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Monfrini E, Avanzino L, Palermo G, Bonato G, Brescia G, Ceravolo R, Cantarella G, Mandich P, Prokisch H, Storm van's Gravesande K, Straccia G, Elia A, Reale C, Panteghini C, Zorzi G, Eleopra R, Erro R, Carecchio M, Garavaglia B, Zech M, Romito L, Di Fonzo A. Dominant VPS16 Pathogenic Variants: Not Only Isolated Dystonia. Mov Disord Clin Pract 2024; 11:87-93. [PMID: 38291845 PMCID: PMC10828607 DOI: 10.1002/mdc3.13927] [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: 08/19/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND VPS16 pathogenic variants have been recently associated with inherited dystonia. Most patients affected by dominant VPS16-related disease display early-onset isolated dystonia with prominent oromandibular, bulbar, cervical, and upper limb involvement, followed by slowly progressive generalization. CASES We describe six newly reported dystonic patients carrying VPS16 mutations displaying unusual phenotypic features in addition to dystonia, such as myoclonus, choreoathetosis, pharyngospasm and freezing of gait. Response to bilateral Globus Pallidus Internus Deep Brain Stimulation (GPi-DBS) is reported in three of them, associated with significant improvement of dystonia but only minor effect on other hyperkinetic movements. Moreover, five novel pathogenic/likely pathogenic variants are described. CONCLUSIONS This case collection expands the genetic and clinical spectrum of VPS16-related disease, prompting movement disorder specialists to suspect mutations of this gene not only in patients with isolated dystonia.
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Affiliation(s)
- Edoardo Monfrini
- Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly
- Foundation IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoNeurology UnitMilanItaly
| | - Laura Avanzino
- Department of Experimental Medicine, Section of Human Physiology and Centro Polifunzionale di Scienze MotorieUniversity of GenoaGenoaItaly
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Giovanni Palermo
- Center for Neurodegenerative Diseases, Parkinson's Disease and Movement Disorders, Unit of Neurology, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Giulia Bonato
- Parkinson and Movement Disorders Unit, Centre for Rare Neurological Diseases (ERN‐RND), Department of Neuroscience University of PaduaPaduaItaly
| | - Gloria Brescia
- Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly
- Medical Genetics LaboratoryFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Roberto Ceravolo
- Center for Neurodegenerative Diseases, Parkinson's Disease and Movement Disorders, Unit of Neurology, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Giovanna Cantarella
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
- Department of OtolaryngologyFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Paola Mandich
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child HealthUniversity of GenoaGenoaItaly
| | - Holger Prokisch
- Institute of Neurogenomics, Helmholtz MunichNeuherbergGermany
- Institute of Human Genetics, Technical University of Munich, School of MedicineMunichGermany
| | - Karin Storm van's Gravesande
- Department of Pediatrics, Child and Adolescent PsychosomaticsTechnical University MunichMunichGermany
- Department of Pediatric NeurologyUniversity Children's Hospital FreiburgFreiburgGermany
| | - Giulia Straccia
- Department of Clinical Neurosciences, Parkinson and Movement Disorders UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Antonio Elia
- Department of Clinical Neurosciences, Parkinson and Movement Disorders UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Chiara Reale
- Medical Genetics and Neurogenetics UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Celeste Panteghini
- Medical Genetics and Neurogenetics UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Giovanna Zorzi
- Department of Pediatric NeuroscienceFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Roberto Eleopra
- Department of Clinical Neurosciences, Parkinson and Movement Disorders UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana,” Neuroscience SectionUniversity of SalernoSalernoItaly
| | - Miryam Carecchio
- Center for Neurodegenerative Diseases, Parkinson's Disease and Movement Disorders, Unit of Neurology, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Barbara Garavaglia
- Medical Genetics and Neurogenetics UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Michael Zech
- Institute of Neurogenomics, Helmholtz MunichNeuherbergGermany
- Institute of Human Genetics, Technical University of Munich, School of MedicineMunichGermany
- Institute for Advanced Study, Technical University of MunichGarchingGermany
| | - Luigi Romito
- Department of Clinical Neurosciences, Parkinson and Movement Disorders UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Alessio Di Fonzo
- Foundation IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoNeurology UnitMilanItaly
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Mainardi M, Ciprietti D, Pilleri M, Bonato G, Weis L, Cianci V, Biundo R, Ferreri F, Piacentino M, Landi A, Guerra A, Antonini A. Deep brain stimulation of globus pallidus internus and subthalamic nucleus in Parkinson's disease: a multicenter, retrospective study of efficacy and safety. Neurol Sci 2024; 45:177-185. [PMID: 37555874 PMCID: PMC10761504 DOI: 10.1007/s10072-023-06999-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/11/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) is an established therapeutic option in advanced Parkinson's disease (PD). Literature data and recent guidelines remain inconclusive about the best choice as a target between the subthalamic nucleus (STN) and the globus pallidus internus (GPi). MATERIALS AND METHODS We retrospectively reviewed the clinical efficacy outcomes of 48 DBS-implanted patients (33 STN-DBS and 15 GPi-DBS) at a short- (<1 year from the surgery) and long-term (2-5 years) follow-up. Also, clinical safety outcomes, including postoperative surgical complications and severe side effects, were collected. RESULTS We found no difference between STN-DBS and GPi-DBS in improving motor symptoms at short-term evaluation. However, STN-DBS achieved a more prominent reduction in oral therapy (L-DOPA equivalent daily dose, P = .02). By contrast, GPi-DBS was superior in ameliorating motor fluctuations and dyskinesia (MDS-UPDRS IV, P < .001) as well as motor experiences of daily living (MDS-UPDRS II, P = .03). The greater efficacy of GPi-DBS on motor fluctuations and experiences of daily living was also present at the long-term follow-up. We observed five serious adverse events, including two suicides, all among STN-DBS patients. CONCLUSION Both STN-DBS and GPi-DBS are effective in improving motor symptoms severity and complications, but GPi-DBS has a greater impact on motor fluctuations and motor experiences of daily living. These results suggest that the two targets should be considered equivalent in motor efficacy, with GPi-DBS as a valuable option in patients with prominent motor complications. The occurrence of suicides in STN-treated patients claims further attention in target selection.
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Affiliation(s)
- Michele Mainardi
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Dario Ciprietti
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Manuela Pilleri
- Service of Neurology, Villa Margherita-Santo Stefano Private Hospital, Arcugnano, Italy
| | - Giulia Bonato
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Luca Weis
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Valeria Cianci
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Roberta Biundo
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
- Department of General Psychology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Florinda Ferreri
- Unit of Neurology, Unit of Clinical Neurophysiology, Department of Neuroscience, University of Padova, 35128, Padova, Italy
| | - Massimo Piacentino
- Department of Neurosurgery, AULSS 8 Berica Ospedale San Bortolo, Viale Rodolfi, 37 36100, Vicenza, Italy
| | - Andrea Landi
- Academic Neurosurgery, Department of Neurosciences, University of Padova, 35128, Padova, Italy
| | - Andrea Guerra
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
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Carrer T, Bonato G, Sandre M, Emmi A, Campagnolo M, Musso G, Carecchio M, Parchi P, Antonini A. Rapidly progressive multiple system atrophy in a patient carrying LRRK2 G2019S mutation. Neurol Sci 2024; 45:309-313. [PMID: 37752324 DOI: 10.1007/s10072-023-07056-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/02/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Multiple system atrophy (MSA) is considered a primarily sporadic neurodegenerative disease, but the role of genetic is poorly understood. CASE We present a female patient of Moroccan origin who developed a rapidly progressive non-levodopa responsive parkinsonism, gait and balance problems, and dysautonomia including severe bulbar symptoms. She was diagnosed with MSA Parkinsonian-type (MSA-P) and suddenly died at night at 58 years of age. Reduced striatal DAT-SPECT, putaminal hyperintensity on T2-MRI, and hypometabolism with FDG-PET were present. Genetic testing documented a G2019S mutation in the LRRK2 gene. A skin biopsy was obtained and used to perform alpha-synuclein RT-QuIC, which was negative, and immunohistochemical analysis, which demonstrated abnormal alpha-synuclein deposits in cutaneous nerves. Elevated blood neurofilament light chain levels were also documented. CONCLUSIONS LRRK2 mutations are the most common cause of monogenic Parkinson's disease (PD) and G2019S is the most frequent variant. Our patient presented with biological, clinical, and radiological features of MSA, but genetic testing revealed a G2019S LRRK2 mutation, which has been previously reported only in one other case of pathologically proven MSA but with mild progression. In our patient, post-mortem confirmation could not be performed, but RT-QuIC and immunohistochemical findings on skin biopsy support the diagnosis of MSA. G2019S LRRK2 may be linked to an increased risk of MSA. Cases of atypical parkinsonism with rapid disease course should be screened for PD-related genes especially in populations with a high prevalence of mutations in known genes.
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Affiliation(s)
- Tommaso Carrer
- Parkinson and Movement Disorders Unit, Center for Rare Neurological Diseases (ERN-RND), Study Center On Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Giulia Bonato
- Parkinson and Movement Disorders Unit, Center for Rare Neurological Diseases (ERN-RND), Study Center On Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Michele Sandre
- Parkinson and Movement Disorders Unit, Center for Rare Neurological Diseases (ERN-RND), Study Center On Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Aron Emmi
- Parkinson and Movement Disorders Unit, Center for Rare Neurological Diseases (ERN-RND), Study Center On Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Marta Campagnolo
- Parkinson and Movement Disorders Unit, Center for Rare Neurological Diseases (ERN-RND), Study Center On Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Giulia Musso
- Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Miryam Carecchio
- Parkinson and Movement Disorders Unit, Center for Rare Neurological Diseases (ERN-RND), Study Center On Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Piero Parchi
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
- Programma Neuropatologia Delle Malattie Neurodegenerative, Istituto Delle Scienze Neurologiche Di Bologna, IRCCS, Bologna, Italy
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Center for Rare Neurological Diseases (ERN-RND), Study Center On Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
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Capasso M, Dioscoridi L, Forti E, Pugliese F, Cintolo M, Bonato G, Mutignani M. Totally endoscopic treatment of duodenal diverticulum. Endoscopy 2023; 55:E1051-E1052. [PMID: 37714211 PMCID: PMC10504031 DOI: 10.1055/a-2155-4535] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Affiliation(s)
- Mario Capasso
- Digestive and Interventional Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
| | - Lorenzo Dioscoridi
- Digestive and Interventional Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
| | - Francesco Pugliese
- Digestive and Interventional Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
| | - Marcello Cintolo
- Digestive and Interventional Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
| | - Giulia Bonato
- Digestive and Interventional Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
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Bonato G, Goodman S, Tjh L. Physiological and performance effects of live high train low altitude training for elite endurance athletes: A narrative review. Curr Res Physiol 2023; 6:100113. [PMID: 38107789 PMCID: PMC10724230 DOI: 10.1016/j.crphys.2023.100113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 11/10/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023] Open
Abstract
Altitude training has become an important training application for athletes due its potential for altering physiology and enhancing performance. This practice is commonly used by athletes, with a popular choice being the live high - train low approach. This model recommends that athletes live at high altitude (1250-3000 m), but train at low altitude or sea-level (0-1200 m). Exposure to altitude often leads to hypoxic stress and in turn stimulates changes in total haemoglobin mass, erythropoietin, and soluble transferrin receptors, which alter further underlying physiology. Through enhanced physiology, improved exercise performance may arise through enhancement of the oxygen transport system which is important for endurance events. Previous investigations into the effects of altitude training on exercise performance have been completed in a range of contexts, including running, cycling, swimming, and triathlon. Often following a LHTL altitude intervention, athletes realise improvements in maximal oxygen consumption capacity, time trial performance and peak power outputs. Although heterogeneity exists among LHTL methodologies, i.e., exposure durations and altitude ranges, we synthesised this data into kilometre hours, and found that the most common hypoxic doses used in LHTL interventions ranged from ∼578-687 km h. As this narrative review demonstrates, there are potential advantages to using altitude training to enhance physiology and improve performance for endurance athletes.
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Affiliation(s)
- G. Bonato
- Exercise and Sports Science, School of Science and Technology, The University of New England, Armidale, 2350, Australia
- College of Arts, Society and Education, James Cook University, Townsville, 4811, Australia
| | - S.P.J Goodman
- Exercise and Sports Science, School of Science and Technology, The University of New England, Armidale, 2350, Australia
| | - Lathlean Tjh
- Exercise and Sports Science, School of Science and Technology, The University of New England, Armidale, 2350, Australia
- The Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, 5000, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, 5000, Australia
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Bonato G, Mozzetta S, Bussè C, Cecchin D, Cagnin A. Correction to: Frontotemporal dementia phenotype in late-onset Huntington disease without chorea. Neurol Sci 2023; 44:3375. [PMID: 37258988 DOI: 10.1007/s10072-023-06878-7] [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: 06/02/2023]
Affiliation(s)
- Giulia Bonato
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
| | - Stefano Mozzetta
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Cinzia Bussè
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Diego Cecchin
- Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
- Nuclear Medicine Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Annachiara Cagnin
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
- Padova Neuroscience Center (PNC), University of Padova, Padova, Italy.
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Bonato G, Mozzetta S, Bussè C, Cecchin D, Cagnin A. Frontotemporal dementia phenotype in late-onset Huntington disease without chorea. Neurol Sci 2023; 44:3327-3329. [PMID: 37140830 DOI: 10.1007/s10072-023-06823-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/17/2023] [Indexed: 05/05/2023]
Affiliation(s)
- Giulia Bonato
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
| | - Stefano Mozzetta
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Cinzia Bussè
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Diego Cecchin
- Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
- Nuclear Medicine Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Annachiara Cagnin
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
- Padova Neuroscience Center (PNC), University of Padova, Padova, Italy.
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Dioscoridi L, Mutignani M, Pugliese F, Bonato G, Cintolo M, Bravo M, Forti E. Comments on "Tube-in-tube endoscopic vacuum therapy for the closure of upper gastrointestinal fistulas, leaks, and perforations". Endoscopy 2023; 55:586. [PMID: 37230076 DOI: 10.1055/a-2021-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Lorenzo Dioscoridi
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | | | - Francesco Pugliese
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Giulia Bonato
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Marcello Cintolo
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Marianna Bravo
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Edoardo Forti
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
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Mutignani M, Forti E, Pugliese F, Cintolo M, Bonato G, Bravo M, Dioscoridi L. Endoscopic entero-enteral bypass to treat postsurgical benign complications of hepatico-jejunostomy: Update of a 7-year single-center experience. Endosc Int Open 2023; 11:E394-E400. [PMID: 37102184 PMCID: PMC10125775 DOI: 10.1055/a-2032-3077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/01/2023] [Indexed: 04/28/2023] Open
Abstract
Background and study aims Since 2014, we have been using a new endoscopic approach to improve management of biliary adverse events (BAEs) after bilio-digestive anastomosis. We provide an update about our experience at 7 years. Patients and methods Patients with BAEs on hepatico-jejunostomy underwent entero-enteral endoscopic by-pass (EEEB) creation between the duodenal/gastric wall and the biliary jejunal loop. Evaluation of results during our seven-year experience was performed. Results Eighty consecutive patients (32 patients from Jan 2014 to Dec 2017 and 48 patients from Jan 2018 to Jan 2021) underwent EEEB, which was successful in all but one patient. The cumulative AEs rate was 32 %. Endoscopic retrograde cholangiography (ERC) through the EEEB successfully treated all types of BAEs in these patients. Cumulative disease recurrence was 3.8 % (three patients) and was retreated through the EEEB. Conclusions The update of our experience with EEEB confirmed that in patients with BAEs after bilio-digestive anastomosis, EEEB allows successful long-term treatment of different BAEs in a tertiary referral center with an acceptable rate of related AEs.
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Affiliation(s)
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
| | - Francesco Pugliese
- Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
| | - Marcello Cintolo
- Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
| | - Giulia Bonato
- Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
| | - Marianna Bravo
- Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
| | - Lorenzo Dioscoridi
- Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
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10
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Carecchio M, Mainardi M, Bonato G. The clinical and genetic spectrum of primary familial brain calcification. J Neurol 2023; 270:3270-3277. [PMID: 36862146 DOI: 10.1007/s00415-023-11650-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023]
Abstract
Primary familial brain calcification (PFBC), formerly known as Fahr's disease, is a rare neurodegenerative disease characterized by bilateral progressive calcification of the microvessels of the basal ganglia and other cerebral and cerebellar structures. PFBC is thought to be due to an altered function of the Neurovascular Unit (NVU), where abnormal calcium-phosphorus metabolism, functional and microanatomical alterations of pericytes and mitochondrial alterations cause a dysfunction of the blood-brain barrier (BBB) and the generation of an osteogenic environment with surrounding astrocyte activation and progressive neurodegeneration. Seven causative genes have been discovered so far, of which four with dominant (SLC20A2, PDGFB, PDGFRB, XPR1) and three with recessive inheritance (MYORG, JAM2, CMPK2). Clinical presentation ranges from asymptomatic subjects to movement disorders, cognitive decline and psychiatric disturbances alone or in various combinations. Radiological patterns of calcium deposition are similar in all known genetic forms, but central pontine calcification and cerebellar atrophy are highly suggestive of MYORG mutations and extensive cortical calcification has been associated with JAM2 mutations. Currently, no disease-modifying drugs or calcium-chelating agents are available and only symptomatic treatments can be offered.
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Affiliation(s)
- Miryam Carecchio
- Department of Neuroscience, University of Padua, Via Niccolò Giustiniani, 5, 35128, Padua, Italy.
| | - Michele Mainardi
- Department of Neuroscience, University of Padua, Via Niccolò Giustiniani, 5, 35128, Padua, Italy
| | - Giulia Bonato
- Department of Neuroscience, University of Padua, Via Niccolò Giustiniani, 5, 35128, Padua, Italy
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11
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Leonardi E, Aspromonte MC, Drongitis D, Bettella E, Verrillo L, Polli R, McEntagart M, Licchetta L, Dilena R, D'Arrigo S, Ciaccio C, Esposito S, Leuzzi V, Torella A, Baldo D, Lonardo F, Bonato G, Pellegrin S, Stanzial F, Posmyk R, Kaczorowska E, Carecchio M, Gos M, Rzońca-Niewczas S, Miano MG, Murgia A. Expanding the genetics and phenotypic spectrum of Lysine-specific demethylase 5C (KDM5C): a report of 13 novel variants. Eur J Hum Genet 2023; 31:202-215. [PMID: 36434256 PMCID: PMC9905063 DOI: 10.1038/s41431-022-01233-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 10/14/2022] [Accepted: 10/31/2022] [Indexed: 11/27/2022] Open
Abstract
Lysine-specific demethylase 5C (KDM5C) has been identified as an important chromatin remodeling gene, contributing to X-linked neurodevelopmental disorders (NDDs). The KDM5C gene, located in the Xp22 chromosomal region, encodes the H3K4me3-me2 eraser involved in neuronal plasticity and dendritic growth. Here we report 30 individuals carrying 13 novel and one previously identified KDM5C variants. Our cohort includes the first reported case of somatic mosaicism in a male carrying a KDM5C nucleotide substitution, and a dual molecular finding in a female carrying a homozygous truncating FUCA1 alteration together with a de novo KDM5C variant. With the use of next generation sequencing strategies, we detected 1 frameshift, 1 stop codon, 2 splice-site and 10 missense variants, which pathogenic role was carefully investigated by a thorough bioinformatic analysis. The pattern of X-chromosome inactivation was found to have an impact on KDM5C phenotypic expression in females of our cohort. The affected individuals of our case series manifested a neurodevelopmental condition characterized by psychomotor delay, intellectual disability with speech disorders, and behavioral features with particular disturbed sleep pattern; other observed clinical manifestations were short stature, obesity and hypertrichosis. Collectively, these findings expand the current knowledge about the pathogenic mechanisms leading to dysfunction of this important chromatin remodeling gene and contribute to a refinement of the KDM5C phenotypic spectrum.
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Affiliation(s)
- Emanuela Leonardi
- Department of Women's and Children's Health, University of Padova, Padova, Italy
- Pediatric Research Institute, Città della Speranza, Padova, Italy
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Maria Cristina Aspromonte
- Department of Women's and Children's Health, University of Padova, Padova, Italy
- Pediatric Research Institute, Città della Speranza, Padova, Italy
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Denise Drongitis
- Institute of Genetics and Biophysics "Adriano Buzzati-Traverso", CNR, Naples, Italy
| | - Elisa Bettella
- Department of Women's and Children's Health, University of Padova, Padova, Italy
- Pediatric Research Institute, Città della Speranza, Padova, Italy
| | - Lucia Verrillo
- Institute of Genetics and Biophysics "Adriano Buzzati-Traverso", CNR, Naples, Italy
| | - Roberta Polli
- Department of Women's and Children's Health, University of Padova, Padova, Italy
- Pediatric Research Institute, Città della Speranza, Padova, Italy
| | - Meriel McEntagart
- Medical Genetics Unit, St. George's University Hospitals, London, UK
| | - Laura Licchetta
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Robertino Dilena
- Neurophysiopathology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano D'Arrigo
- Department of Pediatric Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Claudia Ciaccio
- Department of Pediatric Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Silvia Esposito
- Department of Pediatric Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vincenzo Leuzzi
- Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Annalaura Torella
- University of Campania "Luigi Vanvitelli", Caserta, Italy
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
| | - Demetrio Baldo
- Unit of medical genetics, ULSS 2 Treviso Hospital, Treviso, Italy
| | | | - Giulia Bonato
- Movement Disorders Unit, Department of Neuroscience, University of Padova, Padova, Italy
| | - Serena Pellegrin
- Child Neurology and Neurorehabilitation Unit, Department of Pediatrics, Regional Hospital of Bolzano, Bolzano, Italy
| | - Franco Stanzial
- Genetic Counseling Service, Department of Pediatrics, Regional Hospital of Bolzano, Bolzano, Italy
| | - Renata Posmyk
- Department of Clinical Genetics, Medical University in Bialystok, Bialystok, Poland
| | - Ewa Kaczorowska
- Department of Biology and Medical Genetics, Medical University of Gdansk, Gdansk, Poland
| | - Miryam Carecchio
- Movement Disorders Unit, Department of Neuroscience, University of Padova, Padova, Italy
| | - Monika Gos
- Development Genetics Laboratory, Department of Medical Genetics, Institute of Mother and Child, Warsaw, Poland
| | - Sylwia Rzońca-Niewczas
- Development Genetics Laboratory, Department of Medical Genetics, Institute of Mother and Child, Warsaw, Poland
| | | | - Alessandra Murgia
- Department of Women's and Children's Health, University of Padova, Padova, Italy.
- Pediatric Research Institute, Città della Speranza, Padova, Italy.
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Speciani MC, Cintolo M, Marino M, Oren M, Fiori F, Gargari G, Riso P, Ciafardini C, Mascaretti F, Parpinel M, Airoldi A, Vangeli M, Leone P, Cantù P, Lagiou P, Del Bo’ C, Vecchi M, Carnevali P, Oreggia B, Guglielmetti S, Bonzi R, Bonato G, Ferraroni M, La Vecchia C, Penagini R, Mutignani M, Rossi M. Flavonoid Intake in Relation to Colorectal Cancer Risk and Blood Bacterial DNA. Nutrients 2022; 14:4516. [PMID: 36364779 PMCID: PMC9653960 DOI: 10.3390/nu14214516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 09/29/2023] Open
Abstract
Flavonoids have been inversely associated to colorectal cancer (CRC) and are plausible intermediaries for the relation among gut microbiome, intestinal permeability and CRC. We analyzed the relation of flavonoid intake with CRC and blood bacterial DNA. We conducted a case-control study in Italy involving 100 incident CRC cases and 200 controls. A valid and reproducible food-frequency questionnaire was used to assess dietary habits and to estimate six flavonoid subclass intakes. We applied qPCR and 16S rRNA gene profiling to assess blood bacterial DNA. We used multiple logistic regression to derive odds ratios (ORs) of CRC and Mann-Whitney and chi--square tests to evaluate abundance and prevalence of operational taxonomic units (OTUs) according to flavonoid intakes. Inverse associations with CRC were found for anthocyanidins (OR for the highest versus the lowest tertile = 0.24, 95% confidence interval, CI = 0.11-0.52) and flavanones (OR = 0.18, 95% CI = 0.08-0.42). We found different abundance and prevalence according to anthocyanidin and flavanone intake for OTUs referring to Oligoflexales order, Diplorickettsiaceae family, Staphylococcus, Brevundimonas, Pelomonas and Escherischia-Shigella genera, and Flavobacterium and Legionella species. The study provides evidence to a protective effect of dietary anthocyanidins and flavanones on CRC and suggests an influence of flavonoids on blood bacterial DNA, possibly through intestinal permeability changes.
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Affiliation(s)
- Michela Carola Speciani
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology “G.A. Maccacaro”, Università degli Studi di Milano, 20133 Milan, Italy
| | - Marcello Cintolo
- Digestive and Interventional Endoscopy Unit, Azienda Socio Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Mirko Marino
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università Degli Studi di Milano, 20133 Milan, Italy
| | - Maya Oren
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology “G.A. Maccacaro”, Università degli Studi di Milano, 20133 Milan, Italy
| | - Federica Fiori
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Giorgio Gargari
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università Degli Studi di Milano, 20133 Milan, Italy
| | - Patrizia Riso
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università Degli Studi di Milano, 20133 Milan, Italy
| | - Clorinda Ciafardini
- Gastroenterology and Endoscopy Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Federica Mascaretti
- Gastroenterology and Endoscopy Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Maria Parpinel
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Aldo Airoldi
- Hepatology and Gastroenterology Unit, Azienda Socio Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Marcello Vangeli
- Hepatology and Gastroenterology Unit, Azienda Socio Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Pierfrancesco Leone
- General Surgery Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Paolo Cantù
- Gastroenterology and Digestive Endoscopy Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale Tumori, 20133 Milan, Italy
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, GR-115 27 Athens, Greece
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Cristian Del Bo’
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università Degli Studi di Milano, 20133 Milan, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, 20133 Milan, Italy
| | - Pietro Carnevali
- Division of Minimally–Invasive Surgical Oncology, Niguarda Cancer Center, Azienda Socio Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, 20133 Milan, Italy
| | - Barbara Oreggia
- General Surgery Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Simone Guglielmetti
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università Degli Studi di Milano, 20133 Milan, Italy
| | - Rossella Bonzi
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology “G.A. Maccacaro”, Università degli Studi di Milano, 20133 Milan, Italy
| | - Giulia Bonato
- Digestive and Interventional Endoscopy Unit, Azienda Socio Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Monica Ferraroni
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology “G.A. Maccacaro”, Università degli Studi di Milano, 20133 Milan, Italy
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology “G.A. Maccacaro”, Università degli Studi di Milano, 20133 Milan, Italy
| | - Roberto Penagini
- Gastroenterology and Endoscopy Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, 20133 Milan, Italy
| | - Massimiliano Mutignani
- Digestive and Interventional Endoscopy Unit, Azienda Socio Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Marta Rossi
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology “G.A. Maccacaro”, Università degli Studi di Milano, 20133 Milan, Italy
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13
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Renga A, Dioscoridi L, Massad M, Cintolo M, Bonato G, Aprile F, Mutignani M. Endoscopic "stenting bridge" to treat combined gastric perforation, jejunal stump dehiscence, and biliodigestive anastomosis leak after duodenopancreatectomy followed by pancreatic totalization. Endoscopy 2022; 54:E443-E444. [PMID: 34535031 DOI: 10.1055/a-1625-2892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Alessio Renga
- Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy
| | | | - Mutaz Massad
- Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy
| | | | - Giulia Bonato
- Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy
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14
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Lerjefors L, Andretta S, Bonato G, Mainardi M, Carecchio M, Antonini A. Antiphospholipid‐related chorea: two case reports and role of metabolic imaging. Mov Disord Clin Pract 2022; 9:516-521. [PMID: 35582315 PMCID: PMC9092735 DOI: 10.1002/mdc3.13432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 11/09/2022] Open
Abstract
Background Antiphospholipid syndrome (APS) is a complex acquired autoimmune disease with a wide clinical spectrum. Chorea is a rare neurological manifestation of APS. Cases We report two elderly patients with APS‐related chorea in whom functional imaging (18F‐FDG positron emission tomography, FDG‐PET) supported the diagnosis and compare our findings with existing literature. Literature Review Among 142 clinical cases of antiphospholipid‐related chorea found in literature, only 10 had undergone brain metabolic imaging. Striatal hypermetabolism was evident in all cases (6) that underwent FDG‐PET cerebral imaging. Cerebral perfusion single photon emission computed tomography (SPECT) was normal in two cases, while the other two presented with basal ganglia hypoperfusion. Conclusions Brain FDG‐PET usually shows striatal hypometabolism in neurodegenerative types of chorea as opposed to striatal hypermetabolism observed in most cases of chorea from reversible etiologies, such as APS‐related chorea. When a patient's clinical presentation is not clearly suggestive of either a neurodegenerative or autoimmune chorea, and first‐line investigations are normal, FDG‐PET may help in the differential diagnosis, especially in the presence of striatal hypermetabolism. SPECT data are less numerous and show either normal scans or basal ganglia hypoperfusion.
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Affiliation(s)
- Lisa Lerjefors
- Parkinson and movement Disorders Unit, Centre for Rare Neurological Diseases (ERN‐RND), Department of Neuroscience University of Padua Padua Italy
| | - Silvia Andretta
- Parkinson and movement Disorders Unit, Centre for Rare Neurological Diseases (ERN‐RND), Department of Neuroscience University of Padua Padua Italy
| | - Giulia Bonato
- Parkinson and movement Disorders Unit, Centre for Rare Neurological Diseases (ERN‐RND), Department of Neuroscience University of Padua Padua Italy
| | - Michele Mainardi
- Parkinson and movement Disorders Unit, Centre for Rare Neurological Diseases (ERN‐RND), Department of Neuroscience University of Padua Padua Italy
| | - Miryam Carecchio
- Parkinson and movement Disorders Unit, Centre for Rare Neurological Diseases (ERN‐RND), Department of Neuroscience University of Padua Padua Italy
| | - Angelo Antonini
- Parkinson and movement Disorders Unit, Centre for Rare Neurological Diseases (ERN‐RND), Department of Neuroscience University of Padua Padua Italy
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15
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Dioscoridi L, Melis V, Aldo C, Arlati S, Molinari P, Cintolo M, Pugliese F, Bonato G, Forti E, Massimiliano M. Non-intubated general anesthesia in prone position for advanced biliopancreatic therapeutic endoscopy: A single tertiary referral center experience. Saudi J Anaesth 2022; 16:150-155. [PMID: 35431757 PMCID: PMC9009548 DOI: 10.4103/sja.sja_714_21] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 11/11/2022] Open
Abstract
Background and Study Aim: Advance biliopancreatic endoscopies are nowadays performed in non-operating room anesthesia (NORA) under general anesthesia (GA). We evaluate the outcomes of non-intubated patients in prone position who received GA for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in a tertiary referral center for digestive endoscopy. Patients and Methods: Anesthesiological records, anamnestic, and intraoperative data of patients who underwent advanced therapeutic biliopancreatic endoscopies at our tertiary referral center from January 2019 until January 2020 were collected in the present observational study. Results: One hundred fifty-three patients (93 M; median age: 68-year-old; mean ASA status: 2) were considered eligible for a procedure in the prone position with GA in spontaneous breathing. Prone position was always the initial setting. Propofol administration through a target-controlled infusion (TCI) pump was the choice to achieve GA. In our experience, desaturation appears to be the most frequent adverse event, accounting for 35% of cases (55/153). Treatment foresaw additional oxygen through a nasopharyngeal catheter, which proved to be a sufficient measure in almost all patients (52/55). Other adverse events (i.e., inadequate sedative plan, pain, and bradycardia) accounted for 2.6% of cases (4/153). Conclusions: Non-intubated GA in the prone position may be regarded as a safe procedure, as long as the anesthesiological criteria of exclusion are respected and the anesthesiological team has become acquainted with the peculiar NORA setting and familiar with the management of possible adverse events.
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16
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Antonini A, Garrì F, Mainardi M, Lerjefors L, Bonato G, Andretta S, Campagnolo M, Carecchio M. Challenges in advanced treatments in Parkinson's disease. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Dioscoridi L, Forti E, Pugliese F, Cintolo M, Bonato G, Aprile F, Renga A, Mutignani M. Endoscopic intraductal lithotripsy of biliary stones using thulium laser: preliminary results of a single-center experience. Lasers Med Sci 2021; 37:1361-1364. [PMID: 34308504 DOI: 10.1007/s10103-021-03382-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Lorenzo Dioscoridi
- Digestive Endoscopy Unit, ASST Niguarda, Piazza dell'Ospedale Maggiore 1, 20162, Milan, Italy.
| | - Edoardo Forti
- Digestive Endoscopy Unit, ASST Niguarda, Piazza dell'Ospedale Maggiore 1, 20162, Milan, Italy
| | - Francesco Pugliese
- Digestive Endoscopy Unit, ASST Niguarda, Piazza dell'Ospedale Maggiore 1, 20162, Milan, Italy
| | - Marcello Cintolo
- Digestive Endoscopy Unit, ASST Niguarda, Piazza dell'Ospedale Maggiore 1, 20162, Milan, Italy
| | - Giulia Bonato
- Digestive Endoscopy Unit, ASST Niguarda, Piazza dell'Ospedale Maggiore 1, 20162, Milan, Italy
| | - Francesca Aprile
- Digestive Endoscopy Unit, ASST Niguarda, Piazza dell'Ospedale Maggiore 1, 20162, Milan, Italy
| | - Alessio Renga
- Digestive Endoscopy Unit, ASST Niguarda, Piazza dell'Ospedale Maggiore 1, 20162, Milan, Italy
| | - Massimiliano Mutignani
- Digestive Endoscopy Unit, ASST Niguarda, Piazza dell'Ospedale Maggiore 1, 20162, Milan, Italy
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18
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Dioscoridi L, Giannetti A, Massad MT, Forti E, Pugliese F, Cintolo M, Bonato G, Rosa R, Mutignani M. A "double-hit" damage mechanism can explain self-limited GI bleeding in COVID-19 pneumonia. Gastrointest Endosc 2021; 93:1192-1193. [PMID: 33875144 PMCID: PMC8052210 DOI: 10.1016/j.gie.2020.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 12/09/2020] [Indexed: 02/08/2023]
Affiliation(s)
| | - Aurora Giannetti
- Digestive Endoscopy Unit, Istituto di Ricovero e Cura a Carattere Scientifico Multimedica, Sesto San Giovanni, Milan, Italy
| | - Mu Taz Massad
- Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Edoardo Forti
- Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy
| | | | | | - Giulia Bonato
- Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Roberto Rosa
- Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy
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Affiliation(s)
- Giulio Petrocelli
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy,Associazione Nazionale Operatori Tecniche Endoscopiche (ANOTE), Massa Lubrense, Italy
| | - Lorenzo Dioscoridi
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Francesco Pugliese
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Marcello Cintolo
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Giulia Bonato
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Roberto Rosa
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
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20
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Mutignani M, Dioscoridi L, Venezia L, Larghi A, Pugliese F, Cintolo M, Bonato G, Forti E. Erratum: Endoscopic 'suction room' to treat complex enteral stump leaks after upper gastrointestinal surgery. Endosc Int Open 2021; 9:C3. [PMID: 33758777 PMCID: PMC7979318 DOI: 10.1055/a-1417-5166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
[This corrects the article DOI: 10.1055/a-1336-2922.].
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Affiliation(s)
| | | | - Ludovica Venezia
- Gastroenterology Unit, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Gemelli IRCCS, Rome, Italy,CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
| | | | | | - Giulia Bonato
- Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Edoardo Forti
- Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy
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21
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Mutignani M, Dioscoridi L, Venezia L, Larghi A, Pugliese F, Cintolo M, Bonato G, Forti E. Endoscopic 'suction room' to treat complex enteral stump leaks after upper gastrointestinal surgery. Endosc Int Open 2021; 9:E371-E377. [PMID: 33655036 PMCID: PMC7895649 DOI: 10.1055/a-1336-2922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/11/2020] [Indexed: 11/03/2022] Open
Abstract
Leaks/dehiscence of the enteral stump associated with infected peri-enteric collections after upper gastrointestinal surgery are a life-threatening adverse event, not usually endoscopically treatable. We describe a new endoscopic approach to treat complex entero-cutaneous fistulas (CECF) by creating a "suction room" through placement of multiple stents (enteral, biliary and/or pancreatic) and a large nose-enteral suction tube inside the enteral stent maintained on a continuous negative aspiration suction. Between January 2016 and December 2019, six consecutive patients referred to our unit with CECF of the enteral stump after failed redo surgeries underwent creation of a "suction room." In five patients, enteral, biliary and pancreatic stents were positioned before a nose-to-stent or nose-to-collection large 18 Fr tube placement. In one patient, a pancreatic stent was not placed. Technical and clinical success were achieved in all patients. Mean and median times of aspiration were 49 and 27 days, respectively, with a mean hospital stay of 56 days after the endoscopic procedure. Stents were successfully removed. Mean post-procedural follow-up was 17.3 months. Endoscopic creation of the "suction room" offers the unique possibility of treating complex entero-cutaneous fistulas in surgically altered sites, which are difficult to manage with standard endoscopic methods.
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Affiliation(s)
| | | | - Ludovica Venezia
- Gastroenterology Unit, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Gemelli IRCCS, Rome, Italy,CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
| | | | | | - Giulia Bonato
- Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Edoardo Forti
- Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy
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Dioscoridi L, Giannetti A, Bonato G, Vantaggiato G, Vicari F, Airoldi A. COVID-19 and Diarrhoea: the Therapeutic Role OF LMWH. SN Compr Clin Med 2021; 3:782-783. [PMID: 33644694 PMCID: PMC7896826 DOI: 10.1007/s42399-021-00825-3] [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] [Subscribe] [Scholar Register] [Accepted: 02/14/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Lorenzo Dioscoridi
- COVID DEA, Department of Emergency Medicine, ASST Niguarda, Piazza dell’Ospedale Maggiore 3, 20162 Milan, Italy
| | | | - Giulia Bonato
- COVID DEA, Department of Emergency Medicine, ASST Niguarda, Piazza dell’Ospedale Maggiore 3, 20162 Milan, Italy
| | - Giuseppe Vantaggiato
- COVID DEA, Department of Emergency Medicine, ASST Niguarda, Piazza dell’Ospedale Maggiore 3, 20162 Milan, Italy
| | - Francesco Vicari
- COVID DEA, Department of Emergency Medicine, ASST Niguarda, Piazza dell’Ospedale Maggiore 3, 20162 Milan, Italy
| | - Aldo Airoldi
- COVID DEA, Department of Emergency Medicine, ASST Niguarda, Piazza dell’Ospedale Maggiore 3, 20162 Milan, Italy
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23
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Mutignani M, Bonato G, Dioscoridi L, Mazzola M, Cintolo M, Pugliese F, Rosa R, Italia A, Ferrari G, Forti E. Expanding endoscopic treatment strategies for pancreatic leaks following pancreato-duodenectomy: a single centre experience. Surg Endosc 2021; 35:1908-1914. [PMID: 33403464 DOI: 10.1007/s00464-020-08199-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/17/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM Clinically relevant pancreatic leaks of jejunal-pancreatic anastomosis after pancreato-duodenectomy (PD) occur in 9-15% of cases. Endoscopic strategies for management of pancreatic fistula, may allow to avoid reoperation and shorten times for fistula closure, but are still understudied and not widely performed. Aim of the present paper is to describe different endoscopic techniques used to treat such conditions. METHODS It was a retrospective, single centre, study. All patients who underwent endoscopic treatment for pancreatic leaks following PD between 1st January 2013 and 31th May 2019 at our Centre were reviewed. Depending on the morphology and severity of the leak, four main endoscopic techniques were performed: (1) trans-anastomotic intraductal pancreatic stent insertion; (2) lumen-apposing metal stent between the jejunal loop and the retroperitoneum toward the pancreatic stump insertion ("yoyo-stent"); (3) large calibre nose-to-retroperitoneum drain insertion; (4) when a wide damage of the jejunal wall or a coexistent biliary-jejunal leak were observed, triple metal stent insertion was performed as follow in order to close the defect: enteral fully-covered SEMS in the jejunal stump, a pancreatic metal stent into the Wirsung duct and a fully-covered SEMS across the bilio-digestive anastomosis, through the meshes of the enteral stent. In all cases, surgical drain was simultaneously retracted. RESULTS We identified 13 patients who underwent endoscopic treatment for POPF after PD. In total, 5 patients underwent "Yoyo stent insertion", 3 with nose-to-collection drain placement and four patients were treated with triple-stent insertion; in only one patient intrapancreatic SEMS insertion was performed. Technical success was 100% and clinical success was 83.3%. Mean time for leak closure was 4.8 days (range 2-10). During the follow-up interval, no leak recurrences were observed. CONCLUSIONS Our experience confirms efficacy and safety of endoscopic management of POPF following pancreatoduodenectomy management. Endoscopy should play a central role in this clinical scenario.
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Affiliation(s)
- Massimiliano Mutignani
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Giulia Bonato
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy.
| | - Lorenzo Dioscoridi
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Michele Mazzola
- Department of Oncologic and Minimally Invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marcello Cintolo
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Francesco Pugliese
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Roberto Rosa
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Angelo Italia
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Giovanni Ferrari
- Department of Oncologic and Minimally Invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy
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24
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Rosa R, Dioscoridi L, Forti E, Pugliese F, Cintolo M, Bonato G, Mutignani M. Indeterminate biliary stricture treated by antegrade cholangioscopy through an endoscopic ultrasound-guided hepaticojejunostomy. Endoscopy 2020; 52:1143-1144. [PMID: 32330955 DOI: 10.1055/a-1149-8684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Roberto Rosa
- Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy
| | | | - Edoardo Forti
- Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy
| | | | | | - Giulia Bonato
- Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy
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25
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Affiliation(s)
- Giulia Bonato
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lorenzo Dioscoridi
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimiliano Mutignani
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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26
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Massironi S, Viganò C, Dioscoridi L, Filippi E, Pagliarulo M, Manfredi G, Conti CB, Signorelli C, Redaelli AE, Bonato G, Iiritano E, Frego R, Zucchini N, Ungari M, Pedaci M, Bono F, Di Bella C, Buscarini E, Mutignani M, Penagini R, Dinelli ME, Invernizzi P. Endoscopic Findings in Patients Infected With 2019 Novel Coronavirus in Lombardy, Italy. Clin Gastroenterol Hepatol 2020; 18:2375-2377. [PMID: 32480008 PMCID: PMC7260560 DOI: 10.1016/j.cgh.2020.05.045] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 02/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a major worldwide threat caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), rapidly spreading to a global pandemic. As of May 11, 2020, 4,176,346 cases have been reported worldwide, 219,814 in Italy, and of them, 81,871 occurred in the Lombardy region.1 Although the respiratory manifestations of COVID-19 have been widely described, the impact on the gastrointestinal (GI) system remains less clear. The reported prevalence of digestive symptoms ranges from 3% to 79%, depending on the setting,2-5 but data on GI endoscopic and histologic findings in COVID-19 patients are lacking. Therefore, the aim of this study is to describe the GI endoscopic and histologic findings in COVID-19 patients.
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Affiliation(s)
- Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza.
| | - Chiara Viganò
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza
| | - Lorenzo Dioscoridi
- Niguarda Hospital, Diagnostic and Interventional Digestive Endoscopy Milano, Lombardia
| | - Elisabetta Filippi
- Department of Pathophysiology and Transplantation, University of Milan,Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Guido Manfredi
- Department of Gastroenterology and Endoscopy, Maggiore Hospital, ASST Crema, Crema
| | | | | | | | - Giulia Bonato
- Niguarda Hospital, Diagnostic and Interventional Digestive Endoscopy Milano, Lombardia
| | - Elena Iiritano
- Department of Gastroenterology and Endoscopy, Maggiore Hospital, ASST Crema, Crema
| | | | - Nicola Zucchini
- Division of Pathology, San Gerardo Hospital, ASST Monza, Monza
| | | | - Marianna Pedaci
- Department of Gastroenterology and Endoscopy, Maggiore Hospital, ASST Crema, Crema
| | - Francesca Bono
- Division of Pathology, San Gerardo Hospital, ASST Monza, Monza
| | | | - Elisabetta Buscarini
- Department of Gastroenterology and Endoscopy, Maggiore Hospital, ASST Crema, Crema
| | | | - Roberto Penagini
- Department of Pathophysiology and Transplantation, University of Milan
| | | | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza
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27
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Dioscoridi L, Cristalli A, Forti E, Pugliese F, Cintolo M, Italia A, Bonato G, Petrocelli G, Mutignani M. Digestive endoscopy during Covid-19 outbreak in Italy: a tertiary referral center experience. Endoscopy 2020; 52:619-620. [PMID: 32580228 DOI: 10.1055/a-1159-0697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Lorenzo Dioscoridi
- Digestive Endoscopy, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Aldo Cristalli
- Digestive Endoscopy, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Edoardo Forti
- Digestive Endoscopy, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Pugliese
- Digestive Endoscopy, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marcello Cintolo
- Digestive Endoscopy, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Angelo Italia
- Digestive Endoscopy, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulia Bonato
- Digestive Endoscopy, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulio Petrocelli
- Digestive Endoscopy, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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28
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Dioscoridi L, Forti E, Pugliese F, Italia A, Cintolo M, Bonato G, Mutignani M. Response to 'Endoluminal negative pressure therapy in colorectal anastomotic leaks'. Colorectal Dis 2020; 22:840-841. [PMID: 32034852 DOI: 10.1111/codi.15006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 12/19/2022]
Affiliation(s)
- L Dioscoridi
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - E Forti
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - F Pugliese
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - A Italia
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - M Cintolo
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - G Bonato
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - M Mutignani
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
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29
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Pugliese F, Bonato G, Dioscoridi L, Cintolo M, Aquilano MC, Forti E, Giannetti A, Italia A, Mutignani M. A tiny lesion arising within Barrett's esophagus. Turk J Gastroenterol 2020; 31:410-412. [PMID: 32519961 DOI: 10.5152/tjg.2020.19352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Francesco Pugliese
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulia Bonato
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lorenzo Dioscoridi
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marcello Cintolo
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maria Costanza Aquilano
- Surgical Pathology Unit, Department of Laboratory Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Aurora Giannetti
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Angelo Italia
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimiliano Mutignani
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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30
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Dioscoridi L, Forti E, Pugliese F, Cintolo M, Bonato G, Giannetti A, Mutignani M. Buried lumen-apposing metal stent after gastrojejunal bypass. Endoscopy 2020; 52:E134-E135. [PMID: 31652467 DOI: 10.1055/a-1025-1919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Lorenzo Dioscoridi
- Digestive and Interventional Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Francesco Pugliese
- Digestive and Interventional Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Marcello Cintolo
- Digestive and Interventional Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Giulia Bonato
- Digestive and Interventional Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Aurora Giannetti
- Digestive and Interventional Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
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31
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Mutignani M, Dioscoridi L, Italia A, Forti E, Pugliese F, Cintolo M, Bonato G, Giannetti A, Massad M. Thulium laser to manage a difficult biliary lithiasis: a first case report. Endoscopy 2020; 52:E112-E113. [PMID: 31398743 DOI: 10.1055/a-0983-8278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
| | - Lorenzo Dioscoridi
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Angelo Italia
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Francesco Pugliese
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Marcello Cintolo
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Giulia Bonato
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Aurora Giannetti
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Mutaz Massad
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
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32
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Dioscoridi L, Forti E, Pugliese F, Cintolo M, Italia A, Bini M, Bonato G, Giannetti A, Mutignani M. A Modified Boston Bowel Preparation Scale After Colorectal Surgery. Ann Coloproctol 2020; 37:195. [PMID: 32054257 PMCID: PMC8391046 DOI: 10.3393/ac.2019.08.20] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Lorenzo Dioscoridi
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Francesco Pugliese
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Marcello Cintolo
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Angelo Italia
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Marta Bini
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Giulia Bonato
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
| | - Aurora Giannetti
- Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
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33
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Dioscoridi L, Pugliese F, Forti E, Italia A, Cintolo M, Bonato G, Mutignani M. Commentary on “Efficacy of biofeedback therapy for objective improvement of pelvic function in low anterior resection syndrome (Ann Surg Treat Res 2019;97:194–201)”. Ann Surg Treat Res 2020; 99:127-128. [PMID: 32802818 PMCID: PMC7406399 DOI: 10.4174/astr.2020.99.2.127] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/16/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lorenzo Dioscoridi
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Francesco Pugliese
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Edoardo Forti
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Angelo Italia
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Marcello Cintolo
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Giulia Bonato
- Digestive and Operative Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
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34
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Pugliese F, Italia A, Dioscoridi L, Giannetti A, Bonato G, Mutignani M. Thermal coagulation of mucosal defect margins using monopolar forceps reduces adenoma recurrence after colonic endoscopic mucosal resection. Dig Liver Dis 2019; 51:1206. [PMID: 31272933 DOI: 10.1016/j.dld.2019.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 05/23/2019] [Accepted: 05/26/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Francesco Pugliese
- Digestive and Interventional Endoscopy, ASST Grande Ospedale Metropolitano Niguarda, Milan Italy.
| | - Angelo Italia
- Digestive and Interventional Endoscopy, ASST Grande Ospedale Metropolitano Niguarda, Milan Italy
| | - Lorenzo Dioscoridi
- Digestive and Interventional Endoscopy, ASST Grande Ospedale Metropolitano Niguarda, Milan Italy
| | - Aurora Giannetti
- Digestive and Interventional Endoscopy, ASST Grande Ospedale Metropolitano Niguarda, Milan Italy
| | - Giulia Bonato
- Digestive and Interventional Endoscopy, ASST Grande Ospedale Metropolitano Niguarda, Milan Italy
| | - Massimiliano Mutignani
- Digestive and Interventional Endoscopy, ASST Grande Ospedale Metropolitano Niguarda, Milan Italy
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35
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Bonato G, Forti E, Mutignani M. Which Is the Best Option to Relieve Symptoms of Cholecystitis in High-Risk Cirrhotic Patients? Clin Gastroenterol Hepatol 2019; 17:1919-1920. [PMID: 30928450 DOI: 10.1016/j.cgh.2019.03.036] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 03/12/2019] [Accepted: 03/21/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Giulia Bonato
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Division of Gastroenterology, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimiliano Mutignani
- Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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36
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Tringali A, Tarantino I, Barresi L, Traina M, Bonato G, Cintolo M, Hassan C, Mutignani M, Adler DG. Multiple plastic versus fully covered metal stents for managing post-liver transplantation anastomotic biliary strictures: a meta-analysis of randomized controlled trials. Ann Gastroenterol 2019; 32:407-415. [PMID: 31263364 PMCID: PMC6595920 DOI: 10.20524/aog.2019.0376] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/23/2019] [Indexed: 12/15/2022] Open
Abstract
Background Anastomotic biliary strictures (ABS) following liver transplantation (LT) are one of the most common complications, occurring in 4.5-32% of patients. Multiple plastic stenting (MPS) requires multiple sessions, with the associated risk, cost and patient discomfort. Fully covered self-expandable metal stents (FC-SEMS) have increasingly been used in this setting. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs), comparing the role of FC-SEMS and MPS in the treatment of ABS post-LT. Methods We conducted a bibliographic search using PubMed and EMBASE, aimed at identifying available RCTs that compared MPS to FC-SEMS in patients with ABS post LT from January 2000 to October 2017. Primary outcomes were ABS resolution and recurrence, while secondary outcomes were adverse events and number of procedures performed. Pooled estimates were calculated using random-effects models. Results Four RCTs (205 patients) were included. ABS resolution and recurrence did not differ significantly between the groups (odds ratio [OR] 1.05, 95% confidence interval [CI] 0.43-2.56, P=0.92; and OR 2.37, 95%CI 0.54-10.38, P=0.25). The same was true for adverse events (OR 0.91, 95%CI 0.84-3.48, P=0.86) and migration rate (OR 1.31, 95%CI 0.46-3.71, P=0.61). The mean number of endoscopic retrograde cholangiopancreatography procedures was lower for FC-SEMS (mean difference [MD] -2.08). Conclusions FC-SEMS and MPS had equal ABS resolution and recurrence, although there was a trend towards a higher recurrence rate in FC-SEMS that disappeared when trials with a shorter stent indwelling time were excluding. No difference was found in overall adverse events or migration rate.
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Affiliation(s)
- Alberto Tringali
- Endoscopy Unit, Ospedale Ca' Granda Niguarda, Milan, Italy (Alberto Tringali, Giulia Bonato, Marcello Cintolo, Massimiliano Mutignani)
| | - Ilaria Tarantino
- Endoscopy Unit, IRCCS ISMETT, Palermo Italy (Ilaria Tarantino, Luca Barresi, Mario Traina)
| | - Luca Barresi
- Endoscopy Unit, IRCCS ISMETT, Palermo Italy (Ilaria Tarantino, Luca Barresi, Mario Traina)
| | - Mario Traina
- Endoscopy Unit, IRCCS ISMETT, Palermo Italy (Ilaria Tarantino, Luca Barresi, Mario Traina)
| | - Giulia Bonato
- Endoscopy Unit, Ospedale Ca' Granda Niguarda, Milan, Italy (Alberto Tringali, Giulia Bonato, Marcello Cintolo, Massimiliano Mutignani)
| | - Marcello Cintolo
- Endoscopy Unit, Ospedale Ca' Granda Niguarda, Milan, Italy (Alberto Tringali, Giulia Bonato, Marcello Cintolo, Massimiliano Mutignani)
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy (Cesare Hassan)
| | - Massimiliano Mutignani
- Endoscopy Unit, Ospedale Ca' Granda Niguarda, Milan, Italy (Alberto Tringali, Giulia Bonato, Marcello Cintolo, Massimiliano Mutignani)
| | - Douglas G Adler
- Division of Gastroenterology & Hepatology University of Utah, Salt Lake City, Utah, USA (Douglas G. Adler)
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Mutignani M, Forti E, Larghi A, Dokas S, Pugliese F, Cintolo M, Bonato G, Tringali A, Dioscoridi L. Refractory Bergmann type A bile leak: the need to strike a balance. Endosc Int Open 2019; 7:E264-E267. [PMID: 30705960 PMCID: PMC6353644 DOI: 10.1055/a-0732-4899] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/25/2018] [Indexed: 11/06/2022] Open
Abstract
Background and study aims Endoscopic therapy for postoperative Bergmann type A bile leaks is based on biliary sphincterotomy ± stent insertion. However, recurrent or refractory bile leaks can occur. Patients and methods This was retrospective study including all consecutive patients who were referred to our center with a Bergmann type A bile leak refractory to previous conventional endoscopic treatments. Results Seventeen patients with post-cholecystectomy-refractory Bergmann type A bile leak were included. All had received prior endoscopic biliary sphincterotomy with biliary stent or nasobiliary catheter placement and all had a percutaneous or surgical abdominal drainage. Repeat endoscopic retrograde cholangiopancreatography (ERCP) confirmed a Bergmann type A bile leak and in all patients we observed that the abdominal drainage was placed adjacent to the origin of the fistula. Our treatment consisted of pulling the drain away from the fistulous site, with extension of the previous sphincterotomy when needed. The treatment was successful in all cases. Mild complications occurred in three patients. Conclusions Our retrospective study shows that refractory Bergmann type A bile leak may be a consequence of an unfavorable position of the abdominal drainage tube, which can be corrected by pulling the drain away from the origin of the fistula. This establishes a favorable pressure gradient that leads the bile flowing from the bile duct into the duodenum.
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Affiliation(s)
- Massimiliano Mutignani
- Digestive and Operative Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy,Corresponding author Massimiliano Mutignani, MD Digestive and Operative Endoscopy UnitNiguarda-Ca’ Granda HospitalPiazza dell’Ospedale Maggiore 320121, MilanItaly+00390264442471
| | - Edoardo Forti
- Digestive and Operative Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Stefanos Dokas
- Endoscopy Department, St Lukes Private Hospital, Panorama, Thessaloniki, Greece
| | - Francesco Pugliese
- Digestive and Operative Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
| | - Marcello Cintolo
- Digestive and Operative Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
| | - Giulia Bonato
- Digestive and Operative Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
| | - Alberto Tringali
- Digestive and Operative Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
| | - Lorenzo Dioscoridi
- Digestive and Operative Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
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Tringali A, Bonato G, Dioscoridi L, Mutignani M. New endoscopic technique for retrieval of large colonic foreign bodies and an endoscopy-oriented review of the literature. BMJ Case Rep 2018; 2018:bcr-2018-226348. [PMID: 30173136 DOI: 10.1136/bcr-2018-226348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Colorectal foreign bodies (FB) are challenging issues for the endoscopist especially if the mostly used methods (polypectomy snare, biopsy forceps or wire-guided 40 mm dilation balloon) failed. We report a case of a 31-year-old man who was admitted in the emergency department for the impaction of a 60 cm long and large-size FB in the sigmoid colon. We failed to remove the FB using several different standard technique because of the rigidity, the smoothness and the size of the object. After all these attempts, we built up a 'home-made' device inserting a 0.035 inch non-hydrophilic guidewire (Metro WireGuide, Cook Medical) doubled into an 8.5 Fr stent-pusher-catheter (Cook Medical) serving as an outer sheet in order to create a noose and we finally succeeded in the endoscopic extraction of the device. We suggest this new technique as a valid option to remove large FBs from the colon and rectum when standard endoscopic methods for FB's extraction fail.
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Affiliation(s)
- Alberto Tringali
- Digestive Endoscopy Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Giulia Bonato
- Digestive Endoscopy Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Lorenzo Dioscoridi
- Digestive Endoscopy Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Massimiliano Mutignani
- Digestive Endoscopy Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
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Carbone M, Nardi A, Flack S, Carpino G, Varvaropoulou N, Gavrila C, Spicer A, Badrock J, Bernuzzi F, Cardinale V, Ainsworth HF, Heneghan MA, Thorburn D, Bathgate A, Jones R, Neuberger JM, Battezzati PM, Zuin M, Taylor-Robinson S, Donato MF, Kirby J, Mitchell-Thain R, Floreani A, Sampaziotis F, Muratori L, Alvaro D, Marzioni M, Miele L, Marra F, Giannini E, Gaudio E, Ronca V, Bonato G, Cristoferi L, Malinverno F, Gerussi A, Stocken DD, Cordell HJ, Hirschfield GM, Alexander GJ, Sandford RN, Jones DE, Invernizzi P, Mells GF. Pretreatment prediction of response to ursodeoxycholic acid in primary biliary cholangitis: development and validation of the UDCA Response Score. Lancet Gastroenterol Hepatol 2018; 3:626-634. [PMID: 30017646 DOI: 10.1016/s2468-1253(18)30163-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 04/30/2018] [Accepted: 05/03/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Treatment guidelines recommend a stepwise approach to primary biliary cholangitis: all patients begin treatment with ursodeoxycholic acid (UDCA) monotherapy and those with an inadequate biochemical response after 12 months are subsequently considered for second-line therapies. However, as a result, patients at the highest risk can wait the longest for effective treatment. We determined whether UDCA response can be accurately predicted using pretreatment clinical parameters. METHODS We did logistic regression analysis of pretreatment variables in a discovery cohort of patients in the UK with primary biliary cholangitis to derive the best-fitting model of UDCA response, defined as alkaline phosphatase less than 1·67 times the upper limit of normal (ULN), measured after 12 months of treatment with UDCA. We validated the model in an external cohort of patients with primary biliary cholangitis and treated with UDCA in Italy. Additionally, we assessed correlations between model predictions and key histological features, such as biliary injury and fibrosis, on liver biopsy samples. FINDINGS 2703 participants diagnosed with primary biliary cholangitis between Jan 1, 1998, and May 31, 2015, were included in the UK-PBC cohort for derivation of the model. The following pretreatment parameters were associated with lower probability of UDCA response: higher alkaline phosphatase concentration (p<0·0001), higher total bilirubin concentration (p=0·0003), lower aminotransferase concentration (p=0·0012), younger age (p<0·0001), longer interval from diagnosis to the start of UDCA treatment (treatment time lag, p<0·0001), and worsening of alkaline phosphatase concentration from diagnosis (p<0·0001). Based on these variables, we derived a predictive score of UDCA response. In the external validation cohort, 460 patients diagnosed with primary biliary cholangitis were treated with UDCA, with follow-up data until May 31, 2016. In this validation cohort, the area under the receiver operating characteristic curve for the score was 0·83 (95% CI 0·79-0·87). In 20 liver biopsy samples from patients with primary biliary cholangitis, the UDCA response score was associated with ductular reaction (r=-0·556, p=0·0130) and intermediate hepatocytes (probability of response was 0·90 if intermediate hepatocytes were absent vs 0·51 if present). INTERPRETATION We have derived and externally validated a model based on pretreatment variables that accurately predicts UDCA response. Association with histological features provides face validity. This model provides a basis to explore alternative approaches to treatment stratification in patients with primary biliary cholangitis. FUNDING UK Medical Research Council and University of Milan-Bicocca.
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Affiliation(s)
- Marco Carbone
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, UK; Division of Gastroenterology and Hepatology, Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy.
| | - Alessandra Nardi
- Department of Mathematics, University of Rome Tor Vergata, Rome, Italy
| | - Steve Flack
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - Guido Carpino
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | | | | | - Ann Spicer
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - Jonathan Badrock
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - Francesca Bernuzzi
- Division of Gastroenterology and Hepatology, Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Vincenzo Cardinale
- Department of Medico-Surgical Sciences and Biotechnologies, Polo Pontino, Sapienza University of Rome, Rome, Italy
| | - Holly F Ainsworth
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, UK
| | - Michael A Heneghan
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Douglas Thorburn
- Sheila Sherlock Liver Centre, The Royal Free London NHS Foundation Trust, London, UK
| | - Andrew Bathgate
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rebecca Jones
- Liver Unit, St James's University Hospital, Leeds, UK
| | | | | | - Massimo Zuin
- Division of Internal Medicine and Liver Unit, Ospedale San Paolo, Milan, Italy
| | - Simon Taylor-Robinson
- Liver Unit, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, UK
| | - Maria F Donato
- CRC "AM e A Migliavacca" Center for the Study of Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - John Kirby
- Applied Immunobiology and Transplantation Research Group, Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | | | - Annarosa Floreani
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - Fotios Sampaziotis
- Department of Surgery, Wellcome Trust-Medical Research Council Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK
| | - Luigi Muratori
- Liver Unit, Policlinico di Sant'Orsola-Malpighi, Bologna, Italy
| | - Domenico Alvaro
- Department of Medico-Surgical Sciences and Biotechnologies, Polo Pontino, Sapienza University of Rome, Rome, Italy
| | - Marco Marzioni
- Division of Gastroenterology and Hepatology, Ospedali Riuniti University Hospital, Ancona, Italy
| | - Luca Miele
- Department of Internal Medicine and Gastroenterology, Gemelli University Hospital, Rome, Italy
| | - Fabio Marra
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Edoardo Giannini
- Division of Gastroenterology, Department of Internal Medicine, IRCCS-Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
| | - Eugenio Gaudio
- Department of Anatomy, Histology, Legal Medicine, and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Ronca
- Division of Internal Medicine and Liver Unit, Ospedale San Paolo, Milan, Italy
| | - Giulia Bonato
- Division of Gastroenterology and Hepatology, Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Laura Cristoferi
- Division of Gastroenterology and Hepatology, Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Federica Malinverno
- Division of Gastroenterology and Hepatology, Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Alessio Gerussi
- Division of Gastroenterology and Hepatology, Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Deborah D Stocken
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, UK
| | - Heather J Cordell
- Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Gideon M Hirschfield
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Richard N Sandford
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - David E Jones
- Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Pietro Invernizzi
- Division of Gastroenterology and Hepatology, Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - George F Mells
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, UK
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Carbone M, Bonato G, Invernizzi P. Female preponderance of primary biliary cholangitis is all about our understanding of its autoimmune nature. Hepatology 2018; 67:1210-1212. [PMID: 29091288 DOI: 10.1002/hep.29625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 10/30/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Marco Carbone
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Giulia Bonato
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
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Mutignani M, Forti E, Pugliese F, Tringali A, Cintolo M, Bonato G, Dioscoridi L. Triple stenting to treat a complete Wirsung-to-jejunum anastomotic leak after pancreaticoduodenectomy. Endoscopy 2018; 50:E50-E51. [PMID: 29207407 DOI: 10.1055/s-0043-122595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Massimiliano Mutignani
- Diagnostic and Interventional Digestive Endoscopy, Niguarda Ca-Granda Hospital, Milan, Italy
| | - Edoardo Forti
- Diagnostic and Interventional Digestive Endoscopy, Niguarda Ca-Granda Hospital, Milan, Italy
| | - Francesco Pugliese
- Diagnostic and Interventional Digestive Endoscopy, Niguarda Ca-Granda Hospital, Milan, Italy
| | - Alberto Tringali
- Diagnostic and Interventional Digestive Endoscopy, Niguarda Ca-Granda Hospital, Milan, Italy
| | - Marcello Cintolo
- Diagnostic and Interventional Digestive Endoscopy, Niguarda Ca-Granda Hospital, Milan, Italy
| | - Giulia Bonato
- Diagnostic and Interventional Digestive Endoscopy, Niguarda Ca-Granda Hospital, Milan, Italy
| | - Lorenzo Dioscoridi
- Diagnostic and Interventional Digestive Endoscopy, Niguarda Ca-Granda Hospital, Milan, Italy
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Bongiovanni L, Rossini F, Bonato G, Barbieri F, Tonin P, Vattemi G, Franchini E, Demrozi A, Benini L. 60. Dysphagia in different types of myopathy. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
UNLABELLED Primary sclerosing cholangitis (PSC) is a chronic inflammatory liver disease of unknown etiology, primarily targeting cholangiocytes at any portion of the biliary tree. No effective medical treatments are currently available. A unique feature of PSC is its close association (about 80%) with inflammatory bowel disease (IBD), mainly ulcerative colitis (UC). As in many chronic inflammatory conditions, cancer development can complicate PSC, accounting for >40% of deaths. Cholangiocarcinoma (CCA), gallbladder carcinoma (GBC) and colorectal carcinoma (CRC) have been variably associated to PSC, with a prevalence up to 13-14%. The risk of cancer is one of the most challenging issues in the management of PSC; it raises several questions about cancer surveillance, early diagnosis, prevention and treatment. KEY MESSAGES Among the different cancers complicating PSC, CCA is the most relevant, because it is more frequent (incidence of 0.5-1.5%) and because the prognosis is poor (5-year survival <10%). Early diagnosis of CCA in PSC can be difficult because lesions may not be evident in radiological studies. Surgical resection provides disappointing results; liver transplantation combined with neoadjuvant chemoradiotherapy is being proposed, but this approach is limited to a highly selected group of patients and is available only in a few specialized centers. Similar to CCA, GBC carries a dismal prognosis. Since it is difficult to discriminate GBC from other gallbladder abnormalities, cholecystectomy has been proposed in all gallbladder lesions detected in PSC, regardless of their size. CRC is a frequent complication of PSC associated to UC; its incidence steadily increases with time of colitis, reaching up to 20-30% of the patients after 20 years. Colonoscopy with extensive histologic sampling at an annual/biannual interval is an effective surveillance strategy. However, when dysplastic lesions are detected, preemptive proctocolectomy should be considered. CONCLUSIONS PSC may be regarded as paradigmatic of the sequence leading from chronic inflammatory epithelial damage to neoplastic transformation. Understanding the molecular mechanisms regulating this pathogenetic sequence, may improve strategies of disease surveillance and cancer prevention and treatment. PSC is a chronic inflammatory cholangiopathy of unknown etiology but likely immune-mediated, characterized by peribiliary inflammation and fibrosis leading to strictures in any portion (intra- and/or extrahepatic) of the bile duct system. No effective medical treatments are currently available. A unique feature of PSC is the close association (about 80%) with IBD, mainly UC, often diagnosed before PSC (PSC/UC). As in other chronic inflammatory diseases, development of malignancies is a feared complication of PSC.
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Affiliation(s)
- Giulia Bonato
- Department of Surgery and Translational Medicine, University of Milan-Bicocca, Milan
| | - Laura Cristoferi
- Department of Surgery and Translational Medicine, University of Milan-Bicocca, Milan
| | - Mario Strazzabosco
- Department of Surgery and Translational Medicine, University of Milan-Bicocca, Milan,Section of Digestive Diseases, Yale University, New Haven, Conn., USA
| | - Luca Fabris
- Department of Molecular Medicine, University of Padua School of Medicine, Padua, Italy,Section of Digestive Diseases, Yale University, New Haven, Conn., USA
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Festi D, Schiumerini R, Marzi L, Di Biase AR, Mandolesi D, Montrone L, Scaioli E, Bonato G, Marchesini-Reggiani G, Colecchia A. Review article: the diagnosis of non-alcoholic fatty liver disease -- availability and accuracy of non-invasive methods. Aliment Pharmacol Ther 2013; 37:392-400. [PMID: 23278163 DOI: 10.1111/apt.12186] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 08/09/2012] [Accepted: 11/26/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of clinical conditions, actually representing an emerging disease of great clinical interest. Currently, its diagnosis requires liver biopsy, an invasive procedure not free from potential complications. However, several non-invasive diagnostic strategies have been proposed as potential diagnostic alternatives, each with different sensitivities and accuracies. AIM To review non-invasive diagnostic parameters and tools for NAFLD diagnosis and to formulate a diagnostic and prognostic algorithm for a better classification of patients. METHODS A literature search was carried out on MEDLINE, EMBASE, Web of Science and Scopus for articles and abstracts in English. The search terms used included 'NAFLD', 'non invasive method and NAFLD', 'transient elastography' and 'liver fibrosis'. The articles cited were selected based on their relevancy to the objective of the review. RESULTS Ultrasonography still represents the first-line diagnostic tool for simple liver steatosis; its sensitivity could be enhanced by the complex biochemical score SteatoTest. Serum cytokeratin-18 is a promising and accurate non-invasive parameter (AUROCs: 0.83; 0.91) for the diagnosis of non-alcoholic steatohepatitis (NASH). The staging of liver fibrosis still represents the most important prognostic problem: the most accurate estimating methods are FibroMeter, FIB-4, NAFLD fibrosis score (AUROCs: 0.94; 0.86; 0.82) and transient elastography (AUROC: 0.84-1.00). CONCLUSIONS Different non-invasive parameters are available for the accurate diagnosis and prognostic stratification of non-alcoholic fatty liver disease which, if employed in a sequential algorithm, may lead to a reduced use of invasive methods, i.e. liver biopsy.
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Affiliation(s)
- D Festi
- Department of Medical and Surgical Science, University of Bologna, Department of Pediatrics, University of Modena, Italy.
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Bonomi U, Piacentini I, Bonato G, Gobbis T. [Probable relationship between bacterial count and microbial flora of urine]. Fracastoro 1971; 64:320-3. [PMID: 5151105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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