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de Pretis N, Carlin M, Calderini E, Caldart F, Conti Bellocchi MC, Amodio A, De Marchi G, Campagnola P, Crinò SF, Bernardoni L, Gabbrielli A, Martinelli L, Frulloni L. Clinical features and long-term outcomes of patients with type 2 autoimmune pancreatitis. United European Gastroenterol J 2024; 12:319-325. [PMID: 38217278 PMCID: PMC11017755 DOI: 10.1002/ueg2.12504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/24/2023] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVES Type 2 is a rare form of autoimmune pancreatitis (AIP). Despite being considered a benign disease, only few studies with limited sample size and short follow-up have been published on type 2 AIP. The aim of this observational study was to evaluate long-term outcomes, such as the risk of relapse, pancreatic insufficiency and cancer in a large type 2 AIP cohort with long follow-up. METHODS Patients with definitive or probable diagnosis of type 2 AIP by International Consensus Diagnostic Criteria (ICDC) present in our prospectively maintained database since 1995 at 31.12.2021 were identified. All patients were clinically evaluated during the year 2022. Clinical, radiological, serological, and pathological data were evaluated. RESULTS Eighty-eight out of 420 patients present in the database (21%) were diagnosed with type 2 AIP (mean age 33.5 ± 13.5 years). According to the ICDC, 21 patients (23.8%) had a definitive and 67 (76.2%) a probable diagnosis of type 2 AIP. The mean follow-up was 9.2 ± 7.1 years (range 1-27 years). No differences were observed when comparing patients with definitive and probable type 2 AIP diagnosis. Concomitant IBD was reported in 77 patients (87.5%). The probability of disease relapse was lower in patients treated with steroids versus surgery (at 5 years 13% vs. 33%; p = 0.038) but this difference was not statistically significant at multivariable analysis. The risk of endocrine or severe exocrine insufficiency was low (5% and 25%). Four extra-pancreatic malignancies (5%) were diagnosed, none pancreatic. One patient died in a car accident. CONCLUSIONS Type 2 AIP has benign long-term clinical outcomes. Mortality and cancer rates are low and no specific follow-up is needed after radiological remission.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Luigi Martinelli
- Department of Diagnostics and Public HealthUniversity of VeronaVeronaItaly
| | - Luca Frulloni
- Department of MedicineUniversity of VeronaVeronaItaly
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2
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Conti Bellocchi MC, Bernuzzi M, Brillo A, Bernardoni L, Amodio A, De Pretis N, Frulloni L, Gabbrielli A, Crinò SF. EUS-FNA versus EUS-FNB in Pancreatic Solid Lesions ≤ 15 mm. Diagnostics (Basel) 2024; 14:427. [PMID: 38396466 PMCID: PMC10888305 DOI: 10.3390/diagnostics14040427] [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: 12/08/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
A small tumor size may impact the diagnostic performance of endoscopic ultrasound-guided tissue acquisition (EUS-TA) for diagnosing solid pancreatic lesions (SPLs). We aimed to compare the diagnostic yield of EUS-guided fine-needle aspiration (FNA) and biopsy (FNB) in SPLs with a diameter ≤ 15 mm. Consecutive patients who underwent EUS-TA for SPLs ≤ 15 mm between January 2015 and December 2022 in a tertiary referral center were retrospectively evaluated. The primary endpoint was diagnostic accuracy. The final diagnosis was based on surgical pathology or disease evolution after a minimum follow-up of 6 months. Inadequate samples were all considered false negatives for the study. Secondary outcomes included sample adequacy, factors impacting accuracy, and safety. We included 368 patients (52.4% male; mean age: 60.2 years) who underwent FNA in 72 cases and FNB in 296. The mean size of SPLs was 11.9 ± 2.6 mm. More than three passes were performed in 5.7% and 61.5% of patients in the FNB and FNA groups, respectively (p < 0.0001). FNB outperformed FNA in terms of diagnostic accuracy (89.8% vs. 79.1%, p = 0.013) and sample adequacy (95.9% vs. 86.1%, p < 0.001). On multivariate analysis, using FNA (OR: 2.10, 95% CI: 1.07-4.48) and a final diagnosis (OR: 3.56, 95% CI: 1.82-6.94) of benign conditions negatively impacted accuracy. Overall, the adverse event rate was 0.8%, including one pancreatitis in the FNA group and one pancreatitis and one bleeding in the FNB group, all mild and conservatively managed. EUS-TA for SPLs ≤ 15 mm has a high diagnostic yield and safety. This study suggests the superiority of FNB over FNA, with better performance even with fewer passes performed.
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Affiliation(s)
- Maria Cristina Conti Bellocchi
- Diagnostic and Interventional Endoscopy of the Pancreas, Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy; (L.B.); (S.F.C.)
| | - Micol Bernuzzi
- Department of Medicine, Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy (A.B.); (A.A.); (N.D.P.); (L.F.)
| | - Alessandro Brillo
- Department of Medicine, Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy (A.B.); (A.A.); (N.D.P.); (L.F.)
| | - Laura Bernardoni
- Diagnostic and Interventional Endoscopy of the Pancreas, Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy; (L.B.); (S.F.C.)
| | - Antonio Amodio
- Department of Medicine, Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy (A.B.); (A.A.); (N.D.P.); (L.F.)
| | - Nicolò De Pretis
- Department of Medicine, Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy (A.B.); (A.A.); (N.D.P.); (L.F.)
| | - Luca Frulloni
- Department of Medicine, Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy (A.B.); (A.A.); (N.D.P.); (L.F.)
| | - Armando Gabbrielli
- Diagnostic and Interventional Endoscopy of the Pancreas, Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy; (L.B.); (S.F.C.)
| | - Stefano Francesco Crinò
- Diagnostic and Interventional Endoscopy of the Pancreas, Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy; (L.B.); (S.F.C.)
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Zorzi A, Campagnola P, Amodio A, Caldart F, De Pretis N, Frulloni L. An update on improving long-term outcomes for patients with chronic pancreatitis post-surgery. Expert Rev Gastroenterol Hepatol 2024; 18:25-36. [PMID: 38375780 DOI: 10.1080/17474124.2024.2321947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/19/2024] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Chronic pancreatitis is a common inflammatory disease that severely impairs patients' quality of life, mainly due to abdominal pain which is the most frequent symptom. Current guidelines suggest medical therapy as the first line intervention based on a stepwise use of analgesics (i.e. NSAIDs followed by weak opioids and later by strong oppioids), which is rarely effective in improving pain and often leads to opioid addiction. Interventional procedures are therefore frequently needed. Endoscopic therapy is suggested as the second line of intervention, aiming at decompressing the main pancreatic duct via structure dilatation and ductal stone removal. Endoscopic therapy is usually effective in reducing pain in the short term, but its effects frequently decrease with time and multiple procedures are often required. Surgery is usually reserved as a last resource when medical and endoscopic therapy have failed. Pancreatic surgery is burdened with non negligible morbidity and mortality but is effective in reducing pain and improving quality of life in chronic pancratitis with long lasting effects. AREAS COVERED Surgical treatment of chronic pancreatitis is based on resection of inflammatory head mass or decompression of the ductal system, alone or in combination, which can be performed using different techniques. In this paper we reviewed the current evidence on the long-term outcomes of this type of surgery in terms of pain relief, quality of life, exocrine end endocrine function, and long-term mortality. EXPERT OPINION Quality of current evidence on this field is on average poor; a consensus to define clinically significant outcomes is needed in order to correctly design prospective studies that will enable gastroenterologists to understand which patients, and when, will benefit most from surgery and should therefore be referred to surgeons.
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Affiliation(s)
- Alberto Zorzi
- Gastroenterology B, Pancreas Institute, University of Verona, Verona, Italy
| | - Pietro Campagnola
- Gastroenterology B, Pancreas Institute, University of Verona, Verona, Italy
| | - Antonio Amodio
- Gastroenterology B, Pancreas Institute, University of Verona, Verona, Italy
| | - Federico Caldart
- Gastroenterology B, Pancreas Institute, University of Verona, Verona, Italy
| | - Nicolo De Pretis
- Gastroenterology B, Pancreas Institute, University of Verona, Verona, Italy
| | - Luca Frulloni
- Gastroenterology B, Pancreas Institute, University of Verona, Verona, Italy
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Ambrosetti MC, Grecchi A, Ambrosetti A, Amodio A, Mansueto G, Montemezzi S, Zamboni GA. Quantitative Edge Analysis of Pancreatic Margins in Patients with Chronic Pancreatitis: A Correlation with Exocrine Function. Diagnostics (Basel) 2023; 13:2272. [PMID: 37443666 DOI: 10.3390/diagnostics13132272] [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: 05/15/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Many efforts have been made to improve accuracy and sensitivity in diagnosing chronic pancreatitis (CP), obtaining quantitative assessments related to functional data. Our purpose was to correlate a computer-assisted analysis of pancreatic morphology, focusing on glandular margins, with exocrine function-measured by fecal elastase values-in chronic pancreatitis patients. METHODS We retrospectively reviewed chronic pancreatitis patients who underwent fecal elastase assessment and abdominal MRI in our institute within 1 year. We identified 123 patients divided into three groups based on the fecal elastase value: group A with fecal elastase > 200 μg/g; group B with fecal elastase between 100 and 200 μg/g; and group C with fecal elastase < 100 μg/g. Computer-assisted quantitative edge analysis of pancreatic margins was made on non-contrast-enhanced water-only Dixon T1-weighted images, obtaining the pancreatic margin score (PMS). PMS values were compared across groups using a Kruskal-Wallis test and the correlation between PMS and fecal elastase values was tested with the Spearman's test. RESULTS A significant difference in PMS was observed between the three groups (p < 0.0001), with a significant correlation between PMS and elastase values (r = 0.6080). CONCLUSIONS Quantitative edge analysis may stratify chronic pancreatitis patients according to the degree of exocrine insufficiency, potentially contributing to the morphological and functional staging of this pathology.
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Affiliation(s)
- Maria Chiara Ambrosetti
- Radiology Unit, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, 37126 Verona, Italy
| | - Annamaria Grecchi
- Institute of Radiology, Department of Diagnostics and Public Health, Policlinico GB Rossi, University of Verona, 37134 Verona, Italy
| | - Alberto Ambrosetti
- Department of Physics and Astronomy "Galileo Galilei", University of Padova, 35131 Padova, Italy
| | - Antonio Amodio
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, Department of Medicine, G.B. Rossi University Hospital, 37134 Verona, Italy
| | - Giancarlo Mansueto
- Institute of Radiology, Department of Diagnostics and Public Health, Policlinico GB Rossi, University of Verona, 37134 Verona, Italy
| | - Stefania Montemezzi
- Radiology Unit, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, 37126 Verona, Italy
| | - Giulia A Zamboni
- Institute of Radiology, Department of Diagnostics and Public Health, Policlinico GB Rossi, University of Verona, 37134 Verona, Italy
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Conti Bellocchi MC, Amodio A, Bernardoni L, Gabbrielli A, Crinò SF. A penetrating foreign body mimicking pancreatic cancer (with videos). Endosc Ultrasound 2022; 12:286-287. [PMID: 36510875 DOI: 10.4103/eus-d-22-00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
| | - Antonio Amodio
- Gastroenterology Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Laura Bernardoni
- Diagnostic and Interventional Endoscopy of Pancreas, Pancreas Institute, University of Verona, Italy
| | - Armando Gabbrielli
- Diagnostic and Interventional Endoscopy of Pancreas, Pancreas Institute, University of Verona, Italy
| | - Stefano Francesco Crinò
- Diagnostic and Interventional Endoscopy of Pancreas, Pancreas Institute, University of Verona, Italy
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de Pretis N, Amodio A, De Marchi G, Marconato E, Ciccocioppo R, Frulloni L. The role of serological biomarkers in the diagnosis and management of autoimmune pancreatitis. Expert Rev Clin Immunol 2022; 18:1119-1124. [PMID: 36125384 DOI: 10.1080/1744666x.2022.2125379] [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] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Autoimmune pancreatitis (AIP) is a fibroinflammatory disease of the pancreas. Type 1 AIP is the pancreatic manifestation of a systemic IgG4-related disease and is associated with serum elevation of IgG4, tissue infiltration of IgG4-positive plasma cells, and multiorgan involvement. Although serum IgG4 elevation is considered a useful diagnostic tool, the concomitant presence of more diagnostic criteria is needed to achieve diagnosis. No other biomarkers have been approved in clinical practice in type 1 AIP. Type 2 AIP is a pancreatic-specific disease associated with inflammatory bowel disease. No specific biomarkers for type 2 AIP have been identified. AREAS COVERED The role of serum IgG4 in the diagnosis, management and follow-up of patients with type 1 AIP. Moreover, data on other emerging biomarkers for type 1 and 2 AIP have been reported. EXPERT OPINION The diagnosis of AIP is challenging in clinical practice, especially for focal forms without multiorgan involvement, where distinction from pancreatic cancer can be difficult. Despite the strong association with type 1 AIP, serum IgG4 should only be measured when the suspicion for the disease is high, considering its limited sensitivity. New biomarkers with high diagnostic yield for both type 1 and type 2 AIP are needed.
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Affiliation(s)
- Nicolò de Pretis
- Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Antonio Amodio
- Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Giulia De Marchi
- Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Eugenio Marconato
- Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Rachele Ciccocioppo
- Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Luca Frulloni
- Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
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Goni E, Regel I, Mahajan UM, Amodio A, De Marchi G, Beyer G, Zuppardo RA, Di Leo M, Lanzillotta M, Bonatti F, Kauke T, Dick A, Weiss FU, Schönermarck U, Lerch MM, Frulloni L, Cavestro GM, Mayerle J. HLA-DRB1∗16 and -DQB1∗05 alleles are strongly associated with autoimmune pancreatitis in a cohort of hundred patients. Pancreatology 2022; 22:466-471. [PMID: 35379557 DOI: 10.1016/j.pan.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Autoimmune diseases are often associated with human leukocyte antigen (HLA) haplotypes, indicating that changes in major histocompatibility complex (MHC)-dependent self-peptide or antigen presentation contribute to autoimmunity. In our study, we aimed to investigate HLA alleles in a large European cohort of autoimmune pancreatitis (AIP) patients. METHODS Hundred patients with AIP, diagnosed and classified according to the International Consensus Diagnostic Criteria (ICDC), were prospectively enrolled in the study. Forty-four patients with chronic pancreatitis (CP) and 254 healthy subjects served as control groups. DNA was isolated from blood samples and two-digit HLA typing was performed with sequence-specific primer (SSP-) PCR. HLA allele association strength to AIP was calculated as odds ratio. RESULTS We uncovered a strong enrichment of HLA-DQB1 homozygosity in type 1 and type 2 AIP patients. Moreover, a significantly increased incidence of the HLA-DRB1∗16 and HLA-DQB1∗05 alleles and a concomitant lack of the HLA-DRB1∗13 allele was detected in AIP type 1 and type 2 patients. In contrast, the HLA-DQB1∗02 allele was underrepresented in the 'not otherwise specified' (NOS) AIP subtype. We detected no significant difference in the HLA-DRB3, HLA-DRB4 and HLA-DRB5 allele frequency in our cohort. CONCLUSIONS Although AIP type 1 and type 2 are characterized by distinct histopathological characteristics, both subtypes are associated with the same HLA alleles, indicating that the disease might rely on similar immunogenic mechanisms. However, AIP NOS represented another subclass of AIP.
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Affiliation(s)
- Elisabetta Goni
- Department of Medicine II, University Hospital, LMU, Munich, Germany
| | - Ivonne Regel
- Department of Medicine II, University Hospital, LMU, Munich, Germany.
| | | | - Antonio Amodio
- Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Giulia De Marchi
- Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Georg Beyer
- Department of Medicine II, University Hospital, LMU, Munich, Germany
| | - Raffaella Alessia Zuppardo
- Gastroenterology and Gastrointestinal Endoscopy, Division of Experimental Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Milena Di Leo
- Gastroenterology and Gastrointestinal Endoscopy, Division of Experimental Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Lanzillotta
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, uniRAR, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bonatti
- Department of Medicine and Surgery, Medical Genetics Unit, University of Parma, Italy
| | - Teresa Kauke
- Division of Transfusion Medicine, Cellular Therapeutics and Hemostaseology, University Clinic LMU, Munich, Germany
| | - Andrea Dick
- Division of Transfusion Medicine, Cellular Therapeutics and Hemostaseology, University Clinic LMU, Munich, Germany
| | - Frank Ulrich Weiss
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Ulf Schönermarck
- Department of Medicine IV, University Hospital, LMU, Munich, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Luca Frulloni
- Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Giulia Martina Cavestro
- Gastroenterology and Gastrointestinal Endoscopy, Division of Experimental Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU, Munich, Germany
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Rogger TM, De Marchi G, Brozzi L, Amodio A, Orsolini G, de Pretis N, Conti Bellocchi MC, Crinò SF, Gabbrielli A, Ciccocioppo R, Frulloni L. Immunoglobulin G4-Related Disease Responder Index Correlates With the Risk of 1-Year Relapse in Type 1 Autoimmune Pancreatitis. Pancreas 2021; 50:879-881. [PMID: 34347736 DOI: 10.1097/mpa.0000000000001843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Type 1 autoimmune pancreatitis (AIP) is a manifestation of immunoglobulin G4-related diseases (IgG4-RD). To evaluate the activity of the disease, the IgG4-RD responder index (RI) has been created. This study evaluated the IgG4-RD RI as prognostic factor of 1-year disease relapse. METHODS Patients diagnosed with type 1 AIP between January 2012 and December 2016, with available magnetic resonance imaging and IgG4 dosage, were enrolled. Immunoglobulin G4-RD RI was calculated at baseline (time 0), and at 3 to 6 and 12 to 18 months after the end of steroid therapy (time 1 and time 2, respectively). RESULTS Thirty-three patients were included in the study. Immunoglobulin G4-RD RI was 8.9 (standard deviation [SD], 3.8) at time 0, 2.4 (SD, 3.1) at time 1 (P < 0.0001 vs time 0), and 4.2 (SD, 3.9) at time 2 (P = 0.02 vs time 1). Fourteen patients who relapsed within 1 year showed a higher mean value of IgG4-RD RI at time 0 (10.9; SD, 4.3) versus 19 who did not (7.4; SD, 2.6; P = 0.012). This difference was observed also at time 2 (6.8 vs 2.1; P = 0.002). CONCLUSIONS Immunoglobulin G4-RD RI correlates with type 1 AIP disease activity, and it predicts disease relapse within 1 year.
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Affiliation(s)
| | | | | | | | - Giovanni Orsolini
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | | | | | | | | | | | - Luca Frulloni
- From the Gastroenterology B Unit, Pancreas Institute
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Crinò SF, Ammendola S, Meneghetti A, Bernardoni L, Conti Bellocchi MC, Gabbrielli A, Landoni L, Paiella S, Pin F, Parisi A, Mastrosimini MG, Amodio A, Frulloni L, Facciorusso A, Larghi A, Manfrin E. Comparison between EUS-guided fine-needle aspiration cytology and EUS-guided fine-needle biopsy histology for the evaluation of pancreatic neuroendocrine tumors. Pancreatology 2021; 21:443-450. [PMID: 33390343 DOI: 10.1016/j.pan.2020.12.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/09/2020] [Accepted: 12/21/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Studies comparing EUS-guided fine-needle aspiration (EUS-FNA) with EUS-guided fine-needle biopsy (EUS-FNB) for the evaluation of pancreatic neuroendocrine tumors (pNETs) are lacking. We aimed at comparing EUS-FNA with EUS-FNB in terms of Ki-67 proliferative index (PI) estimation capability, cellularity of the samples, and reliability of Ki-67 PI/tumor grading compared with surgical specimens. METHODS Patients diagnosed with pNETs on EUS and/or surgical specimens were retrospectively identified. Specimens were re-evaluated to assess Ki-67 PI feasibility, sample cellularity by manual counting, and determination of Ki-67 PI value. Outcomes in the EUS-FNA and EUS-FNB groups were compared. Kendall rank test was used for Ki-67 PI correlation between EUS and surgical specimens. Subgroup analysis including small (≤20 mm), non-functioning pNETs was performed. RESULTS Three-hundred samples from 292 lesions were evaluated: 69 EUS-FNA cytology and 231 EUS-FNB histology. Ki-67 PI feasibility was similar for EUS-FNA and EUS-FNB (91.3% vs. 95.7%, p = 0.15), while EUS-FNB performed significantly better in the subgroup of 179 small pNETs (88.2% vs. 96.1%, p = 0.04). Rate of poor cellulated (<500 cells) specimens was equal between EUS-FNA and EUS-FNB. A significant correlation for Ki-67 PI values between EUS and 92 correspondent surgical specimens was found in both groups, but it was stronger with EUS-FNB (tau = 0.626, p < 0.0001 vs. tau = 0.452, p = 0.031). Correct grading estimation was comparable between the two groups (p = 0.482). CONCLUSION Our study showed stronger correlation for Ki-67 values between EUS-FNB and surgical specimens, and that EUS-FNB outperformed EUS-FNA in the evaluation of small pNETs. EUS-FNB should become standard of care for grading assessment of suspected pNETs.
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Affiliation(s)
- Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy.
| | - Serena Ammendola
- Department of Diagnostics and Public Health, G.B. Rossi University Hospital, Verona, Italy
| | - Anna Meneghetti
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Laura Bernardoni
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | | | - Armando Gabbrielli
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Luca Landoni
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Salvatore Paiella
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Federico Pin
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Alice Parisi
- Department of Diagnostics and Public Health, G.B. Rossi University Hospital, Verona, Italy
| | | | - Antonio Amodio
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Luca Frulloni
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Antonio Facciorusso
- Digestive Endoscopy Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Erminia Manfrin
- Department of Diagnostics and Public Health, G.B. Rossi University Hospital, Verona, Italy
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De Marchi G, Amodio A, Frulloni L. Reply to "Painless chronic pancreatitis with pancreatic duct stones". Dig Liver Dis 2021; 53:255. [PMID: 33309020 DOI: 10.1016/j.dld.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Giulia De Marchi
- Department of Medicine, The Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, Verona 37134, Italy.
| | - Antonio Amodio
- Department of Medicine, The Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, Verona 37134, Italy
| | - Luca Frulloni
- Department of Medicine, The Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, Verona 37134, Italy
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Amodio A, De Marchi G, de Pretis N, Crinò SF, D'Onofrio M, Gabbrielli A, Ciccocioppo R, Frulloni L. Painless chronic pancreatitis. Dig Liver Dis 2020; 52:1333-1337. [PMID: 32921601 DOI: 10.1016/j.dld.2020.08.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Painless chronic pancreatitis (CP) is a rare form of the disease. AIM To evaluate the prevalence and the characteristics of this overlooked form of pancreatitis. METHODS Patients with a diagnosis of CP and absence of pain were selected, excluding patients suffering from autoimmune pancreatitis. Clinical data, imaging features, and exocrine and endocrine function were therefore analyzed. RESULTS Among 781 patients observed between 2010 and 2016, 74 patients with painless CP (9.5%) were selected. Mean age at diagnosis was 60.8 (SD 10.8) years. 38(51%) individuals did not report any symptom, 36(49%) were affected by symptoms other than pain. Pancreatic calcifications were diagnosed in 70 patients (95%), main pancreatic duct dilation in 55(74%), and pancreatic atrophy in 39(53%).Thirty-six patients (55%) had severe exocrine pancreatic insufficiency(EPI). Diabetes was observed in 34 out of 72 patients (47%). During a mean follow-up of 2.9 (SD 2.8) years, only a mild pancreatitis was diagnosed in a 71-year old female. No patient underwent endoscopic treatment or surgery, developed pancreatic cancer or died. CONCLUSIONS In a tertiary center painless CP is observed in 10% of cases, and it is frequently associated with EPI. The probability of onset of pain is very low in a short-term follow-up.
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Affiliation(s)
- Antonio Amodio
- Gastroenterology B Unit, Department of Medicine, The Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
| | - Giulia De Marchi
- Gastroenterology B Unit, Department of Medicine, The Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134 Verona, Italy.
| | - Nicolò de Pretis
- Gastroenterology B Unit, Department of Medicine, The Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
| | - Stefano Francesco Crinò
- Gastroenterology B Unit, Department of Medicine, The Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
| | - Mirko D'Onofrio
- Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
| | - Armando Gabbrielli
- Gastroenterology B Unit, Department of Medicine, The Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
| | - Rachele Ciccocioppo
- Gastroenterology B Unit, Department of Medicine, The Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
| | - Luca Frulloni
- Gastroenterology B Unit, Department of Medicine, The Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134 Verona, Italy
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12
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Morandi S, Amodio A, Fioravanti A, Giacomino A, Mazzocchi M, Sacerdoti M, Carotta MC, Skouloudis AN. Operational functionalities of air-quality WSn metal-oxide sensors correlating semiconductor defect levels and surface potential barriers. Sci Total Environ 2020; 706:135731. [PMID: 31818592 DOI: 10.1016/j.scitotenv.2019.135731] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/14/2019] [Accepted: 11/22/2019] [Indexed: 06/10/2023]
Abstract
The comprehension of atmospheric pollution levels worldwide is a crucial issue for assessing the health consequences from human exposure to polluted air, and for identifying emission reductions that will be effective for minimizing the potential risks. Advanced interconnected sensors are required that could monitor on real-time toxic gaseous concentration. The success of these instruments depends on the reliability of these devices to quantify and disseminate the pollution levels to nearby citizens. Metal-oxide semiconductors are widely used as functional materials for gas sensing because of their chemo-resistive effect when interacting with gases. Mixed oxides are usually considered for the superior performances shown with respect to the single oxides. In this work, tungsten-tin mixed oxides with different Sn molar fraction (0.0018, 0.12, 0.33 and 0.89 named WS-1, WS-2, WS-3 and WS-4) were synthesized by sol-gel co-precipitation. The powders were characterized by ICP-OES analysis, specific surface area measurements, electron microscopy, X-ray diffraction, UV-Vis-NIR and FT-IR spectroscopies. The powders were also deposited through screen-printing technology, obtaining thick film gas sensors, on which measurements of conductance as a function of temperature, surface potential barrier and dynamical responses in the presence of oxidizing or reducing gases were carried out. Based on the studied properties, the mixed oxides can be divided into two groups: the WO3-like samples (WS-1, WS-2, WS-3) and the SnO2-like sample (WS-4). All samples present pure crystalline structures: this is a new result for the WO3-like samples. There is no literature data reporting about the introduction of so high Sn content in a WO3 structure. The combination of spectroscopic and electrical characterizations allowed the definition of an interpretative model that correlates the deepness of defect levels in the band gap of these materials to the values of the surface potential barrier in air and, as a consequence, to the electrical responses to oxidizing and reducing gases.
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Affiliation(s)
- S Morandi
- Dipartimento di Chimica and NIS-Interdepartmental Center for Nanostructured Interfaces and Surfaces, Università di Torino, Via Pietro Giuria 7, 10125 Torino, Italy.
| | - A Amodio
- Dipartimento di Chimica and NIS-Interdepartmental Center for Nanostructured Interfaces and Surfaces, Università di Torino, Via Pietro Giuria 7, 10125 Torino, Italy
| | - A Fioravanti
- Laboratorio Sensori e Nanomateriali, IMAMOTER-CNR, Via Canal Bianco 28, 44124 Ferrara, Italy
| | - A Giacomino
- Dipartimento di Scienza e Tecnologia del Farmaco and NIS-Interdepartmental Center for Nanostructured Interfaces and Surfaces, Università di Torino, Via Pietro Giuria 9, 10125 Torino, Italy
| | - M Mazzocchi
- ISTEC-CNR, Via Granarolo 64, 48018 Ravenna, Italy
| | - M Sacerdoti
- Dipartimento di Fisica e Scienze della Terra, Università di Ferrara, Via Giuseppe Saragat 1, 44122 Ferrara, Italy
| | - M C Carotta
- Laboratorio Sensori e Nanomateriali, IMAMOTER-CNR, Via Canal Bianco 28, 44124 Ferrara, Italy
| | - A N Skouloudis
- Institute of Prospective Technological Studies, Joint Research Centre, European Commission, Via E. Fermi 2749 Tp.263, 21027 Ispra, Italy
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13
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Balduzzi A, Marchegiani G, Andrianello S, Romeo F, Amodio A, De Pretis N, Zamboni G, Malleo G, Frulloni L, Salvia R, Bassi C. Pancreaticoduodenectomy for paraduodenal pancreatitis is associated with a higher incidence of diabetes but a similar quality of life and pain control when compared to medical treatment. Pancreatology 2020; 20:193-198. [PMID: 31952917 DOI: 10.1016/j.pan.2019.12.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/23/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Paraduodenal pancreatitis is a focal form of chronic pancreatitis that affects the groove area between the duodenum and the head of the pancreas. Consensus regarding surgical or nonsurgical management as the best treatment option is still lacking. METHODS We retrospectively evaluated all patients managed for PP at The Pancreas Institute of the University Hospital Trust of Verona from 1990 to 2017. The outcomes of surgical vs. medical treatment with regard to pain control, quality of life and pancreatic insufficiency were evaluated through specific questionnaires. RESULTS The final study population consisted of 75 patients: 62.6% underwent surgery, and 37.4% were managed without surgery. All surgical procedures consisted of pancreaticoduodenectomy. The median follow-up from the diagnosis of paraduodenal pancreatitis was 60 (12-240) months. Patients who underwent surgery experienced a similar incidence of steatorrhea (44.7 vs. 52.6%; p = 0.4) but a significantly higher incidence of diabetes (59.6 vs. 10.7%; p < 0.01) when compared to those managed without surgery. There was no difference in terms of reported chronic pain (Graded Chronic Pain Scale, median 0 vs. 1; p = 0.1) and quality of life (Pancreatitis QoL Instrument, median 82 vs. 79; p = 0.2). However, surgical patients reported a worse level of self-care activities associated with glycemic control (Diabetes Self-Management Questionnaire, median 20 vs. 28, p = 0.02). CONCLUSION In patients affected by paraduodenal pancreatitis, surgery and medical therapy seem to obtain similar results in terms of quality of life and pain control. However, surgery is associated with an increased prevalence of postoperative diabetes with consequent relevant issues with self-care management. Surgery should be considered only in selected patients after adequate medical treatment.
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Affiliation(s)
- A Balduzzi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - G Marchegiani
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - S Andrianello
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - F Romeo
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - A Amodio
- Gastroenterology Unit, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - N De Pretis
- Gastroenterology Unit, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - G Zamboni
- Pathology Unit, Hospital Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - G Malleo
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - L Frulloni
- Gastroenterology Unit, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - R Salvia
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - C Bassi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
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14
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de Pretis N, Vieceli F, Brandolese A, Brozzi L, Amodio A, Frulloni L. Autoimmune pancreatitis not otherwise specified (NOS): Clinical features and outcomes of the forgotten type. Hepatobiliary Pancreat Dis Int 2019; 18:576-579. [PMID: 31248720 DOI: 10.1016/j.hbpd.2019.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 05/29/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Autoimmune pancreatitis (AIP) is a well-recognized fibroinflammatory disease of the pancreas. Despite the significant number of studies published on AIP type 1 and 2, no studies have been focused on AIP type not otherwise specified (NOS) and therefore very little is known about clinical features and long-term outcomes of these patients. The aim of this study was to investigate clinical and radiological features of AIP type NOS-patients. METHODS Patients classified as AIP type NOS at clinical onset included in our database prospectively maintained since 1995 were evaluated. Epidemiological, clinical data were collected and analyzed. RESULTS Forty-six patients were included in the study. The clinical onset was mainly characterized by weight loss, jaundice and acute pancreatitis. Eight patients (17.4%) were reclassified as AIP type 2 during follow-up because of the development of ulcerative colitis. Seven patients (15.2%) experienced relapse after steroid treatment but only one (2.2%) needed immunosuppressive drugs because of recurrent relapses. CONCLUSIONS AIP type NOS shares clinical features similar to AIP type 2 and a relevant proportion of patients was reclassified as AIP type 2 during follow-up because of the development of ulcerative colitis. The risk of relapse is low but not irrelevant.
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Affiliation(s)
- Nicolò de Pretis
- Gastroenterology Unit, Pancreas Center, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
| | - Filippo Vieceli
- Gastroenterology Unit, Pancreas Center, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Alessandro Brandolese
- Gastroenterology Unit, Pancreas Center, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Lorenzo Brozzi
- Gastroenterology Unit, Pancreas Center, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Antonio Amodio
- Gastroenterology Unit, Pancreas Center, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Luca Frulloni
- Gastroenterology Unit, Pancreas Center, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
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15
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Conti Bellocchi MC, De Pretis N, Amodio A, Zerbi A, Frulloni L. [Chronic pancreatitis: new definition and perspectives.]. Recenti Prog Med 2019; 109:69-72. [PMID: 29451525 DOI: 10.1701/2848.28757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chronic pancreatitis has been considered over the past years as a single disease, alcohol-induced and different from acute pancreatitis, in terms of etiology and prognosis. Actually, the introduction of a new concept of chronic pancreatitis, now considered as a fibroinflammatory process caused by multiple factors (toxic-metabolic, genetic, immunologic, obstructive), allow to better understand the pathogenesis of this complex disease. Furthermore, the discover of peculiar forms of chronic pancreatitis (autoimmune, paraduodenal, associated to gene mutations), different in term of clinical aspects, findings at imaging, prognosis and therapy, radically changed the concept of the disease. In this brief review, we described the impact of this new concept in the comprehension of pathogenesis, in the definition of peculiar forms of chronic pancreatitis, and in the clinical and therapeutic approach of chronic pancreatitis.
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Affiliation(s)
| | - Nicolò De Pretis
- Dipartimento di Medicina, Istituto del Pancreas, Università di Verona
| | - Antonio Amodio
- Dipartimento di Medicina, Istituto del Pancreas, Università di Verona
| | - Alessandro Zerbi
- Unità Operativa Chirurgia Pancreatica, Humanitas, Rozzano (Milano)
| | - Luca Frulloni
- Dipartimento di Medicina, Istituto del Pancreas, Università di Verona
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16
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Marchegiani G, Landoni L, Andrianello S, Masini G, Cingarlini S, D'Onofrio M, De Robertis R, Davì M, Capelli P, Manfrin E, Amodio A, Paiella S, Malleo G, Damoli I, Miotto M, Bianchi B, Nessi C, Vivani E, Scarpa A, Salvia R, Bassi C. Patterns of Recurrence after Resection for Pancreatic Neuroendocrine Tumors: Who, When, and Where? Neuroendocrinology 2019; 108:161-171. [PMID: 30481765 DOI: 10.1159/000495774] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 11/25/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Pancreatic neuroendocrine tumors (pan-NENs) represent an increasingly common indication for pancreatic resection, but there are few data regarding possible recurrence after surgery. The aim of the study was to describe the frequency, timing, and patterns of recurrence after resection for pan-NENs with consequent implications for postoperative follow-up. METHODS We performed a retrospective analysis of pan-NENs resected between 1990 and 2015 at The Pancreas Institute, University of Verona Hospital Trust. Predictors of recurrence were assessed. Survival analysis was conducted using the Kaplan-Meier and conditional survival (CS) methods. RESULTS The cohort consisted of 487 patients with a median follow-up of 71 months. Recurrence developed in 12.3%: 54 (11.1%) liver metastases, 11 (2.3%) local recurrence, 10 (2.1%) nodal recurrence, and 8 (1.6%) metastases in other organs. Thirty-one (6.4%) died due to disease recurrence. Size > 21 mm, G3 grade, nodal metastasis, and vascular infiltration were independent predictors of overall recurrence. Recurrence occurred either during the first year of follow-up (n = 9), or after 10 years (n = 4). CS analysis revealed that nonfunctioning G1 pan-NEN ≤20 mm without nodal metastasis or vascular invasion had a negligible risk of developing recurrence. In the present series, after 5 years of follow-up without developing recurrence, tumor recurrence occurred only in the form of liver metastases. CONCLUSIONS Recurrence of pan-NENs is rare and is predicted by tumor size, nodal metastasis, grading, and vascular invasion. Patients with G1 pan-NEN without nodal metastasis and vascular invasion may be considered cured by surgery. After 5 years without recurrence, follow-up should focus on excluding the development of liver metastases.
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Affiliation(s)
- Giovanni Marchegiani
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Luca Landoni
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Stefano Andrianello
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Gaia Masini
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Sara Cingarlini
- Department of Oncology, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Mirko D'Onofrio
- Department of Radiology, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Riccardo De Robertis
- Department of Radiology, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Mariavittoria Davì
- Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Paola Capelli
- Pathology, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Erminia Manfrin
- Pathology, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Antonio Amodio
- Department of Gastroenterology, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Salvatore Paiella
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Giuseppe Malleo
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Isacco Damoli
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Marco Miotto
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Beatrice Bianchi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Chiara Nessi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Elena Vivani
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Aldo Scarpa
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy,
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
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17
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Ciaravino V, De Robertis R, Tinazzi Martini P, Cardobi N, Cingarlini S, Amodio A, Landoni L, Capelli P, D'Onofrio M. Imaging presentation of pancreatic neuroendocrine neoplasms. Insights Imaging 2018; 9:943-953. [PMID: 30302635 PMCID: PMC6269331 DOI: 10.1007/s13244-018-0658-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/07/2018] [Accepted: 08/28/2018] [Indexed: 02/07/2023] Open
Abstract
Abstract Pancreatic neuroendocrine neoplasms (P-NENs) are the second most common solid pancreatic neoplasms. P-NENs have a wide range of imaging features presentations and they can be detected with typical and atypical imaging presentations. Typical and atypical appearances can be explained by pathologic correlations. P-NENs are generally hypervascular lesions, showing a typical enhancement behavior after contrast media injection during imaging methods, but they could also have different imaging features, creating some difficulty in differential diagnosis. For this reason, radiologists should be aware of different imaging presentations of these neoplasms. Radiological evaluation has a critical role in P-NENs identification, characterization, and staging of these neoplasms, especially in those cases in which surgery is the treatment of choice. The present paper shows, indicating the underlying pathologic correlations, typical and atypical presentations of NENs. Key Points • P-NENs have a wide range of imaging features presentations, typical and atypical. • Pathology could help in better understanding the typical P-NENs appearance at imaging. • P-NENs are generally hypervascular lesions. • Radiological evaluation has a critical role in P-NENs identification and management. • Radiologists should know every type of different imaging presentation of P-NENs to better diagnose these kinds of lesions.
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Affiliation(s)
- Valentina Ciaravino
- Department of Radiology, University Hospital G.B. Rossi, University of Verona, Verona, Italy. .,Department of Radiology, Hospital Morgagni Pierantoni, Via Carlo Forlanini 4, 47121, Forlì, FC, Italy.
| | - Riccardo De Robertis
- Department of Radiology, Hospital "Casa di Cura Dott. Pederzoli", Peschiera del Garda, Verona, Italy
| | - Paolo Tinazzi Martini
- Department of Radiology, Hospital "Casa di Cura Dott. Pederzoli", Peschiera del Garda, Verona, Italy
| | - Nicolò Cardobi
- Department of Radiology, Hospital "Casa di Cura Dott. Pederzoli", Peschiera del Garda, Verona, Italy
| | - Sara Cingarlini
- Department of Oncology, University Hospital G.B. Rossi, University of Verona, Verona, Italy
| | - Antonio Amodio
- Department of Gastroenterology, University Hospital G.B. Rossi, University of Verona, Verona, Italy
| | - Luca Landoni
- Department of Surgery, University Hospital G.B. Rossi, University of Verona, Verona, Italy
| | - Paola Capelli
- Department of Pathology, University Hospital G.B. Rossi, University of Verona, Verona, Italy
| | - Mirko D'Onofrio
- Department of Radiology, University Hospital G.B. Rossi, University of Verona, Verona, Italy
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18
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Gianotti L, Besselink MG, Sandini M, Hackert T, Conlon K, Gerritsen A, Griffin O, Fingerhut A, Probst P, Abu Hilal M, Marchegiani G, Nappo G, Zerbi A, Amodio A, Perinel J, Adham M, Raimondo M, Asbun HJ, Sato A, Takaori K, Shrikhande SV, Del Chiaro M, Bockhorn M, Izbicki JR, Dervenis C, Charnley RM, Martignoni ME, Friess H, de Pretis N, Radenkovic D, Montorsi M, Sarr MG, Vollmer CM, Frulloni L, Büchler MW, Bassi C. Nutritional support and therapy in pancreatic surgery: A position paper of the International Study Group on Pancreatic Surgery (ISGPS). Surgery 2018; 164:1035-1048. [PMID: 30029989 DOI: 10.1016/j.surg.2018.05.040] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal nutritional therapy in the field of pancreatic surgery is still debated. METHODS An international panel of recognized pancreatic surgeons and pancreatologists decided that the topic of nutritional support was of importance in pancreatic surgery. Thus, they reviewed the best contemporary literature and worked to develop a position paper to provide evidence supporting the integration of appropriate nutritional support into the overall management of patients undergoing pancreatic resection. Strength of recommendation and quality of evidence were based on the approach of the grading of recommendations assessment, development and evaluation Working Group. RESULTS The measurement of nutritional status should be part of routine preoperative assessment because malnutrition is a recognized risk factor for surgery-related complications. In addition to patient's weight loss and body mass index, measurement of sarcopenia and sarcopenic obesity should be considered in the preoperative evaluation because they are strong predictors of poor short-term and long-term outcomes. The available data do not show any definitive nutritional advantages for one specific type of gastrointestinal reconstruction technique after pancreatoduodenectomy over the others. Postoperative early resumption of oral intake is safe and should be encouraged within enhanced recovery protocols, but in the case of severe postoperative complications or poor tolerance of oral food after the operation, supplementary artificial nutrition should be started at once. At present, there is not enough evidence to show the benefit of avoiding oral intake in clinically stable patients who are complicated by a clinically irrelevant postoperative pancreatic fistula (a so-called biochemical leak), while special caution should be given to feeding patients with clinically relevant postoperative pancreatic fistula orally. When an artificial nutritional support is needed, enteral nutrition is preferred whenever possible over parenteral nutrition. After the operation, regardless of the type of pancreatic resection or technique of reconstruction, patients should be monitored carefully to assess for the presence of endocrine and exocrine pancreatic insufficiency. Although fecal elastase-1 is the most readily available clinical test for detection of pancreatic exocrine insufficiency, its sensitivity and specificity are low. Pancreatic enzyme replacement therapy should be initiated routinely after pancreatoduodenectomy and in patients with locally advanced disease and continued for at least 6 months after surgery, because untreated pancreatic exocrine insufficiency may result in severe nutritional derangement. CONCLUSION The importance of this position paper is the consensus reached on the topic. Concentrating on nutritional support and therapy is of utmost value in pancreatic surgery for both short- and long-term outcomes.
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Affiliation(s)
- Luca Gianotti
- School of Medicine and Surgery, University of Milan-Bicocca, and Department of Surgery, San Gerardo Hospital, Monza, Italy.
| | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marta Sandini
- School of Medicine and Surgery, University of Milan-Bicocca, and Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Thilo Hackert
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - Kevin Conlon
- Department of Surgery, Trinity College Dublin, Tallaght Hospital, Dublin, Ireland
| | - Arja Gerritsen
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Oonagh Griffin
- Department of Surgery, Trinity College Dublin, Tallaght Hospital, Dublin, Ireland
| | - Abe Fingerhut
- University of Graz Hospital, Surgical Research Unit, Graz, Austria
| | - Pascal Probst
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | | | - Giovanni Marchegiani
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Gennaro Nappo
- Pancreatic Surgery Unit, Humanitas University, Humanitas Research Hospital, Milan, Italy
| | - Alessandro Zerbi
- Pancreatic Surgery Unit, Humanitas University, Humanitas Research Hospital, Milan, Italy
| | - Antonio Amodio
- Unit of Gastroenterology, University of Verona Hospital Trust, Verona, Italy
| | - Julie Perinel
- Department of Digestive Surgery, E. Herriot Hospital, Hospices Civils de Lyon, Lyon-Sud Faculty of Medicine, Lyon, France
| | - Mustapha Adham
- Department of Digestive Surgery, E. Herriot Hospital, Hospices Civils de Lyon, Lyon-Sud Faculty of Medicine, Lyon, France
| | - Massimo Raimondo
- Division of General Surgery, Department of Surgery, Mayo Clinic, Jacksonville, FL
| | - Horacio J Asbun
- Division of General Surgery, Department of Surgery, Mayo Clinic, Jacksonville, FL
| | - Asahi Sato
- Division of Hepatobiliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kyoichi Takaori
- Division of Hepatobiliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Marco Del Chiaro
- Pancreatic Surgery Unit - Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC) - Karolinska Institutet at Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Maximilian Bockhorn
- Department of General, Visceral and Thoracic-Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic-Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christos Dervenis
- University of Cyprus and Department of Surgical Oncology and HPB Surgery Metropolitan Hospital, Athens, Greece
| | - Richard M Charnley
- Department of HPB & Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Marc E Martignoni
- Department of Surgery, Klinikum rechts der Isar, Technische Universität, München, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technische Universität, München, Germany
| | | | - Dejan Radenkovic
- Clinic for Digestive Surgery, Clinical Center of Serbia and School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marco Montorsi
- Department of Surgery, Humanitas University, Humanitas Research Hospital, Milan, Italy
| | - Michael G Sarr
- Department of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, MN
| | - Charles M Vollmer
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Luca Frulloni
- Department of Medicine, University of Verona, Verona, Italy
| | - Markus W Büchler
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
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Abstract
Autoimmune Pancreatitis (AIP) is a peculiar form of pancreatitis different from all other type of pancreatitis ('one like no one pancreatitis') and characterized by a dramatic response to steroids. AIP can be classified histologically in type 1, included in a larger group of diseases named IgG4-related disease, and type 2. At imaging, AIP may involve all (diffuse form) or only a part (focal form) of the pancreatic gland. Areas covered: In this article, the clinical approach to diagnosis and different therapeutic strategies of this complicated disease are reviewed. Literature search was undertaken using PubMed database entering autoimmune pancreatitis [title] or IgG4-related diseases [title], and selecting the more relevant papers for diagnosis and therapy of AIP in clinical practice. We focus on diagnosis of AIP in focal and diffuse form, and how to achieve diagnosis for type 1 and type 2 AIP. We finally analyzed the different strategies proposed in induction of remission and maintenance therapy (long-term low-dose steroids, immunosuppressants or biologics). Expert commentary: The main issue in clinical practice is how to achieve the diagnosis. A second key point is how to prevent the disease relapse.
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Affiliation(s)
- Nicolò de Pretis
- a Department of Medicine, Pancreas Institute , University of Verona , Verona , Italy
| | - Antonio Amodio
- a Department of Medicine, Pancreas Institute , University of Verona , Verona , Italy
| | - Luca Frulloni
- a Department of Medicine, Pancreas Institute , University of Verona , Verona , Italy
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Abstract
Aims and background We investigated the efficacy and tolerability of two doses of paclitaxel, 175 mg/m2 and 135 mg/m2, over a 3-hr infusion, without prophylactic G-CSF, in heavily pretreated patients with anthracycline-resistant breast cancer. Although paclitaxel may share with anthracyclines a common mechanism of drug resistance, there is evidence that the two drugs are not completely cross resistant. Methods From July 1994 to January 1996, 42 patients were treated every 3 weeks, for a maximum of 6 cycles; paclitaxel dose was established according to pretreatment extension. Results In 41 assessable patients we observed 9 partial responses, for an overall response rate of 22% (95% CI, 10–34%). There was no difference in response rate between the two dose levels. Median duration of response was 9 months, median time to progression 5 months, and median survival 9 months. The dose-limiting toxicity was neutropenia, which was grade 3–4 in 40% (135 mg/m2) and 62% (175 mg/m2) of the patients (P = 0.28); neutropenic fever occurred in 24% of the patients, without significant differences between the two dose levels. Other toxicity was mild to moderate. Conclusions Paclitaxel at doses of 175 mg/m2 or 135 mg/m2 is active and well tolerated in advanced breast cancer patients resistant to anthracyclines. The prophylactic use of colony-stimulating factors seems appropriate in heavily pretreated patients given the higher dose level.
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Affiliation(s)
- P Vici
- II Department of Medical Oncology, Regina Elena Institute for Cancer Research, Rome, Italy
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21
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Crinò SF, Conti Bellocchi MC, Bernardoni L, Manfrin E, Parisi A, Amodio A, De Pretis N, Frulloni L, Gabbrielli A. Diagnostic yield of EUS-FNA of small (≤15 mm) solid pancreatic lesions using a 25-gauge needle. Hepatobiliary Pancreat Dis Int 2018; 17:70-74. [PMID: 29428108 DOI: 10.1016/j.hbpd.2018.01.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/22/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Early detection of small solid pancreatic lesions is increasingly common. To date, few and contradictory data have been published about the relationship between lesion size and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) diagnostic yield. The aim of this study was to assess the relation between the size of solid pancreatic lesions and the diagnostic yield of EUS-FNA using a 25-gauge needle in a center without available rapid on-site evaluation. METHODS In the retrospective cohort study, we selected patients who underwent EUS-FNA for solid pancreatic lesions with a 25-gauge needle from October 2014 to October 2015. Patients were divided into three groups (≤15 mm, 16-25 mm and >25 mm), and the outcomes were compared. RESULTS We analyzed 163 patients. Overall adequacy, sensitivity, specificity and accuracy were 85.2%, 81.8%, 93.7%, and 80.4%, respectively. When stratified by size, the sensitivity and accuracy correlated with size (P = 0.016 and P = 0.042, respectively). Multivariate analysis showed that lesion size was the only independent factor (P = 0.019, OR = 4.76) affecting accuracy. The role of size as an independent factor affecting accuracy was confirmed in a separate multivariate analysis, where size was included in the model as a covariate (P = 0.018, OR = 1.08). CONCLUSION Our study demonstrates that, in the absence of rapid on-site evaluation, mass size affects the accuracy of EUS-FNA of solid pancreatic lesions.
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Affiliation(s)
- Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, G.B. Rossi University Hospital, 11 P.le L.A. Scuro 10, Verona 37134, Italy.
| | - Maria Cristina Conti Bellocchi
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, G.B. Rossi University Hospital, 11 P.le L.A. Scuro 10, Verona 37134, Italy
| | - Laura Bernardoni
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, G.B. Rossi University Hospital, 11 P.le L.A. Scuro 10, Verona 37134, Italy
| | - Erminia Manfrin
- Department of Pathology, University of Verona, G.B. Rossi University Hospital, 11 P.le L.A. Scuro 10, Verona 37134, Italy
| | - Alice Parisi
- Department of Pathology, University of Verona, G.B. Rossi University Hospital, 11 P.le L.A. Scuro 10, Verona 37134, Italy
| | - Antonio Amodio
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, G.B. Rossi University Hospital, 11 P.le L.A. Scuro 10, Verona 37134, Italy
| | - Nicolò De Pretis
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, G.B. Rossi University Hospital, 11 P.le L.A. Scuro 10, Verona 37134, Italy
| | - Luca Frulloni
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, G.B. Rossi University Hospital, 11 P.le L.A. Scuro 10, Verona 37134, Italy
| | - Armando Gabbrielli
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, G.B. Rossi University Hospital, 11 P.le L.A. Scuro 10, Verona 37134, Italy
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22
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de Pretis N, Amodio A, Frulloni L. Hypertriglyceridemic pancreatitis: Epidemiology, pathophysiology and clinical management. United European Gastroenterol J 2018; 6:649-655. [PMID: 30083325 DOI: 10.1177/2050640618755002] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/26/2017] [Indexed: 12/12/2022] Open
Abstract
Hypertriglyceridemic pancreatitis (HTGP) typically occurs in patients with an underlying dyslipidemia (such as type I, IV or V dyslipidemia) and in the presence of a secondary condition, such as inadequately controlled diabetes, excess alcohol consumption or medication use. Although the symptoms of HTGP are similar to those of acute pancreatitis from other etiologies, HTGP is often associated with greater clinical severity and rate of complications. Therefore, accurate diagnosis of HTGP is essential so that patients receive the appropriate treatment. Novel therapies that aim to reduce the incidence of pancreatitis in this patient population are now available or in development. Understanding the etiology, pathophysiology and clinical characteristics of HTGP will enable future development of therapeutic agents to treat HTGP.
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Affiliation(s)
| | - Antonio Amodio
- Department of Medicine, University of Verona, Verona, Italy
| | - Luca Frulloni
- Department of Medicine, University of Verona, Verona, Italy
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23
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Bernardoni L, Crinò SF, De Conti G, Conti Bellocchi MC, De Pretis N, Amodio A, Frulloni L, Gabbrielli A. Preliminary experience with pancreatic sphincterotomy as treatment for intraductal papillary mucinous neoplasm-associated recurrent pancreatitis. Endosc Int Open 2017; 5:E1144-E1150. [PMID: 29124124 PMCID: PMC5677465 DOI: 10.1055/s-0043-119753] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/31/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Pancreatic intraductal papillary mucinous neoplasms (IPMN) are cystic tumors of the pancreas characterized by a malignant potential. IPMN have been associated with recurrent pancreatitis (RP). Obstruction of the main pancreatic duct by thick mucus has been postulated to be the cause of pancreatitis. In a few isolated reports, pancreatic sphincterotomy (PS) has been reported to reduce the frequency of pancreatitis. The aim of this study was to assess the efficacy of PS in patients with IPMN-associated RP. PATIENTS AND METHODS We retrospectively identified patients with RP and IPMN who underwent PS from June 2010 to December 2015. Patients were included in two different groups: (a) main duct/mixed type IPMN (MD-IPMN) and (b) branch duct IPMN (BD-IPMN) with or without worrisome features/high risk stigmata. Other causes of RP were excluded. The number of pancreatitis episodes occurring during a comparable time period before and after PS was evaluated. RESULTS In total, 16 patients were analyzed (seven included in the MD-IPMN group and nine in the BD-IPMN group). The numbers of pancreatitis episodes occurring before and after PS were 3.5 ± 2.32 and 0.56 ± 1.03, respectively ( P < 0.0001). Mean follow-up was 27.4 months (range 6 - 63 months). Complete, partial (reduction of pancreatitis episodes > 50 %), and no response were obtained in 11 (68.7 %), 3 (18.7 %), and 2 patients (12.5 %), respectively. One (6.25 %) case of mild post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis was observed. No cancer was detected in resected patients. None of the BD-IPMN group patients had or developed worrisome features/high risk stigmata during follow-up. CONCLUSIONS PS seems to be effective in reducing the number of episodes of IPMN-associated pancreatitis and should be considered as a treatment option in selected clinical settings. However, active surveillance should be continued considering the malignant potential of IPMN. Further prospective controlled studies are needed to confirm our results.
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Affiliation(s)
- Laura Bernardoni
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, G.B. Rossi University Hospital, Verona, Italy
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, G.B. Rossi University Hospital, Verona, Italy,Corresponding author Stefano Francesco Crinò, MD Gastroenterology and Digestive Endoscopic UnitG.B. Rossi University HospitalP. le L.A. Scuro 10Verona – 37134Italy+39-45-8124898
| | - Giorgia De Conti
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, G.B. Rossi University Hospital, Verona, Italy
| | - Maria Cristina Conti Bellocchi
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, G.B. Rossi University Hospital, Verona, Italy
| | - Nicolò De Pretis
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, G.B. Rossi University Hospital, Verona, Italy
| | - Antonio Amodio
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, G.B. Rossi University Hospital, Verona, Italy
| | - Luca Frulloni
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, G.B. Rossi University Hospital, Verona, Italy
| | - Armando Gabbrielli
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, G.B. Rossi University Hospital, Verona, Italy
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Papa L, Amodio A, Biffi F, Mandara A. Impact of osteopathic therapy on proprioceptive balance and quality of life in patients with dizziness. J Bodyw Mov Ther 2017; 21:866-872. [PMID: 29037641 DOI: 10.1016/j.jbmt.2017.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/30/2017] [Accepted: 02/26/2017] [Indexed: 11/30/2022]
Abstract
The aim of the study was to evaluate the efficacy of osteopathic manipulative treatment (OMT) in patients with Benign-Paroxysmal-Positional Vertigo (BPPV). Thirty-one patients with BPPV were randomly assigned into two groups: 19 patients received osteopathic treatments (TG) and 12 patients received sham therapy (SG), both in four weekly sessions. Before the first and the last treatment, those patients were evaluated using Dizziness Handicap Inventory (DHI) and stabilometric platform to assess lifestyle modification and balance functions. After the treatment session, TG compared to SG showed an improvement in DHI global (p = 0.02), functional (p = 0.03) and physical (p = 0.03) components, as well as a reduction of swinging area (p = 0.02). An association between swinging area and lifestyle measures (global [r = 0.53; p = 0.02]; functional [r = 0.50; p = 0.03]; physical [r = 0.60; p = 0.01]) changes were found in TG. These findings suggest that OMT could be a useful approach to reduce imbalance symptoms and to improve the quality of life in patients suffering from dizziness.
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Affiliation(s)
- L Papa
- European Research Centre for Osteopathic Medicine, Italy; International College of Osteopathic Medicine, Cinisello Balsamo (Milan), Italy.
| | - A Amodio
- International College of Osteopathic Medicine, Cinisello Balsamo (Milan), Italy
| | - F Biffi
- International College of Osteopathic Medicine, Cinisello Balsamo (Milan), Italy
| | - A Mandara
- European Research Centre for Osteopathic Medicine, Italy; International College of Osteopathic Medicine, Cinisello Balsamo (Milan), Italy
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25
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Affiliation(s)
- Luca Frulloni
- Department of Medicine, Pancreas Institute, University of Verona, Verona, Italy
| | - Nicolò de Pretis
- Department of Medicine, Pancreas Institute, University of Verona, Verona, Italy
| | - Antonio Amodio
- Department of Medicine, Pancreas Institute, University of Verona, Verona, Italy
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Paiella S, Impellizzeri H, Zanolin E, Marchegiani G, Miotto M, Malpaga A, De Robertis R, D'Onofrio M, Rusev B, Capelli P, Cingarlini S, Butturini G, Davì MV, Amodio A, Bassi C, Scarpa A, Salvia R, Landoni L. Comparison of imaging-based and pathological dimensions in pancreatic neuroendocrine tumors. World J Gastroenterol 2017; 23:3092-3098. [PMID: 28533666 PMCID: PMC5423046 DOI: 10.3748/wjg.v23.i17.3092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/30/2017] [Accepted: 03/31/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To establish the ability of magnetic resonance (MR) and computer tomography (CT) to predict pathologic dimensions of pancreatic neuroendocrine tumors (PanNET) in a caseload of a tertiary referral center.
METHODS Patients submitted to surgery for PanNET at the Surgical Unit of the Pancreas Institute with at least 1 preoperative imaging examination (MR or CT scan) from January 2005 to December 2015 were included and data retrospectively collected. Exclusion criteria were: multifocal lesions, genetic syndromes, microadenomas or mixed tumors, metastatic disease and neoadjuvant therapy. Bland-Altman (BA) and Mountain-Plot (MP) statistics were used to compare size measured by each modality with the pathology size. Passing-Bablok (PB) regression analysis was used to check the agreement between MR and CT.
RESULTS Our study population consisted of 292 patients. Seventy-nine (27.1%) were functioning PanNET. The mean biases were 0.17 ± 7.99 mm, 1 ± 8.51 mm and 0.23 ± 9 mm, 1.2 ± 9.8 mm for MR and CT, considering the overall population and the subgroup of non-functioning- PanNET, respectively. Limits of agreement (LOA) included the vast majority of observations, indicating a good agreement between imaging and pathology. The MP further confirmed this finding and showed that the two methods are unbiased with respect to each other. Considering ≤ 2 cm non-functioning-PanNET, no statistical significance was found in the size estimation rate of MR and CT (P = 0.433). PBR analysis did not reveal significant differences between MR, CT and pathology.
CONCLUSION MR and CT scan are accurate and interchangeable imaging techniques in predicting pathologic dimensions of PanNET.
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de Pretis N, Amodio A, Bernardoni L, Campagnola P, Capuano F, Chari ST, Crinò S, Gabbrielli A, Massella A, Topazian M, Frulloni L. Azathioprine Maintenance Therapy to Prevent Relapses in Autoimmune Pancreatitis. Clin Transl Gastroenterol 2017; 8:e90. [PMID: 28448071 PMCID: PMC5543465 DOI: 10.1038/ctg.2017.17] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/11/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Steroids are used to induce remission in autoimmune pancreatitis (AIP). Low-dosage steroid therapy or immunosuppressant (IMs) has been proposed as maintenance therapy to prevent AIP relapse. Few and conflicting data have been published on the efficacy of azathioprine (AZA) in preventing AIP relapse. The aim of this study was to evaluate the indication and efficacy of AZA as maintenance therapy to prevent disease relapse in AIP. METHODS Patients suffering from AIP diagnosed according to the ICDC in type 1, type 2, and not otherwise specified (NOS) were divided in those treated with AZA (AZA+ group) as maintenance therapy and not treated with maintenance therapy (AZA- group). Exclusion criteria were: previous pancreatic surgery, other autoimmune diseases as indication for AZA treatment, and use of IMs different from AZA. Drug safety, clinical and instrumental outcome of AZA+ patients were evaluated. RESULTS A total of 23 patients (18 Males and 5 Females, mean age 54±11 years) in AZA+ group and 97 (58 Males and 39 Females, mean age 45±18 years) in AZA- group were compared. In AZA+ group, patients were significantly older (P=0.043), type 1 AIP was more frequently diagnosed (87 vs. 51%, P=0.006), sIgG4 higher (758±625 vs. 311±409 mg/dl, P<0.001), other organ involvement (OOI) more frequently observed (83 vs. 48%, P=0.002), with higher frequency of relapse before AZA treatment (78 vs. 14%, P<0.001). Three patients in AZA+ group required drug discontinuation because of adverse events. Twenty patients were therefore evaluated for outcome. Six out of 20 patients (30%) relapsed after 24±15 months (5 in pancreas and 1 on biliary tract). They were retreated with steroids and continued AZA. Two out of 6 patients (33%) had a second relapse,after respectively 11 months (in pancreas and kidney) and 22 months (in kidney). CONCLUSIONS AZA is an effective and safe treatment to prevent AIP relapses.
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Affiliation(s)
- Nicolò de Pretis
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Antonio Amodio
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Laura Bernardoni
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Pietro Campagnola
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Fabiana Capuano
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Suresh T Chari
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Stefano Crinò
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Armando Gabbrielli
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Arianna Massella
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Mark Topazian
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Luca Frulloni
- Gastroenterology Unit, Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
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Giordano GM, Koenig T, Mucci A, Vignapiano A, Amodio A, Di Lorenzo G, Niolu C, Altamura M, Bellomo A, Galderisi S. Electrophysiological Correlates of Negative Symptom Domains in Schizophrenia. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionNegative symptoms are a core feature of schizophrenia but their pathophysiology remains elusive. They cluster in a motivation-related domain, including apathy, anhedonia, asociality and in an expression-related domain, including alogia and blunted affect.AimOur aim was to investigate the different neurobiological underpinnings of the two domains using the brain electrical microstates (MS), which reflect global patterns of functional connectivity with high temporal resolution.MethodWe recorded multichannel resting EEGs in 142 schizophrenia patients (SCZ) and in 64 healthy controls (HC), recruited to the Italian network for research on psychoses study. Four microstates (MS) classes were computed from resting EEG data using the K-Mean clustering algorithm. Pearson's coefficient was used to investigate correlations of microstates measures with negative symptom domains, assessed by the Brief Negative Symptoms Scale (BNSS).ResultsSCZ, in comparison to HC, showed increased contribution and duration of MS-C. Only the avolition domain of BNSS correlated with the contribution and occurrence of MS-A. Within the same domain, anticipatory anhedonia, apathy and asociality, but not consummatory anhedonia, were positively correlated with contribution and occurrence of microstate A. Asociality was also negatively correlated with contribution and occurrence of MS-D.ConclusionOur findings support different neurobiological underpinnings of the negative symptom domains, avolition and expressive deficit. Furthermore, our results lend support to the hypothesis that only anticipatory anhedonia is linked to the avolition domain of the negative symptoms. Mixed results in the literature concerning the presence of MS-A and D abnormalities in schizophrenia might be related to the syndrome heterogeneity.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Vignapiano A, Koenig T, Mucci A, Giordano GM, Amodio A, Di Lorenzo G, Niolu C, Altamura M, Bellomo A, Galderisi S. Disorganization in Schizophrenia: A Resting EEG Study. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IntroductionIn subjects with schizophrenia (SCZ), the disorganization factor was found to be a strong predictor of real-life functioning. “Conceptual disorganization” (P2), “difficulties in abstract thinking” (N5) and “poor attention” (G11) are considered core aspects of the disorganization factor, as assessed by PANSS. The overlap of these items with neurocognitive functions is debated and should be further investigated.AimsWithin the Italian network for research on psychoses study, electrophysiological and neurocognitive correlates of the disorganization factor and its component items were investigated.MethodsResting state EEGs were recorded in 145 stabilized SCZ and 69 matched healthy controls (HC). Spectral amplitude (SAmp) was averaged in nine frequency bands. MATRICS consensus cognitive battery (MCCB) was used for neurocognitive assessment. Band SAmp differences and correlations with psychopathology and MCCB scores were explored by global randomization statistics.ResultsSCZ showed increased delta, theta, and beta1 and decreased alpha2 SAmp. A negative correlation between alpha1 and disorganization was observed in SCZ. At the item level, only N5 showed this correlation. MCCB neurocognitive composite was associated with P2 and N5 but not with alpha1 SAmp.ConclusionsOur findings suggest an heterogeneity of the disorganization dimension and a partial overlap with neurocognitive domains. The N5, “difficulties in abstract thinking”, had a unique association with alpha1 SAmp, which is thought to be involved in the formation of conceptual maps.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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30
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Crinò SF, Bernardoni L, Conti Bellocchi MC, Malleo G, Manfredi R, Breoni I, Amodio A, Frulloni L, Gabbrielli A. Efficacy of Endoscopic Minor Papilla Sphincterotomy for Symptomatic Santorinicele. Clin Gastroenterol Hepatol 2017; 15:303-306. [PMID: 27521510 DOI: 10.1016/j.cgh.2016.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Santorinicele, a rare focal cystic dilation of the distal portion of the dorsal pancreatic duct at the minor papilla, can be a cause of recurrent acute pancreatitis (RAP). Endoscopic minor papilla sphincterotomy (EMPS) has been evaluated as a treatment in case reports but never systematically investigated. METHODS We performed a retrospective analysis of the efficacy of EMPS in reducing episodes of pancreatitis. We collected data on 30 patients with santorinicele and RAP who underwent EMPS from June 2009 through April 2015 at University Hospital of Verona in Italy. The mean follow-up period was 43.8 months. RESULTS The average number of pancreatitis episodes per year before EMPS was 1.59 vs 0.18 episodes after EMPS; the average number of pancreatitis cases that occurred during a comparable time period before EMPS was 2.63 vs 0.67 cases after EMPS (P < .0001). Complete responses to EMPS (no recurrence of pancreatitis) were reported for 80% of patients. Six patients relapsed after a mean time of 16 months. Five patients were found to have a potential cause of RAP beyond santorinicele (2 patients had post-sphincterotomy stenosis, 1 patient was a chronic consumer of alcohol, 1 patient had a mutation in the CFTR gene, and 1 patient had a side-branch intraductal papillary mucinous neoplasm). CONCLUSIONS EMPS is effective in reducing the incidence of pancreatitis in patients with santorinicele.
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Affiliation(s)
- Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University of Verona, G. B. Rossi University Hospital, Verona, Italy.
| | - Laura Bernardoni
- Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University of Verona, G. B. Rossi University Hospital, Verona, Italy
| | - Maria Cristina Conti Bellocchi
- Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University of Verona, G. B. Rossi University Hospital, Verona, Italy
| | - Giuseppe Malleo
- Unit of General and Pancreatic Surgery, Pancreas Institute, University of Verona, G. B. Rossi University Hospital, Verona, Italy
| | - Riccardo Manfredi
- Department of Radiology, Pancreas Institute, University of Verona, G. B. Rossi University Hospital, Verona, Italy
| | - Irene Breoni
- Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University of Verona, G. B. Rossi University Hospital, Verona, Italy
| | - Antonio Amodio
- Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University of Verona, G. B. Rossi University Hospital, Verona, Italy
| | - Luca Frulloni
- Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University of Verona, G. B. Rossi University Hospital, Verona, Italy
| | - Armando Gabbrielli
- Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University of Verona, G. B. Rossi University Hospital, Verona, Italy
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31
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Frulloni L, Amodio A. Endoscopic ultrasonography in chronic asymptomatic pancreatic hyperenzymemia: The more we see, the less we know. Dig Liver Dis 2017; 49:232-233. [PMID: 28034665 DOI: 10.1016/j.dld.2016.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 11/17/2016] [Accepted: 11/18/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Luca Frulloni
- Department of Medicine, Pancreas Institute, University of Verona, Verona, Italy.
| | - Antonio Amodio
- Department of Medicine, Pancreas Institute, University of Verona, Verona, Italy
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Abstract
The fiduciary nature of the patient-physician relationship requires clinicians to act in the best interest of their patients. Patients are vulnerable due to their health status and lack of medical knowledge, which makes them dependent on the clinicians' expertise. Competent patients, however, may reject the recommendations of their physician, either refusing beneficial medical interventions or procedures based on their personal views that do not match the perceived medical indication. In some instances, the patients' refusal may jeopardize their health or life but also compromise the clinician's moral responsibility to promote the patient's best interests. In other words, health professionals have to deal with patients whose behavior and healthcare decisions seem counterproductive for their health, or even deteriorate it, because of lack of knowledge, bad habits or bias without being the patients' free voluntary choice. The moral dilemma centers on issues surrounding the limits of the patient's autonomy (rights) and the clinician's role to promote the well-being of the patient (duties). In this paper we argue that (1) the use of manipulative strategies, albeit considered beneficent, defeats the purpose of patient education and therefore should be rejected; and (2) the appropriate strategy is to empower patients through patient education which enhances their autonomy and encourages them to become full healthcare partners as opposed to objects of clinical intervention or entities whose values or attitudes need to be shaped and changed through education. First, we provide a working definition of the concept of patient education and a brief historical overview of its origin. Second, we examine the nature of the patient-physician relationship in order to delineate its boundaries, essential for understanding the role of education in the clinical context. Third, we argue that patient education should promote self-rebiasing, enhance autonomy, and empower patients to determine their therapeutic goals. Finally, we develop a moral framework for patient education.
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Affiliation(s)
- Fabrice Jotterand
- Department of Health Care Ethics, Regis University, Denver, CO, USA.
- Institute of Biomedical Ethics, University of Basel, Basel, Switzerland.
| | | | - Bernice S Elger
- Institute of Biomedical Ethics, University of Basel, Basel, Switzerland
- Center for Legal Medicine, University of Geneva, Geneva, Switzerland
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Alessandri G, Amodio A, Landoni L, De' Liguori Carino N, Bassi C. Recurrent acute pancreatitis in bowel malrotation. Eur Rev Med Pharmacol Sci 2016; 20:4719-4724. [PMID: 27906430] [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: 06/06/2023]
Abstract
OBJECTIVE Recurrent acute pancreatitis is an uncommon diagnosis in teenagers. Excluded alcohol and biliary stones, more prevalent aetiologies in these group of patients are genetic pancreatitis, pancreatic duct system abnormalities, neoplasia, traumas and congenital abnormalities of the duodenum such as duodenal duplication or diverticulum. Two reported cases of recurrent pancreatitis associated to midgut malrotation were described in English literature. Bowel malrotation is a difficult diagnosis in a teenager or a young adult and a common delay is documented. Ladd's procedure is largely recognized to be the standard treatment for a symptomatic malrotation. CASE REPORT Our Report describes in details a case of recurrent pancreatitis, where a late diagnosis of midgut malrotation was obtained and an endoscopic management was attempted. A literature review and an analysis of two previously reported cases were performed to explore a possible aetiopathogenesis of the recurrent acute pancreatitis in patients with midgut malrotation. RESULTS 24 months of follow-up showed an asymptomatic patient on a free diet, with a mild deranged Liver Functional Tests and a normal Amylase and Lipase. The recurrence of acute pancreatitis has not been observed until the present day. CONCLUSIONS Recurrent episodes of acute pancreatitis in young adults, without a history of alcohol abuse or evidence of gallstones, might be an atypical presentation of midgut malrotation and it should be in the differential diagnosis. In this case, a Ladd's operation is beneficial and an endoscopic procedure does not obtain advantages.
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Affiliation(s)
- G Alessandri
- HPB Unit, Department of Surgery, Manchester Royal Infirmary Hospital, Central Manchester Foundation Trust, Manchester, UK.
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34
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De Marchi G, Paiella S, Luchini C, Amodio A, Rusev B, Bassi C, Manfredi R, Frulloni L. A rare case of three different tumors in the same pancreatic specimen: a case report and brief review of the literature. J Gastrointest Oncol 2016; 7:E52-7. [PMID: 27284489 DOI: 10.21037/jgo.2016.01.04] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Solid pseudopapillary tumors (SPT) of the pancreas are rare neoplasms mainly affecting young women. Pancreatic serous cystadenomas (SCAs) and pancreatic neuroendocrine tumors (PanNETs) account for about 2% of all pancreatic neoplasms. The combination of these three lesions, to our knowledge, has never been described in literature. Here we report a case of combined SPT, SCA and PanNET affecting a 33-year-old woman.
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Affiliation(s)
- Giulia De Marchi
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Salvatore Paiella
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Claudio Luchini
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Antonio Amodio
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Borislav Rusev
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Claudio Bassi
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Riccardo Manfredi
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Frulloni
- 1 Department of Gastroenterology B, 2 Unit of General and Pancreatic Surgery, Department of Surgery and Pathology, 3 ARC-NET Applied Research on Cancer Center, Department of Pathology and Diagnostics, 4 Department of Radiology, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
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35
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Barba M, Pizzuti L, Conti L, Mandoj C, Digiesi G, Antenucci A, Sergi D, Di Lauro L, Amodio A, Carpano S, Sperati F, Valle M, Garofalo A, Vizza E, Vincenzoni C, Corrado G, Maugeri-Saccà M, Vici P. The impact of fasting glucose on clinical-pathological features in epithelial ovarian cancer: results from a historic cohort. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv339.07] [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: 11/13/2022] Open
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36
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Sánchez Castañón M, Zuliani V, Amodio A, Campagnola P, Granato A, Gabbrielli A, Benini L, López Hoyos M, Frulloni L. Role of Amylase-α2A Autoantibodies in the Diagnosis of Autoimmune Pancreatitis. Pancreas 2015; 44:1078-82. [PMID: 26335011 DOI: 10.1097/mpa.0000000000000417] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Several serological markers have been reported in autoimmune pancreatitis (AIP) patients. However, only serum IgG4 (sIgG4) is available in clinical practice for AIP diagnosis. Antiamylase α antibodies (AMY-α Abs) have been proposed to diagnose AIP. This study evaluates the utility of AMY-α Abs and sIgG4 for AIP diagnosis. METHODS Twenty-five AIP patients, 84 disease control groups (31 chronic pancreatitis, 30 acute pancreatitis, 23 pancreatic adenocarcinoma), and 59 healthy donors were prospectively studied. The AMY-α Abs were determined by homemade enzyme-linked immunosorbent assay and sIgG4 by nephelometry. RESULTS Increased sIgG4 were detected to be present in 52% of AIP, 5% in control groups, and 0% in healthy donors, and AMY-α Abs, respectively, in 76%, 36%, and 2%. sIgG4 was elevated in 92% of the 13 patients with type 1 AIP, but in none of 3 with type 2 and of 8 with not otherwise specified AIP. The AMY-α Abs were present in 79%, 67%, and 75% of type 1, type 2, and not otherwise specified AIP, respectively. Sensitivity and specificity of AMY-α Abs were 76% and 78%, and of sIgG4 50% and 94%. By combining the 2 serological markers, sensitivity was 41%, and specificity was 99%. CONCLUSIONS The AMY-α Abs may help to diagnosis of AIP and to differentiate AIP subtypes.
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Affiliation(s)
- María Sánchez Castañón
- From the *Immunology Service, Hospital Universitario Marqués de Valdecilla-IFIMAV, Santander, Spain; and †Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
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37
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Ikeura T, Manfredi R, Zamboni G, Negrelli R, Capelli P, Amodio A, Caliò A, Colletta G, Gabbrielli A, Benini L, Okazaki K, Vantini I, Frulloni L. Application of international consensus diagnostic criteria to an Italian series of autoimmune pancreatitis. United European Gastroenterol J 2014; 1:276-84. [PMID: 24917972 DOI: 10.1177/2050640613495196] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 05/21/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND International consensus diagnostic criteria (ICDC) have been proposed to classify autoimmune pancreatitis (AIP) in type 1, type 2, or not otherwise specified. OBJECTIVE Aim was to apply the ICDC to an Italian series of patients to evaluate the incidence and clinical profiles among different subtypes of AIP. METHODS we re-evaluated and classified 92 patients diagnosed by Verona criteria, according to the ICDC. RESULTS Out of 92 patients, 59 (64%) were diagnosed as type 1, 17 (18%) as type 2, and 15 (16%) as not otherwise specified according to the ICDC. A significant difference between type 1 and type 2 were found for age (54.5 ± 14.5 vs. 34.4 ± 13.9 respectively; p < 0.0001), male sex (76 vs. 47%; p = 0.007), jaundice (66 vs. 18%; p = 0.002) and acute pancreatitis (9 vs. 47%; p < 0.0001), elevated serum IgG4 levels (85 vs. 7%; p < 0.0001), inflammatory bowel disease (8 vs. 82%; < 0.0001), and relapse of the disease (34 vs. 6%; p = 0.058). Imaging and response to steroids in the not-otherwise-specified group were similar to type 1 and 2. CONCLUSIONS Type 1 has a different clinical profile from type 2 autoimmune pancreatitis. The not-otherwise-specified group has peculiar clinical features which are shared both with type 1 or type 2 groups.
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38
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Benini L, Amodio A, Campagnola P, Agugiaro F, Cristofori C, Micciolo R, Magro A, Gabbrielli A, Cabrini G, Moser L, Massella A, Vantini I, Frulloni L. Fecal elastase-1 is useful in the detection of steatorrhea in patients with pancreatic diseases but not after pancreatic resection. Pancreatology 2012; 13:38-42. [PMID: 23395568 DOI: 10.1016/j.pan.2012.11.307] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 10/18/2012] [Accepted: 11/11/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Fecal elastase-1(FE-1) has been suggested as an alternative to steatorrhea quantification to evaluate pancreatic insufficiency, but its diagnostic performance has not been compared with steatorrhea in chronic pancreatitis or after pancreatic resection. METHODS The relationship between steatorrhea and FE-1 was studied in patients with chronic pancreatic disorders or pancreatic resection. Student's t test and ANOVA were used for statistical analysis, accepting 0.05 as limit for significance. RESULTS Eighty-two patients were studied (42 non-operated; 40 previously submitted to pancreatic resection). Fat output was higher in operated than non-operated patients (29.2 ± 3.1 vs 9.9 ± 2.2 g/day, p < 0.001) FE-1 was more severely reduced in operated patients (202 ± 32.3 μg/g in non operated vs 68.6 ± 18.2 in operated patients; p < 0.001). Steatorrhea was significantly more severe in operated patients across different levels of FE-1. The relationship between FE-1 and steatorrhea was described by a power regression model, with a regression line significantly different in operated and non-operated patients (p < 0.001). A steatorrhea of 7 g (upper limit of normal range) was calculated by this regression line when FE-1 is 15 μg/g in non-operated, but as high as 225 μg/g in operated patients. CONCLUSION FE-1 is useful to identify pancreatic insufficiency. Steatorrhea is anticipated in non-operated patients only when FE-1 is below the limit for a confident measurement of our assay. In operated patients, steatorrhea may be present even if FE-1 is only slightly reduced, that suggests a role for non pancreatic factors. FE1 is not useful to identify operated patients at risk of malabsorption.
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Affiliation(s)
- Luigi Benini
- Gastroenterology Unit, Department of Medicine, University of Verona, Policlinico G.B. Rossi, Piazzale Scuro 10, 37134 Verona, Italy.
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39
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Frulloni L, Amodio A, Katsotourchi AM, Vantini I. A practical approach to the diagnosis of autoimmune pancreatitis. World J Gastroenterol 2011; 17:2076-9. [PMID: 21547125 PMCID: PMC3084391 DOI: 10.3748/wjg.v17.i16.2076] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 01/29/2011] [Accepted: 02/05/2011] [Indexed: 02/06/2023] Open
Abstract
Autoimmune pancreatitis is a disease characterized by specific pathological features, different from those of other forms of pancreatitis, that responds dramatically to steroid therapy. The pancreatic parenchyma may be diffusely or focally involved with the possibility of a low-density mass being present at imaging, mimicking pancreatic cancer. Clinically, the most relevant problems lie in the diagnosis of autoimmune pancreatitis and in distinguishing autoimmune pancreatitis from pancreatic cancer. Since in the presence of a pancreatic mass the probability of tumour is much higher than that of pancreatitis, the physician should be aware that in focal autoimmune pancreatitis the first step before using steroids is to exclude pancreatic adenocarcinoma. In this review, we briefly analyse the strategies to be followed for a correct diagnosis of autoimmune pancreatitis.
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40
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Frulloni L, Falconi M, Gabbrielli A, Gaia E, Graziani R, Pezzilli R, Uomo G, Andriulli A, Balzano G, Benini L, Calculli L, Campra D, Capurso G, Cavestro GM, De Angelis C, Ghezzo L, Manfredi R, Malesci A, Mariani A, Mutignani M, Ventrucci M, Zamboni G, Amodio A, Vantini I, Bassi C, Delle Fave G, Frulloni L, Vantini I, Falconi M, Frulloni L, Gabbrielli A, Graziani R, Pezzilli R, Capurso IV, Cavestro GM, De Angelis C, Falconi M, Gaia E, Ghezzo L, Gabbrielli A, Graziani R, Manfredi R, Malesci A, Mariani A, Mutignani M, Pezzilli R, Uomo G, Ventrucci M, Zamboni G, Vantini I, Magarini F, Albarello L, Alfieri S, Amodio A, Andriulli A, Anti M, Arcidiacono P, Baiocchi L, Balzano G, Benini L, Berretti D, Boraschi P, Buscarini E, Calculli L, Carroccio A, Campra D, Celebrano MR, Capurso G, Casadei R, Cavestro GM, Chilovi F, Conigliaro R, Dall'Oglio L, De Angelis C, De Boni M, De Pretis G, Di Priolo S, Di Sebastiano PL, Doglietto GB, Falconi M, Filauro M, Frieri G, Frulloni L, Fuini A, Gaia E, Ghezzo L, Gabbrielli A, Graziani R, Loriga P, Macarri G, Manes G, Manfredi R, Malesci A, Mariani A, Massucco P, Milani S, Mutignani M, Pasquali C, Pederzoli P, Pezzilli R, Pietrangeli M, Rocca R, Russello D, Siquini W, Traina M, Uomo G, Veneroni L, Ventrucci M, Zilli M, Zamboni G. Italian consensus guidelines for chronic pancreatitis. Dig Liver Dis 2010; 42 Suppl 6:S381-406. [PMID: 21078490 DOI: 10.1016/s1590-8658(10)60682-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This paper gives practical guidelines for diagnosis and treatment of chronic pancreatitis. Statements have been elaborated by working teams of experts, by searching for and analysing the literature, and submitted to a consensus process by using a Delphi modified procedure. The statements report recommendations on clinical and nutritional approach, assessment of pancreatic function, treatment of exocrine pancreatic failure and of secondary diabetes, treatment of pain and prevention of painful relapses. Moreover, the role of endoscopy in approaching pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications was considered. Recommendations for most appropriate use of various imaging techniques and of ultrasound endoscopy are reported. Finally, a group of recommendations are addressed to the surgical treatment, with definition of right indications, timing, most appropriate procedures and techniques in different clinical conditions and targets, and clinical and functional outcomes following surgery.
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Affiliation(s)
- Luca Frulloni
- Department of Medicine, University of Verona, Verona, Italy.
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Frulloni L, Scattolini C, Katsotourchi AM, Amodio A, Gabbrielli A, Zamboni G, Benini L, Vantini I. Exocrine and endocrine pancreatic function in 21 patients suffering from autoimmune pancreatitis before and after steroid treatment. Pancreatology 2010; 10:129-33. [PMID: 20460944 DOI: 10.1159/000265945] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 12/02/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM Autoimmune pancreatitis (AIP) responds rapidly and dramatically to steroid therapy. The aim of this study was to evaluate pancreatic exocrine and endocrine function in patients suffering from AIP both before and after steroid therapy. PATIENTS AND METHODS Fecal elastase 1 and diabetes were evaluated before steroid therapy and within 1 month of its suspension in 21 patients (13 males and 8 females, mean age 43 +/- 16.5 years) diagnosed as having AIP between 2006 and 2008. RESULTS At clinical onset, fecal elastase 1 was 107 +/- 126 microg/g stool. Thirteen patients (62%) showed severe pancreatic insufficiency (<100 microg/g stool), 4 (19%) had mild insufficiency (100-200 microg/g stool), while 4 (19%) had normal pancreatic function (>200 microg/g stool). Before steroids, diabetes was diagnosed in 5 patients (24%), all of whom had very low levels of fecal elastase 1 (<19 microg/g stool). Following steroids, fecal elastase 1 increased in all patients (237 +/- 193 microg/g stool) and observed levels were significantly higher than those seen before steroids (p = 0.001). CONCLUSIONS Patients suffering from AIP display exocrine and/or endocrine pancreatic insufficiency at clinical onset. These insufficiencies improve after steroid therapy.
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Affiliation(s)
- Luca Frulloni
- Department of Biomedical and Surgical Sciences, University of Verona, Verona, Italy.
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42
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Lopez M, Cauchi C, Sergi D, Amodio A, Paoletti G, Vici P, Di Lauro L. [Psyche and cancer]. Clin Ter 2010; 161:69-75. [PMID: 20393684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Although the relationship between psyche and cancer dates back many centuries, and several studies were conducted on this topic during the last decades, the role of psychological factors in the development of cancer is still controversial. Although a lot of factors have been considered, attention has been focused mainly on stress, which has been evaluated also in experimental models. Generally, the results of case-control studies have been contradictory, and at times more stressfull events have been recorded in patients with benign tumors than in those with cancer. On the contrary, a higher incidence of stress-related cancers has not been documented in cohort studies. Since cancer is a genetic disease, it is difficult to hypothesize that psychological factors may permanently alter nucleotide sequence giving rise to multiple mutations needed for cancer development. At present, there is no sufficient evidence to affirm that psychological factors may contribute without doubt to cancer development.
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Affiliation(s)
- M Lopez
- Istituto Nazionale Tumori, Regina Elena, Roma, Italia.
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43
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De Luca C, Vici P, Carpano S, Sergi D, Viola G, Corsetti S, Toglia G, Pinnarò P, Vizza E, Amodio A, Paoletti G, Lopez M. Recent advances in the adjuvant treatment of early breast cancer. Clin Ter 2009; 160:299-306. [PMID: 19795084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The majority of breast cancers are actually diagnosed at an early stage. Selection of the best treatment in the adjuvant setting represents a paramount step to reduce the risk of recurrence and cancer-specific mortality. At the present time decision making is based on individualized risk assessment, that takes into account patient and tumor clinical-pathological characteristics. New available tools, such as gene expression profiling, offer the potential to provide accurate prognostic and predictive information, but they require further validation. The present article provides an overview of current strategies in adjuvant breast cancer setting, and addresses a number of unresolved questions related to the role of taxanes, trastuzumab and hormonal treatment.
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Affiliation(s)
- C De Luca
- Istituto Nazionale Tumori Regina Elena, Roma, Italia
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Conti F, Perri P, Sperduti I, Amodio A, Carpano S, Foggi P, Anzà M, Giulia MD, Lopez M. High-dose CEF (cyclophosphamide, epirubicin, fluorouracil) as primary chemotherapy in locally advanced breast cancer: Long term survival data. EJC Suppl 2008. [DOI: 10.1016/j.ejcsup.2008.06.029] [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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45
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Fattoruso SIS, Di Lauro L, Conti F, Amodio A, Lopez M. [Target selectivity of anticancer drugs]. Clin Ter 2008; 159:189-206. [PMID: 18594750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Since the first use of chemotherapy, many efforts were devoted to develop drugs with a specific anticancer activity. Nevertheless, although several approaches to this end were used leading to significant results in cancer treatment, chemotherapy has mainly a palliative effect. The remarkable scientific advances in the knowledge of molecular changes in neoplastic diseases brought to development of new drugs with a specific molecular target. In some cases, this approach against a single molecular target, has been extremely successful, like imatinib in GIST. However, since in most cases tumor growth involves multiple genetic changes, it seems more appropriate to develop multitargeted agents. A successful way to improve target selectivity of anticancer drugs and to better choose patients to treat could be the use phase 0 clinical trials. In the future, the hope is to discover all genetic changes in each cancer patient and to restore the normal function of the cell with the aid of more advanced technologies.
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Conti F, Carpano S, Sergi D, Di Lauro L, Amodio A, Vici P, Abbate MI, Ferranti FR, Viola G, Botti C, Foggi P, Sperduti I, Lopez M. [High-dose CEF (cyclophosphamide, epirubicin, fluorouracil) as primary chemotherapy in locally advanced breast cancer: long-term results]. Clin Ter 2007; 158:331-341. [PMID: 17953285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE To determine wether primary CEF is effective in locally advanced breast cancer, as measured by response, local recurrences, disease free survival (DFS) and overall survival (OS). MATERIAL AND METHODS From 1990 to 1998, 62 patients with stage III disease were enrolled into a prospective study at Regina Elena Institute for Cancer Research, Rome. Inflammatory breast cancer (IBC) was included. Patients received three 21 days cycles of chemotherapy that consisted in epirubicin 50 mg/m2, cyclophosphamide 400 mg/m2, and fluorouracil 500 mg/m2 i.v. on days 1 and 8. G-CSF (300 microg) was given subcutaneously every other day from day 5 to day 17. After primary chemotherapy, whenever possible, mastectomy or conservative surgery was performed. Subsequently responding patients received the same regimen, while non responders were given a non cross resistant chemotherapy. In case of conservative surgery or initial T4 tumor radiation therapy was performed at the end of adjuvant chemotherapy. ER positive patients received tamoxifen 20 mg/d for five years. RESULTS Seven IIIA patients had a median OS of 43 months (C.I. 95%, 31-55) and DFS of 42 months (C.I. 95%, 16-68), while 15 IBC patients had a median OS of 52 months (C.I. 95%, 52-79) and DFS of 27 months (C.I. 95%, 14-39). Forty IIIB non inflammatory breast cancer patients had a median DFS of 87 months (C.I. 95%, 1-175); median OS was not reached. Ten-year OS was 28.6% for stage IIIA, 50.6% for stage IIIB and 36% for IBC. CONCLUSION Primary CEF appear to be an effective treatment. In our study we obtained a good local control and interesting long term data of disease free and overall survival.
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Affiliation(s)
- F Conti
- Divisione di Oncologia Medica B, Istituto Nazionale Tumori Regina Elena, Roma, Italia
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Itro A, Marra A, Urciuolo V, Difalco P, Amodio A. Oculodentodigital dysplasia. A case report. Minerva Stomatol 2005; 54:453-9. [PMID: 16211004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This report describes a rare case of oculodentodigital (ODD) dysplasia, an autosomic-dominant disease with alteration on the gene GJA1 of connexin 43 on the human chromosome 6q22-q23, highlighting the anomalies affecting face, eyes, teeth and limbs. The case described shows bilateral microphthalmia, microcornea, syndactyly and other phenotypic alterations characteristic of this syndrome, such as: nose of reduced size with hypoplasic wings, partial stenosis of the choanae, micrognathia, ogival palate and hypoplasia of the enamel. The authors emphasize the importance to know the principal features of ODD syndrome in order to make a correct diagnosis and the role of the dentist in the treatment of this pathology.
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Affiliation(s)
- A Itro
- Department of Head and Neck Pathology, Oral Cavity and Audio-Verbal Communication, Second University of Naples, Naples, Italy.
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48
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Foggi P, Amodio A. [Molecular therapy of breast carcinoma in the advanced phase]. Tumori 2003; 89:189-91. [PMID: 12903589] [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: 03/04/2023]
Abstract
Conventional chemotherapy regimens for the treatment of breast cancer have limited efficacy and are associated with significant toxicity, highlighting the need for novel targeted therapies. Increased expression and activation of receptor tyrosine kinases frequently occurs in human breast carcinomas and, therefore, several clinical trials are currently evaluating therapies targeting these receptors. Therapeutic strategies include blockade of individual receptors with monoclonal antibodies (e.g., trastuzumab) and inhibition of tyrosine kinase function (e.g., gefitinib). Trastuzumab is the first agent that has been approved for patients with human epidermal growth factor receptor 2 (HER2)-overexpressing breast cancer. Other growth-factor targeted drugs are in clinical development such as STI-571, farnesyl-transferase inhibitors and antibodies directed at the insulin-like growth factor.
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MESH Headings
- Alkyl and Aryl Transferases/antagonists & inhibitors
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Benzamides
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Enzyme Inhibitors/pharmacology
- Enzyme Inhibitors/therapeutic use
- ErbB Receptors/antagonists & inhibitors
- ErbB Receptors/immunology
- Farnesyltranstransferase
- Female
- Humans
- Imatinib Mesylate
- Insulin-Like Growth Factor Binding Proteins/antagonists & inhibitors
- Insulin-Like Growth Factor Binding Proteins/immunology
- Neoplasm Proteins/antagonists & inhibitors
- Neoplasm Proteins/immunology
- Piperazines/pharmacology
- Piperazines/therapeutic use
- Protein Prenylation/drug effects
- Protein Processing, Post-Translational/drug effects
- Proto-Oncogene Proteins c-kit/drug effects
- Pyrimidines/pharmacology
- Pyrimidines/therapeutic use
- Receptor, IGF Type 1/antagonists & inhibitors
- Receptor, IGF Type 1/immunology
- Receptor, IGF Type 2/antagonists & inhibitors
- Receptor, IGF Type 2/immunology
- Receptors, Platelet-Derived Growth Factor/antagonists & inhibitors
- Trastuzumab
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Giudice M, Marra A, Amodio A, Giudice A. [Unusual case of hypercondensing malignant osteodysplasty: osteopetrosis]. Minerva Stomatol 2001; 50:279-83. [PMID: 11573077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Osteopetrosis, known also as Albers-Schonberg disease, is a genetic disorder causing a generalized sclerosis of the bones and the reduction of the marrow. The diagnosis is often secondary to pathologic processes and its usually observed through specific X-ray researches. The principal cause of osteopetrosis is to attribute to a deficit of bone resorption and remodelling. Osteomyelitis is a complication of osteopetrosis. The purpose of this article is based on several point: 1) to know the cause of osteopetrosis, then to classify and check it; 2) to present the case who did not respond to of a patient with osteopetrosis complicated by maxillary and phalanx osteomyelitis common therapies and give an accurate analysis.
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Affiliation(s)
- M Giudice
- Facoltà di Medicina e Chirurgia, Dipartimento Assistenziale di Patologia della Testa e del Collo, Orale e Maxillo-Facciale, Cattedra di Pedodonzia Chirurgica, II Università degli Studi, Naples, Italy
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50
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Giudice M, Itro A, Marra A, Amodio A. [Pleomorphic adenoma of the parotid gland in childhood]. Minerva Stomatol 2001; 50:205-11. [PMID: 11535976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND The authors report the results of ten years' activity at the Pedodontic Surgery Unit in the Institute of Maxillofacial Surgery at the Second University of Naples and analyse the possibility of conservative treatment of pleomorphic adenoma in childhood. METHODS The study includes 614 cases of salivary gland pathology. The authors illustrate the epidemiological, clinical and therapeutic characteristics of this type of lesion in childhood, emphasising that the data emerging from this study do not differ from the clinical and therapeutic management of pleomorphic adenoma in young patients reported in the literature. RESULTS In particular, they emphasise that satisfactory therapeutic results can be achieved using conservative techniques, like conservative superficial parotidectomy. CONCLUSIONS Conservative superficial parotidectomy has the advantage of being less radical and traumatic for a young patient, without provoking a significant increase in recidivation.
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Affiliation(s)
- M Giudice
- Facoltà di Medicina e Chirurgia, Dipartimento Assistenziale di Patologia della Testa e del Collo, Orale e Maxillo-Facciale, Cattedra e Servizio di Pedodonzia Chirurgica, II Università degli Studi, Naples, Italy
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