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Copetti M, Baroni MG, Buzzetti R, Cavallo MG, Cossu E, D'Angelo P, Cosmo SD, Leonetti F, Morano S, Morviducci L, Napoli N, Prudente S, Pugliese G, Savino AF, Trischitta V. Validation in type 2 diabetes of a metabolomic signature of all-cause mortality. Diabetes Metab Res Rev 2024; 40:e3734. [PMID: 37839040 DOI: 10.1002/dmrr.3734] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/29/2023] [Accepted: 09/25/2023] [Indexed: 10/17/2023]
Abstract
CONTEXT Mortality in type 2 diabetes is twice that of the normoglycemic population. Unravelling biomarkers that identify high-risk patients for referral to the most aggressive and costly prevention strategies is needed. OBJECTIVE To validate in type 2 diabetes the association with all-cause mortality of a 14-metabolite score (14-MS) previously reported in the general population and whether this score can be used to improve well-established mortality prediction models. METHODS This is a sub-study consisting of 600 patients from the "Sapienza University Mortality and Morbidity Event Rate" (SUMMER) study in diabetes, a prospective multicentre investigation on all-cause mortality in patients with type 2 diabetes. Metabolic biomarkers were quantified from serum samples using high-throughput proton nuclear magnetic resonance metabolomics. RESULTS In type 2 diabetes, the 14-MS showed a significant (p < 0.0001) association with mortality, which was lower (p < 0.0001) than that reported in the general population. This difference was mainly due to two metabolites (histidine and ratio of polyunsaturated fatty acids to total fatty acids) with an effect size that was significantly (p = 0.01) lower in diabetes than in the general population. A parsimonious 12-MS (i.e. lacking the 2 metabolites mentioned above) improved patient discrimination and classification of two well-established mortality prediction models (p < 0.0001 for all measures). CONCLUSIONS The metabolomic signature of mortality in the general population is only partially effective in type 2 diabetes. Prediction markers developed and validated in the general population must be revalidated if they are to be used in patients with diabetes.
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Affiliation(s)
- Massimiliano Copetti
- Fondazione IRCCS Casa Sollievo della Sofferenza, Unit of Biostatistics, San Giovanni Rotondo, Italy
| | - Marco Giorgio Baroni
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences (MeSVA), University of L'Aquila, L'Aquila, Italy
- Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli, Italy
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Efiso Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Paola D'Angelo
- Department of Clinical Medicine and Health Service Integration, Diabetology and Nutrition Unit, Sandro Pertini Hospital - aslrm2, Rome, Italy
| | - Salvatore De Cosmo
- Department of Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Frida Leonetti
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Susanna Morano
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Lelio Morviducci
- Unit of Diabetology, Santo Spirito Hospital - ASL RM1, Rome, Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-medico University of Rome, Rome, Italy
| | - Sabrina Prudente
- Fondazione IRCCS Casa Sollievo della Sofferenza, Research Unit of Metabolic and Cardiovascular diseases, San Giovanni Rotondo, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonio Fernando Savino
- Fondazione IRCCS Casa Sollievo della Sofferenza, Laboratory of Clinical Chemistry, San Giovanni Rotondo, Italy
| | - Vincenzo Trischitta
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- Fondazione IRCCS Casa Sollievo della Sofferenza, Research Unit of Diabetes and Endocrine Diseases, San Giovanni Rotondo, Italy
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Salis F, Cossu E, Mandas A. The multidimensional prognostic index (MPI) predicts long-term mortality in old type 2 diabetes mellitus patients: a 13-year follow-up study. J Endocrinol Invest 2024; 47:191-200. [PMID: 37332086 PMCID: PMC10776747 DOI: 10.1007/s40618-023-02135-y] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE The Multidimensional Prognostic Index (MPI) is a tool capable of holistically frame older patients in different settings and affected by different pathologies, establishing a risk of adverse events. Among them, type 2 diabetes mellitus (T2DM), a common metabolic disease in the elderly, is responsible for complications and deaths. Few previous works have focused specifically on MPI and DM, and none have followed up the patients for more than 3 years. The aim of the present study is to analyze MPI accuracy in predicting mortality in a cohort of T2DM patients followed-up for 13 years. METHODS The enrolled subjects were evaluated with MPI, identifying three levels of risk: MPI1 (low risk, 0.0-0.33), MPI2 (moderate risk, 0.34-0.66), and MPI3 (severe risk, 0.67-1.0), and with glycated hemoglobin, and years since T2DM diagnosis. RESULTS One hundred and seven patients met the inclusion criteria. MPI3 was excluded by further analysis since it was made up of only three patients. Overall, cognitive performances, autonomies in daily living, nutritional status, risk of pressure injuries, comorbidities, and taken drugs were better (p ≤ 0.0077) in MPI1 than MPI2; moreover, the story of T2DM was shorter (p = 0.0026). Cox model showed an overall 13-year survival of 51.9%, and survival rates were significantly smaller in MPI2 (HR: 4.71, p = 0.0007). Finally, increased age (HR: 1.15), poorer cognitive abilities (HR: 1.26), vascular (HR: 2.15), and kidney (HR: 2.17) diseases were independently associated with death. CONCLUSION Our results prove that MPI predicts short-, mid-, and even long-term mortality in T2DM patients, whose death seems to be related to age and cognitive status, and even more to vascular and kidney diseases.
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Affiliation(s)
- F Salis
- Department of Medical Sciences, and Public Health, University of Cagliari, SS 554 bivio Sestu, 09042, Monserrato, Cagliari, Italy.
| | - E Cossu
- University Hospital "Azienda Ospedaliero-Universitaria" of Cagliari, Cagliari, Italy
| | - A Mandas
- Department of Medical Sciences, and Public Health, University of Cagliari, SS 554 bivio Sestu, 09042, Monserrato, Cagliari, Italy
- University Hospital "Azienda Ospedaliero-Universitaria" of Cagliari, Cagliari, Italy
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Barchetta I, Dule S, Bertoccini L, Cimini FA, Sentinelli F, Bailetti D, Marini G, Barbonetti A, Loche S, Cossu E, Cavallo MG, Baroni MG. The single-point insulin sensitivity estimator (SPISE) index is a strong predictor of abnormal glucose metabolism in overweight/obese children: a long-term follow-up study. J Endocrinol Invest 2022; 45:43-51. [PMID: 34142364 PMCID: PMC8741725 DOI: 10.1007/s40618-021-01612-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/07/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate the relationship between the single-point insulin sensitivity estimator (SPISE) index, an insulin sensitivity indicator validated in adolescents and adults, and metabolic profile in overweight/obese children, and to evaluate whether basal SPISE is predictive of impaired glucose regulation (IGR) development later in life. METHODS The SPISE index (= 600 × HDL0.185/Triglycerides0.2 × BMI1.338) was calculated in 909 overweight/obese children undergoing metabolic evaluations at University of Cagliari, Italy, and in 99 normal-weight, age-, sex-comparable children, selected as a reference group, together with other insulin-derived indicators of insulin sensitivity/resistance. 200 overweight/obese children were followed-up for 6.5 [3.5-10] years, data were used for longitudinal retrospective investigations. RESULTS At baseline, 96/909 (11%) overweight/obese children had IGR; in this subgroup, SPISE was significantly lower than in normo-glycaemic youths (6.3 ± 1.7 vs. 7 ± 1.6, p < 0.001). The SPISE index correlated positively with the insulin sensitivity index (ISI) and the disposition index (DI), negatively with age, blood pressure, HOMA-IR, basal and 120 min blood glucose and insulin (all p values < 0.001). A correlation between SPISE, HOMA-IR and ISI was also reported in normal-weight children. At the 6.5-year follow-up, lower basal SPISE-but not ISI or HOMA-IR-was an independent predictor of IGR development (OR = 3.89(1.65-9.13), p = 0.002; AUROC: 0.82(0.72-0.92), p < 0.001). CONCLUSION In children, low SPISE index is significantly associated with metabolic abnormalities and predicts the development of IGR in life.
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Affiliation(s)
- I Barchetta
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Dule
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - L Bertoccini
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - F A Cimini
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - F Sentinelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - D Bailetti
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences (MeSVA), University of L'Aquila, L'Aquila, Italy
| | - G Marini
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - A Barbonetti
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences (MeSVA), University of L'Aquila, L'Aquila, Italy
| | - S Loche
- Pediatric Endocrine Unit, Ospedale Pediatrico Microcitemico "A. Cao", Cagliari, Italy
| | - E Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - M G Cavallo
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M G Baroni
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences (MeSVA), University of L'Aquila, L'Aquila, Italy.
- Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli, IS, Italy.
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Bertoccini L, Sentinelli F, Incani M, Bailetti D, Cimini FA, Barchetta I, Lenzi A, Cavallo MG, Cossu E, Baroni MG. Circulating miRNA-375 levels are increased in autoantibodies-positive first-degree relatives of type 1 diabetes patients. Acta Diabetol 2019; 56:707-710. [PMID: 30759280 DOI: 10.1007/s00592-019-01297-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/02/2019] [Indexed: 12/22/2022]
Affiliation(s)
- L Bertoccini
- Endocrinology and Diabetes, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - F Sentinelli
- Endocrinology and Diabetes, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M Incani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - D Bailetti
- Endocrinology and Diabetes, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - F A Cimini
- Endocrinology and Diabetes, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - I Barchetta
- Endocrinology and Diabetes, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Lenzi
- Endocrinology and Diabetes, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M G Cavallo
- Endocrinology and Diabetes, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - E Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - M G Baroni
- Endocrinology and Diabetes, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
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Cossu E, Castellani F, Fiaschetti V, Mariateresa M, Tiziana R, Angelo T. Abstract P5-01-02: Glandular dose in contrast-enhanced dual-energy mammography. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-01-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
INTRODUCTION
Estimation of the Average Glandular Dose (AGD) absorbed by the breast during x-ray based examination is an established part of quality control procedures for breast imaging, both for standard mammography and new techniques as digital breast tomosynthesis (DBT) and contrast enhanced digital mammography (CEDM). It is however fundamental that every optimization program obtains an adequate imaging quality. In our study we evaluated the AGD absorbed by the breast, during CEDM examinations, performed with Dual Energy (DE) technique in our Department.
MATERIALS AND METHODS
We retrospectively evaluated 37 DE mammograms; we reported and analyzed AGD, Entrance Skin Exposure (ESE), anode/filter combinations, breast thickness, kV (kilovolt), mAs (milliAmpere per second), and compression in daN (decaNewton) values, for each mammography view obtained on high and low energy. In 10 Patients, it was possible to compare DE with a recent standard mammography performed on the same mammography unit.
RESULTS
AGD values for the entire DE study, in craniocaudal and mediolateral oblique views, resulted between 4.23 mGy and 13.44 mGy; based on the breast thickness (27-79 mm) and on the anod/filter combination. We found out a significantly lower AGD for small breast thicknesses and Mo/Rh and Mo/Cu combination compared to Rh/Rh and Rh/Cu.
In the whole study evaluation, the AGD percentage report due to low and high energy acquisitions resulted between 76.8% and 81.6%, and between 18.4% and 23.2%, respectively.
For the 10 Patients in which was possible a direct comparison with the data obtained with recent standard mammography, resulted a ratio between DE AGD and standard mammography AGD variable from 1.43 to 2.48 (mean value: 2.0), again with lower AGD values obtained with Mo/Rh - Mo/Cu combination and for small breast thicknesses.
AGD ratio between low energy and standard mammography acquisition resulted between 1.23 and 3.31.
DISCUSSION
CEDM is proving to have all the potential to get a definite role in diagnosis and breast tumor staging, providing a direct correlation between morphologic and functional imaging.
In our study we assessed the dosimetry to determine if an additional x-ray exposure will be a limit to DE use and, if that is the case, in which measure. Data in the literature on DE dosimetry are still spare and extremely heterogenous.
In any case, the increase of delivered dose could be justifiable when compared to the great benefits given by this technique in breast cancer early diagnosis and staging, especially in dense breast tissue, in the follow-up of Patients with breast cancer history and in case of MRI incompatibility.
Furthermore, when compared to MRI, CEDM is an easy-access, low-cost, fast and well accepted exam by the patient.
CONCLUSIONS
Although the risk of induced carcinogenesis associated with x-ray breast modalities is small, dosimetric aspects should be considered both for the risk evaluation and for optimization of acquisition systems; with the advance of the technologies we will be able to have a dose reduction by maintaining high quality standards.
Results obtained from this preliminary study needs to be extended by a larger case study to get a complete evaluation and comprehension of the phenomenon.
Citation Format: Cossu E, Castellani F, Fiaschetti V, Mariateresa M, Tiziana R, Angelo T. Glandular dose in contrast-enhanced dual-energy mammography [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-01-02.
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Affiliation(s)
- E Cossu
- Fondazione Policlinico Tor Vergata, Rome, Italy; Università degli Studi di Ferrara, Ferrara, Italy
| | - F Castellani
- Fondazione Policlinico Tor Vergata, Rome, Italy; Università degli Studi di Ferrara, Ferrara, Italy
| | - V Fiaschetti
- Fondazione Policlinico Tor Vergata, Rome, Italy; Università degli Studi di Ferrara, Ferrara, Italy
| | - M Mariateresa
- Fondazione Policlinico Tor Vergata, Rome, Italy; Università degli Studi di Ferrara, Ferrara, Italy
| | - R Tiziana
- Fondazione Policlinico Tor Vergata, Rome, Italy; Università degli Studi di Ferrara, Ferrara, Italy
| | - T Angelo
- Fondazione Policlinico Tor Vergata, Rome, Italy; Università degli Studi di Ferrara, Ferrara, Italy
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Bailetti D, Bertoccini L, Mancina RM, Barchetta I, Capoccia D, Cossu E, Pujia A, Lenzi A, Leonetti F, Cavallo MG, Romeo S, Baroni MG. ANGPTL4 gene E40K variation protects against obesity-associated dyslipidemia in participants with obesity. Obes Sci Pract 2019; 5:83-90. [PMID: 30820332 PMCID: PMC6381304 DOI: 10.1002/osp4.311] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/05/2018] [Accepted: 11/08/2018] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE ANGPTL4 inhibits lipoprotein lipase in adipose tissue, regulating plasma triglycerides levels. In persons with obesity plasma ANGPTL4 levels have been positively correlated with body fat mass, TG levels and low HDL. A loss-of-function E40K mutation in ANGPTL4 prevents LPL inhibition, resulting in lower TGs and higher HDLc in the general population. Since obesity determines metabolic alterations and consequently is a major risk factor for cardiovascular disease, the aim was to explore if obesity-related metabolic abnormalities are modified by the ANGPTL4-E40K mutation. METHODS ANGPTL4-E40K was screened in 1206 Italian participants, of which 863 (71.5%) with obesity. All subjects without diabetes underwent OGTT with calculation of indices of insulin-sensitivity. RESULTS Participants with obesity carrying the E40K variant had significantly lower TG (p = 0.001) and higher HDLc levels (p = 0.024). Also in the whole population low TGs and high HDLc were confirmed in E40K carriers. In the obese subpopulation it was observed that almost all E40K carriers were within the lowest quartile of TGs (p = 1.1 × 10-9). E40K had no substantial effect of on glucose metabolism. Finally, none of the obese E40K carriers had T2D, and together with the favourable lipid profile, they resemble a metabolically healthy obese (MHO) phenotype, compared to 38% of E40E wild-type obese that had diabetes and/or dyslipidaemia (p = 0.0106). CONCLUSIONS In participants with obesity the ANGPTL4-E40K variant protects against dyslipidemia. The phenotype of obese E40K carriers is that of a patient with obesity without metabolic alterations, similar to the phenotype described as metabolic healthy obesity.
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Affiliation(s)
- D. Bailetti
- Department of Experimental MedicineSapienza University of RomeItaly
| | - L. Bertoccini
- Department of Experimental MedicineSapienza University of RomeItaly
| | - R. M. Mancina
- Department of Molecular and Clinical MedicineUniversity of GothenburgSweden
| | - I. Barchetta
- Department of Experimental MedicineSapienza University of RomeItaly
| | - D. Capoccia
- Department of Experimental MedicineSapienza University of RomeItaly
| | - E. Cossu
- Department of Medical Sciences and Public HealthUniversity of CagliariItaly
| | - A. Pujia
- Department of Medical and Surgical Science, Nutrition UnitUniversity Magna Graecia of CatanzaroItaly
| | - A. Lenzi
- Department of Experimental MedicineSapienza University of RomeItaly
| | - F. Leonetti
- Department of Experimental MedicineSapienza University of RomeItaly
| | - M. G. Cavallo
- Department of Experimental MedicineSapienza University of RomeItaly
| | - S. Romeo
- Department of Molecular and Clinical MedicineUniversity of GothenburgSweden
- Department of Medical and Surgical Science, Nutrition UnitUniversity Magna Graecia of CatanzaroItaly
| | - M. G. Baroni
- Department of Experimental MedicineSapienza University of RomeItaly
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Cossu E, Incani M, Pani MG, Gattu G, Serafini C, Strazzera A, Bertoccini L, Cimini FA, Barchetta I, Cavallo MG, Baroni MG. Presence of diabetes-specific autoimmunity in women with gestational diabetes mellitus (GDM) predicts impaired glucose regulation at follow-up. J Endocrinol Invest 2018; 41:1061-1068. [PMID: 29340972 DOI: 10.1007/s40618-018-0830-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/08/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE Gestational diabetes mellitus (GDM) is the most frequent complication of pregnancy; around 10% of GDM cases may be determined by autoimmunity, and our aims were to establish the role of autoimmunity in a population of Sardinian women affected by GDM, to find predictive factors for autoimmune GDM, and to determine type 1 diabetes (T1D) auto-antibodies (Aabs) together with glucose tolerance after a mean 21.2 months of follow-up. METHODS We consecutively recruited 143 women affected by GDM and 60 without GDM; clinical data and pregnancy outcomes were obtained by outpatient visit or phone recall. T1D auto-antibodies GADA, IA2-A, IAA, ZnT8-A were measured in the whole population at baseline, and in the Aab-positive women at follow-up. RESULTS The overall prevalence of autoimmunity was 6.4% (13/203). No significant difference was found in the prevalence of auto-antibodies between GDM (5.6%) and control (8.3%) women, neither in antibody titres. Highest titres for GADA and ZnT8-A were observed in the control group; no phenotypic factors were predictive for autoimmune GDM. Diabetes-related autoantibodies were still present in all the GDM women at follow-up, and their presence was associated with a 2.65 (p < 0.0016) relative risk (RR) of glucose impairment. CONCLUSION We observed a low prevalence (5.6%) of diabetes-related autoimmunity in our GDM cohort, consistent with the prevalence reported in previous studies. It was not possible to uncover features predictive of autoimmune GDM. However, given the significant risk of a persistent impaired glycemic regulation at follow-up, it is advisable to control for glucose tolerance in GDM women with diabetes-related autoimmunity.
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Affiliation(s)
- E Cossu
- Endocrinology and Diabetes, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - M Incani
- Endocrinology and Diabetes, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - M G Pani
- Endocrinology and Diabetes, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - G Gattu
- Endocrinology and Diabetes, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - C Serafini
- Endocrinology and Diabetes, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - A Strazzera
- Endocrinology and Diabetes, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - L Bertoccini
- Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I, 00161, Rome, Italy
| | - F A Cimini
- Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I, 00161, Rome, Italy
| | - I Barchetta
- Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I, 00161, Rome, Italy
| | - M G Cavallo
- Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I, 00161, Rome, Italy
| | - M G Baroni
- Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I, 00161, Rome, Italy.
- Endocrinology and Diabetes, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
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Buonomo O, Granai AV, Felici A, Piccirillo R, De Liguori Carino N, Guadagni F, Polzoni M, Mariotti S, Cipriani C, Simonetti G, Cossu E, Schiaroli S, Altomare V, Cabassi A, Pernazza E, Casciani CU, Roselli M. Day-surgical Management of Ductal Carcinoma in Situ (Dcis) of the Breast Using Wide Local Excision with Sentinel Node Biopsy. Tumori 2018; 88:S48-9. [PMID: 12365390 DOI: 10.1177/030089160208800342] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- O Buonomo
- Department of Surgery, University of Tor Vergata, Rome, Italy.
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Cossu E, Costano E, Di Trapano R, Pensabene MC, Di Stefano C, Fosi S, Fiaschetti V, Portarena I, Buonomo O. Abstract PD2-17: Dual energy: Potentialities of contrast enhanced mammography in breast desease diagnosis and follow-up. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd2-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Contrast-enhanced Dual-Energy digital mammography (DE) is a recently
used investigation that consists in acquiring low and high energy images after
intravenous injection of iodinated contrast medium. The purpose of this study is to describe our experience about the role of DE in the diagnosis and follow-up of breast cancer.
Materials and Methods: 50 patients, with heterogeneous breast pattern, already studied
by mammography and ultrasound, were selected. They underwent DE mammography: 17
for mammographic or ultrasonographic suspicious findings (9/17 also examined with MRI), 21 for loco-regional staging (21/21 studied with MRI), 10 for oncologic follow-up (6/10 also underwent MRI). DE has been interrupted in two cases due to technical problems. Exclusion criteria of the study were: breast implants, pregnancy or lactation and contraindications to administration of contrast medium. DE results were compared with the post-operative or post-bioptical (Tru-cut or Vacuum Assisted Biopsy) histological findings.
Results: DE showed a sensitivity of 76% in evaluation of Patients with mammographic or ultrasonographic suspicious findings: in comparison with MRI (9 patients), DE had a 55 % specificity (vs 22% of MRI). In locoregional staging DE proved to be more accurate than MRI in dimensional evaluation of unifocal cancer: DE accuracy was 91% vs 62% of MRI, which overestimated the size of most of lesions. In the count of tumor foci number in case of multifocal/multicentric disease MRI corresponded in 9/11 cases with histology (vs 3/11 cases of DE). DE showed a sensitivity of 100% and a 85.7% specificity in assessing oncologic follow-up Patients: in the comparison between DE and MRI (6 patients), DE got 1 false positive result, while MRI 3.
Conclusion: DE can be a valuable diagnostic tool to help conventional techniques; it is also a possible alternative to MRI in some selected type of patients or where MRI is not available.
Citation Format: Cossu E, Costano E, Di Trapano R, Pensabene MC, Di Stefano C, Fosi S, Fiaschetti V, Portarena I, Buonomo O. Dual energy: Potentialities of contrast enhanced mammography in breast desease diagnosis and follow-up [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD2-17.
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Affiliation(s)
- E Cossu
- PTV Foundation, University of Rome Tor Vergata, Roma, Rome, Italy
| | - E Costano
- PTV Foundation, University of Rome Tor Vergata, Roma, Rome, Italy
| | - R Di Trapano
- PTV Foundation, University of Rome Tor Vergata, Roma, Rome, Italy
| | - MC Pensabene
- PTV Foundation, University of Rome Tor Vergata, Roma, Rome, Italy
| | - C Di Stefano
- PTV Foundation, University of Rome Tor Vergata, Roma, Rome, Italy
| | - S Fosi
- PTV Foundation, University of Rome Tor Vergata, Roma, Rome, Italy
| | - V Fiaschetti
- PTV Foundation, University of Rome Tor Vergata, Roma, Rome, Italy
| | - I Portarena
- PTV Foundation, University of Rome Tor Vergata, Roma, Rome, Italy
| | - O Buonomo
- PTV Foundation, University of Rome Tor Vergata, Roma, Rome, Italy
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10
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Incani M, Serafini C, Satta C, Perra L, Scano F, Frongia P, Ricciardi R, Ripoli C, Soro M, Strazzera A, Zampetti S, Buzzetti R, Cavallo MG, Cossu E, Baroni MG. High prevalence of diabetes-specific autoimmunity in first-degree relatives of Sardinian patients with type 1 diabetes. Diabetes Metab Res Rev 2017; 33. [PMID: 27726307 DOI: 10.1002/dmrr.2864] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 09/16/2016] [Accepted: 10/07/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND The incidence of type 1 diabetes mellitus (T1DM) in Sardinia is among the highest in the world (44.8 cases/100,000 person-years). Recommendations of the Immunology of Diabetes Society advise evaluating autoantibody positivity in first-degree relatives (FDRs) of patients with T1DM, for their higher risk to develop the disease. The aim of this study was to determine the prevalence of beta-cell autoimmunity in FDRs of T1DM patients in Sardinia. METHODS A total of 188 Sardinian families were recruited in collaboration between diabetes and pediatric units of university and district hospitals in Sardinia. The recruitment involved 188 patients with diagnosed T1DM and all their available FDRs (n = 447). Autoantibodies (Aabs) against GAD, IA2, insulin, and ZnT8 were measured in all subjects. Human leukocyte antigen (HLA) risk genotypes (HLA-DR and DQ loci) were analyzed in 43 Aabs-positive FDR. RESULTS The prevalence of Aabs (any type of autoantibody, single or multiple) in FDR was 11.9% (53/447). Of those with autoantibodies, 62.3% (33/53) were positive to only 1 autoantibody, 22.6% (12/53) had 2 autoantibodies, 7.55% (4/53) had 3 autoantibodies, and 7.55% (4/53) had all 4 autoantibodies. Typing of HLA-DR and DQ loci showed that 89% of FDR carried moderate- to high-risk genotypes, with only 5 FDR with low-risk genotypes. CONCLUSIONS The prevalence of T1DM autoantibodies in FDRs of T1DM patients was very high (11.9%) in the Sardinian population, higher than in other populations from the United States and Europe, and similar to that observed in Finland. Autoantibody positivity strongly associated with HLA risk. This study provides evidence of the high risk of T1DM in FDR of T1DM patients in Sardinia and warrants longitudinal follow-up to estimate the risk of progression to T1DM in high-risk populations.
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Affiliation(s)
- M Incani
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Italy
| | - C Serafini
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Italy
| | - C Satta
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Italy
| | - L Perra
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Italy
| | - F Scano
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Italy
| | - P Frongia
- Paediatric Unit, San Michele Hospital, Cagliari, Italy
| | - R Ricciardi
- Paediatric Unit, San Michele Hospital, Cagliari, Italy
| | - C Ripoli
- Diabetes Paediatric Unit, San Michele Hospital, Cagliari, Italy
| | - M Soro
- Paediatric Unit, San Martino Hospital, Oristano, Italy
| | - A Strazzera
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Italy
| | - S Zampetti
- Endocrinology, Department Experimental Medicine, Sapienza University of Rome, Italy
| | - R Buzzetti
- Endocrinology, Department Experimental Medicine, Sapienza University of Rome, Italy
| | - M G Cavallo
- Internal Medicine Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
| | - E Cossu
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Italy
| | - M G Baroni
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Italy
- Endocrinology, Department Experimental Medicine, Sapienza University of Rome, Italy
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11
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Sentinelli F, Bertoccini L, Barchetta I, Capoccia D, Incani M, Pani MG, Loche S, Angelico F, Arca M, Morini S, Manconi E, Lenzi A, Cossu E, Leonetti F, Baroni MG, Cavallo MG. The vitamin D receptor (VDR) gene rs11568820 variant is associated with type 2 diabetes and impaired insulin secretion in Italian adult subjects, and associates with increased cardio-metabolic risk in children. Nutr Metab Cardiovasc Dis 2016; 26:407-413. [PMID: 27052925 DOI: 10.1016/j.numecd.2016.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/30/2015] [Accepted: 02/01/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS 1α,25-dihydroxyvitamin-D3, the biologically active vitamin D, plays a central role in several metabolic pathways through the binding to the vitamin D receptor (VDR). VDR has been shown to be involved in cardiovascular diseases, cancer, autoimmunity and type 2 diabetes mellitus (T2DM). Several polymorphisms in the VDR gene have been described. Among these, the rs11568820 G-to-A nucleotide substitution was found to be functional, modulating the transcription of the VDR gene. Objective of this study was to perform an association study between rs11568820 polymorphism and T2DM in a cohort of Italian adults with T2DM and in non-diabetic controls. To add further insight into the role of VDR gene we explored whether this association begins early in life in overweight/obese children, or becomes manifest only in adulthood. METHODS AND RESULTS As many as 1788 adults and 878 children were genotyped for the rs11568820 polymorphism. All participants underwent oral glucose tolerance tests (OGTT), with measurement of glucose and insulin levels. Indices of insulin-resistance and secretion were also calculated. The AA genotype was significantly more frequent in adults with T2DM compared to controls (7.5% vs. 4.6%, P = 0.037), and conferred a higher risk of T2DM (ORHom = 1.69C.I. = [1.13-2.53], P = 0.011). In the adult cohort, rs11568820 was also associated with reduced indices of β-cell insulin secretion. In children, the AA genotype was associated with 2 h high-normal glucose, a marker of cardio-metabolic risk. CONCLUSIONS Our study demonstrates for the first time that VDR gene AA carriers have higher risk of T2DM and impaired insulin secretion. In children, the association between AA homozygous and high-normal 2h glucose suggests that mild alterations associated with this genotype may appear early in life.
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Affiliation(s)
- F Sentinelli
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - L Bertoccini
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - I Barchetta
- Internal Medicine Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
| | - D Capoccia
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - M Incani
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - M G Pani
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - S Loche
- Pediatric Endocrine Unit, Regional Hospital for Microcitemia, Cagliari, Italy
| | - F Angelico
- Internal Medicine Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
| | - M Arca
- Internal Medicine Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
| | - S Morini
- Human Anatomy, (CIR), University Campus Bio-Medico, Rome, Italy
| | - E Manconi
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - E Cossu
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - F Leonetti
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - M G Baroni
- Department of Experimental Medicine, Sapienza University of Rome, Italy; Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Cagliari, Italy.
| | - M G Cavallo
- Internal Medicine Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
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12
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Deiana V, Diana E, Pinna F, Atzeni M, Medda F, Manca D, Mascia E, Farci F, Ghiani M, Cau R, Tuveri M, Cossu E, Elena L, Mariotti S, Carpiniello B. Clinical features in insulin-treated diabetes with comorbid diabulimia, disordered eating behaviors and eating disorders. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.029] [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
Adherence to self-management and medication regimens is required to achieve blood glucose control in diabetic patients. Therefore, diabulimia, the deliberate insulin restriction/omission to lose weight, and other disordered eating behaviors (DEBs) or eating disorders (EDs), place these patients at risk of complications.We aimed to establish the frequency of diabulimia, DEBs and EDs among patients with type 1 and 2 diabetes (T1DM and T2DM) and their association with other clinical features.A total of 211 insulin-treated diabetic patients (13–55 years old) answered the Diabetes Eating Problem Survey-Revised (DEPS-R), a diabetes-specific screening tool for DEBs, and the Eating Disorders Inventory-3 (EDI-3). SCID-I modified according to DSM-5 criteria was used to diagnose EDs.At the DEPS-R, 20.8% of the sample scored above the cutoff, more frequently females (P = 0.005), patients with T1DM (P = 0.045), with a diagnosis of ED (P < 0.001), positive to the EDI-3 (P ≤ 0.001), with physical comorbidities (P = 0.003), with HbA1c > 7% (P = 0.020). Combining data from the interview with the results at the DEPS-R, 60.2% of the sample presented diabulimia. Dividing the sample by gender, we found that diabulimic females more frequently used diet pills (P = 0.006), had significantly higher HbA1c (P = 0.019) and STAI-Y1 scores (P = 0.004). Other DEBs comprised dietary restraint (51.8% of the sample), binge eating (42.2%), vomiting (6.2%), diet pills (7.1%) or laxatives (1.9%) or diuretics use (4.3%). Overall, 21.8% of the sample, mostly females (P < 0.001) met criteria for at least one DSM-5 diagnosis of ED.Diabetic patients, especially women, should be carefully monitored for the presence of diabulimia, BEDs and EDs.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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13
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Sentinelli F, La Cava V, Serpe R, Boi A, Incani M, Manconi E, Solinas A, Cossu E, Lenzi A, Baroni M. Positive effects of Nordic Walking on anthropometric and metabolic variables in women with type 2 diabetes mellitus. Sci Sports 2015. [DOI: 10.1016/j.scispo.2014.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Pisanu C, Cocco C, Cossu E, Baroni MG, Pigliaru F, Manetti L, Lupi I, Martino E, Mariotti S. Anterior pituitary autoantibodies in patients with type 1 diabetes mellitus: methodological problems and clinical correlations. J Endocrinol Invest 2014; 37:973-8. [PMID: 25070044 DOI: 10.1007/s40618-014-0135-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Anti-pituitary antibodies (APA) were described in patients with Type 1 Diabetes (T1D) but their prevalence and relevance remain controversial. MATERIALS AND METHODS We evaluated the APA prevalence in Sardinian sera from 100 T1D patients, 70 Type 2 Diabetes (T2D) patients and 62 healthy controls, using indirect immunofluorescence on bovine pituitary sections. To compare two different substrates, we tested using bovine sections, further T1D patient sera (n = 11, from Pisa) previously analysed for APA on monkey sections, while some T1D Sardinian patient sera (n = 22) were tested on monkey sections. According to preliminary experiments, positivity were considered ≥1:200 and ≥1:20 for bovine and monkey substrates, respectively. RESULTS AND DISCUSSION Using bovine sections, APA were detected in 7/100 Sardinian T1D patients (at 1:200 titer) and in none of the other Sardinian sera tested. When the T1D sera from Pisa were tested on bovine and the T1D Sardinian sera were tested on monkey, none of these sera showed corresponding positivity for APA. Pituitary hormone dysfunctions were not found in the 7 APA-positive Sardinian T1D patients. The present study shows that the presence of APA at low-titer is highly related to T1D but not associated with any pituitary dysfunction while the animal species used as substrate appears crucial. CONCLUSION Further studies are needed to ascertain whether APA detected by different animal species may have different pathological relevance in T1D and/or whether APA in the long run may predict future anterior pituitary dysfunction.
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Affiliation(s)
- C Pisanu
- Endocrinology and Diabetes Unit, Department of Medical Sciences and Azienda, Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
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15
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Fiaschetti V, Pistolese C, Funel V, Rascioni M, Claroni G, Della Gatta F, Cossu E, Perretta T, Simonetti G. Breast MRI artefacts: Evaluation and solutions in 630 consecutive patients. Clin Radiol 2013; 68:e601-8. [DOI: 10.1016/j.crad.2013.05.103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 05/10/2013] [Accepted: 05/24/2013] [Indexed: 01/20/2023]
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16
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Fiaschetti V, Salimbeni C, Gaspari E, Dembele GK, Bolacchi F, Cossu E, Pistolese C, Perretta T, Simonetti G. The role of second-look ultrasound of BIRADS-3 mammary lesions detected by breast MR imaging. Eur J Radiol 2012; 81:3178-84. [DOI: 10.1016/j.ejrad.2012.01.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 12/03/2011] [Accepted: 01/23/2012] [Indexed: 10/28/2022]
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Pistolese CA, Ciarrapico A, Perretta T, Cossu E, della Gatta F, Giura S, Caramanica C, Simonetti G. Cost-effectiveness of two breast biopsy procedures: surgical biopsy versus vacuum-assisted biopsy. Radiol Med 2011; 117:539-57. [PMID: 22020428 DOI: 10.1007/s11547-011-0735-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 02/21/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to compare the cost-effectiveness of two breast biopsy procedures: surgical biopsy and vacuum-assisted biopsy (VAB). MATERIALS AND METHODS Between November 2008 and September 2009, 200 patients with suspicious breast lesions underwent biopsy procedures at our radiology department: 100 underwent VAB and 100 underwent surgical biopsy. 66 lesions were sampled under sonographic guidance, 109 under mammographic guidance and 25 under magnetic resonance guidance. RESULTS All procedures were successfully completed. No significant differences in diagnostic efficacy were found between the biopsy procedures. Surgical biopsy has a higher unit cost compared with VAB. CONCLUSIONS Our analysis emphasises the benefits of VAB compared with surgical biopsy in terms of both cost-effectiveness, and less invasiveness from a psychological and aesthetic point of view.
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Affiliation(s)
- C A Pistolese
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Terapia Radiante, Università degli Studi di Roma Tor Vergata (PTV), Viale Oxford 81, 00133, Rome, Italy.
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18
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Pistolese CA, Perretta T, Cossu E, Della Gatta F, Giura S, Simonetti G. Value of the correct diagnostic pathway through conventional imaging (mammography and ultrasound) in evaluating breast disease. Radiol Med 2011; 116:584-94. [PMID: 21431300 DOI: 10.1007/s11547-011-0657-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE This study evaluated the role of the correct diagnostic pathway through conventional imaging in evaluating breast disease. MATERIALS AND METHODS Six hundred patients aged between 35 and 75 years were enrolled in the study. All patients underwent detailed history and clinical examination, ultrasound (US) and mammography. US scans were repeated after mammography. All suspicious lesions were studied by cytological and histological characterisation and magnetic resonance (MR) imaging. RESULTS The first US scan showed 147 solid lesions, 67 lesions characterised by posterior acoustic shadowing and 193 areas of heterogeneous echostructure. The second US scan, performed after mammography, confirmed 123/147 solid nodular lesions, 53/67 lesions characterised by posterior acoustic shadowing and 183/193 areas of heterogeneous echostructure; it also showed 13 nodular lesions not seen on the first scan and two cases of nodular lesions with irregular calcifications. CONCLUSIONS Our experience suggests that US not performed in conjunction with mammography gives rise to incorrect diagnostic interpretations (either false positive or false negative results). The detection rate of the US scan performed after mammography increases from 4.16% to 5.5%.
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Affiliation(s)
- C A Pistolese
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Terapia Radiante, Università degli studi di Roma Tor Vergata (PTV), Viale Oxford 81, 00133, Roma, Italy.
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19
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Incani M, Cambuli VM, Cavalot F, Congiu T, Paderi M, Sentinelli F, Romeo S, Poy P, Soro M, Pilia S, Loche S, Cossu E, Trovati M, Mariotti S, Baroni MG. Clinical application of best practice guidelines for the genetic diagnosis of MODY2 and MODY3. Diabet Med 2010; 27:1331-3. [PMID: 20950394 DOI: 10.1111/j.1464-5491.2010.03095.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Pistolese CA, Ciarrapico AM, Della Gatta F, Perretta T, Cossu E, Bolacchi F, Bonanno E, Simonetti G. Cost-effectiveness analysis of two vacuum-assisted breast biopsy systems: Mammotome and Vacora. Radiol Med 2009; 114:743-56. [PMID: 19484585 DOI: 10.1007/s11547-009-0404-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 08/07/2008] [Indexed: 11/29/2022]
Abstract
PURPOSE This study was undertaken to compare the cost effectiveness of two vacuum-assisted breast biopsy devices, the Mammotome and Vacora systems. MATERIALS AND METHODS Between January and June 2006, 238 vacuum-assisted breast biopsies were performed at our radiology department. Five out of 238 lesions were excluded because of inadequate sampling. The Mammotome system was used in 108/233 lesions and the Vacora system in 125/233. Fifty-eight lesions underwent ultrasound-guided breast biopsy, and 50 lesions underwent mammography-guided biopsy with both Mammotome and Vacora devices. Magnetic-resonance-guided biopsy was possible with the Vacora system only (17/125 lesions). RESULTS All procedures were successfully completed. No significant differences were found between the results of the Mammotome and Vacora biopsies in terms of effectiveness: sensitivity was 84.4% and 86.2%, respectively, and specificity 100%. In terms of cost, the Mammotome system has higher costs per procedure compared with the Vacora. CONCLUSIONS Our clinical results confirm the diagnostic accuracy of both the Mammotome and Vacora systems, whereas our cost analysis shows that there is a considerable difference, mostly related to the initial investment.
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Affiliation(s)
- C A Pistolese
- Imaging Diagnostics, Molecular Imaging, Interventional Radiology, and Radiation Therapy Department, University "Tor Vergata" (PTV), Rome, Italy.
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21
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Buonomo O, Orsaria P, Contino G, Varvaras D, Gioia A, Bonanno E, Pistolese C, Cossu E, Perretta T, Schillaci O, Del Monte G, Roselli M, Mineo TC, Petrella G. Pathological classification of DCIS and planning of therapeutic management. Anticancer Res 2009; 29:1499-1506. [PMID: 19443357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Ductal intraepitelial neoplasia (DIN) represents a spectrum of disease that may progress from usual hyperplasia to ductal carcinoma in situ (DCIS) grade 3. The aim of the study was to asses the correlation between the DIN classification and the surgical treatment including sentinel lymph node biopsy (SLNB). PATIENTS AND METHODS In this retrospective study, 229 patients with DIN had undergone conservative or radical surgical treatment and SLNB in cases of DIN1C-DIN3. RESULTS Breast conservative surgery was the definitive treatment in 80% of the cases. The H&E evaluation of excised sentinel nodes was negative for metastatic disease; nevertheless the immunohistochemical (IHC) evaluation revealed the presence of metastatic cells in 6 patients (3.7%). CONCLUSION In cases of DIN lesions SLNB is not indicated. The only reason SLNB should be considered is when there is an evidence of invasive foci at definitive histology or when radical mastectomy is proposed.
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Affiliation(s)
- O Buonomo
- Department of Surgery, Tor Vergata University, Rome, Italy.
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22
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Orlacchio A, Bolacchi F, Rotili A, Cossu E, Tanga I, Cozzolino V, Simonetti G. MR breast imaging : a comparative analysis of conventional and parallel imaging acquisition. Radiol Med 2008; 113:465-76. [DOI: 10.1007/s11547-008-0278-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Accepted: 09/06/2007] [Indexed: 10/22/2022]
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23
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Quaranta V, Manenti G, Bolacchi F, Cossu E, Pistolese CA, Buonomo OC, Carotenuto L, Piconi C, Simonetti G. FEM analysis of RF breast ablation: multiprobe versus cool-tip electrode. Anticancer Res 2007; 27:775-84. [PMID: 17465202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Radio-frequency ablation (RFA) has recently received much attention as an effective minimally invasive strategy for the local treatment of tumors. The purpose of this study was to evaluate the efficacy of single-needle cool-tip RF breast ablation in terms of temperature distribution and duration of the procedure as compared to multiprobe RF breast ablation. MATERIALS AND METHODS Two different commercially available radiofrequency ablation needle electrodes were compared. Finite-element method (FEM) models were developed to simulate the thermoablation procedures. A series of ex vivo radiofrequency thermal lesions were induced to check the response of the FEM calculations. RESULTS Data obtained from FEM models and from ex vivo procedures showed that cool-tip RF breast ablation assures better performances than multiprobe RF breast ablation in terms of temperature distribution and duration of the procedure. Histopathological analysis of the cool-tip RF thermoablated specimens showed successful induction of coagulation necrosis in the thermoablated specimens. CONCLUSION Data obtained from FEM models and from ex vivo procedures suggest that the proposed cool-tip RF breast ablation may kill more tumor cells in vivo with a single application than the multiprobe RF breast ablation.
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Affiliation(s)
- V Quaranta
- 1Tecnobiomedica S.p.A. Via Vaccareccia 41, 00040 Pomezia, Rome, Italy.
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Gasparro S, Savarese A, Maggi G, Sega FM, Caruso A, Ferranti F, Cossu E, Simonetti G, Crecco M, Cognetti F. Preliminary analysis of genetic counselling activity at Regina Elena Cancer Institute of Rome - Italy. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.8232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. Gasparro
- Regina Elena Cancer Institute, Rome, Italy; University of Rome Tor Vergata, Rome, Italy
| | - A. Savarese
- Regina Elena Cancer Institute, Rome, Italy; University of Rome Tor Vergata, Rome, Italy
| | - G. Maggi
- Regina Elena Cancer Institute, Rome, Italy; University of Rome Tor Vergata, Rome, Italy
| | - F. M. Sega
- Regina Elena Cancer Institute, Rome, Italy; University of Rome Tor Vergata, Rome, Italy
| | - A. Caruso
- Regina Elena Cancer Institute, Rome, Italy; University of Rome Tor Vergata, Rome, Italy
| | - F. Ferranti
- Regina Elena Cancer Institute, Rome, Italy; University of Rome Tor Vergata, Rome, Italy
| | - E. Cossu
- Regina Elena Cancer Institute, Rome, Italy; University of Rome Tor Vergata, Rome, Italy
| | - G. Simonetti
- Regina Elena Cancer Institute, Rome, Italy; University of Rome Tor Vergata, Rome, Italy
| | - M. Crecco
- Regina Elena Cancer Institute, Rome, Italy; University of Rome Tor Vergata, Rome, Italy
| | - F. Cognetti
- Regina Elena Cancer Institute, Rome, Italy; University of Rome Tor Vergata, Rome, Italy
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Buonomo O, Granai AV, Piccirillo R, Felici A, Muzi F, Cossu E, Marino B, Cipriani C, Roselli M, Simonetti G, Mineo TC. [Intraoperative radiolocalization of intraductal breast carcinoma: sentinel lymph node evaluation]. Tumori 2003; 89:177-8. [PMID: 12903584] [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
Sentinel lymph node biopsy and intraoperatory radiolocalization (RLI) are fast becoming the standard surgical treatment for invasive breast cancer. Actually, it seems, they have the same rule in "high risk" DCIS of the breast.
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Affiliation(s)
- O Buonomo
- Università Tor Vergata, Dipartimento di Chirurgia, Roma
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Cossu E, Fiaschetti V, Talamo M, Comes MS, Serafini G, Simonetti G. New technologies in breast MRI. J Exp Clin Cancer Res 2002; 21:59-64. [PMID: 12585656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- E Cossu
- Dept. of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy
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Buonomo O, Granai AV, Piccirillo R, Felici A, Cossu E, Cipriani C, Casciani CU, Roselli M. [Ductal carcinoma in situ (DCIS): an always present reality; which treatment? Role of sentinel lymph node]. Suppl Tumori 2002; 1:S65-8. [PMID: 12415792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Affiliation(s)
- O Buonomo
- Università di Roma Tor Vergata, Dipartimento di Chirurgia
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Maioli M, Tonolo G, Bekris L, Cirillo R, Schranz D, Cossu E, Ciccarese M, Lernmark A. GAD65 and IA-2 autoantibodies are common in a subset of siblings of Sardinian Type 2 diabetes families. Diabetes Res Clin Pract 2002; 56:41-7. [PMID: 11879720 DOI: 10.1016/s0168-8227(01)00348-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Type 1 diabetes in Sardinia is very common in children, and we hypothesized that Latent Autoimmune Diabetes of Adult (LADA) might constitute a significant proportion of diabetes in adult Sardinian subjects. Since Type 2 diabetes is a familial disorder, we tested this hypothesis by investigating the prevalence of GAD65 and IA-2 autoantibodies (Ab) in Type 2 diabetes multiplex families of Sardinian ancestry enrolled in the Study Group for the Genetics of Diabetes in Sardinia. METHODS A total of 684 individuals were ascertained from 252 Sardinian Type 2 diabetes multiplex families with 2.4 affected siblings per family comprising 190 families with two affected, 37 with three, 15 with four, 7 with five, and 3 with six, in addition to 80 unaffected siblings. Controls were household contacts representing 204 healthy spouses of affected siblings. Diagnosis was at 35-69 years of age and insulin was not given in the first 4 years after diagnosis. GAD65Ab and IA-2Ab were determined in standard radioligand binding assays. RESULTS Among affected siblings GAD65Ab were positive in 8.8% of insulin-treated (n = 137; P = 0.0006), in 2.5% of non-insulin-treated (n = 467), and in 1.2% of non-diabetic siblings (n = 80) compared with 0.5% of controls (n = 204). IA-2Ab was positive in 6.6% insulin-treated (P = 0.04), 2.1% non-insulin-treated, and 2.5% non-diabetic siblings compared with 1.5% of controls. CONCLUSION A high frequency of GAD65Ab and IA-2Ab as markers of Type 1 diabetes was found among Type 2 diabetes siblings from Sardinian multiplex families despite excluding those who had been treated with insulin during the first 4 years of disease. Our data support the hypothesis that LADA may be common in Sardinian Type 2 diabetes and stress the importance of investigating markers of Type 1 diabetes in studies of Type 2 diabetes.
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Affiliation(s)
- Mario Maioli
- Cattedra Malattie Metabolismo, Istituto di Clinica Medica, Viale S. Pietro 8, 07100, Sassari, Italy.
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29
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Buonomo O, Cabassi A, Guadagni F, Piazza A, Felici A, Piccirillo R, Atzei GP, Cipriani C, Schiaroli S, Mariotti S, Guazzaroni MN, Cossu E, Simonetti G, Pernazza E, Casciani CU, Roselli M. Radioguided-surgery of early breast lesions. Anticancer Res 2001; 21:2091-7. [PMID: 11501831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND Radioguided-surgery has been recently proposed in patients with clinically occult breast lesions. This study aimed to evaluate the feasibility of correctly locating and eradicating, by a single intralesional injection of a radiotracer, any breast lesion and, in the case of malignancy, to perform simultaneous sentinel lymph node (SLN) biopsy procedure. PATIENTS AND METHODS Sixty-three women with early breast lesions were enrolled: 42 were invasive carcinomas, 16 in situ ductal carcinomas (DCIS) and 5 fibroadenomas. RESULTS Scintigraphic images clearly identified the lesions in all patients while SLN/s were evident in 88% of them. At surgery all the breast lesions were easily radiolocalized and eradicated with minimum surgical trauma and, for those patients with invasive carcinomas, the SLN technique was performed in 86% of them. No skip metastases were found. CONCLUSION A single intralesional administration of radiotracer is an easy and reliable procedure to simultaneously locate and remove both the non-palpable breast lesion and the SLN when primary malignancy was intraoperatively confirmed.
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Affiliation(s)
- O Buonomo
- Clinical Surgery, University of Rome Tor Vergata, S. Eugenio Hospital, Italy
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Guazzaroni M, Cossu E, Danese V, Montanaro M, Simonetti G. [Use of SHU 508 A Levovist contrast media in the characterization of solid lesions of the breast]. Radiol Med 1998; 96:35-41. [PMID: 9819616] [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: 02/09/2023]
Abstract
INTRODUCTION We investigated the effectiveness of Levovist (SHU508A, Schering AG, Berlin, Germany) in the characterization of breast lesions. MATERIAL AND METHODS June, 1996, to May, 1997, we studied 29 solid lesions in 29 patients (aged 17 to 83 years); our patients were 28 women and 1 man. The 29 solid lesions were 20 carcinomas (15 infiltrating ductal carcinomas, 4 ductal carcinomas in situ, 1 lobular carcinoma in situ), 6 fibroadenomas, 1 suspected postoperative recurrence and 2 apparently benign lesions. We used parameters suitable for the study of slow flows. A single bolus of contrast agent (300 mg/mL) was administered at 1-2 mL/s. Before Levovist injection, we studied the lesion signal intensity and the number of vascular poles. After contrast administration we re-evaluated both these parameters and studied the changes or presence of vessels undetected on the previous images. We also investigated the beginning and duration of enhancement and the presence of vessels inside and outside the lesions. RESULTS We observed no signal enhancement in 17% of cases, mild enhancement in 7% and strong enhancement in 76% of cases. We found 3 more vascular poles (17%) in 5 lesions and 4 more poles in 3 lesions (10%). Increased vascularization was seen inside the lesion in 17% of cases, inside and outside it in 41% and only outside in 35% of cases. Carcinomas showed a rapid and long-lasting enhancement, while fibroadenomas showed a later and weaker enhancement. CONCLUSIONS Levovist can be useful in the differential diagnosis of benign from malignant lesions, of recurrences from postoperative fibrosis, as well as in the staging and follow-up of the patients treated with neoadjuvant chemotherapy.
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Affiliation(s)
- M Guazzaroni
- Istituto di Radiologia, Università degli Studi Tor Vergata, Ospedale S. Eugenio, ASL, Roma
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31
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Bottazzo GF, Loviselli A, Velluzzi F, Mariotti S, Cossu E, Cirillo R, Balestrieri A, Delitala G, Sepe V, Songini M. The "Sardinia-IDDM study": an attempt to unravel the cause of insulin-dependent diabetes mellitus in one of the countries with the highest incidence of the disease in the world. Ann Ist Super Sanita 1998; 33:417-24. [PMID: 9542274] [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: 02/07/2023]
Abstract
Sardinia and Finland have the highest incidence of IDDM in the world. Thus, both regions represent ideal observatories for investigating the environmental, genetic and immunological factors, which have led to this dramatic increase. We have concentrated our efforts in Sardinia. Among several projects, there is the mapping of the Island for hot and cold spots for overt IDDM. In order to map the Island for pre-IDDM, we have collected and bled around 10,000 school children (age 6-14 years) and we are now in the process to enroll around 30,000 newborn. We report here our initial results, which show that progression to IDDM is accompanied in both cohorts by the presence of a combination of ICA with either GAD and IA-2 antibodies or both. This approach should lead to design reliable models of IDDM prediction in the general population, which will benefit an early insulin treatment and, hopefully, an effective prevention of the disease.
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Affiliation(s)
- G F Bottazzo
- Department of Immunology, St Bartholomew's, London, United Kingdom
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Abstract
Early diagnosis of breast cancer plays the leading role in reducing mortality rates and improving the patients' prognosis: mammography is the most sensitive technique currently available for the detection of nonpalpable lesions and therefore the method of choice. However, mammography has some limitations and the technique must be improved with technological devices without affecting image quality. This could be the target to increase diagnostic accuracy. Mammography sensitivity and specificity are now improved with the digital computer assisted technique, teleradiology, digital tomosynthesis or digital angiography--used to study microvascularization--3D imaging or synchrotron light, and laser mammography. Such other technological devices as Mammospot reduce breast thickness and provide better breast compression. Digital mammography can be carried out with film or direct digitization. The advantages of the digital technique are a shorter examination time, less storage space, electronic image recording, with image 'adjustments' made by the radiologist, and especially computerized analysis. The computer aided diagnosis can be defined as the diagnosis made by the radiologist who considers the results of computerized analysis as a 'second opinion'. In this way incidental mistakes made by radiologists, can be corrected by the computer analysis. Computers are a basic element also in teleradiology, which needs immediate and simultaneous admittance to the patient's history and permits radiology optimization in rural areas too. As for tomosynthesis, it permits to study a single slice of the breast without glandular tissue overlapping, which is useful in dense breasts where the diagnosis can be made with a lower X-ray dose. Moreover, this method fits the current mammographic systems easily. 3D imaging is still a work in progress. Synchrotron mammography is used only on surgery specimens, where it exhibits high resolution and contrast, depicting structures and details missed by conventional mammography. Breast DSA allows the study of vessels < 0.20 mm in diameter and of fine microvascular details; it can also demonstrate neoangiogenesis. Laser mammography permits bilateral examinations of the breast in 10-15 mins and is currently used also for breast cancer therapy, although only in animal trials. To conclude, after reviewing new techniques and evaluating the real cost/benefit ratio for each of them, conventional mammography remains the most sensitive tool for breast cancer diagnosis.
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Affiliation(s)
- G Simonetti
- Radiology Institute, Tor Vergata University of Rome, S. Eugenio Hospital, Italy
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Bottazzo GF, Cossu E, Cirillo R, Loviselli A, Velluzzi F, Mariotti S, Balestrieri A, Delitala G, Sepe V, Songini M. Sardinia: a battlefield approach to type I diabetes epidemiology. Sardinia-IDDM Study Groups. Horm Res 1997; 48 Suppl 4:64-6. [PMID: 9350451 DOI: 10.1159/000191317] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Sardinia and Finland have the highest incidence of insulin-dependent diabetes mellitus (IDDM) in the world. Therefore, both regions represent ideal observatories for investigating the environmental, genetic and immunological factors which have led to this dramatic increase. We have concentrated our efforts on Sardinia. Among several projects, there is the mapping of the island for hot and cold spots for overt IDDM. In order to map the island for pre-IDDM, we have collected and bled around 10,000 school children (age 6-14 years) and we are now in the process of enrolling around 30,000 new-born babies. We report here our initial results, which show that progression to IDDM is accompanied in both cohorts by the presence of a combination of islet-cell antibodies with either glutamic acid decarboxylase or IA-2 antibodies or both. This approach should lead to the design of reliable models of IDDM prediction in the general population, which will benefit an early insulin treatment and, hopefully, an effective prevention of the disease.
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Affiliation(s)
- G F Bottazzo
- Department of Immunology, St Bartholomew's, London, UK.
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Maspes F, Innocenzi L, Ascoli Marchetti A, Cossu E, Squillaci E, Pistolese GR, Simonetti G. [Percutaneous transluminal angioplasty in the treatment of iliac stenosis. The authors' new guideline for 100 patients]. Radiol Med 1995; 90:772-80. [PMID: 8685462] [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: 02/01/2023]
Abstract
This retrospective study was carried out from January, 1990, to September, 1994, after reviewing a series of 100 patients submitted to 143 percutaneous maneuvers (PTA) for aortoiliac revascularization (PTA, PTA and stenting, PTA and bypass). This study was aimed at conforming as much as possible our patients selection criteria and the analysis of the results to the current standards adopted by the major interventional radiology and vascular surgery departments. The Fontaine and the SCVIR classification methods were used for patients selection. Long-term patency was analyzed with clinical and noninvasive diagnostic exams. The results were studied with the Life-table analysis statistical method. The patients were divided into 3 groups: the patients treated only with PTA, those treated with PTA and stenting and finally those submitted to PTA before or after a surgical bypass. The results were analyzed separately. In 95/100 patients the maneuver was technically successful and immediate clinical success was not achieved only in one of them. At the first follow-up we collected data on 87 patients; at 3 years we followed-up 30 patients, but only 5 of them had to be resubmitted to PTA (3 PTA and stenting and 2 PTA alone) because of restenosis. Secondary patency was obtained in 91% and 84% of patients at 1 year and 3 years, respectively. With the Life-table analysis, the cumulative patency rate was 95.44% at 36 months. Few complications were observed (11/100 patients), especially considering that they were classified as "severe" in 3 cases only. To conclude, our results prove PTA to be a highly effective tool in the aortoiliac arteries, whose low mortality and complication rates suggest the use of this percutaneous procedure.
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Affiliation(s)
- F Maspes
- Cattedra di Chirurgia Vascolare, Università di Roma Tor Vergata
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Abstract
PURPOSE To determine the feasibility of using synchrotron radiation (SR) in diagnostic mammography. MATERIALS AND METHODS Monochromatic SR of x-ray beams of selected energies of 14-20 keV were used to obtain mammograms of surgically removed breast specimens that contained tumor nodules. For comparison, conventional mammograms of the same specimens were also obtained. RESULTS The mammograms obtained with SR had higher contrast and better resolution than did traditional mammograms and demonstrated excellent detail in all cases studied. The mean glandular doses at 17 and 18 keV were 1.56 and 0.83 mGy, respectively, which is compatible with the mean value of 1.41 mGy delivered with the conventional grid apparatus. CONCLUSION SR mammography appears to be a promising diagnostic imaging technique.
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Affiliation(s)
- E Burattini
- National Institute for Nuclear Physics (INFN), Rome, Italy
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Loviselli A, Pisanu P, Cossu E, Caradonna A, Massa GM, Cirillo R, Balestrieri A. [Low levels of dehydroepiandrosterone sulfate in adult males with insulin-dependent diabetes mellitus]. MINERVA ENDOCRINOL 1994; 19:113-9. [PMID: 7799892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
UNLABELLED Studies on animals and humans have suggested that dehydroepiandrosterone sulphate (DHEAS) has antiatherogenic effects. It has been hypothesized that insulin may have an atherogenic role and it has been reported recently that, surprisingly, DHEAS levels decreased in normal men and women during the hyperinsulinemic-euglycemic technique. Since a hyperinsulinemia frequently occurs during insulin therapy in patients with insulin dependent diabetes mellitus (IDDM), the present work was undertaken to determine whether DHEAS serum concentrations were decreased in IDDM patients as compared to controls and if so, to discover the possible causes. To this, purpose, out of 805 outpatients afferent to our Diabetes Centre from 1989 to 1992, three groups were selected on the basis of the criteria described below. Known interferences with the DHEAS serum concentrations such as gender (all males), age (aged 20-40 years) and Body Mass Index (BMI < 30) were excluded. Group A (cross-sectional study) was made up of 15 IDDM patients on insulin treatment with good metabolic control (HbA1C < 8%); group B (control study) was made of 18 healthy subjects (these patients were selected also on the basis of their normal oral glucose tolerance test) and group C (longitudinal study) was made up of 7 IDDM patients who had been examined previously and who were on insulin treatment. METHODS In all three groups serum concentrations of DHEAS, 17 OH progesterone (17 OHP), delta 4 androstenedione (A4) and cortisol (F) were measured. In 10 patients from group A and in 9 patients from group B the ACTH test (9.25 mg IM Synacthen) was administered and the same hormonal pattern was measured after 60 min. In group C the same hormonal evaluation was performed 5 +/- 2.8 months after commencement of insulin therapy. RESULTS DHEAS serum concentrations were significantly decreased in group A (median 2.9; range 1.1-5.2 mumol/l) with respect to group B (median 5.7; range 3.0-9.5 mumol/l) (p < 0.0012). However, the serum concentrations of 17 OHP (median 3.9 nm/l; range 2.9-6.9 nm/l and A4 (median 5.2 nm/l; range 1.8-10.2 nm/l) were also significantly reduced, while cortisol levels and the 17 OHP/A4 ratio were comparable to group B. After administration of ACTH, the delta increment in cortisol percentage showed a frank increase (55.1%) in group A with respect to group B (33.1%) (p < 0.01). The rise in DHEAS showed a lower increase in group A (10.2%) with respect to group B (65.5%) even though not statistically significant, while the other hormones showed an overlap between the two groups. In group C the serum concentrations of hormones before insulin therapy did not show any statistical differences with respect to the values in group B. A second evaluation, which was performed during insulin therapy, showed that only the 17 OHP/A4 ratio tended towards higher values with respect to pretherapy values (1.1 and 0.6 respectively; p = 0.07). In conclusion our data confirm low DHEAS levels during chronic insulin administration therapy. The underlying mechanism could be a general aspecific reduction in the activity of P 450 C 21 SCC enzymes in contrast with the specific inhibition of 17.20-lyase obtained during insulin bolus. Whether the low serum concentrations of DHEAS can determine an atherogenic effect of insulin needs further investigation, but the hormone could constitute a new parameter for the follow-up of patients affected by diabetes mellitus.
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Affiliation(s)
- A Loviselli
- Istituto di Medicina Interna, Università degli Studi di Cagliari
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Bartalena L, Cossu E, Grasso L, Velluzzi F, Loviselli A, Cirillo R, Martino E. Relationship between nocturnal serum thyrotropin peak and metabolic control in diabetic patients. J Clin Endocrinol Metab 1993; 76:983-7. [PMID: 8473414 DOI: 10.1210/jcem.76.4.8473414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Circadian variations in serum TSH, especially its nocturnal rise, are often blunted in nonthyroidal illness. We analyzed TSH secretion in 15 diabetic patients (7 with type I and 8 with type II diabetes mellitus). Patients were evaluated when diabetes was poorly controlled (fasting blood glucose ranging from 13.7-19.2 mmol/L with absence of ketoacidosis) and after achieving glycemic control. Before correction of hyperglycemia, the nocturnal serum TSH peak (2230-0200 h) was abolished in 11 of 15 patients (73%); the mean (+/- SE) night TSH/morning TSH x 100 was 109.0 +/- 9.5 (range, 66.7-166.7) vs. a mean of 216.5 +/- 27.0 (range, 139.8-462.5) in normal controls. The mean morning TSH value in diabetics (1.9 +/- 0.4 mU/L) did not differ from that in normal age- and sex-matched controls. The mean TSH increase after iv administration of TRH was only slightly reduced (8.4 +/- 1.2 mU/L pretreatment vs. 10.8 +/- 1.6 mU/L posttreatment), with the TRH test blunted in 3 cases. No differences were found between type I and type II patients. Correction of hyperglycemia was associated with the reappearance of a nocturnal TSH peak in all but 1 patient (mean TSH peak, 198.2 +/- 13.0; P = NS vs. controls). This change paralleled the normalization of serum total T3 and rT3, which were reduced and increased, respectively, when diabetes was poorly controlled. An inverse relationship was found between serum fructosamine levels and the nocturnal TSH peak, suggesting that metabolic decompensation accounts for the abolishment of the latter.
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Affiliation(s)
- L Bartalena
- Istituto di Endocrinologia, University of Pisa, Italy
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Crecco M, Squillaci E, Cossu E, Vidiri A, Di Filippo F, Cavaliere R, Simonetti G. [The presurgical staging of soft-tissue sarcomas of the extremities: imaging diagnosis]. Radiol Med 1991; 82:741-50. [PMID: 1788425] [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: 12/28/2022]
Abstract
The authors studied 43 patients affected with soft tissue sarcomas to evaluate the accuracy of different imaging modalities in predicting resectability. Locations included lower (30) and upper (11) limbs, axillary (2) and gluteal (2) regions. MR imaging was performed on 37 patients, CT on 35 and US on 30. All patients were preliminarily subjected to conventional radiographic examination. MR imaging proved to be the most reliable modality because it allowed the lesion site to be correctly determined relative to both anatomical compartments and lesion spread; its relationships to joints and vascular structures were also depicted. Intravenous administration of Gd-DTPA (to 9 patients) allowed important information to be gained as to identifying and quantifying tumoral necrosis, and made it possible to discriminate tumoral component from perilesional edema. In our experience, CT was shown to overstage the T parameter--due to difficult distinction of edemigen component, even with a careful use of angio-CT. On the contrary, CT was the modality of choice in recognizing bone cortical infiltrations, even small ones, and in identifying pulmonary metastases. US played a role in the staging of these neoplasms thanks to its recognizing even small lesions and, in case of suspected vascular involvement, it allowed even small infiltrations of the vascular wall to be demonstrated.
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Affiliation(s)
- M Crecco
- Istituto di Radiologia, II Università di Roma Tor Vergata
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Simonetti G, Meloni GB, Puoti G, Conti M, Profili S, Cossu E, Gadeddu A. [Experience with more than 200 cases of breast biopsy after preoperative spatial localization without radiostereotaxic equipment]. Radiol Med 1991; 81:269-72. [PMID: 2014331] [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: 12/29/2022]
Abstract
The use of mammography as a screening examination has considerably increased our ability to detect non-palpable breast lesions less than 1 cm phi. A conclusive diagnosis frequently requires surgical biopsy. However, breast lesions can be localized prior to surgical biopsy by placing a wire in the lesion, with/without the use of stereotaxic equipment. Our method for lesion localization consisted in acquiring two orthogonal radiographs (cranio-caudal and latero-lateral) centered on the nipple. We used 20-21 G needles, 6-10 cm long, with curved-end wire. Mammographic findings possibly suggesting cancer were: microcalcifications, nodules, spiculated opacities, and architectural distortions. From January 1987 to January 1990, 223 patients were submitted to needle localization of breast lesions under mammographic guidance and without stereotaxic equipment. Sixty-seven cases (30%) were positive for malignancy, with a 2.3:1 benign/malignant ratio. Patients' age ranged 30-70 years, but most of them were 50-60 years old. No significant complications were observed: in one case only the hook wire broke, within breast parenchyma, which was at any rate resected together with the surgical specimen.
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Affiliation(s)
- G Simonetti
- Istituto di Scienze Radiologiche, C. Bompiani, Università, Sassari
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Marongiu F, Conti M, Mameli G, Sorano GG, Cossu E, Cirillo R, Balestrieri A. Is the imbalance between thrombin and plasmin activity in diabetes related to the behaviour of antiplasmin activity? Thromb Res 1990; 58:91-9. [PMID: 1693451 DOI: 10.1016/0049-3848(90)90166-a] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The aim of this study was to evaluate the balance between thrombin and plasmin activity in a group of 79 diabetic patients (IDDM and NIDDM). For this purpose we determined fibrinopeptide A (FPA) and B beta 15-42, specific products of thrombin and plasmin activity. Moreover we investigated the behaviour of antithrombin III and alpha 2 antiplasmin, important inhibitors of blood coagulation and fibrinolysis. Results show an increase both in FPA and B beta 15-42 in IDDM and NIDDM patients when compared to healthy controls. However the ratio between B beta 15-42 and FPA was lower than in controls indicating an imbalance between thrombin and plasmin activity. Antithrombin III levels were not different from the controls and no correlation was found with Hb A1c. alpha 2 antiplasmin was found to be higher in IDDM when compared both with NIDDM and controls. A non linear correlation was found between Hb A1c and alpha 2 AP in both diabetic groups. We conclude that the imbalance between thrombin and plasmin activity may have a role in determining fibrin deposition. These subclinical abnormalities, unrelated to vascular complications and duration of the disease, may progressively contribute to the development of the vascular complications in diabetes.
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Affiliation(s)
- F Marongiu
- Institute of Internal Medicine, University of Cagliari, Italy
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Conti M, Marongiu F, Mameli G, Mamusa AM, Cambuli AB, Cossu E, Sorano GG, Biondi G, Cirillo R, Balestrieri A. [Activity of the coagulation and fibrinolysis in non-insulin-dependent diabetes mellitus. In vivo study]. Recenti Prog Med 1989; 80:297-9. [PMID: 2772395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In vivo study of blood coagulation and fibrinolysis activities in non insulin dependent diabetes mellitus. The aim of the study was to investigate in vivo blood coagulation and fibrinolysis activities in a group of diabetic patients NIDDM with and without vascular complications. For this purpose we determined two sensitive indicators in vivo of blood coagulation and fibrinolytic activities such as fibrinopeptide A and B beta 15-42 respectively. Moreover, we computed the ratio between B beta 15-42 and fibrinopeptide A in order to investigate a possible imbalance in vivo between blood coagulation and fibrinolysis. Control groups were 15 healthy subjects and 28 non diabetic patients affected by atherosclerotic disease. Fibrinopeptide A and B beta values were significantly higher in the diabetic patients than controls but there was no difference between the former group and the atherosclerotic patients. Also, no correlation was found for FPA, B beta, B beta/FPAr and HbAlc, fructosamine and blood glucose levels. There was no difference in B beta, FPA and B beta/FPAr values for patients treated with insulin and for those treated with either hypoglycemic agents or diet. Our data indicate that in diabetic patients fibrinolysis activity is increased, but it cannot counterbalance thrombin activity which appears much more enhanced. Finally, the lack of correlation for FPA, B beta, B beta/FPAr and HbAlc, fructosamine and blood glucose suggests that blood coagulation and fibronolysis abnormalities are not related to the degree of blood glucose control.
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Cirillo R, Balzano S, Cossu E, Bartalena L, Solinas MP, Falcone M, Balestrieri A, Martino E. The effect of altered thyroid function on serum fructosamine concentrations. Clin Biochem 1988; 21:179-81. [PMID: 2455610 DOI: 10.1016/0009-9120(88)90007-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The effect of altered thyroid function on serum fructosamine concentrations was investigated in 31 untreated hyperthyroid patients, 18 short-term hypothyroid patients (i.e., 20 days after withdrawal of thyroid hormone suppressive therapy for thyroid cancer), 7 untreated long-term hypothyroid patients, and 25 age-matched normal controls. No differences in serum fructosamine concentrations were observed between hyperthyroid patients and normal controls; conversely, serum fructosamine concentrations were significantly higher both in short-term and in long-term hypothyroid patients than those found in normal controls. Furthermore, long-term hypothyroid patients showed significantly higher serum fructosamine concentrations than short-term hypothyroid patients. L-Thyroxine (L-T4), replacement therapy in two hypothyroid patients, resulted in a marked decrease in serum fructosamine concentrations. In seven hyperthyroid patients, the restoration of euthyroidism with antithyroid drug therapy was associated with no significant changes in serum fructosamine concentrations. The results of the present study indicate that hypothyroidism is associated with a marked increase in serum fructosamine concentrations. This alteration does not appear to be the consequence of gross abnormalities in plasma protein or glucose metabolism. The duration of hypothyroidism seems to be an important factor, even though the mechanism underlying this alteration remains at present unexplained. These results also suggest that caution must be used in the interpretation of elevated serum fructosamine concentrations as an index of the metabolic control of diabetes mellitus in the presence of hypothyroidism.
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Affiliation(s)
- R Cirillo
- Cattedra di Clinica Medica I, University of Cagliari, Italy
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