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Sportoletti P, Laurenti L, Chiarenza A, Gaidano G, Albi E, Mauro FR, Trentin L, Vallisa D, Pane F, Cuneo A, Albano F, Zamprogna G, Coscia M, Gozzetti A, Reda G, Caira M, Finsinger P, Gualberti G, Iannella E, Malgieri S, Molica S. Patients' preferences for chronic lymphocytic leukemia treatment: The CHOICE study. Hematol Oncol 2024; 42:e3216. [PMID: 37772620 DOI: 10.1002/hon.3216] [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] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/21/2023] [Accepted: 08/09/2023] [Indexed: 09/30/2023]
Abstract
Chronic lymphocytic leukemia (CLL) therapies differ in efficacy, side effects, route, frequency, and duration of administration. We assessed patient preferences for treatment attributes and evaluated associations with disease stage, treatment line, and socio-demographic characteristics in a cross sectional, observational study conducted at 16 Italian hematology centers. Study visits occurred between February and July 2020; 401 adult patients with CLL (201 Watch and Wait (W&W), 200 treated) participated in a discrete choice experiment (DCE), composed of 8 choices between pairs of treatment profiles with different levels of 5 attributes of currently available CLL treatments (length of response, route and duration of administration, risk of side effects including diarrhea, infections, or organ damage). Health-related quality of life was assessed with the EQ-5D-5L, EORTC QLQ-C30 and QLQ CLL-16. Previously treated patients had longer disease duration (7 vs. 5 years), higher prevalence of serious comorbidities (45.5% vs. 36.2%) and high-risk molecular markers (unmutated IGHV 55.6% vs. 17.1%; TP53 mutation 15.2% vs. 4.0%). Health-related quality of life scores were similar between groups. In the DCE, W&W patients rated "possible occurrence of infections" highest (relative importance [RI] = 36.2%), followed by "treatment and relevant duration" (RI = 28.0%) and "progression-free survival (PFS)" (RI = 16.9%). Previously treated patients rated "treatment and relevant duration" highest (RI = 33.3%), followed by "possible occurrence of infections" (RI = 28.8%), "possible occurrence of organ damage" (RI = 19.4%), and "PFS" (RI = 9.8%). Concern over infection was rated highest overall; unexpectedly PFS was not among the most important criteria in either group, suggesting that the first COVID-19 pandemic wave may have influenced patient preferences and concerns about CLL therapy options.
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Affiliation(s)
- Paolo Sportoletti
- Institute of Hematology and Center for Hemato-Oncology Research, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Luca Laurenti
- Hematology Institute, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, Università del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Elisa Albi
- Strategic Research Programme in CLL, Division of Experimental Oncology, IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Livio Trentin
- Hematology Section, Department of Medicine, Azienda Ospedale Università Padova, Padova, Italy
| | - Daniele Vallisa
- Hematology Unit, Department of Oncology and Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences, Azienda Ospedaliera-Universitaria, Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - Francesco Albano
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Hematology and Stem Cell Transplantation Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Giulia Zamprogna
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marta Coscia
- Department of Molecular Biotechnology and Health Sciences, University of Torino and Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessandro Gozzetti
- Hematology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Gianluigi Reda
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore, University of Milan, Milan, Italy
| | | | | | | | | | | | - Stefano Molica
- Department of Hematology-Oncology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
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Laurenti L, Scarfò L, Frustaci AM, Sanna A, Iannella E, Caira M, Finsinger P, Schifano S, Neri B, Molica S, Mauro FR. Real-world evidence on venetoclax in chronic lymphocytic leukemia: The Italian experience. Hematol Oncol 2023; 41:621-630. [PMID: 36680368 DOI: 10.1002/hon.3122] [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] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is the most common form of adult leukemia in the western world. In Italy, venetoclax was approved for use in patients with CLL as monotherapy in 2017 and in combinations in 2019. As a result of this delayed approval, there are relatively few real-world studies from Italian clinical practice and much of the data are in heavily pretreated patients. We have collected the available studies in Italian routine practice. Three studies confirm the effectiveness and tolerability of this agent in patients with relapsed/refractory CLL and high-risk disease characteristics, many of whom had received prior B-cell receptor signaling treatment. Addition of rituximab to venetoclax produced more complete responses in patients with relapsed/refractory CLL, while higher disease burden and progression while receiving a prior Bruton's tyrosine kinase inhibitor were both associated with poorer outcomes in patients treated with venetoclax. Venetoclax was well-tolerated with low discontinuation rates. No studies of venetoclax plus obinutuzumab for the first-line treatment of patients with CLL were available due to the short time since approval in Italy. Several cohorts addressed the impact of COVID-19 on patient management and outcomes, suggesting that treated patients and those in clinical observation had similar rates of COVID-19-related hospital admission, intensive care unit admission, and mortality. Overall, the responses and tolerance to venetoclax observed in the Italian real-world setting confirm the tolerability and effectiveness of venetoclax regimens in high-risk patients.
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Affiliation(s)
- Luca Laurenti
- Diagnostic Imaging, Oncological Radiotherapy and Hematology, IRCCS Agostino Gemelli University Policlinic, Rome, Italy
| | - Lydia Scarfò
- Strategic Research Program on CLL, Division of Experimental Oncology, Università Vita Salute and IRCCS San Raffaele Hospital Milan, Milan, Italy
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3
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Paolino G, Belmonte M, Trasarti S, Santopietro M, Bizzoni L, Riminucci M, Cardarelli L, Iannella E, Albanesi M, Moliterni E, Didona D, Calvieri S, Foà R, Giona F. Mast Cell Disorders, Melanoma and Pancreatic Carcinoma: From a Clinical Observation to a Brief Review of the Literature. Acta Dermatovenerol Croat 2017; 25:112-119. [PMID: 28871925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Mastocytosis can be associated with other clonal or non-clonal hematologic diseases as well as a variety of non-hematologic malignancies. A 75-year-old Caucasian male patient was referred to us with a 5-month history of neutrophilic leukocytosis and mild splenomegaly. He had developed a cutaneous melanoma sixteen years ago. According to the clinical and pathological features, a final diagnosis of systemic mastocytosis was established. The patient started treatment with interferon-α at a dose of 3 MIU/day, combined with low doses of prednisone. We observed a rapid disappearance of symptoms. Unfortunately, after 3 months a diagnosis of pancreatic adenocarcinoma was established. A review of the literature suggests that mastocytes could have a pivotal role in several malignancies. Different chemokines, mitogenic factors, chemical mediators of inflammation, and specific gene mutations could explain the association between mastocytosis and other hematologic and non-hematologic disorders.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Dario Didona
- Dario Didona, MD Istituto Dermopatico dell'Immacolata-IRCCS Via dei Monti di Creta 104, 00167 Rome Italy
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Del Poeta G, Postorino M, Pupo L, Del Principe MI, Dal Bo M, Bittolo T, Buccisano F, Mariotti B, Iannella E, Maurillo L, Venditti A, Gattei V, de Fabritiis P, Cantonetti M, Amadori S. Venetoclax: Bcl-2 inhibition for the treatment of chronic lymphocytic leukemia. Drugs Today (Barc) 2016; 52:249-60. [PMID: 27252989 DOI: 10.1358/dot.2016.52.4.2470954] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Venetoclax (ABT-199) is a small-molecule selective oral inhibitor of the antiapoptotic protein Bcl-2 that promotes programmed cell death of chronic lymphocytic leukemia (CLL) cells regulating the release of proapoptotic factors, such as Smac/Diablo, apoptosis-inducing factor (AIF) and cytochrome c. In April 2016, the U.S. Food and Drug Administration (FDA) granted accelerated approval to venetoclax for patients diagnosed with CLL with 17p deletion, as detected by an FDA-approved test, who have received at least one prior therapy. This review will focus on the mechanism of action, preclinical studies and clinical development of venetoclax both as a monotherapy and in combination with other drugs for CLL in the current milieu of therapy dominated by novel tyrosine kinase inhibitors such as ibrutinib and idelalisib.
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Affiliation(s)
- G Del Poeta
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy.
| | - M Postorino
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - L Pupo
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - M I Del Principe
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - M Dal Bo
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano (PN), Italy
| | - T Bittolo
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano (PN), Italy
| | - F Buccisano
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - B Mariotti
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - E Iannella
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - L Maurillo
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - A Venditti
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - V Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano (PN), Italy
| | - P de Fabritiis
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - M Cantonetti
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - S Amadori
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
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Gentili A, Pasini L, Iannella E, Landuzzi V, Lima M, Bacchi Reggiani ML, Baroncini S. Predictive outcome indexes in neonatal Congenital Diaphragmatic Hernia. J Matern Fetal Neonatal Med 2014; 28:1602-7. [PMID: 25234103 DOI: 10.3109/14767058.2014.963043] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE We examined the reliability of the main prenatal and postnatal prognosis-related indexes that can be used to evaluate congenital diaphragmatic hernia (CDH) outcome. METHODS Seventy-seven neonates with CDH were analyzed according to CDH prognosis-related factors, divided into prenatal findings, postnatal clinical values and postnatal predictive outcome scores applied at birth and within the first 12-24 h. The data are compared between two groups: survivors and non-survivors. RESULTS During prenatal age, major associated anomalies, intrathoracic stomach, diagnosis prior to 25 weeks of gestational age and lung-to-head ratio < 0.6 were statistically significant, demonstrating their greater incidence in non-survivors. The majority of postnatal values at PICU admission were found to be reliable in identifying the CDH outcome: paO2/FiO2, oxygenation index, alveolar-arterial-O2 gradient, arterial-alveolar-O2 tension ratio, pH, mean blood pressure, body temperature. All the postnatal predictive outcome scores (Apgar 1' and 5', CDH-Study-Group equation, Score for Neonatal-Acute-Physiology II, SNAP-Perinatal-Extension II, Pediatric Risk of Mortality III and Wilford-Hall/Santa-Rosa formula) were statistically significant with more favorable values for prognosis in the survivors group. CONCLUSION The chances of predicting CDH outcome are fairly high. During prenatal age, only a few findings may be obtained. Conversely, many postnatal indexes and scores can reliably predict such outcome.
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Affiliation(s)
- A Gentili
- a Department of Paediatric Anaesthesia and Intensive Care
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Torelli GF, Lucarelli B, Iori AP, De Propris MS, Capobianchi A, Barberi W, Valle V, Iannella E, Natalino F, Mercanti C, Perrone S, Gentile G, Guarini A, Foà R. The immune reconstitution after an allogeneic stem cell transplant correlates with the risk of graft-versus-host disease and cytomegalovirus infection. Leuk Res 2011; 35:1124-6. [PMID: 21459444 DOI: 10.1016/j.leukres.2011.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 03/05/2011] [Accepted: 03/05/2011] [Indexed: 10/18/2022]
Abstract
Aim of the study was to correlate the clinical outcome of eighteen patients who have undergone an allogeneic stem cell transplant (SCT) with the concentration in the peripheral blood (PB) of lymphocyte subpopulations evaluated at 1 year from transplant. The occurrence of acute GVHD and CMV infection correlated with the concentration of Tregs in the PB; CMV infection also correlated with the content of NK cells. The obtained results document that the concentration of Tregs in the PB after an allogeneic SCT may protect from GVHD and from CMV infection; the potential anti-viral role of NK cells is confirmed.
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Affiliation(s)
- Giovanni F Torelli
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy.
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Torelli GF, Natalino F, Barberi W, Maggio R, Peragine N, De Propris MS, Piciocchi A, Valle V, Iannella E, Iori AP, Guarini A, Foà R. Clinical responses in allografted acute leukaemia patients with resistant disease using a combined chemo-immunotherapeutic treatment strategy. Br J Haematol 2010; 151:86-9. [PMID: 20618336 DOI: 10.1111/j.1365-2141.2010.08291.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gentili A, Iannella E, Masciopinto F, Latrofa ME, Giuntoli L, Baroncini S. Rhabdomyolysis and respiratory failure: rare presentation of carnitine palmityl-transferase II deficiency. Minerva Anestesiol 2008; 74:205-208. [PMID: 18414363] [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: 05/26/2023]
Abstract
Carnitine palmityl-transferase (CPT) II deficiency is a rare disorder of the fatty acid beta-oxidation cycle. CPT II deficiency can be associated with rhabdomyolysis in particular conditions that increase the requirement for fatty acid oxidation, such as low-carbohydrate and high-fat diet, fasting, exposure to excessive cold, lack of sleep and prolonged exercise. The best known CPT II deficiency is the muscular form with episodic muscle necrosis and paroxysmal myoglobinuria after prolonged exercise. We report a case of a four-year-old male child, who, after one day of hyperthermia and fasting, developed a massive rhabdomyolysis beginning with acute respiratory failure and later complicated by acute renal failure. Appropriate management in Pediatric Intensive Care Unit (PICU) (mechanical ventilatory support, fluid supply combined with mannitol and bicarbonate infusions, administration of acetaminophen and antibiotics, and continuous venovenous haemofiltration) brought about complete resolution with an excellent outcome. Biochemical investigation of muscle biopsy and genetic analysis showed a deficiency of CPT II. The onset of CPT II deficiency with respiratory failure is extremely rare, but a correct and early diagnosis of rhabdomyolysis is the key to successful treatment. A metabolic myopathy such as CPT II deficiency should be suspected in children affected by rhabdomyolysis if trauma, crash, infections, drugs or extreme exertion can be excluded.
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Affiliation(s)
- A Gentili
- Department of Paediatric Anaesthesia and Intensive Care, S. Orsola-Malpighi University Hospital, Bologna, Italy.
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Iori AP, Arcese W, Milano F, Calabrese E, Torelli GF, Barberi W, Mascolo MG, De Felice L, Screnci M, Lucarelli B, Malandruccolo L, Perrone MP, Salvatori S, Laurenti L, Iannella E, Ricci R, Moleti ML, Foà R. Unrelated cord blood transplant in children with high-risk acute lymphoblastic leukemia: a long-term follow-up. Haematologica 2007; 92:1051-8. [PMID: 17640857 DOI: 10.3324/haematol.11271] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Accepted: 05/11/2007] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of this single center study was to assess the impact of pre-transplant factors on long-term follow-up in young patients affected by high-risk acute lymphoblastic leukemia (ALL) who underwent an unrelated cord blood transplant (CBT). The conditioning regimens, graft-versus-host disease (GVHD) prophylaxis and supportive policies were uniform for all patients. DESIGN AND METHODS We analyzed the results of CBT performed in 30 patients, aged <18 years, affected by high risk ALL. As conditioning regimen, all patients received 12 Gy fractionated total body irradiation, etoposide, cyclophosphamide and horse anti-lymphocyte globulin. GVHD prophylaxis consisted of 6-methylprednisolone and cyclosporine A. RESULTS The cumulative incidence of engraftment was 93% (95% CI:0.85-0.93). The cumulative incidence of grade III-IV acute and chronic GVHD was 7% (95% CI:0.01-0.19) and 33% (95% CI: 0.17-0.64), respectively. The 9-year cumulative incidence of transplant-related mortality and relapse was 34% (95% CI:0.13-0.45) and 31% (95% CI:0.16-0.61), respectively. The 9-year overall survival, leukemia-free survival and event-free survival were 42% (95% CI:0.52-0.93), 47% (95% CI:0.25-0.61) and 46% (95% CI:0.33-0.61), respectively. A number of CFU-GM <1 x 10(4)/Kg of recipient body weight was the only factor that negatively affected all outcome parameters both in univariate and multivariate analyses. INTERPRETATION AND CONCLUSIONS The infused cell dose expressed as in vitro progenitor cell growth represents the most important pre-transplant factor affecting the long-term outcome after an unrelated CBT in young patients with high risk ALL. The number of CFU-GM should thus be considered in the selection process of cord blood units for transplant.
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Affiliation(s)
- Anna Paola Iori
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, University La Sapienza, Rome, Italy.
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Volpicelli P, Latagliata R, Breccia M, Carmosino I, Stefanizzi C, Iannella E, Levi A, Natalino F, Alimena G. P125 Pregnancy in patients with myelodysplastic syndromes (MDS). Leuk Res 2007. [DOI: 10.1016/s0145-2126(07)70195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pigna A, Iannella E, Gentili A, Libri M, Lima M, Baroncini S. Gastric perforation in a newborn. Pediatr Med Chir 2003; 25:66-8. [PMID: 12920982] [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] Open
Abstract
Gastric perforation in neonates is an uncommon condition. In most cases, it is attributed to peptic ulceration and/or hemorrhagic gastritis. The high mortality rate in such patients can be improved by early diagnosis and prompt resuscitation, followed by surgery. We report a full-term female newborn, who developed a gastric perforation in the first day of life. The possible aetiology and the perioperative management are discussed.
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Affiliation(s)
- A Pigna
- Department of Anaesthesia, Intensive Care Unit, S. Orsola-Malpighi Hospital, Via Albertoni 19/2, 40138 Bologna.
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Gentili A, Iannella E, Mondardini MC, Morelli A, Pigna A, Tonini C, Baroncini S. [Problems in anesthesia in pulmonary cystic adenomatosis]. Minerva Anestesiol 1999; 65:78-85. [PMID: 10389433] [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: 02/13/2023]
Abstract
Congenital cystic adenomatoid malformation (CCAM) of the lung is a rare disease. It is about an abnormal proliferation of mesenchymal elements and failure of maturation of bronchiolar structures, characterized by the replacement of normal pulmonary tissue with "cysts" in variable size and number. These lesions communicate with the tracheobronchial tree. During fetal period hydrops and polyhydramnios can be associated with CCAM. A cystic adenomatoid malformation can be detected by antenatal ultrasound, and, at the birth, it is confirmed by chest radiography. From January 1990 to December 1998, 24 cases with CCAM came to our observation; 16 of these patients underwent surgery and 14 have come to a complete recovery. The newborns, with CCAM, can show early acute respiratory distress for rapid expansion of the cysts leading to compression of normal lung and mediastinal shift. Conventional mechanical ventilation may cause further expansion of the involved lobe with a ball-valve effect: this take a clinical deterioration. Perioperative ventilatory management with high frequency oscillation (HFO) is useful to stabilize and to improve arterial blood gases of this patients. At the moment, thanks to the early prenatal sonographic diagnosis, it is possible, and strongly advisable, after adequate serial checkings during the pregnancy, to refer CCAM cases to a tertiary centre that is properly equipped, where a poly-specialist team consisting of obstetrician, neonatologist, pediatric anesthetist and pediatric surgeon, will be able to plan and arrange in the best treatment necessary for the newborn.
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Affiliation(s)
- A Gentili
- Servizio di Anestesia e Rianimazione, Policlinico S. Orsola-Malpighi, Bologna.
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