1
|
Arribas C, Decembrino N, Raffaeli G, Amodeo I, González-Caballero JL, Riaza M, Ortiz-Movilla R, Massenzi L, Gizzi C, Araimo G, Cattarelli D, Aversa S, Martinelli S, Frezza S, Orfeo L, Mosca F, Cavallaro G, Garrido F. Ototoxic and nephrotoxic drugs in neonatal intensive care units: results of a Spanish and Italian survey. Eur J Pediatr 2024:10.1007/s00431-024-05467-w. [PMID: 38492032 DOI: 10.1007/s00431-024-05467-w] [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: 12/29/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 03/18/2024]
Abstract
Neonates face heightened susceptibility to drug toxicity, often exposed to off-label medications with dosages extrapolated from adult or pediatric studies. Premature infants in Neonatal Intensive Care Units (NICUs) are particularly at risk due to underdeveloped pharmacokinetics and exposure to multiple drugs. The study aimed to survey commonly used medications with a higher risk of ototoxicity and nephrotoxicity in Spanish and Italian neonatal units. A prospective cross-sectional study was conducted in Italian and Spanish neonatal units using a web-based survey with 43 questions. A modified Delphi method involved experts refining the survey through online consensus. Ethical approval was obtained, and responses were collected from January to July 2023. The survey covered various aspects, including drug-related ototoxic and nephrotoxic management, hearing screening, and therapeutic drug monitoring. Responses from 131 participants (35.9% from Spain and 64.1% from Italy) revealed awareness of drug toxicity risks. Varied practices were observed in hearing screening protocols, and a high prevalence of ototoxic and nephrotoxic drug use, including aminoglycosides (100%), vancomycin (70.2%), loop diuretics (63.4%), and ibuprofen (62.6%). Discrepancies existed in guideline availability and adherence, with differences between Italy and Spain in therapeutic drug monitoring practices. CONCLUSIONS The study underscores the need for clinical guidelines and uniform practices in managing ototoxic and nephrotoxic drugs in neonatal units. Awareness is high, but inconsistencies in practices indicate a necessity for standardization, including the implementation of therapeutic drug monitoring and the involvement of clinical pharmacologists. Addressing these issues is crucial for optimizing neonatal care in Southern Europe. WHAT IS KNOWN • Neonates in intensive care face a high risk of nephrotoxicity and ototoxicity from drugs like aminoglycosides, vancomycin, loop diuretics, and ibuprofen. • Therapeutic drug monitoring is key for managing these risks, optimizing dosing for efficacy and minimizing side effects. WHAT IS NEW • NICUs in Spain and Italy show high drug toxicity awareness but differ in ototoxic/nephrotoxic drug management. • Urgent need for standard guidelines and practices to address nephrotoxic risks from aminoglycosides, vancomycin, loop diuretics, and ibuprofen.
Collapse
Affiliation(s)
- Cristina Arribas
- Neonatal Intensive Care Unit, Clínica Universidad de Navarra, 28027, Madrid, Spain
| | - Nunzia Decembrino
- Neonatal Intensive Care Unit, AOU Policlinico G. Rodolico San Marco, 95123, Catania, Italy
| | - Genny Raffaeli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy.
| | - Ilaria Amodeo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | | | - Mónica Riaza
- Department of Pediatrics, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Roberto Ortiz-Movilla
- Neonatal Intensive Care Unit, Hospital Universitario Puerta de Hierro-Majadahonda, 28222, Madrid, Spain
| | - Luca Massenzi
- Neonatal Intensive Care Unit, Ospedale Regionale Di Bolzano, 39100, Bolzano, Italy
| | - Camilla Gizzi
- Division of Pediatrics and Neonatology, Sandro Pertini Hospital, 00157, Rome, Italy
| | - Gabriella Araimo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Donatella Cattarelli
- Division of Pediatrics and Neonatology, ASST del Garda, 25015, Desenzano del Garda (BS), Italy
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, 25123, Brescia, Italy
| | - Stefano Martinelli
- Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162, Milan, Italy
| | - Simonetta Frezza
- Division of Neonatology, Area of Child Health, Department of Woman, Child Health and Public Health, Fondazione IRCCS Policlinico Universitario Agostino Gemelli, 00168, Rome, Italy
| | - Luigi Orfeo
- Neonatal Intensive Care Unit, Isola Tiberina Hospital Gemelli Isola, 00186, Rome, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, 20122, Milan, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Felipe Garrido
- Neonatal Intensive Care Unit, Clínica Universidad de Navarra, 28027, Madrid, Spain
| |
Collapse
|
2
|
Ghirardo S, Ullmann N, Zago A, Ghezzi M, Minute M, Madini B, D'Auria E, Basile C, Castelletti F, Chironi F, Capodiferro A, Andrenacci B, Risso FM, Aversa S, Dotta L, Coretti A, Vittucci AC, Badolato R, Amaddeo A, Barbi E, Cutrera R. Increased bronchiolitis burden and severity after the pandemic: a national multicentric study. Ital J Pediatr 2024; 50:25. [PMID: 38350986 PMCID: PMC10865582 DOI: 10.1186/s13052-024-01602-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The coronavirus 2019 (COVID-19) related containment measures led to the disruption of all virus distribution. Bronchiolitis-related hospitalizations shrank during 2020-2021, rebounding to pre-pandemic numbers the following year. This study aims to describe the trend in bronchiolitis-related hospitalization this year, focusing on severity and viral epidemiology. METHODS We conducted a retrospective investigation collecting clinical records data from all infants hospitalized for bronchiolitis during winter (1st September-31th March) from September 2018 to March 2023 in six Italian hospitals. No trial registration was necessary according to authorization no.9/2014 of the Italian law. RESULTS Nine hundred fifty-three infants were hospitalized for bronchiolitis this last winter, 563 in 2021-2022, 34 in 2020-2021, 395 in 2019-2020 and 483 in 2018-2019. The mean length of stay was significantly longer this year compared to all previous years (mean 7.2 ± 6 days in 2022-2023), compared to 5.7 ± 4 in 2021-2022, 5.3 ± 4 in 2020-2021, 6.4 ± 5 in 2019-2020 and 5.5 ± 4 in 2018-2019 (p < 0.001), respectively. More patients required mechanical ventilation this winter 38 (4%), compared to 6 (1%) in 2021-2022, 0 in 2020-2021, 11 (2%) in 2019-2020 and 6 (1%) in 2018-2019 (p < 0.05), respectively. High-flow nasal cannula and non-invasive respiratory supports were statistically more common last winter (p = 0.001 or less). RSV prevalence and distribution did not differ this winter, but coinfections were more prevalent 307 (42%), 138 (31%) in 2021-2022, 1 (33%) in 2020-2021, 68 (23%) in 2019-2020, 61 (28%) in 2018-2019 (p = 0.001). CONCLUSIONS This study shows a growth of nearly 70% in hospitalisations for bronchiolitis, and an increase in invasive respiratory support and coinfections, suggesting a more severe disease course this winter compared to the last five years.
Collapse
Affiliation(s)
- Sergio Ghirardo
- Department of Medicine, Surgery and Health Sciences, University of Trieste, via dell'Istria 65/1, Trieste, Italy.
| | - Nicola Ullmann
- Pediatric Pulmonology and Cystic Fibrosis Unit, Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Zago
- Department of Medicine, Surgery and Health Sciences, University of Trieste, via dell'Istria 65/1, Trieste, Italy
| | - Michele Ghezzi
- Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
| | - Marta Minute
- Ospedale Regionale Ca Foncello Treviso, Treviso, Italy
| | - Barbara Madini
- S.C. Pediatria Pneumoinfettivologia Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enza D'Auria
- Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
| | - Cecilia Basile
- Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
| | | | - Federica Chironi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, 20122, Italy
| | - Agata Capodiferro
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, 20122, Italy
| | - Beatrice Andrenacci
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Laura Dotta
- Department of Pediatrics and "A. Nocivelli" Institute for Molecular Medicine, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Antonella Coretti
- Pediatric Pulmonology and Cystic Fibrosis Unit, Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Chiara Vittucci
- Pediatric Pulmonology and Cystic Fibrosis Unit, Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Raffaele Badolato
- Department of Pediatrics and "A. Nocivelli" Institute for Molecular Medicine, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Alessandro Amaddeo
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, 34137, Italy
| | - Egidio Barbi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, via dell'Istria 65/1, Trieste, Italy
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, 34137, Italy
| | - Renato Cutrera
- Pediatric Pulmonology and Cystic Fibrosis Unit, Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| |
Collapse
|
3
|
Garofoli F, Franco V, Accorsi P, Albertini R, Angelini M, Asteggiano C, Aversa S, Ballante E, Borgatti R, Cabini RF, Caporali C, Chiapparini L, Cociglio S, Fazzi E, Longo S, Malerba L, Materia V, Mazzocchi L, Naboni C, Palmisani M, Pichiecchio A, Pinelli L, Pisoni C, Preda L, Riboli A, Risso FM, Rizzo V, Rognone E, Simoncelli AM, Villani P, Tzialla C, Ghirardello S, Orcesi S. Fate of melatonin orally administered in preterm newborns: Antioxidant performance and basis for neuroprotection. J Pineal Res 2024; 76:e12932. [PMID: 38111174 DOI: 10.1111/jpi.12932] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/10/2023] [Accepted: 12/06/2023] [Indexed: 12/20/2023]
Abstract
Preterm infants cannot counteract excessive reactive oxygen species (ROS) production due to preterm birth, leading to an excess of lipid peroxidation with malondialdehyde (MDA) production, capable of contributing to brain damage. Melatonin (ME), an endogenous brain hormone, and its metabolites, act as a free radical scavenger against ROS. Unfortunately, preterms have an impaired antioxidant system, resulting in the inability to produce and release ME. This prospective, multicenter, parallel groups, randomized, double-blind, placebo-controlled trial aimed to assess: (i) the endogenous production of ME in very preterm infants (gestational age ≤ 29 + 6 WE, 28 infants in the ME and 26 in the placebo group); (ii) the exogenous hormone availability and its metabolization to the main metabolite, 6-OH-ME after 15 days of ME oral treatment; (iii) difference of MDA plasma concentration, as peroxidation marker, after treatment. Blood was collected before the first administration (T1) and after 15 days of administration (T2). ME and 6-OH-ME were detected by liquid chromatography tandem mass spectrometry, MDA was measured by liquid chromatograph with fluorescence detection. ME and 6-OH-ME were not detectable in the placebo group at any study time-point. ME was absent in the active group at T1. In contrast, after oral administration, ME and 6-OH-ME resulted highly detectable and the difference between concentrations T2 versus T1 was statistically significant, as well as the difference between treated and placebo groups at T2. MDA levels seemed stable during the 15 days of treatment in both groups. Nevertheless, a trend in the percentage of neonates with reduced MDA concentration at T2/T1 was 48.1% in the ME group versus 38.5% in the placebo group. We demonstrated that very preterm infants are not able to produce endogenous detectable plasma levels of ME during their first days of life. Still, following ME oral administration, appreciable amounts of ME and 6-OH-ME were available. The trend of MDA reduction in the active group requires further clinical trials to fix the dosage, the length of ME therapy and to identify more appropriate indexes to demonstrate, at biological and clinical levels, the antioxidant activity and consequent neuroprotectant potential of ME in very preterm newborns.
Collapse
Affiliation(s)
- Francesca Garofoli
- 1Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Franco
- Department of Internal Medicine and Therapeutics, Clinical and Experimental Pharmacology Unit, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Patrizia Accorsi
- Unit of Child Neurology and Psychiatry, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Riccardo Albertini
- Laboratory of Clinical Chemistry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Micol Angelini
- 1Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlo Asteggiano
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, University Hospital "Spedali Civili" of Brescia, Brescia, Italy
| | - Elena Ballante
- Political and Social Sciences, University of Pavia, Pavia, Italy
- BioData Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Renato Borgatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation, Pavia, Italy
| | | | - Camilla Caporali
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Luisa Chiapparini
- Radiodiagnostic Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Cociglio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Elisa Fazzi
- Unit of Child Neurology and Psychiatry, ASST-Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefania Longo
- 1Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Laura Malerba
- Unit of Child Neurology and Psychiatry, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Valeria Materia
- Neonatal Intensive Care Unit, Children's Hospital, University Hospital "Spedali Civili" of Brescia, Brescia, Italy
| | - Laura Mazzocchi
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Cecilia Naboni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation, Pavia, Italy
| | - Michela Palmisani
- Department of Internal Medicine and Therapeutics, Clinical and Experimental Pharmacology Unit, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Lorenzo Pinelli
- Neuroradiology Department, Pediatric Neuroradiology Section, Spedali Civili, Brescia, Italy
| | - Camilla Pisoni
- 1Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Preda
- Radiodiagnostic Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostics and Pediatric sciences, University of Pavia, Italy
| | - Alice Riboli
- Hospital Pediatric Psychology, Unit of Psychology, Children's Hospital "Spedali Civili" of Brescia, Brescia, Italy
| | - Francesco M Risso
- Neonatal Intensive Care Unit, Children's Hospital, University Hospital "Spedali Civili" of Brescia, Brescia, Italy
| | - Vittoria Rizzo
- Laboratory of Clinical Chemistry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elisa Rognone
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Anna M Simoncelli
- Radiodiagnostic Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paola Villani
- Laboratory of Clinical Chemistry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chryssoula Tzialla
- Neonatal and Pediatric Unit, Polo Ospedaliero Oltrepò, ASST Pavia, Pavia, Italy
| | - Stefano Ghirardello
- 1Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simona Orcesi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation, Pavia, Italy
| |
Collapse
|
4
|
Tzialla C, Auriti C, Aversa S, Merazzi D, Martinelli S, Araimo G, Massenzi L, Cavallaro G, Gagliardi L, Giuffrè M, Mosca F, Cetin I, Trojano V, Valensise H, Colacurci N, Orfeo L, Mondì V. Intersociety Position Statement on the Prevention of Ophthalmia Neonatorum in Italy. Microorganisms 2023; 12:15. [PMID: 38276184 PMCID: PMC10818411 DOI: 10.3390/microorganisms12010015] [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] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
There is currently no worldwide agreement on the real need to administer conjunctival antibiotics to neonates at birth to prevent neonatal conjunctivitis (usually defined as ophthalmia neonatorum) by Chlamydia trachomatis and Neisseria gonorrhoeae. Therefore, there is wide variability in antibiotic administration, conditioned mainly by the social and health context. In Italy, a law enacted in 1940 required doctors and midwives to administer ophthalmic prophylaxis with 2% silver nitrate to all newborns at birth. This law was repealed in 1975 and since then there has been no clear guidance on the use of ophthalmia neonatorum prophylaxis at birth. Since neonatal conjunctivitis caused by C. trachomatis and N. gonorrhoeae is not reported, we carried out a nationwide survey of 1,041,384 neonates across all Italian birth centers to evaluate the incidence of ophthalmia neonatorum and the current practice of prophylaxis. After analyzing the results, we formulated an intersociety position statement on the prevention of ophthalmia neonatorum to update and standardize this prevention strategy in Italy.
Collapse
Affiliation(s)
- Chryssoula Tzialla
- Neonatal and Pediatric Unit, Polo Ospedaliero Oltrepò, ASST Pavia, Via Volturno 14, 27058 Voghera, Italy;
| | - Cinzia Auriti
- Faculty of Medicine, UniCamillus-Saint Camillus International University of Health Sciences, Via di Sant’Alessandro 8, 00131 Rome, Italy
- Neonatologic Unit, Villa Margherita Private Clinic, Viale di Villa Massimo 48, 00161 Rome, Italy
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children’s Hospital, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123 Brescia, Italy;
| | - Daniele Merazzi
- Division of Neonatology, ‘Valduce’ Hospital, Via Dante Alighieri 11, 22100 Como, Italy;
| | - Stefano Martinelli
- Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore 3, 20162 Milan, Italy;
| | - Gabriella Araimo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy; (G.A.); (G.C.); (F.M.)
| | - Luca Massenzi
- Division of Neonatology, Central Teaching Hospital of Bolzano, Via Lorenz Böhler 5, 39100 Bolzano, Italy;
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy; (G.A.); (G.C.); (F.M.)
| | - Luigi Gagliardi
- Department of Mother and Child Health, Azienda USL Toscana Nord Ovest, Via A. Cocchi, 7/9, 56121 Pisa, Italy;
| | - Mario Giuffrè
- Neonatal Intensive Care Unit, A.U.O.Policlinico ‘Paolo Giaccone’, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties ‘G. D’Alessandro’, University of Palermo, Via del Vespro 129, 90126 Palermo, Italy;
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy; (G.A.); (G.C.); (F.M.)
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy
| | - Irene Cetin
- Department of BioMedical and Clinical Sciences, University of Milan, Via Gian Battista Grassi 74, 20122 Milan, Italy;
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Via Lodovico Castelvetro 32, 20154 Milan, Italy
| | - Vito Trojano
- Department of Obstetrics and Gynaecology, Mater Dei Hospital, Via Samuel F. Hahnemann 10, 70125 Bari, Italy;
| | - Herbert Valensise
- Department of Surgical Sciences, University of Rome Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy;
- Obstetrics and Gynecology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Via Luigi De Crecchio 2, 80138 Naples, Italy;
| | - Luigi Orfeo
- Neonatal Intensive Care Unit, Fatebenefratelli Isola Tiberina—Gemelli Isola, Via di Ponte Quattro Capi 39, 00186 Rome, Italy;
| | - Vito Mondì
- Neonatology and Neonatal Intensive Care Unit, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy;
| | | |
Collapse
|
5
|
Corsini I, Rodriguez-Fanjul J, Raimondi F, Boni L, Berardi A, Aldecoa-Bilbao V, Alonso-Ojembarrena A, Ancora G, Aversa S, Beghini R, Meseguer NB, Capasso L, Chesi F, Ciarcià M, Concheiro A, Corvaglia L, Ficial B, Filippi L, Carballal JF, Fusco M, Gatto S, Ginovart G, Gregorio-Hernández R, Lista G, Sánchez-Luna M, Martini S, Massenzi L, Miselli F, Mercadante D, Mosca F, Palacio MT, Perri A, Piano F, Prieto MP, Fernandez LR, Risso FM, Savoia M, Staffler A, Vento G, Dani C. Lung UltrasouNd Guided surfactant therapy in preterm infants: an international multicenter randomized control trial (LUNG study). Trials 2023; 24:706. [PMID: 37925512 PMCID: PMC10625281 DOI: 10.1186/s13063-023-07745-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/24/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND The management of respiratory distress syndrome (RDS) in premature newborns is based on different types of non-invasive respiratory support and on surfactant replacement therapy (SRT) to avoid mechanical ventilation as it may eventually result in lung damage. European guidelines currently recommend SRT only when the fraction of inspired oxygen (FiO2) exceeds 0.30. The literature describes that early SRT decreases the risk of bronchopulmonary dysplasia (BPD) and mortality. Lung ultrasound score (LUS) in preterm infants affected by RDS has proven to be able to predict the need for SRT and different single-center studies have shown that LUS may increase the proportion of infants that received early SRT. Therefore, the aim of this study is to determine if the use of LUS as a decision tool for SRT in preterm infants affected by RDS allows for the reduction of the incidence of BPD or death in the study group. METHODS/DESIGN In this study, 668 spontaneously-breathing preterm infants, born at 25+0 to 29+6 weeks' gestation, in nasal continuous positive airway pressure (nCPAP) will be randomized to receive SRT only when the FiO2 cut-off exceeds 0.3 (control group) or if the LUS score is higher than 8 or the FiO2 requirements exceed 0.3 (study group) (334 infants per arm). The primary outcome will be the difference in proportion of infants with BPD or death in the study group managed compared to the control group. DISCUSSION Based on previous published studies, it seems that LUS may decrease the time to administer surfactant therapy. It is known that early surfactant administration decreases BPD and mortality. Therefore, there is rationale for hypothesizing a reduction in BPD or death in the group of patients in which the decision to administer exogenous surfactant is based on lung ultrasound scores. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT05198375 . Registered on 20 January 2022.
Collapse
Affiliation(s)
- Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | | | - Francesco Raimondi
- Division of Neonatology, Federico II University of Naples, Naples, Italy
| | - Luca Boni
- SC Epidemiologia Clinica IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Policlinico Universitario Modena, Modena, Italy
| | - Victoria Aldecoa-Bilbao
- Neonatal Intensive Care Unit, Hospital Clínic Barcelona, BCNatal (Barcelona Center for Maternal Fetal and Neonatal Medicine), Barcelona, Spain
| | | | - Gina Ancora
- Neonatal Intensive Care Unit, Ospedale Infermi Di Rimini, Rimini, Italy
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Renzo Beghini
- Neonatal Intensive Care Unit, AOUI Verona, Verona, Italy
| | | | - Letizia Capasso
- Division of Neonatology, Federico II University of Naples, Naples, Italy
| | - Francesca Chesi
- Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Martina Ciarcià
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Ana Concheiro
- Neonatal Intensive Care Unit, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - Luigi Corvaglia
- Neonatal Intensive Care Unit IRCCS AUOBO, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Luca Filippi
- Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Jesus Fuentes Carballal
- Neonatal Intensive Care Unit, Complexo Hospitalario Universitario de A Coruña (CHUAC), Coruña, Spain
| | - Monica Fusco
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Sara Gatto
- Neonatal Intensive Care Unit, Ospedale Dei Bambini "V.Buzzi", Milan, Italy
| | - Gemma Ginovart
- Neonatal Intensive Care Unit. Hospital Germans Trias I Pujol, Badalona, Spain
| | | | - Gianluca Lista
- Neonatal Intensive Care Unit, Ospedale Dei Bambini "V.Buzzi", Milan, Italy
| | | | - Silvia Martini
- Neonatal Intensive Care Unit IRCCS AUOBO, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Francesca Miselli
- Neonatal Intensive Care Unit, Policlinico Universitario Modena, Modena, Italy
| | - Domenica Mercadante
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marta Teresa Palacio
- Neonatal Intensive Care Unit, Hospital Clínic Barcelona, BCNatal (Barcelona Center for Maternal Fetal and Neonatal Medicine), Barcelona, Spain
| | | | - Francesca Piano
- Neonatal Intensive Care Unit, Ospedale Infermi Di Rimini, Rimini, Italy
| | | | | | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | | | | | - Giovanni Vento
- Neonatal Intensive Care Unit, Policlinico Gemelli, Rome, Italy
| | - Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy
| |
Collapse
|
6
|
Mondì V, Tzialla C, Aversa S, Merazzi D, Martinelli S, Araimo G, Massenzi L, Cavallaro G, Gagliardi L, Piersigilli F, Giuffrè M, Lozzi S, Manzoni P, Mosca F, Cetin I, Trojano V, Valensise H, Colacurci N, Orfeo L, Auriti C. Antibiotic prophylaxis for ophthalmia neonatorum in Italy: results from a national survey and the Italian intersociety new position statements. Ital J Pediatr 2023; 49:117. [PMID: 37697419 PMCID: PMC10494339 DOI: 10.1186/s13052-023-01507-7] [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: 04/18/2023] [Accepted: 08/08/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Ophthalmia neonatorum is an acute conjunctivitis that occurs in newborns within the first month of life. The most serious infections are due to Chlamydia trachomatis and Neisseria gonorrhoeae, that may cause permanent damages. The use of ophthalmic prophylaxis varies widely around the world, according to the different health and socio-economic contexts. To date in Italy there is no a clear legislation regarding ophthalmia neonatorum prophylaxis at birth. METHODS We invited all birth centers in Italy to carry out a retrospective survey relating the last three years. We collected data regarding demographics of neonates, drugs used for ophthalmic prophylaxis and results of the screening of pregnant women for Chlamydia trachomatis and Neisseria gonorrhoeae vaginal infections. RESULTS Among 419 birth centers, 302 (72,1%) responded to the survey. Overall 1041384 neonates, 82,3% of those born in the three years considered, received ophthalmic prophylaxis. Only 4,585 (0,4%) of them received one of the drugs recommended by the WHO. The Centers that participated to the survey reported 12 episodes of Chlamydial conjunctivitis and no Gonococcal infection in the three years. Only 38% of the Centers performed vaginal swabs to pregnant women: 2,6% screened only for Neisseria, 9,6% only for Chlamydia and 25,8% for both germs. CONCLUSIONS The data obtained from the survey showed a low incidence of neonatal conjunctivitis due to either Neisseria gonorrhoeae or Chlamydia trachomatis in Italy. Due to the lack of legislation regulating the prophylaxis of ophthalmia neonatorum in newborns, the Italian Society of Neonatology, the Italian Society of Obstetrics and Gynecology and the Italian Society of Perinatal Medicine have recently issued new recommendations on this topic.
Collapse
Affiliation(s)
- Vito Mondì
- Neonatology and Neonatal Intensive Care Unit, Policlinico Casilino, Via Casilina 1049, Rome, Italy
| | - Chryssoula Tzialla
- Neonatal and Pediatric Unit, ASST Pavia, Via Volturno 14, Voghera, Italy.
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Piazzale Spedali Civili 1, Brescia, Italy
| | - Daniele Merazzi
- Division of Neonatology, 'Valduce' Hospital, Via Dante Alighieri 11, Como, Italy
| | - Stefano Martinelli
- Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore 3, Milan, Italy
| | - Gabriella Araimo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, Milan, Italy
| | - Luca Massenzi
- Division of Neonatology, Central Teaching Hospital of Bolzano, Via Lorenz Böhler 5, Bolzano, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, Milan, Italy
| | - Luigi Gagliardi
- Division of Neonatology and Pediatrics, Versilia Hospital, Azienda USL Toscana Nord Ovest, SS1 335, ViareggioPisa, Italy
| | - Fiammetta Piersigilli
- Section of Neonatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, Brussels, Belgium
| | - Mario Giuffrè
- Neonatal Intensive Care Unit, A.U.O.P. 'P. Giaccone,' Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Via del Vespro 129, Palermo, Italy
| | - Simona Lozzi
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant - "Bambino Gesù" Children's Hospital IRCCS,, Piazza Di Sant'Onofrio 4, 00165, Rome, Italy
| | - Paolo Manzoni
- Department of Maternal, Neonatal and Infant Medicine, University Hospital "Degli Infermi", Via Dei Ponderanesi 2, Ponderano, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Via Della Commenda 19, Milan, Italy
| | - Irene Cetin
- Department of BioMedical and Clinical Sciences, University of Milan, Via Givan Battista Grassi 74, Milan, Italy
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Via Lodovico Castelvetro 32, Milan, Italy
| | - Vito Trojano
- Department of Obstetrics and Gynaecology, Mater Dei Hospital, Via Samuel F. Hahnemann 10, Bari, Italy
| | - Herbert Valensise
- Department of Surgical Sciences, University of Rome Tor Vergata, Via Montpellier, 1, Rome, Italy
- Obstetrics and Gynecology, Policlinico Casilino, Via Casilina 1049, Rome, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, Naples, Italy
| | - Luigi Orfeo
- Neonatal Intensive Care Unit, Fatebenefratelli Isola Tiberina - Gemelli Isola, Via Di Ponte Quattro Capi 39, Rome, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant - "Bambino Gesù" Children's Hospital IRCCS,, Piazza Di Sant'Onofrio 4, 00165, Rome, Italy
- Villa Margherita Private Clinic, Via Di Villa Massimo 48, 00161, Rome, Italy
| |
Collapse
|
7
|
Borelli E, Aversa S, Motta M, Cavalleri E, Cereda C, Pinelli L, Pilotta A, Risso FM. Newborn with isolated severe deficiency of cranial vault ossification: a case of cleidocranial dysplasia. Arch Dis Child Fetal Neonatal Ed 2023:fetalneonatal-2023-325794. [PMID: 37433588 DOI: 10.1136/archdischild-2023-325794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Elena Borelli
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Mario Motta
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Elisa Cavalleri
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Claudio Cereda
- Neurosurgery Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Lorenzo Pinelli
- Neuroradiology Unit, Department of Diagnostic Imaging, Pediatric Neuroradiology Section, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alba Pilotta
- Pediatric Clinic, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| |
Collapse
|
8
|
Auriti C, Mondì V, Aversa S, Merazzi D, Lozzi S, Petroni S, Baldascino A, Massenzi L, Bellù R, Martinelli S, Mosca F. OPHTHALMIA NEONATORUM in Italy: it is time for change. Ital J Pediatr 2021; 47:238. [PMID: 34922593 PMCID: PMC8684088 DOI: 10.1186/s13052-021-01186-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022] Open
Abstract
Ophthalmia neonatorum (ON) refers to any conjunctivitis occurring in the first 28 days of life. In the past Neisseria gonorrhoeae was the most common cause of ON. It decreased with the introduction of prophylaxis at birth with the instillation of silver nitrate 2% (the Credè’s method of prophylaxis). Today, the term ON is used to define any other bacterial infection, in particular due to Chlamydia Trachomatis. Currently, the WHO reccomends topical ocular prophylaxis for prevention of gonococcal and chlamydial conjunctivitis for all neonates. On the contrary, several European countries no longer require universal prophylaxis, opting for screening and treatment of pregnant women at high risk of infection. And what about Italy? Have a look on Italian history of prophylaxis, starting by the first decree issued in 1940, signed by Benito Mussolini. In the following decades the law has undergone many changes. At the moment, legislation is unclear, therefore careful consideration is required in order to draft the correct appoach.
Collapse
Affiliation(s)
- Cinzia Auriti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy.
| | - Vito Mondì
- Neonatology and Neonatal Intensive Care Unit, Policlinico Casilino Hospital, Rome, Italy
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | | | - Simona Lozzi
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Sergio Petroni
- Ophthalmology Department, Bambino Gesù IRCCS Children's Hospital, Rome, Italy
| | - Antonio Baldascino
- Ophtalmology Department, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Massenzi
- Department of Pediatrics and Neonatology, 'S. Giovanni Calibita' Fatebenefratelli Hospital, Rome, Italy
| | | | - Stefano Martinelli
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| |
Collapse
|
9
|
Raimondi F, Migliaro F, Corsini I, Meneghin F, Pierri L, Salomè S, Perri A, Aversa S, Nobile S, Lama S, Varano S, Savoia M, Gatto S, Leonardi V, Capasso L, Carnielli VP, Mosca F, Dani C, Vento G, Dolce P, Lista G. Neonatal Lung Ultrasound and Surfactant Administration: A Pragmatic, Multicenter Study. Chest 2021; 160:2178-2186. [PMID: 34293317 DOI: 10.1016/j.chest.2021.06.076] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Previous research shows that a lung ultrasound score (LUS) can anticipate CPAP failure in neonatal respiratory distress syndrome. RESEARCH QUESTION Can LUS also predict the need for surfactant replacement? STUDY DESIGN AND METHODS Multicenter, pragmatic study of preterm neonates who underwent lung ultrasound at birth and those given surfactant by masked physicians, who also were scanned within 24 h from administration. Clinical data and respiratory support variables were recorded. Accuracy of LUS, oxygen saturation to Fio2 ratio, Fio2, and Silverman score for surfactant administration were evaluated using receiver operating characteristic curves. The simultaneous prognostic values of LUS and oxygen saturation to Fio2 ratio for surfactant administration, adjusting for gestational age (GA), were analyzed through a logistic regression model. RESULTS Two hundred forty infants were enrolled. One hundred eight received at least one dose of surfactant. LUS predicted the first surfactant administration with an area under the receiver operating characteristic curve (AUC) of 0.86 (95% CI, 0.81-0.91), cut off of 9, sensitivity of 0.79 (95% CI, 0.70-0.86), specificity of 0.83 (95% CI, 0.76-0.89), positive predictive value of 0.79 (95% CI, 0.71-0.87), negative predictive value of 0.82 (95% CI, 0.75-0.89), positive likelihood ratio of 4.65 (95% CI, 3.14-6.89), and negative likelihood ratio of 0.26 (95% CI, 0.18-0.37). No significant difference was shown among different GA groups: 25 to 27 weeks' GA (AUC, 0.91; 95% CI, 0.84-0.99), 28 to 30 weeks' GA (AUC, 0.81; 95% CI, 0.72-0.91), and 31 to 33 weeks' GA (AUC, 0.88; 95% CI, 0.79-0.95), respectively. LUS declined significantly within 24 h in infants receiving one surfactant dose. When comparing Fio2, oxygen saturation to Fio2 ratio, LUS, and Silverman scores as criteria for surfactant administration, only the latter showed a significantly poorer performance. The combination of oxygen saturation to Fio2 ratio and LUS showed the highest predictive power, with an AUC of 0.93 (95% CI, 0.89-0.97), regardless of the GA interval. INTERPRETATION LUS is a reliable criterion to administer the first surfactant dose regardless of GA. Its association with oxygen saturation to Fio2 ratio significantly improves the prediction power for surfactant need.
Collapse
Affiliation(s)
- Francesco Raimondi
- Division of Neonatology and Department of Translational Medical Sciences, Università"Federico II" di Napoli, Naples, Italy.
| | - Fiorella Migliaro
- Division of Neonatology and Department of Translational Medical Sciences, Università"Federico II" di Napoli, Naples, Italy
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Fabio Meneghin
- Neonatal Intensive Care Unit, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Luca Pierri
- Division of Neonatology and Department of Translational Medical Sciences, Università"Federico II" di Napoli, Naples, Italy
| | - Serena Salomè
- Division of Neonatology and Department of Translational Medical Sciences, Università"Federico II" di Napoli, Naples, Italy
| | - Alessandro Perri
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Stefano Nobile
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Lama
- Department of Clinical Sciences and Community Health, University of Milan, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Varano
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | | | - Sara Gatto
- Neonatal Intensive Care Unit, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Valentina Leonardi
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Letizia Capasso
- Division of Neonatology and Department of Translational Medical Sciences, Università"Federico II" di Napoli, Naples, Italy
| | - Virgilio Paolo Carnielli
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Giovanni Vento
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pasquale Dolce
- Department of Public Health, Università"Federico II" di Napoli, Naples, Italy
| | - Gianluca Lista
- Neonatal Intensive Care Unit, Vittore Buzzi Children's Hospital, Milan, Italy
| |
Collapse
|
10
|
Raimondi F, Migliaro F, Corsini I, Meneghin F, Dolce P, Pierri L, Perri A, Aversa S, Nobile S, Lama S, Varano S, Savoia M, Gatto S, Leonardi V, Capasso L, Carnielli VP, Mosca F, Dani C, Vento G, Lista G. Lung Ultrasound Score Progress in Neonatal Respiratory Distress Syndrome. Pediatrics 2021; 147:peds.2020-030528. [PMID: 33688032 DOI: 10.1542/peds.2020-030528] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [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] [Accepted: 01/06/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The utility of a lung ultrasound score (LUS) has been described in the early phases of neonatal respiratory distress syndrome (RDS). We investigated lung ultrasound as a tool to monitor respiratory status in preterm neonates throughout the course of RDS. METHODS Preterm neonates, stratified in 3 gestational age cohorts (25-27, 28-30, and 31-33 weeks), underwent lung ultrasound at weekly intervals from birth. Clinical data, respiratory support variables, and major complications (sepsis, patent ductus arteriosus, pneumothorax, and persistent pulmonary hypertension of the neonate) were also recorded. RESULTS We enrolled 240 infants in total. The 3 gestational age intervals had significantly different LUS patterns. There was a significant correlation between LUS and the ratio of oxygen saturation to inspired oxygen throughout the admission, increasing with gestational age (b = -0.002 [P < .001] at 25-27 weeks; b = -0.006 [P < .001] at 28-30 weeks; b = -0.012 [P < .001] at 31-33 weeks). Infants with complications had a higher LUS already at birth (12 interquartile range 13-8 vs 8 interquartile range 12-4 control group; P = .001). In infants 25 to 30 weeks' gestation, the LUS at 7 days of life predicted bronchopulmonary dysplasia with an area under the curve of 0.82 (95% confidence interval 0.71 to 93). CONCLUSIONS In preterm neonates affected by RDS, the LUS trajectory is gestational age dependent, significantly correlates with the oxygenation status, and predicts bronchopulmonary dysplasia. In this population, LUS is a useful, bedside, noninvasive tool to monitor the respiratory status.
Collapse
Affiliation(s)
- Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences and
| | - Fiorella Migliaro
- Division of Neonatology, Department of Translational Medical Sciences and
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | | | - Pasquale Dolce
- Department of Public Health, Università Federico II di Napoli, Naples, Italy
| | - Luca Pierri
- Division of Neonatology, Department of Translational Medical Sciences and
| | - Alessandro Perri
- Unità Operativa Complessa di Neonatologia, Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Stefano Nobile
- Unità Operativa Complessa di Neonatologia, Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Lama
- Department of Clinical Sciences and Community Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Silvia Varano
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy; and
| | | | - Sara Gatto
- NICU, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Valentina Leonardi
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Letizia Capasso
- Division of Neonatology, Department of Translational Medical Sciences and
| | - Virgilio Paolo Carnielli
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy; and
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Giovanni Vento
- Unità Operativa Complessa di Neonatologia, Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | | |
Collapse
|
11
|
Garofoli F, Longo S, Pisoni C, Accorsi P, Angelini M, Aversa S, Caporali C, Cociglio S, De Silvestri A, Fazzi E, Rizzo V, Tzialla C, Zecca M, Orcesi S. Oral melatonin as a new tool for neuroprotection in preterm newborns: study protocol for a randomized controlled trial. Trials 2021; 22:82. [PMID: 33482894 PMCID: PMC7820522 DOI: 10.1186/s13063-021-05034-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/08/2021] [Indexed: 11/12/2022] Open
Abstract
Background Prevention of neurodevelopmental impairment due to preterm birth is a major health challenge. Despite advanced obstetric and neonatal care, to date there are few neuroprotective molecules available. Melatonin has been shown to have anti-oxidant/anti-inflammatory effects and to reduce brain damage, mainly after hypoxic ischemic encephalopathy. The planned study will be the first aiming to evaluate the capacity of melatonin to mitigate brain impairment due to premature birth. Method In our planned prospective, multicenter, double-blind, randomized vs placebo study, we will recruit, within 96 h of birth, 60 preterm newborns with a gestational age ≤ 29 weeks + 6 days; these infants will be randomly allocated to oral melatonin, 3 mg/kg/day, or placebo for 15 days. After the administration period, we will measure plasma levels of malondialdehyde, a lipid peroxidation product considered an early biological marker of melatonin treatment efficacy (primary outcome). At term-equivalent age, we will evaluate neurological status (through cerebral ultrasound, cerebral magnetic resonance imaging, vision and hearing evaluations, clinical neurological assessment, and screening for retinopathy of prematurity) as well as the incidence of bronchodysplasia and sepsis. We will also monitor neurodevelopmental outcome during the first 24 months of corrected age (using the modified Fagan Test of Infant Intelligence at 4–6 months and standardized neurological and developmental assessments at 24 months). Discussion Preterm birth survivors often present long-term neurodevelopmental sequelae, such as motor, learning, social-behavioral, and communication problems. We aim to assess the role of melatonin as a neuroprotectant during the first weeks of extrauterine life, when preterm infants are unable to produce it spontaneously. This approach is based on the supposition that its anti-oxidant mechanism could be useful in preventing neurodevelopmental impairment. Considering the short- and long-term morbidities related to preterm birth, and the financial and social costs of the care of preterm infants, both at birth and over time, we suggest that melatonin administration could lead to considerable saving of resources. This would be the first study addressing the role of melatonin in very low birth weight preterm newborns, and it could provide a basis for further studies on melatonin as a neuroprotection strategy in this vulnerable population. Trial registration ClinicalTrials.gov NCT04235673. Prospectively registered on 22 January 2020.
Collapse
Affiliation(s)
- Francesca Garofoli
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100, Pavia, Italy
| | - Stefania Longo
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100, Pavia, Italy
| | - Camilla Pisoni
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100, Pavia, Italy.
| | - Patrizia Accorsi
- Child and Adolescence Neuropsychiatry Unit, Children's Hospital, ASST Spedali Civili of Brescia, 25123, Brescia, Italy
| | - Micol Angelini
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100, Pavia, Italy
| | - Salvatore Aversa
- Neonatal Unit and Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili of Brescia, 25123, Brescia, Italy
| | - Camilla Caporali
- Child Neurology and Psychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy.,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100, Pavia, Italy
| | - Sara Cociglio
- Child Neurology and Psychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy
| | - Annalisa De Silvestri
- Unit of Clinical Epidemiology & Biometry, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Elisa Fazzi
- Child and Adolescence Neuropsychiatry Unit, Children's Hospital, ASST Spedali Civili of Brescia, 25123, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, 25123, Brescia, Italy
| | - Vittoria Rizzo
- Clinical Chemistry Laboratory and Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Chryssoula Tzialla
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100, Pavia, Italy
| | - Marco Zecca
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100, Pavia, Italy
| | - Simona Orcesi
- Child Neurology and Psychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy.,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100, Pavia, Italy
| |
Collapse
|
12
|
Perruzza M, Fusha E, Cameli P, Capecchi PL, Selvi E, Gentili F, Mazzei MA, Aversa S, Spina D, Di Lucia D, Sestini P, Luzzi L, Bargagli E. Pleuroparenchymal fibroelastosis (PPFE) associated with giant cell arteritis: A coincidence or a novel phenotype? Respir Med Case Rep 2019; 27:100843. [PMID: 31024793 PMCID: PMC6476809 DOI: 10.1016/j.rmcr.2019.100843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/12/2019] [Accepted: 04/12/2019] [Indexed: 11/16/2022] Open
Abstract
Pleuroparenchymal fibroelastosis (PPFE) is a rare interstitial lung disease characterized by the fibrotic thickening of subpleural and parenchymal areas of the upper lobes. It may be both idiopathic or secondary to infections, interstitial lung diseases and/or drug exposure. Often PPFE patients report recurrent lower respiratory tract infections, suggesting that repeated inflammatory alterations induced by pulmonary infections may contribute to the development/progression of PPFE. Here, we report for the first time the case of a patient affected by Giant cell Arteritis with histologically proven PPFE. The lung involvement in GCA is rare and interstitial lung diseases are usually reported as an uncommon clinical manifestation of GCA. Our patient is probably the first case presenting PPFE associated with GCA and we wonder if this is a real associative disease or a coincidence perhaps, secondary to drug effects.
Collapse
Affiliation(s)
- M Perruzza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - E Fusha
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - P Cameli
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - P L Capecchi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - E Selvi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - F Gentili
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - M A Mazzei
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - S Aversa
- Pathology Section, Department of Human Pathology and Oncology, Siena University Hospital, Siena, Italy
| | - D Spina
- Pathology Section, Department of Human Pathology and Oncology, Siena University Hospital, Siena, Italy
| | - D Di Lucia
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - P Sestini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - L Luzzi
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Siena University Hospital, Italy
| | - E Bargagli
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| |
Collapse
|
13
|
Filippi L, Cavallaro G, Berti E, Padrini L, Araimo G, Regiroli G, Raffaeli G, Bozzetti V, Tagliabue P, Tomasini B, Mori A, Buonocore G, Agosti M, Bossi A, Chirico G, Aversa S, Fortunato P, Osnaghi S, Cavallotti B, Suzani M, Vanni M, Borsari G, Donati S, Nascimbeni G, Nardo D, Piermarocchi S, la Marca G, Forni G, Milani S, Cortinovis I, Calvani M, Bagnoli P, Dal Monte M, Calvani AM, Pugi A, Villamor E, Donzelli G, Mosca F. Propranolol 0.2% Eye Micro-Drops for Retinopathy of Prematurity: A Prospective Phase IIB Study. Front Pediatr 2019; 7:180. [PMID: 31134171 PMCID: PMC6514240 DOI: 10.3389/fped.2019.00180] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/18/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Oral propranolol reduces retinopathy of prematurity (ROP) progression, although not safely. Propranolol 0.1% eye micro-drops administered to newborns with stage 2 ROP are well-tolerated, but not sufficiently effective. Methods: A multi-center open-label trial was conducted to assess the safety and efficacy of propranolol 0.2% eye micro-drops in newborns with stage 1 ROP. The progression of the disease was evaluated with serial ophthalmologic examinations. Hemodynamic, respiratory, biochemical parameters, and propranolol plasma levels were monitored. Demographic and perinatal characteristics, co-morbidities and co-intervention incidences, together with ROP progression, were compared with a historical control group in the same centers participating in the trial. Results: Ninety-eight newborns were enrolled and compared with the historical control group. Populations were not perfectly homogeneous (as demonstrated by the differences in the Apgar score and the different incidence rate in surfactant administration and oxygen exposure). The progression to ROP stage 2 or 3 plus was significantly lower than the incidence expected on the basis of historical data (Risk Ratio 0.521, 95% CI 0.297- 0.916). No adverse effects related to propranolol were observed and the mean propranolol plasma level was significantly lower than the safety cut-off of 20 ng/mL. Unexpectedly, three newborns treated with oral propranolol before the appearance of ROP, showed a ROP that was unresponsive to propranolol eye micro-drops and required laser photocoagulation treatment. Conclusion: Propranolol 0.2% eye micro-drops were well-tolerated and appeared to reduce the ROP progression expected on the basis of a comparison with a historical control group. Propranolol administered too early appears to favor a more aggressive ROP, suggesting that a β-adrenoreceptor blockade is only useful during the proliferative phase. Further randomized placebo-controlled trials are required to confirm the current results. Clinical Trial Registration The trial was registered at ClinicalTrials.gov with Identifier NCT02504944 and with EudraCT Number 2014-005472-29.
Collapse
Affiliation(s)
- Luca Filippi
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Elettra Berti
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Letizia Padrini
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Gabriella Araimo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Regiroli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Genny Raffaeli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Valentina Bozzetti
- Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy
| | - Paolo Tagliabue
- Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy
| | - Barbara Tomasini
- Neonatal Intensive Care Unit, University Hospital of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Annalisa Mori
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Massimo Agosti
- Neonatal Intensive Care Unit, Del Ponte Hospital, Varese, Italy
| | - Angela Bossi
- Neonatal Intensive Care Unit, Del Ponte Hospital, Varese, Italy
| | - Gaetano Chirico
- Neonatal Intensive Care Unit, Children's Hospital, University Hospital "Spedali Civili" of Brescia, Brescia, Italy
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, University Hospital "Spedali Civili" of Brescia, Brescia, Italy
| | - Pina Fortunato
- Pediatric Ophthalmology, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Silvia Osnaghi
- Department of Ophthalmology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milan, Milan, Italy
| | - Barbara Cavallotti
- Department of Ophthalmology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Martina Suzani
- Department of Ophthalmology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Maurizio Vanni
- Pediatric Ophthalmology, University Hospital of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Giulia Borsari
- Pediatric Ophthalmology, University Hospital of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Simone Donati
- Department of Surgical and Morphological Sciences, Section of Ophthalmology, University of Insubria, Varese, Italy
| | - Giuseppe Nascimbeni
- Department of Ophthalmology, University Hospital "Spedali Civili" of Brescia, Brescia, Italy
| | - Daniel Nardo
- Department of Women's and Children's Health, Azienda Ospedaliera di Padova, University of Padua, Padua, Italy
| | | | - Giancarlo la Marca
- Newborn Screening, Biochemistry and Pharmacology Laboratory, Meyer Children's University Hospital, Florence, Italy
| | - Giulia Forni
- Newborn Screening, Biochemistry and Pharmacology Laboratory, Meyer Children's University Hospital, Florence, Italy
| | - Silvano Milani
- Laboratory "G.A. Maccacro," Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ivan Cortinovis
- Laboratory "G.A. Maccacro," Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maura Calvani
- Oncohematology Unit, Department of Pediatric Oncology, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Paola Bagnoli
- Department of Biology, Unit of General Physiology, University of Pisa, Pisa, Italy
| | - Massimo Dal Monte
- Department of Biology, Unit of General Physiology, University of Pisa, Pisa, Italy
| | - Anna Maria Calvani
- Department of Pharmacy, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Alessandra Pugi
- Clinical Trial Office, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Eduardo Villamor
- Department of Pediatrics, Maastricht University Medical Center, School for Oncology and Developmental Biology, Maastricht, Netherlands
| | - Gianpaolo Donzelli
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| |
Collapse
|
14
|
Filippi L, Cavallaro G, Berti E, Padrini L, Araimo G, Regiroli G, Bozzetti V, De Angelis C, Tagliabue P, Tomasini B, Buonocore G, Agosti M, Bossi A, Chirico G, Aversa S, Pasqualetti R, Fortunato P, Osnaghi S, Cavallotti B, Vanni M, Borsari G, Donati S, Nascimbeni G, la Marca G, Forni G, Milani S, Cortinovis I, Bagnoli P, Dal Monte M, Calvani AM, Pugi A, Villamor E, Donzelli G, Mosca F. Study protocol: safety and efficacy of propranolol 0.2% eye drops in newborns with a precocious stage of retinopathy of prematurity (DROP-ROP-0.2%): a multicenter, open-label, single arm, phase II trial. BMC Pediatr 2017; 17:165. [PMID: 28709412 PMCID: PMC5513165 DOI: 10.1186/s12887-017-0923-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 07/05/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Retinopathy of prematurity (ROP) still represents one of the leading causes of visual impairment in childhood. Systemic propranolol has proven to be effective in reducing ROP progression in preterm newborns, although safety was not sufficiently guaranteed. On the contrary, topical treatment with propranolol eye micro-drops at a concentration of 0.1% had an optimal safety profile in preterm newborns with ROP, but was not sufficiently effective in reducing the disease progression if administered at an advanced stage (during stage 2). The aim of the present protocol is to evaluate the safety and efficacy of propranolol 0.2% eye micro-drops in preterm newborns at a more precocious stage of ROP (stage 1). METHODS A multicenter, open-label, phase II, clinical trial, planned according to the Simon optimal two-stage design, will be performed to analyze the safety and efficacy of propranolol 0.2% eye micro-drops in preterm newborns with stage 1 ROP. Preterm newborns with a gestational age of 23-32 weeks, with a stage 1 ROP will receive propranolol 0.2% eye micro-drops treatment until retinal vascularization has been completed, but for no longer than 90 days. Hemodynamic and respiratory parameters will be continuously monitored. Blood samplings checking metabolic, renal and liver functions, as well as electrocardiogram and echocardiogram, will be periodically performed to investigate treatment safety. Additionally, propranolol plasma levels will be measured at the steady state, on the 10th day of treatment. To assess the efficacy of topical treatment, the ROP progression from stage 1 ROP to stage 2 or 3 with plus will be evaluated by serial ophthalmologic examinations. DISCUSSION Propranolol eye micro-drops could represent an ideal strategy in counteracting ROP, because it is definitely safer than oral administration, inexpensive and an easily affordable treatment. Establishing the optimal dosage and treatment schedule is to date a crucial issue. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02504944, registered on July 19, 2015, updated July 12, 2016. EudraCT Number 2014-005472-29.
Collapse
Affiliation(s)
- Luca Filippi
- Neonatal Intensive Care Unit - Medical Surgical Fetal-Neonatal Department, Meyer University Children's' Hospital, viale Pieraccini 24, 50134, Florence, Italy.
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Elettra Berti
- Neonatal Intensive Care Unit - Medical Surgical Fetal-Neonatal Department, Meyer University Children's' Hospital, viale Pieraccini 24, 50134, Florence, Italy
| | - Letizia Padrini
- Neonatal Intensive Care Unit - Medical Surgical Fetal-Neonatal Department, Meyer University Children's' Hospital, viale Pieraccini 24, 50134, Florence, Italy
| | - Gabriella Araimo
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Giulia Regiroli
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Valentina Bozzetti
- Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy
| | - Chiara De Angelis
- Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy
| | - Paolo Tagliabue
- Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy
| | - Barbara Tomasini
- Department of Pediatrics, Obstetrics and Reproductive Medicine, Neonatal Intensive Care Unit, University Hospital of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, Via Banchi di Sotto, 55, 53100, Siena, Italy
| | - Massimo Agosti
- Neonatal Intensive Care Unit, Del Ponte Hospital, Varese, Italy
| | - Angela Bossi
- Neonatal Intensive Care Unit, Del Ponte Hospital, Varese, Italy
| | - Gaetano Chirico
- Neonatal Intensive Care Unit, Children's Hospital, University Hospital "Spedali Civili" of Brescia, Brescia, Italy
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, University Hospital "Spedali Civili" of Brescia, Brescia, Italy
| | - Roberta Pasqualetti
- Pediatric Ophthalmology, A. Meyer" University Children's Hospital, Florence, Italy
| | - Pina Fortunato
- Pediatric Ophthalmology, A. Meyer" University Children's Hospital, Florence, Italy
| | - Silvia Osnaghi
- Department of Ophthalmology, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Barbara Cavallotti
- Department of Ophthalomolgy, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Maurizio Vanni
- Pediatric Ophthalmology, University Hospital of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Giulia Borsari
- Pediatric Ophthalmology, University Hospital of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Simone Donati
- Department of Surgical and Morphological Sciences, Section of Ophthalmology, University of Insubria, Varese, Italy
| | - Giuseppe Nascimbeni
- Department of Ophthalmology, University Hospital "Spedali Civili" of Brescia, Brescia, Italy
| | - Giancarlo la Marca
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Newborn Screening, Biochemistry and Pharmacology Laboratory, Meyer Children's University Hospital, Florence, Italy
| | - Giulia Forni
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Newborn Screening, Biochemistry and Pharmacology Laboratory, Meyer Children's University Hospital, Florence, Italy
| | - Silvano Milani
- Laboratory "G.A. Maccacro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ivan Cortinovis
- Laboratory "G.A. Maccacro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paola Bagnoli
- Department of Biology, Unit of General Physiology, University of Pisa, Pisa, Italy
| | - Massimo Dal Monte
- Department of Biology, Unit of General Physiology, University of Pisa, Pisa, Italy
| | - Anna Maria Calvani
- Department of Pharmacy, "A. Meyer" University Children's Hospital, Florence, Italy
| | - Alessandra Pugi
- Clinical Trial Office, "A. Meyer" University Children's Hospital, viale Pieraccini 24, 50134, Florence, Italy
| | - Eduardo Villamor
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), Maastricht, The Netherlands
| | - Gianpaolo Donzelli
- Neonatal Intensive Care Unit - Medical Surgical Fetal-Neonatal Department, Meyer University Children's' Hospital, viale Pieraccini 24, 50134, Florence, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
15
|
Raimondi F, Rodriguez Fanjul J, Aversa S, Chirico G, Yousef N, De Luca D, Corsini I, Dani C, Grappone L, Orfeo L, Migliaro F, Vallone G, Capasso L. Lung Ultrasound for Diagnosing Pneumothorax in the Critically Ill Neonate. J Pediatr 2016; 175:74-78.e1. [PMID: 27189678 DOI: 10.1016/j.jpeds.2016.04.018] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [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: 11/26/2015] [Revised: 03/14/2016] [Accepted: 04/07/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the accuracy of lung ultrasound for the diagnosis of pneumothorax in the sudden decompensating patient. STUDY DESIGN In an international, prospective study, sudden decompensation was defined as a prolonged significant desaturation (oxygen saturation <65% for more than 40 seconds) and bradycardia or sudden increase of oxygen requirement by at least 50% in less than 10 minutes with a final fraction of inspired oxygen ≥0.7 to keep stable saturations. All eligible patients had an ultrasound scan before undergoing a chest radiograph, which was the reference standard. RESULTS Forty-two infants (birth weight = 1531 ± 812 g; gestational age = 31 ± 3.5 weeks) were enrolled in 6 centers; pneumothorax was detected in 26 (62%). Lung ultrasound accuracy in diagnosing pneumothorax was as follows: sensitivity 100%, specificity 100%, positive predictive value 100%, and negative predictive value 100%. Clinical evaluation of pneumothorax showed sensitivity 84%, specificity 56%, positive predictive value 76%, and negative predictive value 69%. After sudden decompensation, a lung ultrasound scan was performed in an average time of 5.3 ± 5.6 minutes vs 19 ± 11.7 minutes required for a chest radiography. Emergency drainage was performed after an ultrasound scan but before radiography in 9 cases. CONCLUSIONS Lung ultrasound shows high accuracy in detecting pneumothorax in the critical infant, outperforming clinical evaluation and reducing time to imaging diagnosis and drainage.
Collapse
Affiliation(s)
- Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy.
| | | | | | | | - Nadya Yousef
- Division of Pediatrics and Neonatal Critical Care, South Paris University Hospitals-APHP, Paris, France
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, South Paris University Hospitals-APHP, Paris, France
| | - Iuri Corsini
- Division of Neonatology, Ospedale Careggi, University of Florence, Florence, Italy
| | - Carlo Dani
- Division of Neonatology, Ospedale Careggi, University of Florence, Florence, Italy
| | - Lidia Grappone
- Division of Neonatology, Ospedale Rummo, Benevento, Italy
| | - Luigi Orfeo
- Division of Neonatology, Ospedale Rummo, Benevento, Italy
| | - Fiorella Migliaro
- Division of Neonatology, Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
| | - Gianfranco Vallone
- Division of Pediatric Diagnostics, Department of Biomorphological and Functional Sciences, Università "Federico II," Naples, Italy
| | - Letizia Capasso
- Division of Neonatology, Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
| | | |
Collapse
|
16
|
Gray S, Raschetti R, Beşer ÖF, Elicin PU, Aversa S, Pamuk G, Ozdil M, Berlese P, Ferreira-Magalhães M, Magner M, Ignat A, Lupu VV, Zsigmond B, Ghazaryan H, Rosenbaum S, Bendavid M, Bacquet M, Varga N, James D, Bon A, Vecchio D. European Young Pediatricians Association: Laying the Foundations for Collaboration, Integration, and Networking among Pediatricians of the Future. J Pediatr 2016; 171:324-5.e1. [PMID: 27017465 DOI: 10.1016/j.jpeds.2015.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Sebastian Gray
- Royal College of Pediatrics and Child Health Trainee Committee, United Kingdom.
| | | | | | | | - Salvatore Aversa
- National Observatory for Trainees and Young Pediatricians, Italy
| | - Gizem Pamuk
- Turkish Young Pediatricians Association, Turkey
| | - Mine Ozdil
- Turkish Young Pediatricians Association, Turkey
| | - Paola Berlese
- National Observatory for Trainees and Young Pediatricians, Italy
| | | | - Martin Magner
- Residents Committee, Czech Pediatric Society, Czech Republic
| | | | | | | | | | | | | | | | - Norbi Varga
- Armenian Young Pediatric Association, Armenia
| | - David James
- Royal College of Pediatrics and Child Health Trainee Committee, United Kingdom
| | - Andrea Bon
- National Observatory for Trainees and Young Pediatricians, Italy
| | - Davide Vecchio
- National Observatory for Trainees and Young Pediatricians, Italy
| |
Collapse
|
17
|
Marseglia L, D'Angelo G, Manti M, Aversa S, Fiamingo C, Arrigo T, Barberi I, Mamì C, Gitto E. Visfatin: New marker of oxidative stress in preterm newborns. Int J Immunopathol Pharmacol 2016; 29:23-9. [PMID: 26525831 PMCID: PMC5806730 DOI: 10.1177/0394632015607952] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/01/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Oxidative stress is involved in several neonatal conditions characterized by an upregulation in the production of oxidative or nitrative free radicals and a concomitant decrease in the availability of antioxidant species. Oxygen, which is obviously vital to survival, can be highly damaging to neonatal tissue which is known to be poorly equipped to neutralize toxic derivatives. Thus, exposure of the newborn infant to high oxygen concentrations during resuscitation at birth increases oxidative damage. Visfatin is an adipocytokine involved in oxidative stress and an important mediator of inflammation that induces dose-dependent production of both pro-inflammatory and anti-inflammatory cytokines. To our knowledge, the diagnostic value of visfatin as a marker of oxidative stress in preterm newborns has not been investigated. OBJECTIVE The aim of this study was to evaluate visfatin levels in preterm neonates resuscitated with different concentrations of oxygen in the delivery room. PATIENTS Fifty-two preterm newborns with gestational age less than 32 weeks, resuscitated randomly with different oxygen concentrations (40%, 60%, or 100%) were enrolled at the University Hospital of Messina, over a 12-month period to evaluate serum visfatin levels at T0 (within 1 h after birth), T24 h, T72 h, and T168 h of life. RESULTS At T72 h and T168 h, higher serum visfatin values in the high-oxygen group compared to the low- and mild-oxygen subjects (P=0.002 and P<0.001, respectively) were noted. CONCLUSION The results of this study suggest that visfatin could be a new marker of oxidative stress in preterm newborns.
Collapse
Affiliation(s)
- Lucia Marseglia
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Messina, Italy
| | - Gabriella D'Angelo
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Messina, Italy
| | | | - Salvatore Aversa
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Messina, Italy
| | - Chiara Fiamingo
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Messina, Italy
| | - Teresa Arrigo
- Unit of Paediatric Genetics and Immunology, Department of Paediatrics, University of Messina, Italy
| | - Ignazio Barberi
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Messina, Italy
| | - Carmelo Mamì
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Messina, Italy
| | - Eloisa Gitto
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Messina, Italy
| |
Collapse
|
18
|
Reale L, Ferranti F, Mantilacci S, Corboli M, Aversa S, Landucci F, Baldisserotto C, Ferroni L, Pancaldi S, Venanzoni R. Cyto-histological and morpho-physiological responses of common duckweed (Lemna minor L.) to chromium. Chemosphere 2016; 145:98-105. [PMID: 26688244 DOI: 10.1016/j.chemosphere.2015.11.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/06/2015] [Accepted: 11/16/2015] [Indexed: 06/05/2023]
Abstract
Along with cadmium, lead, mercury and other heavy metals, chromium is an important environmental pollutant, mainly concentrated in areas of intense anthropogenic pressure. The effect of potassium dichromate on Lemna minor populations was tested using the growth inhibition test. Cyto-histological and physiological analyses were also conducted to aid in understanding the strategies used by plants during exposure to chromium. Treatment with potassium dichromate caused a reduction in growth rate and frond size in all treated plants and especially at the highest concentrations. At these concentrations the photosynthetic pathway was also altered as shown by the decrease of maximum quantum yield of photosystem II and the chlorophyll b content and by the chloroplast ultrastructural modifications. Starch storage was also investigated by microscopic observations. It was the highest at the high concentrations of the pollutant. The data suggested a correlation between starch storage and reduced growth; there was greater inhibition of plant growth than inhibition of photosynthesis, resulting in a surplus of carbohydrates that may be stored as starch. The investigation helps to understand the mechanism related to heavy metal tolerance of Lemna minor and supplies information about the behavior of this species widely used as a biomarker.
Collapse
Affiliation(s)
- L Reale
- Department of Agricultural, Food and Environmental Sciences, University of Perugia, Borgo XX Giugno 74, 06121 Perugia, Italy.
| | - F Ferranti
- Department of Agricultural, Food and Environmental Sciences, University of Perugia, Borgo XX Giugno 74, 06121 Perugia, Italy.
| | - S Mantilacci
- Biotecnologie B.T. Srl, Frazione Pantalla di Todi, 06059 Perugia, Italy.
| | - M Corboli
- Biotecnologie B.T. Srl, Frazione Pantalla di Todi, 06059 Perugia, Italy.
| | - S Aversa
- Biotecnologie B.T. Srl, Frazione Pantalla di Todi, 06059 Perugia, Italy.
| | - F Landucci
- Department of Botany and Zoology, Masaryk University, Kotlářská 2, CVZ-61137 Brno, Czech Republic.
| | - C Baldisserotto
- Department of Life Sciences and Biotechnology, University of Ferrara, C.so Ercole I d'Este, 32, 44121 Ferrara, Italy.
| | - L Ferroni
- Department of Life Sciences and Biotechnology, University of Ferrara, C.so Ercole I d'Este, 32, 44121 Ferrara, Italy.
| | - S Pancaldi
- Department of Life Sciences and Biotechnology, University of Ferrara, C.so Ercole I d'Este, 32, 44121 Ferrara, Italy.
| | - R Venanzoni
- Department of Agricultural, Food and Environmental Sciences, University of Perugia, Borgo XX Giugno 74, 06121 Perugia, Italy.
| |
Collapse
|
19
|
Aversa S, Marseglia L, Manti S, D'Angelo G, Cuppari C, David A, Chirico G, Gitto E. Ventilation strategies for preventing oxidative stress-induced injury in preterm infants with respiratory disease: an update. Paediatr Respir Rev 2016; 17:71-9. [PMID: 26572937 DOI: 10.1016/j.prrv.2015.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/16/2015] [Accepted: 08/23/2015] [Indexed: 10/22/2022]
Abstract
Reactive oxygen and nitrogen species are produced by several inflammatory and structural cells of the airways. The lungs of preterm newborns are susceptible to oxidative injury induced by both reactive oxygen and nitrogen species. Increased oxidative stress and imbalance in antioxidant enzymes may play a role in the pathogenesis of inflammatory pulmonary diseases. Preterm infants are frequently exposed to high oxygen concentrations, infections or inflammation; they have reduced antioxidant defense and high free iron levels which enhance toxic radical generation. Multiple ventilation strategies have been studied to reduce injury and improve outcomes in preterm infants. Using lung protective strategies, there is the need to reach a compromise between satisfaction of gas exchange and potential toxicities related to over-distension, derecruitment of lung units and high oxygen concentrations. In this review, the authors summarize scientific evidence concerning oxidative stress as it relates to resuscitation in the delivery room and to the strategies of ventilation.
Collapse
Affiliation(s)
- Salvatore Aversa
- Neonatal Intensive Care Unit, Children Hospital, Spedali Civili of Brescia, Brescia, Italy, PhD course in Intensive Care, University of Messina, Messina, Italy
| | - Lucia Marseglia
- Department of Pediatrics, University of Messina, Messina, Italy.
| | - Sara Manti
- Department of Pediatrics, University of Messina, Messina, Italy
| | | | | | - Antonio David
- Department of Neurosciences, Psychiatric and Anesthesiological Sciences, University of Messina, Messina, Italy
| | - Gaetano Chirico
- Neonatal Intensive Care Unit, Children Hospital, Spedali Civili of Brescia, Brescia, Italy
| | - Eloisa Gitto
- Department of Pediatrics, University of Messina, Messina, Italy
| |
Collapse
|
20
|
Marseglia L, D'Angelo G, Manti S, Aversa S, Reiter RJ, Antonuccio P, Centorrino A, Romeo C, Impellizzeri P, Gitto E. Oxidative Stress-Mediated Damage in Newborns with Necrotizing Enterocolitis: A Possible Role of Melatonin. Am J Perinatol 2015; 32:905-9. [PMID: 25738791 DOI: 10.1055/s-0035-1547328] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 10/23/2022]
Abstract
BACKGROUND Necrotizing enterocolitis is a gastrointestinal surgical emergency in premature neonates. Free radicals have been linked to the development of the disease in infants. Ischemia, hypoxia-reperfusion, infection, and inflammation produce elevated levels of reactive oxygen species, impairing the redox balance and shifting cells into a state of oxidative stress. Melatonin, an effective direct free-radical scavenger and indirect antioxidant agent, exerts pleiotropic action on the human body. Several studies have tested the efficacy of melatonin in counteracting oxidative injury in diseases of newborns. Melatonin has been widely used in newborns including cases of asphyxia, respiratory distress syndrome, and sepsis, and no significant toxicity or treatment-related side effects with long-term melatonin therapy have been reported. CONCLUSION Therefore, melatonin, besides standard therapies, could be considered as a potentially safe approach to prevent and treat necrotizing enterocolitis in premature infants. This review summarizes what is known about the role of oxidative stress, and potentially beneficial effects of antioxidants, such as melatonin, in necrotizing enterocolitis.
Collapse
Affiliation(s)
- Lucia Marseglia
- Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - Gabriella D'Angelo
- Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - Sara Manti
- Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - Salvatore Aversa
- Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - Russel J Reiter
- Department of Cellular and Structural Biology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Pietro Antonuccio
- Unit of Pediatric Surgery, Department of Pediatrics, University of Messina, Messina, Italy
| | - Antonio Centorrino
- Unit of Pediatric Surgery, Department of Pediatrics, University of Messina, Messina, Italy
| | - Carmelo Romeo
- Unit of Pediatric Surgery, Department of Pediatrics, University of Messina, Messina, Italy
| | - Pietro Impellizzeri
- Unit of Pediatric Surgery, Department of Pediatrics, University of Messina, Messina, Italy
| | - Eloisa Gitto
- Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University of Messina, Messina, Italy
| |
Collapse
|
21
|
Marseglia L, D'Angelo G, Manti S, Aversa S, Arrigo T, Reiter RJ, Gitto E. Analgesic, anxiolytic and anaesthetic effects of melatonin: new potential uses in pediatrics. Int J Mol Sci 2015; 16:1209-20. [PMID: 25569095 PMCID: PMC4307299 DOI: 10.3390/ijms16011209] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 12/25/2014] [Indexed: 11/16/2022] Open
Abstract
Exogenous melatonin is used in a number of situations, first and foremost in the treatment of sleep disorders and jet leg. However, the hypnotic, antinociceptive, and anticonvulsant properties of melatonin endow this neurohormone with the profile of a drug that modulates effects of anesthetic agents, supporting its potential use at different stages during anesthetic procedures, in both adults and children. In light of these properties, melatonin has been administered to children undergoing diagnostic procedures requiring sedation or general anesthesia, such as magnetic resonance imaging, auditory brainstem response tests and electroencephalogram. Controversial data support the use of melatonin as anxiolytic and antinociceptive agents in pediatric patients undergoing surgery. The aim of this review was to evaluate available evidence relating to efficacy and safety of melatonin as an analgesic and as a sedative agent in children. Melatonin and its analogs may have a role in antinociceptive therapies and as an alternative to midazolam in premedication of adults and children, although its effectiveness is still controversial and available data are clearly incomplete.
Collapse
Affiliation(s)
- Lucia Marseglia
- Neonatal and Paediatric Intensive Care Unit, Department of Paediatrics, University of Messina, Via Consolare Valeria, Messina 98125, Italy.
| | - Gabriella D'Angelo
- Neonatal and Paediatric Intensive Care Unit, Department of Paediatrics, University of Messina, Via Consolare Valeria, Messina 98125, Italy.
| | - Sara Manti
- Unit of Paediatric Genetics and Immunology, Department of Paediatrics, University of Messina, Via Consolare Valeria 1, Messina 98125, Italy.
| | - Salvatore Aversa
- Neonatal and Paediatric Intensive Care Unit, Department of Paediatrics, University of Messina, Via Consolare Valeria, Messina 98125, Italy.
| | - Teresa Arrigo
- Unit of Paediatric Genetics and Immunology, Department of Paediatrics, University of Messina, Via Consolare Valeria 1, Messina 98125, Italy.
| | - Russel J Reiter
- Department of Cellular and Structural Biology, University of Texas Health Science Center at San Antonio, San Antonio, TX 40729, USA.
| | - Eloisa Gitto
- Neonatal and Paediatric Intensive Care Unit, Department of Paediatrics, University of Messina, Via Consolare Valeria, Messina 98125, Italy.
| |
Collapse
|
22
|
Marseglia L, Aversa S, Barberi I, Salpietro CD, Cusumano E, Speciale A, Saija A, Romeo C, Trimarchi G, Reiter RJ, Gitto E. High endogenous melatonin levels in critically ill children: a pilot study. J Pediatr 2013; 162:357-60. [PMID: 22910100 DOI: 10.1016/j.jpeds.2012.07.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 06/15/2012] [Accepted: 07/11/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the serum melatonin levels in critically ill pediatric patients and to test the effect of light on the melatonin's circadian rhythm. Data on melatonin secretion in critically ill pediatric subjects are lacking. STUDY DESIGN We investigated the serum melatonin levels of 16 sedated and mechanically ventilated patients in a pediatric intensive care unit. Children (mean age, 5.1 ± 3.1 years) were randomly assigned to a dark-exposed or to a light-exposed group to evaluate the effects of light on serum melatonin concentrations. Blood samples for serum melatonin analysis were collected at 10 p.m., 1 a.m., 3 a.m., 5 a.m., 8 a.m., and 12 p.m. RESULTS The melatonin circadian rhythm was severely disrupted in critically ill children; light exposure lowered serum melatonin even in a context of highly altered circadian cycle; melatonin peaks were greater for healthy age-matched children. CONCLUSION The high melatonin levels in the critically ill children may be a response to counteract the elevated oxidative stress associated with serious diseases. Whether these elevated melatonin levels confer any beneficial effects in pediatric critically ill patients remains unknown.
Collapse
Affiliation(s)
- Lucia Marseglia
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Aversa S, Ondolo C, Abbadessa G, Piccione F, Carriero V, Fulcheri A, Lauria A, De Francia S, Racca S. Steroid resistance in nasal polyposis: role of glucocorticoid receptor and TGF-beta1. Rhinology 2012. [DOI: 10.4193/rhino11.249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background: Glucocorticoids (GCs) are considered drugs of choice for treating nasal polyps (NPs). However, a subset of patients shows a limited clinical response even to high doses of GCs. Altered expression of glucocorticoid receptors (GRs), namely GR-alpha; and GR-beta;, is a potential mechanism underlying GC insensitivity. GCs modulate the expression of several cytokines, including transforming growth factor-beta (TGF-beta), which may contribute to cellular proliferation in NPs. The study investigates some biomolecular features of GC-resistant NPs, and examines possible differences from normal mucosa (NM). Methodology: Radioligand binding assay (binding) was used to determine GR-alpha; binding capacity; Western blotting was used to evaluate GR-alpha;, GR-beta;, and TGF-beta; expression and GR-alpha; subcellular distribution. NPs were sampled in 32 patients during ethmoidectomy; NM was taken from 15 healthy patients during rhinoplasty. Results: GR-alpha; was present in NPs and NM, with lower affinity for the ligand in NPs. GR-alpha; was prevalent in the cytosol of NPs that were GR-alpha-negative to the binding assay. GR-beta was expressed in NPs and absent in the majority of NM. TGF-beta1 expression was higher in NPs than in NM. Conclusions: GR-beta and TGF-beta1 might be involved in NP pathogenesis, but their role in modulating GC sensitivity is still unclear.
Collapse
|
24
|
Abstract
Endotracheal intubation is a common painful procedure in newborn care. Neonates are more sensitive to pain than older infants, children, and adults, and this hypersensitivity is further exacerbated in preterm neonates. The aim of this study was to evaluate the analgesic activity of melatonin during endotracheal intubation of the newborn by using the Neonatal Infant Pain Scale (NIPS) and Premature Infant Pain Profile (PIPP) score. Secondary outcome was an evaluation of melatonin as inflammatory responses. This was performed by measuring the levels of pro- and anti-inflammatory cytokines implicated in the pain. Sixty preterm infants were enrolled in the study and were randomly divided into two groups: 30 infants treated with melatonin plus common sedation and analgesia recommended by Italian Society of Neonatology (group 1) and 30 infants treated with only common sedation and analgesia. The sedative and analgesic drugs included atropine, fentanyl, and vecuronium. The reduction in pain score (NIPS) was similar in both groups at an early phase, while it (PIPP score) was lower in melatonin-treated group infants than the other newborns at a late phase, during intubation and mechanical ventilation. The differences were statistically significant at 12, 24, 48, and 72 hr (P < 0.001). Pro-inflammatory and anti-inflammatory cytokines (IL-6, IL-8, IL-10 and IL-12) were higher in the common sedation and analgesia group than in melatonin-treated infants at 24, 48, 72 hr and 7 days (P < 0.001). This study suggests the use of melatonin as an adjunct analgesic therapy during procedural pain, especially when an inflammatory component is involved.
Collapse
Affiliation(s)
- Eloisa Gitto
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Gitto E, Pellegrino S, Aversa S, Romeo C, Trimarchi G, Barberi I, Calabró MP, Salpietro CD, Reiter RJ. Oxidative stress and persistent pulmonary hypertension of the newborn treated with inhaled nitric oxide and different oxygen concentrations. J Matern Fetal Neonatal Med 2012; 25:1723-6. [PMID: 22320379 DOI: 10.3109/14767058.2012.663020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aim of this study was to determine the effects of inhaled NO with different oxygen concentrations on the inflammatory cascade in newborns with hypoxic respiratory failure secondary to persistent pulmonary hypertension. METHODS 60 newborns received iNO and 30 of them received an initial oxygen concentration of 45% (group 1), while the other 30 newborns received an initial oxygen concentration of 80% (group 2). The levels of inflammatory cytokines (IL-6, IL-8, TNF-α) were measured. The clinical outcome was also recorded. RESULTS The findings show that interleukin concentrations (IL-6, IL-8, TNF-α) were significantly decreased between 0 and 72 hours (p < 0.01) in the newborns exposed to initial oxygen concentration of 45% and significantly increased in the other group. CONCLUSIONS When inhaled, NO was co-administered with concentration of O(2) <45%, anti-inflammatory responses occurred, in accord with evidence in the published literature. The benefits of iNO on the clinical outcome in the current study demonstrate that inhaled NO in both groups was associated with improved short-term oxygenation.
Collapse
Affiliation(s)
- Eloisa Gitto
- Department of Pediatrics, Neonatal Intensive Care Unit, University of Messina, Messina, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Caraci P, Fulcheri A, Ondolo C, Laino F, Volante M, Aversa S. Hyalinizing trabecular tumor of the thyroid: a case report. Head Neck Pathol 2011; 5:423-7. [PMID: 21720843 PMCID: PMC3210228 DOI: 10.1007/s12105-011-0276-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [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: 03/24/2011] [Accepted: 06/11/2011] [Indexed: 11/30/2022]
Abstract
Hyalinizing trabecular tumor (HTT) of the thyroid is a rare neoplasm that was first described by Carney in 1987. It is a tumor of follicular derivation with peculiar nuclear, architectural, histochemical, and immunohistochemical features. We report a case of HTT in a 69-year-old woman with a mutinodular goiter. Since the clinical and ultrasonographic features were nonspecific, fine needle aspiration biopsy (FNAB) of the left lobe-dominant node was performed that resulted in an indeterminate cytologic diagnosis (category THY-3). The patient underwent total thyroidectomy, with a histologic diagnosis of HTT. We discuss the clinical and diagnostic approach, including the role of FNAB, and the pathologic features of HTT with special reference to the possible differential diagnosis. Total thyroidectomy or hemithyroidectomy represent adequate treatments, while radioiodine ablation is not standard. Although rare cases of malignant HTT have been documented, this tumor should be considered a benign neoplasm or, at most, a neoplasm of extremely low malignant potential. As a consequence, once this diagnosis is rendered, clinical management should be conservative, which may include a precautionary annual follow-up in order to exclude the very rare possibility of recurrence, as exceptionally reported.
Collapse
Affiliation(s)
- P. Caraci
- Section of Internal Medicine, San Luigi Hospital, regione Gonzole 10, Orbassano (Torino), 10043 Italy
| | - A. Fulcheri
- Section of Otolaryngology – Head and Neck Surgery, Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, regione Gonzole 10, Orbassano (Torino), 10043 Italy
| | - C. Ondolo
- Section of Otolaryngology – Head and Neck Surgery, Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, regione Gonzole 10, Orbassano (Torino), 10043 Italy
| | - F. Laino
- Section of Internal Medicine, San Luigi Hospital, regione Gonzole 10, Orbassano (Torino), 10043 Italy
| | - M. Volante
- Section of Pathology, Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, regione Gonzole 10, Orbassano (Turin), 10043 Italy
| | - S. Aversa
- Section of Otolaryngology – Head and Neck Surgery, Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, regione Gonzole 10, Orbassano (Torino), 10043 Italy
| |
Collapse
|
27
|
Aversa S, Pellegrino S, Barberi I, Reiter RJ, Gitto E. Potential utility of melatonin as an antioxidant during pregnancy and in the perinatal period. J Matern Fetal Neonatal Med 2011; 25:207-21. [PMID: 21557691 DOI: 10.3109/14767058.2011.573827] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Reactive oxygen species (ROS) play a critical role in the pathogenesis of various diseases during pregnancy and the perinatal period. Newborns are more prone to oxidative stress than individuals later in life. During pregnancy, increased oxygen demand augments the rate of production of ROS and women, even during normal pregnancies, experience elevated oxidative stress compared with non-pregnant women. ROS generation is also increased in the placenta during preeclampsia. Melatonin is a highly effective direct free-radical scavenger, indirect antioxidant, and cytoprotective agent in human pregnancy and it appears to be essential for successful pregnancy. This suggests a role for melatonin in human reproduction and in neonatal pathologies (asphyxia, respiratory distress syndrome, sepsis, etc.). This review summarizes current knowledge concerning the role for melatonin in human pregnancy and in the newborn. Numerous studies agree that short-term melatonin therapy is highly effective in reducing complications during pregnancy and in the neonatal period. No significant toxicity or treatment-related side effects with long-term melatonin therapy in children and adults have been reported. Treatment with melatonin might result in a wide range of health benefits, including improved quality of life and reduced healthcare costs.
Collapse
Affiliation(s)
- Salvatore Aversa
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Italy
| | | | | | | | | |
Collapse
|
28
|
Messina MF, Cannavò SP, Aversa S, De Luca F. Transient natural killer deficiency in a boy with herpes simplex virus-associated recurrent erythema multiforme. ACTA ACUST UNITED AC 2011; 43:550-2. [PMID: 21351816 DOI: 10.3109/00365548.2011.560185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Erythema multiforme is characterized by itching macules, papules and bullae, symmetrically distributed on the dorsum of the hands. They can follow the administration of several drugs or infections with various agents, and in particular with herpes simplex virus. The recurrent variant is very rare, especially in the paediatric age group. We describe the case of a male adolescent with recurrent erythema multiforme caused by herpes virus and transient natural killer deficiency.
Collapse
|
29
|
Abstract
Melatonin, an endogenously produced indoleamine, is a highly effective antioxidant, free radical scavenger, and a primary circadian regulator. Melatonin has important antioxidant properties owing to direct and indirect effects. It directly scavenges reactive oxygen and reactive nitrogen species, prevents molecular oxidation, improves mitochondrial physiology, and restores glutathione homeostasis. Its indirect antioxidant effects stem from its ability to stimulate the activities of the enzymes involved in the glutathione cycling and production. Melatonin, by reducing free radical damage, may be an effective protective agent for the fetus as it is in adults. Several clinical studies on melatonin have shown that it reduces oxidative stress in human newborns with sepsis, hypoxic distress, or other conditions, where there is excessive free radical generation. A role of melatonin in infant development has also been suggested. Pineal dysfunction may be associated with deleterious outcomes in infants and may contribute to an increased prevalence of sudden infant death syndrome. Delayed melatonin production is evident in infants who had experienced an apparent life-threatening event. Melatonin has been used as a pharmacologic treatment for insomnias associated with shift work, jet lag, and delayed sleep onset in adults for decades. In children as well, melatonin has value as a sleep-promoting agent. Evidence suggests that melatonin has utility as an analgesic agent presumably related to its ability to release β-endorphin. The data support the notion that melatonin, or one of its analogs, might find use as an anesthetic agent in children.
Collapse
Affiliation(s)
- Eloisa Gitto
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Messina, Italy.
| | | | | | | | | |
Collapse
|
30
|
Conticello S, Fulcheri A, Gorzegno MG, Malinverni G, Ruo Redda MG, Gabriele P, Aversa S, Ondolo C. Larynx organ preservation in subjects with hypopharynx-larynx cancer. BMC Geriatr 2010. [PMCID: PMC3290197 DOI: 10.1186/1471-2318-10-s1-a53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
31
|
Ondolo C, Aversa S, Passali F, Ciacco C, Gulotta C, Lauriello M, Conticello S. Nasal and lung function in competitive swimmers. Acta Otorhinolaryngol Ital 2009; 29:137-143. [PMID: 20140159 PMCID: PMC2815359] [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] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Accepted: 04/29/2009] [Indexed: 05/28/2023]
Abstract
Nasal and sinusal complaints are considered common among swimmers. Aim of the present study was to evaluate the nasal and bronchial functions, before and after swimming, and the relationship between nasal resistances and FEV1 in competitive swimmers. A group of 30 competitive swimmers were examined: spirometry and nasal respiratory tests were carried out before and after swimming. Moreover, both the competitive swimmers and the 150 visitors of a swimming pool were asked to complete a specific questionnaire. In this questionnaire, 18% of the population reported nasal-sinusal symptoms after swimming. The differences between nasal volumes and resistances before and after swimming were not statistically significant. Nasal patency increased or remained unchanged in 21/30 athletes. The variations in FEV1 were not statistically significant. In conclusion, results showed that swimming is able to increase nasal patency or to leave it unchanged. Temporary worsening of the nasal patency was observed in only a few hyper-reactive patients. In the whole group, no variations, at bronchial level, were found.
Collapse
Affiliation(s)
- C Ondolo
- Department of Otolaryngology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | | | | | | | | | | | | |
Collapse
|
32
|
Messina MF, Valenzise M, Aversa S, Arrigo T, De Luca F. Iatrogenic Cushing syndrome caused by ocular glucocorticoids in a child. BMJ Case Rep 2009; 2009:bcr11.2008.1224. [PMID: 21686405 DOI: 10.1136/bcr.11.2008.1224] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A boy aged 7.6 years presented to our Unit of Paediatric Endocrinology for evaluation of obesity. Progressive weight gain (10 kg) started 6 months earlier after an accidental penetrating orbital injury on the right eye. During this period the child has been treated with oral betamethasone (0.5 mg/day) for 1 month and dexamethasone 2% ocular drops (2 hourly by day) for 6 months. Physical examination showed he was 113.5 cm in height (-1.5 SD), weight 36.0 kg, blood pressure 110/90 mmHg (90th centile), body mass index 28 (+5 SD), truncal obesity, buffalo hump, "moon-face", increased lanugo hair and supraclavicular fullness. Endocrinological work-up revealed undetectable levels of basal adrenocorticotropic hormone (ACTH), basal and ACTH-stimulated cortisol and 24 h urine excretion cortisol, confirming the diagnosis of iatrogenic Cushing syndrome. The abrupt withdrawal of ocular glucocorticoids by the parents evoked two adrenal crises; 4 months later the patient recovered. In conclusion, we would alert doctors that every formulation of glucocorticoids, no ocular drops excluded, can determine severe systemic side effects and iatrogenic Cushing syndrome.
Collapse
|
33
|
Gemelli A, Paciolla A, Oliosi F, Basso A, Moscardin R, Tineo MC, Romano P, Alaibac M, Aversa S, Furian L, D'Angelo A, Bonfante L. [A case of Kaposi's sarcoma in the rapamycin era]. G Ital Nefrol 2009; 26:90-93. [PMID: 19255968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report a case of Kaposi's sarcoma in a patient who received a double kidney transplant in 2005. Immunosuppression was induced with rapamycin and antilymphocyte serum while maintenance therapy consisted of rapamycin, corticosteroids and mycophenolic acid. The patient developed delayed graft function but no rejection. In November 2006 and March 2007 two graft biopsies were taken because of a significant rise in serum creatinine; they revealed chronic allograft nephropathy and polyomavirus infection. Meanwhile a skin biopsy of the leg was performed to determine the nature of a discolored lesion. The morphohistological diagnosis was Kaposi's sarcoma. For this reason rapamycin was stopped and steroid treatment gradually reduced. Specific therapy with doxorubicin was started; radiological and endoscopic examination excluded disseminated disease while serological tests were positive for antibodies to HHV-8, a virus known to cause Kaposi's sarcoma. Unfortunately, withdrawal of antirejection therapy caused loss of the graft, so the patient had to start dialysis. In this report we stress the possible development of malignancy in transplanted patients who are given rapamycin. Rapamycin is known to be an antirejection drug and to have antineoplastic activity; the major risk of malignancy is probably related to immunosuppression rather than the type of drugs used to obtain it.
Collapse
Affiliation(s)
- A Gemelli
- Clinica Nefrologica, Dipartimento di Scienza Mediche e Chirurgiche, Universita' degli Studi di Padova, Padova, Italy
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Corona G, Giogianni G, Aversa S, Decembrino N, Artemisia A, Cordaro V, Barberi I. Variations of Procalcitonin Serum Levels in Neonatal Period. Int J Infect Dis 2008. [DOI: 10.1016/j.ijid.2008.05.1311] [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: 11/15/2022] Open
|
35
|
Motta G, Casolino D, Cassiano B, Conticello S, Esposito E, Galletti F, Galli V, Larotonda G, Laudadio P, Mansi N, Mevio E, Mira E, Motta G, Ceroni AR, Tarantino V, Tavormina P, Vicini C, Motta S, Aversa S, Canani FB, Cappello V, Carra P, Cifarelli D, Cinquegrana G, Consolo E, Ondolo C, Ripa G, Romano G. Adeno-tonsillar surgery in Italy. Acta Otorhinolaryngol Ital 2008; 28:1-6. [PMID: 18533547 PMCID: PMC2640065] [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] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Accepted: 11/19/2007] [Indexed: 05/26/2023]
Abstract
Indications to surgery for adeno-tonsillar inflammatory disorders and analysis of the effectiveness of surgical treatment, compared with watchful waiting strategy, continue to be the subject of scientific debate. The present investigation focuses on the surgical activity of 14 Italian Otorhinolaryngological Units between 1999 and 2004. Surgical interventions (adeno-tonsillectomy, adenoidectomy, tonsillectomy) on 26915 children (age range: 2-11 years) were considered. Data on adeno-tonsillar interventions were analysed in relation to other interventions of ENT interest, performed in the same units and in the same period. Adeno-tonsillar interventions accounted for 35.4% of all operations of ENT interest. Adeno-tonsillectomy accounted for 56.6% of overall adeno-tonsillar operations, adenoidectomy 31.6%, tonsillectomy 11.8%. The percentage for the three interventions was homogeneous in the period of the study and in the recruited units. The percentage of children who underwent adeno-tonsillar surgery in paediatric units was higher as compared to general units, as far as concerns the overall number of operations performed. In southern Italy, the number of adeno-tonsillar interventions, in general, and of adeno-tonsillectomy, in particular, was higher compared to that in northern Italy. Results of the present study suggest that environmental factors, cultural issues and local health demands, may influence indications and, therefore, the different incidence of the operations under consideration in the units taking part in the investigation.
Collapse
Affiliation(s)
- G Motta
- Otorhinolaryngology Unit, Cesena, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Leyvraz S, Pampallona S, Martinelli G, Ploner F, Aversa S, Rosti G, Brunsvig P, Montes A, Yilmaz U, Perey L. Randomized phase III study of high-dose sequential chemotherapy (CT) supported by peripheral blood progenitor cells (PBPC) for the treatment of small cell lung cancer (SCLC): Results of the EBMT Random-ICE trial. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7064 Background: EBMT has defined in a phase II trial (JCO 1999, 3531) feasibility and activity of high-dose sequential CT for SCLC increasing 3 fold the dose-intensity and significantly the peak-dose and the total dose of CT. Methods: Randomized prospective study aiming to improve the 3-year survival from 12% in the standard (S) to 24% in the high-dose (H) arm, for a total accrual of 340 patients. Limited or extensive ≤ 2 metastatic sites, age ≤ 65 y.o., PS 0–1. Arm S/Arm H: ifosfamide 5 g/m2 d1/2.5 g/m2/d × 4; carboplatin 300 mg/m2 d1/AUC = 5/d × 4; etoposide 180 mg/m2/d. × 2/300 mg/m2/d × 4, every 28 days, for 6 cycles in Arm S. Three cycles were given in Arm H supported by PBPC collected after 2 courses of epirubicin 150 mg/m2/paclitaxel 175 mg/m2. Due to low accrual, a formal stopping rule was introduced with boundaries for early stopping in favour of a difference (O’Brien-Fleming) or of lack thereof (Pocock). The present analysis has been done with 110 deaths. Results: Since June 1997, 145 patients have been accrued (evaluable =140, S = 71, H = 69), median age 53, prognostic factors balanced. Mobilization toxicity ≥ 3: neutropenia 61%, thrombopenia 11%, anemia 7%, infection 6%, mucositis 9% and 2 toxic deaths. Toxicity ≥ 3 among 353 cycles of S and 152 of H respectively: neutropenia 26%/100%, thrombopenia 12%/100%, anemia 8%/69%, infection 1%/15%, fever 11%/72%, toxic death 1/8. Response rate of S and H: 67% (CR 32%)/77% (CR 37%) (p = 0.188). Median follow-up 4.9 years. Progression free survival 8.8 and 12 months (p = 0.737, unadjusted) and median overall survival 15 and 19.1 months (p = 0.659, unadjusted) for S and H respectively. At 3 years, 19% of the patients were alive in both arms. Conclusions: Random-ICE was designed with strong statistical power and shows no evidence that the treatment of SCLC can be improved by increasing the dose-intensity, the peak-dose or the total dose of ICE and that such intensification strategy should probably be abandoned. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- S. Leyvraz
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - S. Pampallona
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - G. Martinelli
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - F. Ploner
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - S. Aversa
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - G. Rosti
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - P. Brunsvig
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - A. Montes
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - U. Yilmaz
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - L. Perey
- University Hospital, Lausanne, Switzerland; forMed, Evolène, Switzerland; Instituto Europeo Di Oncologia, Milano, Italy; Universität Klinik, Graz, Austria; Azienda Ospitaliera, Padova, Italy; Ospidale Civile, Ravenna, Italy; Norwegian Radium Hospital, Oslo, Norway; Institute Catalan of Oncology, Barcelona, Spain; Dokuz Eylul University School of Medicine, Izmir, Turkey
| |
Collapse
|
37
|
Abstract
BACKGROUND This study evaluates the diagnostic role of preoperative cytology of parotid neoplasms. The method is particularly useful in the evaluation of the parotid diseases in which the same clinical features may be treated variously. Fine-needle aspiration biopsy is a simple and well-tolerated diagnostic tool, which provides accurate information for diagnosis and follow-up of the disease. The accuracy of the method partly depends on the operator skill. MATERIALS AND METHODS From a series of 452 subjects who underwent parotidectomy, preoperative cytological evaluation was available in 310 and compared with histological diagnosis in a retrospective review. RESULTS The agreement between histotype determination using fine-needle aspiration biopsy and final histological diagnosis was 79%, specificity was 100%, sensitivity was 83%, and diagnostic accuracy was 97%. CONCLUSION These findings demonstrated that, given the low complication rate, preoperative cytology is particularly useful in diagnosing parotid disease and in planning the surgical strategy and approach.
Collapse
Affiliation(s)
- Salvatore Aversa
- Department of Otolaryngology, University of Turin, San Luigi Hospital, Orbassano, Torino, Italy
| | | | | | | | | |
Collapse
|
38
|
Olivieri A, Santini G, Patti C, Chisesi T, De Souza C, Rubagotti A, Aversa S, Billio A, Porcellini A, Candela M, Centurioni R, Congiu AM, Brunori M, Nati S, Spriano M, Vimercati R, Marino G, Contu A, Tedeschi L, Majolino I, Crugnola M, Sertoli MR. Upfront high-dose sequential therapy (HDS) versus VACOP-B with or without HDS in aggressive non-Hodgkin's lymphoma: long-term results by the NHLCSG. Ann Oncol 2005; 16:1941-8. [PMID: 16157621 DOI: 10.1093/annonc/mdi399] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is not univocal concordance for using high-dose sequential therapy (HDS) as first-line treatment for aggressive non-Hodgkin's lymphoma (NHL). We designed this study to evaluate the usefulness of HDS followed by high-dose therapy (HDT) with autologous stem cell transplantation as front-line treatment in different subsets of aggressive NHL. PATIENTS AND METHODS Among 223 patients aged 15-60 years with aggressive, advanced stage NHL, 106 patients were randomized to VACOP-B (etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, bleomycin) for 12 weeks (plus HDS/HDT in case of persistent disease) (arm A), and 117 patients to VACOP-B for 8 weeks plus upfront HDS/HDT (arm B). RESULTS According to the intention-to-treat analysis, the complete response rate was 75% for arm A and 72.6% for arm B. With a median follow-up of 62 months there was no difference in 7-year probability of survival (60% and 57.8%; P = 0.5), disease-free survival (DFS) (62% and 71%; P = 0.2) and progression-free survival (PFS) (44.9% and 40.9%; P = 0.7) between the two arms. Subgroup analyses confirmed that the best results in terms of survival, DFS and PFS were achieved by patients with large B-cell NHL without bone marrow (BM) involvement, independently of the treatment arm. Results were poorer in other categories of patients and poorest in patients with BM involvement. CONCLUSIONS Aggressive NHL patients do not benefit from upfront HDS/HDT.
Collapse
Affiliation(s)
- A Olivieri
- Department of Hematology, University of Ancona, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Blandamura S, Vendraminelli R, Aversa S, Fedrigo M. Collecting duct carcinoma of kidney producing alpha-fetoprotein. Eur J Surg Oncol 2005; 31:1039-41. [PMID: 16126361 DOI: 10.1016/j.ejso.2005.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2005] [Accepted: 07/08/2005] [Indexed: 01/20/2023] Open
Abstract
AIM A case of a collecting duct carcinoma (CDC) of the kidney alpha-fetoprotein producing is reported. Serum elevation of alpha-fetoprotein (AFP) is a common marker for hepatocellular carcinoma, although some extrahepatic carcinomas, also of the kidney, with elevated AFP levels have also been reported in the literature. CASE REPORT A 62-year-old man with a collecting duct carcinoma of the kidney presenting as a mediastinal mass and supra-clavicular lymph node enlargement, and with a serum alpha-fetoprotein (AFP) level of 102.8 microg/L. RESULTS AND CONCLUSIONS CDC of the kidney is associated with an aggressive course and extremely poor prognosis. There are no standard treatment regimens, and neither immunotherapy nor chemotherapy has been found to be effective. In the present case, nephrectomy followed by a chemotherapeutic association of carboplatin and gemcitabine gave promising results, with lessening of the patient's symptoms.
Collapse
Affiliation(s)
- S Blandamura
- Section of Pathological Anatomy, Department of Oncological and Surgical Sciences, University of Padova, Via A. Gabelli 61, 35121 Padova, Italy.
| | | | | | | |
Collapse
|
40
|
Favaretto AG, Loreggian L, Rea F, Stefani M, Bortolotti L, Marchi R, Aversa S, Sotti G, Monfardini S. Preoperative concomitant chemo-radiotherapy (CT-RT) in non small cell lung cancer patients with superior sulcus tumor (SST): A single institution experience. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - F. Rea
- Azienda Ospedaliera, Padova, Italy
| | | | | | | | | | - G. Sotti
- Azienda Ospedaliera, Padova, Italy
| | | |
Collapse
|
41
|
Santini G, De Souza C, Aversa S, Patti C, Tedeschi L, Candela M, Olivieri A, Chisesi T, Rubagotti A, Centurioni R, Nardi V, Congiu M, Gennaro M, Truini M. A third generation regimen VACOP-B with or without adjuvant radiotherapy for aggressive localized non-Hodgkin's lymphoma: report from the Italian Non-Hodgkin's Lymphoma Co-operative Study Group. Braz J Med Biol Res 2004; 37:719-28. [PMID: 15107935 DOI: 10.1590/s0100-879x2004000500014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The objective of this multicenter prospective study was to determine the clinical efficacy and toxicity of a polychemotherapeutic third generation regimen, VACOP-B, with or without radiotherapy as front-line therapy in aggressive localized non-Hodgkin's lymphoma. Ninety-three adult patients (47 males and 46 females, median age 45 years) with aggressive localized non-Hodgkin's lymphoma, 43 in stage I and 50 in stage II (non-bulky), were included in the study. Stage I patients received VACOP-B for 6 weeks plus involved field radiotherapy and stage II patients received 12 weeks VACOP-B plus involved field radiotherapy on residual masses. Eighty-six (92.5%) achieved complete remission and 4 (4.3%) partial remission. Three patients (3.2%) were primarily resistant. Ten-year probability of survival, progression-free survival and disease-free survival were 87.3, 79.9 and 83.9%, respectively. Eighty-four patients are surviving at a median observation time of 57 months (range: 6-126). Statistical analysis showed no difference between stages I and II in terms of response, ten-year probability of survival, progression-free survival or disease-free survival. Side effects and toxicity were negligible and were similar in the two patient groups. The results of this prospective study suggest that 6 weeks of VACOP-B treatment plus radiotherapy may be the therapy of choice in stage I aggressive non-Hodgkin's lymphoma. Twelve weeks of VACOP-B treatment with or without radiotherapy was shown to be effective and feasible for stage II. These observations need to be confirmed by a phase III study comparing first and third generation protocols in stage I-II aggressive non-Hodgkin's lymphoma.
Collapse
Affiliation(s)
- G Santini
- Department of Hematology, San Martino Hospital, Genoa, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Saggiorato E, Aversa S, Deandreis D, Arecco F, Mussa A, Puligheddu B, Cappia S, Conticello S, Papotti M, Orlandi F. Galectin-3: presurgical marker of thyroid follicular epithelial cell-derived carcinomas. J Endocrinol Invest 2004; 27:311-7. [PMID: 15233548 DOI: 10.1007/bf03351054] [Citation(s) in RCA: 27] [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: 10/25/2022]
Abstract
Preoperative follicular lesion characterisation represents an unsolved diagnostic problem in thyroid nodular disease. Although fine-needle aspiration biopsy is the most reliable preoperative diagnostic procedure, it shows inherent limitations in differentiating adenoma from follicular carcinoma and, sometimes, follicular variants of papillary carcinoma. Galectin-3 cytoplasmic neoexpression has been proposed as a peculiar feature of thyroid malignant cells, easily detectable in cytological and histological samples. The aim of this study was to re-evaluate the galectin-3 expression in a large sample of thyroid lesions using an immunohistocytochemical biotin-free detection system and a specific anti-human-galectin-3 monoclonal antibody in order to avoid the interference of technical factors, a cause of conflicting results recently reported by some authors. We analysed galectin-3 expression of 39 follicular carcinomas, 26 papillary carcinomas, and 105 adenomas in both cell-block samples and their histological counterparts. All cell-block and histological papillary carcinoma samples showed high levels of galectin-3 immunoreactivity. Thirty-four follicular carcinomas were positive, whereas 5 were negative in cell-blocks but positive in their histological counterparts. Twelve out of 105 adenomas expressed galectin-3 in cell-blocks and histological samples. The diagnostic accuracy of preoperative galectin-3 evaluation in adenomas vs follicular carcinomas was 90.0%. Galectin-3 expression was also investigated in 22 minimally-invasive follicular carcinomas. All of them showed galectin-3 immunoreactivity in both cytological and histological specimens with the exception of two cases, where galectin-3 positivity was observed only in the surgical material. The routine correct use of galectin-3, by increasing the diagnostic accuracy of conventional cytology, improves the management of thyroid nodules and can lead to a sensitive reduction of useless thyroid surgeries.
Collapse
MESH Headings
- Adenocarcinoma, Follicular/chemistry
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/pathology
- Adenoma/chemistry
- Adenoma/diagnosis
- Adenoma/pathology
- Antibodies, Monoclonal
- Biomarkers, Tumor/analysis
- Biopsy, Fine-Needle
- Carcinoma, Papillary/chemistry
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/pathology
- Cell Nucleus/chemistry
- Cytoplasm/chemistry
- Diagnosis, Differential
- Galectin 3/analysis
- Humans
- Immunohistochemistry
- Preoperative Care
- Retrospective Studies
- Sensitivity and Specificity
- Thyroid Neoplasms/chemistry
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/pathology
- Thyroid Nodule/pathology
- Thyroid Nodule/surgery
Collapse
Affiliation(s)
- E Saggiorato
- Section of Endocrinology, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Caraci P, Aversa S, Mussa A, Pancani G, Ondolo C, Conticello S. Role of fine-needle aspiration biopsy and frozen-section evaluation in the surgical management of thyroid nodules. Br J Surg 2002; 89:797-801. [PMID: 12027995 DOI: 10.1046/j.1365-2168.2002.02070.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The role of routine frozen section (FS) in the surgical management of thyroid nodules remains uncertain. This study reviewed the role of FS in the presence of an adequate fine-needle aspiration biopsy (FNAB). METHODS FNAB and FS were evaluated in 206 patients who had surgery for a thyroid nodule. Cytological specimens were classified as benign, malignant or suspicious. The FS diagnoses were benign, malignant or deferred. RESULTS A cytological diagnosis was obtained in 93 nodules; the remaining 113 were classified as suspicious, of which 21 were malignant on definitive examination. The overall accuracy of FNAB was 53 per cent. FS evaluation identified 165 lesions as benign; the diagnosis was deferred until definitive histological evaluation in only eight. The overall accuracy, therefore, was 96 per cent. Routine use of FS was cost-effective; lowering the number of reoperations led to an estimated saving of about 40 per cent. CONCLUSION These data suggest that FS remains an important tool in the surgical management of thyroid nodules and can reduce the number of patients requiring reoperation.
Collapse
Affiliation(s)
- P Caraci
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | | | | | | | | | | |
Collapse
|
44
|
Abstract
Using the ASI, a multi-dimensional survey instrument, data were collected on women in Florida's welfare program (WAGES). The women manifested serious problems in terms of physical and mental health, employment skills and childcare needs. Length of time on welfare was strongly associated with the severity of recipients' problems. Women with 2 + years on welfare were significantly more likely to have problems. However, substance use was lower than anticipated which may be because substance abusers are dropping out of welfare. This possibility raises concerns that, rather than going into the workfore, women may be returning to the streets. If so, instead of reducing the welfare costs, we are shifting those costs to local health, social service and criminal justice systems.
Collapse
Affiliation(s)
- J C Merrill
- University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, USA
| | | | | | | | | |
Collapse
|
45
|
Aversa S, Pivano G, Vergano R, Mussa A, Gonzatto I, Ondolo C, Orlandi F. [The accuracy of the fine needle aspiration biopsy in 1250 thyroid nodules]. Acta Otorhinolaryngol Ital 1999; 19:260-4. [PMID: 10827799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Between 1989 and 1998 a total of 1250 thyroid nodes underwent Fine Needle Aspiration Biopsy (FNAB). Of these 150 went on to surgery with subsequent histological examination which proved positive for malignant neoplasm in 35 nodes. The remaining 115 nodes presented benign lesions. The cytological diagnoses were preventatively broken down into three groups: a) benign; b) malignant; c) suspected malignancy. Group a) included 53 nodes; histology confirmed the diagnosis of a benign lesion in 50 of these nodes (True Negatives), while 3 proved malignant (False Negatives). The cytological diagnosis of malignancy was reached in 24 nodes (group b) and subsequent histology confirmed the malignancy in 18 cases (True Positives) while the remaining 6 nodes tested negative for neoplasm (False Positives). Group c) included those thyroid nodes which cytology classified as follicular neoplasms and for which histology was required to reach a diagnosis of malignancy or benignity; for this reason these cases were not used in the evaluation of diagnostic reliability. Of these 15 (20.5%) proved malignant and 58 (79.5%) benign (44 follicular adenomas and 14 micro-macrofollicular struma nodes). On the basis of the above data, the diagnostic accuracy of FNAB is 88.3%, sensitivity 85.7% and specificity 89.3%. These findings are substantially in agreement with the international literature which considers cytological testing highly reliable. In analyzing the cases which were not confirmed by histology, it was interesting to note that among the 4 false positives--defined as the "presence of atypical cells in a lymphocyte infiltration context"--a full three were thyroadenitis nodes for which the presence of atypical cells is quite common. The three false negative nodes, on the other hand, included two cysts for which cytology did not reveal neoplastic cells. The present experience suggests the following: 1) FNAB is still the most reliable technique for the diagnosis of thyroid neoplasms; 2) the presence of atypical cells in thyroid node lesions is not always indication of a malignancy; 3) cysts must be subject to careful follow-up since they can mask a malignant neoplasm.
Collapse
Affiliation(s)
- S Aversa
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino
| | | | | | | | | | | | | |
Collapse
|
46
|
Salvagno L, Sorarù M, Busetto M, Puccetti C, Sava C, Endrizzi L, Giusto M, Aversa S, Chiarion Sileni V, Polico R, Bianco A, Rupolo M, Nitti D, Doglioni C, Lise M. Gastric non-Hodgkin's lymphoma: analysis of 252 patients from a multicenter study. Tumori 1999; 85:113-21. [PMID: 10363077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
AIMS AND BACKGROUND The stomach is the most common site of primary extranodal non-Hodgkin's lymphoma (NHL) and no agreement has been reached so far on the best therapeutic approach. The main objects of this study were to report the long-term results and to evaluate the importance of some possible prognostic factors in a large series of patients. NHL was considered primary gastric if the main symptoms at presentation were those of gastric disease. METHODS AND STUDY DESIGN We analyzed 252 consecutive patients treated between 1980 and 1993 in five hospitals in north-east Italy. According to the Working Formulation, 98 patients had low grade lymphoma, 59 intermediate grade (D to F), 81 G or high grade and 14 were not classified. The patients were divided into two groups: one including patients with limited disease (localized to the stomach or perigastric lymph nodes: 165 patients) and one including those with advanced disease (87 patients). The treatment consisted of surgery, chemotherapy, radiotherapy or combinations of these. Sixteen patients received only supportive therapy. RESULTS The five-year overall survival was 65.4%: 80.3% for patients with limited disease and 36.7% for those with advanced disease (P < 0.0001). Among the limited disease patients the five-year survival was 84.4% for those treated with gastrectomy alone and 88.7% for those who received also adjuvant chemotherapy (P = 0.11). However, while chemotherapy did not improve survival in low grade NHL, it seemed to produce a better survival in the intermediate and high grade groups (P = 0.06). Twelve patients were treated with primary chemotherapy and the five-year survival was 71.2%. In multivariate regression analysis the most important variable for overall survival was surgery for the whole group of 252 patients (P < 0.0001), while it was age for the group with limited disease (P = 0.0008). CONCLUSIONS Surgery alone can be curative for most patients with gastric lymphoma limited to the stomach or to the perigastric lymph nodes; surgery followed by chemotherapy seems to produce better results than surgery alone in intermediate and high grade lymphomas. Also a non-surgical approach with first-line chemotherapy is associated with a high rate of complete remissions and five-year survival. In advanced disease the five-year survival is similar to that of nodal NHL.
Collapse
Affiliation(s)
- L Salvagno
- Divisione di Oncologia Medica, Centro Oncologico Regionale, Padua
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
This report describes the development and validation of an instrument to assess the attributions human immunodeficiency virus (HIV)-infected persons who are currently taking antiretrovirals make about the effects of these medications. The specific limitations in functioning that the subjects attributed to the effects of medication were assessed. The scores on a ten-item instrument were found to have high internal consistency reliability and to be related to beliefs about the benefits and barriers to taking antiretrovirals. The attribution that the use of antiretrovirals had contributed to an increase in depressive symptoms was related to reports of having temporarily discontinued use of antiretrovirals during the preceding month. The summated score on the Medication Attribution Scale (MAS) and other subscale scores were not found to predict self-reported intentional alterations of treatment regimens. Multiple regression analyses indicated that negative attributions about the effects of medications contributed to the amount of variance in quality of life explained over and above that explained by perceived health status and level of symptomology.
Collapse
Affiliation(s)
- S Aversa
- School of Medicine, University of Miami, FL, USA
| | | | | |
Collapse
|
48
|
|
49
|
Salvagno L, Sorarù M, Sotti G, Aversa S, Chiarion Sileni V, Mazzarotto R, Scarzello G, Bianco A, Pappagallo GL, Fiorentino MV. Hybrid MOPP/ABVD and radiotherapy in advanced Hodgkin's disease. Ann Oncol 1995; 6:173-9. [PMID: 7540419 DOI: 10.1093/oxfordjournals.annonc.a059113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND In patients with advanced Hodgkin's disease (HD), the alternation of MOPP with ABVD or hybrid MOPP/ABVD are associated with a high CR rate and a high probability of 5-year survival. However, even after effective chemotherapy the risk of nodal relapse is not negligible, and not only in initial bulky site(s) of disease. For this reason, in an attempt to prevent relapses after combination chemotherapy alone, we performed a prospective study to evaluate the efficacy and toxic effects of 6 courses of hybrid MOPP/ABVD followed by radiotherapy (RT) in stages II A bulky, II B, III and also in stage IV with bulky disease of residual after chemotherapy. PATIENTS AND METHODS From January 1985 to August 1993, 133 patients with HD (128 newly diagnosed, stage II A bulky-IV, 5 in first relapse after RT) were treated according to the following program: 6 courses of the hybrid MOPP/ABVD regimen followed by RT (STNI + spleen in stages II A, II B, III without pelvic lymph node involvement, TNI + spleen in stage III with pelvic lymph node involvement, involved field in stage IV with bulky disease or residual after chemotherapy). The total dose of RT was 4000 cGy to the sites of bulky or residual disease and 2000 cGy to the other sites. RESULTS After hybrid MOPP/ABVD, 107 of 130 (82.3%) fully evaluable patients were classified as in CR or CR(U). After completion of RT, 108 patients were in CR and 3 were in PR, for an overall response rate of 85%. With a median follow-up duration of 45 months, the actuarial 5-year survival is 76% and the progression-free survival 68.6%. So far, only 14 patients have relapsed (6 within the irradiation field) and the 5-year relapse-free survival is 82.5%. CONCLUSION Six courses of hybrid MOPP/ABVD followed by RT in stages II A bulky, II B, III and in stage IV with bulky disease or residual after chemotherapy produced a high CR rate with low risk of relapse. However, a longer follow-up is necessary to evaluate the late effects of combined therapy.
Collapse
Affiliation(s)
- L Salvagno
- Division of Medical Oncology, Centro Oncologico Regionale, Padova, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Nicoletto MO, Padrini R, Koussis H, Rosabian A, Aversa S, Endrizzi L, Azzoni P, Palumbo M, Fiorentino MV. Continuous mitoxantrone infusion in pretreated epithelial ovarian cancer. Cancer Chemother Pharmacol 1995; 35:506-10. [PMID: 7882459 DOI: 10.1007/bf00686836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Mitoxantrone has shown moderate activity in advanced epithelial ovarian cancer following intermittent i.v. administration. Experiments and clinical data suggest that long-term continuous drug infusion may achieve a better therapeutic result with less toxicity. This hypothesis was tested in patients with advanced ovarian cancer who had been pretreated with other agents. Mitoxantrone was infused continuously in 21-day courses beginning every 6 weeks. If severe toxicity did not occur, the infusion rate was increased by 0.1-0.2 mg/m2 per day. The mitoxantrone solution proved to be stable over the 21-day infusion period. For ethical reasons an optimal two-stage design was employed. The trial was interrupted at the end of the first recruitment stage because the target of 3 responses out of 13 patients had not been achieved (only 1 patient had a partial response). Hematologic toxicity was observed in 11 patients, and 2 of them had a catheter occlusion. In conclusion, we found that 21-day of infusion of mitoxantrone apparently has no clinical benefit as compared with bolus administration in patients with advanced ovarian cancer.
Collapse
Affiliation(s)
- M O Nicoletto
- Medical Oncology Department, Padova General Hospital, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|