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Tendas A, Niscola P, Scaramucci L, Giovannini M, Cupelli L, Trawinska MM, Siniscalchi A, Abruzzese E, Caravita T, Palombi M, Dentamaro T, Perrotti A, de Fabritiis P. Dysgeusia in patients with hematological malignancies: a reminder for hematologist. J Oral Pathol Med 2013; 42:352-3. [DOI: 10.1111/jop.12034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Siniscalchi A, Gamberini L, Mordenti A, Bernardi E, Cimatti M, Riganello I, Toccaceli L, Vecchiatini T, Diamanti M, Faenza S. Postoperative troponin T elevation as a predictor of early acute kidney injury after orthotopic liver transplantation: a preliminary retrospective study. Transplant Proc 2013; 44:1999-2001. [PMID: 22974891 DOI: 10.1016/j.transproceed.2012.06.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Slight alterations in cardiac enzymes are frequently observed perioperatively among liver transplant patients. The significance of these changes in the absence of ongoing acute cardiac pathology is unknown. We sought to evaluate the link between early postoperative anomalies of serum cardiac troponin T (cTnT) in the absence of an evident cardiac cause and kidney injury during the first week of hospital stay. METHODS We retrospectively enrolled 30 patients in the study, recording several perioperative variables, particularly cTnT on intensive care unit ICU arrival as well as 6 and 12 hours later. We grouped patients with cTnT levels >0.03 ng/mL as the high-TnT group; the others were control subjects. We recorded the highest serum creatinine, aspartate aminotransferase, alanine aminotransferase, and bilirubin levels during the first week of the hospital stay. Glomerular filtration rate (GFR) was calculated according to the Cockroft-Gault formula. RESULTS Ten patients composed the high-TnT group. Their perioperative variables showed higher Model for End-Stage Liver Disease (MELD) scores and significantly greater incidences of acute kidney injury, failure, and dialysis need than control patients. GFR dropped from 118 to 66 mL/min among this group versus 112 to 105 mL/min in control subjects (P = .021). Binary logistic regression analysis revealed a higher association between the high-TnT group and acute kidney injury (P = .036) than with the MELD score (P = .719). CONCLUSIONS Serum cTnT levels could be influenced by both preoperative and intraoperative conditions that predispose to kidney injury.
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Siniscalchi A, Aurini L, Spedicato S, Bernardi E, Zanoni A, Dante A, Cimatti M, Gamberini L, Faenza S. Hyperdynamic circulation in cirrhosis: predictive factors and outcome following liver transplantation. Minerva Anestesiol 2013; 79:15-23. [PMID: 23090103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Liver cirrhosis is associated with a hyperdynamic circulation (HC). In this observational study, we aimed to investigate the predictive factors of HC, its impact on intraoperative hemodynamic and postoperative outcome, early ICU and in-hospital mortality, in cirrhotic patients undergoing orthotopic liver transplantation (OLT). METHODS Two hundred and forty-two patients with cirrhosis undergoing cadaveric OLT were included. Before starting the transplant procedure and under general anesthesia, a pulmonary artery catheter was introduced to assess hemodynamic parameters. The baseline assessment was carried out approximately 30 minutes after the catheter placement and repeated during the anhepatic phase, 10 minutes after the reperfusion and at the end of surgery. The patients were divided into two groups: in group 1 the patients had SVR>900dynes s-1 m-2 cm-5, in group 2 SVR ≤900 dynes s-1 m-2 cm-5. RESULTS Eighty-two patients (33%) presented severe HC. In multivariate analysis 2 factors were associated with the occurrence of HC: beta-blockers use (Exp [B]=4.42 (95% CI 1.18-17); P=0.001, [34% and 12% in groups 1 and 2, P<0.001, respectively]) and model for end-stage liver disease (MELD) score (Exp [B]=1.066; 95% CI=1.025-1.109; P=0.001). CONCLUSION MELD score was an independent predictor of HC, and beta-blockers resulted associated with lower incidence of HC in cirrhotic patients undergoing cadaveric OLT. Intraoperative HC correlates with hemodynamic alterations, requiring more blood products and vasopressor use, this may increase the risk of renal failure, early ICU death and in-hospital mortality.
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Petrucci MT, Levi A, Bringhen S, Scotti S, Gentilini F, Russo S, Siniscalchi A, Larocca A, Grammatico S, Boccadoro M, Foà R, Palumbo A. Bortezomib, melphalan, and prednisone in elderly patients with relapsed/refractory multiple myeloma. Cancer 2012; 119:971-7. [DOI: 10.1002/cncr.27820] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 08/09/2012] [Accepted: 08/13/2012] [Indexed: 11/09/2022]
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Caravita T, Offidani M, Siniscalchi A, Gentili S, Caraffa P, Perrotti A, de Fabritiis P, Leoni P. Infection complications in an unselected cohort of patients with multiple myeloma treated with lenalidomide combinations. Eur J Haematol 2012; 89:276-7. [PMID: 22672700 DOI: 10.1111/j.1600-0609.2012.01814.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Rago A, Grammatico S, Za T, Levi A, Mecarocci S, Siniscalchi A, De Rosa L, Felici S, Bongarzoni V, Piccioni AL, La Verde G, Pisani F, Franceschini L, Paviglianiti AL, Caravita T, Petrucci MT, De Stefano V, Cimino G. Prognostic factors associated with progression of smoldering multiple myeloma to symptomatic form. Cancer 2012; 118:5544-9. [PMID: 22786730 DOI: 10.1002/cncr.27657] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 04/05/2012] [Accepted: 04/16/2012] [Indexed: 01/10/2023]
Abstract
BACKGROUND Smoldering multiple myeloma (SMM) presents a high risk of progression to symptomatic MM (sy-MM). Herein, we analyzed some predictors of development of sy-MM. In 144 patients with SMM, we also compared the risk of progression predicted by bone marrow plasma cell (BMPC) involvement on the bone marrow biopsy (BMB) versus bone marrow aspirates (BMA). METHODS From January 1980 to July 2010, 397 patients with SMM observed in 12 centers of the Multiple Myeloma GIMEMA (Gruppo Italiano Malattie EMatologiche dell'Adulto) Latium Working Group have been analyzed. At progression to sy-MM, the severity of clinical presentation was graded according to the need of intensive supportive care. RESULTS After a median follow-up of 135 months, the cumulative incidence of progression rates to sy-MM were 45%, 55%, and 75% at 10, 15, and 20 years, respectively. Hemoglobin ≤12.5 g/dL, monoclonal component ≥2.5 g/dL, and BMPC ≥60% were the only parameters negatively affecting the cumulative incidence of progression. In particular, 10 of 397 (2.5%) patients with BMPC ≥60% had a 5.6-fold increased risk of fast progression (within 2 years), which occurred with severe clinical manifestations in 62% of cases. BMB was more sensitive for the detection of BMPC involvement, even though BMA was a more reliable indicator of a rapid progression to sy-MM. CONCLUSIONS The highest risk of rapid evolution to sy-MM and the severity of clinical manifestation at the progression suggest that SMM patients with a BMPC ≥60% should be treated soon after diagnosis. Moreover, BMPC is a more reliable index for progression to sy-MM if assessed by BMA.
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Andriani A, Petrucci MT, Caravita T, Montanaro M, Villivà N, Levi A, Siniscalchi A, Bongarzoni V, Pisani F, De Muro M, Coppetelli U, Avvisati G, Zullo A, Agrillo A, Gaglioti D. Evolution of bisphosphonate-related osteonecrosis of the jaw in patients with multiple myeloma and Waldenstrom's macroglobulinemia: a retrospective multicentric study. Blood Cancer J 2012; 2:e62. [PMID: 22829257 PMCID: PMC3317527 DOI: 10.1038/bcj.2012.9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 09/13/2011] [Accepted: 09/28/2011] [Indexed: 02/05/2023] Open
Abstract
Bisphosphonates (BPs) are used intravenously to treat cancer-related conditions for the prevention of pathological fractures. Osteonecrosis of the jaw (BRONJ) is a rare complication reported in 4-15% of patients. We studied, retrospectively, 55 patients with multiple myeloma or Waldenstrom's macroglobulinemia followed up from different haematological departments who developed BRONJ. All patients were treated with BPs for bone lesions and/or fractures. The most common trigger for BRONJ was dental alveolar surgery. After a median observation of 26 months, no death caused by BRONJ complication was reported. In all, 51 patients were treated with antibiotic therapy, and in 6 patients, this was performed in association with surgical debridement of necrotic bone, in 16 with hyperbaric O(2) therapy/ozonotherapy and curettage and in 12 with sequestrectomy and O(2)/hyperbaric therapy. Complete response was observed in 20 cases, partial response in 21, unchanged in 9 and worsening in 3. The association of surgical treatment with antibiotic therapy seems to be more effective in eradicating the necrotic bone than antibiotic treatment alone. O(2) hyperbaric/ozonotherapy is a very effective treatment. The cumulative dosage of BPs is important for the evolution of BRONJ. Because the most common trigger for BRONJ was dental extractions, all patients, before BP treatment, must achieve an optimal periodontal health.
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Siniscalchi A, Gallelli L, De Sarro G, Malferrari G, Santangelo E. Antiepileptic drugs for central post-stroke pain management. Pharmacol Res 2011; 65:171-5. [PMID: 21925602 DOI: 10.1016/j.phrs.2011.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 08/28/2011] [Accepted: 09/05/2011] [Indexed: 12/14/2022]
Abstract
Antiepileptic drugs (AEDs) are commonly prescribed for a wide range of disorders other than epilepsy, including both neurological and psychiatric disorders. AEDs play also a role in pharmacological management of neuropathic pain. Central post-stroke pain (CPSP) is a disabling morbidity occurring in 35% of patients with stroke. The pathophysiology of CPSP is not well known but central disinhibition with increased neuronal excitability has been suggested. AEDs include many different drugs acting on pain through several mechanisms, such as reduction of neuronal hyperexcitability. To our knowledge conclusive evidence has not been published yet. The aim of this review is to delineate efficacy and safety of AEDs in CPSP.
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Boccadoro M, Cavallo F, Nagler A, Ben Yehuda D, Omedè P, Cavalli M, Levi A, Crippa C, Siniscalchi A, Brasca P, Carella AM, Zanetti BA, Patriarca F, Pezzati S, Montefusco V, Stanevsky A, Lupo B, Caravita T, Di Raimondo F, Palumbo AP. Melphalan/prednisone/lenalidomide (MPR) versus high-dose melphalan and autologous transplantation (MEL200) in newly diagnosed multiple myeloma (MM) patients: A phase III trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Siniscalchi A, Gallelli L, De Sarro G. Use of antiepileptic drugs for hyperkinetic movement disorders. Curr Neuropharmacol 2010; 8:359-66. [PMID: 21629443 PMCID: PMC3080592 DOI: 10.2174/157015910793358187] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 04/23/2010] [Accepted: 04/30/2010] [Indexed: 11/23/2022] Open
Abstract
Many studies investigated the use of antiepileptic drugs (AEDs) in several neurological diseases other than epilepsy. These neurological disorders, usually, involve neuronal excitability through the modulating of ion channels, receptors and intracellular signaling pathways, and are the targets of the AEDs. This article provides a review of the clinical efficacy of both conventional and newer AEDs in hyperkinetic movement disorders. Some of these indications for AEDs have been established, while others are under investigation. The modulation of GABAergic transmission may explain the neuronal hyper-excitability that underlies some forms of hyperkinetic movement disorders. So, AEDs able to increase GABAergic neurotransmission may play a role in hyperkinetic movement disorders treatment. Therefore, AEDs could represent a useful therapeutic option in the management of hyperkinetic movement disorders where the available treatments are ineffective.
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Siniscalchi A, Dante A, Spedicato S, Riganello L, Zanoni A, Cimatti M, Pierucci E, Bernardi E, Miklosova Z, Moretti C, Faenza S. Hyperdynamic circulation in acute liver failure: reperfusion syndrome and outcome following liver transplantation. Transplant Proc 2010; 42:1197-9. [PMID: 20534260 DOI: 10.1016/j.transproceed.2010.03.097] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND/AIMS Liver transplantation (OLT) is a valid therapeutic option for patients with fulminant hepatic failure (FHF). The most critical phase during OLT is considered to be graft reperfusion, where in large changes in patient homeostasis occur. The aims of the present study were to evaluate the hemodynamic and cardiac changes among a large series of patients with FHF, to determine independent clinical predictors of the occurrence of postreperfusion syndrome (PSR) and its relationship to clinical and hemodynamic parameters and transplant outcomes. METHODS Systemic hemodynamic and cardiac functions were evaluated by Swan-Ganz catheterization in 58 patients before OLT. The patients were divided into two subgroups on the basis of PSR, which was defined as a mean arterial blood pressure 30% lower than the immediate previous value lasting for at least 1 minute within 5 minutes after unclamping. RESULTS PSR occurred in 24 patients (41%). Significant differences upon bivariate analysis was observed for the Model for End-stage Liver Disease score, which was significantly higher among patients with PSR, namely 32 (range = 18-43) versus 23 (range = 12-32) (P = .001). Higher serum creatinine values were significantly different among patients with PSR: 1.4 (range = 1.2-2.2) versus 2.1 (range = 2.5-3.2) mg/dL (P < .01). CONCLUSION Systemic hemodynamic alterations of FHF progressively worsen with increasing severity of liver disease. PSR developed in approximately 40% of patients; its prevalence was significantly related to the severity of the disease. Finally, patients with renal failure showed greater risk to develop an PSR during OLT.
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Tendas A, Niscola P, Dentamaro T, Cupelli L, Di Matteo G, Finocchi A, Siniscalchi A, Fratoni S, Scimò T, Scaramucci L, Giovannini M, Ales M, Pio Perrotti A, de Fabritiis P. Pancytopenia and severe sepsis in an adult case of congenital X-linked agammaglobulinemia (XLA). Ann Hematol 2010; 89:949-51. [DOI: 10.1007/s00277-009-0891-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Accepted: 12/21/2009] [Indexed: 10/20/2022]
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Siniscalchi A, Miklosova Z, Spedicato S, Bernardi E, Zanoni A, Dante A, Pierucci E, Cimatti M, Riganello I, Aurini L, Bernabè L, Faenza S. Anesthesia for liver transplantation: the experience of the University of Bologna in the MELD era. MINERVA GASTROENTERO 2010; 56:253-260. [PMID: 21037544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM The hepatic cirrhosis is associated with an important cardiovascular alterations. In this report, we review our transplant center experience with liver transplantation in the Model for End-Stage Liver Disease (MELD) era, in particular this study investigate the relationship between severity of liver disease assessed by MELD score and postoperative events. METHODS Our retrospective review was performed on 242 cirrhotic patients underwent liver transplanation at the Department of Surgery and Transplantation of the University of Bologna. Biochemical and hemodynamic variables were evaluated by Swan-Ganz catherization. Dindo's classification of postoperative complications was used for the evaluation of postoperative course. RESULTS Morbidity occurred in 158 patients (65.2%) and 13 patients died during the hospital stay. Considering the highest grade of complication occurred, non life-threatening complications occurred in the 47.9% of cases (116 patients) and life-threatening complications, excluding patient death, in 17.3% (42 patients). Patients with MELD >30 showed a longer ICU stay, tracheal intubation and in-hospital stay. CONCLUSION In conclusion MELD score is tightly related to postoperative complications.
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Niscola P, Scaramucci L, Romani C, Giovannini M, Tendas A, Brunetti G, Cartoni C, Palumbo R, Vischini G, Siniscalchi A, Fabritiis PD, Caravita T. Pain management in multiple myeloma. Expert Rev Anticancer Ther 2010; 10:415-425. [DOI: 10.1586/era.10.5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Zanfi C, Lauro A, Cescon M, Dazzi A, Ercolani G, Grazi G, Zanello M, Vivarelli M, Del Gaudio M, Ravaioli M, Cucchetti A, Vetrone G, Tuci F, Di Gioia P, Lazzarotto T, D'Errico A, Bagni A, Faenza S, Siniscalchi A, Pironi L, Pinna A. Comprehensive Surgical Intestinal Rescue and Transplantation Program in Adult Patients: Bologna Experience. Transplant Proc 2010; 42:39-41. [DOI: 10.1016/j.transproceed.2009.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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42
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Siniscalchi A, Dentamaro T, Perrotti A, Tatangelo P, de Fabritiis P, Caravita T. Bortezomib-based therapy as induction regimen of an autograft program in front-line treatment of multiple myeloma with end-stage renal disease. Ann Hematol 2009; 89:821-2. [DOI: 10.1007/s00277-009-0867-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 11/13/2009] [Indexed: 11/29/2022]
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Caravita T, Siniscalchi A, Montanaro M, Niscola P, Stasi R, Amadori S, de Fabritiis P. High-dose epoetin alfa as induction treatment for severe anemia in multiple myeloma patients. Int J Hematol 2009; 90:270-272. [PMID: 19609645 DOI: 10.1007/s12185-009-0378-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Revised: 05/19/2009] [Accepted: 06/17/2009] [Indexed: 10/20/2022]
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Siniscalchi A, Stasi R, Fratoni S, de Fabritiis P, Caravita T. Management of immune thrombocytopoenia in a patient with newly-diagnosed smouldering myeloma and colorectal cancer. BMJ Case Rep 2009; 2009:bcr03.2009.1715. [PMID: 21686970 DOI: 10.1136/bcr.03.2009.1715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Immune thrombocytopoenia (ITP) is one of the most common autoimmune manifestations of B cell lymphoproliferative diseases. The association with multiple myeloma (MM) and solid tumours is rare. Here, a case of ITP associated with asymptomatic multiple myeloma and colon carcinoma, refractory to standard therapy and responsive to rituximab, is described. ITP should be considered in the differential diagnosis of thrombocytopoenia in MM and colon cancer. Understanding of the potential risk and reversibility of ITP should aid in the management of these patients.
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Siniscalchi A, Fratoni S, Santeusanio G, Del Poeta G, de Fabritiis P, Caravita T. Cutaneous involvement in multiple myeloma and bortezomib. Ann Hematol 2009; 88:1137-9. [PMID: 19259673 DOI: 10.1007/s00277-009-0717-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 02/18/2009] [Indexed: 11/27/2022]
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Siniscalchi A, Tendas A, Ales M, Fratoni S, Cupelli L, Dentamaro T, Scaramucci L, Giovannini M, Caravita T, Santeusanio G, Niscola P, de Fabritiis P. Bortezomib-related colon mucositis in a multiple myeloma patient. Support Care Cancer 2009; 17:325-7. [DOI: 10.1007/s00520-008-0573-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Accepted: 12/22/2008] [Indexed: 11/29/2022]
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Tendas A, Niscola P, Cupelli L, Dentamaro T, Scaramucci L, Siniscalchi A, Ales M, Giovannini M, Perrotti A, Fabritiis PD. Palliative sedation therapy in a bone marrow transplant unit. Support Care Cancer 2008; 17:107-8. [DOI: 10.1007/s00520-008-0525-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Accepted: 10/09/2008] [Indexed: 12/01/2022]
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Siniscalchi A, Gallelli L, Mercuri NB, De Sarro G. Serum prolactin levels in repetitive temporal epileptic seizures. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2008; 12:365-368. [PMID: 19146198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The primary aim of this work was: to evaluate the time course of serum prolactin (PRL) increase following repetitive seizures in epileptic patients with (Group II) and without (Group I) temporal ischemia. Epileptic patients were examined after 2 or 3 epileptic seizures in wakefulness with seizure-free intervals of 4 hours. Serum PRL levels was assessed within 3 hours of the last epileptic seizure and up to 48 hours after. The increase of serum PRL attained within baseline levels after 6 h in Group I and after 12 h in Group II. A longer increase of serum PRL levels were observed in Group II patients respect to Group I (P < 0.01). In conclusion, this different long time attenuation of serum PRL following repetitive temporal seizures with and without damage of temporal structure, may be useful in order to better analyse the synaptic transmission involved in the pathways interconnect limbic areas.
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Siniscalchi A, Spedicato S, Dante A, Riganello I, Bernardi E, Pierucci E, Cimatti M, Zanoni A, Miklosova Z, Piraccini E, Mazzanti G, Spiritoso R, Ravaioli M, Cucchetti A, Lauro A, Pinna A, Faenza S. Fluid Management of Patients Undergoing Intestinal and Multivisceral Transplantation. Transplant Proc 2008; 40:2031-2. [DOI: 10.1016/j.transproceed.2008.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Del Poeta G, Bruno A, Del Principe MI, Venditti A, Maurillo L, Buccisano F, Stasi R, Neri B, Luciano F, Siniscalchi A, de Fabritiis P, Amadori S. Deregulation of the mitochondrial apoptotic machinery and development of molecular targeted drugs in acute myeloid leukemia. Curr Cancer Drug Targets 2008; 8:207-22. [PMID: 18473734 DOI: 10.2174/156800908784293640] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Apoptosis plays a key role in the control of rapidly renewing tissues, such as the hematopoietic system and leukemia cells invariably have abnormalities in one or more apoptotic pathways, determining a survival advantage of these cells and the development of drug resistance. These defects are also frequently associated with a low rate of response to standard chemotherapy and with a poor survival in acute myeloid leukemia (AML). The major form of apoptosis proceeds through the mitochondrial pathway, with the mitochondrial outer membrane permeabilization, leading to the release of proteins normally found in the space between the inner and outer mitochondrial membranes (cytochrome C, AIF and others). Higher levels of anti-apoptosis proteins bcl-2, bcl-x(L), Mcl-1 block permeabilization of the membrane and are reported in AML patients presenting a poor outcome. On the contrary, activated pro-apoptotic bax or bad proteins allow this permeabilization and are correlated to a good prognosis in AML. Defects in the mitochondrial pathway induce multidrug-resistance and confer important prognostic information in AML. High ratios of bcl-2 to bax protein confer a poor prognosis with decreased rates of complete remission and overall survival. The prognostic information from the ratio of the proteins is greater than bcl-2 levels alone. Recently, we confirmed the impressive impact of the bax/bcl-2 ratio, determined by flow cytometry, on AML prognosis (complete remission and overall survival) in 255 AML patients. Bcl-2 down regulation might lower the apoptotic threshold of leukemic cells and, through this mechanism, favor response to chemotherapy. Phase II studies of oblimersen (antisense Bcl-2), cytarabine and daunorubicin or oblimersen plus gentuzumab, a cytotoxic antibody directed against CD33+ cells in relapsed AMLs, showed promising results. Defects in apoptosome proteins, such as APAF-1, are frequent in AML and treatment with 5-aza-2'-deoxycytidine, a specific inhibitor of DNA methylation, restored APAF-1 expression in leukemic cells. In conclusion, targeted therapies that are designed to induce apoptosis in leukemic cells, are the most promising anti-leukemia strategies. The elucidation of the apoptotic machinery and of its defects in AML lays the basis for developing new drugs able to trigger apoptosis and overcome therapy resistance.
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