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Urbani C, Dassie F, Zampetti B, Mioni R, Maffei P, Cozzi R, Bogazzi F. Real-life data of Pasireotide LAR in acromegaly: a long-term follow-up. J Endocrinol Invest 2024:10.1007/s40618-023-02275-1. [PMID: 38244140 DOI: 10.1007/s40618-023-02275-1] [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] [Received: 07/07/2023] [Accepted: 12/07/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE Pasireotide LAR (PAS-LAR) was released in Italy in 2017 to treat acromegaly patients resistant to SRLs (Somatostatin Receptors Ligands). The long-term follow-up data of PAS-LAR therapy in Italy are limited. This study aimed to evaluate the efficacy and safety of PAS-LAR in acromegaly. DESIGN Patients with acromegaly in PAS-LAR treatment were enrolled in three tertiary Italian endocrinological centers and evaluated by a retrospective observational real-life multicentre study. METHODS Patients have been studied before (baseline) and 1, 6, 12, 24 and > 36 months after PAS-LAR start. Clinical, biochemical, and pituitary magnetic resonance data were collected, along with information on adverse events. Acromegaly disease activity was classified according to the IGF-1 index (normal value < 1.0). RESULTS Fifty patients (female 23) were enrolled. PAS-LAR treatment (mean follow-up 24 ± 16 months) significantly decreased IGF-1 levels (IGF-1 index baseline vs last visit: 1.9 ± 0.6 vs 1.2 ± 0.6, p < 0.0001). At the last visit, 67% of patients had controlled disease, and 44% showed a decrease in tumor volume. Clinical and biochemical efficacy was observed as early as after 1-month of PAS-LAR treatment (IGF-1 index baseline vs 1-month: 1.9 ± 0.6 vs 1.4 ± 0.7, p < 0.0001). Also, 50% of patients referred headache improvement or disappearance. Fifteen patients discontinued PAS-LAR due to failure of treatment and poor glycaemic control. The prevalence of diabetes increased from 33% at the baseline to 54% at the last visit (p = 0.0072). CONCLUSION In real-life settings, PAS-LAR significantly decreases symptoms, IGF-1 levels, and the size of adenoma in patients with acromegaly resistant to SRLs. Beneficial effects may occur early after the first injection.
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Affiliation(s)
- C Urbani
- Endocrinology Unit, Department of Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - F Dassie
- Department of Medicine, University of Padua, Padua, Italy
| | - B Zampetti
- Endocrine Unit, Grande Ospedale Metropolitano Niguarda-Milano, Milan, Italy
| | - R Mioni
- Department of Medicine, University of Padua, Padua, Italy
| | - P Maffei
- Department of Medicine, University of Padua, Padua, Italy.
| | - R Cozzi
- Endocrine Unit, Grande Ospedale Metropolitano Niguarda-Milano, Milan, Italy
| | - F Bogazzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Camerini S, Wennberg A, Adriani M, Martin B, Vettor R, Maffei P, Dassie F. Questionnaire and tools: clinical powerful instrument in acromegaly diagnosis and management. J Endocrinol Invest 2022; 45:1823-1834. [PMID: 35322391 PMCID: PMC9463243 DOI: 10.1007/s40618-022-01782-x] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/07/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE Acromegaly is a rare chronic disease characterized by systemic comorbidity and reduced quality of life. Although achieving biochemical control has always been the primary goal of acromegaly therapy, recent evidence has shown that the traditional assessment does not adequately capture the complexity of symptoms and patients' perception. These findings result in the need to improve a fast decision-making process of the clinician, who should not only take into account biochemical-instrumental criteria, but also patients' symptoms. With the aim of supporting the clinician in the diagnostic and therapeutic decision-making process several disease-specific tools have been developed. The aim of this review is to provide a description of the acromegaly-specific tools, presenting their main features, their application in daily practice, and their efficacy and utility. METHODS A systematic search of Medline/PubMed, ISI-Web of Knowledge, and Google Scholar databases was done. RESULTS Specific instruments and questionnaires have recently been developed to assist clinicians in the assessment of acromegaly. These are either Patient-Reported Outcome tools, such as Acromegaly Quality of Life Questionnaire (AcroQoL) and Pain Assessment Acromegaly Symptom Questionnaire (PASQ), or Clinician-Reported Outcome tools, such as ACROSCORE, SAGIT® and Acromegaly Disease Activity Tool (ACRODAT®). Such tools are extremely flexible and, therefore, have been widely adopted by endocrinologists and other professionals, so much so that they have also been included as recommendations in the 2018 international guidelines. CONCLUSION Questionnaires and tools are useful in the management of acromegaly patients. They help clinicians evaluate patients' symptoms and could assist in the evaluation of disease activity.
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Affiliation(s)
- S Camerini
- DIMED, University of Padua, Padua, Italy
| | - A Wennberg
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M Adriani
- DIMED, University of Padua, Padua, Italy
| | - B Martin
- DIMED, University of Padua, Padua, Italy
| | - R Vettor
- DIMED, University of Padua, Padua, Italy
| | - P Maffei
- DIMED, University of Padua, Padua, Italy
| | - F Dassie
- DIMED, University of Padua, Padua, Italy.
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Grottoli S, Bianchi A, Bogazzi F, Bona C, Carlsson MO, Colao A, Dassie F, Giampietro A, Gomez R, Granato S, Maffei P, Pivonello R, Prencipe N, Ragonese M, Urbani C, Cannavò S. Are there country-specific differences in the use of pegvisomant for acromegaly in clinical practice? An analysis from ACROSTUDY. J Endocrinol Invest 2022; 45:1535-1545. [PMID: 35359232 PMCID: PMC9270309 DOI: 10.1007/s40618-022-01789-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/16/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE A comprehensive picture of pegvisomant use for treating acromegaly in routine clinical practice in different countries is lacking. We aimed, therefore, to document country-specific behaviors in real-life pegvisomant use, and the main safety and effectiveness outcomes in the ACROSTUDY. DESIGN ACROSTUDY is an open-label, non-interventional, post-marketing safety surveillance study. METHODS A descriptive analysis was performed using data from the six top-recruiter ACROSTUDY countries, i.e., Germany (n = 548 patients), Italy (n = 466), France (n = 312), USA (n = 207), Spain (n = 200) and the Netherlands (n = 175). These nations accounted for > 85% of the ACROSTUDY cases. RESULTS The mean pegvisomant dose at treatment start was lowest in the Netherlands (9.4 mg/day), whereas it ranged between 10.9 and 12.6 mg/day in the other countries. At year 5, the mean pegvisomant dose was around 15 mg/day in all countries, except France (18.1 mg/day). At starting pegvisomant, patients treated with monotherapy ranged between 15% in the Netherlands and 72% in Spain. Monotherapy remained lowest over time in the Netherlands. In all countries, the percentage of patients with normal IGF-1 increased steeply from < 20% at baseline to 43-58% at month 6 and 51-67% at year 1. After that, we observed minor changes in the rate of acromegaly control in all countries. The Netherlands peaked in disease control at year 2 (72%). The proportion of patients reporting changes in pituitary tumor size was generally low. Serious treatment-related adverse events were < 5% in all countries. CONCLUSIONS Our study provided a detailed summary of real-life use of pegvisomant in the six top-recruiter ACROSTUDY nations.
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Affiliation(s)
- S Grottoli
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
| | - A Bianchi
- Pituitary Unit, Department of Endocrinology, Fondazione A Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Bogazzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Bona
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M O Carlsson
- Global Medical Affairs, Pfizer Rare Disease, Brussels, Belgium
| | - A Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, 80131, Naples, Italy
| | - F Dassie
- Department of Medicine, Padua University Hospital, Padua, Italy
| | - A Giampietro
- Pituitary Unit, Department of Endocrinology, Fondazione A Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Gomez
- Global Medical Affairs, Pfizer Rare Disease, Brussels, Belgium
| | - S Granato
- Medical Department, Pfizer Italia, Rome, Italy
| | - P Maffei
- Department of Medicine, Padua University Hospital, Padua, Italy
| | - R Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, 80131, Naples, Italy
| | - N Prencipe
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M Ragonese
- Unit of Endocrinology, Department of Human Pathology, University of Messina, Messina, Italy
| | - C Urbani
- Endocrinology II Unit, Department of Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Cannavò
- Unit of Endocrinology, Department of Human Pathology, University of Messina, Messina, Italy
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Gagliardi I, Mungari R, Gamberini MR, Fortini M, Dassie F, Putti MC, Maffei P, Aliberti L, Bondanelli M, Zatelli MC, Ambrosio MR. GH/IGF-1 axis in a large cohort of ß-thalassemia major adult patients: a cross-sectional study. J Endocrinol Invest 2022; 45:1439-1445. [PMID: 35305249 PMCID: PMC9184367 DOI: 10.1007/s40618-022-01780-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/03/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE GH deficit (GHD) could represent an endocrine issue in ß-Thalassemia Major (ßTM) patients. GH/IGF-1 axis has not been extensively explored in ßTM adults, so far. We aim to assess GHD and IGF-1 deficiency prevalence in ßTM adult population, focusing on the relationship with liver disease. METHODS Cross-sectional multi-centre study conducted on 81 adult ßTM patients (44 males, mean age 41 ± 8 years) on transfusion and chelation therapy. GHD was investigated by GHRH + arginine test. IGF-1 levels, routine biochemical exams, Fibroscan, Hepatic Magnetic Resonance Imaging (MRI) and pituitary MRI were collected. RESULTS Eighteen patients were affected by GHD and 63 were not (nGHD) according to GHRH + arginine test, while basal GH levels did not differ. GHD was associated with a higher BMI and a worse lipid profile (p < 0.05). No significant differences were observed regarding liver function between the two groups. Pituitary MRI scan was normal except for one case of empty sella. The 94.4% and 93.6% of GHD and nGHD, respectively, presented lower IGF-1 levels than the reference range, and mean IGF-1 SDS was significantly lower in GHD patients. CONCLUSION GHD is frequent in adult ßTM patients and is associated with higher BMI and worse lipid profile. nGHD patients present lower IGF-1 levels as well. There was no relationship between IGF-1 levels and liver disease. Further, multicentric studies with larger cohorts and standardized diagnostic protocols are needed.
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Affiliation(s)
- I Gagliardi
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - R Mungari
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - M R Gamberini
- Unit of Thalassaemia and Haemoglobinopathies Day Hospital, Regional HUB Centre, Department of Medicine, Azienda Ospedaliero Universitaria S. Anna, Cona, Ferrara, Italy
| | - M Fortini
- Unit of Thalassaemia and Haemoglobinopathies Day Hospital, Regional HUB Centre, Department of Medicine, Azienda Ospedaliero Universitaria S. Anna, Cona, Ferrara, Italy
| | - F Dassie
- Department of Medicine (DIMED), Clinica Medica 3, University of Padua, Padua, Italy
| | - M C Putti
- Dipartimento di Salute della Donna e del Bambino (SDB), Clinica Oncoematologica, Padua University Hospital, Padua, Italy
| | - P Maffei
- Department of Medicine (DIMED), Clinica Medica 3, University of Padua, Padua, Italy
| | - L Aliberti
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - M Bondanelli
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - M C Zatelli
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - M R Ambrosio
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy.
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Parolin M, Dassie F, Vettor R, Steeds RP, Maffei P. Electrophysiological features in acromegaly: re-thinking the arrhythmic risk? J Endocrinol Invest 2021; 44:209-221. [PMID: 32632903 DOI: 10.1007/s40618-020-01343-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acromegaly is disease associated with a specific cardiomyopathy. Hitherto, it has been widely understood that acromegaly carries an increased risk of arrhythmia. PURPOSE In this review we show that evidences are limited to a small number of case-control studies that reported increased rates of premature ventricular beats (PVB) but no more significant arrhythmia. In contrast, there are several studies that have reported impaired preclinical markers of arrhythmia, including reduced heart rate variability, increased late potentials, QT interval dispersion, impaired heart rate recovery after physical exercise and left ventricular dysynchrony. Whilst these markers are associated with an adverse cardiovascular prognosis in the general population, they do not have a high independent positive predictive accuracy for arrhythmia. In acromegaly, case reports have described sudden cardiac death, ventricular tachyarrhythmia and advanced atrio-ventricular block that required implantation of a cardio-defibrillator or permanent pacemaker. Treatment with somatostatin analogues can reduce cardiac dysrhythmia in some cases by reducing heart rate, PVBs and QT interval. Pegvisomant reduces mean heart rate. Pasireotide is associated with QT prolongation. In the absence of good quality data on risk of arrhythmia in acromegaly, the majority of position statements and guidelines suggest routine 12-lead electrocardiography (ECG) and transthoracic echocardiography (TTE) in every patient at diagnosis and then follow up dependent on initial findings.
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Affiliation(s)
- M Parolin
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy.
| | - F Dassie
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy
| | - R Vettor
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy
| | - R P Steeds
- University Hospital Birmingham and University of Birmingham, Cardiology, Birmingham, West Midlands, UK
| | - P Maffei
- Department of Medicine (DIMED), University of Padua, Clinica Medica 3, via Giustiniani 2, 35128, Padova, Italy
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Mioni R, Gallea M, Granzotto M, Dassie F, Parolin M, Maffei P, Faggian D, De Marchi F, Litta P, Vettor R. Ovarian 25OH-vitamin D production in young women affected by polycystic ovary syndrome. J Endocrinol Invest 2020; 43:1623-1630. [PMID: 32319048 DOI: 10.1007/s40618-020-01247-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 04/02/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Vitamin D is involved in the regulatory mechanisms of ovarian function and is frequently low in PCOS patients. Since obesity and hyperinsulinemic state negatively influenced vitamin D levels, therefore, we evaluated the production of vitamin D at the ovarian level only in lean and normoinsulinemic PCOS subjects. Basal, GnRH analogue-induced ovarian production of 25OH-vitamin D (VitD) and a direct sampling at ovarian vein level were investigated. METHODS Basal and GnRH analogue-induced hormone levels were evaluated at peripheral level in 45 subjects, aged 18-39 years, and in 22 healthy women with age- and BMI-matched as controls. In 12 PCOS patients, undergoing laparoscopy, a venous sampling at both peripheral and ovarian level was further done. All subjects presented low VitD levels, appropriate to the season and with no difference between PCOS and control subjects. RESULTS GnRH analogue significantly stimulated plasma LH, FSH, 17-OHP and estradiol secretion (p from < 0.05 to < 0.001 vs basal levels), whereas no effect was observed on both serum AMH and VitD concentrations in all groups. A significant difference (p < 0.006), between peripheral and ovarian veins, was observed in both AMH and estradiol levels in PCOS subjects, while no gradient of VitD was detected. CONCLUSIONS All patients presented with low VitD levels. The absence of any VitD variation, both at basal and after GnRH analogue administration, or at peripheral-ovarian vein gradient, suggests no pituitary-ovarian axis involvement in VitD production or its direct ovarian production in lean and normoinsulinemic PCOS subjects.
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Affiliation(s)
- R Mioni
- Department of Medicine, Clinica Medica 3, Azienda Ospedaliera di Padova, University of Padua, Via Giustiniani 2, 35128, Padua, PD, Italy.
| | - M Gallea
- Department of Medicine, Clinica Medica 3, Azienda Ospedaliera di Padova, University of Padua, Via Giustiniani 2, 35128, Padua, PD, Italy
| | - M Granzotto
- Department of Medicine, Clinica Medica 3, Azienda Ospedaliera di Padova, University of Padua, Via Giustiniani 2, 35128, Padua, PD, Italy
| | - F Dassie
- Department of Medicine, Clinica Medica 3, Azienda Ospedaliera di Padova, University of Padua, Via Giustiniani 2, 35128, Padua, PD, Italy
| | - M Parolin
- Department of Medicine, Clinica Medica 3, Azienda Ospedaliera di Padova, University of Padua, Via Giustiniani 2, 35128, Padua, PD, Italy
| | - P Maffei
- Department of Medicine, Clinica Medica 3, Azienda Ospedaliera di Padova, University of Padua, Via Giustiniani 2, 35128, Padua, PD, Italy
| | - D Faggian
- Department of Laboratory Medicine, Azienda Ospedaliera di Padova, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - F De Marchi
- Department of Women's and Children's Health, Azienda Ospedaliera di Padova, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - P Litta
- Department of Women's and Children's Health, Azienda Ospedaliera di Padova, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - R Vettor
- Department of Medicine, Clinica Medica 3, Azienda Ospedaliera di Padova, University of Padua, Via Giustiniani 2, 35128, Padua, PD, Italy
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Abstract
BACKGROUND Acromegaly is a rare disease caused by an excess of growth hormone and insulin-like growth factor 1. It is usually diagnosed because of typical signs such as macroglossia, acral enlargement, jaw prognathism and malocclusion. Systemic complications are a major cause of morbidity and mortality in acromegaly, and many patients remain undiagnosed for several years. Increased ultrasound (US) application in the general population, and including among acromegaly patients, has revealed many suggestive features which, taken together with clinical suspicion, could induce suspicion of this disease. PURPOSE This review describes main US features in acromegaly. Echocardiography shows a typical cardiomyopathy, characterized by left ventricular hypertrophy, diastolic and systolic dysfunction, aortic and mitral regurgitation, and increased aortic root diameters. US preclinical markers of atherosclerosis, such as intima media thickness (IMT), seem also to be impaired. Visceromegaly and increased organ stiffness are other features of acromegaly, including enlarged prostate, kidneys, liver, and thyroid. In addition, other US findings are: renal cysts, micronephrolithiasis, impairment of renal haemodynamic parameters, gallstones and gallbladder polyps, hepatic steatosis, thyroid nodules, multinodular goiter, and polycystic ovaries. Musculoskeletal US findings are increased cartilage thickness, impaired density and elasticity of bones, nerve enlargement, carpal and cubital tunnel syndrome, and trigger finger. CONCLUSIONS Acromegaly patients frequently present systemic complications and a diagnostic delay. US features of acromegaly are not specific, but could potentially have a key role in early detection of the disease in the presence of typical clinical features.
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Affiliation(s)
- M Parolin
- Clinica Medica 3, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128, Padua, Italy.
| | - F Dassie
- Clinica Medica 3, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128, Padua, Italy
| | - R Vettor
- Clinica Medica 3, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128, Padua, Italy
| | - P Maffei
- Clinica Medica 3, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128, Padua, Italy
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Wennberg A, Lorusso R, Dassie F, Benavides-Varela S, Parolin M, De Carlo E, Fallo F, Mioni R, Vettor R, Semenza C, Maffei P. Sleep disorders and cognitive dysfunction in acromegaly. Endocrine 2019; 66:634-641. [PMID: 31473920 DOI: 10.1007/s12020-019-02061-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE In the general population, sleep disorders are associated with an increased risk of cognitive impairment. The prevalence of sleep disorders, such as sleep apnea, in acromegalic patients is higher than in the general population, and they may have additional risk of cognitive impairment due to acromegaly treatment and comorbidities. We aim to study the relationship between sleep disturbances and cognitive dysfunction in a group of acromegalic patients. METHODS We studied 67 consecutive acromegalic patients. We performed a neurocognitive assessment and patients completed the Acromegaly Quality of Life Questionnaire (AcroQoL), Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index. RESULTS Of the 67 acromegaly patients in the study, 38.8% were male and median age at the neurological examination was 56 (IQR 48, 65). Approximately 6-10% of patients had impaired cognitive assessment, depending on the test. In linear regression models adjusted for age, sex, BMI, disease duration, and disease activity, poorer sleep quality was associated with lower global cognitive z-score (B = -0.03, 95% CI -0.06, -0.002). Daytime somnolence was associated with poorer physical AcroQoL sub-score (B = -0.04, 95% CI -0.08, -0.002). Sleep quality was associated with poorer overall AcroQoL (B = -0.03, 95% CI -0.05, -0.006), physical AcroQoL (B = -0.04, 95% CI -0.07, -0.005), psychological AcroQoL (B = -0.02, 95% CI -0.04, -0.001), and social AcroQoL (B = -0.02, 95% CI -0.04, -0.0009). CONCLUSIONS In acromegaly patients, we found robust evidence that poor sleep quality is associated with poorer quality of life, and some evidence that it is associated with poorer cognitive function.
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Affiliation(s)
- A Wennberg
- Department of Neuroscience, University of Padua, Padova, PD, Italy
| | - R Lorusso
- Department of Medicine, University of Padua, Padova, PD, Italy
| | - F Dassie
- Department of Medicine, University of Padua, Padova, PD, Italy.
| | - S Benavides-Varela
- Department of Developmental Psychology and Socialisation, University of Padua, Padova, PD, Italy
- Department of General Psychology, University of Padua, Padova, PD, Italy
| | - M Parolin
- Department of Medicine, University of Padua, Padova, PD, Italy
| | - E De Carlo
- Department of Medicine, University of Padua, Padova, PD, Italy
| | - F Fallo
- Department of Medicine, University of Padua, Padova, PD, Italy
| | - R Mioni
- Department of Medicine, University of Padua, Padova, PD, Italy
| | - R Vettor
- Department of Medicine, University of Padua, Padova, PD, Italy
| | - C Semenza
- Department of Neuroscience, University of Padua, Padova, PD, Italy
- IRCCS Ospedale San Camillo, Venezia, Italy
| | - P Maffei
- Department of Medicine, University of Padua, Padova, PD, Italy
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9
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Fatti LM, Cangiano B, Vitale G, Persani L, Mantovani G, Sala E, Arosio M, Maffei P, Dassie F, Mormando M, Giampietro A, Tanda L, Masiello ER, Nazzari E, Ferone D, Corbetta S, Passeri E, Guaraldi F, Grottoli S, Cannavò S, Torre MLT, Soranna D, Zambon A, Cavagnini F, Scacchi M. Arthropathy in acromegaly: a questionnaire-based estimation of motor disability and its relation with quality of life and work productivity. Pituitary 2019; 22:552-560. [PMID: 31032537 DOI: 10.1007/s11102-019-00966-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Arthropathy is a common and disabling complication of acromegaly. Since in this condition radiological findings rarely correspond to functional impairment, we elected to quantify in a large cohort of acromegalic patients: the degree of motor disability compared with data from general population, the impact of joint involvement on quality of life and work productivity, and to look for associated factors. METHODS In 211 acromegalic patients, 131 with controlled disease and 80 with active disease, eight validated scales were used to evaluate the (i) prevalence and distribution of arthropathy, (ii) degree of motor disability and joint symptoms (VAS, AIMS symptoms and WOMAC), (iii) quality of life (AcroQoL and PASQ) and work capability (WPAI:GH) as consequences of joint complications. RESULTS Using the WOMAC questionnaire, for which population based normative values are available, a significantly higher prevalence and severity of motor disability was detected in acromegalics compared to the general population from literature. The results provided by the different questionnaires turned out to be highly concordant. All measures of motor disability correlated both with impaired quality of life and motor disability and were worse in females and in patients with higher BMI. CONCLUSIONS The questionnaires VAS, AIMS symptoms, and WOMAC (this latter both as a whole and with its functionality subscale), with their scores, proved to be the most adequate tools to evaluate motor disability and its consequences on both quality of life and work productivity in acromegaly. Female gender and higher BMI are associated with worse articular symptoms.
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Affiliation(s)
- L M Fatti
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - B Cangiano
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Vitale
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - L Persani
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Mantovani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - E Sala
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Arosio
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P Maffei
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - F Dassie
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - M Mormando
- Pituitary Unit, Section of Endocrinology, Department of Internal Medicine, Catholic University, 'A. Gemelli' University Hospital, Rome, Italy
| | - A Giampietro
- Pituitary Unit, Section of Endocrinology, Department of Internal Medicine, Catholic University, 'A. Gemelli' University Hospital, Rome, Italy
| | - L Tanda
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - E R Masiello
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - E Nazzari
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - D Ferone
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - S Corbetta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Endocrinology and Diabetology Service, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - E Passeri
- Endocrinology and Diabetology Service, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - F Guaraldi
- Pituitary Unit, Department of Biomedical and Neuromotor Sciences, IRCCS Institute of Neurological Sciences of Bologna, University of Bologna, Bologna, Italy
| | - S Grottoli
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - S Cannavò
- Department of Human Pathology, University of Messina, Messina, Italy
- Endocrine Unit, University Hospital of Messina, Messina, Italy
| | - M L T Torre
- Department of Human Pathology, University of Messina, Messina, Italy
| | - D Soranna
- Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - A Zambon
- Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - F Cavagnini
- Istituto Auxologico Italiano IRCCS, Center for Biomedical Research and Technology, Cusano Milanino, Milan, Italy
| | - M Scacchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Division of General Medicine, Istituto Auxologico Italiano, IRCCS, Ospedale S. Giuseppe, Strada Cadorna 90, 28824, Località Piancavallo, Oggebbio-Verbania, Italy.
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10
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Squitti R, Cerchiaro G, Giovannoni I, Francalanci P, Siotto M, Maffei P, Ricordi C, Rongioletti MC. A case of a mild Wolfram Syndrome with concomitant ATP7B mutation. CellR4 Repair Replace Regen Reprogram 2019; 7. [PMID: 33869661 DOI: 10.32113/cellr4_20198_2735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Wolfram Syndrome 1 (WS1) has been characterized on the basis of mutation in the WFS1 gene encoding a calcium storage wolframin endoplasmatic reticulum transmembrane glycoprotein. Patients and Methods We observed a WS 10-years old female subject, with Type 1 diabetes-mellitus (DM), that had compound heterozygous WSF1 mutations but without other symptoms generally observed in WS subjects, such as optic atrophy or neurodegeneration. Results Decreased copper, ceruloplasmin, and transferrin levels, pointing to a copper deficiency, were associated with a new c.18703A>G mutation in the ATP7B gene, while lower calcium levels were associated with WSF1 mutations. An omega-3 fatty acids therapy was administrated to the subject in the attempt to ameliorate diabetes symptoms, restored copper deficiency, and normal calcium levels. Conclusions This specific case report provides new insights into the potential interplay of ATP7B mutation in shaping a milder WS clinical picture.
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Affiliation(s)
- R Squitti
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - G Cerchiaro
- Center of Natural Sciences and Humanities, Federal University of ABC - UFABC, Santo André, São Paulo, Brazil
| | - I Giovannoni
- Department of Pathology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - P Francalanci
- Department of Pathology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - M Siotto
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - P Maffei
- Department of Medicine (DIMED), Clinica Medica 3, Padua University Hospital, Italy
| | - C Ricordi
- Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, FL, USA
| | - M C Rongioletti
- Department of Laboratory Medicine, Research and Development Division, 'San Giovanni Calibita', Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
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11
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Grepioni F, Braga D, Chelazzi L, Shemchuk O, Maffei P, Sforzini A, Viscomi GC. Improving solubility and storage stability of rifaximin via solid-state solvation with Transcutol®. CrystEngComm 2019. [DOI: 10.1039/c9ce00567f] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Crystallization of rifaximin from Transcutol® affords the new anhydrous τ-form, which combines a high dissolution rate with a high storage stability, as it is not affected by exposure to humidity.
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Affiliation(s)
- F. Grepioni
- Molecular Crystal Engineering Laboratory
- Dipartimento di Chimica “G. Ciamician”
- Università di Bologna
- 40126 Bologna
- Italy
| | - D. Braga
- Molecular Crystal Engineering Laboratory
- Dipartimento di Chimica “G. Ciamician”
- Università di Bologna
- 40126 Bologna
- Italy
| | - L. Chelazzi
- Molecular Crystal Engineering Laboratory
- Dipartimento di Chimica “G. Ciamician”
- Università di Bologna
- 40126 Bologna
- Italy
| | - O. Shemchuk
- Molecular Crystal Engineering Laboratory
- Dipartimento di Chimica “G. Ciamician”
- Università di Bologna
- 40126 Bologna
- Italy
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12
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Postiaux G, Maffei P, Villiot-Danger JC, Dubus JC. [Respiratory physiotherapy in acute viral bronchiolitis in the newborn. Pro/con arguments]. Rev Mal Respir 2018; 35:403-415. [PMID: 29754840 DOI: 10.1016/j.rmr.2017.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 03/08/2017] [Accepted: 09/30/2017] [Indexed: 11/30/2022]
Abstract
This article reports an exchange of unbiased arguments between Mr Guy Postiaux speaking in favour of respiratory physiotherapy in acute viral bronchiolitis in the newborn and Prof. Jean-Christoph Dubus arguing against. A review of the literature suggests that traditional methods of physiotherapy should be abandoned because they are not validated and because they have harmful side effects. The latest Cochrane revue (2016) suggests the use of slow expiration techniques that have some validated elements and cause no harmful side effects. Large multicentre studies should be undertaken to confirm or refute the results of the five studies in the Cochrane review. Their analysis would allow extraction of objective evidence for the efficacy of slow expiration techniques on the relief of bronchopulmonary obstruction and the reduction of the degree of severity in the short and medium term. Studies of the effect of ambulatory respiratory physiotherapy for bronchiolitis of a moderate degree not requiring hospitalisation are not available. An evaluation is needed which is based on the pathophysiology of multifactorial bronchial obstruction and on the physical signs, of which auscultation is the cornerstone.
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Affiliation(s)
- G Postiaux
- Groupe d'étude pluridisciplinaire stéthacoustique, services des soins intensifs, de médecine interne et de pédiatrie, grand hôpital de Charleroi (GHDC), 6000 Charleroi, Belgique.
| | - P Maffei
- Pôle de médecine physique et de réadaptation, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille, 147, boulevard Baille, 13385 Marseille cedex 5, France
| | | | - J-C Dubus
- Médecine infantile, pneumo-allergologie et CRCM & CNRS, URMITE 6236, Assistance publique-Hôpitaux de Marseille, 13385 Marseille cedex 5, France
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13
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Ragonese M, Grottoli S, Maffei P, Alibrandi A, Ambrosio MR, Arnaldi G, Bianchi A, Puglisi S, Zatelli MC, De Marinis L, Ghigo E, Giustina A, Maffezzoni F, Martini C, Trementino L, Cannavo S. How to improve effectiveness of pegvisomant treatment in acromegalic patients. J Endocrinol Invest 2018; 41:575-581. [PMID: 29080965 DOI: 10.1007/s40618-017-0773-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/10/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Pegvisomant (PEGV) treatment in acromegaly patients resistant to somatostatin analogues is less effective in the real life than in clinical trials. This is a multicenter, observational, retrospective, longitudinal study. The aim was to detect characteristics which improve long-term PEGV effectiveness. METHODS 87 acromegalic patients treated with PEGV have been enrolled in seven referral Italian centres. PEGV was administered for up to 4 years, at doses up titrated until IGF-1 normalization or to ≥ 30 mg/day. The rate of patients who reached IGF-1 normalization at last visit has been calculated. RESULTS IGF-1 was normalized in 75.9% of patients after 1 year and in 89.6% at last visit. Disease control was associated with lower baseline GH, IGF-1 and IGF-1 xULN and was more frequent when baseline IGF-1 was < 2.7 × ULN (p < 0.02). PEGV dose was dependent on baseline IGF-1 > 2.7 × ULN (p < 0.05) and doses > 1.0 mg/BMI/day were administered more frequently when baseline IGF-1 was > 2.0 × ULN (p = 0.03). PEGV resistance was associated with higher BMI (p = 0.006) and was more frequent when BMI was > 30 kg/m2 (p = 0.07). There were no significant differences between patients treated with monotherapy or combined treatment. IGF-1 normalization, PEGV dose and rate of associated treatment were similar between males and females. PEGV effectiveness was independent from previous management. Diabetic patients needed higher doses of PEGV than non-diabetic ones. CONCLUSIONS PEGV effectiveness improves when up titration is appropriate. Higher PEGV doses at start and a more rapid up-titration are necessary in patients with obesity and/or IGF-1 > 2.7 × ULN.
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Affiliation(s)
- M Ragonese
- Dipartimento di Patologia Umana dell'adulto e dell'età evolutiva "G. Barresi", AOU Policlinico G. Martino, University of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - S Grottoli
- Divisione di Endocrinologia, Diabetologia E Metabolismo, Dipartimento di Scienze Mediche, AO Città Della Salute E Della Scienza di Torino, Università di Torino, Turin, Italy
| | - P Maffei
- Dipartimento di Medicina, AO di Padova, Padua, Italy
| | - A Alibrandi
- Dipartimento di Economia, Sezione di Scienze Statistiche E Matematiche, Università di Messina, Messina, Italy
| | - M R Ambrosio
- Dipartimento di Scienze Mediche, Sezione di Endocrinologia E Medicina Interna, Università di Ferrara, Ferrara, Italy
| | - G Arnaldi
- SOD Clinica di Endocrinologia E Malattie Del Metabolismo, AOU Ospedali Riuniti di Ancona, Università di Ancona, Torrette, Ancona, Italy
| | - A Bianchi
- UOS Patologia Ipofisaria, Istituto di Patologia Medica, Policlinico Universitario A. Gemelli, Rome, Italy
| | - S Puglisi
- Dipartimento di Patologia Umana dell'adulto e dell'età evolutiva "G. Barresi", AOU Policlinico G. Martino, University of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - M C Zatelli
- Dipartimento di Scienze Mediche, Sezione di Endocrinologia E Medicina Interna, Università di Ferrara, Ferrara, Italy
| | - L De Marinis
- UOS Patologia Ipofisaria, Istituto di Patologia Medica, Policlinico Universitario A. Gemelli, Rome, Italy
| | - E Ghigo
- Divisione di Endocrinologia, Diabetologia E Metabolismo, Dipartimento di Scienze Mediche, AO Città Della Salute E Della Scienza di Torino, Università di Torino, Turin, Italy
| | - A Giustina
- Struttura Ambulatoriale di Endocrinologia, AO Spedali Civili di Brescia, Università di Brescia, Brescia, Italy
| | - F Maffezzoni
- Struttura Ambulatoriale di Endocrinologia, AO Spedali Civili di Brescia, Università di Brescia, Brescia, Italy
| | - C Martini
- Dipartimento di Medicina, AO di Padova, Padua, Italy
| | - L Trementino
- SOD Clinica di Endocrinologia E Malattie Del Metabolismo, AOU Ospedali Riuniti di Ancona, Università di Ancona, Torrette, Ancona, Italy
| | - S Cannavo
- Dipartimento di Patologia Umana dell'adulto e dell'età evolutiva "G. Barresi", AOU Policlinico G. Martino, University of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy.
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14
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Giustina A, Arnaldi G, Bogazzi F, Cannavò S, Colao A, De Marinis L, De Menis E, Degli Uberti E, Giorgino F, Grottoli S, Lania AG, Maffei P, Pivonello R, Ghigo E. Correction to: Pegvisomant in acromegaly: an update. J Endocrinol Invest 2018; 41:267. [PMID: 29285678 PMCID: PMC6828225 DOI: 10.1007/s40618-017-0800-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Unfortunately, in page 584, second column, the first sentence under the heading "Type of switch" has been published incorrectly. The complete correct sentence is given below.
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Affiliation(s)
- A Giustina
- Chair of Endocrinology, Vita-Salute San Raffaele University, Milano, Italy.
| | - G Arnaldi
- Clinic of Endocrinology and Metabolism Disease, Ospedali Riuniti di Ancona, Ancona, Italy
| | - F Bogazzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Cannavò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - A Colao
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - L De Marinis
- Pituitary Unit, Catholic University School of Medicine, Rome, Italy
| | - E De Menis
- Department of Internal Medicine, General Hospital, Montebelluna (TV), Italy
| | - E Degli Uberti
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - F Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - S Grottoli
- Endocrinology, Diabetology and Metabolism, AOU Città della Salute e della Scienza of Turin, Turin, Italy
| | - A G Lania
- Endocrinology Unit, Department of Biomedical Sciences, Humanitas University and Humanitas Research Hospital, Rozzano, Italy
| | - P Maffei
- Department of Medicine (DIMED), 3rd Medical Clinic, Azienda Ospedaliera Padova, Padova, Italy
| | - R Pivonello
- Department of Clinical and Surgery Medicine, Endocrinology and Metabolism, University of Naples, Naples, Italy
| | - E Ghigo
- Department of Medical Sciences, School of Medicine, University of Turin, Turin, Italy
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Parolin M, Dassie F, Russo L, Mazzocut S, Ferrata M, De Carlo E, Mioni R, Fallo F, Vettor R, Martini C, Maffei P. Guidelines versus real life practice: the case of colonoscopy in acromegaly. Pituitary 2018; 21:16-24. [PMID: 28936751 DOI: 10.1007/s11102-017-0841-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this study is to investigate guideline application and colonoscopy findings in real-life practice in acromegaly. METHODS We conducted a retrospective observational non-interventional and cross-sectional analysis on 146 patients with acromegaly (ACRO) referred to our clinic. We evaluated colonoscopy data, focusing on the correlation between colonoscopy findings and hormonal/metabolic values. RESULTS The total number of colonoscopies performed in ACRO patients increased from 6 in the period 1990-1994 to 57 in the period 2010-2014. Colonoscopy procedures were performed according to guidelines in 25% of ACRO patients at diagnosis, 51% at follow-up and 11% globally (both at diagnosis and follow-up). Among the 146 ACRO patients, 68% were subjected to at least one colonoscopy and in 32% of the cases a polyp was detected during the procedure. The presence of polyps was significantly associated with mean levels of growth hormone (GH), insulin-like growth factor 1 (IGF-1), fasting glucose and insulin levels (p < 0.05). Polyps were detected in 48% of untreated patients and in 26% of patients under treatment for acromegaly (p = 0.04). The general risk of polyps and adenomatous polyps in ACRO patients was higher compared to the control population of Veneto Region, Italy (odds ratio 1.33 and 1.16, respectively). No cancerous polyps were detected in our analysis. CONCLUSION In real-life practice, adherence to ACRO colonoscopy clinical guidelines was lower than expected. Among patients who underwent colonoscopy, the prevalence of colon polyps was higher for ACRO patients, suggesting the need for new strategies to ensure adherence to colonoscopy guidelines.
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Affiliation(s)
- M Parolin
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy.
| | - F Dassie
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
| | - L Russo
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
| | - S Mazzocut
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
| | - M Ferrata
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
| | - E De Carlo
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
| | - R Mioni
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
| | - F Fallo
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
| | - R Vettor
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
| | - C Martini
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
| | - P Maffei
- Department of Medicine (DIMED), Padua University Hospital, via Giustiniani 2, 35128, Padua, Italy
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16
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Giustina A, Arnaldi G, Bogazzi F, Cannavò S, Colao A, De Marinis L, De Menis E, Degli Uberti E, Giorgino F, Grottoli S, Lania AG, Maffei P, Pivonello R, Ghigo E. Pegvisomant in acromegaly: an update. J Endocrinol Invest 2017; 40:577-589. [PMID: 28176221 PMCID: PMC5443862 DOI: 10.1007/s40618-017-0614-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 01/10/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND In 2007, we published an opinion document to review the role of pegvisomant (PEG) in the treatment of acromegaly. Since then, new evidence emerged on the biochemical and clinical effects of PEG and on its long-term efficacy and safety. AIM We here reviewed the emerging aspects of the use of PEG in clinical practice in the light of the most recent literature. RESULTS The clinical use of PEG is still suboptimal, considering that it remains the most powerful tool to control IGF-I in acromegaly allowing to obtain, with a pharmacological treatment, the most important clinical effects in terms of signs and symptoms, quality of life and comorbidities. The number of patients with acromegaly exposed to PEG worldwide has become quite elevated and the prolonged follow-up allows now to deal quite satisfactorily with many clinical issues including major safety issues, such as the concerns about possible tumour (re)growth under PEG. The positive or neutral impact of PEG on glucose metabolism has been highlighted, and the clinical experience, although limited, with sleep apnoea and pregnancy has been reviewed. Finally, the current concept of somatostatin receptor ligands (SRL) resistance has been addressed, in order to better define the acromegaly patients to whom the PEG option may be offered. CONCLUSIONS PEG increasingly appears to be an effective and safe medical option for many patients not controlled by SRL but its use still needs to be optimized.
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Affiliation(s)
- A Giustina
- Chair of Endocrinology, Vita-Salute San Raffaele University, Milano, Italy.
| | - G Arnaldi
- Clinic of Endocrinology and Metabolism Disease, Ospedali Riuniti di Ancona, Ancona, Italy
| | - F Bogazzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Cannavò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - A Colao
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - L De Marinis
- Pituitary Unit, Catholic University School of Medicine, Rome, Italy
| | - E De Menis
- Department of Internal Medicine, General Hospital, Montebelluna (TV), Italy
| | - E Degli Uberti
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - F Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - S Grottoli
- Endocrinology, Diabetology and Metabolism, AOU Città della Salute e della Scienza of Turin, Turin, Italy
| | - A G Lania
- Endocrinology Unit, Department of Biomedical Sciences, Humanitas University and Humanitas Research Hospital, Rozzano, Italy
| | - P Maffei
- Department of Medicine (DIMED), 3rd Medical Clinic, Azienda Ospedaliera Padova, Padova, Italy
| | - R Pivonello
- Department of Clinical and Surgery Medicine, Endocrinology and Metabolism, University of Naples, Naples, Italy
| | - E Ghigo
- Department of Medical Sciences, School of Medicine, University of Turin, Turin, Italy
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17
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Faure A, Dicrocco E, Hery G, Boissier R, Bienvenu L, Thirakul S, Maffei P, Panait N, Karsenty G, Merrot T, Alessandrini P, Guys JM, Lechevallier E. Postural therapy for renal stones in children: A Rolling Stones procedure. J Pediatr Urol 2016; 12:252.e1-6. [PMID: 27140003 DOI: 10.1016/j.jpurol.2016.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 11/23/2015] [Accepted: 02/28/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Despite many advances, the management of renal stones - especially lower caliceal stones (LCS) - remains a challenge. The gravity-dependent location of the lower calices hinders the spontaneous clearance of fragments, which can be a nidus for future growth and symptomatic recurrence. Currently, there is no standard adjunctive therapy to facilitate fragment passage. OBJECTIVES To report the safety and effectiveness of mechanical percussion diuresis and inversion (PDI) therapy for eliminating renal stones in children. PATIENTS AND METHODS Since November 2013, children with residual fragments (after shock wave lithotripsy or flexible ureteroscopy) or native symptomatic renal stones were prospectively included in a protocol of four PDI sessions. After giving written consent, the children drank 10 ml/kg of water 30 min before therapy. They then laid in a prone Trendelenburg position on a couch angled at 45° and received continuous 10-min mechanical percussion applied over the affected flank by a physiotherapist (Figure summary). Tolerance stone burden reduction and stone clearance were documented with ultrasound 4 weeks after the last session. RESULTS Seventeen participants, with a median age of 10.8 years (range 18 months to 18 years), received 82 PDI sessions performed over 22 months. The median stone diameter was 5 mm (range 3-9). All children tolerated the PDI therapy well. Over a median follow-up of 11 months (range 3-18), no significant adverse effects were noted. The overall stone-free rate was 65%. Four of the six patients with residual fragment passed their fragments. The patients who did not become stone free by PDI experienced a decrease in fragment size of 57% (range 34-71). The observance rate was 100%. DISCUSSION Many studies have demonstrated that the gravity-dependent position of the lower calyces appears to be an important factor limiting the clearance of LCS. Positioning patients with a degree of inversion in order to put the collecting system beyond the horizontal plane affected the LCS through gravitational force. Complications were rare. PDI appeared to save costs and have similar success rates as shock wave lithotripsy for native small renal stones in children. CONCLUSION PDI is safe and effective for facilitating gravity-dependent drainage of renal stones and provides an opportunity to treat children in a quick, non-invasive, economic, painless, non-radiative and diverting fashion. This therapy is a valuable alternative in the pattern of stone management. In case of persistent fragments, it is recommend that the number of sessions be increased to six.
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Affiliation(s)
- A Faure
- Paediatric Surgery Department, Aix-Marseille Université, APHM, CHU Hopital Nord, Marseille, France; Paediatric Surgery Department, Aix-Marseille Université, APHM, CHU Hopital La Timone, Marseille, France.
| | - E Dicrocco
- Urology Department, Aix-Marseille Université, APHM, CHU Hopital La Conception, Marseille, France
| | - G Hery
- Paediatric Surgery Department, Aix-Marseille Université, APHM, CHU Hopital La Timone, Marseille, France
| | - R Boissier
- Urology Department, Aix-Marseille Université, APHM, CHU Hopital La Conception, Marseille, France
| | - L Bienvenu
- Physical Therapy and Rehabilitation Department, Aix-Marseille Université, APHM, CHU Hopital La Conception, Marseille, France
| | - S Thirakul
- Physical Therapy and Rehabilitation Department, Aix-Marseille Université, APHM, CHU Hopital La Conception, Marseille, France
| | - P Maffei
- Physical Therapy and Rehabilitation Department, Aix-Marseille Université, APHM, CHU Hopital La Conception, Marseille, France
| | - N Panait
- Paediatric Surgery Department, Aix-Marseille Université, APHM, CHU Hopital Nord, Marseille, France
| | - G Karsenty
- Urology Department, Aix-Marseille Université, APHM, CHU Hopital La Conception, Marseille, France
| | - T Merrot
- Paediatric Surgery Department, Aix-Marseille Université, APHM, CHU Hopital Nord, Marseille, France
| | - P Alessandrini
- Paediatric Surgery Department, Aix-Marseille Université, APHM, CHU Hopital Nord, Marseille, France
| | - J-M Guys
- Paediatric Surgery Department, Aix-Marseille Université, APHM, CHU Hopital La Timone, Marseille, France
| | - E Lechevallier
- Urology Department, Aix-Marseille Université, APHM, CHU Hopital La Conception, Marseille, France
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Cannavo S, Bogazzi F, Colao A, De Marinis L, Maffei P, Gomez R, Graziano E, Monterubbianesi M, Grottoli S. Does pegvisomant treatment expertise improve control of resistant acromegaly? The Italian ACROSTUDY experience. J Endocrinol Invest 2015; 38:1099-109. [PMID: 25916431 DOI: 10.1007/s40618-015-0289-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 04/09/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE GH receptor antagonist pegvisomant is indicated for treatment of patients with resistant acromegaly. We compared safety and treatment outcomes of pegvisomant therapy in patients managed by Italian centers enrolling less or more than 15 cases in ACROSTUDY, a safety surveillance study of long-term pegvisomant treatment of patients with acromegaly. A noninterventional safety surveillance study in which safety and treatment outcomes of pegvisomant were evaluated on the basis of data collected during a 7-year period. METHODS A total of 204 acromegaly patients treated by seven centers enrolling 16-49 patients each (group A) and 137 subjects by 18 centers following 3-14 cases ( group B). RESULTS Patients of group A and B were treated for 4.4 ± 2.7 and 4.2 ± 2.2 years, respectively. IGF-1 ULN normalized in 64.4 % (n = 56) and 54.4 % (n = 31) in group A and B, respectively, after 1-year treatment, and in 57.3 % (n = 106) and 72.5 % (n = 87) at last visit. Starting doses were significantly higher in group A. They were progressively increased during treatment in both groups, but were higher in uncontrolled patients than in controlled ones only in group A. Reported adverse events were more frequent, and the prevalence of patients with adverse events was higher in group B. CONCLUSIONS On the basis of this original study approach, we could speculate that in the centers in which more patients are treated with pegvisomant, less adverse events are reported, but the long-term effectiveness is lower than in centers with less cases, perhaps because of an inadequate patient's selection.
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Affiliation(s)
- S Cannavo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - F Bogazzi
- Department of Endocrinology and Metabolic Diseases, Ospedale Cisanello, Pisa, Italy
| | - A Colao
- Endocrinological Clinic, Departmeno of Endocrinology and Molecular and Clinic Oncology, Policlinico Universitario Federico II, Naples, Italy
| | - L De Marinis
- Institute of Endocrinology, Cattolica del Sacro Cuore University, Policlinico A. Gemelli, Rome, Italy
| | - P Maffei
- III Medical Clinic, Department of Medicine, Azienda Ospedaliera di Padova, Padua, Italy
| | - R Gomez
- Pfizer Europe Medical Affairs, Endocrinology, Puurs, Belgium
| | - E Graziano
- Pfizer Italia, Medical Department Endocrinology, Rome, Italy
| | | | - S Grottoli
- Department of Medicine, Division of Endocrinology, Diabetology and Metabolism, Città della, Salute e della Scienza di Torino, University of Torino, Turin, Italy.
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19
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Comunello A, Dassie F, Martini C, De Carlo E, Mioni R, Battocchio M, Paoletta A, Fallo F, Vettor R, Maffei P. Heart rate variability is reduced in acromegaly patients and improved by treatment with somatostatin analogues. Pituitary 2015; 18:525-34. [PMID: 25261332 DOI: 10.1007/s11102-014-0605-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cardiovascular complications, including arrhythmias and cardiac sudden death, are the most common causes of enhanced mortality in acromegaly. However, few data are available on cardiac autonomic functions and sympathovagal balance in acromegalic patients. OBJECTIVE The aim of this study was to investigate both the time and frequency domain parameters of Heart Rate Variability (HRV), in order to characterize the cardiac autonomic functions in patients affected by acromegaly. This study correlated anthropometric, metabolic, echocardiographic parameters and blood pressure with those relating to HRV, to identify the main factors responsible for the HRV related alterations possibly present. We also aimed to analyze the effects of the treatment with somatostatin analogues (SSAs) on HRV. MATERIALS AND METHODS This study enrolled 47 acromegalic patients (23 males, age 49.1 ± 13.5 years) and 37 (13 males) age matched (52.3 ± 13.3 years) healthy subjects. All participants underwent 12-lead 24 h ECG Holter recordings and a HRV analysis of the ECG tracings was performed. The parameters obtained from the time domain analysis of HRV included pNN50, SDNN, SDNN index, SDANN and RMSSD. The power spectral analysis of HRV was obtained by summing powers of the LF (low frequency) and the HF (high frequency) band. Sympathovagal balance was estimated by calculating the LF/HF ratio during 24 h and 15 min of clinostatism. The HRV of 28 acromegalic patients was studied before and after SSAs treatment. RESULTS Acromegalic patients showed significantly lower SDNN and SDANN compared to controls. Diabetic and non-diabetic acromegalic patients showed decreased SDNN and SDANN, when compared to healthy subjects. Diabetic acromegalic patients had a lower LF/HF ratio during 24 h when compared to non-diabetic acromegalic patients. Similar results were obtained analyzing patients affected by acromegaly and impaired glucose tolerance. SDNN and SDANN were lowered by hypertension in the acromegalic population, when compared to controls, and hypertensive acromegalic patients also displayed a decreased LF/HF ratio during 24 h when compared to normotensive acromegalic subjects. Patients with ventricular arrhythmias in Lown classes 3-5 showed a decreased SDANN compared to patients in Lown class 0-2. The treatment with SSAs was able to ameliorate all the time domain parameters of HRV, without altering the 24 h LF/HF ratio. CONCLUSION Cardiac autonomic functions and sympathovagal balance are altered in patients affected by acromegaly and could be ameliorated by SSAs therapy. HRV analysis allows an estimation of the autonomic sympathovagal balance and may be a useful clinical tool for the cardiac risk stratification in acromegalic patients.
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Affiliation(s)
- A Comunello
- DIMED, Padua University Hospital, Padua, Italy
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20
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Grottoli S, Maffei P, Bogazzi F, Cannavò S, Colao A, Ghigo E, Gomez R, Graziano E, Monterubbianesi M, Jonsson P, De Marinis L. ACROSTUDY: the Italian experience. Endocrine 2015; 48:334-41. [PMID: 25150035 DOI: 10.1007/s12020-014-0393-9] [Citation(s) in RCA: 32] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 08/11/2014] [Indexed: 11/28/2022]
Abstract
ACROSTUDY is a world-wide non-interventional, post marketing surveillance study performed to monitor the safety and outcomes of pegvisomant (PEG) in clinical practice. We report data from acromegaly patients who have been included in the Italian ACROSTUDY registry. The data of 341 acromegaly patients (171 males) were available for analysis using data freeze (12/9/2012). Patients were enrolled in 25 Italian endocrine centres. Before and during PEG treatment IGF-I, liver enzymes, metabolic parameters, and pituitary MRI were assessed. Before PEG, 54.3% patients had been treated with medical therapy and surgery, 22.9% medical therapy only, and 15.8% medical plus radiation and surgical therapy. 199 adverse events were reported in 98 patients (28.7%). Serious adverse events were documented in 29 patients (8.5%). 71.1% of patients had no significant change in tumor volume. Central MRI reading was performed in 34 patients; in 7 patients, an increase in tumor volume was found. Hormonal efficacy progressively increased since the start of PEG. After 6 years, normal IGF-I levels were found in 70.9% of patients (mean daily dose 18.1 mg). 87.1% of patients were treated with daily PEG although in 8.8% of patients, it was administered 2-6 times per week and in 3.8% with weekly injections. 74.8% received a PEG dose 10-15 mg/daily. PEG is a drug with a favorable safety profile which is efficacious also considering that in Italy it is currently available as third-line therapy.
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Affiliation(s)
- S Grottoli
- Divisione di Endocrinologia, Diabetologia e Metabolismo, Dipartimento di Scienze Mediche, AO Città della Salute e della Scienza di Torino, Università di Torino, C.so AM Dogliotti 14, 10126, Turin, Italy,
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21
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Manara R, Citton V, Maffei P, Marshall JD, Naggert JK, Milan G, Vettor R, Baglione A, Vitale A, Briani C, Di Salle F, Favaro A. Degeneration and plasticity of the optic pathway in Alström syndrome. AJNR Am J Neuroradiol 2015; 36:160-5. [PMID: 25355816 PMCID: PMC7965932 DOI: 10.3174/ajnr.a4115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/04/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Alström syndrome is a rare inherited ciliopathy in which early progressive cone-rod dystrophy leads to childhood blindness. We investigated functional and structural changes of the optic pathway in Alström syndrome by using MR imaging to provide insight into the underlying pathogenic mechanisms. MATERIALS AND METHODS Eleven patients with genetically proved Alström syndrome (mean age, 23 years; range, 6-45 years; 5 females) and 19 age- and sex-matched controls underwent brain MR imaging. The study protocol included conventional sequences, resting-state functional MR imaging, and diffusion tensor imaging. RESULTS In patients with Alström syndrome, the evaluation of the occipital regions showed the following: 1) diffuse white matter volume decrease while gray matter volume decrease spared the occipital poles (voxel-based morphometry), 2) diffuse fractional anisotropy decrease and radial diffusivity increase while mean and axial diffusivities were normal (tract-based spatial statistics), and 3) reduced connectivity in the medial visual network strikingly sparing the occipital poles (independent component analysis). After we placed seeds in both occipital poles, the seed-based analysis revealed significantly increased connectivity in patients with Alström syndrome toward the left frontal operculum, inferior and middle frontal gyri, and the medial portion of both thalami (left seed) and toward the anterior portion of the left insula (right and left seeds). CONCLUSIONS The protean occipital brain changes in patients with Alström syndrome likely reflect the coexistence of diffuse primary myelin derangement, anterograde trans-synaptic degeneration, and complex cortical reorganization affecting the anterior and posterior visual cortex to different degrees.
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Affiliation(s)
- R Manara
- From the Department of Medicine and Surgery (R.M., A.V., F.D.S.), Neuroradiology, University of Salerno, Salerno, Italy
| | - V Citton
- Department of Radiology (V.C.), Neuroradiology Unit, IRCCS San Camillo Hospital, Venezia, Italy
| | - P Maffei
- Department of Internal Medicine (P.M., G.M., R.V.), University Hospital of Padova, Padova, Italy
| | - J D Marshall
- Jackson Laboratory (J.D.M., J.K.N.), Bar Harbor, Maine
| | - J K Naggert
- Jackson Laboratory (J.D.M., J.K.N.), Bar Harbor, Maine
| | - G Milan
- Department of Internal Medicine (P.M., G.M., R.V.), University Hospital of Padova, Padova, Italy
| | - R Vettor
- Department of Internal Medicine (P.M., G.M., R.V.), University Hospital of Padova, Padova, Italy
| | - A Baglione
- Department of Neurosciences (A.B., C.B., A.F.), University of Padua, Padova, Italy
| | - A Vitale
- From the Department of Medicine and Surgery (R.M., A.V., F.D.S.), Neuroradiology, University of Salerno, Salerno, Italy
| | - C Briani
- Department of Neurosciences (A.B., C.B., A.F.), University of Padua, Padova, Italy
| | - F Di Salle
- From the Department of Medicine and Surgery (R.M., A.V., F.D.S.), Neuroradiology, University of Salerno, Salerno, Italy
| | - A Favaro
- Department of Neurosciences (A.B., C.B., A.F.), University of Padua, Padova, Italy
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Bertrand P, Grieten L, Smeets C, Verbrugge F, Mullens W, Vrolix M, Rivero-Ayerza M, Verhaert D, Vandervoort P, Tong L, Ramalli A, Tortoli P, D'hoge J, Bajraktari G, Lindqvist P, Henein M, Obremska M, Boratynska M, Kurcz J, Zysko D, Baran T, Klinger M, Darahim K, Mueller H, Carballo D, Popova N, Vallee JP, Floria M, Chistol R, Tinica G, Grecu M, Rodriguez Serrano M, Osa-Saez A, Rueda-Soriano J, Buendia-Fuentes F, Domingo-Valero D, Igual-Munoz B, Alonso-Fernandez P, Quesada-Carmona A, Miro-Palau V, Palencia-Perez M, Bech-Hanssen O, Polte C, Lagerstrand K, Janulewicz M, Gao S, Erdogan E, Akkaya M, Bacaksiz A, Tasal A, Sonmez O, Turfan M, Kul S, Vatankulu M, Uyarel H, Goktekin O, Mincu R, Magda L, Mihaila S, Florescu M, Mihalcea D, Enescu O, Chiru A, Popescu B, Tiu C, Vinereanu D, Broch K, Kunszt G, Massey R, De Marchi S, Aakhus S, Gullestad L, Urheim S, Yuan L, Feng J, Jin X, Bombardini T, Casartelli M, Simon D, Gaspari M, Procaccio F, Hasselberg N, Haugaa K, Brunet A, Kongsgaard E, Donal E, Edvardsen T, Sahin T, Yurdakul S, Cengiz B, Bozkurt A, Aytekin S, Cesana F, Spano' F, Santambrogio G, Alloni M, Vallerio P, Salvetti M, Carerj S, Gaibazzi N, Rigo F, Moreo A, Wdowiak-Okrojek K, Michalski B, Kasprzak J, Shim A, Lipiec P, Generati G, Pellegrino M, Bandera F, Donghi V, Alfonzetti E, Guazzi M, Marcun R, Stankovic I, Farkas J, Vlahovic-Stipac A, Putnikovic B, Kadivec S, Kosnik M, Neskovic A, Lainscak M, Iliuta L, Szymanski P, Lipczynska M, Klisiewicz A, Sobieszczanska-Malek M, Zielinski T, Hoffman P, Gjerdalen GF, Hisdal J, Solberg E, Andersen T, Radunovic Z, Steine K, Svanadze A, Poteshkina N, Krylova N, Mogutova P, Shim A, Kasprzak J, Szymczyk E, Wdowiak-Okrojek K, Michalski B, Stefanczyk L, Lipiec P, Benedek T, Matei C, Jako B, Suciu Z, Benedek I, Yaroshchuk NA, Kochmasheva VV, Dityatev VP, Kerbikov OB, Przewlocka-Kosmala M, Orda A, Karolko B, Mysiak A, Kosmala W, Rechcinski T, Wierzbowska-Drabik K, Lipiec P, Chmiela M, Kasprzak J, Aziz A, Hooper J, Rayasamudra S, Uppal H, Asghar O, Potluri R, Zaroui A, Mourali M, Rezine Z, Mbarki S, Jemaa M, Aloui H, Mechmeche R, Farhati A, Gripari P, Maffessanti F, Tamborini G, Muratori M, Fusini L, Vignati C, Bartorelli A, Alamanni F, Agostoni P, Pepi M, Ruiz Ortiz M, Mesa D, Delgado M, Seoane T, Carrasco F, Martin M, Mazuelos F, Suarez De Lezo Herreros De Tejada J, Romero M, Suarez De Lezo J, Brili S, Stamatopoulos I, Misailidou M, Chrisochoou C, Christoforatou E, Stefanadis C, Ruiz Ortiz M, Mesa D, Delgado M, Martin M, Seoane T, Carrasco F, Ojeda S, Segura J, Pan M, Suarez De Lezo J, Cammalleri V, Ussia G, Muscoli S, Marchei M, Sergi D, Mazzotta E, Romeo F, Igual Munoz B, Bel Minguez A, Perez Guillen M, Maceira Gonzalez A, Monmeneu Menadas J, Hernandez Acuna C, Estornell Erill J, Lopez Lereu P, Francisco Jose Valera Martinez F, Montero Argudo A, Sunbul M, Akhundova A, Sari I, Erdogan O, Mutlu B, Cacicedo A, Velasco Del Castillo S, Anton Ladislao A, Aguirre Larracoechea U, Rodriguez Sanchez I, Subinas Elorriaga A, Oria Gonzalez G, Onaindia Gandarias J, Laraudogoitia Zaldumbide E, Lekuona Goya I, Ding W, Zhao Y, Lindqvist P, Nilson J, Winter R, Holmgren A, Ruck A, Henein M, Attenhofer Jost CH, Soyka R, Oxenius A, Kretschmar O, Valsangiacomo Buechel E, Greutmann M, Weber R, Keramida K, Kouris N, Kostopoulos V, Karidas V, Damaskos D, Makavos G, Paraskevopoulos K, Olympios C, Eskesen K, Olsen N, Fritz-Hansen T, Sogaard P, Cameli M, Lisi M, Righini F, Curci V, Massoni A, Natali B, Maccherini M, Chiavarelli M, Massetti M, Mondillo S, Mabrouk Salem Omar A, Ahmed Abdel-Rahman M, Khorshid H, Rifaie O, Santoro C, Santoro A, Ippolito R, De Palma D, De Stefano F, Muscariiello R, Galderisi M, Squeri A, Censi S, Baldelli M, Grattoni C, Cremonesi A, Bosi S, Saura Espin D, Gonzalez Canovas C, Gonzalez Carrillo J, Oliva Sandoval M, Caballero Jimenez L, Espinosa Garcia M, Garcia Navarro M, Valdes Chavarri M, De La Morena Valenzuela G, Ryu S, Shin D, Son J, Choi J, Goh C, Choi J, Park J, Hong G, Sklyanna O, Yuan L, Yuan L, Planinc I, Bagadur G, Ljubas J, Baricevic Z, Skoric B, Velagic V, Bijnens B, Milicic D, Cikes M, Gospodinova M, Chamova T, Guergueltcheva V, Ivanova R, Tournev I, Denchev S, Ancona R, Comenale Pinto S, Caso P, Arenga F, Coppola M, Calabro R, Neametalla H, Boitard S, Hamdi H, Planat-Benard V, Casteilla L, Li Z, Hagege A, Mericskay M, Menasche P, Agbulut O, Merlo M, Stolfo D, Anzini M, Negri F, Pinamonti B, Barbati G, Di Lenarda A, Sinagra G, Stolfo D, Merlo M, Pinamonti B, Gigli M, Poli S, Porto A, Di Nora C, Barbati G, Di Lenarda A, Sinagra G, Coppola C, Piscopo G, Cipresso C, Rea D, Maurea C, Esposito E, Arra C, Maurea N, Nemes A, Kalapos A, Domsik P, Forster T, Voilliot D, Huttin O, Vaugrenard T, Schwartz J, Sellal JM, Aliot E, Juilliere Y, Selton-Suty C, Sanchez Millan PJ, Cabeza Lainez P, Castillo Ortiz J, Chueca Gonzalez E, Gheorghe L, Fernandez Garcia P, Herruzo Rojas M, Del Pozo Contreras R, Fernandez Garcia M, Vazquez Garcia R, Rosca M, Popescu B, Botezatu D, Calin A, Beladan C, Gurzun M, Enache R, Ginghina C, Farouk H, Al-Maimoony T, Alhadad A, El Serafi M, Abdel Ghany M, Poorzand H, Mirfeizi S, Javanbakht A, Tellatin S, Famoso G, Dassie F, Martini C, Osto E, Maffei P, Iliceto S, Tona F, Radunovic Z, Steine K, Jedrzejewska I, Braksator W, Krol W, Swiatowiec A, Sawicki J, Kostarska-Srokosz E, Dluzniewski M, Maceira Gonzalez AM, Cosin-Sales J, Diago J, Aguilar J, Ruvira J, Monmeneu J, Igual B, Lopez-Lereu M, Estornell J, Olszanecka A, Dragan A, Kawecka-Jaszcz K, Czarnecka D, Scholz F, Gaudron P, Hu K, Liu D, Florescu C, Herrmann S, Bijnens B, Ertl G, Stoerk S, Weidemann F, Krestjyaninov M, Razin V, Gimaev R, Bogdanovic Z, Burazor I, Deljanin Ilic M, Peluso D, Muraru D, Cucchini U, Mihaila S, Casablanca S, Pigatto E, Cozzi F, Punzi L, Badano L, Iliceto S, Zhdanova E, Rameev V, Safarova A, Moisseyev S, Kobalava Z, Magnino C, Omede' P, Avenatti E, Presutti D, Losano I, Moretti C, Bucca C, Gaita F, Veglio F, Milan A, Bellsham-Revell H, Bell A, Miller O, Simpson J, Hwang Y, Kim G, Jung M, Woo G, Driessen M, Leiner T, Schoof P, Breur J, Sieswerda G, Meijboom F, Bellsham-Revell H, Hayes N, Anderson D, Austin B, Razavi R, Greil G, Simpson J, Bell A, Zhao X, Xu X, Qin Y, Szmigielski CA, Styczynski G, Sobczynska M, Placha G, Kuch-Wocial A, Ikonomidis I, Voumbourakis A, Triantafyllidi H, Pavlidis G, Varoudi M, Papadakis I, Trivilou P, Paraskevaidis I, Anastasiou-Nana M, Lekakis I, Kong W, Yip J, Ling L, Milan A, Tosello F, Leone D, Bruno G, Losano I, Avenatti E, Sabia L, Veglio F, Zaborska B, Baran J, Pilichowska-Paszkiet E, Sikora-Frac M, Michalowska I, Kulakowski P, Budaj A, Mega S, Bono M, De Francesco V, Castiglione I, Ranocchi F, Casacalenda A, Goffredo C, Patti G, Di Sciascio G, Musumeci F, Kennedy M, Waterhouse D, Sheahan R, Foley D, Mcadam B, Ancona R, Comenale Pinto S, Caso P, Arenga F, Coppola M, Calabro R, Remme EW, Smedsrud MK, Hasselberg NE, Smiseth OA, Edvardsen T, Halmai L, Nemes A, Kardos A, Neubauer S, Degiovanni A, Baduena L, Dell'era G, Occhetta E, Marino P, Hotchi J, Yamada H, Nishio S, Bando M, Hayashi S, Hirata Y, Amano R, Soeki T, Wakatsuki T, Sata M, Lamia B, Molano L, Viacroze C, Cuvelier A, Muir J, Lipczynska M, Piotr Szymanski P, Anna Klisiewicz A, Lukasz Mazurkiewicz L, Piotr Hoffman P, Van 'T Sant J, Wijers S, Ter Horst I, Leenders G, Cramer M, Doevendans P, Meine M, Hatam N, Goetzenich A, Aljalloud A, Mischke K, Hoffmann R, Autschbach R, Sikora-Frac M, Zaborska B, Maciejewski P, Bednarz B, Budaj A, Evangelista A, Torromeo C, Pandian N, Nardinocchi P, Varano V, Schiariti M, Teresi L, Puddu P, Storve S, Dalen H, Snare S, Haugen B, Torp H, Fehri W, Mahfoudhi H, Mezni F, Annabi M, Taamallah K, Dahmani R, Haggui A, Hajlaoui N, Lahidheb D, Haouala H, Colombo A, Carminati M, Maffessanti F, Gripari P, Pepi M, Lang R, Caiani E, Walker J, Abadi S, Agmon Y, Carasso S, Aronson D, Mutlak D, Lessick J, Saxena A, Ramakrishnan S, Juneja R, Ljubas J, Reskovic Luksic V, Matasic R, Pezo Nikolic B, Lovric D, Separovic Hanzevacki J, Quattrone A, Zito C, Alongi G, Vizzari G, Bitto A, De Caridi G, Greco M, Tripodi R, Pizzino G, Carerj S, Ibrahimi P, Jashari F, Johansson E, Gronlund C, Bajraktari G, Wester P, Henein M, Kosmala W, Marwick T, Souza JRM, Zacharias LGT, Geloneze B, Pareja JC, Chaim A, Nadruz WJ, Coelho OR, Apostolovic S, Stanojevic D, Jankovic-Tomasevic R, Salinger-Martinovic S, Djordjevic-Radojkovic D, Pavlovic M, Tahirovic E, Musial-Bright L, Lainscak M, Duengen H, Filipiak D, Kasprzak J, Lipiec P. Poster session Wednesday 11 December all day display: 11/12/2013, 09:30-16:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet202] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Romano S, Maffei P, Bettini V, Milan G, Favaretto F, Gardiman M, Marshall JD, Greggio NA, Pozzan GB, Collin GB, Naggert JK, Bronson R, Vettor R. Alström syndrome is associated with short stature and reduced GH reserve. Clin Endocrinol (Oxf) 2013; 79:529-36. [PMID: 23445176 PMCID: PMC3718851 DOI: 10.1111/cen.12180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 02/01/2013] [Accepted: 02/09/2013] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Alström syndrome (ALMS) is a rare autosomal recessive monogenic disease included in an emerging class of genetic disorders called 'ciliopathies' and is likely to impact the central nervous system as well as metabolic and endocrine function. Individuals with ALMS present clinical features resembling a growth hormone deficiency (GHD) condition, but thus far no study has specifically investigated this aspect in a large population. MATERIAL AND METHODS Twenty-three patients with ALMS (age, 1-52 years; 11 males, 12 females) were evaluated for anthropometric parameters (growth charts and standard deviation score (SDS) of height, weight, BMI), GH secretion by growth hormone-releasing hormone + arginine test (GHRH-arg), bone age, and hypothalamic-pituitary magnetic resonance imaging (MRI). A group of 17 healthy subjects served as controls in the GH secretion study. Longitudinal retrospective and prospective data were utilized. RESULTS The length-for-age measurements from birth to 36 months showed normal growth with most values falling within -0·67 SDS to +1·28 SDS. A progressive decrease in stature-for-age was observed after 10 years of age, with a low final height in almost all ALMS subjects (>16-20 years; mean SDS, -2·22 ± 1·16). The subset of 12 patients with ALMS tested for GHRH-arg showed a significantly shorter stature than age-matched controls (154·7 ± 10·6 cm vs 162·9 ± 4·8 cm, P = 0·009) and a mild increase in BMI (Kg/m(2) ) (27·8 ± 4·8 vs 24·1 ± 2·5, P = 0·007). Peak GH after GHRH-arg was significantly lower in patients with ALMS in comparison with controls (11·9 ± 6·9 μg/l vs 86·1 ± 33·2 μg/l, P < 0·0001). Severe GHD was evident biochemically in 50% of patients with ALMS. The 10 adult ALMS patients with GHD showed a reduced height in comparison with those without GHD (149·7 ± 6·2 cm vs 161·9 ± 9·2 cm, P = 0·04). MRIs of the diencephalic and pituitary regions were normal in 11 of 12 patients. Bone age was advanced in 43% of cases. CONCLUSIONS Our study shows that 50% of nonobese ALMS patients have an inadequate GH reserve to GHRH-arg and may be functionally GH deficient. The short stature reported in ALMS may be at least partially influenced by impairment of GH secretion.
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Affiliation(s)
- S Romano
- Department of Medicine, University of Padua, Padua, Italy
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Tellatin S, Famoso G, Dassie F, Maffei P, Osto E, Martini C, Vettor R, Iliceto S, Tona F. Coronary microvascular dysfunction in patients with acromegaly: a hint for their increased cardiovascular risk. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.2658] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Barrett T, Farmer A, Aymé S, Maffei P, McCafferty S, Mlynarski W, Nunes V, Paquis V, Parkinson K, Rohayem J, Sinnott R, Tillmann V, Tranebjaerg L. http://www.euro-wabb.org: an EU Register for Alstrom, Bardet Biedl andother rare syndromes. Cilia 2012. [PMCID: PMC3555751 DOI: 10.1186/2046-2530-1-s1-p2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Maffei P. Massage et douleur postopératoire après chirurgie lombaire. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.403] [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: 11/28/2022]
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Kocova M, Sukarova-Angelovska E, Kacarska R, Maffei P, Milan G, Marshall JD. The unique combination of dermatological and ocular phenotypes in Alström syndrome: severe presentation, early onset and two novel ALMS1 mutations. Br J Dermatol 2011; 164:878-80. [PMID: 21128906 DOI: 10.1111/j.1365-2133.2010.10157.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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De Carlo E, Baiguera S, Conconi MT, Vigolo S, Grandi C, Lora S, Martini C, Maffei P, Tamagno G, Vettor R, Sicolo N, Parnigotto PP. Pancreatic acellular matrix supports islet survival and function in a synthetic tubular device: in vitro and in vivo studies. Int J Mol Med 2010; 25:195-202. [PMID: 20043127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Increasing pancreatic islet survival and function is a starting point for obtaining a valuable bioartificial pancreas for the treatment of type 1 diabetes. In this context, decellularized matrices, obtained after the removal of tissue cellular part, are known to support in vitro adhesion, growth, and function of several cell types. We demonstrate that a homologous acellular pancreatic matrix is a suitable scaffold for rat islet cultures maintaining their long-term viability and function. Islets adhered to the pancreatic matrix showed a constant glucose-induced insulin release during long-term in vitro incubation, while islets cultured without a matrix or on the liver matrix showed a progressive reduction. In order to obtain implantable devices, acellular matrix/islet cultures were entrapped into poly(vinyl alcohol) (PVA)/ poly(ethylene glycol) (PEG) tubes obtained by the freezing/thawing procedure. Under this condition, an in vitro constant insulin release was detected. The devices were then implanted into diabetic rats where reduced insulin requirement was noted suggesting insulin secretory activity of islets contained in the device. Indeed, immunofluorescence confirmed the presence of insulin- and glucagon-producing cells into the explanted devices. These data show that PVA/PEG semi-permeable membrane can obtain devices that restore, at least in part, insulin secretion.
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Affiliation(s)
- E De Carlo
- Clinica Medica III, Hospital/University of Padova, I-35128 Padova, Italy.
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Abstract
Cardiac autonomic dysfunction is associated with increased cardiovascular mortality. No data on sympathovagal balance are available in patients with Cushing's syndrome, in whom cardiovascular risk is high. We studied 10 patients with newly diagnosed Cushing's syndrome (1 male/9 females; age mean+/-SD, 47+/-10 yr) and 10 control subjects matched for age, sex, body mass index, and cardiovascular risk factors. In both groups there were 7 patients with arterial hypertension, 3 with diabetes mellitus, and 2 with obesity. Cardiac autonomic function was evaluated by analysis of short time heart rate variability (HRV) measures in frequency domain over 24-h, daytime, and nighttime. The 24-h ambulatory blood pressure monitoring and echocardiography were also performed. In comparison with controls, patients with Cushing's syndrome had lower 24-h (1.3+/-0.6 vs 3.7+/-1.5, mean+/-SD, p<0.01), daytime (2.0+/-1.4 vs 4.5+/-1.6, p<0.01), and night-time (1.0+/-0.4 vs 3.5+/-2.3, p<0.01) low-frequency/ high frequency (LF/HF) power ratio. In the presence of similar LF power, the difference was due to elevation in HF power in Cushing's syndrome compared to controls: 24-h, 12.7+/-6.7 vs 5.8+/-2.8, p<0.01; daytime, 10.2+/-7.3 vs 4.5+/-2.1, p<0.05; nighttime, 14.2+/-7.0 vs 7.8+/-4.7, p<0.05. Eight Cushing patients vs 4 controls had a non-dipping blood pressure profile. At echocardiography, Cushing patients had a greater left ventricular mass index and/or relative wall thickness, and impaired diastolic function, compared with controls. Compared to controls, patients with Cushing's syndrome showed a sympathovagal imbalance, characterized by a relatively increased parasympathetic activity. Whether this autonomic alteration is meant to counterbalance cortisol-induced effects on blood pressure and cardiac structure/function or has a different pathophysiological significance is still unknown.
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Affiliation(s)
- F Fallo
- Department of Medical and Surgical Sciences, University of Padua, 35128 Padua, Italy.
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Maffei P, Lombardi Borgia S, Sforzini A, Bergamante V, Ceschel GC, Fini A, Ronchi C. Mucoadhesive Tablets for Buccal Administration Containing Sodium Nimesulide. Drug Deliv 2008; 11:225-30. [PMID: 15371103 DOI: 10.1080/10717540490446017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The possibility of improving the flux of nimesulide across the buccal mucosa using the drug in the form of a sodium salt was investigated in our study. The salt form may increase to flux across buccal membrane, starting from a suspension; its lower permeation coefficient is compensated by a higher concentration gradient. The salt was inserted into a mucoadhesive tablet for buccal administration. The tablets were designed to prevent the loss of the drug into the saliva by means of a protective layer and placed on the area not in contact with the mucosa. Ten volunteers were used. The in vitro release from mucoadhesive tablets was examined through a porcine buccal mucosa, using a standard Franz cell, modified for present purposes. The advantages of a higher concentration gradient for the flux, related to a higher solubility of the salt, and to a sufficiently high permeation coefficient of the drug, despite the ionized form, could not be completely exploited, because the composition of the formulation destroys the chemical form of the drug.
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Affiliation(s)
- P Maffei
- Pharmaceutical Sciences Department, University of Bologna, Bologna, Italy
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Mioni R, Xamin N, Zuliani L, Belligoli A, Pierobon A, Bleve L, Granzotto M, Maffei P, Sicolo N, Vettor R, Fallo F. 9.7 Insulin-Resistance and Altered Circadian Blood Pressure Profile in Normotensive Young Women with Polycystic Ovary Syndrome. High Blood Press Cardiovasc Prev 2008. [DOI: 10.1007/bf03263679] [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: 11/27/2022] Open
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Colao A, Arnaldi G, Beck-Peccoz P, Cannavò S, Cozzi R, degli Uberti E, De Marinis L, De Menis E, Ferone D, Gasco V, Giustina A, Grottoli S, Lombardi G, Maffei P, Martino E, Minuto F, Pivonello R, Ghigo E. Pegvisomant in acromegaly: why, when, how. J Endocrinol Invest 2007; 30:693-9. [PMID: 17923803 DOI: 10.1007/bf03347452] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Colao
- Department of Molecular and Clinical Endocrinology and Oncology, University Federico II of Naples, Naples, Italy
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Barzon L, Maffei P, Sonino N, Pilon C, Baldazzi L, Balsamo A, Del Maschio O, Masi G, Trevisan M, Pacenti M, Fallo F. The role of 21-hydroxylase in the pathogenesis of adrenal masses: review of the literature and focus on our own experience. J Endocrinol Invest 2007; 30:615-23. [PMID: 17848847 DOI: 10.1007/bf03346358] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
An exaggerated response of 17- hydroxyprogesterone (17-OHP) to exogenous ACTH stimulation has been found in 30 to 70% of patients with incidentally discovered adrenal tumors, supporting the concept that congenital 21- hydroxylase deficiency may be a predisposing factor for adrenocortical tumorigenesis. Decreased expression of 21-hydroxylase gene has been observed in sporadic non-functioning adrenocortical adenomas and adrenocortical carcinomas, in agreement with the reduced steroidogenic activity found in these types of tumors. Screening studies for the presence of mutations in CYP21A2 gene, encoding 21-hydroxylase, in patients with sporadic adrenocortical tumors yielded discordant results. Overall, a higher frequency of germline 21-hydroxylase mutation carriers has been found among patients with adrenal tumors, including incidentalomas, than in the general population. However, the presence of mutations did not correlate with endocrine test results and tumor mass features, suggesting that 21-hydroxylase deficiency does not represent a relevant mechanism in adrenal tumorigenesis. Mechanisms leading to reduced 21-hydroxylase expression and activity are still unknown.
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Affiliation(s)
- L Barzon
- Department of Histology, Microbiology and Medical Biotechnologies, University of Padua, Padua, Italy
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Mulatero P, Leotta G, Terzolo M, Maffei P, Monticone S, Saglio E, Viola A, Tosello F, Degli Uberti EC, Angeli A, Veglio F. Relationship Between CYP11B2 -344T/C Gene Polymorphism and Blood Pressure Values in Acromegalic Patients. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00092] [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: 11/02/2022] Open
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Abstract
Binary systems containing Nimesulide and PEG 4000 were prepared by the melting method in the concentration range 3-25% w/w of the drug. The systems are homogeneous in the molten state, while, after cooling, two phases were formed of different density. They were manually separated and separately studied. Upper phases are richer in PEG 4000, while the lower ones contain the drug at levels even higher than those of the starting mixtures. The two phases were examined by DSC and UV techniques; high dissolution rates were observed with upper phases, while lower phases did not display improvement with respect to a physical mixture or micronized drug. With the aim to avoid phase separation, a third component was added to the binary system containing 5% w/w drug, during the melting. The ternary systems were prepared containing sodium dodecyl sulfate, triethanolamine, polysorbate 80, poloxamer, and cetomacrogol: a homogeneous phase was obtained only in two cases (with the addition of sodium dodecyl sulfate and triethanolamine), but only in the presence of triethanolamine dissolution rate was improved. Finally, a factor analysis was performed for complex systems containing a combination of the four additives, each one at two concentrations (1.25 and 2.5% w/w), to evaluate the optimum system in terms of both kinetic and composition parameters. Results suggest that additives affect mainly the physical aspect of the formulation rather than the kinetic behavior, which appears little improved only in a few cases.
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Affiliation(s)
- G Ceschel
- Department of Pharmaceutical Sciences, Via San Donato 19/2, University of Bologna, 40127, Italy.
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Abstract
We describe the case of a patient with obscure gastrointestinal bleeding and anaemia, who required repeated transfusions for about 1 year. Because of the absence of a certain diagnosis and of a surgical approach indication, we established long-acting octreotide therapy, obtaining clinical stabilisation and interruption of the transfusional need. Withdrawal of long-acting somatostatin analogue therapy was associated with renewal of bleeding that was again successfully stopped by continuous i.v. somatostatin administration followed by re-establishment of the long-acting octreotide therapy. We suggested, in absence of surgical indications and when only palliative therapies are available, a therapeutic approach with long-term SMS analogues in patients with lower digestive bleeding of a known or unknown source.
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Affiliation(s)
- G Tamagno
- Department of Medical and Surgical Sciences, Medical Clinic 111, University of Padua, 35128 Padua, Italy
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De Carlo E, Tamagno G, Martini C, Maffei P, Rubello D, Luca M, Sicolo N. Autoimmune diabetes mellitus, Hodgkin's disease and Graves' ophthalmopathy in a patient with 8.1 ancestral haplotype. Horm Metab Res 2004; 36:97-100. [PMID: 15002059 DOI: 10.1055/s-2004-814218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In this report, we describe the case of a 43-year-old woman affected by type 1 diabetes mellitus diagnosed 8 years before, who developed Graves' disease 2 years after chemotherapy and mantle radiotherapy treatment for Hodgkin's disease. Bilateral Graves' ophthalmopathy appeared four months before our observations. Intravenous methyl-prednisolone therapy was started, but was interrupted due to severe metabolic failure. Autoantibodies (anti-islet cells, anti-thyroid, thyroid-stimulating, non-organ-specific) were positive. Since the clinical picture suggested a genetic immunological ground predisposing to autoimmunity, we evaluated her HLA haplotype. Genomic typing of the patient permitted identification of the 8.1 ancestral haplotype, a Caucasoid haplotype unique in its association with many immunopathological diseases. Moreover, we also observed a haplotype unusual in Caucasians, trans DRB1*1101, DQA1*0103, DQB1*0603. To our knowledge, HLA-related genetic risk of developing thyroid autoimmunity after neck irradiation has never been studied. Although we cannot confirm a direct association between the 8.1 ancestral haplotype or DRB1*1101, DQA1*0103, DQB1*0603 and the diseases described, we suggest considering immunological parameters and HLA typing in candidate patients for mantle radiation therapy for Hodgkin's disease or other tumors. HLA haplotype determination could be useful in identifying the patients at raised risk of developing autoimmune diseases after irradiation, thus permitting a more appropriate follow-up schedule.
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Affiliation(s)
- E De Carlo
- Department of Medical and Surgical Sciences, Clinica Medica III, University of Padua, Via N. Giustiniani 2, 35128 Padua, Italy.
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Abstract
OBJECTIVE To document frequency of severe hypertriglyceridaemia in Alström's syndrome (AS) and its relationship to hepatic and renal function, glycaemia and insulin resistance. PATIENTS AND METHODS Thirty-seven subjects with AS aged 5-35 years, 51% male, were assessed at multidisciplinary clinics in Canada, UK and Italy. Diagnostic criteria were: severe cone/rod dystrophy leading to severe visual impairment in early childhood, sensorineural deafness, moderate overall obesity and normal intelligence. Three patients were treated with thyroxine for primary hypothyroidism and one female patient for secondary amenorrhoea with 20 micro g ethinyloestradial combined oral contraceptive. Two male patients were receiving monthly intramuscular testosterone enanthate for secondary hypogonadism. Fasting bloods were taken for serum insulin, serum glucose, serum triglycerides, hepatic and renal function and glycosylated Hb. Triglyceride levels > 8 mmol/l and fasting serum insulin levels > 16 microunits/ml were considered to represent severe hypertriglyceridaemia and severe insulin resistance, respectively. All subjects with (23) hypertriglyceridaemia also had high insulin resistance, as measured by HOMA modelling. However, there was no significant correlation between log tyriglyceride and log serum insulin or HOMA in the whole group (P = 0.2 and 0.14, respectively). There was no clear relationship between serum triglyceride levels and age, body mass index (BMI), hepatic or renal impairment or glycaemia. CONCLUSION The first overview of serum triglyceride levels in a significant number of reported cases of Alström Syndrome shows an overlap between severe hypertriglyceridaemia and severe hyperinsulinism, but not a direct correlation between the two nor with insulin resistance measured by HOMA. Triglyceride levels were not related to glycaemia, hepatic or renal dysfunction.
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Affiliation(s)
- R B Paisey
- Torbay Hospital, Lawes Bridge, Torquay, UK.
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Maffei P, Lombardi Borgia S, Sforzini A, Yasin A, Ronchi C, Ceschel G. Design and in vitro-in vivo evaluation of a bi-layered tablet containing benzocaine for local buccal administration. J Drug Deliv Sci Technol 2004. [DOI: 10.1016/s1773-2247(04)50065-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Information about the stability of drug components and drug formulations is needed to predict the shelf-life of the final products. The studies on the interaction between the drug and the excipients may be carried out by means of accelerated stability tests followed by analytical determination of the active principle (HPLC and other methods) and by means of the differential scanning calorimetry (DSC). This research has been focused to the acetyl salicylic acid (ASA) physical-chemical characterisation by using DSC method in order to evaluate its compatibility with some of the most used excipients. It was possible to show, with the DSC method, the incompatibility of magnesium stearate with ASA; the HPLC data confirm the reduction of ASA concentration in the presence of magnesium stearate. With the other excipients the characteristic endotherms of the drug were always present and no or little degradation was observed with the accelerated stability tests. Therefore, the results with the DSC method are comparable and in good agreement with the results obtained with other methods.
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Affiliation(s)
- G C Ceschel
- Dipartimento di Scienze Farmaceutiche, Facoltà di Farmacia, Istituto di Scienze Chimiche, Alma Mater Studiorum, Università di Bologna, Via S. Donato 15, 40127 Bologna, Italy
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Maffei P, Martini C, Mioni R, De Carlo E, Vettor R, Federspil G, Sicolo N. The cardiac complications of acromegaly. J Endocrinol Invest 2003; 26:20-7. [PMID: 15233207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Affiliation(s)
- P Maffei
- Department of Medical and Surgical Sciences, Clinica Medica 3, University School of Medicine, Padua, Italy.
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Ceschel GC, Maffei P, Sforzini A, Lombardi Borgia S, Yasin A, Ronchi C. In vitro permeation through porcine buccal mucosa of caffeic acid phenetyl ester (CAPE) from a topical mucoadhesive gel containing propolis. Fitoterapia 2002; 73 Suppl 1:S44-52. [PMID: 12495709 DOI: 10.1016/s0367-326x(02)00190-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Recent studies have shown that propolis has on the oral cavity appreciable antibacterial, antifungal and antiviral actions, as well as anti-inflammatory, anaesthetic and cytostatic properties. In light of these studies, an assessment of the diffusion and permeation of caffeic acid phenetyl ester (CAPE) through porcine buccal mucosa was considered useful as a possible application in the stomatological field. To do so, a mucoadhesive topical gel was prepared to apply to the buccal mucosa. The gel was formulated in such a way as to improve the solubility of the propolis, conducting to an increase of the flux. The mucosal permeation of CAPE from the formulation was evaluated using Franz cells, with porcine buccal mucosa as septum between the formulation (donor compartment) and the receptor phase chamber. The diffusion through the membrane was determined by evaluating the amount of CAPE present in the receiving solution, the flux and the permeation coefficient (at the steady state) in the different formulations at set intervals. Qualitative and quantitative determinations were done by HPLC analysis. From the results, CAPE allowed a high permeability coefficient in comparison to the coefficient of other molecules, as expected from its physical-chemical structure. Moreover, the developed gel improved the CAPE flux approximately 35 times more with respect to an ethanol solution formulated at the same gel concentration. The developed gel was also tested in order to evaluate the mucoadhesive behaviour and comfort in vivo on 10 volunteers in a period of 8 h. The in vivo evaluation of mucoadhesive gel revealed adequate comfort and non-irritancy during the period of study and it was well accepted by the volunteers.
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Affiliation(s)
- G C Ceschel
- Dipartimento di Scienze Farmaceutiche, Università di Bologna, Via San Donato 19/2, 4100, Bologna, Italy.
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Ceschel GC, Maffei P, Porzio S, Melillo G, Caselli GF, Dragani MC, Gentile MM, Clavenna G. In vitro permeation screening of a new formulation of thiocolchicoside containing various enhancers. Drug Deliv 2002; 9:259-63. [PMID: 12511205 DOI: 10.1080/10717540260397882] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Thiocolchicoside, a muscle relaxant agent with anti-inflammatory and analgesic actions, also is used topically for the treatment of muscular spasms and for rheumatologic, orthopedic, and traumatologic disorders. In this study, thiocolchicoside was formulated to use as foam to avoid contact with the afflicted area during the spreading phase. To enhance drug penetration, various enhancers were added to the base formulation. The tested enhancers were ethoxyethylendiglycol (Transcutol), highly purified phosphatidylcholine (Lipoid S20), capsaicin, propylene glycol dipelargonate (DPPG), and glycolysed ethoxylated glycerides (Labrafil M1944 CS). The transdermal absorption of the tested formulations containing enhancers, in comparison with base formulation, was evaluated in vitro through rat skin using standard Franz diffusion cells. Base formulation was found to have a higher permeation profile than the simple aqueous and hydroalcoholic solutions of the drug, meaning that the base formulation by itself enhances the drug permeation. Among the tested formulations, only the formulation containing DPPG/ethanol was found to be statistically different, showing an enhancement factor of 3.58. In the same experimental session, Muscoril ointment, the commercially available pharmaceutical product containing the same thiocolchicoside concentration (0.25%), also was tested. The formulation containing DPPG/ethanol showed a 4.86 times increase of permeability constant in comparison with Muscoril ointment. The formulation containing DPPG/ethanol as an enhancer could be a good candidate for a new topical foam, considering its good characteristics of permeability and compliance.
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Affiliation(s)
- G C Ceschel
- Pharmaceutical Sciences Department, University of Bologna, Bologna, Italy
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Maffei P, Kiene L, Canet D. Application of NMR microimaging by radio-frequency field gradients to the observation of solvent penetration in polymeric materials. Macromolecules 2002. [DOI: 10.1021/ma00052a007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ceschel GC, Maffei P, Lombardi Borgia S. Correlation between the transdermal permeation of ketoprofen and its solubility in mixtures of a pH 6.5 phosphate buffer and various solvents. Drug Deliv 2002; 9:39-45. [PMID: 11839207 DOI: 10.1080/107175402753413163] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
The passage of a drug through the skin is directly proportional to the concentration of the drug in the donor phase and to the permeability coefficient constant Kp. Kp is determined essentially by two factors: the dissolution of the drug in the stratum corneum (measured by the partition coefficient P) and the diffusion in the same stratum (measured by the diffusion constant D). In our study, several saturated solutions of ketoprofen in mixtures of a pH 6.5 phosphate buffer and various co-solvents were studied to find correlations between the solubility of the ketoprofen in the mixtures and its permeation parameters in in vitro permeation studies with Franz cells. The results show that D does not change in the different mixtures; the diffusion of the drug into the stratum corneum is not influenced by the presence of the co-solvents, whereas the partition coefficient is strongly influenced. In particular, Kp and P were found to be inversely proportional to solubility, meaning that when the co-solvent increases the solubility, the partition of the drug and consequently Kp decrease. These findings were confirmed in some developed gels, and the developed gels were found to enhance the ketoprofen permeation with respect to the formulation in a commercial Fastum gel.
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Affiliation(s)
- G C Ceschel
- Pharmaceutical Sciences Department, Bologna University, Bologna, Italy
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Sicolo N, Martini C, Mioni R, Maffei P, Scandellari C. [Errors in medicine: consequences and prevention]. Pathologica 2001; 93:613-8. [PMID: 11725372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Affiliation(s)
- N Sicolo
- Dipartimento di Scienze Mediche e Chirurgiche, Clinica Medica 3 Azienda Ospedale, Università di Padova, Padova, Italia
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Abstract
The antimycotic imidazole derivative clotrimazole is employed locally for the treatment of genitourinary tract mycotic infections and is formulated as creams, foams, tablets, gels, irrigations, or pessaries. In this study, a new dosage form was developed by including bioadhesive polymers (polycarbophyl, hydroxypropylmethylcellulose, and hyaluronic sodium salt) into pessaries made of semisynthetic solid triglycerides. These polymers hold the delivery systems in the vaginal tract for a few days without any toxic effects or important physiological modifications, prolonging the permanence of the drug on the vaginal mucosa. Technological controls (compatibility with differential scanning calorimetry [DSC] studies, particle size analysis, and liquefaction time test) and biopharmaceutics studies for the evaluation of the release of the drug from the dosage form and of the bioadhesive properties were carried out. Moreover, a new test for the evaluation of the permanence of the drug in a simulated application site was developed from a modification of the Satnikar and Fantelli method for the evaluation of the liquefaction time of rectal suppositories. This test simulates the physiological vaginal condition and verifies the efficiency of the polymers in prolonging the permanence of the dosage form in the location where it is applied. The technological controls demonstrated that the presence of the polymers did not have an influence on the characteristics of the pessaries. On the other hand, there was an improvement in adhesivity of the pessaries in the in vitro adhesion test and prolonging of the liquefaction time in the liquefaction time test in the presence of mucoadhesive polymers, which increased with increasing polymer concentration. The presence of the mucoadhesive had a large influence on the permanence of the drug in the simulated application site because it modified the distribution of the drug along the simulated application site. In conclusion, the developed new formulations showed good technological and adhesion properties and the capacity of hold the dosage form in the target site. Among the employed bioadhesive polymers, the best behavior in the performed test was by polycarbophyl at its maximum concentration.
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Affiliation(s)
- G C Ceschel
- Department of Pharmaceutical Science, University of Bologna, Italy.
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Abstract
Many studies have shown that topical buccal therapy with steroid anti-inflammatory drugs is useful in controlling ulcerative and inflammatory mucosal diseases. This local treatment is based on the concept that a high activity of steroids can be produced at the site of administration and, at the same time, the degree of systemic side effects can be minimized or avoided. In this study we developed a new formulation consisting of a mucoadhesive tablet formulation for buccal administration of hydrocortisone acetate (HCA). Three types of tablet were developed containing three mucoadhesive components: hydroxypropylmethyl cellulose (Methocel K4M), carboxyvinyl polymer (Carbopol 974P), and polycarbophyl (Noveon AA1); the first polymer is a cellulose derivative, the others are both polyacrylic acid derivatives. For each of those, three tablet batches were produced changing the quantity of the mucoadhesive component (10, 20, and 30%), resulting in 9 different formulations. The compatibility of HCA with all excipients using Differential Scanning Calorimetry (DSC) was assessed. Tablets were manufactured by wet granulation followed by compression. Technological controls on granulates (Hausner index, Carr index, granulometry and Karl-Fischer percentage humidity) and tablets (thickness, diameter, friability, hardness, uniformity of content, weigh uniformity and dissolution kinetic) were carried out. Mucoadhesion properties, ex vivo permeability through porcine buccal mucosa, in vivo behavior and compliance were evaluated. Technological controls have demonstrated that the increase in the (percentage) of mucoadhesive causes an increase in granulometry followed by a reduction in the granulate flowability, however all the tablets have given satisfactory technological results and conformed to the 3rd Ed. European Pharmacopoeia specifications. Mucoadhesion, ex vivo permeability and in vivo behavior results notably differed among tablets, depending on the quality and quantity of the mucoadhesive component. An overall comparison of results showed the tablets containing Carbopol 20% resulted to be the best formulation among those developed.
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Affiliation(s)
- G C Ceschel
- Pharmaceutical Sciences Department Bologna University, Italy.
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Jaffrain-Rea ML, Moroni C, Baldelli R, Battista C, Maffei P, Terzolo M, Correra M, Ghiggi MR, Ferretti E, Angeli A, Sicolo N, Trischitta V, Liuzzi A, Cassone R, Tamburrano G. Relationship between blood pressure and glucose tolerance in acromegaly. Clin Endocrinol (Oxf) 2001; 54:189-95. [PMID: 11207633 DOI: 10.1046/j.1365-2265.2001.01206.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hypertension represents a well-known risk factor for cardiovascular diseases. The pathogenesis of hypertension in acromegaly is commonly viewed as multifactorial, but the possible influence of metabolic disorders on blood pressure (BP) in affected patients is largely unknown. OBJECTIVE The aim of the present study was to evaluate the impact of glucose metabolism abnormalities on BP values in a series of patients with active acromegaly. DESIGN An open multicentre prospective study. PATIENTS Sixty-eight patients with active disease, aged 47.5 +/- 11.7 years, have been studied. Thirty-nine had normal glucose tolerance (NGT), 16 impaired glucose tolerance (IGT) and 13 suffered from diabetes mellitus (DM). MEASUREMENTS Mean clinical BP values were calculated as the mean of BP values obtained by sphygmomanometric measurement in three separate occasions and mean 24-h, diurnal and nocturnal systolic (SBP) and diastolic (DBP) values were obtained by 24-h ambulatory blood pressure monitoring (ABPM). RESULTS Patient's age and the degree of glucose tolerance abnormalities were found to significantly and independently influence BP values. All clinical and ABPM SBP and DBP values significantly increased with age by linear regression (P < 0.02 for all BP values, 0.30 < or = R < or = 0.43), and the independent influence of this parameter on BP values was confirmed by mutivariate analysis. Similarly, the independent influence of glucose tolerance abnormalities on BP values was confirmed when introducing age as a covariable in a multivariate analysis, and patients with DM presented significantly higher clinical SBP and 24-h, diurnal and nocturnal SBP and DBP than patients with NGT (P < 0.02 for clinical SBP, P < 0.015 for all ABPM values, respectively). In addition, patients with DM showed significantly higher 24-h, diurnal and nocturnal DBP than those with IGT (P < 0.05 in all cases). In contrast, no significant difference was found between NGT and IGT patients. No significant influence of disease duration, BMI, GH, IGF-I, or fasting and 2-h post glucose load insulinaemia on BP values was observed. CONCLUSIONS Abnormalities of glucose metabolism significantly contribute to increase systolic blood pressure and especially diastolic blood pressure in acromegalic patients. Careful control of blood pressure and of risk factors for developing systemic hypertension, with special reference to glucose tolerance, is mandatory to decrease cardiovascular morbidity and mortality in such patients.
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Affiliation(s)
- M L Jaffrain-Rea
- Department of Experimental Medicine, University of L'Aquila, Italy.
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