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Bin Wan Hassan WMN, Mistretta F, Molinaro S, Russo R, Bosco G, Gambino A, Bergui M. Overview of Spontaneous Intracranial Hypotension and Differential Diagnosis with Chiari I Malformation. J Clin Med 2023; 12:jcm12093287. [PMID: 37176727 PMCID: PMC10179697 DOI: 10.3390/jcm12093287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
Spontaneous intracranial hypotension (SIH) occurs due to a leakage of the cerebrospinal fluid (CSF) lowering the pressure of subarachnoid space, mostly caused by a dural breach or discogenic microspur. As a result of less support provided by CSF pressure, intracranial structures are stretched downward, leading to a constellation of more or less typical MRI findings, including venous congestion, subdural effusions, brainstem sagging and low-lying cerebellar tonsils. Clinic examination and an MRI are usually enough to allow for the diagnosis; however, finding the location of the dural tear is challenging. SIH shares some MRI features with Chiari malformation type I (CM1), especially low-lying cerebellar tonsils. Since SIH is likely underdiagnosed, these findings could be interpreted as signs of CM1, leading to a misdiagnosis and an incorrect treatment pathway. Medical treatment, including steroids, bed rest, hydration caffeine, and a blind epidural blood patch, have been used in this condition with variable success rates. For some years, CSF venous fistulas have been described as the cause of SIH, and a specific diagnostic and therapeutic pathway have been proposed. The current literature on SIH with a focus on diagnosis, treatment, and differential diagnosis with CM1, is reviewed and discussed.
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Affiliation(s)
| | - Francesco Mistretta
- Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Stefano Molinaro
- Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Riccardo Russo
- Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Giovanni Bosco
- Department of Neuroscience, Stroke Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Andrea Gambino
- Department of Surgical Sciences, Radiology Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Mauro Bergui
- Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, 10126 Turin, Italy
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Ravetti E, Gambino A, Jorfida M, Castagno D, Bergui M, Cerrato P, De Ferrari GM. 492 EMBOLIC STROKE OF UNDETERMINED SOURCE: ROLE OF IMPLANTABLE LOOP RECORDER IN ASYMPTOMATIC ATRIAL FIBRILLATION DETECTION AND SECONDARY PREVENTION OF NEW EMBOLIC EVENTS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.071] [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: 12/23/2022]
Abstract
Abstract
Background and Aims
AF (Atrial Fibrillation) is the most important cause of Embolic Stroke of Undetermined Source (ESUS). Implantable Loop Recorder (ILR) demonstrated the highest sensitivity for detecting post-stroke asymptomatic AF.
This register was created to assess the prevalence of AF episodes in patients after ESUS and to verify possible benefits on clinical outcomes such as TIA or stroke recurrence and death using ILR.
Methods
278 patients admitted to the Stroke Unit of “Città della Salute e della Scienza” hospital in Torino between 2011 and 2019, underwent ILR implantation if they had at least one risk factor for AF including obesity, hyperthyroidism, atrial enlargement at transthoracic echocardiography, severe mitral valve disease, CHADS-VASc score ≥ 4, age > 70 years old and diabetes.
The control group was composed of 165 patients admitted in other departments of the same hospital diagnosed with ESUS, not implanted with ILR.
We used propensity score matching to select 132 patients from each group (matching age, sex, CHADS-VASc, and HAS-BLED baseline characteristics).
Risk and protective factors were estimated for clinical outcomes (deaths and TIA or stroke recurrence) and were evaluated with logistic regression univariate and multivariate analyses.
Results
The detection rate of AF episodes longer than 5 minutes was significantly higher in the ILR group (41.7% vs 15.9%, p<0.001).
On univariate analysis, we found a trend towards a protective role of ILR for the composite outcome of TIA or stroke recurrence and mortality (OR 0.52, CI 0.26–1.04, p 0.06).
On multivariate analysis, we found a protective role of ILR in terms of deaths (OR 0.4, CI 0.17–0.94, p 0.03) and for the composite outcome of ischemic event recurrences and deaths (OR 0.41, CI 0.19–0.87, p 0.02). Age was consistently identified as a risk factor for all the clinical outcomes.
Conclusion
In patients with ESUS and at least one risk factor for AF, episodes of AF longer than 5 minutes are identified in 41.7% of the cases thanks to ILR.
Our study demonstrated that a policy including ILR in patients with ESUS also gives a clinical benefit in terms of TIA or stroke recurrence and death, although limited size of the population and possible presence of selection bias may limit the generalisation of our results.
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Affiliation(s)
- Emanuele Ravetti
- Division Of Cardiology, Cardiovascular And Thoracic Department, ”Citta’ Della Salute E Della Scienza” Hospital , Turin , Italy
- Department Of Medical Sciences, University Of Turin , Turin , Italy
| | - Andrea Gambino
- Department Of Medical Sciences, University Of Turin , Turin , Italy
- Department Of Neuroscience, Neuroradiological Unit, ”Citta’ Della Salute E Della Scienza” Hospital , Turin , Italy
| | - Marcella Jorfida
- Division Of Cardiology, Cardiovascular And Thoracic Department, ”Citta’ Della Salute E Della Scienza” Hospital , Turin , Italy
| | - Davide Castagno
- Division Of Cardiology, Cardiovascular And Thoracic Department, ”Citta’ Della Salute E Della Scienza” Hospital , Turin , Italy
- Department Of Medical Sciences, University Of Turin , Turin , Italy
| | - Mauro Bergui
- Department Of Medical Sciences, University Of Turin , Turin , Italy
- Department Of Neuroscience, Neuroradiological Unit, ”Citta’ Della Salute E Della Scienza” Hospital , Turin , Italy
| | - Paolo Cerrato
- Department Of Neurology, Stroke Unit, ”Citta’ Della Salute E Della Scienza” Hospital , Turin , Italy
| | - Gaetano Maria De Ferrari
- Division Of Cardiology, Cardiovascular And Thoracic Department, ”Citta’ Della Salute E Della Scienza” Hospital , Turin , Italy
- Department Of Medical Sciences, University Of Turin , Turin , Italy
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Bergui M, Mistretta F, Bosco G, Cester G, Chioffi F, Gambino A, Molinaro S, Russo R, Sorarù G, Causin F. CSF-venous leak responsible for spontaneous intracranial hypotension treated by endovascular venous route: First cases in Italy. Interv Neuroradiol 2022:15910199221116011. [PMID: 35861992 DOI: 10.1177/15910199221116011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Spontaneous intracranial hypotension (SIH) is due to a leakage of CSF lowering the pressure of subarachnoid space, mostly caused by a dural breach or discogenic microspur. Clinical and MRI are usually typical enough to allow diagnosis, while finding the location of the dural breach is challenging. Since some years, CSF venous fistulas have been described as the cause of SIH, and a specific diagnostic and therapeutic path has been proposed. Here we report the first two successfully treated patients in Italy. Both had chronic and non specific symptoms, with severe reduction of quality of life; clinical symptoms improved after endovascular occlusion of the responsible vein.
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Affiliation(s)
- Mauro Bergui
- Department of Neuroscience, Neuroradiological Unit, University of Turin, 18691Azienda Ospedaliera Città della Salute e della Scienza Hospital, Turin, Italy
| | - Francesco Mistretta
- Department of Surgical Sciences, Radiology Unit, University of Turin, 18691Azienda Ospedaliera Città della Salute e della Scienza Hospital, Turin, Italy
| | - Giovanni Bosco
- Department of Neuroscience, Stroke Unit, University of Turin, 18691Azienda Ospedaliera Città della Salute e della Scienza Hospital, Turin, Italy
| | - Giacomo Cester
- Neuroradiology Unit, University Hospital of Padova, Padua, Italy
| | - Franco Chioffi
- Neurosurgery Unit, University Hospital of Padova, Padua, Italy
| | - Andrea Gambino
- Department of Surgical Sciences, Radiology Unit, University of Turin, 18691Azienda Ospedaliera Città della Salute e della Scienza Hospital, Turin, Italy
| | - Stefano Molinaro
- Department of Neuroscience, Neuroradiological Unit, University of Turin, 18691Azienda Ospedaliera Città della Salute e della Scienza Hospital, Turin, Italy
| | - Riccardo Russo
- Department of Neuroscience, Neuroradiological Unit, University of Turin, 18691Azienda Ospedaliera Città della Salute e della Scienza Hospital, Turin, Italy
| | - Gianni Sorarù
- Neurology Unit, Department of Neuroscience, 18624Azienda Ospedaliera di Padova, Padua, Italy
| | - Francesco Causin
- Neuroradiology Unit, University Hospital of Padova, Padua, Italy
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Russo R, Morana G, Mistretta F, Gambino A, Garbossa D, Bergui M. Trans-oral approach for occipital condyle biopsy: Case report and review of literature. Neuroradiol J 2021; 35:508-511. [PMID: 34550830 PMCID: PMC9437500 DOI: 10.1177/19714009211044705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Isolated occipital condyle lesions are commonly treated with empirical radiation, with the sole aim of relieving symptoms. Patients rarely undergo surgical biopsy, considering the morbidity associated with open surgery approaches and the importance of surrounding structures limiting the application of computed tomography (CT) scan or fluoroscopic percutaneous needle biopsies. We describe the case of a 66-year-old woman who was admitted on an emergency basis. Her clinical presentation included unilateral occipital headache and ipsilateral hypoglossal nerve palsy. Imaging revealed findings consistent with an isolated right occipital condyle lesion. In order to pursue a tissue diagnosis, essential to dictate medical management accurately, a minimally invasive biopsy of the occipital condyle through the trans-oral route was performed. Combined fluoroscopy, cone-bean CT and angiography allowed safe access to the lesion.
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Affiliation(s)
- Riccardo Russo
- Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, Italy
| | - Giovanni Morana
- Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, Italy
| | - Francesco Mistretta
- Department of Surgical Sciences, Radiology Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, Italy
| | - Andrea Gambino
- Department of Surgical Sciences, Radiology Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, Italy
| | - Diego Garbossa
- Department of Neuroscience, Neurosurgery Section, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, Italy
| | - Mauro Bergui
- Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, Italy
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Arduino PG, Carbone M, Gambino A, Cabras M, Cannarsa F, Macciotta A, Conrotto D, Broccoletti R. Challenging management of gingival squamous cell carcinoma: a 10 years single-center retrospective study on Northern-Italian patients. Med Oral Patol Oral Cir Bucal 2021; 26:e21-e27. [PMID: 32851989 PMCID: PMC7806350 DOI: 10.4317/medoral.23913] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/27/2020] [Indexed: 12/02/2022] Open
Abstract
Background Aim of this study was to describe the outcome of patients with gingival squamous cell carcinoma (GSCC), and to recognize aspects affecting clinical course and to consider survival rate.
Material and Methods The case records of patients, over a 10-year period, were retrospectively examined. Differences in distribution of the potential risk factors by prognosis were investigated through non-parametrical tests (Wilcoxon Rank-Sum and Fisher’s Exact). Survival curves for age, therapy and stage were built by the Kaplan-Meier method and compared with Log-Rank test.
Results 79 patients were analysed. Significant increase in mortality for patients older than 77 and for those with advanced stages was found. Cumulative survival rate 5 years after the diagnosis was 43%, while at 10 years was of 11%.
Conclusions With a statistical relationship between age and tumour stage with survival rates, and 70% of GSCC cases identified as stage IV, early GSCC diagnosis remains challenging. Key words:Gingival cancer, clinical appearance, treatment, retrospective study.
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Affiliation(s)
- P-G Arduino
- Department of Surgical Sciences CIR-Dental School, University of Turin Via Nizza 230, 10126 Turin, Italy
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Cecere A, Kerkhof P, Angelini A, Gambino A, Fraiese A, Bottio T, Osto E, Famoso G, Fedrigo M, Giacomin E, Montisci R, Iliceto S, Gerosa G, Tona F. Multiparametric evaluation of coronary flow predicts long-term outcome in heart transplantation: from coronary flow velocity reserve to its newly introduced companion. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Coronary microvascular dysfunction (CMD) leads to a worse prognosis in heart transplantation (HT) patients. Coronary flow velocity reserve (CFVR) estimates the physiologic impact of allograft disease on the coronary circulation.
Purpose
Our aim was to determine the prognostic role of CFVR and its companion (CFVRC) on long-term survival of HT patients with a follow-up of 28 years.
Methods
134 HT patients, surviving at least 5 years after HT, with normal systolic ventricular function and no evidence of angiographic allograft vasculopathy or symptoms/signs of rejection were included. The enrolled population underwent echocardiographic evaluation of microvascular function by the assessment of both the ratio of hyperemic to rest diastolic peak velocity (DPVh and DPVr). These measurements yield CFVR and its associated companion, defined as CFVRC = √{(DPVr)2 + (DPVh)2}, as well as basal and hyperemic coronary microvascular resistance (BMR and HMR). A CFVR≤2.5 was considered abnormal; the median value of DPVh (75 cm/s) and CFVRC (80 cm/s) were utilized to dichotomize the population.
Results
Based on CFVR and DPVh, HT patients can be assigned to four groups: group 1 (n=32), discordant with preserved CFVR (3.1±0.4); group 2 (n=60), concordant with preserved CFVR (3.4±0.5); group 3 (n=31), concordant with impaired CFVR (1.8±0.3) and group 4 (n=11), discordant with impaired CFVR (2.0±0.2). Survival for each patient group is presented in the Figure (panel A). Specifically, survival was similar in group 1 when compared to group 3 (p=0.8), but significantly lower when compared to group 2 (p=0.03). Therefore, a normal CFVR (>2.5) may not be able to predict the unfavourable long-term outcome. CFVR in fact is an incomplete dimensionless ratio; if the paired velocities are low with high BMR and HMR (group 1), the use of CFVR alone may miss some events, that are yet captured by CFVRC. Differences between survivors and no survivors are presented in the Table. At multivariable survival analysis, CMD, DPVh<75 cm/s, CFVRC<80 cm/s were independent predictors of mortality in HT patients. Consequently, we evaluated the added role of the CMD, DPVh<75 cm/s and CFVRC<80 cm/s to prognostic models including the clinical (Figure, panel B) predictors of mortality. The inclusion of CFVRC<80 cm/s to model with clinical predictors of mortality permitted better prediction of survival in HT patients, compared to only adding CMD or DPVh<75 cm/s.
Conclusions
This study is the first to demonstrate that the CFVR alone, even representing a determinant of survival in long-term HT patients, is not sufficient to completely predict long-term survival in HT patients. In comparison to CMD and DPVh, the CFVRC provides a significant improvement in survival prediction in long-term HT patients. Thus, the proposed multiparametric approach offers a more comprehensive evaluation of prognosis in HT patients, just by applying available data without the need to perform additional measurements.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Cecere
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
| | - P.L.M Kerkhof
- VU University Medical Center, Radiology and Nuclear Medicine, Amsterdam, Netherlands (The)
| | - A Angelini
- University of Padova, Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - A Gambino
- University of Padua, Division of Cardiac Surgery, Padova, Italy
| | - A Fraiese
- University of Padua, Division of Cardiac Surgery, Padova, Italy
| | - T Bottio
- University of Padua, Division of Cardiac Surgery, Padova, Italy
| | - E Osto
- University Heart Center, Cardiology Department, Zurich, Switzerland
| | - G Famoso
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
| | - M Fedrigo
- University of Padova, Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - E Giacomin
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
| | - R Montisci
- University of Cagliari, Clinical Cardiology, Department of Medical Science and Public Health, Cagliari, Italy
| | - S Iliceto
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
| | - G Gerosa
- University of Padua, Division of Cardiac Surgery, Padova, Italy
| | - F Tona
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
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Cecere A, Kerkhof P, Angelini A, Gambino A, Fraiese A, Bottio T, Osto E, Famoso G, Fedrigo M, Giacomin E, Montisci R, Iliceto S, Gerosa G, Tona F. Coronary flow evaluation in heart transplant patients compared to healthy controls documents the inadequacy of the coronary flow velocity reserve metric. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Coronary microvasculopathy has impact on prognosis in heart transplantation (HT). Distinct contributions by functional or structural alterations of coronary microcirculation in HT and their prognostic role have not been fully elucidated.
Purpose
We aimed to identify the mechanisms of coronary microvascular impairment in HT and their possible prognostic implications by applying a comprehensive analysis in a comparative study.
Methods
Included were 134 patients, surviving at least 5 years, with normal systolic function and no evidence of allograft vasculopathy or symptoms/signs of rejection. To permit comparison, 50 healthy volunteers without cardiovascular diseases, and matched for age and sex, served as controls. All underwent echocardiographic evaluation of microvascular function by the assessment of rest and hyperemic diastolic peak blood velocity (DPVr and DPVh). These paired data enable calculation of coronary flow velocity reserve (CFVR) and its inherent companion that is based on the quadratic mean: CFVRC = √{(DPVr)2 + (DPVh)2}. Additionally, basal and hyperemic coronary microvascular resistance (BMR and HMR) were estimated. A CFVR ≤2.5 was considered abnormal; the median value of DPVh (75 cm/s) and CFVRC (80 cm/s) were selected as cut-offs to classify patients.
Results
HT patients can be assigned to four groups, based on their CFVR and DPVh (Figure A): group 1 (n=32), discordant with preserved CFVR (3.1±0.4); group 2 (n=60), concordant with preserved CFVR (3.4±0.5); group 3 (n=31), concordant with impaired CFVR (1.8±0.3) and group 4 (n=11), discordant with impaired CFVR (2.0±0.2). Group 3 represents the structural microvascular remodeling with high HMR, while group 4 represents the functional remodeling with low BMR. Intriguingly, group 1 showed lower DPVr (p<0.0001) and lower DPVh (p<0.0001) than controls (Figure B, upper panel) with lower CFVR (p<0.0001), even if normal, and lower CFVRC (p<0.0001) than controls (Figure B, lower panel). Moreover, both BMR and HMR were higher in group 1 than in controls (5.3±1 vs 4.4±1.2, p=0.001 and 1.5±0.3 vs 1.1±0.2, p<0.0001, respectively), suggesting structural microvascular remodeling. Conversely, group 2 was comparable with controls (Figure B). Clinical characteristics of the different groups are shown in the Table. 13/32 (40.6%) patients in group 1 died in a follow up of 28 years and mortality rate was comparable to group 3 (14/31, 45.2%). However, CFVRC was <80 cm/s in all 13 deaths in group 1, yet being characterized by preserved CFVR (Figure C).
Conclusions
A normal CFVR could hide detection of microvascular damage with high flow resistance and low flow velocities at rest. This microvasculopathy seems to be secondary to factors unrelated to HT (i.e., less rejections and more often diabetes). Being a dimensionless ratio, CFVR may miss some deaths, yet captured by CFVRC. Thus, the combined use of CFVR and CFVRC provides more complete clinical information on coronary microvasculopathy in HT.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Cecere
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
| | - P.L.M Kerkhof
- VU University Medical Center, Radiology and Nuclear Medicine, Amsterdam, Netherlands (The)
| | - A Angelini
- University of Padova, Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - A Gambino
- University of Padua, Division of Cardiac Surgery, Padova, Italy
| | - A Fraiese
- University of Padua, Division of Cardiac Surgery, Padova, Italy
| | - T Bottio
- University of Padua, Division of Cardiac Surgery, Padova, Italy
| | - E Osto
- University Heart Center, Cardiology Department, Zurich, Switzerland
| | - G Famoso
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
| | - M Fedrigo
- University of Padova, Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - E Giacomin
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
| | - R Montisci
- University of Cagliari, Clinical Cardiology, Department of Medical Science and Public Health, Cagliari, Italy
| | - S Iliceto
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
| | - G Gerosa
- University of Padua, Division of Cardiac Surgery, Padova, Italy
| | - F Tona
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
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Signorelli M, Gregorini M, Platto C, Orabona R, Zambelloni C, Torri F, Franceschetti L, Gambino A, Sartori E. The prognostic value of antenatal ultrasound in cases complicated by fetal ovarian cysts. J Neonatal Perinatal Med 2020; 12:339-343. [PMID: 30883366 DOI: 10.3233/npm-1870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Ovarian cysts are relatively common prenatal findings in female fetuses. The aim of this study is to evaluate the ability of antenatal ultrasound in predicting spontaneous regression or a need for surgery. DESIGN All cases of fetal ovarian cysts treated in our Department between 2007 and 2016 were included. Patients underwent a sonographic monitoring in utero and after birth until spontaneous or surgical resolution. Subjects were divided into two groups according to their postnatal management. Receiver-operating characteristics (ROC) curves were used to test the predictive ability for postnatal surgery of the cyst's mean and maximum diameters; their optimal cut off points were also determined. RESULTS 38 cases of antenatally-detected fetal ovarian cysts were included. 12/38 cases underwent surgery (Group A). 26/38 cases were resolved spontaneously (Group B). Cyst size of those which were surgically excised significantly differed from those that regressed spontaneously. ROC curve pointed to 45 mm and 47 mm as optimal cut off points for the mean and the maximum cystic diameters, respectively. CONCLUSIONS Cyst size and echo-structure seemed good predictors for prognosis after birth. The optimal cut off points of the cysts mean and maximum diameters in predicting postnatal surgery have been identified as 45 mm and 47 mm, respectively.
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Affiliation(s)
- M Signorelli
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - M Gregorini
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - C Platto
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - R Orabona
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - C Zambelloni
- Department of Neonatology, University of Brescia, Brescia BS, Italy
| | - F Torri
- Department of Pediatric Surgery, Spedali Civili Children's Hospital of Bescia, Brescia BS, Italy
| | - L Franceschetti
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - A Gambino
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - E Sartori
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
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Fusco V, Fasciolo A, Gambino A, Cabras M, Erovigni F, Bianchi C, Benzi L, De Martino I, Monaco F, Rossi M, Numico G, Carossa S. Inadequacy of current definition and staging system of Medication-Related Osteonecrosis of Jaw (MRONJ) released by AAOMS: A computed tomography study in 151 cancer and myeloma patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz265.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Cabras M, Gambino A, Broccoletti R, Arduino PG. Desquamative gingivitis: a systematic review of possible treatments. J BIOL REG HOMEOS AG 2019; 33:637-642. [PMID: 30888131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- M Cabras
- Department of Surgical Sciences, Oral Medicine Section, CIR-Dental School, University of Turin, Turin, Italy
| | - A Gambino
- Department of Surgical Sciences, Oral Medicine Section, CIR-Dental School, University of Turin, Turin, Italy
| | - R Broccoletti
- Department of Surgical Sciences, Oral Medicine Section, CIR-Dental School, University of Turin, Turin, Italy
| | - P G Arduino
- Department of Surgical Sciences, Oral Medicine Section, CIR-Dental School, University of Turin, Turin, Italy
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Carrozzini M, Bejko J, Gambino A, Tarzia V, Cozzi E, Gregori D, Bottio T, Gerosa G. OC34 IMPACT OF CONTINUOUS FLOW LEFT VENTRICULAR ASSIST DEVICES AS BRIDGE TO TRANSPLANT ON GRAFT REJECTION AND DEVELOPMENT OF DONOR-SPECIFIC ANTIBODIES. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549921.16208.63] [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: 11/05/2022]
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Carrozzini M, Bejko J, Comisso M, Toto F, Toscano G, Tarzia V, Gambino A, Cozzi E, Gregori D, Bottio T, Gerosa G. Impact of Continuous Flow Left Ventricular Assist Device on Graft Rejection and Donor-specific Antibodies Development After Heart Transplant. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Dall'Amico R, Montini G, Murer L, Andreetta B, Zacchello G, Gambino A, Feltrin G, Caforio A, Tursi V, Livi U. Extracorporeal Photochemotherapy after Cardiac Transplantation: A New Therapeutic Approach to Allograft Rejection. Int J Artif Organs 2018. [DOI: 10.1177/039139880002300108] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Photopheresis (ECP) is a new immunomodulatory therapy in which recipient lymphocytes are treated extracorporeally with 8-methoxypsoralen and ultraviolet light. The treatment seems to induce an inhibition of both humoral and cellular rejection after transplantation. Objective Since recurrent rejection (RR) continues to be a severe complication after heart transplantation (HTx) and the immunosuppressive regimes used for the treatment are often associated with increased morbidity and mortality, we investigated whether ECP could have a beneficial effect on the number and severity of rejection episodes. Methods Eleven HTX recipients (5 M and 6 F, mean age 48.5 yrs) with RR were enrolled in the study. ECP was performed at weekly intervals during the 1st month, at 2 week intervals during the 2nd and 3rd month, and then monthly for another 3 months. Results The fraction of biopsies (EMB) with a grade 0/1A rejection increased during ECP from 46% to 72% while the EMB showing a 3A/3B rejection decreased from 42% to 18%. It is also noteworthy that out of the 78 EMB performed during ECP only one showed a 3B rejection in comparison with 13 out of 110 EMB in the pre-ECP period. Six rejection relapses were observed in a total follow-up of 60 months, two of them occurring during the tapering of oral steroid. Four relapses were reversed by ECP, one by IV steroids and the last by methotrexate after the failure of both IV steroids and ECP. The mean doses of immunosuppressive drugs resulted lower after 6 months of ECP: steroids were reduced from 13 to 8.25 mg/day, cyclosporine from 375 to 285 mg/day, azathioprine from 55 to 35 mg/day. Conclusions ECP is a well tolerated treatment. Its administration allows better RR control and significant reduction in immunosuppressive therapy. (Int J Artif Organs 2000; 23: 49–54)
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Affiliation(s)
| | | | | | | | | | - A. Gambino
- Institute of Cardiovascular Surgery, University of Padova, Padova - Italy
| | - G. Feltrin
- Institute of Cardiovascular Surgery, University of Padova, Padova - Italy
| | - A. Caforio
- Institute of Cardiovascular Surgery, University of Padova, Padova - Italy
| | - V. Tursi
- Institute of Cardiovascular Surgery, University of Padova, Padova - Italy
| | - U. Livi
- Institute of Cardiovascular Surgery, University of Padova, Padova - Italy
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Arduino PG, Campolongo MG, Sciannameo V, Conrotto D, Gambino A, Cabras M, Ricceri F, Carossa S, Broccoletti R, Carbone M. Randomized, placebo-controlled, double-blind trial of clobetasol propionate 0.05% in the treatment of oral lichen planus. Oral Dis 2018; 24:772-777. [PMID: 29297958 DOI: 10.1111/odi.12821] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 10/18/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To perform a randomized, placebo-controlled, double-blind study, with a follow-up period of 6 months, for the use of topical clobetasol in cases of symptomatic oral lichen planus (OLP). SUBJECTS AND METHODS Thirty-two participants were analyzed, with the aims of: (I) to compare the usefulness of topically applied clobetasol propionate 0.05% (mixed with 4% hydroxyethyl cellulose gel) and 4% hydroxyethyl cellulose gel alone (considered as placebo) in the management of OLP; (II) to describe which of them is quicker in decreasing signs and reported symptoms, and (III) which is able to give the proper longer remission in the follow-up. RESULTS Symptoms improved in all clobetasol-treated patients during the first 2 months of therapy, while only 50% of placebo control group (p = .005) displayed similar results; of the remaining half, 12.5% did experienced a worsening while 37.5% remained stable. Regarding clinical signs, 87.5% of clobetasol-treated patients improved, while only 62.5% of the placebo-treated patients had a positive response (p = .229). CONCLUSIONS It is possible to report that clobetasol, at this dosage, has been more effective than a placebo at provoking symptoms improvement in subjects affected by atrophic-erosive oral lesions.
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Affiliation(s)
- P G Arduino
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - M G Campolongo
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - V Sciannameo
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco, Italy
| | - D Conrotto
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - A Gambino
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - M Cabras
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - F Ricceri
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco, Italy
| | - S Carossa
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - R Broccoletti
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - M Carbone
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
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Gambino A, Carbone M, Broccoletti R, Carcieri P, Conrotto D, Carrozzo M, Arduino PG. A report on the clinical-pathological correlations of 788 gingival lesion. Med Oral Patol Oral Cir Bucal 2017; 22:e686-e693. [PMID: 29053652 PMCID: PMC5813986 DOI: 10.4317/medoral.21845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 09/05/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The diagnosis and treatment of a variety of non-plaque related gingival diseases have become an integrated aspect of everyday dentistry. The aim of this study was to analyse the relationship between clinical appearance and histopathological features of gingival lesions in a large Northern Italian population. MATERIAL AND METHODS A retrospective study of 788 cases of gingival and alveolar mucosal biopsies was set up. Statistical analysis was performed by calculating the odds ratio and 95% confidence interval (C.I.), in order to assess the degree of association between the clinical parameters considered (primary lesions) and the single pathologies, statistically evaluated by Mantel-Haenszel tests. The correlation between clinical and histological diagnosis was classified as follow: 1) expected data (ED): provisional clinical diagnosis; 2) real data (RD): final histopathology diagnosis; 3) concordant data (CD): correspondence between the expected data and real data. The correlation was calculated as follow: CC (complete concordance) = CD x 100 / ED, this expressing the percentage in which the clinical and the histological diagnosis overlapped. RESULTS The most frequently observed and biopsied primary lesions resulted to be exophytic, followed by mucosal colour changes and finally by losses of substance. The statistically significant association between primary lesion and their manifestation in gingival pathologies was reported. Volume increases, for instance, were positively correlated to plasma cell epulis, pyogenic granuloma, fibrous reactive hyperplasia and hemangioma. Verrucous-papillary lesions were most often seen in verrucous carcinoma, verrucous leukoplakia and mild dysplasia. White lesion resulted to be related to leukoplakia or oral lichen planus. Red lesions resulted to be related only oral lichen planus. Erosive vesicle-bullous lesions were linked to disimmune pathologies. Ulcerative lesions were positively associated to oral squamous cell cancer. Finally, potentially malignant disorders have the most percentage high concordance. Among the malignant lesions, the correlation increased up to the squamous cell carcinoma and leukaemia. CONCLUSIONS This article presented the frequency and the clinico-pathological concordance of all primary lesions and the histopathological diagnosis of gingival lesions. For every primary lesion, it is possible to correlate a specific histopathological diagnosis in a statistical manner. This can be a valuable aid for not specialist clinicians who daily observe mucosae and have the opportunity to intercept major diseases.
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Affiliation(s)
- A Gambino
- Department of Surgical Sciences, University of Turin, CIR - Dental School, Oral Medicine Section, Via Nizza 230, 10126 Turin, Italy,
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Gambino A, Cabras M, Fusco V, Bertetto O, De Martino I, Alessio M, Numico G. Osteonecrosis of jaw (ONJ) after antiresorptive treatment (bisphosphonates, denosumab) of cancer-treatment induced bone loss (CTIBL): a negligible risk? Ann Oncol 2017. [DOI: 10.1093/annonc/mdx436.009] [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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Conrotto D, Barattero R, Carbone M, Gambino A, Sciannameo V, Ricceri F, Conrotto F, Broccoletti R, Arduino PG. Can atrophic-erosive oral lichen planus promote cardiovascular diseases? A population-based study. Oral Dis 2017. [PMID: 28627728 DOI: 10.1111/odi.12700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Lichen planus has been recently associated with an increased risk of cardiovascular diseases (CVDs). The oral manifestations can be divided into white hyperkeratotic lesions (WL) and atrophic and erosive lesions (RL). The aim of this report was to compare the presence of CVDs between patients affected by WL or RL, to test the hypothesis that RL are associated with an increased incidence of CVDs. SUBJECTS AND METHODS Patients were analysed through a complete collection of all the risk factors for CVDs. The primary endpoint was the occurrence of a cardiovascular event-acute coronary syndrome (ACS), any revascularization or stroke/TIA. A multivariable logistic regression model, adjusted for age at diagnosis, body mass index, smoking, alcohol consumption, diabetes, hypertension, CVDs familiarity and periodontitis, was performed. RESULTS A prospective cohort of 307 patients has been evaluated; 185 (60.3%) had WL and 122 RL (39.7%). Twenty-four patients had a CVD. ACS occurred more frequently in RL (adjusted odds ratio 5.83; 95% CI: 1.16-29.39), mainly due to the higher risk of it after the histological diagnosis of Oral lichen planus OLP (odds ratio 4.23; 95% CI: 0.66-27.23). CONCLUSION Patients with RL could possibly have a higher risk of developing ACS. Further analysis on larger cohort is however warranted.
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Affiliation(s)
- D Conrotto
- Department of Surgical Sciences, Oral Medicine Section, CIR-Dental School, University of Turin, Turin, Italy
| | - R Barattero
- Department of Surgical Sciences, Oral Medicine Section, CIR-Dental School, University of Turin, Turin, Italy
| | - M Carbone
- Department of Surgical Sciences, Oral Medicine Section, CIR-Dental School, University of Turin, Turin, Italy
| | - A Gambino
- Department of Surgical Sciences, Oral Medicine Section, CIR-Dental School, University of Turin, Turin, Italy
| | - V Sciannameo
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco, Italy
| | - F Ricceri
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco, Italy
| | - F Conrotto
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - R Broccoletti
- Department of Surgical Sciences, Oral Medicine Section, CIR-Dental School, University of Turin, Turin, Italy
| | - P-G Arduino
- Department of Surgical Sciences, Oral Medicine Section, CIR-Dental School, University of Turin, Turin, Italy
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Arduino PG, Broccoletti R, Carbone M, Conrotto D, Pettigiani E, Giacometti S, Gambino A, Elia A, Carrozzo M. Describing the gingival involvement in a sample of 182 Italian predominantly oral mucous membrane pemphigoid patients: A retrospective series. Med Oral Patol Oral Cir Bucal 2017; 22:e149-e152. [PMID: 28160581 PMCID: PMC5359700 DOI: 10.4317/medoral.21431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 01/23/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The oral cavity has been frequently described as the only site of involvement or as the first manifestation of mucous membrane pemphigoid (MMP), being the gingival tissues often involved, but usually this has been effusively detailed in limited case series. This is a retrospective evaluation of the gingival involvement in 182 Italian patients with oral MMP. MATERIAL AND METHODS The diagnosis of MMP was established by both clinical morphology and direct immunofluorescence finding. Patient information (age, gender, risk factors and medical status) and parameters of manifestation (lesions' distribution, site and type) were detailed. RESULTS The mean age was 62 years for women (n=137) and 67 years for men (n=45). Patients had several sites of oral involvement; the gingiva was the most common one, affecting 151 patients (82.96%; 119 f - 32 m). Female subjects had more possibilities to develop gingival lesions than male patients (P = 0.005). Sixty-five patients (35.7%; 58 f - 7 m) had pure gingival involvement. Patients with lower gingival involvement statistically had more complaints (P = 0.006). CONCLUSIONS This report is one of the largest about predominantly oral MMP cases, detailing the very frequent gingival involvement; this could be crucial not only for oral medicine specialists but also for primary dental healthcare personnel and for periodontists.
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Affiliation(s)
- P-G Arduino
- Department of Surgical Sciences; CIR - Dental School, School of Medicine, University of Turin, Via Nizza 230, 10126 Turin, Italy,
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Carcieri P, Broccoletti R, Giacometti S, Gambino A, Conrotto D, Cabras M, Arduino PG. Favourably effective formulation of sodium iodide and salicylic acid plus professional hygiene in patients affected by desquamative gingivitis. J BIOL REG HOMEOS AG 2016; 30:1141-1145. [PMID: 28078866] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of this prospective pilot study was to evaluate the efficiency of an oral hygiene protocol, in combination with a solution of sodium iodide associated to salicylic acid (SISA), in patients affected by desquamative gingivitis (DG). Twenty patients not totally responding to conventional topical therapies, were selected. They received oral hygiene instructions with non-surgical periodontal therapy in a 21-day cohort study (during 3 weekly appointments). The SISA was used at the end of each session, with an impregnated gauze (with 5 ml of the solution) applied for 15 minutes for the upper jaw, and for a further 15 minutes with a new gauze for the lower. Evaluated clinical outcome variables included the full mouth plaque (FMPS) and bleeding (FMBS) scores, probing depth, patient related outcome and clinical gingival signs. Two months after concluding the planned protocol, a statistically significant reduction was observed for FMPS (P=0.032), FMBS (P=0.038), reported pain (P=0.000) and gingival clinical improvement (P=0.005). Topical application of SISA and professional oral hygiene procedures are connected with improvement of gum status, and decrease of related pain in subjects affected by severe DG.
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Affiliation(s)
- P Carcieri
- Department of Surgical Sciences, Cir-Dental School, University of Turin, Italy
| | - R Broccoletti
- Department of Surgical Sciences, Cir-Dental School, University of Turin, Italy
| | - S Giacometti
- Department of Surgical Sciences, Cir-Dental School, University of Turin, Italy
| | - A Gambino
- Department of Surgical Sciences, Cir-Dental School, University of Turin, Italy
| | - D Conrotto
- Department of Surgical Sciences, Cir-Dental School, University of Turin, Italy
| | - M Cabras
- Department of Surgical Sciences, Cir-Dental School, University of Turin, Italy
| | - P G Arduino
- Department of Surgical Sciences, Cir-Dental School, University of Turin, Italy
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Lutrino E, Tucci M, Caffo O, Di Maio M, Procopio G, Scagliotti C, Mssari F, Milano A, Atzori F, Barni S, Gambino A, Fontanella C, Scavelli C, Cinieri S. Prognostic role of body mass index (BMI) in patients with metastatic castration resistant prostate cancer (mCRPC) receiving chemotherapy: PRO-BMI study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw334.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Toscano G, Fabozzo A, Fedrigo M, Gambino A, Angelini A, Gerosa G. Post-transplant Lymphoproliferative Disorders: A Rare Case of Primary Pericardial Involvement Epstein-Barr Virus-Correlated in Heart Transplantation. Transplant Proc 2015; 47:2287-90. [PMID: 26361701 DOI: 10.1016/j.transproceed.2015.04.085] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 04/15/2015] [Indexed: 11/18/2022]
Abstract
Post-transplant lymphoproliferative disorders (PTLDs) are considered a fatal consequence of immunosuppression. We report a case of a 52-year-old patient, who underwent a cardiac transplantation and presented undefined recurrent episodes of pleuropericardial effusions without lymphoadenomegaly at chest radiographs and computed tomography. Histopathological analysis of the bioptic pericardium showed a specific chronic inflammation. Monitoring endomyocardial biopsies (EMBs) showed only 1 episodes of greater than grade 2R acute cellular rejection requiring immunosuppressive treatment, mild vasculitis in 2 subsequently EMBs while constantly negative for antibody-mediated rejection or infection. Only a post-mortem examination demonstrated the presence of an aggressive acute non-Epstein-Barr virus (EBV)-related proliferative disorder with unusual primitive localization into the pericardium and with coronary epicardial and intramyocardial necrotizing vasculitis and superimposed occlusive and subocclusive thrombosis. Recurrence of unexplained early pleuropericardial effusion and mild intramyocardial vasculitis should raise the suspicion of PTLD requiring reduction of immunosuppression, even in the setting of negative intramyocardial cellular infiltrate and tissue EBV-negative molecular assessment.
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Affiliation(s)
- G Toscano
- Heart Transplant Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
| | - A Fabozzo
- Heart Transplant Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - M Fedrigo
- Pathological Anatomy, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - A Gambino
- Heart Transplant Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - A Angelini
- Pathological Anatomy, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - G Gerosa
- Heart Transplant Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
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Forcignanò R, Bria E, Fabi A, Petrucelli L, Furlanetto J, Carbognin L, Gambino A, Vicentini C, Saracino V, Lupo L, Chiuri V, Cairo G, Tortora G, De Matteis E, Ronzino G, Tornesello A, Sperduti I, Giannarelli D, Ciccarese M. Overall Prognosis of Advanced Breast Cancer (Abc) According to Chemotherapy (Ct) Treatment Lines: Correlation Analysis Between Progression-Free-, Post-Progression- and Overall- Survival (Pfs, Pps and Os). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu329.26] [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: 11/12/2022] Open
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Lorusso V, Giotta F, Bordonaro R, Maiello E, Del Prete S, Gebbia V, Filippelli G, Pisconti S, Cinieri S, Romito S, Riccardi F, Forcignanò R, Ciccarese M, Petrucelli L, Saracino V, Lupo LI, Gambino A, Leo S, Colucci G. Non-pegylated liposome-encapsulated doxorubicin citrate plus cyclophosphamide or vinorelbine in metastatic breast cancer not previously treated with chemotherapy:a multicenter phase III study. Int J Oncol 2014; 45:2137-42. [PMID: 25176223 DOI: 10.3892/ijo.2014.2604] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 06/20/2014] [Indexed: 11/05/2022] Open
Abstract
We conducted a phase III multicenter randomized trial to compare the efficacy of the combination of liposome encapsulated doxorubicin (Myocet(©)) plus either cyclophosphamide (MC) or vinorelbine (MV). Since July 2006, 233 patients affected with metastatic breast cancer were randomized to receive the combination of Myocet (M) 60 mg/m(2) i.v. plus cyclophosphamide (C) 600 mg/m2 on Day 1 of a 21‑day cycle (Arm A) or Myocet (M) at 50 mg/m2 plus vinorelbine (V) 25 mg/m2 i.v. on Day 1 and V 60 mg/m2 orally on Day 8 on a 21‑day cycle (Arm B). The primary endpoints of the study was time to progression (TTP); secondary endpoints were RR, toxicity and OS. Response was observed in 53/116 (45.7%) evaluable patients of Arm A vs. 51/112 (45.5%) of Arm B, respectively (P=NS). Median TTP was 41 weeks (95% CI, 32‑51) and 34 weeks (95% CI, 26‑39), for M/C and M/V, respectively (P=0.0234). The difference in median OS was not statistically significant (131 vs. 122 weeks; P=0.107). With regard to toxicity, patients treated with MV showed a slight increase of neutropenia and constipation, as compared to those treated with MC. No clinical signs of cardiotoxicity were observed. The MC combination remains as an unbeaten 'standard' in first line treatment of MBC.
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Affiliation(s)
- V Lorusso
- National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - F Giotta
- National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Bari, Italy
| | | | - E Maiello
- Casa Sollievo della Sofferenza Hospital IRCCS, San Giovanni Rotondo (FG), Italy
| | - S Del Prete
- Frattamaggiore Hospital, Frattamaggiore (NA), Italy
| | - V Gebbia
- La Maddalena Hospital, Palermo, Italy
| | | | | | - S Cinieri
- Brindisi Medical Oncology Department and Breast Unit e Medical Department, European Insitute of Oncology, Milan, Italy
| | - S Romito
- Ospedali Riuniti Hospital, Foggia, Italy
| | | | | | | | | | | | - L I Lupo
- Vito Fazzi Hospital, Lecce, Italy
| | | | - S Leo
- Vito Fazzi Hospital, Lecce, Italy
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Fedrigo M, Abate D, Sgarabotto D, Feltrin G, Castellani C, Gambino A, Gerosa G, Valente M, Thiene G, Angelini A. P761Antibody mediated rejection related with CMV and EBV infection in heart transplants recipients: a possible relation with infection and complement activation. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu098.180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ciccarese M, Forcignanò R, Petrucelli L, Fabi A, Chiuri VE, Cairo G, Lupo L, Gambino A, Saracino V, Ronzino G, Licchetta A, Giannarelli D. Abstract P6-10-01: Evaluation of post-progression survival (PPS) in advanced breast cancer (ABC) according to treatment line: Correlation with PFS and OS in an unselected population. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-10-01] [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: 11/16/2022]
Abstract
Abstract
Background: MBC remains an incurable disease with a median survival of 2-3 years despite the use of new drugs. The validation of PPS as surrogate endpoint and its correlation to PFS and OS is matter of debate.
Methods: From 2006-2012 we analyzed retrospectively consecutive 192 pts treated for MBC outside of clinical trials, 103 with at least 3 lines CT, in order to evaluate post-progression survival (PPS) according to treatment line and its relation to PFS and OS. Moreover we evaluated the gain of benefit after CT3 and predictive factors of response to multiple lines of therapy.
Results: Median age at M+ diagnosis was 59 years (30-89), median site of disease was 2 (1-6), 67% visceral, HER-2 + pts 32%, median number of anti-Her-2 treatment was 2 (0-6); median number of treatment was 3 (1-8). Median OS for all pts was 45.6 (95% CI: 36.5-54.7). Median OS for CT > = 3 vs CT < 3 was respectively 52.5 (95% CI: 43.3-61.7) and 32.3 (95% CI: 23.6-41.2) P = 0.007. Multivariate Cox analysis showed that OS is related with ER/Pgr status (positive versus negative p<0.0001) number of lines (>3 vs ≤3) p = 0.001 and number of metastatic sites (>2 vs ≤2) p<0.0001. We evaluated the relation between PFS and OS and between PPS and OS until the 6th line of therapy with a linear regression model.
Median PFS (95% c.i.)Median PPS (95% c.i.)Median OS from M+ diagnosisCorrelation OS-PPSCorrelation OS-PFS1st line11.0 (9.5-12.5)29.9 (18.2-41.6)Not reachedP<0.0001 OS-PPS1P<0.0001 OS-PFS12nd line7.0 (5.8-8.2)20.9 (11.7-30.0)29.1 (17.5-40.7)P<0.0001 OS-PPS2P<0.0001 OS-PFS23rd line5.6 (4.5-6.7)19.5 (14.9-24.1)41.9 (15.5-68.2)P<0.0001 OS-PPS3P<0.0001 OS-PFS34th line5.7 (4.0-7.4)15.3 (13.4-17.2)50.4 (27.4-73.4)P<0.0001 OS-PPS4P<0.0001 OS-PFS45th line3.9 (3.1-4.7)11.2 (7.8-14.5)65.9 (20.8-112.2)P = 0.004 OS-PPS5P<0.0001 OS-PFS56th line3.3 (2.6-4.0)8.2 (2.2-14.2)56.8 (48.7-64.9)P = 0.36 OS- PPS6P = 0.002 OS-PFS6
Conclusion: These results supported the use of chemotherapy after CT3. PFS and PPS are related to OS until the 6th line of treatment. The utility of PPS as surrogate endpoint of OS is a valid hypothesis that could be evaluated in prospective trials of MBC.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-10-01.
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Affiliation(s)
- M Ciccarese
- “Vito Fazzi” Hospital, Lecce, Italy; Regina Elena Cancer Institute, Rome, Italy
| | - R Forcignanò
- “Vito Fazzi” Hospital, Lecce, Italy; Regina Elena Cancer Institute, Rome, Italy
| | - L Petrucelli
- “Vito Fazzi” Hospital, Lecce, Italy; Regina Elena Cancer Institute, Rome, Italy
| | - A Fabi
- “Vito Fazzi” Hospital, Lecce, Italy; Regina Elena Cancer Institute, Rome, Italy
| | - VE Chiuri
- “Vito Fazzi” Hospital, Lecce, Italy; Regina Elena Cancer Institute, Rome, Italy
| | - G Cairo
- “Vito Fazzi” Hospital, Lecce, Italy; Regina Elena Cancer Institute, Rome, Italy
| | - L Lupo
- “Vito Fazzi” Hospital, Lecce, Italy; Regina Elena Cancer Institute, Rome, Italy
| | - A Gambino
- “Vito Fazzi” Hospital, Lecce, Italy; Regina Elena Cancer Institute, Rome, Italy
| | - V Saracino
- “Vito Fazzi” Hospital, Lecce, Italy; Regina Elena Cancer Institute, Rome, Italy
| | - G Ronzino
- “Vito Fazzi” Hospital, Lecce, Italy; Regina Elena Cancer Institute, Rome, Italy
| | - A Licchetta
- “Vito Fazzi” Hospital, Lecce, Italy; Regina Elena Cancer Institute, Rome, Italy
| | - D Giannarelli
- “Vito Fazzi” Hospital, Lecce, Italy; Regina Elena Cancer Institute, Rome, Italy
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Gambino A, Cafaro A, Arduino PG, Conrotto D, Broccoletti R. LLLT in combination with non-surgical periodontal therapy in patients with gingival oral lichen planus: a pilot study. Ann Stomatol (Roma) 2013; 4:19. [PMID: 24353781 PMCID: PMC3860251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- A Gambino
- Department of Surgical Sciences, Oral Medicine Section, CIR - Dental School, University of Turin, Italy
| | - A Cafaro
- Department of Surgical Sciences, Oral Medicine Section, CIR - Dental School, University of Turin, Italy
| | - P G Arduino
- Department of Surgical Sciences, Oral Medicine Section, CIR - Dental School, University of Turin, Italy
| | - D Conrotto
- Department of Surgical Sciences, Oral Medicine Section, CIR - Dental School, University of Turin, Italy
| | - R Broccoletti
- Department of Surgical Sciences, Oral Medicine Section, CIR - Dental School, University of Turin, Italy
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Arduino P, Carbone M, Della Ferrera F, Elia A, Conrotto D, Gambino A, Comba A, Calogiuri P, Broccoletti R. Pimecrolimus vs. tacrolimus for the topical treatment of unresponsive oral erosive lichen planus: a 8 week randomized double-blind controlled study. J Eur Acad Dermatol Venereol 2013; 28:475-82. [DOI: 10.1111/jdv.12128] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 02/04/2013] [Indexed: 12/17/2022]
Affiliation(s)
- P.G. Arduino
- Department of Surgical Sciences; Oral Medicine Section; University of Turin; Turin Italy
| | - M. Carbone
- Department of Surgical Sciences; Oral Medicine Section; University of Turin; Turin Italy
| | - F. Della Ferrera
- Department of Surgical Sciences; Oral Medicine Section; University of Turin; Turin Italy
| | - A. Elia
- Department of Surgical Sciences; Oral Medicine Section; University of Turin; Turin Italy
| | - D. Conrotto
- Department of Surgical Sciences; Oral Medicine Section; University of Turin; Turin Italy
| | - A. Gambino
- Department of Surgical Sciences; Oral Medicine Section; University of Turin; Turin Italy
| | - A. Comba
- Department of Surgical Sciences; Oral Medicine Section; University of Turin; Turin Italy
| | - P.L. Calogiuri
- Department of Surgical Sciences; Oral Medicine Section; University of Turin; Turin Italy
| | - R. Broccoletti
- Department of Surgical Sciences; Oral Medicine Section; University of Turin; Turin Italy
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Silvestrini-Biavati A, Angiero F, Gambino A, Ugolini A. Do changes in spheno-occipital synchondrosis after rapid maxillary expansion affect the maxillomandibular complex? Eur J Paediatr Dent 2013; 14:63-67. [PMID: 23597224] [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: 06/02/2023]
Abstract
AIM This was to evaluate changes in spheno-occipital synchondrosis one year after rapid maxillary expansion (RME), in order to assess the influence that any change might have on sagittal and vertical skeletal cephalometric variables. MATERIALS AND METHODS Patients were selected consecutively and grouped into: Group 1 comprised 30 Caucasian patients (13 m; 17 f) undergoing RME therapy; after active expansion therapy, the Haas expander was worn as passive retainer for an average of 7 months. Group 2 as control included 14 untreated subjects (6 m, 8 f), matched by age, sex and vertebral skeletal maturity (CVM method, stages 1-3). Six cephalometric variables concerning spheno-occipital synchondrosis were studied: N-S-Ba; SOS-Ba; SOS-S; S-Ba; Ba-N; S-N; nine skeletal variables for sagittal and vertical evaluation were also checked. T-test was used for comparing the 2 groups data. RESULTS A statistically-significant opening of the spheno-occipital synchondrosis and increase of the posterior cranial base length (Ba-SOS) were found between group 1 and 2. After 1 year, these modifications in spheno-occipital syncondrosis produced no change in the anteroposterior or vertical skeletal parameters examined. CONCLUSION After RME there were statistically significant effects on spheno-occipital synchondrosis length and cranial base angle; however, these changes in the mid-term did not affect the vertical or sagittal parameters of the skeletal maxillomandibular complex.
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Leo⁎ S, Romano G, Accettura C, Giampaglia M, Licchetta A, Gnoni A, Mauro A, Cocciolo A, Saracino V, Lupo L, Gambino A, Lorusso V. Retrospective analysis of Erlotinib in the treatment of patients over 70years with NSCLC: Our experience in the Geriatric Oncologic Unit. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2012.10.072] [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: 11/24/2022]
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Gambino A, Carbone M, Arduino P. Displasia sul bordo della lingua in paziente con follow-up di 15 anni: caso clinico. Dental Cadmos 2012. [DOI: 10.1016/j.cadmos.2011.12.006] [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: 11/26/2022]
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Castellani C, Angelini A, de Boer O, van der Loos C, Fedrigo M, Gambino A, Tona F, Feltrin G, Gerosa G, Thiene G, van der Wal A. 809 Intraplaque Haemorrhage as a Trigger of Lesion Progression in Cardiac Allograft Vasculopathy. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Allred SR, Wood MJ, Gambino A, Brining E. Color constancy in perception and memory for real illuminated objects. J Vis 2011. [DOI: 10.1167/11.11.381] [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: 11/24/2022] Open
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Caretta N, Feltrin G, d'Agostino C, Gambino A, Foresta C, Gerosa G. 287 Erectile Dysfunction, Penile Atherosclerosis and Coronary Artery Disease in Heart Transplant Recipients. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.294] [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: 11/24/2022] Open
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Fedrigo M, Gambino A, Benazzi E, Poli F, Frigo A, Tona F, Caforio A, Castellani C, Toscano G, Feltrin G, Gerosa G, Thiene G, Angelini A. 31 Value of Immunoperoxidase Staining of C3d in the Diagnosis of Antibody Mediated Rejection in Heart Transplant Recipients. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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d'Agostino C, Caretta N, Feltrin G, Tona F, Gambino A, Gerosa G, Foresta C. 286 Erectyle Dysfunction in Heart Transplanted Patients: Correlation with Peripheral and Cardiac Vasculopaty and Role of Endothelial Progenitor Cells. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Gambino A, Gorio A, Carrara L, Agoni L, Franzini R, Lupi GP, Maggino T, Romagnolo C, Sartori E, Pecorelli S. Cancer in pregnancy: maternal and fetal implications on decision-making. EUR J GYNAECOL ONCOL 2011; 32:40-45. [PMID: 21446323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Cancer complicates one out of 1,000 pregnancies. No standardized therapeutic interventions have been reported for these patients. METHODS Fifteen patients with cancer during pregnancy were diagnosed between 6.5 and 36 weeks of gestational age between January 1991 and December 2007. RESULTS Among the 15 cases one patient with early diagnosis (11 weeks) asked for interruption of pregnancy, two patients rejected chemotherapy in order to avoid fetal effects, seven patients underwent surgery during the first or second trimester, and two patients agreed to start the treatment only after delivery. Standard platinum-based chemotherapy (cisDDP) was postponed in six patients to the second trimester (administered after surgery in 2 cases). Chemotherapy was started between 18.3 and 29.6 weeks (median 22.3 weeks). One patient had pPROM (22.3 weeks) after chemotherapy with cisDDP. Ten patients were delivered by elective cesarean section and three by vaginal delivery. Mean gestational age at delivery was 33.5 weeks (range 32.1-40.0); mean weight at birth was 2,550 g (range 1,250-3,450). None of the newborns showed congenital malformations, and all had normal Apgar scores. Anemia occurred in two newborns. At a median follow-up of 56 months (range 2-198 months) all children were well and healthy. Eleven out of 15 mothers are alive and well, and one is alive with disease. An advanced neoplasm was diagnosed in three patients who died. CONCLUSION When platinum-based chemotherapy is administered during the 2nd-3rd trimester, adverse effects in newborns are comparable to those in the general population. Deliberate treatment delay to achieve fetal viability or to improve fetal outcome may be reasonable for patients with early-stage cancer.
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Affiliation(s)
- A Gambino
- Department Obstetrics and Gynecology, University of Brescia, Italy
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Tona F, Osto E, Tarantini G, Gambino A, Cavallin F, Feltrin G, Montisci R, Caforio ALP, Gerosa G, Iliceto S. Coronary flow reserve by transthoracic echocardiography predicts epicardial intimal thickening in cardiac allograft vasculopathy. Am J Transplant 2010; 10:1668-76. [PMID: 20642688 DOI: 10.1111/j.1600-6143.2010.03160.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cardiac allograft vasculopathy (CAV) is the leading cause of morbidity and mortality in heart transplantation (HT). We sought to investigate the role of coronary flow reserve (CFR) by contrast-enhanced transthoracic echocardiography (CE-TTE) in CAV diagnosis. CAV was defined as maximal intimal thickness (MIT) assessed by intravascular ultrasound (IVUS) > or =0.5 mm. CFR was assessed in the left anterior descending coronary artery in 22 HT recipients at 6 +/- 4 years post-HT. CAV was diagnosed in 10 patients (group A), 12 had normal coronaries (group B). The mean MIT was 0.7 +/- 0.1 mm (range 0.03-1.8). MIT was higher in group A (1.16 +/- 0.3 mm vs. 0.34 +/- 0.07 mm, p < 0.0001). CFR was 3.1 +/- 0.8 in all patients and lower in group A (2.5 +/- 0.6 vs. 3.7 +/- 0.3, p < 0.0001). CFR was inversely related with MIT (r =-0.774, p < 0.0001). A cut point of < or =2.9, identified as optimal by receiver operating characteristics analysis was 100% specific and 80% sensitive (PPV = 100%, NPV = 89%, Accuracy = 91%). CFR assessment by CE-TTE is a novel noninvasive diagnostic tool in the detection of CAV defined as MIT > or =0.5 mm. CFR by CE-TTE may reduce the need for routine IVUS in HT.
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Affiliation(s)
- F Tona
- Department of Cardiology, University of Padova, Italy.
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Potena L, d'Agostino C, Abate D, Magnani G, Baccolini F, Ionico T, Grigioni F, Gambino A, Sgarabotto D, Toscano G. 474: Interaction of CMV Prophylaxis and Pre-Emptive Strategies with Immunosuppressive Therapy: Potential Antiviral Effect of Everolimus. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Favaro A, d'Agostino C, Zarnieri D, Boscolo S, Moz M, Gambino A, Volpe B, Santonastaso P, Gerosa G. 466: Posttraumatic Stress Disorder and Major Depression in Heart Transplantation Recipients: The Relationship with Outcome and Medical Compliance. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Fedrigo M, Tona F, Gambino A, Castellani C, Poli F, Benazzi E, Vinci A, Caforio A, Feltrin G, Gerosa G, Valente M, Thiene G, Angelini A. 37: The Role of C4d Immunostaining in the Evaluation of Microvascular Damage in Heart Transplantation. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Osto E, Tona F, Castellani C, Gambino A, Tarantini G, Vinci A, Napodano M, Ramondo A, Caforio A, Thiene G, Gerosa G, Angelini A, Iliceto S. 321: Everolimus Prevents Allograft Microvasculopathy after Heart Transplantation. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.328] [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: 12/01/2022] Open
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Osto E, Tona F, Castellani C, Fadini G, Baesso I, Gambino A, Vinci A, Avogaro A, Ramondo A, Caforio A, Gerosa G, Thiene G, Angelini A, Iliceto S. 74: Endothelial Progenitor Cells Are Decreased in the Blood and in the Graft of Heart Transplant Patients with Microvasculopathy. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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De Pas T, Spitaleri G, Vigna PD, Toffalorio F, Curigliano G, Gambino A, Boselli S, Catania C, de Braud F. Gemcitabine-induced progressive and sustained tumour response in a patient with multi-drug resistant uterine leiomyosarcoma. Ecancermedicalscience 2009; 2:102. [PMID: 22275981 PMCID: PMC3234072 DOI: 10.3332/ecancer.2008.102] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Indexed: 12/03/2022] Open
Abstract
Background: despite the fact that the combination of gemcitabine (GCB) and docetaxel shows an increased benefit for disease-free survival and overall survival compared to GCB alone in patients with soft-tissue sarcoma, GCB mono-chemotherapy should be considered as a preferable option with respect to the combination because of its lower toxicity profile and the possibility of it being administered continuously for a long time period. Case report: we report a clinical case of a woman with advanced high-grade uterine leiomyosarcoma, refractory to ifosfamide, doxorubicin and trabectedin, who experienced a sustained and progressive response to GCB alone. Conclusions: GCB given as mono-chemotherapy can obtain long-lasting tumour control in patients heavily pre-treated with various chemotherapeutic regimes for uterine LMS and should be considered as a possible option for this subset of patients.
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Affiliation(s)
- T De Pas
- Clinical Pharmacology and New Drugs Development Unit, Department of Medicine, European Institute of Oncology, Ripamonti 435, Milan, Italy.
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Aversa SML, Stragliotto S, Marino D, Calabrese F, Rigotti P, Marchini F, Gambino A, Feltrin G, Boso C, Canova F, Soldà C, Mazzarotto R, Burra P. Post-transplant lymphoproliferative disorders after heart or kidney transplantation at a single centre: presentation and response to treatment. Acta Haematol 2008; 120:36-46. [PMID: 18797163 DOI: 10.1159/000155234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Accepted: 06/30/2008] [Indexed: 01/02/2023]
Abstract
Post-transplant lymphoproliferative disorders (PTLD) is a serious complication after solid organ transplantation. Reduction of immunosuppression (RI) alone is not able to control the disease. We report a prospective analysis of 30 patients with PTLD after heart or kidney transplantation. Only 5 of 30 patients, treated solely with RI, obtained a complete response. Five patients were treated heterogeneously; in the remaining 20, the efficacy and safety of a weekly anthracycline-based chemotherapy were assessed. Sixteen patients obtained a complete remission. One death was related to treatment. With a median follow-up of 36 months, 3-year overall survival was 63.3% and 57% for the entire group and the chemotherapy-treated group, respectively. Moreover, 4 second neoplasms were observed in the chemotherapeutic group. In this study, we demonstrated that most PTLD need other treatment than RI and a weekly regimen is manageable and has a favourable impact on long-term survival.
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Affiliation(s)
- S M L Aversa
- Division of Medical Oncology, Istituto Oncologico Veneto, IRCCS, Padua, Italy.
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Sartori E, Pasinetti B, Carrara L, Gambino A, Odicino F, Pecorelli S. Pattern of failure and value of follow-up procedures in endometrial and cervical cancer patients. Gynecol Oncol 2007; 107:S241-7. [PMID: 17826824 DOI: 10.1016/j.ygyno.2007.07.025] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 07/06/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the outcome benefit of follow-up protocols for patients with recurrent endometrial and cervical cancer. METHODS A retrospective review on patients primarily treated at the Division of Gynecologic Oncology, University of Brescia, was performed. We focused our attention on recurrent patients and we evaluated the pattern of relapse and the presence of symptoms or signs of disease at recurrence and evidence of disease on routine follow-up test or visits. RESULTS The vast majority of recurrences occurred within the first 3 years after primary treatment (78% and 87% in endometrial and cervical cancers, respectively). A better overall survival from relapse was observed when vaginal relapse was compared to other sites in endometrial cancer patients and when pelvic recurrence was compared to distant sites in cervical cancer cases. Recurrent endometrial and cervical cancer patients were symptomatic in 52% and 65% of cases, respectively. Among asymptomatic recurrent endometrial cancer cases, pelvic examination, abdominal or pelvic ultrasound and CT could detect 92% of relapses, while the vast majority of cervical cancer relapses could be diagnosed by pelvic examination and/or CT (85%). CONCLUSION Endometrial cancer patients showed a significantly better prognosis when the recurrence was detected during follow-up visits, thus supporting the real advantage of our surveillance programs, while no statistically significant differences were found in survival of cervical cancer patients between the symptomatic and the asymptomatic group.
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Affiliation(s)
- E Sartori
- Department of Gynecology and Obstetrics, University of Brescia, Brescia, Italy.
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Tona F, Caforio A, Montisci R, Gambino A, Ramondo A, Toscano G, Ruscazio M, Angelini A, Gerosa G, Iliceto S. 190: Predictors of microvascular damage in heart transplant recipients without cardiac allograft vasculopathy: A contrast-enhanced echocardiographic study. J Heart Lung Transplant 2007. [DOI: 10.1016/j.healun.2006.11.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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47
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Tona F, Caforio A, Montisci R, Gambino A, Feltrin G, Dequal G, Ramondo A, Angelini A, Gerosa G, Iliceto S. 254: Clinical and functional determinants of coronary flow reserve in heart transplantation: A contrast-enhanced echocardiographic study. J Heart Lung Transplant 2007. [DOI: 10.1016/j.healun.2006.11.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Angelini A, Tona F, Castellani C, Caforio A, Gambino A, Della Barbera M, Feltrin G, Valente M, Ilicieto S, Gerosa G, Thiene G. 236: Preserved microcirculation allows cardiomyocyte engraftment in human sex-mismatched heart transplantation. J Heart Lung Transplant 2007. [DOI: 10.1016/j.healun.2006.11.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Calabrese F, Angelini A, Gambino A, Gerosa G, Rizzo S, Carturan E, Thiene G. 180: Recurrent viral myocarditis after cardiac transplantation in pediatric population. J Heart Lung Transplant 2007. [DOI: 10.1016/j.healun.2006.11.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Tona F, Caforio ALP, Montisci R, Angelini A, Ruscazio M, Gambino A, Ramondo A, Thiene G, Gerosa G, Iliceto S. Coronary flow reserve by contrast-enhanced echocardiography: a new noninvasive diagnostic tool for cardiac allograft vasculopathy. Am J Transplant 2006; 6:998-1003. [PMID: 16611336 DOI: 10.1111/j.1600-6143.2006.01298.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Noninvasive tests have proven unsatisfactory in cardiac allograft vasculopathy (CAV) diagnosis. We assessed coronary flow reserve (CFR) by contrast-enhanced transthoracic echocardiography (CE-TTE) in heart transplantation (HT). CFR was assessed in the left anterior descending coronary artery in 73 HT recipients (59 male, aged 50+/-12 years at HT), at 8+/-4.5 years post-HT. CFR measurements were taken blindly from coronary angiographies. CFR cut points were the standard value of <or=2 and those defined by receiver operating characteristics (ROC) curve analysis. CFR was lower in patients with CAV (2.3+/-0.7 vs. 3.2+/-0.5, p<0.0001). The <or=2 cut point was 100% specific and 38% sensitive. The <or=2.7 cut point, optimal by ROC analysis, was 87% specific and 82% sensitive. Accuracy rose from 71% with the standard<or=2 cut point to 85% with the optimal cut point of <or=2.7. CFR by CE-TTE may offer promise as a novel, easily repeatable and accurate noninvasive tool in CAV detection. However, further longitudinal studies in larger patient cohorts are warranted before widespread adoption can be advocated.
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Affiliation(s)
- F Tona
- Department of Cardiology, University of Padova, Padova, Italy
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