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Boggi U, Kauffmann E, Napoli N, Barreto SG, Besselink MG, Fusai GK, Hackert T, Abu Hilal M, Marchegiani G, Salvia R, Shrikhande S, Truty M, Werner J, Wolfgang C, Bannone E, Capretti G, Cattelani A, Coppola A, Cucchetti A, De Sio D, Di Dato A, Di Meo G, Fiorillo C, Gianfaldoni C, Ginesini M, Hidalgo Salinas C, Lai Q, Miccoli M, Montorsi R, Pagnanelli M, Poli A, Ricci C, Sucameli F, Tamburrino D, Viti V, Addeo PF, Alfieri S, Bachellier P, Baiocchi G, Balzano G, Barbarello L, Brolese A, Busquets J, Butturini G, Caniglia F, Caputo D, Casadei R, Chunhua X, Colangelo E, Coratti A, Costa F, Crafa F, Dalla Valle R, De Carlis L, de Wilde RF, Del Chiaro M, Di Benedetto F, Di Sebastiano P, Domak S, Hogg M, Egorov VI, Ercolani G, Ettorre GM, Falconi M, Ferrari G, Ferrero A, Filauro M, Giardino A, Grazi GL, Gruttaduaria S, Izbicki JR, Jovine E, Katz M, Keck T, Khatkov I, Kiguchi G, Kooby D, Lang H, Lombardo C, Malleo G, Massani M, Mazzaferro V, Memeo R, Miao Y, Mishima K, Molino C, Nagakawa Y, Nakamura M, Nardo B, Panaro F, Pasquali C, Perrone V, Rangelova E, Riu L, Romagnoli R, Romito R, Rosso E, Schulick R, Siriwardena A, Spampinato M, Strobel O, Testini M, Troisi R, Uzunoglo FG, Valente R, Veneroni L, Zerbi A, Vicente E, Vistoli F, Vivarelli M, Wakabayashi G, Zanus G, Zureikat A, Zyromski NJ, Coppola R, D'Andrea V, Davide J, Dervenis C, Frigerio I, Konlon KC, Michelassi F, Montorsi M, Nealon W, Portolani N, Sousa Silva D, Bozzi G, Ferrari V, Trivella MG, Cameron J, Clavien PA, Asbun HJ. REDISCOVER International Guidelines on the Perioperative Care of Surgical Patients With Borderline-resectable and Locally Advanced Pancreatic Cancer. Ann Surg 2024:00000658-990000000-00795. [PMID: 38407228 DOI: 10.1097/sla.0000000000006248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVE The REDISCOVER consensus conference aimed at developing and validate guidelines on the perioperative care of patients with borderline resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC). SUMMARY BACKGROUND DATA Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic surgery supports resection of BR-PDAC and, to a lesser extent, LA-PDAC. Guidelines outlining the selection and perioperative care for these patients are lacking. METHODS The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used to develop the REDISCOVER guidelines and create recommendations. The Delphi approach was used to reach consensus (agreement ≥80%) among experts. Recommendations were approved after a debate and vote among international experts in pancreatic surgery and pancreatic cancer management. A Validation Committee used the AGREE II-GRS tool to assess the methodological quality of the guidelines. Moreover, an independent multidisciplinary advisory group revised the statements to ensure adherence to non-surgical guidelines. RESULTS Overall, 34 recommendations were created targeting centralization, training, staging, patient selection for surgery, possibility of surgery in uncommon scenarios, timing of surgery, avoidance of vascular reconstruction, details of vascular resection/reconstruction, arterial divestment, frozen section histology of perivascular tissue, extent of lymphadenectomy, anticoagulation prophylaxis and role of minimally invasive surgery. The level of evidence was however low for 29 of 34 clinical questions. Participants agreed that the most conducive mean to promptly advance our understanding in this field is to establish an international registry addressing this patient population ( https://rediscover.unipi.it/ ). CONCLUSIONS The REDISCOVER guidelines provide clinical recommendations pertaining to pancreatectomy with vascular resection for patients with BR- and LA-PDAC, and serve as the basis of a new international registry for this patient population.
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Affiliation(s)
- Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Emanuele Kauffmann
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Niccolò Napoli
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - S George Barreto
- College of Medicine and Public Health, Flinders University, South Australia, Australia, Division of Surgery and Perioperative Medicine, Flinders Medical Center, Beadfor Park, Australia
| | - Marc G Besselink
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | | | - Thilo Hackert
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Germany
| | - Mohammad Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giovanni Marchegiani
- Hepatopancreatobiliary and Liver Transplant Surgery, Department of Surgery, Oncology and Gastroenterology, DiSCOG, University of Padua, Padua, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Shailesh Shrikhande
- Tata Memorial Hospital, Gastrointestinal and HPB Service, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India
| | - Mark Truty
- Division of Hepatobiliary & Pancreas Surgery, Department of Surgery, Mayo Clinic Rochester, MN, USA
| | - Jens Werner
- Department of General, Visceral, and Transplant Surgery, LMU, University of Munich, Germany
| | - Christopher Wolfgang
- Department of Surgery, The NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Elisa Bannone
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | - Alice Cattelani
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | | | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum Università di Bologna; Bologna, Italy
| | - Davide De Sio
- Gemelli Pancreatic Center, CRMPG (Advanced Pancreatic Research Center), Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Armando Di Dato
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Giovanna Di Meo
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J) University of Bari, Italy
| | - Claudio Fiorillo
- Gemelli Pancreatic Center, CRMPG (Advanced Pancreatic Research Center), Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Cesare Gianfaldoni
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Michael Ginesini
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | | | - Quirino Lai
- Department of General and Specialty Surgery, Sapienza University of Rome, AOU Policlinico Umberto I of Rome, Rome, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberto Montorsi
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | | | - Andrea Poli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudio Ricci
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Italy, Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna (IRCCS AOUBO)
| | - Francesco Sucameli
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Domenico Tamburrino
- Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Virginia Viti
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Pietro F Addeo
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Sergio Alfieri
- Gemelli Pancreatic Center, CRMPG (Advanced Pancreatic Research Center), Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Philippe Bachellier
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Gianluca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia and UOC General Surgery, ASST Cremona, Italy
| | - Gianpaolo Balzano
- Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Linda Barbarello
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Alberto Brolese
- Department of General Surgery & HPB Unit, APSS, Trento, Italy
| | - Juli Busquets
- Division of Pancreatobiliary Surgery and Liver Transplantation, Department of Surgery, Bellvitge University Hospital, IDIBELL, L´Hospitalet de Llobregat, Barcelona, Spain
| | - Giovanni Butturini
- Hepatopancreatobiliary Surgery, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Fabio Caniglia
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Damiano Caputo
- Research Unit of General Surgery, Department of Medicine and Surgery, University Campus Bio-Medico di Roma, Via Alvaro del Portillo 200,00128 Rome, Italy
- Operative Research Unit of General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Riccardo Casadei
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Italy, Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna (IRCCS AOUBO)
| | - Xi Chunhua
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Institute, Nanjing Medical University
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University
| | - Ettore Colangelo
- Department of General Surgery, "G. Mazzini" Hospital, Teramo, Italy
| | - Andrea Coratti
- Department of General and Emergency Surgery, AUSL Toscana Sud Est, Misericordia Hospital of Grosseto, Italy
| | - Francesca Costa
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Francesco Crafa
- Division of General, Oncological and Robotic Surgery, San Giuseppe Moscati Hospital, Avellino Italy
| | | | - Luciano De Carlis
- Division of HPB Surgery and Transplantation, Niguarda Hospital , University of Milano-Bicocca, Milan, Italy
| | - Roeland F de Wilde
- Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marco Del Chiaro
- Department of Surgery, University of Colorado School of Medicine. Aurora, Colorado, USA
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Pierluigi Di Sebastiano
- Surgical Oncology, Pierangeli Clinic, Department of Innovative Technology in Medicine & Dentistry, G. D'Annunzio University Chieti-Pescara, Italy
| | - Safi Domak
- department of HPB surgery and liver transplantation, Beaujon hospital, Clichy, France. University Paris Cité, Paris, France
| | - Melissa Hogg
- Division of HPB Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Vyacheslav I Egorov
- Department for Surgical Oncology and HPB Surgery, Ilyinskaya Hospital, Moscow, Russia
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum Università di Bologna; Bologna, Italy
| | - Giuseppe Maria Ettorre
- Department of General Surgery and Transplantation. San Camillo Forlanini Hospital-POIT. Rome, Italy
| | - Massimo Falconi
- Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Giovanni Ferrari
- Division of Minimally-invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, "Umberto I" Mauriziano Hospital, Turin, Italy
| | - Marco Filauro
- Department of Surgery Galliera Hospital, Genova, Italy
| | - Alessandro Giardino
- Hepatopancreatobiliary Surgery, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Gian Luca Grazi
- Division of HepatoBiliaryPancreatic Surgery, AOU Careggi, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Salvatore Gruttaduaria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center Italy (UPMC Italy), Palermo, Italy
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Jakob R Izbicki
- Department of general visceral and thoracic surgery, University Hospital Eppendorf University of Hamburg, Hamburg, Germany
| | - Elio Jovine
- Department of Surgery, Alma Mater Studiorum University of Bologna, IRCCS Azienda Ospedaliera Universitaria di Bologna
| | - Matthew Katz
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Igor Khatkov
- Department of High Technology Surgery, Moscow Clinical Scientific Center. Moscow, Russia
| | - Gozo Kiguchi
- Department of Surgery, Hirakata Kohsai Hospital, Osaka, Japan
| | - David Kooby
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Hauke Lang
- University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Carlo Lombardo
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Giuseppe Malleo
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Marco Massani
- Department of Surgery, Regional Hospital of Treviso, Treviso, Italy
| | - Vincenzo Mazzaferro
- Department of Oncology and Hemato-oncology, University of Milan HPB Surgery and Liver Transplantation Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Riccardo Memeo
- Department of HPB Surgery, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Yi Miao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Institute, Nanjing Medical University
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Kohei Mishima
- Research Institute against Digestive Cancer (IRCAD), Strasbourg, France
| | - Carlo Molino
- Department of General and Speciality Surgery, General and Pancreatic Surgery Team 1, AORN A. Cardarelli, Naples, Italy
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Bruno Nardo
- Division of General Surgery, Department of Surgery and Robotic, Annunziata Hub Hospital, School of Medicine Surgery and TD, University of Calabria, Cosenza, Italy
| | - Fabrizio Panaro
- Department of Surgery, Division of HBP Surgery & Transplantation. Montpellier University Hospital School of Medicine, Montpellier, France
| | - Claudio Pasquali
- Pancreatic & Digestive Endocrine Surgery Research Group - Department of Surgery, Oncology and Gastroenterology, DiSCOG, University of Padua, Padua, Italy
| | - Vittorio Perrone
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Elena Rangelova
- Section for Upper Abdominal Surgery at the Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Surgery at the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Long Riu
- Second Department of Hepatopancreatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing 100853, China
| | - Renato Romagnoli
- Division of General Surgery 2U - Liver Transplant Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Raffaele Romito
- Division of General Surgery II and HPB Unit, A.O.U. Maggiore della Carità di Novara, Novara, Italy
| | - Edoardo Rosso
- Service de Chirurgie Générale, Mini-Invasive et Robotique, Centre Hôspitalier de
| | - Richard Schulick
- Department of Surgery, University of Colorado School of Medicine. Aurora, Colorado, USA
| | - Ajith Siriwardena
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK
| | - Marcello Spampinato
- Department of General and Minimally Invasive Surgery, "Vito Fazzi" Hospital, Lecce, Italy Luxembourg, Luxembourg, Luxembourg
| | - Oliver Strobel
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J) University of Bari, Italy
| | - Roberto Troisi
- Division of HBP, Minimally Invasive and Robotic Surgery, Transplantation Service Federico II University Hospital - Naples, Italy
| | - Faik G Uzunoglo
- Department of general visceral and thoracic surgery, University Hospital Eppendorf University of Hamburg, Hamburg, Germany
| | | | - Luigi Veneroni
- Chirurgia Generale, Infermi Hospital Rimini, AUSL Romagna, Rimini, Italy
| | | | - Emilio Vicente
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Fabio Vistoli
- Division of General Surgery and Transplantation, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marco Vivarelli
- Division of Hepatobiliary, Pancreatic and Transplantation Surgery, Polytechnic University of Marche, Ospedali Riuniti delle Marche, Ancona, Italy
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
| | - Giacomo Zanus
- Second Division of Surgery-Treviso-Department of Surgery, Oncology and Gastroenterology, DiSCOG, University of Padua, Padua, Italy
| | - Amer Zureikat
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Roberto Coppola
- Research Unit of General Surgery, Department of Medicine and Surgery, University Campus Bio-Medico di Roma, Via Alvaro del Portillo 200,00128 Rome, Italy
- Operative Research Unit of General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Vito D'Andrea
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - José Davide
- Department of Surgery, HEBIPA - Hepatobiliary and Pancreatic Unit, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | - Isabella Frigerio
- Hepatopancreatobiliary Surgery, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Kevin C Konlon
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Fabrizio Michelassi
- Department of Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital at Weill Cornell, New Yourk, NY, USA
| | - Marco Montorsi
- Department of Biomedical Sciences, Humanitas University, Italy
- Division of General and Digestive Surgery, Department of General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - William Nealon
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA; Zucker School of Medicine at Hofstra, New Hyde Park, NY, USA
| | - Nazario Portolani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Italy
| | - Donzília Sousa Silva
- Department of Surgery, HEBIPA - Hepatobiliary and Pancreatic Unit, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | | | | | - John Cameron
- Department of Surgery, John Hopkins University School of Medicine, Baltimore, MD
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Horacio J Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA
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Degli Esposti L, Borghi C, Galvani M, Giacomini E, Manotti P, Marra A, Passaro A, Perrone V, Pieraccini F, Sangiorgi D, Navazio A. P342 REAL–WORLD ANALYSIS ON THE ECONOMIC VALUE OF REACHING LIPID TARGET IN ITALY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
The study aimed to evaluate the healthcare direct costs for Italian National Health System of patients treated with lipid–lowering drugs that do not achieve the low–density lipoprotein (LDL)–cholesterol target compared to those reaching their targets, and to analyze costs according to the distance from LDL target by using real–world data.
An observational analysis was performed on administrative and laboratory data from selected Italian Healthcare Departments. Patients were included if they presented at least one laboratory LDL test between 2012 and 2019 and if they were prescribed lipid–lowering drugs during 6 months prior the last LDL detection (index date). Mean annual direct costs were evaluated in the 12 months before index date in terms of all drugs prescribed, all–cause hospitalizations and all outpatient services. Distance to LDL target was calculated as difference between the index LDL level and LDL target. Total mean annual healthcare direct cost for patients that did not reach LDL target was higher compared to total cost of patients achieving LDL target (€3,678 vs €2,906). Costs were mainly driven by hospitalization (€1,330) followed by drugs expenditure (€1,012) and outpatient services (€563). Mean total annual healthcare costs increased with the distance from LDL target, specifically from €3,004 for patients with 10% distance from LDL target up to €4,823 for those 50% or more distance from LDL target. This trend was particularly evident for the cost item related to hospitalization, that went from €1,486 to €2,819 moving from 10% to ≥ 50 distance from LDL target. Results from this real–world study highlighted the higher economic burden for patients that do not reach the therapeutic LDL target, that tend to rise along with increasing distance from the LDL target. Overall, our findings could suggest that reducing the distance from LDL target could have a positive impact also on the economic outcomes for these patients.
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Affiliation(s)
- L Degli Esposti
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - C Borghi
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - M Galvani
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - E Giacomini
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - P Manotti
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - A Marra
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - A Passaro
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - V Perrone
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - F Pieraccini
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - D Sangiorgi
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - A Navazio
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
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Degli Esposti L, Borghi C, Galvani M, Giacomini E, Manotti P, Marra A, Passaro A, Perrone V, Pieraccini F, Sangiorgi D, Navazio A. P358 THE ROLE OF ADHERENCE TO LIPID–LOWERING THERAPIES IN ACHIEVING LIPID TARGET: FINDINGS FROM REAL–WORLD ANALYSIS IN ITALY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
The objective of the present real–world analysis was to evaluate the impact of adherence to lipid–lowering drugs in reaching the lipid target in settings of clinical practice in Italy.
The analysis was based on administrative and laboratory database of selected Healthcare Units in Italy covering approximately 10% of Italian population. Adult patients prescribed with statin and with at least a low–density lipoprotein (LDL) determination were included between 2012 and 2019. The index date was defined as the first prescription for statin within the inclusion period. Patients fell into 4 clusters collectively exhaustive and mutually exclusive based on their characteristics assessed during the year prior index date. Patients were considered as adherent if they had a proportion of days covered (PDC)≥80%. Among overall patients prescribed statin and with a LDL determination, 1% was with familial hypercholesterolemia, 28% with previous cardiovascular events, 21% with diabetes and 50% in primary prevention. Regardless their risk profile, the increasing of adherence was related to a higher achievement of LDL–target, with an increment of + 53.2% among familial hypercholesterolemia, +43.1% in diabetes and +30% in previous cardiovascular events and primary prevention clusters while progressing from low (PDC<40%) to high (PDC≥80%) levels of adherence. However, while in diabetes and primary prevention clusters 80% and 86% of adherent patients, respectively, had their cholesterol level under control, in the familial hypercholesterolemia and previous cardiovascular events clusters only 46% of adherent patients achieve the lipid target.
The analysis showed adherence to be a key factor for cholesterol control. However, our findings underline a therapeutic need for patients that, although adherent, fail to achieve the lipid target, especially among patients with previous cardiovascular events (that have low level of LDL to achieve) and with familial hypercholesterolemia (that have high LDL basal level), suggesting therapeutic intensification should be applied.
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Affiliation(s)
- L Degli Esposti
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - C Borghi
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - M Galvani
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - E Giacomini
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - P Manotti
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - A Marra
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - A Passaro
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - V Perrone
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - F Pieraccini
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - D Sangiorgi
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - A Navazio
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
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Degli Esposti L, Borghi C, Galvani M, Giacomini E, Manotti P, Marra A, Passaro A, Perrone V, Pieraccini F, Sangiorgi D, Navazio A. P357 THE MANAGEMENT OF CHOLESTEROL LEVEL CONTROL WITH LIPID–LOWERING DRUGS IN ITALIAN CLINICAL PRACTICE: FINDINGS FROM THE STREAM (SUPPORTING WITH THE REAL–WORLD EVIDENCE THE ASSESSMENT OF MEDICINES AND HEALTH TECHNOLOGIES) STUDY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
The study aimed to evaluate the proportion of patients not reaching their low–density lipoprotein (LDL)–cholesterol target according to their risk profile in real–world settings of Italian clinical practice.
This observational analysis was based on administrative and laboratory databases from a pool of Italian Entities covering around 10% of Italian population. All patients included had at least one laboratory LDL test between 2012 and 2019. Presence of lipid–lowering drugs was analyzed in the 6 months before index date (last LDL test detected), during which time adherence to these therapies was measured as proportion of days covered (PDC). Risk profile was assessed based on ESC guidelines.1 Among patients with LDL tests that received lipid–lowering drugs, 49.7% were deemed as very high–risk (VHR), 38.3% at high risk (HR), 12% with other risks (OR). Overall, 80% of patients did not reach their LDL–cholesterol target: 87.2% in the HR–cohort, 82.9% in the VHR–cohort (LDL level target 70 mg/dl and 55 mg/dl, respectively) and 49.6% in OR–cohort (LDL level target 116 mg/dl). Statin and ezetimibe combination was observed only in 6.5% of HR and OR and 10.3% of VHR patients, while patients were mainly in monotherapy with statins (87.5 VHR, 91.2% HR, 90.6% OR). Furthermore, patients adherent to treatment (PDC≥80%) accounted for the 52% of VHR–cohort, 47.2% of HR–cohort and 39.1% of OR–cohort. Our findings highlight the need to optimize the management of cholesterol control, especially among patients at risk. Despite the high proportion of patients not reaching LDL target, sub–optimal levels of adherence and a low use of combination regimens were observed, thus suggesting LDL–control could be supported by increasing adherence and/or the use of combination therapies and, if the target is not yet achieved, by the utilization of more recent therapies.
European Heart Journal (2020) 41, 111–188
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Affiliation(s)
- L Degli Esposti
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - C Borghi
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - M Galvani
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - E Giacomini
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - P Manotti
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - A Marra
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - A Passaro
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - V Perrone
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - F Pieraccini
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - D Sangiorgi
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - A Navazio
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
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Boggi U, Baronti W, Amorese G, Pilotti S, Occhipinti M, Perrone V, Marselli L, Barsotti M, Campani D, Gianetti E, Insilla AC, Bosi E, Kaufmann E, Terrenzio C, Vistoli F, Marchetti P. Treating Type 1 Diabetes by Pancreas Transplant Alone: A Cohort Study on Actual Long-term (10 Years) Efficacy and Safety. Transplantation 2022; 106:147-157. [PMID: 33909390 DOI: 10.1097/tp.0000000000003627] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Physiologically regulated insulin secretion and euglycemia are achievable in type 1 diabetes (T1D) by islet or pancreas transplantation. However, pancreas transplant alone (PTA) remains a debated approach, with uncertainties on its relative benefits and risks. We determined the actual long-term (10 y) efficacy and safety of PTA in carefully characterized T1D subjects. METHODS This is a single-center, cohort study in 66 consecutive T1D subjects who received a PTA between April 2001 and December 2007, and were then all followed until 10 y since transplant. Main features evaluated were patient survival, pancreas graft function, C-peptide levels, glycemic parameters, and the function of the native kidneys. RESULTS Ten-year actual patient survival was 92.4%. Optimal (insulin independence) or good (minimal insulin requirement) graft function was observed in 57.4% and 3.2% of patients, respectively. Six (9.0%) patients developed stage 5 or 4 chronic kidney disease. In the remaining individuals bearing a successful PTA, estimated glomerular filtration rate (eGFR) decline per year was -2.29 ± 2.69 mL/min/1.73 m2. Reduction of eGFR at 1 y post-PTA was higher in those with pre-PTA hyperfiltration and higher HbA1c concentrations; eGFR changes afterward significantly correlated with diabetes duration. In recipients with normoglycemia at 10 y, 74% of normoalbuminuric or microalbuminuric subjects pre-PTA remained stable, and 26% progressed toward a worse stage; conversely, in 62.5% of the macroalbuminuric individuals albuminuria severity regressed. CONCLUSIONS These long-term effects of PTA on patient survival, graft function, and the native kidneys support PTA as a suitable approach to treat diabetes in selected T1D patients.
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Affiliation(s)
- Ugo Boggi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy
| | - Walter Baronti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriella Amorese
- Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy
| | - Silvia Pilotti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Margherita Occhipinti
- Diabetes Unit, Versilia Hospital, Azienda ASL Area Vasta Nord-Ovest, Lido di Camaiore, Lucca, Italy
| | - Vittorio Perrone
- Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy
| | - Lorella Marselli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Departmental Section of Endocrinology and Metabolism of Organ and Cellular Transplantation, Cisanello University Hospital, Pisa, Italy
| | | | - Daniela Campani
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, Pisa University Hospital, Pisa, Italy
| | - Elena Gianetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Cacciato Insilla
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, Pisa University Hospital, Pisa, Italy
| | - Emanuele Bosi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Emanuele Kaufmann
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Chiara Terrenzio
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Vistoli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy
| | - Piero Marchetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Departmental Section of Endocrinology and Metabolism of Organ and Cellular Transplantation, Cisanello University Hospital, Pisa, Italy
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Del Casale A, Rossi-Espagnet MC, Napolitano A, Lucignani M, Bonanni L, Kotzalidis GD, Buscajoni A, Manelfi L, Perrone V, Gualtieri I, Brugnoli R, De Pisa E, Girardi P, Romano A, Ferracuti S, Bozzao A, Pompili M. Cerebral cortical thickness and gyrification changes in first-episode psychoses and multi-episode schizophrenia. Arch Ital Biol 2021; 159:3-20. [PMID: 34159573 DOI: 10.12871/00039829202111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Cortical thickness (CT) and local gyrification index (LGI) in psychotic disorders may show modifications that relate to clinical course. This observational study aimed to analyse such variables in patients with schizophrenia, compared to healthy controls (HCs). We compared CT and LGI of 18 patients with first-episode psychosis with that of 21 with multi-episode schizophrenia and 16 HCs. CT corrected for false-positive cases (Family-Wise Error Rate) showed a reduction in the multi-episode group compared to HCs in left temporal and parietal, and right temporal, parietal, occipital, and hippocampal cortices. Family-wise corrected LGI was increased in the left inferior and middle frontal cortices, and in the right fusiform gyrus, cingulate, lingual, and parahippocampal gyri in first onset patients compared to HCs. Increased LGI was absent from later stages of psychosis, suggesting that specific CT and LGI alterations may underlie different stages of illness.
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Affiliation(s)
- A Del Casale
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University, Rome; Unit of Psychiatry, 'Sant'Andrea' University Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy -
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Degli Esposti L, Perrone V, Sangiorgi D, Sinigaglia L. Assessment of patients affected by rheumatoid arthritis eligible for biotechnological agents and evaluation of their healthcare resource utilization and related costs. Reumatismo 2021; 73:5-14. [PMID: 33874642 DOI: 10.4081/reumatismo.2021.1329] [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: 08/01/2020] [Accepted: 02/15/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To provide estimates of patients with rheumatoid arthritis (RA) eligible for biotechnological therapy and to evaluate their healthcare costs. METHOD An observational analysis was performed based on data-linkage between administrative databases of selected Italian Regional/Local healthcare departments. Data were then re-proportioned to the Italian population. Patients with RA diagnosis defined by discharge diagnosis and/or exemption code during 01/01/2013- 31/12/2017 were included. The criteria applied to evaluate the elegibility for biotechnological therapy were: 1) methotrexate (MTX)-treatment failure ≥6 months and start of a different conventional-synthetic diseasemodifying antirheumatic drugs (csDMARD); 2) corticosteroid ≥6 months with dosage ≥7.5 mg/die; 3) MTX-contraindication (therapy or hospitalization for renal damage/interstizial lung disease/hepatic failure). Mean annual costs per patient included drugs, hospitalizations, outpatient services. RESULTS Data re-proportioned to the Italian population estimated 318,328 RA patients: 43,361 with, 274,967 without biotechnological agents. Among the latter, 26,487(9.6%) patients met ≥1 criteria applied for eligibility: 1,896 had MTX-treatment failure and started another csDMARD; 15,833 received corticosteroid ≥7.5 mg/die; 7,788 had MTX-contraindication. Regarding patients fulfilling two criteria, 107 had MTX-treatment failure followed by another csDMARDs and corticosteroid ≥7.5 mg/die, 53 were treated with another csDMARDs after MTX-treatment failure and also presented MTX-contraindication, 810 had corticosteroid ≥7.5 mg/die and MTX-contraindication. Mean total annual costs for patients estimated eligible for biotechnological therapy was € 3,132, of which € 177 related to drugs indicated for RA and € 2,955 related to other direct costs. CONCLUSIONS According to our estimates, around 10% RA patients not currently treated with biotechnological agents are eligible for such therapies, highlighting a trend of under-use in clinical practice for RA management.
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Affiliation(s)
- L Degli Esposti
- Clicon S.r.l., Health Economics and Outcomes Research, Bologna.
| | - V Perrone
- Clicon S.r.l., Health Economics and Outcomes Research, Bologna.
| | - D Sangiorgi
- Clicon S.r.l., Health Economics and Outcomes Research, Bologna.
| | - L Sinigaglia
- Department of Rheumatology, Gaetano Pini Institute, Milan.
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Perrone V, Losi S, Filippi E, Antonelli S, Giovannitti M, Giacomini E, Sangiorgi D, Degli Esposti L. FRI0288 TREATMENT PATTERNS AND PHARMACOUTILIZATION AMONG PATIENTS AFFECTED BY ANKYLOSING SPONDYLITIS: AN ITALIAN REAL-WORLD STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Ankylosing spondylitis (AS) is a chronic rheumatologic condition requiring lifelong treatments. To date, few real-world studies on AS patients in Italy are reported.Objectives:Aims of the study were to evaluate treatment patterns and to analyse pharmacoutilization on patients affected by AS in a real-world setting of Italian clinical practice.Methods:This observational study was based on administrative databases of a pool of Italian settings. A retrospective cross-sectional analysis was performed for years 2015-2017 to evaluate AS-diagnosed patients and, among them, to estimate percentage of treated and untreated ones. Patients were included if having a hospitalization discharge diagnosis at any level of AS (ICD-9-CM: 720.0) or exemption code for AS (054.720.0). Index date (ID) was date in which patients met one of the inclusion criteria. Patients with a prescription for drugs indicated for AS [non-steroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs (DMARDs) - targeted synthetic (tsDMARDs) and biological (bDMARDs)] at ID were defined “treated”. Patients without such drug prescriptions at ID were considered “untreated”. To analyse treatment patterns of b/tsDMARDs-treated patients a longitudinal cohort study was conducted considering as inclusion periods the year 2014 and a period from 01/07/2016 to 30/06/2017. ID was date of first b/tsDMARDs prescription during inclusion period. Follow-up (F-up) lasted one year after ID. The interruption of treatment was defined as the absence of prescriptions in the last 3 months of F-up.Results:For cross-sectional-cohort: AS-diagnosed patients were 4,824 in 2015, 5,357 in 2016, 5,894 in 2017. In all years analysed, about 50% of patients were male. Mean age±SD ranged from 51.5±13.7 (2015) to 52.4±14.0 (2017). Untreated patients were 33.6% (2015), 35.1% (2016) and 37.9% (2017), while patients in therapy with b/tsDMARDs were 22.7% (2015), 22.3% (2016) and22.2% (2017). The remaining percentage of patients were treated with csDMARDs/NSAIDS: 43.7% (2015), 42.6% (2016), 39.9% (2017)). In 2015 and 2016 all b/tsDMARDs-treated patients were in therapy with anti-TFN agents, while the advent of IL-inhibitors was observed starting from 2017 (8.2% b/tsDMARDs-treated patients with IL-inhibitors). For longitudinal-cohort: in 2014, 310 patients had a b/tsDMARDs prescription and during 1-year F-up 11.9% of them interrupted the treatment after a mean time ±SD of 83.3±66.9 days. Of the 183 patients who had a prescription of b/tsDMARDs at ID during 2016-2017, 22.4% had a treatment interruption after a mean time±SD of 134.4±86.1 days during F-up.Conclusion:This real-world study provided insights on AS treatment patterns. Preliminary results showed that approximately one third of AS patients are untreated and about one in five are treated with b/tsDMARDs. Despite the improvement in treatment duration observed from 2014 to 2016/17, still 22.4% of b/tsDMARDs-treated patients interrupted therapy in the most recent cohort. A larger sample size is needed to confirm results.Disclosure of Interests:Valentina Perrone: None declared, Serena Losi Shareholder of: minor stockholder at Eli Lilly, Employee of: Employed by Eli Lilly, Erica Filippi Shareholder of: minor stockholder at Eli Lilly, Employee of: Employed by Eli Lilly, Silvia Antonelli Shareholder of: minor stockholder at Eli Lilly, Employee of: Employed by Eli Lilly, Massimo Giovannitti Shareholder of: minor stockholder at Eli Lilly, Employee of: Employed by Eli Lilly, Elisa Giacomini: None declared, Diego Sangiorgi: None declared, Luca Degli Esposti: None declared
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Degli Esposti L, Andretta M, Di Pasquale G, Gambera M, Saragoni S, Perrone V, Buda S. Clinical Characteristics And Health Care Resources In Patients Treated With Oral Anticoagulants: Evidences From Italian Administrative Databases. Vasc Health Risk Manag 2019; 15:429-437. [PMID: 31632047 PMCID: PMC6793461 DOI: 10.2147/vhrm.s216749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/26/2019] [Indexed: 12/27/2022] Open
Abstract
Objectives 1) To evaluate anticoagulation treatment patterns and health care resource use in adult patients with a discharge diagnosis of non-valvular atrial fibrillation (NVAF) in an Italian real-world setting and 2) to describe the characteristics of NVAF patients in relation to treatment. Design A retrospective cohort study in a "real-world" setting. Setting Data were analysed by integrating administrative databases that included approximately 2,000,000 individuals assisted by the National Health System from two Italian Local Health Units. Participants All adult patients with at least one hospital discharge or ≥2 outpatient visits with a diagnosis code for NVAF from 1/01/2011 to 31/12/2015 were included. Main outcome measures Anticoagulation treatment patterns, health care resource use and major bleeding events that occurred during the follow-up period were evaluated. Results 32,863 NVAF patients were included, of whom 7,831 had at least one prescription of oral anticoagulants. Among them, 6,876 patients were vitamin K antagonists (VKA) users and 955 were non-vitamin K antagonist oral anticoagulant (NOAC) users at index date (ID). During the follow-up period, the use of antiplatelet drugs was higher among VKA-naïve users than the NOAC-naïve users. Among NOAC users, 76.1% showed an adherence level ≥80% during follow-up. The rate of bleeding events resulted higher for VKA patients compared to NOAC patients. The unadjusted incidence rate was 10.46 per 1000 person-year for VKA patients and 4.55 per 1,000 person-years for NOAC patients. The overall annual cost (in term of drugs, hospitalisations and outpatient specialist services) was € 5,156.13 for VKA and € 4,630.57 for NOAC. Conclusion This unselected cohort study, on NVAF patients being prescribed oral anticoagulants, highlights that VKA was largely prescribed and the great majority of patients on NOACs were adherent to treatment. Most of the OAC patients still received antiplatelet agents in combination, and in NOAC patients, we registered a lower number of bleeding events compared with VKA.
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Affiliation(s)
- L Degli Esposti
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - M Andretta
- Local Pharmaceutical Service, Verona Local Health Authority, Verona, Italy
| | - G Di Pasquale
- Department of Cardiology, Maggiore Hospital, Bologna, Italy
| | - M Gambera
- Local Pharmaceutical Service, Bergamo Local Health Authority, Bergamo, Italy
| | - S Saragoni
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - V Perrone
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - S Buda
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
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Perrone V, Veronesi C, Nica M, Colombo D, Degli Esposti L, Castello R. Explorative analysis of gender-specific characteristics in patients with heart failure in an Italian hospital. Ther Clin Risk Manag 2019; 15:847-850. [PMID: 31360063 PMCID: PMC6625643 DOI: 10.2147/tcrm.s203011] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/06/2019] [Indexed: 11/23/2022] Open
Abstract
Sex-related differences have been shown to deeply affect health-related aspects of patients. However, the lack of gender-specific analysis makes it difficult to advance personalized medicine in terms of a gender-based approach. The aim of the present study was to describe gender-specific features of patients diagnosed with heart failure (HF), with a focus on the clinical presentation. Data were collected from a properly designed database and referred to an Italian hospital. Patients aged ≥18 years with a primary or secondary diagnosis of HF between 1 January 2012 and 31 December 2016 were included, and their demographic and clinical characteristics were analyzed according to gender. Of the 719 HF patients included, 317 (44.1%) were male and 402 (55.9%) were female. Women tended to be older compared to men (82.4±8.8 years and 77.1±10.6 years, respectively). As for clinical presentation, 62.1% of female and 38.3% of male patients had preserved ejection fraction, and 56.1% of men and 58.2% of women suffered from atrial fibrillation. The left atrium was partially compromised in 62.4% of male and 63% of female patients, while right atrium dysfunction tended to be more frequent in male patients compared to female patients (29.1% and 25.5%, respectively). In conclusion, gender-specific features of a cohort of HF patients from a clinical setting were accurately described.
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Affiliation(s)
- V Perrone
- Clicon S.R.L. Health, Economics and Outcomes Research, Ravenna, Italy
| | - C Veronesi
- Clicon S.R.L. Health, Economics and Outcomes Research, Ravenna, Italy
| | - M Nica
- Novartis Pharma, Origgio, VA, Italy
| | | | - L Degli Esposti
- Clicon S.R.L. Health, Economics and Outcomes Research, Ravenna, Italy
| | - R Castello
- Division of General Medicine, University Hospital of Verona, Verona, Italy
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Degli Esposti L, Perrone V, Sangiorgi D, Alessandrini D, Buda S, Cantini F, Mazzini E, Toma C, De Solda F. Therapeutic strategies utilization and resource consumption in patients treated for psoriatic arthritis: findings from a real-world analysis in an Italian setting. Patient Prefer Adherence 2019; 13:187-194. [PMID: 30774314 PMCID: PMC6348972 DOI: 10.2147/ppa.s178603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The purpose of this study was to analyze the therapeutic strategies and estimate the health care resource consumption in patients with psoriatic arthritis (PsA). PATIENTS AND METHODS An observational retrospective cohort analysis of administrative databases of six Italian Local Health Units was performed. Patients ≥18 years with a hospitalization discharge diagnosis of PsA (International Classification of Diseases, Ninth Revision code: 696.0) or exemption code (045.696.0) for PsA from January 1, 2010 to December 31, 2015 (inclusion period), with at least one prescription of any therapy used for PsA were included. The index date (ID) was the first date matching with at least one of the inclusion criteria during the inclusion period. All patients were followed up after the ID until the end of data availability. Baseline C-reactive protein (CRP) levels (±6 months in relation to the ID) were also analyzed. RESULTS A total of 2,408 (prevalence 0.83 per 1,000) patients with PsA (male 52%; median age 54 years) were included in the study; patients were already treated for PsA in 42.4% of cases. At 1 year of follow-up, 73% of the patients received one systemic drug, while 22% of patients received two systemic drugs; in addition, our results show an increase in the number of add-on or switches in a longer follow-up period. The utilization of biologic agents was higher among patients with previous PsA treatment, showing a progression of the pathology. Overall, a medium/high level of CRP at baseline was observed among more than half of the overall sample, with slight changes across subgroups in analysis. The average health care costs were €1,966.4 and €13,914 per year for patients treated with conventional systemic therapy and biological agents, respectively. CONCLUSION A better knowledge of prescription therapeutic scheme and economic burden of PsA could stimulate the rational development of health programs aimed at potentiating services for its management.
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Affiliation(s)
- L Degli Esposti
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy,
| | - V Perrone
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy,
| | - D Sangiorgi
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy,
| | - D Alessandrini
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy,
| | - S Buda
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy,
| | - F Cantini
- Division of Rheumatology, Hospital of Prato, Azienda USL Toscana Centro, Prato, Italy
| | | | - C Toma
- Bristol-Myers Squibb, Roma, Italy
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Corcione A, Angelini P, Bencini L, Bertellini E, Borghi F, Buccelli C, Coletta G, Esposito C, Graziano V, Guarracino F, Marchi D, Misitano P, Mori AM, Paternoster M, Pennestrì V, Perrone V, Pugliese L, Romagnoli S, Scudeller L, Corcione F. Joint consensus on abdominal robotic surgery and anesthesia from a task force of the SIAARTI and SIC. Minerva Anestesiol 2018; 84:1189-1208. [PMID: 29648413 DOI: 10.23736/s0375-9393.18.12241-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Minimally invasive surgical procedures have revolutionized the world of surgery in the past decades. While laparoscopy, the first minimally invasive surgical technique to be developed, is widely used and has been addressed by several guidelines and recommendations, the implementation of robotic-assisted surgery is still hindered by the lack of consensus documents that support healthcare professionals in the management of this novel surgical procedure. Here we summarize the available evidence and provide expert opinion aimed at improving the implementation and resolution of issues derived from robotic abdominal surgery procedures. A joint task force of Italian surgeons, anesthesiologists and clinical epidemiologists reviewed the available evidence on robotic abdominal surgery. Recommendations were graded according to the strength of evidence. Statements and recommendations are provided for general issues regarding robotic abdominal surgery, operating theatre organization, preoperative patient assessment and preparation, intraoperative management, and postoperative procedures and discharge. The consensus document provides evidence-based recommendations and expert statements aimed at improving the implementation and management of robotic abdominal surgery.
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Affiliation(s)
- Antonio Corcione
- Department of Critical Care Area, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Pierluigi Angelini
- Department of General, Laparoscopic and Robotic Surgery, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Lapo Bencini
- Division of Surgical Oncology and Robotics, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Elisabetta Bertellini
- Department of Anesthesia and Intensive Care, New Civile S. Agostino-Estense, Policlinico Hospital, Modena, Italy
| | - Felice Borghi
- Division of General and Surgical Oncology, Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
| | - Claudio Buccelli
- Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Coletta
- Division of Operating Room Management, Department of Emergency and Critical Care, S. Croce e Carle Hospital, Cuneo, Italy
| | - Clelia Esposito
- Department of Critical Care Area, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Vincenzo Graziano
- Department of Anesthesia and Critical Care Medicine, Cardiothoracic Anesthesia and Intensive Care, Pisa University Hospital, Pisa, Italy
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Cardiothoracic Anesthesia and Intensive Care, Pisa University Hospital, Pisa, Italy
| | - Domenico Marchi
- Department of General Surgery, New Civile S. Agostino-Estense, Policlinico Hospital, Modena, Italy
| | - Pasquale Misitano
- Unit of General and Mini-Invasive Surgery, Department of General Surgery, Misericordia Hospital, Grosseto, Italy
| | - Anna M Mori
- Department of Anesthesiology and Reanimation, IRCCS Policlinic San Matteo Foundation, Pavia, Italy
| | - Mariano Paternoster
- Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Vincenzo Pennestrì
- Department of Anesthesia and Intensive Care Medicine, Misericordia Hospital, Grosseto, Italy
| | - Vittorio Perrone
- Department of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy
| | - Luigi Pugliese
- Unit of General Surgery 2, IRCCS Policlinic San Matteo, Foundation, Pavia, Italy
| | - Stefano Romagnoli
- Department of Anesthesia and Critical Care, Careggi University Hospital, Florence, Italy
| | - Luigia Scudeller
- Unit of Clinical Epidemiology, Scientific Direction, IRCCS Policlinic San Matteo Foundation, Pavia, Italy -
| | - Francesco Corcione
- Department of General, Laparoscopic and Robotic Surgery, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
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Oliva F, Perrone V, Sangiorgi D, Degli Esposti L, Gensini G. P603Healthcare resources consumption in patients with Heart Failure in Italy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Moglia A, Perrone V, Ferrari V, Morelli L, Boggi U, Ferrari M, Mosca F, Cuschieri A. Influence of videogames and musical instruments on performances at a simulator for robotic surgery. MINIM INVASIV THER 2016; 26:129-134. [PMID: 27981866 DOI: 10.1080/13645706.2016.1267018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 02/08/2023]
Abstract
OBJECTIVE To assess if exposure to videogames, musical instrument playing, or both influence the psychomotor skills level, assessed by a virtual reality simulator for robot-assisted surgery (RAS). MATERIALS AND METHODS A cohort of 57 medical students were recruited: playing musical instruments (group 1), videogames (group 2), both (group 3), and no activity (group 4); all students executed four exercises on a virtual simulator for RAS. RESULTS Subjects from group 3 achieved the best performances on overall score: 527.09 ± 130.54 vs. 493.73 ± 108.88 (group 2), 472.72 ± 85.31 (group 1), and 403.13 ± 99.83 (group 4). Statistically significant differences (p < .05) between group 3 and group 4 were found for overall score (p = .009) and for time of completion (p = .044). As regards experience with the piano, subjects from group 3 outperformed those from group 1 on overall score (496.98 ± 122.71 vs. 470.25 ± 92.31), but without statistically significant difference (p = .646). CONCLUSIONS The present study suggests that the level of psychomotor skills in subjects exposed to both musical instrument playing and videogames is higher than that in those practicing either one alone. The effect of videogames appears negligible in individuals playing the piano.
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Affiliation(s)
- Andrea Moglia
- a EndoCAS, Center for Computer Assisted Surgery , University of Pisa , Pisa , Italy
| | - Vittorio Perrone
- b Cisanello Teaching Hospital of Pisa , Pisa , Italy.,c Multidisciplinary Center of Robotic Surgery , University Hospital of Pisa , Pisa , Italy
| | - Vincenzo Ferrari
- a EndoCAS, Center for Computer Assisted Surgery , University of Pisa , Pisa , Italy.,d Information Engineering Department , University of Pisa , Pisa , Italy
| | - Luca Morelli
- b Cisanello Teaching Hospital of Pisa , Pisa , Italy.,c Multidisciplinary Center of Robotic Surgery , University Hospital of Pisa , Pisa , Italy
| | - Ugo Boggi
- b Cisanello Teaching Hospital of Pisa , Pisa , Italy.,c Multidisciplinary Center of Robotic Surgery , University Hospital of Pisa , Pisa , Italy
| | - Mauro Ferrari
- a EndoCAS, Center for Computer Assisted Surgery , University of Pisa , Pisa , Italy.,b Cisanello Teaching Hospital of Pisa , Pisa , Italy
| | - Franco Mosca
- a EndoCAS, Center for Computer Assisted Surgery , University of Pisa , Pisa , Italy.,b Cisanello Teaching Hospital of Pisa , Pisa , Italy
| | - Alfred Cuschieri
- e Scuola Superiore Sant'Anna of Pisa , Pisa , Italy.,f Institute for Medical Science and Technology, University of Dundee , Dundee , UK
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Vivaldi C, Vasile E, Caparello C, Perrone V, Caniglia F, De Lio N, Croce C, Fornaro L, Musettini G, Pasquini G, Pecora I, Lencioni M, Cappelli C, Caramella D, Falcone A, Boggi U. PD-022 FOLFOXIRI as primary treatment for locally advanced unresectable pancreatic cancer (LAPC): a prospective study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw200.22] [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: 11/14/2022] Open
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Brusadelli T, Carnovale C, Gentili M, Borsadoli C, Speziali A, Perrone V, Pellegrino P, Antoniazzi S, Pozzi M, Radice S, Clementi E. Throbbing headache associated with enoxaparin administration: a case report, a review of pharmacovigilance databases for similar cases and possible mechanisms. J Clin Pharm Ther 2015; 40:342-4. [PMID: 25726970 DOI: 10.1111/jcpt.12257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 02/05/2015] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES To date, no case of headache has been reported with enoxaparin. We present the case of a 60-years-old man, who developed enoxaparin-induced throbbing headache and discuss the possible pharmacological mechanisms. We provide an analysis of enoxaparin-induced headache in three international databases. CASE SUMMARY A few hours after the subcutaneous administration of this drug at therapeutic dose, the patient experienced throbbing headache. Rechallenge on two other separate occasions separated by several days produced the same effect although with reduced intensity when the dose was lowered. The Naranjo Algorithm indicated a 'certain' relationship. WHAT IS NEW AND CONCLUSION We report a case of throbbing headache associated with the use of enoxaparin; with the increasing use of enoxaparin, physicians who prescribe this drug should be aware of this potential ADR. We suggest that it is a heparin class-effect, and therefore, a more general caution is also appropriate.
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Affiliation(s)
- T Brusadelli
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, Luigi Sacco University Hospital, Università di Milano, Milan, Italy
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Funel N, Genova G, Perrone V, Caniglia F, Boggi U. Effect of gemcitabine-ALK-014 combination on MMP9 expression in primary pancreatic adenocarcinoma CELL cultures (PCCs). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
332 Background: Pancreatic ductal adenocarcinoma (PDAC) is the fourth highest cause of death in the western world. The adjuvant chemotherapy can increase the overall survivor (OS) of PDAC patients. The Gemcitabine (GEM) and alkaloids mixture (ALK-014) combination shows the increase two time the OS non resectable in PDAC patients with respect to gemcitabine treatment alone. Indeed the Alkaoids compound modulated the Matrix MetalloProteinase 9 (MMP9) in PDAC cell clines. AIM: Our goal was to investigate the MMP 9 protein modulation in primary cell cultures (PCCs) of PDAC by Gem and ALK-014 combination treatment. Methods: Two PCCs (LPc006 and LPc028) were seeded in 4 multi-well chamber slids (8,000 each/well) for cytotoxicity study by Gem [10 Nm], ALk-014 [1µm]and their combination. After 48 h of treatment the cells were stained Immunocytochemistry (IHC) using polyclonal antibody for MMP9. We used no-treated cells to evaluate basic level of MMP9 protein. No–stained cells were used as negative control. All experiments were done in triplicates. We evaluated protein expression and cellular morphology by computer for imaging analysis (D-Sight, Menarini, Italy). The expression differences was evaluated by ANOVA and t-test analyses. Results: We found a significant reduction of MMP9 expression in both cell lines treated with Gem/ALK-014 combination with respect to their controls ( p<0.01). The same drug combination reduced significantly the number of proliferating cells and showed the modification of the structure of nuclei with respect to untreated cells (p<0.001). Conclusions: New therapeutic approaches are warranted to reduce the metastatic behavior of PDAC. The present drug combination seems to be a promising tool for PDAC treatment in vitro. The new computerized approach for MMP9 evaluation could be a first quantitative attempt for protein quantification in preclinical model.
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Affiliation(s)
- Niccola Funel
- Department of Translational Research and New Technologies in Medicine and Surgery, Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | | | - Vittorio Perrone
- Department of Translational Research and New Technologies in Medicine and Surgery, Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Fabio Caniglia
- Department of Translational Research and New Technologies in Medicine and Surgery, Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Ugo Boggi
- Department of Translational Research and New Technologies in Medicine and Surgery, Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
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Pellegrino P, Falvella FS, Perrone V, Carnovale C, Brusadelli T, Pozzi M, Antoniazzi S, Cheli S, Perrotta C, Clementi E, Radice S. The first steps towards the era of personalised vaccinology: predicting adverse reactions. Pharmacogenomics J 2014; 15:284-7. [PMID: 25287071 DOI: 10.1038/tpj.2014.57] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/01/2014] [Accepted: 08/21/2014] [Indexed: 01/11/2023]
Abstract
Until now, the occurrence of adverse reactions among individuals inoculated with identical vaccines has been ascribed to unpredictable stochastic processes. Recent advances in pharmacogenomics indicate that some features of host response to immunisation are influenced by genetic traits, henceforth predictable. The ability to predict the adverse reaction to vaccination would represent an important step towards the development of personalised vaccinology and could enhance public confidence in the safety of vaccines. Herein, we have reviewed all the available information on the association between genetic variants and the risk for healthy subjects to develop adverse reactions.
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Affiliation(s)
- P Pellegrino
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital 'Luigi Sacco', Universitá di Milano, Milan, Italy
| | - F S Falvella
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital 'Luigi Sacco', Universitá di Milano, Milan, Italy
| | - V Perrone
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital 'Luigi Sacco', Universitá di Milano, Milan, Italy
| | - C Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital 'Luigi Sacco', Universitá di Milano, Milan, Italy
| | - T Brusadelli
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital 'Luigi Sacco', Universitá di Milano, Milan, Italy
| | - M Pozzi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - S Antoniazzi
- IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Cheli
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital 'Luigi Sacco', Universitá di Milano, Milan, Italy
| | - C Perrotta
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital 'Luigi Sacco', Universitá di Milano, Milan, Italy
| | - E Clementi
- 1] Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy [2] Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, Consiglio Nazionale delle Ricerche Institute of Neuroscience, University Hospital 'Luigi Sacco', Universitá di Milano, Milan, Italy
| | - S Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital 'Luigi Sacco', Universitá di Milano, Milan, Italy
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Boggi U, Palladino S, Massimetti G, Vistoli F, Caniglia F, De Lio N, Perrone V, Barbarello L, Belluomini M, Signori S, Amorese G, Mosca F. Laparoscopic robot-assisted versus open total pancreatectomy: a case-matched study. Surg Endosc 2014; 29:1425-32. [PMID: 25159652 DOI: 10.1007/s00464-014-3819-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 08/12/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND The enhanced dexterity offered by robotic assistance could be excessive for distal pancreatectomy but not enough to improve the outcome of laparoscopic pancreaticoduodenectomy. Total pancreatectomy retains the challenges of uncinate process dissection and digestive reconstruction, but avoids the risk of pancreatic fistula, and could be a suitable operation to highlight the advantages of robotic assistance in pancreatic resections. METHODS Eleven laparoscopic robot-assisted total pancreatectomies (LRATP) were compared to 11 case-matched open total pancreatectomies. All operations were performed by one surgeon during the same period of time. Robotic assistance was employed in half of the patients, based on robot availability at the time of surgery. Variables examined included age, sex, American Society of Anesthesiologists score, body mass index, estimated blood loss, need for blood transfusions, operative time, tumor type, tumor size, number of examined lymph nodes, margin status, post-operative complications, 90-day or in-hospital mortality, length of hospital stay, and readmission rate. RESULTS No LRATP was converted to conventional laparoscopy, hand-assisted laparoscopy or open surgery despite two patients (18.1 %) required vein resection and reconstruction. LRATP was associated with longer mean operative time (600 vs. 469 min; p = 0.014) but decreased mean blood loss (220 vs. 705; p = 0.004) than open surgery. Post-operative complications occurred in similar percentages after LRATP and open surgery. Complications occurring in most patients (5/7) after LRATP were of mild severity (Clavien-Dindo grade I and II). One patient required repeat laparoscopic surgery after LRATP, to drain a fluid collection not amenable to percutaneous catheter drainage. One further patient from the open group required repeat surgery because of bleeding. No patient had margin positive resection, and the mean number of examined lymph nodes was 45 after LRATP and 36 after open surgery. CONCLUSIONS LRATP is feasible in selected patients, but further experience is needed to draw final conclusions.
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Affiliation(s)
- Ugo Boggi
- Division of General and Transplant Surgery, Pisa University Hospital Pisa, Via Paradisa 2, 56124, Pisa, Italy,
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Boggi U, Amorese G, Vistoli F, Caniglia F, De Lio N, Perrone V, Barbarello L, Belluomini M, Signori S, Mosca F. Laparoscopic pancreaticoduodenectomy: a systematic literature review. Surg Endosc 2014; 29:9-23. [PMID: 25125092 DOI: 10.1007/s00464-014-3670-z] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 05/31/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic pancreaticoduodenectomy (LPD) is gaining momentum, but there is still uncertainty regarding its safety, reproducibility, and oncologic appropriateness. This review assesses the current status of LPD. METHODS Our literature review was conducted in Pubmed. Articles written in English containing five or more LPD were selected. RESULTS Twenty-five articles matched the review criteria. Out of a total of 746 LPD, 341 were reported between 1997 and 2011 and 405 (54.2 %) between 2012 and June 1, 2013. Pure laparoscopy (PL) was used in 386 patients (51.7 %), robotic assistance (RA) in 234 (31.3 %), laparoscopic assistance (LA) in 121 (16.2 %), and hand assistance in 5 (0.6 %). PL was associated with shorter operative time, reduced blood loss, and lower rate of pancreatic fistula (vs LA and RA). LA was associated with shorter operative time (vs RA), but with higher blood loss and increased incidence of pancreatic fistula (vs PL and RA). Conversion to open surgery was required in 64 LPD (9.1 %). Operative time averaged 464.3 min (338-710) and estimated blood 320.7 mL (74-642). Cumulative morbidity was 41.2 %, and pancreatic fistula was reported in 22.3 % of patients (4.5-52.3 %). Mean length of hospital stay was 13.6 days (7-23), showing geographic variability (21.9 days in Europe, 13.0 days in Asia, and 9.4 days in the US). Operative mortality was 1.9 %, including one intraoperative death. No difference was noted in conversion rate, incidence of pancreatic fistula, morbidity, and mortality when comparing results from larger (≥30 LPD) and smaller (≤29 LPD) series. Pathology demonstrated ductal adenocarcinoma in 30.6 % of the specimens, other malignant tumors in 51.7 %, and benign tumor/disease in 17.5 %. The mean number of lymph nodes examined was 14.4 (7-32), and the rate of microscopically positive tumor margin was 4.4 %. CONCLUSIONS In selected patients, operated on by expert laparoscopic pancreatic surgeons, LPD is feasible and safe.
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Affiliation(s)
- Ugo Boggi
- Division of General and Transplant Surgery, Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy,
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Pellegrino P, Carnovale C, Perrone V, Salvati D, Gentili M, Brusadelli T, Antoniazzi S, Pozzi M, Radice S, Clementi E. Epidemiological analysis on two decades of hospitalisations for meningitis in the United States. Eur J Clin Microbiol Infect Dis 2014; 33:1519-24. [DOI: 10.1007/s10096-014-2102-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 03/27/2014] [Indexed: 11/29/2022]
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Carnovale C, Pellegrino P, Perrone V, Antoniazzi S, Pozzi M, Nisic A, Clementi E, Radice S. Neurological and psychiatric adverse events with prucalopride: case report and possible mechanisms. J Clin Pharm Ther 2013; 38:524-5. [PMID: 23889005 DOI: 10.1111/jcpt.12087] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 06/20/2013] [Accepted: 07/04/2013] [Indexed: 01/31/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Chronic constipation is very frequent in the general population. Although usually considered banal, this disorder has considerable personal, social and healthcare impact. Several studies have shown that the psychological impact exceeds that caused by rheumatoid arthritis or haemodialysis. Recently, prucalopride, a highly selective 5-HT4 receptor agonist has been shown to improve the symptoms of chronic constipation and to have a beneficial effect on social and healthcare impact. The drug was approved by the European Medicine Agency, in 2009 at a dose of 2 mg/day, 'for symptomatic treatment of chronic constipation in women in whom laxatives fail to provide adequate relief'. Neurological side effects or psychiatric disorders have not been reported previously with prucalopride. We present the case of a 61-year-old woman, who developed such adverse effects when given prucalopride for the treatment for chronic constipation. CASE SUMMARY A few hours after oral administration of this drug at therapeutic dose (2 mg/day), the patient experienced life-threatening neurological effects that included visual hallucination, loss of balance and memory, disorientation, exhaustion and suicidal ideation. Analysis with the Naranjo algorithm indicated a 'possible' relationship between prucalopride and these disorders. WHAT IS NEW AND CONCLUSION This is the first report of prucalopride-induced neurological side effects and psychiatric disorders with prucalopride. The absence of other similar reports suggests that prucalopride rarely causes these adverse effects.
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Affiliation(s)
- C Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, 'Luigi Sacco' University Hospital, University of Milan, Milan, Italy
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Vasile E, De Lio N, Cappelli C, Pollina L, Funel N, Sainato A, Ginocchi L, Lucchesi M, Caparello C, Caponi S, Perrone V, Pasqualetti F, Caniglia F, Signori S, Mazzeo S, Greco C, Falcone A, Campani D, Mosca F, Boggi U. Phase II study of neoadjuvant chemotherapy with modified FOLFOXIRI in borderline resectable or unresectable stage III pancreatic cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.4062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4062 Background: FOLFIRINOX has shown high activity in metastatic pancreatic cancer (PC) patients and could be an interesting regimen also for patients with inoperable locally advanced disease. Our group had developed a similar schedule in metastatic colorectal cancer named FOLFOXIRI with good tolerance and activity. Therefore, we have decided to perform a phase II trial to prospectively evaluate the activity of modified FOLFOXIRI in borderline resectable or unresectable PC. Methods: Modified FOLFOXIRI consisted of a lower dose of irinotecan (150 mg/sqm) and of infusional 5-fluorouracil (2800 mg/sqm as a 48-hour continuous infusion on days 1 to 3) with no bolus 5-fluorouracil. Folinic acid and oxaliplatin (85 mg/sqm) remained unchanged. The study enrolled patients with diagnosis of pancreatic adenocarcinoma, stage III borderline resectable or unresectable disease (cT4,cN0-1,cM0), ECOG PS 0-1, age 18-75. The primary end-point of the study was the percent of patients who undergo radical surgical resection after chemotherapy. Results: Thirty-two patients have been enrolled; M/F=12/20; PS 0/1=16/16. Median age was 60 years (range 44-75). Median number of FOLFOXIRI cycles was 6 (range 2-14). Grade 3-4 toxicities was experienced by 20 patients during chemotherapy. Twelve partial responses (37%) and 14 stable diseases (45%) have been observed; 2 patients had progressive diseases (6%). The remaining 4 patients (12%) have not been yet evaluated because are still in the first months of treatment. A local treatment was received after chemotherapy by 18 patients until now: 13 (41%) received radical surgical resection and 5 received concomitant chemo-radiotherapy. Three explorative laparotomy showed occult metastases. In other 7 cases surgery is planned while 2 patients refused surgery. Median progression-free survival is 14.0 months and median overall survival is 24.2 months with a two-year survival rate of 54%. Conclusions: Chemotherapy with FOLFOXIRI seems active in locally advanced PC and may allow to obtain a downstaging of disease leading to achieve a curative surgical resection in some cases. Longer follow up is needed to better evaluate long-term outcome of this strategy.
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Affiliation(s)
- Enrico Vasile
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Nelide De Lio
- U.O. Chirurgia Generale e Trapianti, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Carla Cappelli
- U.O. Radiologia 1, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Luca Pollina
- Dipartimento di Medicina di Laboratorio e Diagnosi Molecolari, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Niccola Funel
- U.O. Anatomia Patologica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Aldo Sainato
- U.O.Radoiterapia, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Laura Ginocchi
- U.O. Oncologia 2 Univeristaria, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Maurizio Lucchesi
- U.O. Oncologia 2 Univeristaria, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Chiara Caparello
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Sara Caponi
- U.O. Oncologia 2 Univeristaria, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Vittorio Perrone
- U.O. Chirurgia Generale e Trapianti, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Fabio Caniglia
- U.O. Chirurgia Generale e Trapianti, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Stefano Signori
- U.O. Chirurgia Generale e Trapianti, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Salvatore Mazzeo
- U.O. Radiologia 1, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Carlo Greco
- U.O. Radioterapia, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Alfredo Falcone
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Daniela Campani
- U.O. Anatomia Patologica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Franco Mosca
- Azienda Ospedaliero-Universitaria Pisana, Università di Pisa, Pisa, Italy
| | - Ugo Boggi
- U.O. Chirurgia Generale e Trapianti, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Abstract
Recent findings from the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications study showed that long-term improved glycemic control in patients with type 1 diabetes with normal renal function and normoalbuminuria can delay development of impaired renal function by at least 6.5 years, although the reduction in the relative risk of end-stage renal disease (ESRD) was not significant. The unanswered question is: can improvement of glycemic control delay the onset of ESRD in patients with established diabetic nephropathy? In this context, pancreas transplantation (PATx) can be considered the most effective intervention to restore normoglycemia. Can this aggressive/experimental intervention be applied to arrest/retard renal function decline? To answer this question, this review summarizes the relevant findings from observational studies conducted in cohorts of patients, followed up for 4 to 15 years, who underwent PATx. These noncontrolled studies provided positive answers to the earlier question, principally concerning a significant decrease in albumin excretion levels. However, current drugs used to prevent rejection could impair renal function, principally in recipients with low pretransplant estimated glomerular filtration rate (ie, <60 mL/min). Unfortunately, all these studies had shortcuts that qualify interpretation of the findings. First, it is unclear how much initial estimated glomerular filtration rate loss results from nephrotoxic effect of antirejection drugs, and how much results from improved glycemia and its impact on the reduction of hyperfiltration. Second, the study designs did not consider the wide variation in rates of renal function loss observed in patients with established nephropathy (ie, one third are nonprogressors, one third are slow progressors, and one third are rapid progressors). Third, all studies were observational in nature and clinical trials are needed to properly evaluate the effectiveness of normalization of hyperglycemia through PATx on postponing the onset of ESRD in type 1 diabetes.
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Affiliation(s)
- Diego Cantarovich
- Division of Nephrology, General and Transplant Surgery, Azienda-Ospedaliero-Universitaria Pisana, Pisa, Italy.
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25
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Carnovale C, Perrone V, Borsadoli C, Mambrini A, Speziali A, Froldi G, Antoniazzi S, Magistro L, Clementi E, Radice S. A case of urinary incontinence by hydroxychloroquine in a geriatric patient. J Clin Pharm Ther 2012. [DOI: 10.1111/jcpt.12024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C. Carnovale
- Scientific Institute; IRCCS Eugenio Medea; Lecco Italy
| | - V. Perrone
- Unit of Clinical Pharmacology; Department of Biomedical and Clinical Sciences; University Hospital ‘Luigi Sacco’; Università di Milano; Milan Italy
| | - C. Borsadoli
- Pharmaceutical Service; Azienda Sanitaria Locale di Mantova; Mantua Italy
| | - A. Mambrini
- Physician, Azienda Sanitaria Locale di Mantova; Mantua Italy
| | - A. Speziali
- Pharmaceutical Service; Azienda Sanitaria Locale di Mantova; Mantua Italy
| | - G. Froldi
- Pharmaceutical Service; Azienda Sanitaria Locale di Mantova; Mantua Italy
| | - S. Antoniazzi
- Unit of Clinical Pharmacology; Department of Biomedical and Clinical Sciences; University Hospital ‘Luigi Sacco’; Università di Milano; Milan Italy
| | - L. Magistro
- Postgraduate School of Clinical Pharmacology; Department of Pharmacology “E. Trabucchi”; Università di Milano, Milan Italy
| | - E. Clementi
- Scientific Institute; IRCCS Eugenio Medea; Lecco Italy
- Unit of Clinical Pharmacology; Department of Biomedical and Clinical Sciences; University Hospital ‘Luigi Sacco’; Università di Milano; Milan Italy
| | - S. Radice
- Unit of Clinical Pharmacology; Department of Biomedical and Clinical Sciences; University Hospital ‘Luigi Sacco’; Università di Milano; Milan Italy
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Giovannetti E, van der Velde A, Funel N, Vasile E, Perrone V, Leon LG, De Lio N, Avan A, Caponi S, Pollina LE, Gallá V, Sudo H, Falcone A, Campani D, Boggi U, Peters GJ. High-throughput microRNA (miRNAs) arrays unravel the prognostic role of MiR-211 in pancreatic cancer. PLoS One 2012; 7:e49145. [PMID: 23155457 PMCID: PMC3498320 DOI: 10.1371/journal.pone.0049145] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 10/04/2012] [Indexed: 12/11/2022] Open
Abstract
Background Only a subset of radically resected pancreatic ductal adenocarcinoma (PDAC) patients benefit from chemotherapy, and identification of prognostic factors is warranted. Recently miRNAs emerged as diagnostic biomarkers and innovative therapeutic targets, while high-throughput arrays are opening new opportunities to evaluate whether they can predict clinical outcome. The present study evaluated whether comprehensive miRNA expression profiling correlated with overall survival (OS) in resected PDAC patients. Methodology/Principal Findings High-resolution miRNA profiles were obtained with the Toray's 3D-Gene™-miRNA-chip, detecting more than 1200 human miRNAs. RNA was successfully isolated from paraffin-embedded primary tumors of 19 out of 26 stage-pT3N1 homogeneously treated patients (adjuvant gemcitabine 1000 mg/m2/day, days-1/8/15, every 28days), carefully selected according to their outcome (OS<12 (N = 13) vs. OS>30 months (N = 6), i.e. short/long-OS). Highly stringent statistics included t-test, distance matrix with Spearman-ranked correlation, and iterative approaches. Unsupervised hierarchical analysis revealed that PDACs clustered according to their short/long-OS classification, while the feature selection algorithm RELIEF identified the top 4 discriminating miRNAs between the two groups. These miRNAs target more than 1500 transcripts, including 169 targeted by two or more. MiR-211 emerged as the best discriminating miRNA, with significantly higher expression in long- vs. short-OS patients. The expression of this miRNA was subsequently assessed by quantitative-PCR in an independent cohort of laser-microdissected PDACs from 60 resected patients treated with the same gemcitabine regimen. Patients with low miR-211 expression according to median value had a significantly shorter median OS (14.8, 95%CI = 13.1–16.5, vs. 25.7 months, 95%CI = 16.2–35.1, log-rank-P = 0.004). Multivariate analysis demonstrated that low miR-211 expression was an independent factor of poor prognosis (hazard ratio 2.3, P = 0.03) after adjusting for all the factors influencing outcome. Conclusions/Significance Through comprehensive microarray analysis and PCR validation we identified miR-211 as a prognostic factor in resected PDAC. These results prompt further prospective studies and research on the biological role of miR-211 in PDAC.
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Affiliation(s)
- Elisa Giovannetti
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands.
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Boggi U, Vistoli F, Egidi FM, Marchetti P, De Lio N, Perrone V, Caniglia F, Signori S, Barsotti M, Bernini M, Occhipinti M, Focosi D, Amorese G. Transplantation of the pancreas. Curr Diab Rep 2012; 12:568-79. [PMID: 22828824 DOI: 10.1007/s11892-012-0293-4] [Citation(s) in RCA: 16] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Pancreas transplantation consistently induces insulin-independence in beta-cell-penic diabetic patients, but at the cost of major surgery and life-long immunosuppression. One year after grafting, patient survival rate now exceeds 95 % across recipient categories, while insulin independence is maintained in some 85 % of simultaneous pancreas and kidney recipients and in nearly 80 % of solitary pancreas transplant recipients. The half-life of the pancreas graft currently averages 16.7 years, being the longest among extrarenal grafts, and substantially matching the one of renal grafts from deceased donors. The difference between expected (100 %) and actual insulin-independence rate is mostly explained by technical failure in the postoperative phase, and rejection in the long-term period. Death with a functioning graft remains a further major issue, especially in uremic patients who have undergone prolonged periods of dialysis. Refinements in graft preservation, surgical techniques, immunosuppression, and prophylactic treatments are expected to further improve the results of pancreas transplantation.
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Affiliation(s)
- Ugo Boggi
- Division of General and Transplant Surgery, Azienda Ospedaliera Universitaria Pisana, Università di Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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Boggi U, Amorese G, De Lio N, Perrone V, D’Imporzano S, Croce C, Vistoli F, Signori S, Cappelli C, Mosca F. Central pancreatectomy with inframesocolic pancreatojejunostomy. Langenbecks Arch Surg 2012; 397:1013-21. [DOI: 10.1007/s00423-011-0895-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 12/12/2011] [Indexed: 01/18/2023]
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Boggi U, Signori S, Vistoli F, Amorese G, Consani G, De Lio N, Perrone V, Croce C, Marchetti P, Cantarovich D, Mosca F. Current perspectives on laparoscopic robot-assisted pancreas and pancreas-kidney transplantation. Rev Diabet Stud 2011; 8:28-34. [PMID: 21720670 DOI: 10.1900/rds.2011.8.28] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Pancreas transplant recipients continue to suffer high surgical morbidity. Current robotic technology provides a unique opportunity to test whether laparoscopy can improve the post-operative course of pancreas transplantation (PT). Current knowledge on robotic pancreas and renal transplantation was reviewed to determine feasibility and safety of robotic PT. Information available from literature was included in this review, together with personal experience including three PT, and two renal allotransplants. As of April 2011, the relevant literature provides two case reports on robotic renal transplantation. The author's experience consists of one further renal allotransplantation, two solitary PT, and one simultaneous pancreas-kidney transplantation. Information obtained at international conferences include several other renal allotransplants, but no additional PT. Preliminary data show that PT is feasible laparoscopically under robotic assistance, but raises concerns regarding the effects of increased warm ischemia time on graft viability. Indeed, during construction of vascular anastomoses, graft temperature progressively increases, since maintenance of a stable graft temperature is difficult to achieve laparoscopically. There is no proof that progressive graft warming produces actual damage to transplanted organs, unless exceedingly long. However, this important question is likely to elicit a vibrant discussion in the transplant community.
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Affiliation(s)
- Ugo Boggi
- Division of General and Transplant Surgery, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy.
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Manassero F, Mogorovich A, Di Paola G, Valent F, Perrone V, Signori S, Boggi U, Selli C. Renal cell carcinoma with caval involvement: contemporary strategies of surgical treatment. Urol Oncol 2009; 29:745-50. [PMID: 19963407 DOI: 10.1016/j.urolonc.2009.09.018] [Citation(s) in RCA: 20] [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] [Received: 07/12/2009] [Revised: 09/29/2009] [Accepted: 09/29/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We retrospectively evaluated the outcome of the surgical treatment of patients with renal cell carcinoma (RCC) and extensive inferior vena cava (IVC) involvement. Our aim was to investigate if a particular surgical technique could reduce morbidity and complications associated with this condition. MATERIALS AND METHODS From 1996 to 2007, 22 patients with RCC and extensive IVC involvement underwent radical surgical treatment with the intention to avoid, whenever possible, sternotomy and cardiopulmonary bypass. The level of the tumor thrombus was I (<2 cm above the renal vein) in 2 patients, II (below the intrahepatic vena cava) in 9 patients, III (intrahepatic vena cava below the diaphragm) in 7 patients, and IV (atrial) in 4 patients. Extracorporeal vascular bypass was used for 4 patients with level IV and for 2 patients with level III tumor thrombi, with hypothermic circulatory arrest in 2 patients. Extensive liver mobilization techniques were adopted in 16 patients. Overall and cancer-specific survival (CSS) were analyzed based on tumor extent (N0M0, N+M+), pathologic stage (pT3b, pT3c, pT4), thrombus level, and caval wall infiltration. RESULTS Two patients died within 1 month of surgery and the remaining 20 patients have a mean follow-up of 32.2 months (range 6-90): 8 are alive (overall survival 40%), but 2 with disease (CSS 30%). A total of 10 severe complications developed in 8 patients (36%). Both overall and CSS were significantly associated with tumor stage (Log-rank P = 0.0237 and 0.0465), presence of nodal or systemic metastases (Log-rank P = 0.0835 and 0.0669; Wilcoxon's test P = 0.0407 and 0.0411), and caval wall infiltration (Log-rank P = 0.0200 and 0.0418). CONCLUSIONS Despite the low overall survival, related to the high percentage of nodal and systemic metastases, aggressive surgical management with resection of synchronous metastatic disease for symptom palliation and cytoreduction, followed by immunotherapy is justified in this setting. A transabdominal approach to RCC and IVC involvement, even in patients with level III thrombus, can provide the surgeon with an exposure similar to thoracoabdominal incisions without the complications associated with thoracotomy.
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Busi M, Šnábel V, Varcasia A, Garippa G, Perrone V, De Liberato C, D’Amelio S. Genetic variation within and between G1 and G3 genotypes of Echinococcus granulosus in Italy revealed by multilocus DNA sequencing. Vet Parasitol 2007; 150:75-83. [DOI: 10.1016/j.vetpar.2007.09.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 08/21/2007] [Accepted: 09/07/2007] [Indexed: 11/24/2022]
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Urbani L, Mazzoni A, Catalano G, De Simone P, Vanacore R, Pardi C, Bortoli M, Biancofiore G, Campani D, Perrone V, Mosca F, Scatena F, Filipponi F. The use of extracorporeal photopheresis for allograft rejection in liver transplant recipients. Transplant Proc 2004; 36:3068-70. [PMID: 15686696 DOI: 10.1016/j.transproceed.2004.10.071] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Originally introduced for cutaneous T-cell lymphomas and autoimmune diseases, extracorporeal photopheresis (ECP) has been proven effective to reverse allograft rejection. The aim of the present work was to show the results of a single-center experience with ECP for the treatment of biopsy-proven rejection in selected liver transplant (LT) recipients. PATIENTS AND METHODS A retrospective review of five LT patients (M:F=4:1; median age 51 years) undergoing ECP for biopsy-proven allograft rejection between January 1996 and December 2003. In this period 476 LT were performed on 441 patients. RESULTS The indications for LT were three cases of HCV-related cirrhosis, complicated by hepatocellular carcinoma in two; one HBV-HDV-alcoholic cirrhosis; and one fulminant HBV hepatitis. All patients received calcineurin-inhibitor (CNI)-based immunosuppression with induction using anti-IL2R monoclonal antibodies. Indications for ECP were: ductopenic rejection in one patient with HCV recurrence; steroid-resistant acute rejection in two; acute rejection in a major ABO-mismatched liver graft; and one acute rejection in a patient with a proven allergy to steroids. The median interval from LT to inception of ECP was 43 days. The median number of ECP sessions per patient was 20. During the course of ECP, two patients tested positive for CMV antigenemia, associated in one case with bacterial pneumonia. All patients tolerated ECP and there were no procedure-related complications. At a median follow-up of 7.9 months after start of ECP, neither rejection relapses nor HCV/HBV recurrences have been observed. Three patients are off ECP with complete reversal and low-dose immunosuppression. Two patients are still receiving ECP with full-dose immunosuppression: one has achieved normal liver function but ECP is indicated due to a major ABO-incompatible liver graft, while the other patient's liver functions have not yet returned to baseline values.
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Affiliation(s)
- L Urbani
- Liver Transplant Unit, University of Pisa, Pisa, Italy
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33
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Urbani L, Catalano G, Biancofiore G, Bindi L, Consani G, Bisà M, Boldrini A, Campatelli A, Signori S, Morelli L, Coletti L, Perrone V, Vignali C, Cioni R, Petruzzi P, Boraschi P, Campani D, Mosca F, Filipponi F. Surgical complications after liver transplantation. MINERVA CHIR 2003; 58:675-92. [PMID: 14603147] [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: 04/27/2023]
Abstract
AIM The number of liver transplantations in Italy has steadily increased over the last 10 years as a result of the use of donors aged more than 60 years. The use of organs with a reduced functional reserve has been compensated for by improvements in immunosuppressive therapy, surgical techniques and the management of postoperative complications. This article describes the incidence and treatment of the main surgical complications after liver transplantation. METHODS Between January 1996 and June 2003, 398 patients received 430 transplants at our Centre. Thirty-seven early relaparotomies were performed (8.6%), including 12 retransplantation (2.8%). The 1-, 3- and 5-year actuarial survival of the patients was 79.8%, 72.2% and 67.5%, and that of the grafts was 75.9%, 68% and 63.4%. Perioperative mortality was 10.5% (with no intraoperative deaths). RESULTS The overall incidence of biliary complications was 31.6%, 9.1% of which were due to the removal of the Kehr tube. There were 42 (9.8%) anastomotic stenoses, 5 (1.2%) extra-anastomotic stenoses, 1 (0.2%) anastomotic leak, 5 (1.2%) extra-anastomotic leaks, and 19 (4.4%) ischemic-type biliary lesions. The overall incidence of vascular complications was 6.9%: 7 (1.6%) cases of hepatic artery thrombosis, 17 (4.0%) arterial stenoses, 1 (0.2%) arterial pseudoaneurysm, 4 (0.9%) cases of portal thromboses and 1 (0.2%) case of caval laminar thrombosis. Eight patients (1.9%) developed massive and persistent post-transplant ascites and/or hydrothorax. CONCLUSION The use of donors aged more than 60 years makes it possible to maintain high standards of patient and graft survival that is not only due to the optimisation of immunosuppressive protocols, but also to improvements in surgical techniques, intensive care and the management of surgical complications.
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Affiliation(s)
- L Urbani
- Liver Transplant Unit, University of Pisa, Pisa, Italy
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Martín-Algarra A, Messina A, Perrone V, Russo S, Maate A, Martín-Martín M. A Lost Realm in the Internal Domains of the Betic-Rif Orogen (Spain and Morocco): Evidence from Conglomerates and Consequences for Alpine Geodynamic Evolution. J Geol 2000; 108:447-467. [PMID: 10856014 DOI: 10.1086/314410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/1999] [Accepted: 02/15/2000] [Indexed: 05/23/2023]
Abstract
The Malaguide-Ghomaride Complex is capped by Upper Oligocene-Aquitanian clastic deposits postdating early Alpine orogenesis but predating the main tectonic-metamorphic evolution, end of nappe emplacement, unroofing, and exhumation of the metamorphic units of the Betic-Rif Orogen. Two conglomerate intervals within these deposits are characterized by clasts of sedimentary, epimetamorphic, and mafic volcanic rocks derived from Malaguide-Ghomaride units and by clasts of acidic magmatic and orthogneissic rocks of unknown provenance, here studied. Magmatic rocks originated from late-Variscan two-mica cordierite-bearing granitoids and, subordinately, from aplitic dikes. Orthogneisses derive from similar plutonic rocks but are affected by an Alpine metamorphic overprint evolving from greenschist (T=510&j0;-530 degrees C and P=5-6 kbar) to low-temperature amphibolite facies (T>550&j0;C and P<3 kbar). Such a plutonic rock suite is unknown in any Betic-Rif unit or in the basement of the Alboran Sea, and the metamorphic evolution in the orthogneisses is different from (and older than) that of Alpujarride-Sebtide rocks to which they were formerly ascribed. Magmatic and metamorphic rocks very similar to those studied characterize the basements of some Kabylia and Calabria-Peloritani units. Therefore, the source area is a currently lost continental-crust realm of Calabria-Peloritani-Kabylia type, located to the ESE of the Malaguide-Ghomaride Domain and affected by a pre-latest Oligocene Alpine metamorphism. Increasingly active tectonics transformed this realm into rising areas from which erosion fed small subsiding synorogenic basins formed on the Malaguide-Ghomaride Complex. This provenance analysis demonstrates that all these domains constituted a single continental-crust block until Aquitanian-Burdigalian times, before its dispersal around nascent western Mediterranean basins.
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Tranquilli Leali P, Merolli A, Perrone V, Caruso L, Giannotta L. The effectiveness of the circular external fixator in the treatment of post-traumatic of the tibia nonunion. Chir Organi Mov 2000; 85:235-42. [PMID: 11569086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Authors report the results they obtained when the Ilizarov circular external fixator was used for the treatment of post-traumatic nonunion of the tibia. A total of 20 patients were treated. Of these 12 had been submitted to treatment elsewhere and using other methods; 9 presented with septic nonunion; 10 revealed radiographic findings of atrophic nonunion, and 10 were hypertrophic. There was axial deviation in 18 patients. The results of treatment were always: healing of the nonunion; functional recovery of the limb; correction of leg length discrepancy; recovery of the mechanical axis. The mean stabilization time (days between the application and the removal of the fixator) was 138 days. The Ilizarov method thus proved that it was effective in the treatment of post-traumatic nonunion of the tibia where other types of treatment had failed.
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Merolli A, Perrone V, Tranquilli Leali P, Ambrosio L, De Santis R, Nicolais L, Gabbi C. Response to polyetherimide based composite materials implanted in muscle and in bone. J Mater Sci Mater Med 1999; 10:265-268. [PMID: 15348142 DOI: 10.1023/a:1008949311714] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The in-vivo response to a composite material obtained with polyetherimide (PEI) reinforced with carbon/glass fibers was investigated by histological methods by implanting cylinders in muscle and in bone of the New Zealand White rabbit. A common metallic alloy, widely used in orthopaedic surgery, was used as control (Stellite). The aim of the study was to analyze the biological response towards the surface of the material. Composite implants and metallic implants did not induce adverse or inflammatory reactions. The morphological picture produced was similar, in muscle and in bone, for both materials. In muscle, cylinders were confined by an extremely thin fibrous layer and the overall appearance of the muscular tissue was normal. In bone, cylinders were confined by a nearly annular rim of newly formed bone. From these data it is possible to derive that the response to PEI-based composite material is comparable with the response to metallic substrate and, then, the material can be suitable for clinical application.
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Affiliation(s)
- A Merolli
- Clinica Ortopedica dell'Universita' Cattolica, largo Gemelli 8, 00168 Roma, Italy
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Palmieri B, Gozzi G, Perrone V, Palmieri B. [Ultrasonic liquid medium for lipo-emulsification. An experimental study]. MINERVA CHIR 1994; 49:199-201. [PMID: 8028731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The technique of ultrasonic lipo-emulsification is currently gaining increasing support. This method consists in the dissolution of human adipose tissue using ultrasound generated by a special appliance and transmitted using (mini-invasive) titanium probes inserted into the subcutis. This procedure is preceded by the infiltration of subcutaneous fat using specially studied hypotonic solutions. On the basis of their previous experience and using data reported in the literature, the authors carried out a study to establish whether among the solutions routinely used there are alternative saline solutions which might enhance the lipolytic efficiency of ultrasound or allow possible saving in terms of time and money. Samples of ex-vivo subcutaneous adipose tissue weighing 5 g were exposed to ultrasonic energy at a frequency of 19800 Hz and an output of 65 Watt until fully dissolved. Prior to this the samples were immersed in a saline solution commonly used in clinical practice for perfusion at a different osmotic pressure. The authors succeeded in identifying saline solutions able to mediate the lipolytic ultrasonic action with greater efficiency than the solutions currently used by other authors.
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Affiliation(s)
- B Palmieri
- Cattedra di Semeiotica Chirurgia, Università degli Studi di Modena
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Palazzi S, Perrone V. Home visits in Italy. West J Med 1994. [DOI: 10.1136/bmj.308.6922.207b] [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: 11/03/2022]
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Polverino W, Basso A, Muto P, Genovese A, Perrone V, Apice G, Farace J. [Calcium antagonists: effects on cardiotoxicity caused by adriamycin. Preliminary trials]. Minerva Cardioangiol 1983; 31:115-20. [PMID: 6856096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
A Kaposi's sarcoma case with involvement of the gastrointestinal tract resulting in an unusual clinical syndrome characterized by diarrhea and protein-losing enteropathy is described. A careful examination of the literature reveals only one account of this rare pathologic condition.
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Perrone V, Pergola M, Abate G, Silvestro P, Bruni G. [Alternative chemotherapy of Hodgkin's lymphogranuloma in the advanced phase]. G Ital Chemioter 1980; 27:19-22. [PMID: 7286539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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de Matteis A, Perrone V, Marone A. [Clinical considerations on the use of a new synthetic androgen, Calusterone, in the treatment of advanced breast cancer]. Minerva Med 1977; 68:2499-504. [PMID: 142218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Results with a new synthetic androgen (Calusterone) in the management of 22 cases of advanced breast cancer are presented. Reference is made to the doses employed, the therapeutic results observed, and the side-effects caused by the drug. By comparison with the literature data, a partial response to treatment was observed in 47% of the series.
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Zarrilli D, Perrone V, Pergola M. [Treatment of systemic hemolymphopathies and of epithelial and connective-tissue neoplasms with a methylhydrazine derivative]. Clin Ter 1966; 39:123-36. [PMID: 4871417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Perrone V, Zarrilli D, Faiella A, Pagnotta G. Chemiotrattamento delle leucopenie secondarie a terapia citostatica e fisica. Chemotherapy 1963. [DOI: 10.1159/000220067] [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: 11/19/2022]
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