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Nappi RE, Martella S, Tiranini L, Cucinella L, Palacios S. Efficacy and safety of a device that combines multipolar radiofrequency with pulsed electromagnetic field for the treatment of vulvovaginal atrophy: a randomized, sham-controlled trial. J Sex Med 2024; 21:203-210. [PMID: 38286753 DOI: 10.1093/jsxmed/qdad166] [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] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/26/2023] [Accepted: 11/09/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Vulvovaginal atrophy (VVA) negatively affects the sexual well-being and quality of life of postmenopausal women, yet it is underreported and undertreated. AIM The study sought to investigate the efficacy and safety of a nonablative, noncoagulative multipolar radiofrequency (RF) and pulsed electromagnetic field-based device (PEMF) in treatment of symptoms related to VVA. METHODS Seventy-six women ≥19 years of age with symptoms associated with VVA were enrolled into this prospective, randomized, sham-controlled, multicenter clinical study. Subjects were randomized to receive 3 RF + PEMF treatments (active group) or sham treatments (sham group) delivered to vaginal tissue at monthly intervals. The Vaginal Health Index (VHI), along with the Female Sexual Function Index (FSFI), subject sexual satisfaction and vaginal laxity (VL) score, treatment-associated pain, and adverse events were assessed at 4 follow-up (FU) visits between 1 and 12 months after treatment. OUTCOMES Changes from baseline VHI, pH, FSFI, VL, and sexual satisfaction scores between the active and sham groups were compared before and after treatment. RESULTS Mean VHI scores in the active group were significantly better compared with the sham group after treatment at all but the last FU visit (P < .001). A greater decrease in pH (active over sham) was seen at 1 and 4 months after treatment (P < .05). FSFI improvement was shown in the active group; however, it was not significantly better than sham improvement at all FU visits. Subject sexual satisfaction in the active group showed better improvement over sham at all FU visits (P < .05), while VL evaluations saw greater improvement in the active group at 4, 6, and 12 months posttreatment (P < .05). Treatment satisfaction was greater in the active group and pain was minimal in both groups. No serious adverse effects were reported. CLINICAL IMPLICATIONS As a noninvasive alternative to traditional surgical and topical procedures, 3 sessions of noninvasive combination RF/PEMF safely demonstrated improvement in symptoms related to VVA. STRENGTHS AND LIMITATIONS This study was strengthened by the randomized, sham-controlled design; large sample size; and extended FU period. The study assessments were decreased at later FU visits due to the global COVID pandemic, and this was a key limitation to the study. CONCLUSION Nonablative, noncoagulative multipolar RF/PEMF therapy was safe, improved symptoms associated with VVA, and improved female sexual function while yielding high subject satisfaction.
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Affiliation(s)
- Rossella E Nappi
- University of Pavia, Pavia 27100, Italy
- IRCCS Policlinico San Matteo, Pavia 27100, Italy
| | - Silvia Martella
- Unit of Preventative Gynecology, IRCCS European Institute of Oncology, Milan 20141, Italy
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Cucinella L, Tiranini L, Cassani C, Martella S, Nappi RE. Genitourinary Syndrome of Menopause in Breast Cancer Survivors: Current Perspectives on the Role of Laser Therapy. Int J Womens Health 2023; 15:1261-1282. [PMID: 37576184 PMCID: PMC10422970 DOI: 10.2147/ijwh.s414509] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023] Open
Abstract
Genitourinary syndrome of menopause (GSM) is a frequent consequence of iatrogenic menopause or anti-estrogenic adjuvant therapies in breast cancer survivors (BCSs). GSM may profoundly affect sexual health and quality of life, and a multidimensional unique model of care is needed to address the burden of this chronic heterogeneous condition. Severe symptoms may be insufficiently managed with non-hormonal traditional treatments, such as moisturizers and lubricants, recommended as the first-line approach by current guidelines, because concerns exist around the use of vaginal estrogens, particularly in women on aromatase inhibitors (AIs). Vaginal laser therapy has emerged as a promising alternative in women with GSM who are not suitable or do not respond to hormonal management, or are not willing to use pharmacological strategies. We aim to systematically review current evidence about vaginal laser efficacy and safety in BCSs and to highlight gaps in the literature. We analyzed results from 20 studies, including over 700 BCSs treated with either CO2 or erbium laser, with quite heterogeneous primary outcomes and duration of follow up (4 weeks-24 months). Although evidence for laser efficacy in BCSs comes mostly from single-arm prospective studies, with only one randomized double-blind sham-controlled trial for CO2 laser and one randomized comparative trial of erbium laser and hyaluronic acid, available data are reassuring in the short term and indicate effectiveness of both CO2 and erbium lasers on the most common GSM symptoms. However, further studies are mandatory to establish long-term efficacy and safety in menopausal women, including BCSs.
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Affiliation(s)
- Laura Cucinella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - Lara Tiranini
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - Chiara Cassani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Unit of Obstetrics and Gynecology, IRCCS San Matteo Foundation, Pavia, Italy
| | - Silvia Martella
- Unit of Preventive Gynecology, IRCCS European Institute of Oncology, Milan, Italy
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
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Tiranini L, Cucinella L, Martella S, Bosoni D, Martini E, Nappi RE. Is now the time to reconsider risks, benefits, and limitations of estrogen preparations as a treatment for menstrually related migraine? Expert Rev Neurother 2023; 23:377-388. [PMID: 37038655 DOI: 10.1080/14737175.2023.2198705] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
INTRODUCTION Estrogen fluctuations modulate pain threshold and play a pivotal role in the central and peripheral pathogenesis of menstrually related migraine (MRM). Estrogen-withdrawal during the perimenstrual phase of a spontaneous menstrual cycle or the hormone-free interval (HFI) of hormonal treatments seems to be the culprit. AREA COVERED The authors report the most relevant data on risks, benefits, and limitations of exogenous estrogens as a treatment for MRM considering gynecological comorbidities associated with chronic pelvic pain that may be effectively managed by the use of combined hormonal contraception (CHC). Given that migraine and CHC are both currently known as independent risk factors for stroke, levels of evidence contraindicate CHC in women with migraine with aura, whereas quality of evidence is low in women with migraine without aura, including MRM. Continuous/extended/flexible CHC regimens, shorter HFI, or estrogens supplementation during the HFI/perimenstrual spontaneous phase may be beneficial in women with MRM. EXPERT OPINION Safety is a main issue, and it is mandatory to investigate the impact of CHC containing natural estrogens, instead of ethinylestradiol, on clinical pattern of MRM and cardiovascular associated risk. Reproductive characteristics may be relevant and should be considered in a multidisciplinary approach to increase the power of endocrine management in MRM.
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Affiliation(s)
- Lara Tiranini
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Laura Cucinella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Silvia Martella
- Unit of Preventive Gynecology, IRCCS European Institute of Oncology, Milan, Italy
| | - David Bosoni
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - Ellis Martini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
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Pino I, Di Giminiani M, Radice D, Vidal Urbinati AM, Iacobone AD, Guerrieri ME, Preti EP, Martella S, Franchi D. Sparing Is Caring: Hormonal Retreatment in Women with Recurrent Endometrial Cancer after Fertility Preservation Management-A Single Centre Retrospective Study. Healthcare (Basel) 2023; 11:healthcare11071058. [PMID: 37046985 PMCID: PMC10094155 DOI: 10.3390/healthcare11071058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
Fertility-sparing treatment (FTS) of endometrial cancer (EC) has a high rate of remission but also a high rate of relapse (10-88%). Many women still wish to conceive at the time of relapse, but results regarding retreatment are still lacking. This study aims to evaluate the safety, oncological and pregnancy outcomes of repeated FST in women with recurrent EC. This is a retrospective single-center study that recruited patients who had uterine recurrence after achieving a complete response (CR) with FST for FIGO stage IA, well-differentiated (G1), endometrioid EC. All eligible women underwent a second FST. Among 26 patients with recurrence, 6 decided to receive a hysterectomy and 20 received fertility-sparing retreatment. In total, 17 out of 20 women (85%) achieved a CR in a median time of 6 months. A total of 2/20 women showed a stable disease and continued the treatment for a further 6 months and finally achieved a CR. In total, 1/20 women showed disease progression and underwent demolitive surgery. After relapse and a CR, 14 patients attempted to become pregnant, among whom 7 became pregnant (pregnancy rate 50%-life birth rate 29%). Secondary FST is a safe and effective option for women who desire to preserve fertility after the recurrence of early-stage EC.
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Affiliation(s)
- Ida Pino
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Maria Di Giminiani
- Unit of Obstetrics and Gynecology, ASST Fatebenefratelli-Sacco, Department of Biological and Clinical Sciences L. Sacco, University of Milan, 20157 Milan, Italy
| | - Davide Radice
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Ailyn Mariela Vidal Urbinati
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Anna Daniela Iacobone
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Maria Elena Guerrieri
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Eleonora Petra Preti
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Silvia Martella
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Dorella Franchi
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
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Vidal Urbinati AM, Pino I, Iacobone AD, Radice D, Azzalini G, Guerrieri ME, Preti EP, Martella S, Franchi D. Vaginosonography versus MRI in Pre-Treatment Evaluation of Early-Stage Cervical Cancer: An Old Tool for a New Precision Approach? Diagnostics (Basel) 2022; 12:diagnostics12122904. [PMID: 36552913 PMCID: PMC9776852 DOI: 10.3390/diagnostics12122904] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
This study aims to analyze the sensitivity of vaginosonography (VGS) and magnetic resonance imaging (MRI) in the preoperative local evaluation of early-stage cervical cancers and to assess their accuracy in the detection of tumors, size of the lesions and stromal invasion by comparing them with the final histopathology report. This single-center study included 56 consecutive patients with cervical cancer who underwent VGS and MRI from November 2012 to January 2021. VGS significantly overestimated the lesion size by 2.7 mm (p = 0.002), and MRI underestimated it by 1.9 mm (p = 0.11). Both MRI and VGS had a good concordance with the pathology report (Cohen’s kappa of 0.73 and 0.81, respectively). However, MRI had a false-negative rate (38.1%) that was greater than VGS (0%) in cases of cervical tumor size <2 cm. We found a good concordance between histology and VGS in the stromal infiltration assessment, with 89% sensitivity (95% CI 0.44−0.83) and 89% specificity (95% CI 0.52−0.86). VGS is a simple, inexpensive, widely available, and fast execution method that can complement ultrasound in particular cases and show a good correlation with MRI in the assessment of tumor dimensions, with a better performance in detecting small tumors (<2 cm).
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Affiliation(s)
- Ailyn M. Vidal Urbinati
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
- Correspondence: ; Tel.: +39-02-57-489-120; Fax: +39-02-94379243
| | - Ida Pino
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Anna D. Iacobone
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Davide Radice
- Division of Epidemiology and Biostatistics, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giulia Azzalini
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Obstetrics and Gynecology Specialization School, University of Udine, 33100 Udine, Italy
| | - Maria E. Guerrieri
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Eleonora P. Preti
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Silvia Martella
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Dorella Franchi
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy
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Pino I, Iacobone AD, Vidal Urbinati AM, Di Giminiani M, Radice D, Guerrieri ME, Preti EP, Martella S, Franchi D. Fertility-Sparing Treatment for Endometrial Cancer: Oncological and Obstetric Outcomes in Combined Therapies with Levonorgestrel Intrauterine Device. Cancers (Basel) 2022; 14:cancers14092170. [PMID: 35565299 PMCID: PMC9101107 DOI: 10.3390/cancers14092170] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 01/25/2023] Open
Abstract
Simple Summary This article discusses a retrospective study describing sixteen years of experience in the fertility-sparing treatment (FST) of endometrial cancer (EC) in a tertiary referral center for oncology. The aim of the study is to compare oncological and reproductive outcomes of different combined therapy with LNG-IUD in FST of presumed FIGO STAGE IA endometrioid G1 EC. We assessed outcomes for 75 patients treated with three different approaches: GnRH analogue (GnRHa) + LNG-IUD vs. Megestrol acetate (MA) + LNG-IUD vs. MA + LNG-IUD + Metformin (MET). We reported, although not statistically significant, an increasing rate of CR from the regimen with GnRHa to one with MA+MET (65% vs. 83%) and showed a statistically significant lower risk of recurrence in women treated with MA+ LNG-IUD+MET when compared to GnRHa+ LNG-IUD regimen. There were no differences in obstetric outcomes among different therapeutic regimens. Abstract Background: The prevalence of reaches up to 5% in women younger than 40 years. Therefore, the fertility preservation should be the goal of the clinical practice in women with desire of pregnancy and low-risk features. The aim of this study is to compare oncological and reproductive outcomes of different hormonal therapies in FST of EC. Methods: A retrospective single-center study recruiting patients with presumed FIGO STAGE IA endometrioid G1 EC from 2005 to 2020 was performed. We assessed outcomes for three different therapeutic options: GnRHa + LNG-IUD vs. MA + LNG-IUD vs. MA + LNG-IUD + MET. Results: In total, 75 patients were enrolled and followed up for a median of 45 months. Complete response (CR) was achieved in 75% of patients at 12 months. Although not statistically significant, we reported an increasing rate of CR from the regimen with GnRHa to the one with MA + MET (65% vs. 83%). We showed a statistically significant lower risk of recurrence in women treated with MA + LNG-IUD + MET, when compared to GnRHa + LNG-IUD regimen. The pregnancy rate was 74% and live birth rate was 42%, with no differences among regimens. Conclusions: FST is a safe and effective option in women who desire to preserve fertility.
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Affiliation(s)
- Ida Pino
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.D.I.); (A.M.V.U.); (M.E.G.); (E.P.P.); (S.M.); (D.F.)
- Correspondence: ; Tel.: +39-02-57489120
| | - Anna Daniela Iacobone
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.D.I.); (A.M.V.U.); (M.E.G.); (E.P.P.); (S.M.); (D.F.)
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Ailyn Mariela Vidal Urbinati
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.D.I.); (A.M.V.U.); (M.E.G.); (E.P.P.); (S.M.); (D.F.)
| | - Maria Di Giminiani
- Unit of Obstetrics and Gynecology, ASST Fatebenefratelli-Sacco, Department of Biological and Clinical Sciences L. Sacco, University of Milan, 20157 Milan, Italy;
| | - Davide Radice
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Maria Elena Guerrieri
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.D.I.); (A.M.V.U.); (M.E.G.); (E.P.P.); (S.M.); (D.F.)
| | - Eleonora Petra Preti
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.D.I.); (A.M.V.U.); (M.E.G.); (E.P.P.); (S.M.); (D.F.)
| | - Silvia Martella
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.D.I.); (A.M.V.U.); (M.E.G.); (E.P.P.); (S.M.); (D.F.)
| | - Dorella Franchi
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.D.I.); (A.M.V.U.); (M.E.G.); (E.P.P.); (S.M.); (D.F.)
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Affiliation(s)
- R. E. Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - L. Cucinella
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - E. Martini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - M. Rossi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - L. Tiranini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - S. Martella
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - D. Bosoni
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - C. Cassani
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
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Nappi RE, Martini E, Cucinella L, Martella S, Tiranini L, Inzoli A, Brambilla E, Bosoni D, Cassani C, Gardella B. Addressing Vulvovaginal Atrophy (VVA)/Genitourinary Syndrome of Menopause (GSM) for Healthy Aging in Women. Front Endocrinol (Lausanne) 2019; 10:561. [PMID: 31496993 PMCID: PMC6712495 DOI: 10.3389/fendo.2019.00561] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [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: 05/22/2019] [Accepted: 07/31/2019] [Indexed: 12/23/2022] Open
Abstract
Vaginal health is an essential component of active and healthy aging in women at midlife and beyond. As a consequence of hormonal deprivation and senescence, the anatomy and function of urogenital tissues are significantly affected and vulvovaginal atrophy (VVA) may occur. In a high proportion of postmenopausal women, progressive and chronic VVA symptoms have a strong impact on sexual function and quality of life. The new definition of genitourinary syndrome of menopause (GSM) comprises genital symptoms (dryness, burning, itching, irritation, bleeding), sexual symptoms (dyspareunia and other sexual dysfunctions) and urinary symptoms (dysuria, frequency, urgency, recurrent urinary infections). Many variables (age, sexual activity and partnership status) influence the clinical impact VVA/GSM symptoms and attitudes of elderly women to consult for receiving effective treatments. Psychosocial factors play a critical role in sexual functioning, but the integrity of the urogenital system is as well important affecting many domains of postmenopausal women's health, including sexual function. Several international surveys have extensively documented the need to improve VVA/GSM management because of the strong impact on women's daily life and on couple's intimacy. Health care providers (HCPs) need to be proactive in the early recognition of VVA/GSM in order to preserve urogenital and sexual longevity, by using hormonal and non-hormonal strategies. The clinical diagnosis is based on genital examination to identify objective signs and on the use of subjective scales to rate most bothersome symptoms (MBS), especially vaginal dryness. Recent studies point to the importance of addressing VVA/GSM as a potential early marker of poor general health in analogy with vasomotor symptoms. Therefore, a standard of VVA/GSM care in elderly women is desirable to enhance physical, emotional and mental well-being.
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Affiliation(s)
- Rossella E. Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- *Correspondence: Rossella E. Nappi
| | - Ellis Martini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
| | - Laura Cucinella
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Silvia Martella
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Lara Tiranini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Alessandra Inzoli
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Emanuela Brambilla
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - David Bosoni
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Chiara Cassani
- Obstetrics and Gynecology Unit, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Barbara Gardella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Obstetrics and Gynecology Unit, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
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Nappi RE, Cagnacci A, Becorpi AM, Nappi C, Paoletti AM, Busacca M, Martella S, Bellafronte M, Tredici Z, Di Carlo C, Corda V, Vignali M, Bagolan M, Sardina M. Monurelle Biogel® vaginal gel in the treatment of vaginal dryness in postmenopausal women. Climacteric 2017; 20:467-475. [DOI: 10.1080/13697137.2017.1335703] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- R. E. Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - A. Cagnacci
- Maternal–Childhood Department, University of Modena and Reggio Emilia, Modena, Italy
| | - A. M. Becorpi
- Obstetrics and Gynecology Clinic I, University Hospital Careggi, Florence, Italy
| | - C. Nappi
- Department of Gynecology, Obstetrics and Physiopathology of Reproductive Medicine, University Federico II, Naples, Italy
| | - A. M. Paoletti
- Department of Surgery Sciences, Gynecology and Obstetrics Clinic, University of Cagliari, Cagliari, Italy
| | - M. Busacca
- Obstetrics and Gynecology, II Hospital Department, Macedonio Melloni-A.O. Fatebenefratelli and Oftalmico Hospital, Maternal–Childhood Department, Milan, Italy
| | - S. Martella
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - M. Bellafronte
- Maternal–Childhood Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Z. Tredici
- Obstetrics and Gynecology Clinic I, University Hospital Careggi, Florence, Italy
| | - C. Di Carlo
- Department of Gynecology, Obstetrics and Physiopathology of Reproductive Medicine, University Federico II, Naples, Italy
| | - V. Corda
- Department of Surgery Sciences, Gynecology and Obstetrics Clinic, University of Cagliari, Cagliari, Italy
| | - M. Vignali
- Obstetrics and Gynecology, II Hospital Department, Macedonio Melloni-A.O. Fatebenefratelli and Oftalmico Hospital, Maternal–Childhood Department, Milan, Italy
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Nappi RE, Cucinella L, Martella S, Rossi M, Tiranini L, Martini E. Female sexual dysfunction (FSD): Prevalence and impact on quality of life (QoL). Maturitas 2016; 94:87-91. [PMID: 27823751 DOI: 10.1016/j.maturitas.2016.09.013] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 09/18/2016] [Accepted: 09/20/2016] [Indexed: 01/23/2023]
Abstract
Female sexual dysfunction (FSD) and quality of life (QOL) are both multidimensional and have a bidirectional relationship across the reproductive life span and beyond. Methodological difficulties exist in estimating the real prevalence of FSD because it is hard to determine the level of distress associated with sexual symptoms in a large-scale survey. Approximately 40-50% of all women report at least one sexual symptom, and some conditions associated with hormonal changes at menopause, such as vulvovaginal atrophy (VVA) and hypoactive sexual desire disorder (HSDD), have a significant impact on sexual function and QOL. Sexual distress peaks at midlife, declines with age and is strongly partner-related. Many postmenopausal women are still sexually active, especially if they are in a stable partnership. Even though sexual functioning is impaired, a variety of psychosocial factors may maintain sexual satisfaction. That being so, health care providers (HCPs) should proactively address sexual symptoms at midlife and in older women, from a balanced perspective. Adequate counselling should be offered. Women with distressing symptoms may benefit from tailored hormonal and non-hormonal therapies, whereas women without distress related to their sexual experiences should not receive any specific treatment.
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Affiliation(s)
- Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Dept of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.
| | - Laura Cucinella
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Dept of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Silvia Martella
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Dept of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Margherita Rossi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Dept of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Lara Tiranini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Dept of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Ellis Martini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Dept of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
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De Icco R, Cucinella L, De Paoli I, Martella S, Sances G, Bitetto V, Sandrini G, Nappi G, Tassorelli C, Nappi RE. Modulation of nociceptive threshold by combined hormonal contraceptives in women with oestrogen-withdrawal migraine attacks: a pilot study. J Headache Pain 2016; 17:70. [PMID: 27488685 PMCID: PMC4972742 DOI: 10.1186/s10194-016-0661-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 05/12/2016] [Accepted: 07/22/2016] [Indexed: 01/03/2023] Open
Abstract
Background Menstrually-related headache and headaches associated with oestrogen withdrawal are common conditions, whose pathophysiology has not been completely elucidated. In this study we evaluated the influence of combined hormonal contraceptives (CHC) on pain threshold in women presenting migraine attacks during hormone-free interval. Findings Eleven women with migraine attacks recurring exclusively during the oestrogen-withdrawal period were studied with the nociceptive flexion reflex, a neurophysiological assessment of the pain control systems, during the third week of active treatment and during the hormone-free interval. During the hormone-free interval, nociceptive withdrawal reflex threshold was significantly lower (12.8 ± 8.0 mA) as compared to the third week of hormonal treatment (15.6 ± 6.6 mA) (p = 0.02). No change was observed in the pain perceived and in the temporal summation. Conclusions Oestrogen withdrawal may mediate an increased sensitivity to somatosensory stimuli in women with migraine attacks recurring during the hormone-free interval.
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Affiliation(s)
- Roberto De Icco
- Headache Science Centre, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy. .,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Laura Cucinella
- Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Irene De Paoli
- Headache Science Centre, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Silvia Martella
- Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Grazia Sances
- Headache Science Centre, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - Vito Bitetto
- Headache Science Centre, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - Giorgio Sandrini
- Headache Science Centre, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Giuseppe Nappi
- Headache Science Centre, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - Cristina Tassorelli
- Headache Science Centre, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Rossella E Nappi
- Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
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Nappi RE, Benedetto C, Campolo F, Martella S, Tosti C, Cianci A, Caruso S, Guaschino S, Grimaldi E, Bagolan M, Sardina M. Efficacy, tolerability and safety of a new medical device, Monurelle Biogel(®) vaginal gel, in the treatment of vaginal dryness: a randomized clinical trial in women of reproductive age. Eur J Obstet Gynecol Reprod Biol 2016; 203:82-8. [PMID: 27261817 DOI: 10.1016/j.ejogrb.2016.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 12/05/2015] [Revised: 05/01/2016] [Accepted: 05/04/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To prove the efficacy, tolerability and safety of Monurelle Biogel(®) (ZP-025) vaginal gel, which contains a purified, dialyzed, lyophilized bovine colostrum, in women of reproductive age suffering from vaginal dryness. DESIGN Randomized clinical trial (RCT) (Z7213M01). SETTING Five University Gynaecological Units. PATIENTS Ninety-five subjects were allocated at random to receive either ZP-025 (n=48) for about 23 intermenstrual days (1 or 2 times/daily intra-vaginally) or no treatment (lubricants on demand were allowed). MAIN OUTCOME MEASURES Change of Verbal Rating Scale (VRS) total and single score for vaginal symptoms, Vaginal Health Index (VHI) score, Female Sexual Function index (FSFI) and Female Sexual Distress Scale-revised (FSDS-R) scores. RESULTS A total number of 85 subjects was evaluable for primary analyses. Symptoms (VRS) of vaginal discomfort improved significantly already after 11 days, as compared to the control arm (p<0.0001). The mean VHI score was also significantly higher in ZP-025 group (p<0.001) at the end of the study. The analysis of covariance with the baseline value as covariate carried out on the FSFI Total Score showed a statistically significant difference in favour of the ZP-025 arm (p<0.032). A shift from presence to absence of sexual distress (≤11 points) was more prominent in the ZP-025 arm [10 subjects (40%) in the ZP-025 arm (p<0.0001) and 6 subjects (21.4%) in the control arm (p=0.01)]. Women reported a compliance rate of 100% for one ZP-025 application/day. Local tolerability of ZP-025 was excellent or good in 82.9% of the subjects. CONCLUSIONS The present multicentre RCT supports the use of Monurelle Biogel(®) in women of reproductive age reporting symptoms of vaginal dryness. A positive impact on vaginal health and sexual function was also evident.
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Affiliation(s)
- Rossella E Nappi
- Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Italy; Dept. of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.
| | - Chiara Benedetto
- University Gynaecology and Obstetrics 1, Sant'Anna Hospital, Turin, Italy
| | - Federica Campolo
- University Gynaecology and Obstetrics 1, Sant'Anna Hospital, Turin, Italy
| | - Silvia Martella
- Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Italy; Dept. of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Claudia Tosti
- Obstetrics and Gynaecology Clinic, University of Siena, Italy
| | - Antonio Cianci
- Obstetrics and Gynaecology Clinic, Polyclinic of Catania, Italy
| | | | | | - Eva Grimaldi
- Obstetrics and Gynaecology Clinical, University of Trieste, Italy
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Barreto M, Piacentini G, Chiossi L, Ruggeri F, Caiazzo I, Campisano M, Martella S, Villa MP. Tidal-breathing measurement of exhaled breath temperature (EBT) in schoolchildren. Pediatr Pulmonol 2014; 49:1196-204. [PMID: 24604829 DOI: 10.1002/ppul.22994] [Citation(s) in RCA: 6] [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: 10/13/2013] [Accepted: 01/05/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Non-invasive assessment of airway inflammation is particularly useful in children. The exhaled breath temperature (EBT) may reflect inflammatory vasodilation and serve to assess respiratory symptoms and therapy with inhaled corticosteroids (ICs). AIMS To compare EBT with other non-invasive measurements in unselected schoolchildren in relation to respiratory symptoms and IC-therapy, as well as to assess reproducibility, and potentially influencing factors. METHODS In 298 Italian schoolchildren, we assessed tidal-EBT, FE(NO), spirometry, skin-prick tests, questionnaires on chronic respiratory symptoms, and medication. Subjects were divided as follows: reported wheeze, respiratory symptoms other than wheeze, and without symptoms. RESULTS Subjects with reported wheeze (n = 30) more frequently presented atopy, respiratory symptoms, higher FE(NO), lower lung function than subjects with symptoms other than wheeze (n = 141) and those without symptoms (n = 127), but had a similar EBT. IC-treated children (5 wheeze, 9 respiratory symptoms other than wheeze, 4 without chronic symptoms) had lower median (interquartile range) EBT levels than IC-untreated children (n = 280) [EBT: 31.7 (30.1-32.5) vs. 32.6 (31.4-33.4), P = 0.027]. Duplicate EBT measurements were highly reproducible (ICC = 0.94). In a multiple linear-regression model, EBT was explained by age, weight, duration of EBT measurement, FE(NO), and ambient temperature (r = 0.63, P < 0.001). CONCLUSION Tidal-EBT measurements are easy to perform, reproducible, though symptom misclassification may affect the results obtained regarding the effect of IC therapy. Factors influencing EBT should be addressed in further epidemiological studies.
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Affiliation(s)
- M Barreto
- Pediatric Unit, Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
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Vermeulen S, Barreto M, La Penna F, Prete A, Martella S, Biagiarelli F, Villa MP. Exhaled breath temperature in children: reproducibility and influencing factors. J Asthma 2014; 51:743-50. [PMID: 24654705 DOI: 10.3109/02770903.2014.906606] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study will investigate the reproducibility and influencing factors of exhaled breath temperature measured with the tidal breathing technique in asthmatic patients and healthy children. METHODS Exhaled breath temperature, fractional exhaled nitric oxide, and spirometry were assessed in 124 children (63 healthy and 61 asthmatic), aged 11.2 ± 2.5 year, M/F 73/51. A modified version of the American Thoracic Society questionnaire on the child's present and past respiratory history was obtained from parents. Parents were also asked to provide detailed information on their child's medication use during the previous 4 weeks. Ear temperature, ambient temperature, and relative-ambient humidity were also recorded. RESULTS Exhaled breath temperature measurements were highly reproducible; the second measurement was higher than the first measurement, consistent with a test-retest situation. In 13 subjects, between-session within-day reproducibility of exhaled breath temperature was still high. Exhaled breath temperature increased with age and relative-ambient humidity. Exhaled breath temperature was comparable in healthy and asthmatic children; when adjusted for potential confounders (i.e. ambient conditions and subject characteristics), thermal values of asthmatic patients exceeded those of the healthy children by 1.1 °C. Normalized exhaled breath temperature, by subtracting ambient temperature, was lower in asthmatic patients treated with inhaled corticosteroids than in those who were corticosteroid-naive. CONCLUSION Measurements of exhaled breath temperature are highly reproducible, yet influenced by several factors. Corrected values, i.e. normalized exhaled breath temperature, could help us to assess the effect of therapy with inhaled corticosteroids. More studies are needed to improve the usefulness of the exhaled breath temperature measured with the tidal breathing technique in children.
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Affiliation(s)
- S Vermeulen
- Faculty of Medical Sciences, University of Groningen , Groningen , The Netherlands and
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15
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Abstract
Sexual health in the menopause is a medical challenge because the progressive decline of sexual hormones interacts with the aging process and many psychosocial stressors modulate vulnerability for sexual symptoms (low sexual desire, poor arousal and lubrication, dyspareunia, orgasmic dysfunction and lack of satisfaction). In clinical practice, a coordinated approach is needed to optimally manage the risk for developing female sexual dysfunction (FSD), especially when chronic conditions are present. Biomedical and psychosocial interventions include general education, recognition of signs and symptoms, promotion of health, attention to the partner and individualization of treatment. Counselling to overcome personal and relational difficulties should be always combined with hormonal and non-hormonal strategies to maximize biological signals driving the sexual response. By enhancing women's abilities to cope with sexual changes at midlife, health care providers may significantly optimize healthy aging and partnership.
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Affiliation(s)
- Rossella E Nappi
- Research Centre for Reproductive Medicine, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Ellis Martini
- Research Centre for Reproductive Medicine, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Silvia Martella
- Research Centre for Reproductive Medicine, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesca Capuano
- Research Centre for Reproductive Medicine, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - David Bosoni
- Research Centre for Reproductive Medicine, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Sonia Giacomini
- Research Centre for Reproductive Medicine, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Matteo Beraghi
- Research Centre for Reproductive Medicine, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Arsenio Spinillo
- Research Centre for Reproductive Medicine, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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16
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Petit JY, Rietjens M, Botteri E, Rotmensz N, Bertolini F, Curigliano G, Rey P, Garusi C, De Lorenzi F, Martella S, Manconi A, Barbieri B, Veronesi P, Intra M, Brambullo T, Gottardi A, Sommario M, Lomeo G, Iera M, Giovinazzo V, Lohsiriwat V. Evaluation of fat grafting safety in patients with intraepithelial neoplasia: a matched-cohort study. Ann Oncol 2013; 24:1479-84. [PMID: 23393126 DOI: 10.1093/annonc/mds660] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Fat grafting is widely carried out in breast cancer patients to improve quality in breast reconstruction. Recently, in vitro and animal studies have questioned the role of adipose tissues in cancer development. DESIGNS Matched-cohort study. We analysed: (i) 59 intraepithelial neoplasia patients who had undergone lipofilling, with no recurrence between primary surgery and lipofilling. (ii) A control group of 118 matched patients (two controls per lipofilling patient) with the corresponding recurrence-free intervals. Both groups were also matched for main cancer criteria. A local event (LE) was the primary end point, with follow-up starting from the baseline. RESULTS Median follow-up was 63 and 66 months from surgery, and 38 and 42 from baseline, for the lipofilling and control groups, respectively; the 5-year cumulative incidence of LE was 18% and 3% (P = 0.02). Ki-67 was the significant factor in univariate survival analysis. A subgroup analysis showed that lipofilling increased the risk of LE in women <50 years, with high grade neoplasia, Ki-67 ≥ 14 or who had undergone quadrantectomy. CONCLUSION Higher risk of LE was observed in intraepithelial neoplasia patients following lipofilling. Although further studies are required to validate our conclusions, patients belonging to this subgroup should be informed of these results and the potential risks.
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Affiliation(s)
- J Y Petit
- Department of Reconstructive Surgery, European Institute of Oncology, Milan, Italy.
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Kneubil MC, Brollo J, Botteri E, Curigliano G, Rotmensz N, Goldhirsch A, Lohsiriwat V, Manconi A, Martella S, Santillo B, Petit JY, Rietjens M. Breast cancer subtype approximations and loco-regional recurrence after immediate breast reconstruction. Eur J Surg Oncol 2013; 39:260-5. [PMID: 23313014 DOI: 10.1016/j.ejso.2012.12.004] [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] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 11/06/2012] [Accepted: 12/07/2012] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND A small but significant proportion of patients with breast cancer (BC) will develop loco-regional recurrence (LRR) after immediate breast reconstruction (IBR). The LRR also varies according to breast cancer subtypes and clinicopathological features. METHODS We studied 1742 consecutive BC patients with IBR between 1997 and 2006. According to St Gallen conference consensus 2011, its BC approximations were applied to classify BC into five subtypes: estrogen receptor (ER) and/or progesterone receptor (PgR) positive, HER2 negative, and low Ki67 (<14%) [luminal A]; ER and/or PgR positive, HER2 negative and high Ki67(≥ 14%) [luminal B/HER2 negative]; ER and/or PgR positive, any Ki67 and HER2 positive [luminal B/HER2 positive]; ER negative, PgR negative and HER2 positive [HER2 positive/nonluminal]; and ER negative, PgR negative and HER2 negative [triple negative]. Cumulative incidences of LRR were compared across different subgroups by means of the Gray test. Multivariable Cox regression models were applied. RESULTS Median follow up time was 74 months (range 3-165). The cumulative incidence of LRR was 5.5% (121 events). The 5-year cumulative incidence of LRR was 2.5% for luminal A; 5.0% for luminal B/HER2 negative; 9.8% for luminal B/HER2 positive; 3.8% for HER2 non luminal; and 10.9% for triple negative. On multivariable analysis, tumor size (pT) >2 cm, body mass index (BMI) ≥ 25, triple negative and luminal B/HER2 positive subtypes were associated with increased risk of LRR. CONCLUSION Luminal B/HER2 positive, triple negative subtypes and BMI ≥ 25 are independent prognostic factors for risk of LRR after IBR.
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Affiliation(s)
- M C Kneubil
- Division of Plastic Reconstruction Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milano, Italy.
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18
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Petit JY, Botteri E, Lohsiriwat V, Rietjens M, De Lorenzi F, Garusi C, Rossetto F, Martella S, Manconi A, Bertolini F, Curigliano G, Veronesi P, Santillo B, Rotmensz N. Locoregional recurrence risk after lipofilling in breast cancer patients. Ann Oncol 2012; 23:582-588. [PMID: 21610155 DOI: 10.1093/annonc/mdr158] [Citation(s) in RCA: 184] [Impact Index Per Article: 15.3] [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: 11/12/2022] Open
Abstract
BACKGROUND Lipofilling has been indicated for postmastectomy and postlumpectomy breast reconstruction. The clinical literatures underline its technical efficacy but experimental studies raise important questions about the potential detrimental effect of adipocytes on the stimulation of cancer growth and reappearance. DESIGN We collected 321 consecutive patients operated for a primary breast cancer between 1997 and 2008 who subsequently underwent lipofilling for reconstructive purpose. For each patient, we selected two matched patients with similar characteristics who did not undergo a lipofilling. RESULTS Eighty-nine percent of the tumors were invasive. Median follow-up was 56 months from the primary surgery and 26 months from the lipofilling. Eight and 19 patients had a local event in the lipofilling and control group, respectively, leading to comparable cumulative incidence curves [P = 0.792; Hazard Ratio(Lipo vs No lipo) = 1.11 (95% confidence interval 0.47-2.64)]. These results were confirmed when patients undergoing quadrantectomy and mastectomy were analyzed separately and when the analysis was limited to invasive tumors. Based on 37 cases, the lipofilling group resulted at higher risk of local events when the analysis was limited to intraepithelial neoplasia. CONCLUSIONS Lipofilling seems to be a safe procedure in breast cancer patients. Longer follow-up and further experiences from oncological series are urgently required to confirm these findings.
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Affiliation(s)
| | - E Botteri
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - V Lohsiriwat
- Division of Plastic Surgery; Department of Surgery, Mahidol University, Siriraj Hospital, Bangkok, Thailand
| | | | | | | | | | | | | | | | - G Curigliano
- Division of Medical Oncology, Department of Medicine
| | - P Veronesi
- Division of Breast Surgery, European Institute of Oncology, Milan; University of Milan, Milan, Italy
| | - B Santillo
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - N Rotmensz
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
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Rietjens M, De Lorenzi F, Rossetto F, Brenelli F, Manconi A, Martella S, Intra M, Venturino M, Lohsiriwat V, Ahmed Y, Petit J. Safety of fat grafting in secondary breast reconstruction after cancer. J Plast Reconstr Aesthet Surg 2011; 64:477-83. [DOI: 10.1016/j.bjps.2010.06.024] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 06/22/2010] [Accepted: 06/28/2010] [Indexed: 01/15/2023]
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Martella S, Rietjens M, Lohsiriwat V, Lazzari R, Vavassori A, Jereczek B, Lazzati V, Leonardi M, Petit J. Acute radiation dermatitis in breast cancer: topical therapy with vitamin E acetate in lipophilic gel base. Ecancermedicalscience 2010; 4:190. [PMID: 22276039 PMCID: PMC3234031 DOI: 10.3332/ecancer.2010.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Radiotherapy can cause adverse skin reactions over the course of their treatment. Currently, management is based on several tropical products although there is no gold-standard approach to prevention and management of radiation toxicity. METHOD We report our experience of vitamin E acetate in the treatment of radiation dermatitis in breast cancer patients who experienced grade 4 side effects (according to Radiation Therapy Oncology Group criteria). RESULTS Clinical management consisted of oral antibiotics and local application of vitamin E acetate and local escarectomy. All of the patients achieved complete re-epithelialization within 40 days. CONCLUSION Skin ulceration and necrosis post-radiation may interrupt oncological treatment in breast cancer patients. In acute radiodermatitis with skin necrosis, we propose the use of oral antibiotics together with escarectomy and the application of vitamin E acetate to facilitate the healing process in order to minimize the interruption to the oncological treatment.
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Petit JY, Veronesi U, Orecchia R, Rey P, Martella S, Didier F, Viale G, Veronesi P, Luini A, Galimberti V, Bedolis R, Rietjens M, Garusi C, De Lorenzi F, Bosco R, Manconi A, Ivaldi GB, Youssef O. Nipple sparing mastectomy with nipple areola intraoperative radiotherapy: one thousand and one cases of a five years experience at the European institute of oncology of Milan (EIO). Breast Cancer Res Treat 2009; 117:333-8. [PMID: 19152026 DOI: 10.1007/s10549-008-0304-y] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 12/31/2008] [Indexed: 02/04/2023]
Abstract
In order to reduce mutilation, nipple-areola complex (NAC) conservation can be proposed for the treatment of breast cancer when mastectomy is indicated. To reduce the risk of retro areolar recurrence, a novel radiosurgical treatment combining subcutaneous mastectomy with intraoperative radiotherapy (ELIOT) is proposed. One thousand and one nipple sparing mastectomies (NSM) were performed from March 2002 to November 2007 at the European institute of oncology (EIO), for invasive carcinoma in 82% of the patients and in situ carcinoma in 18%. Clinical complications, aesthetic results, oncological and psychological results were recorded. A comparison was performed between the 800 patients who received ELIOT and the 201 who underwent delayed one-shot radiotherapy on the days following the operation. The median follow up time was 20 months (range 1-69) for a follow up performed in 83% of the patients. The NAC necrosed totally in 35 cases (3.5%) and partially in 55 (5.5%) and was removed in 50 (5%). Twenty infections (2%) were observed and 43 (4.3%) prostheses removed. The median rate of the patients for global cosmetic result on a scale ranging from 0 (worst) to 10 (excellent) was 8. Evaluation by the surgeon in charge of the follow-up gave a similar result. Only 15% of the patients reported a partial sensitivity of the NAC. Of the fourteen (1.4%) local recurrences, ten occurred close to the tumour site, all far from the NAC corresponding to the field of radiation. No recurrences were observed in the NAC. In a group of patients characterized by a very close free margin under the areola, no local recurrence was observed. Overall, 36 cases of metastases and 4 deaths were observed. No significant outcome difference was observed between the 800 patients receiving intraoperative radiotherapy (ELIOT) and the 201 patients receiving delayed irradiation.
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Affiliation(s)
- J Y Petit
- Plastic Surgery Department, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
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Didier F, Radice D, Gandini S, Bedolis R, Rotmensz N, Maldifassi A, Santillo B, Luini A, Galimberti V, Scaffidi E, Lupo F, Martella S, Petit JY. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality? Breast Cancer Res Treat 2008; 118:623-33. [PMID: 19003526 DOI: 10.1007/s10549-008-0238-4] [Citation(s) in RCA: 198] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 10/27/2008] [Indexed: 11/30/2022]
Abstract
We investigated the influence of nipple areolar complex (NAC) sparing in mastectomy, on patient satisfaction with cosmetic results, body-image, sexuality and psychological well-being. We developed a specific questionnaire and compared two groups of women who underwent radical mastectomy with immediate breast reconstruction (IBR). Between 2004 and 2006, 310 women with NAC preservation and 143 patients with successive NAC reconstruction were mailed the questionnaire at follow-up 1 year after definitive complete breast reconstruction surgery. 256 questionnaires was available. Our results showed significant differences in favour of the NAC sparing group regarding body image (difficulty in looking at themselves naked and being seen naked by their partners after surgery, P = 0.001 and P = 0.003, respectively); regarding satisfaction with the appearance of the nipple (P < .0001) and with the sensitivity of the nipple (P = 0.001); regarding the feeling of mutilation (P = 0.003). NAC sparing in mastectomy has a positive impact on patient satisfaction, body image and psychological adjustment.
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Affiliation(s)
- F Didier
- Psycho-Oncology Unit, Department of Medicine (Prof. A. Goldhirsch), European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
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23
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Martella S, Agazzi A, Petit JY, Barbosa F, Rietjens M, Letkus J, Brenelli F, Caldarella P, Chifu C, Luini A, Caliskan M. Severe skin necrosis after breast reconstruction with a transverse rectus abdominis musculocutaneous flap in methylenetetrahydrofolate reductase deficiency. J Plast Reconstr Aesthet Surg 2008; 62:e356-9. [PMID: 18774766 DOI: 10.1016/j.bjps.2008.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Revised: 02/20/2008] [Accepted: 02/29/2008] [Indexed: 11/30/2022]
Abstract
We report a case of unexpected severe skin necrosis after autologous transverse rectus abdominis musculocutaneous flap breast reconstruction in a patient with homozygosis for the 5,10- methylenetetrahydrofolate reductase (MTHFR) gene. This genetic deficiency is hypothesised as the cause of this exceptional skin necrosis. A 46-year-old woman underwent a radical mastectomy and immediate rectus abdominis musculocutaneous flap breast reconstruction. At the end of surgery, the blood supply to the flap and the abdominal wall was excellent. On the 5th postoperative day, the patient developed an extensive abdominal skin necrosis and a partial flap necrosis on the reconstructed breast. The rectus abdominis musculocutaneous flap breast reconstruction can be proposed to patients without any haemostatic defect in order to avoid life-threatening complications and unaesthetic results. This procedure requires careful patient selection, detailed preoperative planning, and complete laboratory investigations: However, mutation of the 5,10- methylenetetrahydrofolate reductase gene is too exceptional to form part of the routine preoperative investigation and can be looked for in these cases of extensive necrosis.
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Affiliation(s)
- S Martella
- Division of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy
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24
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Rodriguez-Fernandez J, Brenelli F, Caliskan M, Martella S, Rossetto F, Chifu C, Garcia-Etienne C, Rietjens M, Veronesi P. Sentinel node biopsy in patients with prior aesthetic breast surgery. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)70677-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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25
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Petit JY, Veronesi U, Rey P, Rotmensz N, Botteri E, Rietjens M, Garusi C, De Lorenzi F, Martella S, Bosco R, Manconi A, Luini A, Galimberti V, Veronesi P, Ivaldi GB, Orecchia R. Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases. Breast Cancer Res Treat 2008; 114:97-101. [PMID: 18360773 DOI: 10.1007/s10549-008-9968-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 03/05/2008] [Indexed: 11/12/2022]
Abstract
BACKGROUND When the conservative treatment is not recommended, Nipple Sparing Mastectomy (NSM) is proposed more and more frequently for the surgical treatment of breast cancer. The risk of local recurrence behind the nipple areolar complex (NAC) is the main limiting factor of the NSM procedure. To minimize such risk, we proposed in 2002 a intraoperative radiotherapy of the preserved NAC. PATIENTS AND METHODS From March 2002 to November 2006, 579 cases (in 570 patients) of NSM were performed for carcinoma. The median follow up time was 19 months (Range: 1-60). The subcutaneous mastectomy was performed through an incision removing a portion of the skin overlying the tumour. An extemporaneous histological examination was performed on the retroareolar glandular tissue. If the histology was positive the patient was not considered eligible. Then an intraoperative radiotherapy with electrons (ELIOT) of 16 Gy in one shot was delivered on the NAC area. An immediate breast reconstruction was done using implants in most cases and in several cases a musculocutaneous flaps, usually in large breast. The number of local recurrences was recorded and the correlation between their occurrence and the clinical and histological criteria were analysed using the Gray test statistical method in a competing framework. RESULTS In 516 cases the negative retroareolar frozen section biopsy was confirmed by the final histology, while in 63 cases, the final histology showed foci of carcinoma. Seven out of these 63 cases underwent a secondary NAC removal. In the 56 cases which preserved areolas we did not observe any local recurrence after 19 months follow up. The probability of retro areola positive histology increases with the tumour size. and was not related to the nodal status. The rate of local relapses was 0.9% per year. We didn't find any significant difference in the local relapse rate according to different patient's and tumour's features. Most relapses were located close to the tumour bed but never in the NAC area. CONCLUSION Our study confirms that the local recurrence rate in the NSM completed with local radiotherapy on the NAC is not higher than the usual rate observed in the literature and the preservation of the NAC does not increase the risk. The absence of local recurrence in the region where a portion of glandular tissue has been purposely preserved is a good argument in favour of ELIOT.
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Affiliation(s)
- J Y Petit
- Department of Plastic Surgery, European Institute of Oncology, Via Ripamonti 435, Milan, 20 141, Italy.
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26
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Petit JY, Gentilini O, Rotmensz N, Rey P, Rietjens M, Garusi C, Botteri E, De Lorenzi F, Martella S, Bosco R, Khuthaila DK, Luini A. Oncological results of immediate breast reconstruction: long term follow-up of a large series at a single institution. Breast Cancer Res Treat 2008; 112:545-9. [DOI: 10.1007/s10549-008-9891-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 01/02/2008] [Indexed: 10/22/2022]
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Barreto M, Villa MP, Corradi M, Barberi S, Monaco G, Martella S, Bohmerova Z, Sabatino G, Ronchetti R. Non-invasive assessment of airway inflammation in ship-engine workers. Int J Immunopathol Pharmacol 2006; 19:601-8. [PMID: 17026845 DOI: 10.1177/039463200601900316] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Smoking is harmful for respiratory function. In young to middle-aged men the damage is insidious and difficult to demonstrate. The respiratory impairment could increase under specific stressful conditions in the professional environment. On the hypothesis that exhaled markers are useful for assessing airway susceptibility to inhaled irritants, we measured exhaled markers and lung function in smoking and non-smoking engine-driver military coastguards before and after a patrol at sea. Eighteen men, mean age 39 yrs (range 23-58 yrs), 8 smokers, underwent spirometry, exhaled and nasal nitric oxide (eNO, nNO), exhaled carbon monoxide (CO) and exhaled breath condensate (EBC) for measures of hydrogen peroxide (H2O2), leukotriene B4 (LTB4), proteins (Prots), 8-isoprostanes (8-IsoPs), nitrite (NO2-) and nitrosothiols (RS-NOs) at baseline and after an 8-hour patrol navigation on board small, high-speed diesel-powered ships. At baseline, the smokers showed higher middle flows and CO levels, lower eNO and nNO than non-smokers, but similar levels of EBC markers; geometric means (95% confidence interval), CO: 23.6 (14.5 to 38.3) vs. 3.5 (2.5 to 5.3) ppm; eNO: 7.9 (4.8 to 12.9) vs. 26.7 (15.7 to 45.5) ppb, p=0.000. After navigation, Prots, 8-IsoPs and RS-NOs (but not lung function variables or other markers) significantly increased only in smokers; baseline vs post-navigation RS-NOs: 0.27 (0.11 to 0.65) vs. 1.30 (0.58 to 2.89) micromol, p=0.012. The respiratory consequences of a stressing environment in engine-driver military coastguards who actively smoke are better assessed by measuring EBC markers than by eNO, nNO or lung function. By increasing airway inflammation from oxidative-stress, tobacco smoking appears to interact with other chemical or physical factors elicited during sea navigation. Precisely what these factors are deserves further investigation.
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Affiliation(s)
- M Barreto
- Pediatric Clinic, S. Andrea Hospital, II Faculty of Medicine, University of Rome, La Sapienza, Rome, Italy.
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Didier F, Scaffidi E, Leida E, Lupo F, Radice D, Luini A, Galimberti V, Gatti G, Martella S, Petit J. Assessment of patients' satisfaction with cosmetic results, impact on body image and sexuality after mastectomy and immediate plastic surgery with nipple preservation. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)80267-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Curigliano G, Petit JY, Bertolini F, Colleoni M, Peruzzotti G, de Braud F, Gandini S, Giraldo A, Martella S, Orlando L, Munzone E, Pietri E, Luini A, Goldhirsch A. Systemic effects of surgery: quantitative analysis of circulating basic fibroblast growth factor (bFGF), Vascular endothelial growth factor (VEGF) and transforming growth factor beta (TGF-beta) in patients with breast cancer who underwent limited or extended surgery. Breast Cancer Res Treat 2005; 93:35-40. [PMID: 16184456 DOI: 10.1007/s10549-005-3381-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To assess if feature, extent and duration of surgery could influence levels of systemic proangiogenic cytokines vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and transforming growth factor beta (TGF-beta). PATIENTS AND METHODS We collected blood samples from 82 consecutive breast cancer patients who underwent various types of surgery, classified according to the magnitude of tissue injury in: minimal (quadrantectomy), moderate (mastectomy without reconstruction), and heavy [mastectomy followed by reconstruction with transversus recto-abdominal muscle cutaneous flap (TRAM)]. Samples were collected one day before surgery (D(-1)), at the end of surgical tumor removal (D0), and on 1st (D(+1)), 2nd (D(+2)) and 5th (D(+5)) day after surgery. Serum VEGF, bFGF and TGF-beta levels were measured by the enzyme immunoassay method. RESULTS On average a continuous decrease was observed for all growth factors from the day before operation to the 5th day after operation. On day (D(+5)) an increase was observed for patients who underwent extended respect to moderate surgery. These differences were found statistically significant for bFGF and VEGF (p = 0.05 and p = 0.025 respectively). A statistically different trend for type of operation was observed also for TGF-beta at 24-48 h: a minor reduction, compared to time of operation, was observed for minimal surgery, an intermediate reduction for moderate surgery and a higher decrease for extended surgery. CONCLUSIONS Angiogenic cytokines perioperative levels could be increased on 5th day (D(+5)) by extent of surgery and should induce perioperative stimulation of residual cancer cells. A better understanding of the time interval during which the sequelae of events in wound healing occur may be the basis for defining new therapeutic strategies that can interfere with tumor outgrowth sparing wound healing processes.
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Affiliation(s)
- G Curigliano
- Department of Medicine, Division of Medical Oncology, Clinical Pharmacology and New Drugs Development Unit, European Institute of Oncology, Via Ripamonti 435, 20141 Milano, Italy.
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Petit JY, Veronesi U, Luini A, Orecchia R, Rey PC, Martella S, Didier F, De Lorenzi F, Rietjens M, Garusi C, Sonzogni A, Galimberti V, Leida E, Lazzari R, Giraldo A. When mastectomy becomes inevitable: The nipple-sparing approach. Breast 2005; 14:527-31. [PMID: 16226028 DOI: 10.1016/j.breast.2005.08.028] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [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: 10/25/2022] Open
Abstract
The preservation of the nipple areola complex (NAC) could improve the quality of life in cases of mastectomy. A novel radiosurgical treatment combining subcutaneous mastectomy with intraoperative radiotherapy is proposed. Three hundred nipple-sparing mastectomies (NSM) were performed. Invasive (58%) and in situ (42%) carcinomas were included. Clinical complications, aesthetic results, oncological and psychological results were recorded. The NAC necrosed totally in 10 cases and partially in 29 and it was removed in 12. Nine infections (3%) were observed and 10 prostheses removed. Good results were rated by 82.3% of the patients and by 84.8% of the surgeons. In 7.5% a radiodystrophy was observed. The sensitivity of the NAC recovered partially in 48%. Two local recurrences occurred outside the radiated field. Overall, we observed three metastases and no deaths. Sixty-eight of the patients were satisfied with their reconstructed breast and 85.5% were satisfied having preserved the NAC.
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Affiliation(s)
- J Y Petit
- Plastic Surgery Department, European Institute of Oncology, Via Ripamonti 435, 20 141 Milan, Italy.
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31
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De Lorenzi F, Yamaguchi S, Petit JY, Rietjens M, Garusi C, Martella S, Rey PC, Gennari R. Evaluation of skin perfusion after nipple-sparing mastectomy by indocyanine green dye. Preliminary results. J Exp Clin Cancer Res 2005; 24:347-54. [PMID: 16270520] [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: 05/05/2023]
Abstract
The aim of the study was to investigate the blood supply of the normal nipple areola complex (NAC) and the spared areola complex after a nipple-sparing mastectomy using the analysis of the fluorescence from the indocianine green dye (ICG) injection. Between December 2002 and July 2003 we performed the ICG analysis in 10 cases of healthy breasts and in 9 patients after a nipple-sparing mastectomy and one patient after subcutaneous mastectomy. In all cases, the resulting fluorescence was measured in three different zones: nipple, areola, surrounding mammary skin. Three parameters of the fluorescence curve (slope, maximum intensity, time to achieve a maximum level) were recorded. On the healthy breast, the nipple showed a very high perfusion as compared to the other zones. On the contrary, after the mastectomy the fluorescent pattern was completely altered, being the perfusion of the nipple very low. In conclusion, these preliminary results confirm the applicability and the importance of the ICG technique for evaluating the perfusion of the healthy and spared areola after surgery. Because of the small number of patients further studies are needed.
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Affiliation(s)
- F De Lorenzi
- Dept. of Plastic and Reconstructive Surgery, European Institute of Oncology, Milano, Italy.
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Petit JY, Curigliano G, Bertolini F, Peruzzotti G, Gandini S, Zurrida S, Martella S, Ghisini R, De Braud F, Goldhirsch A. Systemic effects of surgery: Quantitative analysis of circulating basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF) and transforming growth factor beta (TGF-β) in patients with breast cancer who underwent limited or extended surgery. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.672] [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)
- J. Y. Petit
- European Institute of Oncology, Milano, Italy
| | | | | | | | - S. Gandini
- European Institute of Oncology, Milano, Italy
| | - S. Zurrida
- European Institute of Oncology, Milano, Italy
| | - S. Martella
- European Institute of Oncology, Milano, Italy
| | - R. Ghisini
- European Institute of Oncology, Milano, Italy
| | - F. De Braud
- European Institute of Oncology, Milano, Italy
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Ronchetti R, Villa MP, Pagani J, Martella S, Guglielmi F, Paggi B, Bohmerova Z, Falasca C, Barreto M. Immediate skin reactivity to histamine and to allergens in cohorts of 9-year-old schoolchildren studied 16 years apart. Clin Exp Allergy 2003; 33:1232-7. [PMID: 12956744 DOI: 10.1046/j.1365-2222.2003.01746.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Differing or increasing prevalence of positive allergen skin-prick tests observed in Europe could at least in part be explained by population changes in histamine skin reactivity. These changes would also alter the relationship between positive allergen skin-prick tests and serum IgE. OBJECTIVE To assess changes in histamine reactivity, allergen skin-prick tests and serum IgE in our geographical setting. METHODS We compared the outcome of two epidemiological surveys conducted 16 years apart in unselected 9-year-old schoolchildren (170 in 1983 and 176 in 1999) from a semi-rural region in central Italy. Outcome measures were skin-prick tests with two histamine concentrations (10 and 1 mg/mL) and 11 locally relevant allergens; serum total and specific IgE for positive allergens. RESULTS The two histamine concentrations induced significantly larger mean weal diameters in 1999 than in 1983 (10 mg/mL: 5.28+/-0.82 mm vs. 3.25+/-0.97 mm; P<0.001). Whereas the prevalence of subjects with at least one positive allergen-induced weal reaction (>or=3 mm) increased over the 16 years (from 15.3% in 1983 to 25.6% in 1999), the prevalence of positive skin-prick tests, expressed as the allergen/ histamine weal ratio, remained almost unchanged. A given allergen weal diameter yielded less total (P<0.05 by Student's t-test for cumulative weals <8 mm) and specific (P<0.01 by Student's t-test for weals <3 mm, P<0.05 by Kruskal-Wallis test) serum IgE in 1999 than in 1983. CONCLUSIONS Although the causes and mechanisms remain unclear, the increased histamine skin reactivity over time is associated with an increase in positive allergen skin-prick tests. In the presence of increased tissue and organ susceptibility to histamine, minute amounts of specific IgE could have important biological consequences.
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Affiliation(s)
- R Ronchetti
- Department of Pediatrics, Second School of Medicine, University La Sapienza, Rome, Italy.
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Licata A, Martella S, Ainis L, Ricca M, Lauriano E, Calabrò C. 605 Glycoconjugates distribution pattern and oxidative enzymes activity as biomarkers of polluant contaminations in the mussel, Mytilus galloprovincialis, from Lake Faro (Messina, Italy). Toxicol Lett 2003. [DOI: 10.1016/s0378-4274(03)90604-7] [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: 11/29/2022]
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Licata A, Mauceri A, Ainis L, Martella S, Ricca MB, Licata P, Amato A. Lectin histochemistry of epidermal glandular cells in the earthworm Lumbricus terrestris (Annelida Oligochaeta). Eur J Histochem 2003; 46:173-8. [PMID: 12152795 DOI: 10.4081/1667] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Carbohydrate residues were localized in the glandular cells of the epidermis of Lumbricus terrestris by lectin histochemistry. The following biotinylated lectins were used: ConA, PNA, WGA, UEA-I. Each lectin has a specific binding pattern in the epidermal glandular cells. The ConA binding is evident in the orthochromatic mucous cells; PNA in the metachromatic mucous cells; WGA in the neuroendocrine-like cells; UEA-I in the cuticle. The epidermal glandular cells possess specific sites for the different lectins in relation to their functional characteristics. Therefore, these sugar residues indicate different behaviours of the cells in epidermal functions related to ion transport, receptor-secretory processes and defence.
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Affiliation(s)
- A Licata
- Department of Animal Biology and Marine Ecology, University of Messina.
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Martella S, Cicconetti P, Tafaro L, Zannino G, Tedeschi G, Lorido A, Tombesi F, Casagrande Raffi I, Marigliano V. Causes of death in over-85-year-old hospitalized patients: a retrospective study. Arch Gerontol Geriatr 2002; 8:199-207. [PMID: 14764392 DOI: 10.1016/s0167-4943(02)00134-6] [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: 11/17/2022]
Affiliation(s)
- S Martella
- Department of Aging Science, Policlinico Umberto I, University La Sapienza of Rome, Italy.
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Barreto M, Villa MP, Martella S, Ronchetti F, Darder MT, Falasca C, Pagani J, Massa F, Ronchetti R. Exhaled nitric oxide in asthmatic and non-asthmatic children: influence of type of allergen sensitization and exposure to tobacco smoke. Pediatr Allergy Immunol 2001; 12:247-56. [PMID: 11737671 DOI: 10.1034/j.1399-3038.2001.00041.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Asthmatic bronchial inflammation is associated with increased nitric oxide concentrations in exhaled air (eNO). Recent data suggest that this effect arises from atopy. Our aim in this study was to find out whether atopy and sensitization to particular allergens influences eNO levels. A total of 213 subjects (41 asthmatics and 172 controls) (96 boys and 117 girls, 7.3-14 years of age) were studied. Parents completed a questionnaire that sought information on their children's respiratory symptoms and exposure to tobacco smoke. Subjects underwent skin-prick tests for the following common allergens: Dermatophagoides pteronyssinus (Dpt), cat fur, Aspergillus fumigatus, Alternaria tenuis, mixed grass, mixed tree pollen, Parietaria officinalis, egg, and cow's milk. eNO was collected in 1-l mylar bags (exhaled pressure 10 cmH2O, flow 58 ml/s) and analyzed by using chemiluminescence. Atopic and non-atopic children without a history of chronic respiratory symptoms had a similar geometric mean eNO (atopics, n = 28, 11.2 p.p.b.; non-atopics, n = 96, 10.0 p.p.b.; mean ratio 1.1, 95% confidence interval [CI]: 0.7-1.6). Conversely, atopic asthmatic subjects had significantly higher eNO values than non-atopic asthmatic subjects (atopics, n = 25, 24.8 p.p.b.; non-atopics, n = 16, 11.4 p.p.b.; mean ratio 2.2, 95% CI: 1.2-3.9, p= 0.000). In children with rhinitis alone (n = 15) and those with lower respiratory symptoms other than asthma (n = 33), eNO increased slightly, but not significantly, with atopy. eNO levels correlated significantly with Dpt wheal size (r = 0.51) as well with the wheal size for cat, mixed grass, and Parietaria officinalis (r = 0.30-0.29), and with the sum of all wheals (r = 0.47) (p= 0.000). Subjects sensitized only for Dpt (but not those subjects sensitized only for grass pollen or other allergens) showed significantly higher eNO levels than non-atopic subjects (16.4 p.p.b. vs. 10.2 p.p.b., mean ratio 1.6, 95% CI: 1.1-2.3, p= 0.002). In asthmatic subjects, Dpt sensitization markedly increased eNO levels (Dpt-sensitized subjects: 28.0 p.p.b.; Dpt-unsensitized subjects: 12.2 p.p.b.; mean ratio 2.3, 95% CI: 1.5-3.5, p= 0.000). Non-asthmatic Dpt-sensitized subjects also had significantly higher eNO values than non-asthmatic, non-Dpt-sensitized subjects (14.2 p.p.b. vs. 10.1 p.p.b.; mean ratio 1.4, 95% CI: 1.1-1.9, p= 0.008). No difference was found between eNO levels in asthmatic subjects and control subjects exposed or unexposed to tobacco smoke. In conclusion, eNO concentrations are high in atopic asthmatic children and particularly high in atopic asthmatics who are sensitized to house-dust mite allergen.
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Affiliation(s)
- M Barreto
- II Paediatric Department, University La Sapienza, Rome, Italy.
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Abstract
The concentration of exhaled nitric oxide (eNO) is a useful marker of asthmatic bronchial inflammation. eNO can now be measured away from the laboratory (off-line), even in children. Short exhalation maneuvers (8 sec) and small samples (1 L) of exhaled gas are probably sufficient in children, but more information is needed about the effect of different measurement conditions. As a preliminary step before conducting epidemiological studies in schoolchildren, we investigated the effects of expiratory flow, dead space, and expiratory time on eNO concentrations collected in 1-L mylar collection bags. We studied 101 cooperative subjects (62 males) aged 5-18 years (30 healthy volunteers, 51 asthmatics, and 20 children with various other respiratory diseases) in our pulmonary function laboratory. On-line and off-line eNO were compared in a single session, and analyzed with a Sievers NOA 280 nitric oxide analyzer. For both methods of collecting expired gas, subjects did a single exhalation without breath-holding against an expiratory pressure 10 cm H(2)O. We investigated the effects of expiratory flow, dead space, and exhalation time on eNO; we also compared on-line and off-line eNO measurements, and the repeatability of both techniques at a given flow rate. Expiratory flows of 58 mL/sec provided more reproducible data than lower flows (coefficient of repeatability 1.1 ppb for 58 mL/sec vs. 2.8 for 27 mL/sec vs. 5.7 for 18 mL/sec). eNO concentrations were about 25% higher in off-line than in on-line recordings if the initial 250 mL of exhaled gas were not eliminated, and 37% higher if exhalation lasted longer (16 sec vs. 8 sec). Eliminating 250 mL of dead space and shortening the filling time to 8 sec yielded off-line eNO values close to those on-line (geometric mean off-line eNO 14.4 ppb, 95% confidence interval: 12.2-17.0) vs. on-line eNO 13.8 ppb (95% confidence interval: 11.6-16.5). On-line and off-line results were highly correlated (r = 0.996, P = 0.000) and had similar coefficients of variation (on-line eNO 2.6%, off-line 2.8%). Neither agreement nor repeatability of eNO measurements were affected by disease status or baseline FEV(1) (% predicted values). Once standardized, the off-line eNO technique using 1-L gas collection bags will provide results similar to those recorded on-line.
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Affiliation(s)
- M Barreto
- II Pediatric Department, University "La Sapienza," Rome, Italy.
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Tafaro L, Cicconetti P, Martella S, Tedeschi G, Zannino G, Troisi G, Pastena I, Fioravanti M, Marigliano V. An investigation on behavioral problems in centenarians. Arch Gerontol Geriatr Suppl 2001; 7:375-8. [PMID: 11431089 DOI: 10.1016/s0167-4943(01)00164-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- L Tafaro
- Department of Aging Science, Policlinico Umberto I, University La Sapienza, Roma, Italy
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Ronchetti R, Villa MP, Barreto M, Rota R, Pagani J, Martella S, Falasca C, Paggi B, Guglielmi F, Ciofetta G. Is the increase in childhood asthma coming to an end? Findings from three surveys of schoolchildren in Rome, Italy. Eur Respir J 2001; 17:881-6. [PMID: 11488320 DOI: 10.1183/09031936.01.17508810] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Time trends in the prevalence of asthma, family history of asthma and atopy in Roman schoolchildren were assessed. The study population consisted of all children (aged 6-14 yrs) attending two primary schools in Rome, situated in urban areas that differed markedly in socioeconomic conditions and environmental pollution. Three questionnaire-based surveys were conducted in 1974, 1992 and 1998 in 2,259, 1,229 and 1,139 children. The prevalence of asthma in males and females increased significantly during 1974-1992 and remained stable from 1992-1998. In age groups born in the subsequent 4-yr periods it increased almost linearly, for children born from 1962-1965 to 1982-1985 (4.4%-12.5%), and remained remarkably stable in children born after 1985. Because the prevalence of asthma had a steeper trend in males than in females (approximately 0.55% x yr(-1) versus 0.25% x yr(-1)), the male:female asthma ratio increased (1:38 in 1974; 1:84 in 1992 and 1:62 in 1998). No single environmental factor, including area of residence, seemed to influence the prevalence of asthma. Family history of asthma and atopy also increased steadily (0.72% x yr(-1) and 0.30% x yr(-1) respectively) more than doubling during the 24-yr study period. The strong relationship between asthma and a family history of atopy not only persisted but also strengthened over time (23.3% of asthmatic children belonged to families with atopic illnesses in 1974 but 44.2% in 1998). The environmental factors that might explain the almost three-fold rise in childhood asthma between 1974 and 1992 remain unknown but the genetic background of the disease has presumably remained unchanged since the early 1970s. The fact that the prevalence of asthma increased no further during the past 6 yrs suggests that the progressive induction of asthma symptoms in genetically predisposed subjects is a self-limiting process that has probably come to an end in the authors' study area.
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Affiliation(s)
- R Ronchetti
- Paediatric Clinic of the 2nd Faculty of Medicine, University of Rome La Sapienza, Italy
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Ronchetti R, Pia Villa M, Ciofetta G, Barreto M, Falasca C, Martella S. Changes over 13 years in skin reactivity to histamine in cohorts of children aged 9-13 years. Allergy 2001; 56:436-41. [PMID: 11350308 DOI: 10.1034/j.1398-9995.2001.056005436.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Several studies report substantial differences in the prevalence of skin test reactivity to allergens in children from adjacent geographic areas; others report an increased prevalence over time. To find out whether these differences depend on variations in skin reactivity to histamine, we determined the time trend of histamine wheal sizes in successive cohorts of unselected children living in the same area (Viterbo, Italy). METHODS We conducted three epidemiologic surveys, each including children aged 9 and 13 years. The 1983-7 study investigated 170 children (150 were tested twice); the 1992 study, 158 children; and the 1996 study, 208 children. RESULTS In both age groups, the mean diameter of the wheal induced by histamine skin prick tests (10 mg/ml) increased significantly over time (9-year-olds: 3.25 mm in 1983, 4.68 in 1992, and 5.89 in 1996; 13-year-olds: 3.89 mm in 1987, 5.18 in 1992, and 6.50 in 1996) (P < 0.001 between subsequent studies). The distribution of the wheal diameters for both ages showed a trend to a right shift in the three successive studies (P < 0.001). The dose-response curves for three histamine concentrations (0.2, 1, and 10 mg/ml) had significantly steeper slopes in 1996 than in 1983-7 (P < 0.001). CONCLUSION The marked time-related increase in the size of the histamine wheals could help to explain the trend toward an increased prevalence of positive allergen skin test reactions reported during the past years. The causes of increased skin reactivity to histamine remain conjectural.
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Affiliation(s)
- R Ronchetti
- II Pediatric Clinic, University of Rome La Sapienza , Rome, Italy
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Pianalto B, Bonanni G, Martella S, Renier M, Ancona E. [Results of laparoscopic bilateral varicocelectomy]. Ann Ital Chir 2000; 71:587-91; discussion 591-2. [PMID: 11217476] [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: 02/19/2023]
Abstract
Left varicocele (LV) is a common clinical condition that is present in approximately 15% of the general male population. Bilateral varicocele (BV) is an association of clinical LV and subclinical or ultrasound diagnosed right varicocele. Recent diagnostic technology suggests that BV is much more common than previously suspected varying from 15 to 57%. The laparoscopic technique offers the possibility of planning bilateral varix ligation but only a few reports are currently available. The aim of this study was to evaluate the outcome of contemporary bilateral correction of BV on spermatogenesis. From 1992 January to 1998 December a total of 207 patients with clinical left varicocele and a pathological sperm count were studied. Scrotal sonography was performed and in 96 patients (group A) subclinical right varicocele was diagnosed while 111 patients (group B) only had LV. 84 patients were married and had tried unsuccesfully for a pregnancy for at least one year before evaluation. All patients underwent laparoscopic varicocelectomy, performed under general anesthesia with a three trocar technique with application of clips to the spermatic vein and resection. Patients with right reflux received bilateral varix ligation. Operating time averaged 28 minutes for unilateral cases and 42 minutes for bilateral legatures. No significant differences were found in age distribution or preoperative seminal paramenters between the two groups. Postoperative hospital stay was 1.2 and 1.3 days respectively. 168 patients underwent sperm count four to six months after surgery. Both groups showed improvements in number (group A 41 millions, group b 27 millions), 2nd hour motility (group A 32%, group B 19%) and morphology (group A 52%, group B 51%). 95 patients achieved normalization of seminal parameters, 40 (63%) in group A and 37 (30%) in group B, and there was a statistically significant difference between the two groups. The pregnancy rate was calculated on married population after one year; it was 41% in total. The role of the subclinical right varicocele associated to clinical left varicocele is uncertain and there are few papers concerning this argument. In this serie normalization of seminal parameters and the pregnancy rate were significantly higher in patients with bilateral correction of reflux. In conclusion our data confirm that subclinical right reflux also has a detrimental effect on spermatogenesis and we suggest that it must be corrected contemporary when associated with clinical left varicocele.
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Affiliation(s)
- B Pianalto
- Università degli Studi di Padova Dipartimento di Scienze Mediche e Chirurgiche Sezione di Clinica Chirurgica 4
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Licata A, Mauceri A, Ricca MB, Lo Cascio P, Martella S, Amato A. Immunohistochemical localization of calcium-binding proteins (CaBPs) in the epidermis of the earthworm Lumbricus terrestris (Annelida, Oligochaeta). Acta Histochem 2000; 102:159-66. [PMID: 10824609 DOI: 10.1078/s0065-1281(04)70025-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The present immunohistochemical study provides the first evidence of the presence of calcium-binding proteins (CaBPs) in the epidermis of the earthworm Lumbricus terrestris (Annelida, Oligochaeta) a lower invertebrate. The entire epidermis was labelled for calmodulin which is in agreement with its ubiquitous occurrence. Immunopositivity for calbindin D28K was limited to mucous cells, while that for S-100 protein was present only in neuroendocrine-like small granular cells. Finally, labelling for parvalbumin was specifically present in the subcutaneous nerve plexus. S-100 protein is considered to be a marker of neuroendocrine cells, at least in lower invertebrates such as Annelida. Although calbindin D28K is considered to be a marker of these cells in vertebrates, the same function cannot be attributed in Lumbricus terrestris. However, we can conclude that S-100 protein, as a regulatory protein, is phylogenetically older than calbindin D28K. We assume that the latter has an autoregulatory function in secretory processes. In agreement with previous data, we suggest that small granular cells exert a paracrine action in osmoregulatory and secretory processes.
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Affiliation(s)
- A Licata
- Department of Animal Biology and Marine Ecology, University of Messina, Faculty of Science, Messina-S. Agata, Italy.
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Licata A, Mauceri A, Ainis L, Martella S, Ricca MB, Lauriano ER, Amato A. Immunohistochemical localization of bioactive substances in the epidermis of the earthworm, Lumbricus terrestris (Annelida, oligochaeta). Eur J Histochem 1999; 42:303-8. [PMID: 10068903] [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: 02/11/2023] Open
Abstract
Serotonin (5HT), endothelin-big (ET-big) and neuron-specific enolase (NSE) are present in some epithelial paraneuronal cells of vertebrates. In the invertebrates, we show for the first time, by immunofluorescence and immunoperoxidase methods, the immunoreactions to antibodies raised to ET, 5-HT and NSE in the epidermis of the Lumbricus terrestris. It is assumed that the reactive cells are small granular cells that may have a paracrine action in the mechanisms of cell proliferation and secretory processes. The function of these bioactive substances in the epidermis of the earthworm awaits investigation. Phylogenetically it is very interesting that paraneuronal-like type of cells appear in such an ancient species of invertebrate which uses the epidermis for various functional activities.
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Affiliation(s)
- A Licata
- Department of Animal Biology and Marine Ecology, University of Messina, Faculty of Science, Italy
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Bauco C, Borriello C, Cinti A, Martella S, Zannino G, Rossetti C, Cacciafesta M, Marigliano V. Correlation between MMSE performance, age and education in centenarians. Arch Gerontol Geriatr 1998. [DOI: 10.1016/s0167-4943(98)80004-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Midulla F, Strappini PM, Ascoli V, Villa MP, Indinnimeo L, Falasca C, Martella S, Ronchetti R. Bronchoalveolar lavage cell analysis in a child with chronic lipid pneumonia. Eur Respir J 1998; 11:239-42. [PMID: 9543299 DOI: 10.1183/09031936.98.11010239] [Citation(s) in RCA: 33] [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: 02/07/2023]
Abstract
In an asymptomatic 4 yr old child with radiographic evidence of parenchymal lung disease, bronchoalveolar lavage (BAL) yielded the diagnosis of chronic lipid pneumonia caused by chronic aspiration of mineral oil given as a laxative. BAL analysis showed a marked reduction in the total number of alveolar macrophages; almost 70% of these cells contained intracytoplasmic lipid vacuoles. It also disclosed lymphocytic (cytotoxic/suppressor) alveolitis. A high percentage of lymphocytes expressed antigen markers of activation (human leucocyte antigen (HLA)-DR), CD54 and CD25). BAL analysis 18 months after mineral oil intake revealed that lymphocytes bearing antigen markers of activation had markedly decreased whereas alveolar macrophages (normal and lipid-laden) had increased. A subsequent whole lung BAL was considered unnecessarily invasive in this otherwise healthy child.
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Affiliation(s)
- F Midulla
- IV Dept of Pediatrics, Institute of Pediatrics, University of Rome La Sapienza, Italy
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