive interaction between postmenopausal condition and either HLA-B35 (RR = 15.2; p = 0.000) or the diagnosis of CREST (RR = 14.1; p = 0.000) was found. Postmenopausal condition alone or in combination with HLA-B35 and CREST syndrome is the main risk-factor for developing primary pulmonary hypertension in scleroderma patients. This suggests that hormonal replacement therapy could play a role in preventing isolated PHT in patients with systemic sclerosis.
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Affiliation(s)
- Raffaella Scorza
- Clinical Immunology and Allergology Unit, IRCCS Ospedale Maggiore and University of Milan, Milan, Italy.
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Castellani M, Vanoli M, Calì G, Bacchiani G, Origgi L, Reschini E, Scorza R, Gerundini P. Ventilation-perfusion lung scan for the detection of pulmonary involvement in Takayasu's arteritis. Eur J Nucl Med 2001; 28:1801-5. [PMID: 11734918 DOI: 10.1007/s002590100648] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of study was to analyse ventilation and perfusion (V/Q) lung scan findings in a series of Italian patients with Takayasu's arteritis. Eighteen consecutive patients underwent V/Q lung planar scintigraphy and single-photon emission tomography (SPET). Before perfusion scan acquisition was started, a first-pass study with (99m)Tc-macroaggregates of albumin was performed to assess the right ventricular ejection fraction (RVEF). All patients had normal chest X-rays and were symptom free at the time of the investigation. They also underwent echocardiography to evaluate pulmonary artery pressure and in 13 patients respiratory function tests were performed. In four patients, perfusion lung scan was repeated after 1 year. In 10/18 patients (55.5%), 43 unmatched lobar, segmental or subsegmental perfusion defects were found on planar images; ventilation scintigraphy was normal in all cases. On SPET images, 55 defects were found; no defects were found with SPET in the remaining patients who had normal planar images. All patients had normal RVEF and 5/13 patients had mild restrictive-obstructive lung disease. The pulmonary artery pressure was increased in two patients with perfusion defects. In the four patients who had repeat scintigraphy, all defects remained unchanged. The prevalence of lung perfusion abnormalities observed in Italian patients with Takayasu's arteritis is within the range of values reported in other countries, and V/Q planar scintigraphy is sufficient for the screening of patients.
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Affiliation(s)
- M Castellani
- Department of Nuclear Medicine, Ospedale Maggiore, Pad. Granelli, Via F. Sforza 35, 20122 Milan, Italy
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20
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Vanoli M, Bacchiani G, Origg L, Scorza R. Takayasu's arteritis: a changing disease. J Nephrol 2001; 14:497-505. [PMID: 11783606] [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: 02/23/2023]
Abstract
Takayasu's arteritis (TA) is a chronic, giant-cell vasculitis of unknown etiology, which primarily involves the aorta, its main branches and coronary and pulmonary arteries. This review focuses on the epidemiological, diagnostic, and clinical aspects of the disease, which have been changed since the first description made by Mikito Takayasu in 1908. The article also summarizes the data collected by the Italian Registry of TA in the period 1993-1998.
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Affiliation(s)
- M Vanoli
- Division of Internal Medicine, IRCCS Ospedale Maggiore, Milan, Italy.
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21
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Beretta L, Caronni M, Vanoli M, Scorza R. Churg-Strauss vasculitis with brain involvement following hepatitis B vaccination. Clin Exp Rheumatol 2001; 19:757. [PMID: 11791655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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22
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Scorza R, Caronni M, Mascagni B, Berruti V, Bazzi S, Micallef E, Arpaia G, Sardina M, Origgi L, Vanoli M. Effects of long-term cyclic iloprost therapy in systemic sclerosis with Raynaud's phenomenon. A randomized, controlled study. Clin Exp Rheumatol 2001; 19:503-8. [PMID: 11579708] [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: 02/21/2023]
Abstract
OBJECTIVE Iloprost is a stable prostacyclin analogue which has been shown to be effective in the short-term symptomatic treatment of Raynaud's phenomenon (RP) secondary to systemic sclerosis (SSc). The aim of this study was to evaluate the effects of long-term cyclic therapy with iloprost in comparison with nifedipine on the skin score, pulmonary function and Raynaud's severity score in patients with SSc and RP. METHODS We conducted a 12-month prospective, randomised, parallel-group, blind-observer trial to compare the effects of intravenously infused iloprost (2 ng/kg/min on 5 consecutive days over a period of 8 hours/day and subsequently for 8 hours on one day every 6 weeks) with those of conventional vasodilating therapy with nifedipine (40 mg/day for os) in 46 patients with SSc and RP. RESULTS At 12 months, iloprost but not nifedipine reduced the skin score (iloprost: from 13.26 +/- 2.05 to 9.26 +/- 1.32, p = 0.002; nifedipine: from 10.83 +/- 2.09 to 12.17 +/- 3.02, p = n.s.; iloprost vs nifedipine: p = 0.016) and the RP severity score (iloprost: from 2.17 +/- 0.2 to 1.22 +/- 0.13, p = 0.02 vs baseline; nifedipine: from 2.08 +/- 0.34 to 1.33 +/- 0.22, p = n.s.). Carbon monoxide diffusing capacity (DLCO), expressed as % of the predicted normal value, worsened significantly in the nifedipine group (from 69.6 +/- 7.4% to 61.5 +/- 6.5%, p = 0.044) and remained stable in patients treated with iloprost (from 53.2 +/- 4.8 to 56.0 +/- 4.6%, iloprost vs nifedipine: p = 0.026). CONCLUSION In SSc patients, cyclic intravenous iloprost infusion is able to control vasospastic disease. Our results suggest that it might also act as a disease-modifying agent, as it seems to improve the course of the disease. Further studies principally focused on organ involvement and the natural history of the disease are needed to confirm our results.
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Affiliation(s)
- R Scorza
- Clinical Immunology and Allergy, University of Milan, IRCCS Ospedale Maggiore, Milan, Italy.
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23
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Bigi G, Vanoli M, Pomati M. Myeloid differentiation in long term culture of human peripheral blood. Exp Hematol 2000. [DOI: 10.1016/s0301-472x(00)00585-3] [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: 11/26/2022]
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24
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Bazzi P, Tancredi L, Scarpini E, Messina S, Sciacco M, Livraghi S, Vanoli M, Prelle A, Scarlato G, Moggio M. Severe polyneuropathy in a patient with Churg-Strauss syndrome. J Peripher Nerv Syst 2000; 5:106-10. [PMID: 10905470 DOI: 10.1046/j.1529-8027.2000.00010.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We describe the clinicopathologic features of a 56-year-old woman affected with Churg-Strauss syndrome with major peripheral nerve involvement. The patient presented with a 1-month history of mainly distal upper-limb symmetrical paresthesias and hypostenia (bilateral "wrist drop"), palpable purpura and eosinophilia. Multiple pulmonary infiltrates and asthma had been present since the age of 52. Skin biopsy demonstrated an eosinophilic necrotizing vasculitis. During the hospitalization she was submitted to cardiac, bronchopulmonary, renal, and gastrointestinal evaluation and EMG. Peripheral nerve and skeletal muscle biopsies were performed. Sural nerve biopsy showed a marked degree of demyelination. A perivascular cellular infiltrate within the epineurium was immunoreactive for T lymphocytes and macrophages. Strong HLA-DR immunostaining was present in the endoneurium. IgM, IgE and fibrinogen deposition was found in some epi- and endoneurial vessels. Muscle biopsy showed neurogenic changes and 1 thrombosed vessel surrounded by mononuclear cells. Membrane attack complex (MAC) deposition was present in a few capillaries and major histocompatibility complex products I (MHCP I) was expressed at the subsarcolemmal level in a few isolated perivascular muscle fibers. After immunosuppressive therapy, the patient showed progressive improvement of both clinical symptoms and neurophysiological parameters.
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Affiliation(s)
- P Bazzi
- Centro Dino Ferrari, Istituto di Clinica Neurologica, Ospedale Maggiore Policlinico, IRCCS, Milan, Italy
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25
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Danieli MG, Fraticelli P, Franceschini F, Cattaneo R, Farsi A, Passaleva A, Pietrogrande M, Invernizzi F, Vanoli M, Scorza R, Sabbadini MG, Gerli R, Corvetta A, Farina G, Salsano F, Priori R, Valesini G, Danieli G. Five-year follow-up of 165 Italian patients with undifferentiated connective tissue diseases. Clin Exp Rheumatol 1999; 17:585-91. [PMID: 10544842] [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: 02/14/2023]
Abstract
OBJECTIVE To study those conditions with a proven or hypothesised immunologic pathogenesis and denominated under a working definition of undifferentiated connective tissue diseases (UCTD). METHODS A multicentre prospective study was organised involving 10 tertiary referral centers of internal medicine in Italy, with the aim of describing the natural history of UCTD and the prevalence of its different clinical and immunological manifestations. RESULTS After a five-year follow-up period, data on 165 patients were available for analysis. UCTDs occur mainly in females in their fourth decade of life. Articular and mucocutaneous features and Raynaud's phenomenon represent the most common findings. Nevertheless, we also detected a relatively high incidence of permanent major organ damage. Regarding the immunologic parameters, we documented some conflicting results in the correlation between serologic abnormalities and clinical features. In 10 patients UCTD evolved to a major disease, generally systemic lupus erythematosus or Sjögren's syndrome. CONCLUSION A low rate of evolution to a defined autoimmune disease, the limited use of steroid or immunosuppressive therapy, and a favourable course in the majority of cases are the main characteristics of patients with UCTDs.
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Affiliation(s)
- M G Danieli
- Istituto di Clinica Medica, Ematologia ed Immunologia Clinica, Università di Ancona.
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Vanoli M, Castellani M, Bacchiani G, Calì G, Mietner B, Origgi L, Scorza R. Non-invasive assessment of pulmonary artery involvement in Takayasu's arteritis. Clin Exp Rheumatol 1999; 17:215-8. [PMID: 10342048] [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: 02/12/2023]
Abstract
OBJECTIVE To evaluate pulmonary involvement in Italian patients with Takayasu's arteritis (TA). METHODS A prospective analysis of 15 Italian patients with TA was carried out, including evaluation by perfusion and ventilation lung scintigraphy (planar and tomographic), standard chest X-ray, spirography and color-doppler echocardiography. All the patients were free of respiratory symptoms when examined. RESULTS In all patients standard chest X-rays and ventilation scintigraphies were normal. 9/15 patients showed unmatched segmental perfusion defects (41 by planar evaluation vs. 48 by SPET). The number of defects was greater in the right lung than in the left (26 vs 18), with a higher frequency of moderate or large defects. Thirteen patients underwent spirography, which proved to be abnormal in 5 cases. Two of these patients were also positive on scintigraphy. No patient showed alterations attributable to TA on color-doppler echocardiography, except for 3 patients with mild to moderate aortic valve regurgitation. CONCLUSIONS Our results show that vascular pulmonary involvement is frequent in TA (60% of cases) even in the absence of clinical signs. The planar image, simpler than the SPET to acquire, was sufficient to make an accurate diagnosis. Italian patients seem to show a pattern of extrapulmonary and pulmonary vascular involvement very similar to that reported in Japanese subjects, and different from that observed in other ethnic groups.
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Affiliation(s)
- M Vanoli
- 3rd Division of Internal Medicine, Università di Milano, Italy
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27
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Sabbadini MG, Manfredi AA, Bozzolo E, Ferrario L, Rugarli C, Scorza R, Origgi L, Vanoli M, Gambini O, Vanzulli L, Croce D, Campana A, Messa C, Fazio F, Tincani A, Anzola G, Cattaneo R, Padovani A, Gasparotti R, Gerli R, Quartesan R, Piccirilli M, Farsi A, Emmi E, Passaleva A. Central nervous system involvement in systemic lupus erythematosus patients without overt neuropsychiatric manifestations. Lupus 1999; 8:11-9. [PMID: 10025594 DOI: 10.1191/096120399678847344] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To verify whether features of CNS involvement can be detected in SLE patients without overt neuropsychiatric manifestations. METHODS 114 SLE patients who had never received a diagnosis of neuropsychiatric lupus (never-NPSLE) were studied and compared to 65 SLE patients with known neuropsychiatric involvement (NPSLE). The study relied on evaluation of neurocognitive functions by means of a battery of neuropsychological tests, on psychiatric and neuropsychological assessments and on neuroimaging studies (computed tomography, magnetic resonance, single photon emission computed tomography (SPECT)). RESULTS Clinical features, including disease duration/activity and pharmacological therapy, of never-NPSLE and NPSLE patients were similar. Short-term and long-term memory, visuo-spatial and verbal information processing were similarly compromised in never-NPSLE and in NPSLE patients; only attention was significantly more compromised in NPSLE patients. Psychiatric morbidity was higher than expected in never-NPSLE patients, although less than in the control neuropsychiatric group. Ischemic lesions, multiple small high intensity lesions and cortical atrophy, detected by CT and MR scans, as well as abnormal SPECT were also frequently detected in never-NPSLE patients. Interestingly, left parietal and occipital area hypoperfusion by SPECT was significantly more frequent in the patients with impaired visuo-spatial intelligence and short-term memory. CONCLUSIONS Most abnormalities detected by available diagnostic tools and characteristics of neuropsychiatric SLE are also present in non-symptomatic patients. They may derive from an unexpected widespread involvement of the CNS and are not per se sufficient, in the absence of clinical manifestations, for a diagnosis of neuropsychiatric SLE.
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Zuccaro G, Della Bella S, Polizzi B, Vanoli M, Scorza R. Common variable immunodeficiency following Epstein-Barr virus infection. J Clin Lab Immunol 1998; 49:41-5. [PMID: 9819672] [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: 02/09/2023]
Abstract
The authors present a case of a patient who developed recurrent bacterial upper respiratory and pulmonary infections and marked hypogammaglobulinemia with a gradual decrease of serum IgG, IgA and IgM some months after acute Epstein-Barr virus infection. Test for identification of lymphocyte subpopulation showed increased CD8+ T-cells with a surface phenotype (CD8+, CD57+, HLA-DR+) characteristic of virus-induced, activated cytotoxic cells. Viral investigations showed a positive anti-EBNA titer, an IgG titer anti-VCA of 1:40, a negative IgG titer anti-EA and human immunodeficiency virus negativity. The authors conclude that these clinical features are indicative of possible common variable immunodeficiency following Epstein-Barr virus infection.
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Affiliation(s)
- G Zuccaro
- Institute of Internal Medicine, Infectious Diseases and Immunopathology, University of Milan, Italy
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29
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Origgi L, Vanoli M, Lunghi G, Carbone A, Grasso M, Scorza R. Hepatitis C virus genotypes and clinical features in hepatitis C virus-related mixed cryoglobulinemia. Int J Clin Lab Res 1998; 28:96-9. [PMID: 9689550 DOI: 10.1007/s005990050026] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mixed cryoglobulinemia is a systemic disease, almost always associated with hepatitis C virus infection and characterized by purpura and cutaneous vasculitis, asthenia, arthralgias, and often renal and neurological involvement. No significant differences have been described to date in mixed cryoglobulinemia patients with type 1, 2, or 3 hepatitis C virus infection with respect to symptoms, while a higher prevalence of genotype 2a has been reported in patients without clinical and biochemical signs of liver disease or with serum autoantibodies. We examined 33 hepatitis C virus-positive patients with mixed cryoglobulinemia to assess if any clinical or serological feature is related to infection with different genotypes. All subjects underwent viral genotype determination by means of a single-step polymerase chain reaction. Thirteen patients (39%) were infected with hepatitis C virus type 1b, 17 (52%) with type 2a or 2a/c, and 3 (9%) with type 3. There was a significant difference in the frequency of peripheral nervous system involvement: paresthesias or other symptoms of peripheral neuropathy were less frequent in patients with 2a or 2a/c infection (29%) than in patients with type 1b or type 3 infection (88%, P = 0.003). Only patients with hepatitis C virus type 2 had urticaria or cutaneous ulcers. These patients also had a lower frequency of arthralgias, lower cryocrit values (P = 0.02), and lower serum levels of alanine-aminotransferase and gamma-glutamyl-transpeptidase (P < 0.04) than patients with type 1 and type 3 infection. The prevalence of antinuclear antibody positivity was similar in the three groups.
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Affiliation(s)
- L Origgi
- Terza Divisione di Medicina Interna, IRCCS Ospedale Maggiore, Milan, Italy
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30
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Abstract
Central nervous system involvement was rarely described in patients with mixed cryoglobulinemia (MC). Most cases were reported before 1991, so these patients were not tested for hepatitis C virus (HCV) infection. However, two cases of cerebral ischemia in patients with HCV-related MC were recently reported. We describe three patients with chronic HCV and cryoglobulinemia, who complained of mild neurologic symptoms (dizziness, equilibrium impairment, monolateral hyposthenia, and defective sensitivity) which can be ascribed to central nervous system involvement. In all of these patients, brain magnetic resonance imaging showed multiple small hyperintensities compatible with ischemic lesions.
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Affiliation(s)
- L Origgi
- Third Division of Internal Medicine, Ospedale Maggiore, University of Milan, Italy
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31
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Abstract
Central nervous system involvement was rarely described in patients with mixed cryoglobulinemia (MC). Most cases were reported before 1991, so these patients were not tested for hepatitis C virus (HCV) infection. However, two cases of cerebral ischemia in patients with HCV-related MC were recently reported. We describe three patients with chronic HCV and cryoglobulinemia, who complained of mild neurologic symptoms (dizziness, equilibrium impairment, monolateral hyposthenia, and defective sensitivity) which can be ascribed to central nervous system involvement. In all of these patients, brain magnetic resonance imaging showed multiple small hyperintensities compatible with ischemic lesions.
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Affiliation(s)
- L Origgi
- Third Division of Internal Medicine, Ospedale Maggiore, University of Milan, Italy
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33
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Abstract
We have carried out a phase II study in advanced or metastatic transitional cell carcinoma of the bladder. Eligible patients had unresectable bladder cancer, previously treated with one line of systemic chemotherapy. Treatment consisted of ifosfamide 1000 mg/sm in a 2-hour infusion for 5 consecutive days from d.1 to d.5. Mesna was administered intravenously at a 20% of the ifosfamide dosage before ifosfamide and orally at 40% after 4 and 8 hours from the ifosfamide infusion. Twenty patients entered the study and received a total of 62 cycles: the treatment resulted feasible on an outpatient basis, with mild toxicity. Only one partial response was observed. With this dose and schedule, ifosfamide appeared less effective than in a previous report at higher doses. Toxicity was acceptable.
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Affiliation(s)
- P Pronzato
- U.O. Oncologia Medica, Ospedale S. Andrea, La Spezia, Italy
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34
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Pronzato P, Bertelli G, Bruna F, Tani F, Vaira F, Vanoli M, Vigani A. Intensified M-VEC chemotherapy with G-CSF support as outpatient treatment for advanced bladder cancer. Anticancer Res 1997; 17:2325-7. [PMID: 9216710] [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: 02/04/2023]
Abstract
The M-VAC regimen (methotrexate, vinblastine, doxorubicin and cisplatin) is widely used in the treatment of advanced or metastatic bladder cancer. In the present trial, an alternate week regimen of M-VEC (with epidoxorubicin instead of doxorubicin) supported by G-CSF (filgrastim) was evaluated. Eligible patients had metastatic or surgically unresectable bladder cancer, not previously treated with systemic chemotherapy. Treatment consisted of methotrexate 30 mg/m2 day 1, vinblastine 3 mg/m2 day 2, epidoxorubicin 60 mg/m2 day 2 and cisplatin 35 mg/m2 days 2 and 3. G-CSF was administered s.c. at the dose of 300 mcg from day 4 to day 11: the treatment was repeated every 2 weeks for six cycles. Twenty-one patients entered the study, and 19 received more than 1 cycle: 78.9% were able to receive full doses of M-VEC as scheduled. The treatment resulted feasible on an outpatient basis, with mild toxicity. Three complete responses (15.8%) and 9 partial responses (47.4%), with an overall objective response rate of 63.2%, were observed.
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Affiliation(s)
- P Pronzato
- U.O. Oncologia Medica, Ospedale S. Andrea, La Spezia, Italy
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35
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Della Bella S, Molteni M, Compasso S, Zulian C, Vanoli M, Scorza R. Differential effects of cyclo-oxygenase pathway metabolites on cytokine production by T lymphocytes. Prostaglandins Leukot Essent Fatty Acids 1997; 56:177-84. [PMID: 9089795 DOI: 10.1016/s0952-3278(97)90531-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cyclo-oxygenase pathway metabolites released in the microenvironment by activated platelets and endothelial cells are potential local modulators of the immune response. In the present study, we have investigated the modulatory role of PGE2, iloprost (prostacyclin analogue), U-46619 (thromboxane analogue) on the release of IL-2, IFN-gamma, TNF-alpha and IL-6 by T lymphocytes. Our results show that PGE2 and prostacyclin differ in the regulation of cytokine production. PGE2 inhibited the release of IL-2 and IFN-gamma, while iloprost did not affect their production. The addition of PGE2 or iloprost greatly decreased the amount of TNF-alpha measured in the supernatants, although the rates of inhibition differed according to the kind of stimulation. Unlike that of PGE2, inhibition by iloprost was stronger in alloactivated cultures than in PHA-stimulated ones. In vitro IL-6 production was stimulated by PGE2 in alloactivated cultures and by iloprost, whatever the stimulus. These results are probably due to other cellular subsets contaminating the T-lymphocyte preparations. After complete removal of monocytes from cell cultures, there were inhibitory effects of lloprost and PGE2 on IL-6 released in the supernatants. We did not observe any significant effect of thromboxane analogue on the production of either cytokine.
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Affiliation(s)
- S Della Bella
- Institute of Internal Medicine, Infectious Diseases and Immunopathology, IRCCS Ospedale Maggiore di Milano, University of Milan, Italy
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36
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Della Bella S, Vanoli M, Bazzi S, Scorza R. Successful treatment of common variable immunodeficiency and related disorders with cimetidine and zinc sulfate. Int J Clin Lab Res 1997; 27:79-80. [PMID: 9144034 DOI: 10.1007/bf02827249] [Citation(s) in RCA: 2] [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: 02/04/2023]
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37
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Pronzato P, Vigani A, Vaira F, Tani F, Vanoli M. Interleukin-2 and interferon alpha 2 combination. Oncol Rep 1996; 3:1137-9. [PMID: 21594525 DOI: 10.3892/or.3.6.1137] [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: 11/05/2022] Open
Abstract
We have studied activity and toxicity of subcutaneous recombinant interleukin-2 and interferon alpha 2b in a series of 14 patients with advanced renal cell carcinoma. No objective response was observed, and the median survival was 16 months (range 3-19); toxicity was acceptable. All the patients had poor prognostic factors and were pretreated with interferon.
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Affiliation(s)
- P Pronzato
- OSPED S ANDREA,DEPT UROL,I-19100 LA SPEZIA,ITALY. OSPED S ANDREA,DEPT RADIOTHERAPY,I-19100 LA SPEZIA,ITALY
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38
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Abstract
OBJECTIVE To test the effect of body position on oesophageal acid clearance time in patients with systemic sclerosis. DESIGN AND METHODS Fifteen consecutive patients with systemic sclerosis and six healthy subjects underwent oesophageal manometry and an acid clearance test in three body positions (supine, recumbent at 30 degrees and seated at 90 degrees) in randomized order. RESULTS In healthy subjects the body position did not affect acid clearance time, whereas in patients the oesophagus cleared mainly by gravity. In patients the acid clearance time was significantly longer in the supine than in the seated position (P < 0.05). Nine patients did not have a detectable peristaltic wave in the distal oesophagus. In the other six oesophageal peristalsis was still detectable but contractions had reduced amplitude and often had double and triple peaks; also in this subgroup the acid clearance time recorded in the supine position was prolonged. CONCLUSIONS In systemic sclerosis gravity plays a major role in oesophageal acid clearance time. The finding of delayed acid clearance in a supine patient may suggest initial oesophageal involvement in the disease.
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Affiliation(s)
- G Basilisco
- Department of Gastroenterology, IRCCS Ospedale Maggiore, Università degli Studi di Milano, Italy
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39
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Pronzato P, Bruna F, Neri E, Roveri D, Trabucchi A, Vanoli M, Vigani A, Vaira F, Losardo P, Bertelli G. Radiotherapy plus carboplatin and teniposide in patients with brain metastases from non small cell lung cancer. Anticancer Res 1995; 15:517-9. [PMID: 7539236] [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: 01/25/2023]
Abstract
BACKGROUND The role of chemotherapy alone or added to radiation treatment for the palliation of multiple, unresectable brain metastases from non small cell lung cancer (NSCLC), is not yet well defined. Carboplatin and teniposide, however, are an interesting combination in this setting since they are active in NSCLC and because of encouraging results against brain metastases in other tumor types. METHODS Twenty patients with brain metastases from NSCLC were treated with whole brain irradiation (total dose of 45 Gy) and chemotherapy (carboplatin, 300 mg/sm on day 1 and teniposide, 60 mg/sm on days 1, 2 and 3). RESULTS Nine patients (45%) showed a complete remission of neurologic symptoms, and 7 (35%) an improvement. Neurologic signs disappeared in 8 patients (40%) and improved in 7 (35%). Three patients (15%) had partial (50%) regression of brain metastases at CT scan, and also showed response in other tumor sites. One other patient had a response of chest and liver lesions, while the cerebral metastases remained stable. Median survival was 7 months with a range of 1-9 months. Toxicity was mild, with no toxic deaths. CONCLUSIONS Aggressive treatment can be taken into consideration also in the case of NSCLC patients with brain metastases and negative prognostic features. Their participation in clinical trials should be encouraged, since this will allow definition of the contribution of combined radiotherapy, chemotherapy and supportive care to the quality and duration of the patient's life.
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Affiliation(s)
- P Pronzato
- U.O. Oncologia Medica, Ospedale S. Andrea, La Spezia, Italy
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40
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Vanoli M, Miani S, Amft N, Bacchiani G, Radelli L, Scorza R. Takayasu's arteritis in Italian patients. Clin Exp Rheumatol 1995; 13:45-50. [PMID: 7774102] [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: 01/27/2023]
Abstract
OBJECTIVE To evaluate the clinical features, angiographic findings and evolution of Takayasu's arteritis in Italian patients. METHODS Retrospective analysis of the case records of 27 Italian patients with Takayasu's arteritis, all meeting the 1990 ACR criteria for classification of this vasculitis, with a median disease duration of 9.5 years. RESULTS The patterns of arterial involvement and the frequencies of systemic and specific symptoms were similar, with some exceptions, to those reported in the literature. In our patients weight loss was rare, the incidence of respiratory symptoms and seizures was low, and no clinical manifestations of intestinal involvement were reported. All of the patients were treated with antiplatelet or anticoagulant medications, and 14 were also treated with corticosteroids and immunosuppressants; a stabilization of the vascular involvement was seen in most of them. Thirteen patients underwent surgery, and 5 had percutaneous transluminal renal angioplasties. Five pregnancies were observed, without complications. Two patients died, one after an angiographic evaluation and one for reasons unrelated to the disease. CONCLUSIONS Takayasu's arteritis is heterogeneous in presentation, evolution and response to therapy. In our series of patients the disease seems to have showed a more favorable course than that previously reported. This can be attributed to the effectiveness of therapy, but also, at least partially, to the better prognosis that the disease seems to have for Western than for Eastern subjects.
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Affiliation(s)
- M Vanoli
- Institute of Internal Medicine, Infectious Diseases and Immunopathology, University of Milan, IRCCS Ospedale Maggiore di Milano, Italy
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41
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Molteni M, Della Bella S, Mascagni B, Coppola C, De Micheli V, Zulian C, Birindelli S, Vanoli M, Scorza R. Secretion of cytokines upon allogeneic stimulation: effect of aging. J BIOL REG HOMEOS AG 1994; 8:41-7. [PMID: 7863811] [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: 01/27/2023]
Abstract
The aim of the present study was to investigate the in vitro mitotic response and cytokine production after allogeneic stimulation of peripheral blood mononuclear cells (PBMC) from healthy elderly subjects. Interleukin-1 (IL-1), interleukin-2 (IL-2), gamma-Interferon (gamma-IFN), and Tumor Necrosis Factor alpha (TNF-alpha) were detected in the supernatants of mixed lymphocyte cultures (MLC). The in vitro proliferative response was significantly reduced in the elderly subjects. The amount of IL-2 detected in the supernatant from cultures of cells from elderly donors was higher than for young controls, as were the production of cytokines predominantly secreted by the macrophage population (IL-1 and TNF-alpha). There was no difference in the production of gamma-IFN by cells of elderly and young subjects.
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Affiliation(s)
- M Molteni
- Laboratory of Cellular Immunology, University of Milan, Italy
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42
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Abstract
This study examined the hypothesis that impaired oesophageal peristalsis was associated with delayed oesophageal clearance of acid in patients with progressive systemic sclerosis (PSS), some of whom are thought to have impaired oesophageal sensitivity to acid. Sixteen patients with PSS had: (a) oesophageal manometry and endoscopy; (b) acid perfusion of the oesophagus with simultaneous measurement of intraoesophageal pH during perfusion and for the next 10 minutes; (c) 22 hour monitoring of intraoesophageal pH; and (d) an evaluation of reflux symptoms during and after perfusion and during overnight pH monitoring. By oesophageal manometry, eight patients had normal peristalsis and eight patients had impaired peristalsis. Oesophageal endoscopy was unremarkable in patients with normal peristalsis, whereas all patients with impaired peristalsis had oesophagitis. The time needed to clear the oesophagus of perfused acid was shorter (p < 0.01) in patients with normal peristalsis and acid clearance time was significantly correlated (p < 0.01) with acid exposure time during overnight pH monitoring. During and after oesophageal perfusion, the nature, duration, and severity of symptoms did not differ between the groups, but overnight symptoms lasted longer (p < 0.05) in patients with impaired peristalsis. It is concluded that in PSS: (1) Impaired oesophageal motility delayed the clearance of acid and increased the exposure time to acid. (2) Acid clearance time is a useful parameter of impaired oesophageal motor function. The assessment of acid clearance time can be used as an alternative to overnight pH monitoring, to assess the impairment of oesophageal acid clearance. (3) Oesophageal sensitivity to acid was preserved in patients with impaired peristalsis and oesophagitis. (4) Reflux symptoms lasted longer in patients with prolonged oesophageal acid exposure but were still reported for a small fraction of the total acid exposure time. Thus, reflux symptoms reflect poorly prolonged exposure of the oesophagus to acid and are not a reliable guide to acid injury of the oesophagus in PSS.
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Affiliation(s)
- G Basilisco
- Department of Gastroenterology, Università degli Studi di Milano, Italy
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Abstract
We studied 14 unselected patients with progressive systemic sclerosis (PSS), six with constipation, and eight with normal bowel habits. A control group, matched for age and sex, comprised six patients with idiopathic constipation and seven healthy subjects. Anorectal manometry was performed with perfused catheters and segmental colonic transit was measured by a radiopaque marker technique. The resting pressure of the anal canal was significantly reduced in PSS with constipation (P < 0.05). The rectoanal inhibitory reflex was detected in only one PSS patient with constipation, but was present in seven of eight PSS patients with normal bowel habits and in all controls (P < 0.01). Total and right colonic transit times were significantly delayed in PSS with constipation and in patients with idiopathic constipation (P < 0.05). In patients with PSS, colonic transit was delayed and anal sphincter function was impaired in constipated patients, suggesting involvement of both the colon and the anorectum by the disease.
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Affiliation(s)
- G Basilisco
- Cattedra di Patologia Medica III, IRCCS, Università degli Studi di, Milano, Italy
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44
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45
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Affiliation(s)
- M Vanoli
- Institute of Internal Medicine, Infectious Diseases and Immunopathology, University of Milan, I.R.C.C.S. Ospedale Maggiore di Milano, Italy
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46
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Radelli L, Della Bella S, Molteni M, Galimberti D, Mascagni B, Vanoli M, Coppola C, Scorza R. Cimetidine and zinc sulfate in the treatment of relapsing herpetic infections. Int J Clin Lab Res 1992; 21:204. [PMID: 1840029 DOI: 10.1007/bf02591646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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47
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48
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Honorati MC, Travaglini P, De Bernardi B, Scorza R, Hu C, Togni ME, Radelli L, Vanoli M, Zanussi C. NK activity in patients with pathological hyperprolactinemia: effect of bromocriptine. Int J Neurosci 1990; 51:303-5. [PMID: 2279890 DOI: 10.3109/00207459008999727] [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: 12/31/2022]
Affiliation(s)
- M C Honorati
- Institute of Internal Medicine, Infectious Diseases and Immunopathology, University of Milan, Italy
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49
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Asero R, Banfi G, Radelli L, Origgi L, Bertetti E, Vanoli M, Riboldi P. Relationship between antibodies to dsDNA and to soluble cellular antigens and histologically defined glomerulonephritis in patients with SLE. Autoimmunity 1990; 7:13-21. [PMID: 2103306 DOI: 10.3109/08916939009041046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
To better define the relationships between circulating autoantibodies and renal involvement in systemic lupus erythematosus (SLE), antibodies to both dsDNA and soluble cellular antigens were detected in sera from a large series of SLE patients. Significantly higher dsDNA binding activities and lower complement levels at onset were found in patients with renal disease; however, this was uniquely due to subjects with diffuse or focal proliferative glomerulonephritis. Patients with membranous nephropathy (MGN) showed very low dsDNA binding activities (6/9 of them being negative for dsDNA antibodies) and normal mean C3 and C4 levels. A comparison between patients with proliferative nephritis and patients without renal involvement with high dsDNA binding activities revealed significantly lower complement levels in the former group. No significant difference was observed in the prevalence of antibodies to soluble cellular antigens between patients with or without renal disease; however, nRNP antibody was two-fold more frequent in patients with MGN than in all other subgroups. This study highlights the close relationship between concurrently high anti-dsDNA and low complement levels and proliferative glomerulonephritis in SLE, and suggests that subjects with MGN may represent a subgroup of SLE patients showing peculiar serological features. Different mechanisms possibly involved in the pathogenesis of MGN in SLE are discussed.
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Affiliation(s)
- R Asero
- Istituto di Medicina Interna, Malattie Infettive e Immunopathologia, Università degli Studi di Milano, Italia
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50
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Scorza R, Vanoli M, Eisera N, Zanussi C. Genetic conditioning of the in vitro human lymphocyte sensitivity to cyclosporin-A. Recenti Prog Med 1988; 79:338-42. [PMID: 2974171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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