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Gnech M, Bebi C, Clementi MC, Minoli DG, De Marco EA, Molinari F, Paraboschi I, Barbi E, Berrettini A, Manzoni G. Surgical and functional outcomes of Dorsal Inlay Graft urethroplasty in revision vs primary hypospadias repair in the pediatric age. J Pediatr Urol 2024:S1477-5131(24)00015-9. [PMID: 38341358 DOI: 10.1016/j.jpurol.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 11/21/2023] [Accepted: 01/10/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Over the years, Dorsal Inlay Graft (DIG) urethroplasty has gained worldwide acceptance for primary hypospadias repair. However, its safety and effectiveness for revision surgery are yet to be proven. OBJECTIVE The aim of the study is to assess and compare complication rates and functional outcomes of DIG surgery in revision versus primary hypospadias repair. MATERIAL AND METHODS We carried out a retrospective analysis of data collected from 53 consecutive DIG urethroplasties performed by a single surgeon at our institution. Patients were stratified in two groups - primary repair and redo-urethroplasty. For each group, we recorded standard pre-operative characteristics, surgical technicalities, complication rates and uroflowmetry parameters. RESULTS Out of 53 DIG urethroplasties, 21 (39.6 %) where primary and 32 (60.4 %) were re-do. As expected, the two groups differed for median age at surgery: 20 months for primary and 68.5 months for revision surgery (p < 0.001). Additionally, all 21 (100 %) primary interventions were performed with a preputial graft, whereas among revision DIG urethroplasties only 2 (6.3 %) where preputial and 30 (93.8 %) were buccal (p < 0.001). Catheterization time (7 vs 8 days, p = 0.155) and postoperative complication rates (14.3 % vs 9.4 %, p = 0.581) were comparable between the primary and revision surgery group, respectively (all p > .05). Forty-two of the 53 patients underwent uroflowmetry during follow-up. Of these, 19 (63 %) patients presented with abnormal uroflowmetry and 11 (37 %) had equivocal parameters with no difference between the two groups. DISCUSSION Dorsal Inlay Graft urethroplasty has long been known to be safe and effective for primary hypospadias repair. On the other hand, data on dorsal inlay graft urethroplasty as a salvage surgery after primary hypospadias repair failure is scarce. Surprisingly, according to our findings, surgical outcomes and complication rates are comparable between primary and revision hypospadias cases. Additionally, our results in the redo group are absolutely encouraging if compared to those reported in the literature for the same subset of patients. CONCLUSIONS According to our findings, DIG urethroplasty is a safe and effective option to treat revision hypospadias repair.
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Affiliation(s)
- M Gnech
- Paediatric Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - C Bebi
- Paediatric Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - M C Clementi
- Paediatric Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - D G Minoli
- Paediatric Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - E A De Marco
- Paediatric Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - F Molinari
- Paediatric Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - I Paraboschi
- Paediatric Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - E Barbi
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy; University of Trieste, Trieste, Italy.
| | - A Berrettini
- Paediatric Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - G Manzoni
- Paediatric Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Bebi C, Gnech M, Clementi M, Minoli D, De Marco E, Molinari F, Paraboschi I, Berrettini A, Manzoni G. Is dorsal inlay graft urethroplasty safe and effective for revisional hypospadias repair in the pediatric age? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00658-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Cannistraci R, Bonacina E, Garbellini A, Muraca E, Ciardullo S, Manzoni G, Mattavelli F, Perseghin G, Zerbini F. An unexpected bilateral mass after total thyroidectomy. Endocrine 2021; 73:758-761. [PMID: 33630245 DOI: 10.1007/s12020-021-02658-5] [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: 11/05/2020] [Accepted: 02/10/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Rosa Cannistraci
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
- Department of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Edgardo Bonacina
- Department of Laboratory Diagnostics and Cytopathology, Policlinico di Monza, Monza, Italy
| | | | - Emanuele Muraca
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Stefano Ciardullo
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
- Department of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Giuseppina Manzoni
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | | | - Gianluca Perseghin
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy.
- Department of Medicine and Surgery, Milano-Bicocca University, Monza, Italy.
| | - Francesca Zerbini
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
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Ciardullo S, Muraca E, Zerbini F, Manzoni G, Perseghin G. NAFLD and Liver Fibrosis Are Not Associated With Reduced Femoral Bone Mineral Density in the General US Population. J Clin Endocrinol Metab 2021; 106:e2856-e2865. [PMID: 33878156 DOI: 10.1210/clinem/dgab262] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Indexed: 12/18/2022]
Abstract
CONTEXT It is still debated whether nonalcoholic fatty liver disease (NAFLD) may be a risk factor for reduced bone mineral density (BMD), and it is not known whether liver fibrosis, the major predictor of future development of liver-related events in NAFLD, has an influence on BMD. OBJECTIVE To assess whether liver steatosis and fibrosis are associated with reduced BMD in the general US population. METHODS We performed a cross-sectional analysis of the population-based 2017-2018 cycle of the National Health and Nutrition Examination Survey (NHANES), in which vibration-controlled transient elastography (VCTE) and dual-energy x-ray absorptiometry (DXA) of the femoral neck were simultaneously available. Controlled attenuation parameter (CAP) ≥ 274 dB/m was considered indicative of liver steatosis, while a median liver stiffness measurement (LSM) ≥ 8 kPa indicated the presence of significant liver fibrosis. We included all participants older than 50 years with reliable VCTE and femoral neck DXA results (925 men and 859 women). The main outcome measures were femoral neck BMD values indicative of osteopenia or osteoporosis. RESULTS Steatosis and significant fibrosis were highly prevalent in the studied population, being present in 53.1% and 9.6% of men and 44.2% and 8.0% of women, respectively. In univariate analysis, liver steatosis was associated with a lower prevalence of osteoporosis in both men and women, while no difference was noted according to the degree of liver fibrosis. After adjustment for potential confounders, including age, BMI, race/ethnicity, cigarette smoking, and diabetes, neither CAP nor LSM were significantly associated with reduced BMD in both sexes. CONCLUSION Liver steatosis and fibrosis are not associated with femoral DXA-based diagnosis of osteopenia or osteoporosis in the US population older than 50 years.
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Affiliation(s)
- Stefano Ciardullo
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza (MB), Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Monza (MB), Italy
| | - Emanuele Muraca
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza (MB), Italy
| | - Francesca Zerbini
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza (MB), Italy
| | - Giuseppina Manzoni
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza (MB), Italy
| | - Gianluca Perseghin
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza (MB), Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Monza (MB), Italy
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Muraca E, Oltolini A, Binda A, Pizzi M, Ciardullo S, Manzoni G, Zerbini F, Bianconi E, Cannistraci R, Perra S, Pizzi P, Lattuada G, Perseghin G, Villa M. Metabolic and Psychological Features are Associated with Weight Loss 12 Months After Sleeve Gastrectomy. J Clin Endocrinol Metab 2021; 106:e3087-e3097. [PMID: 33705552 DOI: 10.1210/clinem/dgab161] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Laparoscopic sleeve gastrectomy (LSG) is a recognized effective procedure of bariatric surgery, but a poor response in weight loss may still represent a clinical problem. To date there are no validated predictors useful to better perform patient selection. OBJECTIVE To establish the association of baseline anthropometric, metabolic, and psychologic features with the percent total weight loss (%TWL) and percent excess weight loss (%EWL) 12 months after surgery. DESIGN Retrospective longitudinal analysis of a set of data about obese patients attending the outpatient service of a single obesity center from June 2016 to June 2019. PATIENTS A total of 106 obese patients underwent LSG with presurgery evaluation and follow-up at 12 months after surgery. MAIN OUTCOME Weight loss 12 months after LSG. RESULTS Patients who achieved a %TWL higher than the observed median (≥34%) were younger, with a lower fasting plasma glucose and glycated hemoglobin, with a lower prevalence of hypertension and with a lower score in the impulsiveness scale, compared with patients with a %TWL < 34%. Similar findings were found when %EWL was considered. Multivariable stepwise regression analysis showed that younger age, lower impulsiveness, higher-than-normal urinary free cortisol, and lower HbA1c were associated with higher %TWL, explaining about 31.5% of the weight loss. CONCLUSION Metabolic and psychologic features at baseline were independently associated with weight loss and explained a non-negligible effect on the response to LSG. These data suggest that careful metabolic and psychologic profiling could help in sharper indications and personalized pre- and postsurgical follow-up protocols in candidates for LSG.
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Affiliation(s)
- Emanuele Muraca
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Alice Oltolini
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Alberto Binda
- Clinical Psychology; Policlinico di Monza, 20900 Monza, Italy
| | - Mattia Pizzi
- Centro per lo Studio, la Ricerca e la terapia dell'Obesità, Policlinico di Monza, 20900 Monza, Italy
| | - Stefano Ciardullo
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca; 20900 Monza, Italy
| | - Giuseppina Manzoni
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Francesca Zerbini
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Eleonora Bianconi
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Rosa Cannistraci
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca; 20900 Monza, Italy
| | - Silvia Perra
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Pietro Pizzi
- Centro per lo Studio, la Ricerca e la terapia dell'Obesità, Policlinico di Monza, 20900 Monza, Italy
| | - Guido Lattuada
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Gianluca Perseghin
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca; 20900 Monza, Italy
| | - Matteo Villa
- Clinical Psychology; Policlinico di Monza, 20900 Monza, Italy
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Sampogna G, Berrettini A, Zanetti S, Gallioli A, Gnech M, De Marco E, Minoli D, Longo F, Manzoni G, Montanari E. Semi-closed-circuit vacuum-assisted Mini-PCNL system for renal stones in pediatric patients: The experience by a tertiary referral center. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01660-2] [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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Ciardullo S, Muraca E, Cannistraci R, Manzoni G, Perra S, Bianconi E, Oltolini A, Zerbini F, Grassi G, Mancia G, Lattuada G, Perseghin G. Seasonal variation in estimated cardiovascular risk in patients with type 2 diabetes. Nutr Metab Cardiovasc Dis 2021; 31:1494-1500. [PMID: 33810954 DOI: 10.1016/j.numecd.2021.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/13/2021] [Accepted: 01/22/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Seasonal variations in several risk factors for cardiovascular events (CVD) were described. Here, we evaluate the impact of seasonal variations in blood pressure (BP), lipid profile and glycemic control on estimated CVD risk in patients with type 2 diabetes (T2D). METHODS AND RESULTS Retrospective monocentric study of patients with T2D who were visited at least once in the winter period and once in the summer period, less than 8 months apart, for which data related to systolic (S) BP, diastolic (D) BP, body mass index, glycosylated hemoglobin (HbA1c), total cholesterol, HDL cholesterol and smoking habit were available on both occasions. The 10-year CVD risk was calculated using the UKPDS risk engine and the ASCVD risk estimator. As many as 411 patients were included in the study. Significant within-patient differences between summer and winter were found for the absolute risk of events assessed with both calculators (Δs-w UKPDS-CHD: -1.33%, Δs-w UKPDS-Stroke: -0.84%, Δs-w ASCVD: -2.21%). The seasonal change in SBP was the main responsible for the change in risk estimated with both the UKPDS-Stroke (r2 = 0.43) and the ASCVD (r2 = 0.50) scores, while the change in total cholesterol was the main determinant of the change in risk for the UKPDS-CHD (r2 = 0.34). A significant correlation was identified between changes in temperature and changes in SBP (ρ = 0.130, p = 0.008), but not in other risk factors. CONCLUSIONS Seasonal variations in the classic CVD risk factors influence the risk estimated using validated calculators.
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Affiliation(s)
- Stefano Ciardullo
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy; School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Emanuele Muraca
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Rosa Cannistraci
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy; School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Giuseppina Manzoni
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Silvia Perra
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Eleonora Bianconi
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Alice Oltolini
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Francesca Zerbini
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Guido Grassi
- Clinica Medica, University of Milano Bicocca, Milan, Italy
| | - Giuseppe Mancia
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy; School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Guido Lattuada
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Gianluca Perseghin
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy; School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.
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Ciardullo S, Zerbini F, Perra S, Muraca E, Cannistraci R, Lauriola M, Grosso P, Lattuada G, Ippoliti G, Mortara A, Manzoni G, Perseghin G. Impact of diabetes on COVID-19-related in-hospital mortality: a retrospective study from Northern Italy. J Endocrinol Invest 2021; 44:843-850. [PMID: 32776197 PMCID: PMC7415410 DOI: 10.1007/s40618-020-01382-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of pre-existing diabetes on in-hospital mortality in patients admitted for Coronavirus Disease 2019 (COVID-19). METHODS This is a single center, retrospective study conducted at Policlinico di Monza hospital, located in the Lombardy region, Northern Italy. We reviewed medical records of 373 consecutive adult patients who were hospitalized with COVID-19 between February 22 and May 15, 2020. Data were collected on diabetes status, comorbid conditions and laboratory findings. Multivariable logistic regression was performed to evaluate the effect of diabetes on in-hospital mortality after adjustment for potential confounding variables. RESULTS Mean age of the patients was 72 ± 14 years (range 17-98), 244 (65.4%) were male and 69 (18.5%) had diabetes. The most common comorbid conditions were hypertension (237 [64.8%]), cardiovascular disease (140 [37.7%]) and malignant neoplasms (50 [13.6%]). In-hospital death occurred in 142 (38.0%) patients. In the multivariable model older age (Relative Risk [RR] 1.06 [1.04-1. 09] per year), diabetes (RR 1.56 [1.05-2.02]), chronic obstructive pulmonary disease (RR 1.82 [1.13-2.35]), higher values of lactic dehydrogenase and C-reactive protein were independently associated with in-hospital mortality. CONCLUSION In this retrospective single-center study, diabetes was independently associated with a higher in-hospital mortality. More intensive surveillance of patients with this condition is to be warranted.
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Affiliation(s)
- S Ciardullo
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - F Zerbini
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - S Perra
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - E Muraca
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - R Cannistraci
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - M Lauriola
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - P Grosso
- Department of Anesthesiology and Intensive Care, Policlinico di Monza, Monza, Italy
| | - G Lattuada
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - G Ippoliti
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - A Mortara
- Department of Clinical Cardiology, Policlinico di Monza, Monza, Italy
| | - G Manzoni
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - G Perseghin
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy.
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, MB, Italy.
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Muraca E, Ciardullo S, Perra S, Zerbini F, Oltolini A, Cannistraci R, Bianconi E, Villa M, Pizzi M, Pizzi P, Manzoni G, Lattuada G, Perseghin G. Hypercortisolism and altered glucose homeostasis in obese patients in the pre-bariatric surgery assessment. Diabetes Metab Res Rev 2021; 37:e3389. [PMID: 32738094 DOI: 10.1002/dmrr.3389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/16/2020] [Accepted: 07/28/2020] [Indexed: 01/20/2023]
Abstract
AIMS Hypothalamus-pituitary-adrenal (HPA) axis hyperactivity was suggested to be associated with the metabolic syndrome (MS), obesity and diabetes. The aim of this study was to test whether hypercortisolism was associated with altered glucose homeostasis and insulin resistance, hypertension and dyslipidemia in a homogeneous population of obese patients. MATERIALS/METHODS In retrospective analysis of a set of data about obese patients attending the outpatient service of a single obesity centre between January 2013 and January 2020, 884 patients with BMI >30 kg/m2 were segregated in two subgroups: patients with urinary free cortisol (UFC) higher than normal (UFC+; n = 129) or within the normal range (UFC-; n = 755). RESULTS The overall prevalence of UFC+ was 14.6% and double test positivity (morning cortisol >1.8 mcg/dL following overnight dexamethasone suppression test, ODST) was detected in 1.0% of patients. Prediabetes (OR 1.74; 95%CI 1.13-2.69; p = 0.012) and diabetes (OR 2.03; 95%CI 1.21-3.42; p = 0.008) were associated with higher risk of UFC+ when analysis was adjusted for confounding variables. Conversely, hypertension and dyslipidemia were not related to UFC+. Within the individuals with normal FPG and HbA1c, those with higher estimated insulin resistance (HOMA2-IR) maintained a higher risk of UFC+ (OR 2.84, 95%CI 1.06-7.63; p = 0.039) and this relationship was weakened only when the body fat percentage was included into the model. CONCLUSIONS In obese patients, hypercortisolism was more frequent across the entire spectrum of altered glucose homeostasis including the very early stages; this relation could not be detected for the other criteria of the MS, as waist, hypertension and atherogenic dyslipidemia.
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Affiliation(s)
- Emanuele Muraca
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Stefano Ciardullo
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
- Department of Medicine and Surgery, Università degli Studi Milano Bicocca, Monza, Italy
| | - Silvia Perra
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Francesca Zerbini
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Alice Oltolini
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Rosa Cannistraci
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
- Department of Medicine and Surgery, Università degli Studi Milano Bicocca, Monza, Italy
| | - Eleonora Bianconi
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Matteo Villa
- Clinical Psychology, Policlinico di Monza, Monza, Italy
| | - Mattia Pizzi
- Centro per lo Studio, la Ricerca e la terapia dell'Obesità, Policlinico di Monza, Monza, Italy
| | - Pietro Pizzi
- Centro per lo Studio, la Ricerca e la terapia dell'Obesità, Policlinico di Monza, Monza, Italy
| | - Giuseppina Manzoni
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Guido Lattuada
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Gianluca Perseghin
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
- Department of Medicine and Surgery, Università degli Studi Milano Bicocca, Monza, Italy
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Minoli DG, De Marco EA, Gnech M, Rocco B, Manzoni G, Berrettini A. Laparoscopic robotic-assisted "keel" bladder neck construction. J Pediatr Urol 2020; 16:857-858. [PMID: 33077387 DOI: 10.1016/j.jpurol.2020.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/15/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Robotic technology has gained popularity allowing performance of several complex and difficult reconstructive procedures. This video demonstrates the advantages of the robotic approach for a "keel" bladder neck construction in an obese patient. MATERIAL AND METHODS A 13 year-old-girl (BMI = 28) already treated elsewhere for a uro-genital sinus (Total Urogenital Mobilization) has been evaluated for disturbing persistent total urinary incontinence. Cisto-colposcopy revealed an extremely short and tortuous urethra. Bladder neck was wide open and incompetent. Video-Urodynamic evaluation showed a bladder with a capacity of 280 mL with low voiding pressures (14-16 cmH20) and continuous urinary leakage. MAG3 scan confirmed normal renal function. Thus, the girl underwent a laparoscopic robotic-assisted "keel" bladder neck construction. RESULTS The patient was discharged on 5th post-operative day without complications. After 4 years she is voiding spontaneously (300 cc) without post-void residuals. She has presented a persistent mild stress incontinence successfully treated with subsequent endoscopic bulking agent injection. CONCLUSIONS Robotic access to the bladder neck region is an excellent option with ideal anatomical exposure compared to conventional open surgery, especially in obese patients. The "keel" procedure allows to reconfigure and tubularize a wide and incompetent bladder neck creating a continent funnel without the absolute need of concomitant ureteric reimplantation.
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Affiliation(s)
- D G Minoli
- Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Via Della Commenda 10, 20122, Milan, Italy.
| | - E A De Marco
- Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Via Della Commenda 10, 20122, Milan, Italy
| | - M Gnech
- Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Via Della Commenda 10, 20122, Milan, Italy; PhD School of Science of Reproduction and Development, Department of Medicine, Surgery and Health Science, University of Trieste, Italy
| | - B Rocco
- Urology - Azienda Ospedaliero-Universitaria Policlinico di Modena, Largo Del Pozzo, 71, 41125, Modena, Italy
| | - G Manzoni
- Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Via Della Commenda 10, 20122, Milan, Italy
| | - A Berrettini
- Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Via Della Commenda 10, 20122, Milan, Italy
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Sampogna G, Gallioli A, Berrettini A, Llorens E, Quiróz Y, Gnech M, De Lorenzis E, Albo G, Palou J, Manzoni G, Bujons A, Montanari E. Semi-closed-circuit vacuum-assisted mini-PCNL in the pediatric population: the initial experience by two tertiary referral centers. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35668-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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12
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Minoli D, Albo G, De Marco E, Gnech M, Berrettini A, Montanari E, Manzoni G. Robotic bladder neck plication for incontinence treatment. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35661-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ciardullo S, Ronchetti C, Muraca E, Oltolini A, Perra S, Bianconi E, Zerbini F, Cannistraci R, Manzoni G, Gastaldelli A, Lattuada G, Perseghin G. Impact of using different biomarkers of liver fibrosis on hepatologic referral of individuals with severe obesity and NAFLD. J Endocrinol Invest 2020; 43:1019-1026. [PMID: 32008185 DOI: 10.1007/s40618-020-01188-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to estimate how many individuals with severe obesity and NAFLD should be referred to hepatologists according to the EASL-EASD-EASO guidelines and whether the choice of specific indicators of liver fibrosis would significantly impact the number of referrals. METHODS This was a single-center retrospective study of 495 individuals with severe obesity screened at our institution between 2012 and 2018 for a bariatric surgery intervention. The guidelines were applied using the NAFLD Liver Fat Score (NLFS) to assess the presence of steatosis and the NAFLD fibrosis score (NFS), Fibrosis-4 (FIB-4) and Hepamet Fibrosis Score (HFS) to assess the risk of advanced fibrosis. RESULTS Three hundred and seventy-nine patients (76.6%) had evidence of liver steatosis. The application of the guidelines would lead to referral of 66.3% of patients using NFS, 31.7% using FIB-4 and 34.2% using HFS. When referrals due to abnormal liver function tests were excluded, these percentages dropped to 55.8%, 7.3% and 12.1%, respectively. The strongest inter-biomarker agreement was found between FIB-4 and HFS (κ = 0.86, 95% CI 0.815-0.910). CONCLUSION Strict application of the guidelines in individuals with severe obesity would probably lead to over-referral, although a great variability exists among the different scores.
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Affiliation(s)
- S Ciardullo
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy
| | - C Ronchetti
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy
| | - E Muraca
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - A Oltolini
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - S Perra
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - E Bianconi
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - F Zerbini
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - R Cannistraci
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy
| | - G Manzoni
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - A Gastaldelli
- Cardiometabolic Risk Laboratory, Institute of Clinical Physiology (IFC), CNR, Pisa, Italy
| | - G Lattuada
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - G Perseghin
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy.
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy.
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Sampogna G, Gallioli A, Berrettini A, Zanetti S, Llorens E, Quiróz Y, Gnech M, De Marco E, Minoli D, Taroni F, De Lorenzis E, Montini G, Manzoni G, Bujons Tur A, Montanari E. Mini-PCNL with a semi-closed-circuit vacuum-assisted system in pediatric patients treated by two European tertiary referral centers. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33345-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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15
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Muraca E, Ciardullo S, Oltolini A, Zerbini F, Bianconi E, Perra S, Villa M, Cannistraci R, Castoldi G, Pizzi P, Manzoni G, Lattuada G, Perseghin G. Resting Energy Expenditure in Obese Women with Primary Hypothyroidism and Appropriate Levothyroxine Replacement Therapy. J Clin Endocrinol Metab 2020; 105:5771362. [PMID: 32119074 DOI: 10.1210/clinem/dgaa097] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/26/2020] [Indexed: 12/20/2022]
Abstract
CONTEXT Growing evidence suggests that appropriate levothyroxine (LT4) replacement therapy may not correct the full set of metabolic defects afflicting individuals with hypothyroidism. OBJECTIVE To assess whether obese subjects with primary hypothyroidism are characterized by alterations of the resting energy expenditure (REE). DESIGN Retrospective analysis of a set of data about obese women attending the outpatients service of a single obesity center from January 2013 to July 2019. PATIENTS A total of 649 nondiabetic women with body mass index (BMI) > 30 kg/m2 and thyrotropin (TSH) level 0.4-4.0 mU/L were segregated into 2 groups: patients with primary hypothyroidism taking LT4 therapy (n = 85) and patients with normal thyroid function (n = 564). MAIN OUTCOMES REE and body composition assessed using indirect calorimetry and bioimpedance. RESULTS REE was reduced in women with hypothyroidism in LT4 therapy when compared with controls (28.59 ± 3.26 vs 29.91 ± 3.59 kcal/kg fat-free mass (FFM)/day), including when adjusted for age, BMI, body composition, and level of physical activity (P = 0.008). This metabolic difference was attenuated only when adjustment for homeostatic model assessment of insulin resistance (HOMA-IR) was performed. CONCLUSIONS This study demonstrated that obese hypothyroid women in LT4 therapy, with normal serum TSH level compared with euthyroid controls, are characterized by reduced REE, in line with the hypothesis that standard LT4 replacement therapy may not fully correct metabolic alterations related to hypothyroidism. We are not able to exclude that this feature may be influenced by the modulation of insulin sensitivity at the liver site, induced by LT4 oral administration.
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Affiliation(s)
- Emanuele Muraca
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Stefano Ciardullo
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Monza, Italy
| | - Alice Oltolini
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Francesca Zerbini
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Eleonora Bianconi
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Silvia Perra
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Matteo Villa
- Clinical Psychology, Policlinico di Monza, Monza, Italy
| | - Rosa Cannistraci
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Monza, Italy
| | - Giovanna Castoldi
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Monza, Italy
| | - Pietro Pizzi
- Centro per lo Studio, la Ricerca e la terapia dell'Obesità, Policlinico di Monza, Monza Italy
| | - Giuseppina Manzoni
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Guido Lattuada
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Gianluca Perseghin
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Monza, Italy
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16
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Ciardullo S, Muraca E, Perra S, Bianconi E, Zerbini F, Oltolini A, Cannistraci R, Parmeggiani P, Manzoni G, Gastaldelli A, Lattuada G, Perseghin G. Screening for non-alcoholic fatty liver disease in type 2 diabetes using non-invasive scores and association with diabetic complications. BMJ Open Diabetes Res Care 2020; 8:8/1/e000904. [PMID: 32049637 PMCID: PMC7039600 DOI: 10.1136/bmjdrc-2019-000904] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/06/2019] [Accepted: 12/01/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Non-alcoholic fatty liver disease (NAFLD) is prevalent in patients with type 2 diabetes. Here, we estimate the proportion of patients with type 2 diabetes that should be referred to hepatologists according to the European Association for the Study of the Liver (EASL)-European Association for the Study of Diabetes (EASD)-European Association for the Study of Obesity (EASO) Guidelines and evaluate the association between non-invasive biomarkers of steatosis and fibrosis and diabetic complications. RESEARCH DESIGN AND METHODS This is a retrospective analysis of type 2 diabetes patients who attended on a regular basis our diabetes clinic between 2013 and 2018 (n=2770). Steatosis was assessed using Fatty Liver Index (FLI), Hepatic Steatosis Index and NAFLD Ridge Score and fibrosis using NAFLD Fibrosis Score (NFS), Fibrosis-4 (FIB-4), aspartate aminotransferase (AST) to platelet ratio index (APRI) and AST/alanine aminotransferase (ALT) ratio. Outcome measures were altered albumin excretion rate (AER), chronic kidney disease (CKD) and cardiovascular disease (CVD). RESULTS The prevalence of advanced fibrosis varied from 1% (APRI) to 33% (NFS). The application of the guidelines using a sequential combination of FLI and FIB-4 would lead to referral of 28.3% of patients when using standard FIB-4 cut-offs, while this number dropped to 13.4% when age-adjusted FIB-4 thresholds were applied. A higher prevalence of altered AER was associated with liver steatosis (FLI: OR: 3.49; 95% CI 2.05 to 5.94, p<0.01), whereas liver fibrosis was associated with CKD (FIB-4: OR: 6.39; 95% CI 4.05 to 10.08, p<0.01) and CVD (FIB-4: OR: 2.62; 95% CI 1.69 to 4.04, p<0.01). CONCLUSIONS While specific fibrosis scores identify different proportion of patients with advanced fibrosis, the use of age-adjusted FIB-4 cut-offs leads to a drop in gray-zone results, making referrals to hepatologists more sustainable. Interestingly non-invasive biomarkers were consistently associated with a different pattern of diabetic complications.
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Affiliation(s)
- Stefano Ciardullo
- Medicine and Rehabilitation, Policlinico di Monza SpA, Monza, Italy
- Medicine and Surgery, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Emanuele Muraca
- Medicine and Rehabilitation, Policlinico di Monza SpA, Monza, Italy
| | - Silvia Perra
- Medicine and Rehabilitation, Policlinico di Monza SpA, Monza, Italy
| | | | | | - Alice Oltolini
- Medicine and Rehabilitation, Policlinico di Monza SpA, Monza, Italy
| | - Rosa Cannistraci
- Medicine and Rehabilitation, Policlinico di Monza SpA, Monza, Italy
- Medicine and Surgery, Università degli Studi di Milano-Bicocca, Milano, Italy
| | | | | | - Amalia Gastaldelli
- Cardiometabolic Risk Unit, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Guido Lattuada
- Medicine and Rehabilitation, Policlinico di Monza SpA, Monza, Italy
| | - Gianluca Perseghin
- Medicine and Rehabilitation, Policlinico di Monza SpA, Monza, Italy
- Medicine and Surgery, Università degli Studi di Milano-Bicocca, Milano, Italy
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Manzoni G, Oltolini A, Perra S, Muraca E, Ciardullo S, Pizzi M, Castoldi G, Lattuada G, Pizzi P, Perseghin G. Resting Whole Body Energy Metabolism in Class 3 Obesity; from Preserved Insulin Sensitivity to Overt Type 2 Diabetes. Diabetes Metab Syndr Obes 2020; 13:489-497. [PMID: 32158244 PMCID: PMC7047991 DOI: 10.2147/dmso.s228229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/22/2020] [Indexed: 01/07/2023] Open
Abstract
CONTEXT Insulin resistance and diabetes may influence separately or in combination whole body energy metabolism. OBJECTIVE To assess the impact of insulin resistance and/or overt type 2 diabetes on resting energy expenditure (REE) in class 3 obese individuals. DESIGN AND SETTING Retrospective, cross-sectional analysis of a set of data about individuals attending the outpatients service of a single center of bariatric surgery between January 2015 and December 2017. PATIENTS We screened 382 patients in which abnormal thyroid function was excluded, and segregated them in three groups of subjects: patients with type 2 diabetes (T2DM; n=70), non-diabetic insulin-resistant patients with HOMA-IR ≥ 3 (n=236), non-diabetic insulin-sensitive patients with HOMA-IR < 3 (n=75). MAIN OUTCOME MEASURE Resting energy expenditure (REE), body composition and insulin resistance assessed using indirect calorimetry, bioimpedance and HOMA-IR. RESULTS Non-diabetic insulin-sensitive patients resulted to be younger, with lower BMI and higher prevalence of female subjects; meanwhile, non-diabetic but insulin-resistant patients and T2DM patients were not different in terms of anthropometric parameters. REE was higher in T2DM than in non-diabetic insulin-resistant and insulin-sensitive individuals when expressed as percent of the predicted REE (based on Harris Benedict equation) (p<0.0001) or when adjusted for kg of free fat mass (p<0.0001) and was found to be higher also in insulin-resistant vs insulin-sensitive patients (p<0.001). The respiratory quotient was different between groups (0.87±0.11, 0.86±0.12 and 0.91±0.14 in T2DM, insulin-resistant and insulin-sensitive patients, respectively; p<0.03). Regression analysis confirmed that HOMA-IR was independently associated with the REE (R2=0.110, p<0.001). CONCLUSION Class 3 obese patients with normal insulin sensitivity are characterized by reduced fasting REE in comparison to insulin-resistant obese patients and obese patients with short duration of diabetes supporting the hypothesis that down-regulation of nutrients' oxidative disposal may represent an adaptation of energy metabolism in obese individuals with preserved insulin sensitivity.
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Affiliation(s)
- Giuseppina Manzoni
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Alice Oltolini
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Silvia Perra
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Emanuele Muraca
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Stefano Ciardullo
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
- Department of Medicine and Surgery, Università Degli Studi di Milano Bicocca, Monza, Italy
| | - Mattia Pizzi
- Centre for Obesity Research, Policlinico di Monza, Monza, Italy
| | - Giovanna Castoldi
- Department of Medicine and Surgery, Università Degli Studi di Milano Bicocca, Monza, Italy
| | - Guido Lattuada
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
| | - Pietro Pizzi
- Centre for Obesity Research, Policlinico di Monza, Monza, Italy
| | - Gianluca Perseghin
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
- Department of Medicine and Surgery, Università Degli Studi di Milano Bicocca, Monza, Italy
- Correspondence: Gianluca Perseghin Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, Monza, MB20900, ItalyTel +39 039 281 0430 Email
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De Cobelli F, Rossini A, Esposito A, Canu T, Manzoni G, Del Maschio A, Rubinacci A, Sirtori M, Losa M, Lanzi R, Perseghin G. Short-term evaluation of cardiac morphology, function, metabolism and structure following diagnosis of adult-onset growth hormone deficiency. Growth Horm IGF Res 2019; 46-47:50-54. [PMID: 31276905 DOI: 10.1016/j.ghir.2019.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/03/2019] [Accepted: 06/24/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The impact of growth hormone (GH) deficiency of the adult on cardiovascular function remains only partially elucidated. Purpose of this study was to test cardiac function in adult GH deficient patients using cardiac magnetic resonance (CMR). DESIGN Cardiac magnetic resonance (CMR) techniques, including cardiac 31P MR spectroscopy and evaluation of gadolinium late-enhancement, were applied to assess simultaneously, in a cross-sectional fashion, morphological, functional, metabolic, and structural parameters of the left (LV) and right ventricle (RV) in 15 patients with adult onset GH deficiency. Fifteen healthy individuals served as controls. RESULTS In GH deficient patients LV systolic function (EF%: 61 ± 1.7 vs 62.1 ± 0.8; p = .44) was not different in spite of a lower LV mass (83.2 ± 5.3 vs 145.3 ± 11.9 g; p = .001), a subclinical impairment of diastolic function (E/A peak ratio: 1.6 ± 0.2 vs 2.1 ± 0.2 p = .05), and a trend for lower PCr/ATP ratio (2.1 ± 0.8 vs 2.3 ± 0.1 p = .07). The RV showed reduced chamber size (end diastolic volume 123.8 ± 9 vs 147.9 ± 7.6 mL; p = .021) with preserved mass. No structural alterations of the LV and RV at late-enhancement were detected in these patients. CONCLUSIONS GH deficient patients represent a unique model of reduced LV myocardial mass in which major structural and metabolic alterations are lacking. Mal-adaptive mechanisms developing in the long term in response to GH deficiency and more severely affecting the LV remain to be elucidated.
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Affiliation(s)
- Francesco De Cobelli
- Department of Radiology and Center for Experimental Imaging, San Raffaele Scientific Institute, Milano, Italy; Vita-Salute University, Milano, Italy
| | - Alessandro Rossini
- Endocrinology and Diabetes Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
| | - Antonio Esposito
- Department of Radiology and Center for Experimental Imaging, San Raffaele Scientific Institute, Milano, Italy; Vita-Salute University, Milano, Italy
| | - Tamara Canu
- Department of Radiology and Center for Experimental Imaging, San Raffaele Scientific Institute, Milano, Italy
| | - Giuseppina Manzoni
- Department of Medicine and Rehabilitation, Unit of Metabolic Medicine, Policlinico di Monza, Monza, Italy
| | - Alessandro Del Maschio
- Department of Radiology and Center for Experimental Imaging, San Raffaele Scientific Institute, Milano, Italy; Vita-Salute University, Milano, Italy
| | | | - Marcella Sirtori
- Bone Metabolic Unit, San Raffaele Scientific Institute, Milano, Italy
| | - Marco Losa
- Department of Neurosurgery, San Raffaele Scientific Institute, Milano, Italy
| | - Roberto Lanzi
- Unit of Endocrinology, San Raffaele Scientific Institute, Milano, Italy
| | - Gianluca Perseghin
- Department of Medicine and Rehabilitation, Unit of Metabolic Medicine, Policlinico di Monza, Monza, Italy; Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy
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Di Grazia M, Berrettini A, De Marco E, Gnech M, Minoli D, Russo G, Manzoni G. PO-01-025 46, XY Cloaca Estrophy: Sex assignment and reassignment. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.187] [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: 10/26/2022]
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Castoldi G, di Gioia CRT, Roma F, Carletti R, Manzoni G, Stella A, Zerbini G, Perseghin G. Activation of angiotensin type 2 (AT2) receptors prevents myocardial hypertrophy in Zucker diabetic fatty rats. Acta Diabetol 2019; 56:97-104. [PMID: 30187136 DOI: 10.1007/s00592-018-1220-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/26/2018] [Indexed: 12/14/2022]
Abstract
AIMS Compound 21 (C21), selective AT2 receptor agonist, has cardioprotective effects in experimental models of hypertension and myocardial infarction. The aims of the study was to evaluate the effect of C21, losartan, or both in Zucker diabetic fatty (ZDF) rats (type 2 diabetes) on (1) the prevention of myocardial hypertrophy; (2) myocardial expression of phosphatase and tensin homolog (PTEN), a target gene of miR-30a-3p, involved in myocardial remodelling. METHODS Experiments were performed in ZDF (n = 33) and in control Lean (8) rats. From the 6th to the 20th week of age, we administered C21 (0.3 mg/kg/day) to 8 ZDF rats. 8 ZDF rats were treated with losartan (10 mg/kg/day), 8 rats underwent combination treatment, C21+ losartan, and 9 ZDF rats were left untreated. Blood glucose and blood pressure were measured every 4 weeks. At the end of the study the hearts were removed, the apex was cut for the quantification of PTEN mRNA and miR-30a-3p expression (realtime-PCR). Myocardial hypertrophy was evaluated by histomorphometric analysis, and nitrotyrosine expression (as marker of oxidative stress) by immunohistochemistry. RESULTS ZDF rats had higher blood glucose (p < 0.0001) with respect to control Lean rats, while blood pressure did not change. Both parameters were not modified by C21 treatment, while losartan and losartan + C21 reduced blood pressure in ZDF rats (p < 0.05). miR-30a-3p expression was increased in ZDF rats (p < 0.01) and PTEN mRNA expression was decreased (p < 0.05). ZDF rats developed myocardial hypertrophy (p < 0.01) and increased oxidative stress (p < 0.01), both were prevented by C21 or losartan, or combination treatment. C21 or losartan normalized the expression of miR-30a-3p and PTEN. CONCLUSIONS Activation of AT2 receptors or AT1 receptor blockade prevents the development of myocardial hypertrophy in ZDF rats. This occurs through the modulation of the miR-30a-3p/PTEN interaction.
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MESH Headings
- Animals
- Blood Glucose/drug effects
- Blood Glucose/metabolism
- Cardiomegaly/etiology
- Cardiomegaly/pathology
- Cardiomegaly/prevention & control
- Diabetes Mellitus, Experimental/complications
- Diabetes Mellitus, Experimental/drug therapy
- Diabetes Mellitus, Experimental/pathology
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/pathology
- Diabetic Cardiomyopathies/pathology
- Diabetic Cardiomyopathies/prevention & control
- Losartan/pharmacology
- Male
- Obesity/complications
- Obesity/drug therapy
- Obesity/pathology
- Oxidative Stress/drug effects
- Rats
- Rats, Zucker
- Receptor, Angiotensin, Type 2/agonists
- Sulfonamides/therapeutic use
- Thiophenes/therapeutic use
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Affiliation(s)
- Giovanna Castoldi
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Via Cadore, 48, 20900, Monza, MB, Italy.
| | - Cira R T di Gioia
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Istituto di Anatomia Patologica, Sapienza Universita' di Roma, Rome, Italy
| | - Francesca Roma
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Via Cadore, 48, 20900, Monza, MB, Italy
| | - Raffaella Carletti
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Istituto di Anatomia Patologica, Sapienza Universita' di Roma, Rome, Italy
| | - Giuseppina Manzoni
- Dipartimento di Medicina Interna e Riabilitazione, Policlinico di Monza, Monza, Italy
| | - Andrea Stella
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Via Cadore, 48, 20900, Monza, MB, Italy
| | - Gianpaolo Zerbini
- Unità Complicanze del Diabete, Diabetes Research Institute, Istituto Scientifico San Raffaele, Milan, Italy
| | - Gianluca Perseghin
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Via Cadore, 48, 20900, Monza, MB, Italy
- Dipartimento di Medicina Interna e Riabilitazione, Policlinico di Monza, Monza, Italy
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Radaelli MG, Martucci F, Perra S, Accornero S, Castoldi G, Lattuada G, Manzoni G, Perseghin G. NAFLD/NASH in patients with type 2 diabetes and related treatment options. J Endocrinol Invest 2018; 41:509-521. [PMID: 29189999 DOI: 10.1007/s40618-017-0799-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 11/17/2017] [Indexed: 02/06/2023]
Abstract
Type 2 diabetes may reduce life expectancy and patients' quality of life due to its micro- and macro-vascular complications and to the higher risk of several types of cancer. An emerging important factor is represented by the hepatic involvement; it is recognized that excessive hepatic fat accumulation represents a typical feature of diabetic patients and that it also plays an important pathogenic role. It is now evident that non-alcoholic fatty liver disease (NAFLD), generally perceived as a benign condition, may have on the contrary an important deleterious impact for diabetic patients increasing the risk to develop cardiovascular complications but also serious hepatic diseases, in particular non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma. Lifestyle intervention, bariatric surgery and several drug therapies have now accumulated evidence of efficacy in treating NASH. On the other hand, their durability and safety in the long-term is yet to be proven and their use may be sometimes associated with side effects or higher risk of adverse events limiting the regular administration or contraindicating it. Professional health care providers, building awareness about the importance of these hepatic complications, should put more efforts in primary prevention using a behavioral therapy needing a multidisciplinary approach, in secondary prevention applying on a regular basis in the clinical setting available predictive algorithms to identify the patients at higher cardiovascular and hepatologic risk, and in tertiary prevention treating, when not contraindicated, the diabetic patients preferentially with drugs with proven benefit on NAFLD/NASH.
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Affiliation(s)
- M G Radaelli
- Dipartimento di Medicina e Riabilitazione, Policlinico di Monza, Via Amati 111, 20900, Monza, MB, Italy
| | - F Martucci
- Dipartimento di Medicina e Riabilitazione, Policlinico di Monza, Via Amati 111, 20900, Monza, MB, Italy
| | - S Perra
- Dipartimento di Medicina e Riabilitazione, Policlinico di Monza, Via Amati 111, 20900, Monza, MB, Italy
| | - S Accornero
- Dipartimento di Medicina e Riabilitazione, Policlinico di Monza, Via Amati 111, 20900, Monza, MB, Italy
| | - G Castoldi
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano Bicocca, Milan, MI, Italy
| | - G Lattuada
- Dipartimento di Medicina e Riabilitazione, Policlinico di Monza, Via Amati 111, 20900, Monza, MB, Italy
| | - G Manzoni
- Dipartimento di Medicina e Riabilitazione, Policlinico di Monza, Via Amati 111, 20900, Monza, MB, Italy
| | - G Perseghin
- Dipartimento di Medicina e Riabilitazione, Policlinico di Monza, Via Amati 111, 20900, Monza, MB, Italy.
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano Bicocca, Milan, MI, Italy.
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Docci D, Manzoni G, Bilancioni R, Delvecchio C, Capponcini C, Baldrati L, Neri L, Feletti C. Serum Lipoprotein (a) and Coronary Artery Disease in Uremic Patients on Chronic Hemodialysis. Int J Artif Organs 2018. [DOI: 10.1177/039139889401700107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is convincing clinical and experimental evidence to support the notion that lipoprotein(a) [Lp(a)] is atherogenic. Patients undergoing chronic hemodialysis have an increased risk of atherosclerotic cardiovascular complications. In the present study, we investigated the possible relation between the alteration, if any, in serum Lp(a) and coronary artery disease in such patients. The mean serum concentration of Lp(a) tended to be higher in the 64 hemodialysis patients than in the 30 normal controls (15.1 ± 15.2 vs. 9.7 ± 10.4 mg/dl). However the difference did not reach statistical significance. The prevalence of levels above 30 mg/dl was 14% (9/64) and 10% (3/10), respectively, and the difference was also not statistically significant. Eleven hemodialysis patients with coronary artery disease had a significantly higher mean serum concentration of Lp(a) than the unaffected 53 (33.7 ± 18.4 vs. 11.1 ± 11.2 mg/dl, p < 0.001). Elevated levels were present in 63.6% (7/11) and 3.8% (2/53), respectively (p<0.01). Other parameters of lipid metabolism were not different between the two groups. We observed statistically significant positive correlations of Lp(a) to total cholesterol, LDL cholesterol and apolipoprotein B in controls, in hemodialysis patients as a whole and in those without coronary artery disease. No such correlations were obtained when hemodialysis patients with coronary artery disease were analysed separately. It is concluded that firstly, high serum levels of Lp(a) in hemodialysis patients are strongly associated with coronary artery disease, as well as in the general population; and secondly, abnormalities in the metabolism of Lp(a) may underlie atherogenesis in these patients, independently of alterations in other lipid constituents
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Affiliation(s)
- D. Docci
- Department of Nephrology and Dialysis, Cesena - Italy
| | | | - R. Bilancioni
- Laboratory Analysis, M. Bufalini Hospital, Cesena - Italy
| | - C. Delvecchio
- Laboratory Analysis, M. Bufalini Hospital, Cesena - Italy
| | - C. Capponcini
- Department of Nephrology and Dialysis, Cesena - Italy
| | - L. Baldrati
- Department of Nephrology and Dialysis, Cesena - Italy
| | - L. Neri
- Department of Nephrology and Dialysis, Cesena - Italy
| | - C. Feletti
- Department of Nephrology and Dialysis, Cesena - Italy
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Persico N, Berrettini A, Fabietti I, Dallagiovanna C, Minoli D, Mosca F, Fedele L, Manzoni G. New minimally invasive technique for cystoscopic laser treatment of fetal ureterocele. Ultrasound Obstet Gynecol 2017; 50:124-127. [PMID: 27607564 DOI: 10.1002/uog.17296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/08/2016] [Accepted: 08/23/2016] [Indexed: 06/06/2023]
Abstract
Prenatal ultrasound detection of fetal ureterocele with bilateral hydroureteronephrosis, obstruction of the bladder outlet and progressive amniotic fluid reduction have been associated with a significant risk of end-stage chronic renal disease after birth. Fetal cystoscopic laser incision of the ureterocele, using standard 3.5-mm fetoscopic access to the amniotic cavity and the fetal bladder with the aim of relieving the bladder outflow obstruction to preserve renal function, has been reported previously in a case with a favorable outcome. We report on two additional cases of fetal ureterocele treated by cystoscopic laser decompression. In the first case, a standard 3.3-mm uterine entry was used. In the second case, a new approach was adopted using an 'all-seeing needle' 1.6-mm endoscope. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- N Persico
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A Berrettini
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - I Fabietti
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - C Dallagiovanna
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - D Minoli
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - F Mosca
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - L Fedele
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - G Manzoni
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Amorese V, Corda M, Donadu M, Usai D, Pisanu F, Milia F, Marras F, Sanna A, Delogu D, Mazzarello V, Manzoni G, Conti M, Meloni GB, Zanetti S, Doria C. Total hip prosthesis complication, periprosthetic infection with external fistulizing due to Enterobacter cloacae complex multiple drugs resistance: A clinical case report. Int J Surg Case Rep 2017; 36:90-93. [PMID: 28558347 PMCID: PMC5447565 DOI: 10.1016/j.ijscr.2017.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/11/2017] [Accepted: 05/14/2017] [Indexed: 12/02/2022] Open
Abstract
The incidence of periprosthetic hip infections his just below 2%, and the Enterobacteriaceae are fairly rare, being the cause of infection in 3–6% of cases. A 76 year old woman with multiple comorbidities underwent surgical implantation of endoprosthesis of the left hip. Multidisciplinary diagnosis of a rare periprosthetic infection.
Introduction The Enterobacter cloacae is a microorganism found in the intestinal flora of the majority of animals, including humans. Primary infections caused by E. cloacae are rare in immunocompetent patients, but are very common in hospital settings in newborns and immunocompromised patients, and can be aggravated by the insurgence of antibiotic resistance. The incidence of periprosthetic hip infections is just below 2%. Case presentation A 76 year old woman with multiple comorbidities underwent surgical implantation of intermediary total hip prosthesis of the left hip, in a different health facility, in February 2014, after the basicervical fracture of the upper femur extremity due to trauma. After an episode of dislocation of the prosthetic implant, in September 2014, she underwent a surgical operation to implant the acetabular component. A month later not in our facility, following a re-hospitalization for the dislocation of the arthroprosthesis, an infection from E. cloacae complex was discovered. After 2 years of chronic infection she came to our attention; the clinical picture featured coxalgia and secreting fistula in the surgical wound. Following a specific antibiotic therapy, carried out intravenously over the course of a month, we decided to intervene removing the left hip arthroprosthesis and placing an antibiotic spacer following the direction deduced from the antibiogram study of August 2016. Conclusion The patient was hospitalized in our facility and 2 months later she underwent another operation to remove the antibiotic spacer and to place a new total hip arthroprosthesis. Multiple swabs showed the complete healing from the infection, which was confirmed a couple of months later.
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Affiliation(s)
- V Amorese
- Department of Orthopaedic, University of Sassari, Sardinia, Italy
| | - M Corda
- Department of Orthopaedic, University of Sassari, Sardinia, Italy
| | - M Donadu
- Department of Biomedical Sciences, University of Sassari, Sassari, Sardinia, Italy.
| | - D Usai
- Department of Biomedical Sciences, University of Sassari, Sassari, Sardinia, Italy
| | - F Pisanu
- Department of Orthopaedic, University of Sassari, Sardinia, Italy
| | - F Milia
- Department of Orthopaedic, University of Sassari, Sardinia, Italy
| | - F Marras
- Department of Orthopaedic, University of Sassari, Sardinia, Italy
| | - A Sanna
- Department of Orthopaedic, University of Sassari, Sardinia, Italy
| | - D Delogu
- Department of Biomedical Sciences, University of Sassari, Sassari, Sardinia, Italy
| | - V Mazzarello
- Department of Biomedical Sciences, University of Sassari, Sassari, Sardinia, Italy
| | - G Manzoni
- Department of Radiology, University of Sassari, Sassari, Sardinia, Italy
| | - M Conti
- Department of Radiology, University of Sassari, Sassari, Sardinia, Italy
| | - G B Meloni
- Department of Radiology, University of Sassari, Sassari, Sardinia, Italy
| | - S Zanetti
- Department of Biomedical Sciences, University of Sassari, Sassari, Sardinia, Italy
| | - C Doria
- Department of Orthopaedic, University of Sassari, Sardinia, Italy
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25
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Manzoni G, Gragnaniello L, Autès G, Kuhn T, Sterzi A, Cilento F, Zacchigna M, Enenkel V, Vobornik I, Barba L, Bisti F, Bugnon P, Magrez A, Strocov VN, Berger H, Yazyev OV, Fonin M, Parmigiani F, Crepaldi A. Evidence for a Strong Topological Insulator Phase in ZrTe_{5}. Phys Rev Lett 2016; 117:237601. [PMID: 27982645 DOI: 10.1103/physrevlett.117.237601] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Indexed: 05/05/2023]
Abstract
The complex electronic properties of ZrTe_{5} have recently stimulated in-depth investigations that assigned this material to either a topological insulator or a 3D Dirac semimetal phase. Here we report a comprehensive experimental and theoretical study of both electronic and structural properties of ZrTe_{5}, revealing that the bulk material is a strong topological insulator (STI). By means of angle-resolved photoelectron spectroscopy, we identify at the top of the valence band both a surface and a bulk state. The dispersion of these bands is well captured by ab initio calculations for the STI case, for the specific interlayer distance measured in our x-ray diffraction study. Furthermore, these findings are supported by scanning tunneling spectroscopy revealing the metallic character of the sample surface, thus confirming the strong topological nature of ZrTe_{5}.
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Affiliation(s)
- G Manzoni
- Universitá degli Studi di Trieste, Via Alfonso Valerio 2, Trieste 34127, Italy
| | - L Gragnaniello
- Department of Physics, University of Konstanz, 78457 Konstanz, Germany
| | - G Autès
- Institute of Physics, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
- National Centre for Computational Design and Discovery of Novel Materials MARVEL, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
| | - T Kuhn
- Department of Physics, University of Konstanz, 78457 Konstanz, Germany
| | - A Sterzi
- Universitá degli Studi di Trieste, Via Alfonso Valerio 2, Trieste 34127, Italy
| | - F Cilento
- Elettra-Sincrotrone Trieste S.C.p.A., Strada Statale 14, km 163.5, Trieste I-34149, Italy
| | - M Zacchigna
- Officina dei Materiali (IOM)-CNR, Laboratorio TASC, Area Science Park - Basovizza, I-34149 Trieste, Italy
| | - V Enenkel
- Department of Physics, University of Konstanz, 78457 Konstanz, Germany
| | - I Vobornik
- Officina dei Materiali (IOM)-CNR, Laboratorio TASC, Area Science Park - Basovizza, I-34149 Trieste, Italy
| | - L Barba
- Institute of Crystallography, CNR, Area Science Park, Strada Statale 14, km 163.5 Trieste I-34149, Italy
| | - F Bisti
- Swiss Light Source, Paul Scherrer Institut, CH-5232 Villigen, Switzerland
| | - Ph Bugnon
- Institute of Physics, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
| | - A Magrez
- Institute of Physics, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
| | - V N Strocov
- Swiss Light Source, Paul Scherrer Institut, CH-5232 Villigen, Switzerland
| | - H Berger
- Institute of Physics, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
| | - O V Yazyev
- Institute of Physics, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
- National Centre for Computational Design and Discovery of Novel Materials MARVEL, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
| | - M Fonin
- Department of Physics, University of Konstanz, 78457 Konstanz, Germany
| | - F Parmigiani
- Universitá degli Studi di Trieste, Via Alfonso Valerio 2, Trieste 34127, Italy
- Elettra-Sincrotrone Trieste S.C.p.A., Strada Statale 14, km 163.5, Trieste I-34149, Italy
- International Faculty, University of Köln, 50937 Köln, Germany
| | - A Crepaldi
- Institute of Physics, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
- Elettra-Sincrotrone Trieste S.C.p.A., Strada Statale 14, km 163.5, Trieste I-34149, Italy
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26
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Silay MS, Spinoit AF, Undre S, Fiala V, Tandogdu Z, Garmanova T, Guttilla A, Sancaktutar AA, Haid B, Waldert M, Goyal A, Serefoglu EC, Baldassarre E, Manzoni G, Radford A, Subramaniam R, Cherian A, Hoebeke P, Jacobs M, Rocco B, Yuriy R, Zattoni F, Kocvara R, Koh CJ. Global minimally invasive pyeloplasty study in children: Results from the Pediatric Urology Expert Group of the European Association of Urology Young Academic Urologists working party. J Pediatr Urol 2016; 12:229.e1-7. [PMID: 27346071 DOI: 10.1016/j.jpurol.2016.04.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/24/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Minimally invasive pyeloplasty (MIP) for ureteropelvic junction (UPJ) obstruction in children has gained popularity over the past decade as an alternative to open surgery. The present study aimed to identify the factors affecting complication rates of MIP in children, and to compare the outcomes of laparoscopic (LP) and robotic-assisted laparoscopic pyeloplasty (RALP). MATERIALS AND METHODS The perioperative data of 783 pediatric patients (<18 years old) from 15 academic centers who underwent either LP or RALP with an Anderson Hynes dismembered pyeloplasty technique were retrospectively evaluated. Redo cases and patients with anatomic renal abnormalities were excluded. Demographics and operative data, including procedural factors, were collected. Complications were classified according to the Satava and modified Clavien systems. Failure was defined as any of the following: obstructive parameters on diuretic renal scintigraphy, decline in renal function, progressive hydronephrosis, or symptom relapse. Univariate and multivariate analysis were applied to identify factors affecting the complication rates. All parameters were compared between LP and RALP. RESULTS A total of 575 children met the inclusion criteria. Laparoscopy, increased operative time, prolonged hospital stay, ureteral stenting technique, and time required for stenting were factors influencing complication rates on univariate analysis. None of those factors remained significant on multivariate analysis. Mean follow-up was 12.8 ± 9.8 months for RALP and 45.2 ± 33.8 months for LP (P = 0.001). Hospital stay and time for stenting were shorter for robotic pyeloplasty (P < 0.05 for both). Success rates were similar between RALP and LP (99.5% vs 97.3%, P = 0.11). The intraoperative complication rate was comparable between RALP and LP (3.8% vs 7.4%, P = 0.06). However, the postoperative complication rate was significantly higher in the LP group (3.2% for RALP and 7.7% for LP, P = 0.02). All complications were of no greater severity than Satava Grade IIa and Clavien Grade IIIb. DISCUSSION This was the largest multicenter series of LP and RALP in the pediatric population. Limitations of the study included the retrospective design and lack of surgical experience as a confounder. CONCLUSIONS Both minimally invasive approaches that were studied were safe and highly effective in treating UPJ obstruction in children in many centers globally. However, shorter hospitalization time and lower postoperative complication rates with RALP were noted. The aims of the study were met.
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Affiliation(s)
- M S Silay
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey; Department of Urology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
| | - A F Spinoit
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - S Undre
- Department of Pediatric Urology, Great Ormond Street Hospital, London, UK
| | - V Fiala
- Department of Urology, General Teaching Hospital in Prague and Charles University, 1st Faculty of Medicine, Prague, Czech Republic
| | - Z Tandogdu
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK
| | - T Garmanova
- Department of Urology, Institute of Moscow, Moscow, Russia
| | - A Guttilla
- Department of Urology, University of Padua, Padua, Italy
| | | | - B Haid
- Department of Pediatric Urology, Sisters of the Charity Hospital, Linz, Austria
| | - M Waldert
- Department of Urology, University of Vienna, Vienna, Austria
| | - A Goyal
- Department of Pediatric Urology, University of Manchester, Manchester, UK
| | - E C Serefoglu
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - E Baldassarre
- Department of Urology, Umberto Parini Hospital, Aosta, Italy
| | - G Manzoni
- Department of Urology, Policlinico, Milan, Italy
| | - A Radford
- Department of Pediatric Urology, Leeds Children's Hospital, Leeds, UK
| | - R Subramaniam
- Department of Pediatric Urology, Leeds Children's Hospital, Leeds, UK
| | - A Cherian
- Department of Pediatric Urology, Great Ormond Street Hospital, London, UK
| | - P Hoebeke
- Department of Urology, General Teaching Hospital in Prague and Charles University, 1st Faculty of Medicine, Prague, Czech Republic
| | - M Jacobs
- Department of Pediatric Urology, Children's Medical Center, Dallas, USA
| | - B Rocco
- Department of Urology, Policlinico, Milan, Italy
| | - R Yuriy
- Department of Urology, Institute of Moscow, Moscow, Russia
| | - Fabio Zattoni
- Department of Urology, University of Padua, Padua, Italy
| | - R Kocvara
- Department of Urology, General Teaching Hospital in Prague and Charles University, 1st Faculty of Medicine, Prague, Czech Republic
| | - C J Koh
- Department of Urology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
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Manzoni G, Ponzoni S, Galimberti G, Scarselli M, Pulci O, Camilli L, Matthes L, Castrucci P, Pagliara S. Ultrafast dynamics in unaligned MWCNTs decorated with metal nanoparticles. Nanotechnology 2016; 27:235704. [PMID: 27146216 DOI: 10.1088/0957-4484/27/23/235704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The relaxation dynamics of unaligned multi-walled carbon nanotubes decorated with metallic nanoparticles have been studied by using transient optical measurements. The fast dynamics due to the short-lived free-charge carriers excited by the pump are not affected by the presence of nanoparticles. Conversely, a second long dynamics, absent in bare carbon nanotubes, appears only in the decorated samples. A combination of experiment and theory allows us to ascribe this long dynamics to relaxation channels involving electronic states localized at the tube-nanoparticle interface.
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Affiliation(s)
- G Manzoni
- -LAMP and Dipartimento di Matematica e Fisica, Università Cattolica, 25121 Brescia, Italy
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28
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Manzoni G, Sterzi A, Crepaldi A, Diego M, Cilento F, Zacchigna M, Bugnon P, Berger H, Magrez A, Grioni M, Parmigiani F. Ultrafast Optical Control of the Electronic Properties of ZrTe₅. Phys Rev Lett 2015; 115:207402. [PMID: 26613470 DOI: 10.1103/physrevlett.115.207402] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Indexed: 06/05/2023]
Abstract
We report on the temperature dependence of the ZrTe(5) electronic properties, studied at equilibrium and out of equilibrium, by means of time and angle resolved photoelectron spectroscopy. Our results unveil the dependence of the electronic band structure across the Fermi energy on the sample temperature. This finding is regarded as the dominant mechanism responsible for the anomalous resistivity observed at T*∼160 K along with the change of the charge carrier character from holelike to electronlike. Having addressed these long-lasting questions, we prove the possibility to control, at the ultrashort time scale, both the binding energy and the quasiparticle lifetime of the valence band. These experimental evidences pave the way for optically controlling the thermoelectric and magnetoelectric transport properties of ZrTe(5).
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Affiliation(s)
- G Manzoni
- Universitá degli Studi di Trieste, Via A. Valerio 2, Trieste 34127, Italy
| | - A Sterzi
- Universitá degli Studi di Trieste, Via A. Valerio 2, Trieste 34127, Italy
| | - A Crepaldi
- Elettra-Sincrotrone Trieste S. C. p. A., Strada Statale 14, km 163.5, 34149 Basovizza, Trieste, Italy
| | - M Diego
- Universitá degli Studi di Trieste, Via A. Valerio 2, Trieste 34127, Italy
| | - F Cilento
- Elettra-Sincrotrone Trieste S. C. p. A., Strada Statale 14, km 163.5, 34149 Basovizza, Trieste, Italy
| | - M Zacchigna
- C.N.R.-I.O.M., Strada Statale 14, km 163.5, 34149 Trieste, Italy
| | - Ph Bugnon
- Institute of Condensed Matter Physics, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
| | - H Berger
- Institute of Condensed Matter Physics, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
| | - A Magrez
- Institute of Condensed Matter Physics, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
| | - M Grioni
- Institute of Condensed Matter Physics, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
| | - F Parmigiani
- Universitá degli Studi di Trieste, Via A. Valerio 2, Trieste 34127, Italy
- Elettra-Sincrotrone Trieste S. C. p. A., Strada Statale 14, km 163.5, 34149 Basovizza, Trieste, Italy
- International Faculty, University of Köln, 50937 Köln, Germany
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29
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Salerno A, Fragasso G, Esposito A, Canu T, Lattuada G, Manzoni G, Del Maschio A, Margonato A, De Cobelli F, Perseghin G. Effects of short-term manipulation of serum FFA concentrations on left ventricular energy metabolism and function in patients with heart failure: no association with circulating bio-markers of inflammation. Acta Diabetol 2015; 52:753-61. [PMID: 25559351 DOI: 10.1007/s00592-014-0695-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/05/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS We wanted to assess the effects of short-term changes in serum free fatty acids (FFAs) on left ventricular (LV) energy metabolism and function in patients with heart failure and whether they correlated with circulating markers of inflammation. METHODS AND RESULTS LV function and phosphocreatine (PCr)/ATP ratio were assessed using MR imaging (MRI) and 31P magnetic resonance spectroscopy (MRS) in 11 men with chronic heart failure in two experimental conditions 7 days apart. Study 1: MRI and 31P-MRS were performed before and 3-4 h after i.v. bolus + continuous heparin infusion titrated to achieve a serum FFA concentration of 1.20 mM. Study 2: The same protocol was performed before and after the oral administration of acipimox titrated to achieve a serum FFA concentration of 0.20 mM. Serum concentrations of IL6, TNF-α, PAI-1, resistin, visfatin and leptin were simultaneously assessed. Serum glucose and insulin concentrations were not different between studies. The PCr/ATP ratio (percent change from baseline: +6.0 ± 16.9 and -16.6 ± 16.1 % in Study 1 and Study 2, respectively; p = 0.005) and the LV ejection fraction (-1.5 ± 4.0 and -6.9 ± 6.3 % in Study 1 and Study 2, respectively; p = 0.044) were reduced during low FFA when compared to high FFA. Serum resistin was higher during Study 1 than in Study 2 (p < 0.05 repeated measures ANOVA); meanwhile, the other adipocytokines were not different. CONCLUSION FFA deprivation, but not excess, impaired LV energy metabolism and function within hours. Cautions should be used when sudden iatrogenic modulation of energy substrates may take place in vulnerable patients.
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Affiliation(s)
- A Salerno
- Clinical Cardiology - Heart Failure Clinic, Ospedale San Raffaele, Milan, Italy
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Berrettini A, Castagnetti M, Salerno A, Nappo SG, Manzoni G, Rigamonti W, Caione P. Bladder urothelial neoplasms in pediatric age: experience at three tertiary centers. J Pediatr Urol 2015; 11:26.e1-5. [PMID: 25305695 DOI: 10.1016/j.jpurol.2014.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Urothelial bladder neoplasms (UBN) typically occur in patients in their sixth or seventh decade of life while they are infrequent in children and young adults. They occur in 0.1-0.4% of the population in the first two decades of life. Their management is controversial and paediatric guidelines are currently unavailable. OBJECTIVE To further expound the available data on the outcome of patients younger than 18 year old diagnosed with UBN. STUDY DESIGN We retrospectively reviewed the files of all the consecutive paediatric patients with UBN treated in three tertiary paediatric urology units from January 1999 to July 2013. Lesions were classified according to the 2004 WHO/ISUP criteria as urothelial papillomas (UP), papillary urothelial neoplasm of low malignant potential (PUNLMP), low-grade urothelial carcinoma (LGUC), and high-grade urothelial carcinoma (HGUC). RESULTS The table shows the results. Management after TURB varied among centres. One centre recommended only follow-up US at increasing intervals whereas another follow-up US plus urine cytologies and endoscopies, every three months in the first year, and at increasing intervals thereafter. After a median follow-up of 5 years (range 9 months-14.5 years), none of the patients showed disease recurrence or progression. DISCUSSION UBN is an uncommon condition in children and adolescents and, unlike in adults, its incidence, follow-up and outcome still controversial. Paediatric guidelines are currently lacking and management varies among centres. Gross painless haematuria is the most common presenting symptom. Therefore, this symptom should never be underestimated. US is generally the first investigation and additional imaging seems unnecessary. TURB often allows for complete resection. Lesions are generally solitary, non-muscle invasive, and low-grade (mainly UP and PUNLMP). Ideal follow-up protocol is the most controversial point. Reportedly, recurrence or progression during follow-up is uncommon in patients under 20 years, recurrence rate 7% and a single case of progression reported so far. Accordingly, a follow-up mainly based on serial US might be considered in this age group compared to adults where also serial endoscopies and urine cytologies are recommended. In the selection of the follow-up investigations, it should also be taken into consideration that urine cytology has a low sensibility in the detection of low-grade lesions while cystoscopy in young patients requires a general anaesthesia and hospitalization, and carries an increased risk of urethral manipulation. CONCLUSION UBN is a rare condition in children. Ultrasound is generally accurate in order to visualize the lesion, and TURB can treat the condition. Lesions are generally low-grade and non-muscle invasive, but high-grade lesions can also be detected. In present series, after TURB, follow-up US monitoring at increasing intervals was used at all centres, follow-up cystoscopies were added in two centres, but with different schedules. Urine cytologies were considered only at one centre. After a median follow-up of 5 years (range 9 months-14.5 years), none of the patients showed recurrence or progression of the disease.
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Affiliation(s)
- A Berrettini
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Commenda 10, 20122 Milano, Italy.
| | - M Castagnetti
- Section of Paediatric Urology, Urology Unit, Department of Oncological and Surgical Sciences, University Hospital of Padova, Via Giustiniani, 2, 35128 Padua, Italy.
| | - A Salerno
- Department Nephrology-Urology, Division of Pediatric Urology, 'Bambino Gesù' Children's Hospital Rome, IRCCS, Piazza S. Onofrio, 4, 00165 Roma, Italy.
| | - S G Nappo
- Department Nephrology-Urology, Division of Pediatric Urology, 'Bambino Gesù' Children's Hospital Rome, IRCCS, Piazza S. Onofrio, 4, 00165 Roma, Italy.
| | - G Manzoni
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Commenda 10, 20122 Milano, Italy.
| | - W Rigamonti
- Section of Paediatric Urology, Urology Unit, Department of Oncological and Surgical Sciences, University Hospital of Padova, Via Giustiniani, 2, 35128 Padua, Italy.
| | - P Caione
- Department Nephrology-Urology, Division of Pediatric Urology, 'Bambino Gesù' Children's Hospital Rome, IRCCS, Piazza S. Onofrio, 4, 00165 Roma, Italy.
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Vallasciani S, Berrettini A, Nanni L, Manzoni G, Marrocco G. Observational retrospective study on acquired megalourethra after primary proximal hypospadias repair and its recurrence after tapering. J Pediatr Urol 2013; 9:364-7. [PMID: 22658746 DOI: 10.1016/j.jpurol.2012.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Accepted: 05/07/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Acquired megalourethra (AMU) after repair of proximal hypospadias can be a serious complication. An observational retrospective study of its incidence among different types of repair was performed. MATERIALS AND METHODS Clinical charts of patients operated on for proximal hypospadias were reviewed. INCLUSION CRITERIA all primary hypospadias operated in 1991-2004, with the meatus positioned in proximal penile, scrotal or perineal position. RESULTS Of 770 hypospadias cases treated, 130 (16%) were proximal. Seventy-two patients (55%) were treated using preputial flaps: 36 with a tubularized preputial island flap (TIF) and 36 an onlay island flap (OIF). Fifty-eight patients (45%) underwent staged repairs: Belt-Fuquà (BF) in 18 and Bracka procedure in 40 cases. After a mean follow up of 16 years (range 6-19) the overall incidence of complications for each technique was: TIF 36%; OIF 33%; BF 25%; two-stage Bracka 7.5%. The most common complication encountered was neo-urethral fistula. AMU occurred in only 5 cases, none with associated distal urethral stenosis, all in the TIF and OIF groups, and all successfully treated by reduction re-do urethroplasty. CONCLUSION A very small number of the patients operated using preputial island flaps techniques developed AMU. None of the staged repairs developed AMU, and this is the preferred choice in proximal hypospadias when the urethral plate requires division and/or substitution. All cases of AMU resolved after urethral tapering.
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Affiliation(s)
- S Vallasciani
- Pediatric Urology Unit, Ospedale Maggiore-Policlinico, Via della Commenda 10, 20122 Milan, Italy.
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Vallasciani S, Manzoni G, Marrocco G, Berrettini A, Nanni L. Response to Snodgrass and Bush. J Pediatr Urol 2013. [PMID: 23182949 DOI: 10.1016/j.jpurol.2012.10.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pecori Giraldi F, Manzoni G, Michailidis J, Scacchi M, Stramba-Badiale M, Cavagnini F. High prevalence of prolonged QT interval in obese hypogonadal males. Obesity (Silver Spring) 2011; 19:2015-8. [PMID: 21350439 DOI: 10.1038/oby.2011.33] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Obese subjects show several electrocardiographic alterations, including prolonged QT interval, a marker for fatal cardiac arrhythmias. Prolonged QT interval has recently been linked to low testosterone levels, a frequent occurrence in male obese patients but no study has yet assessed whether hypoandrogenism contributes to QT interval prolongation in this population. Aim of this study was to evaluate whether prolonged QT interval is linked to hypogonadism in male obese subjects. QT interval corrected for heart rate (QTc) was measured from standard electrocardiogram recordings in 136 obese men (BMI 30 >kg/m(2), range 30.1-75.4 kg/m(2)). Obese men were classified as eugonadal or hypogonadal according to serum total testosterone levels (i.e., greater or less than 9.9 nmol/l). Our study showed that QTc measurements corrected by either Bazett (419 ± 3.2 vs. 408 ± 3.4 ms, P < 0.05), Fridericia (406.3 ± 3.39 vs. 396.4 ± 3.03 ms, P < 0.05) or Hodges (407.0 ± 3.12 vs. 397.3 ± 2.84 ms, P < 0.05) were longer in hypogonadal compared with eugonadal obese men; further, prolonged QTc interval (i.e., >440 ms) was more frequent among hypogonadal compared with eugonadal obese men (23% vs. 10%, P < 0.05). The degree of weight excess, diabetes, sleep apnoea and potassium levels were not associated with prolonged QTc. In conclusion, obese hypogonadal men show a greater prevalence of prolonged QT interval compared with their eugonadal counterparts. It appears therefore that low levels of testosterone in obese men may contribute to the arrhythmogenic profile of these patients, a heretofore unknown link which warrants further clinical attention.
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Farina E, Fioravanti R, Pignatti R, Alberoni M, Mantovani F, Manzoni G, Chiavari L, Imbornone E, Villanelli F, Nemni R. Functional living skills assessment: a standardized measure of high-order activities of daily living in patients with dementia. Eur J Phys Rehabil Med 2010; 46:73-80. [PMID: 20332730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM Performance measures are tools aimed to directly evaluate social function in older adults. The authors present the standardization of a new direct performance measure for patients with dementia, the functional living skills assessment (FLSA). METHODS FLSA was conceived to detect functional impairment in very mild to moderate patients and to pick up functional modification due to intervention. The patient is asked to perform an activity, and the performance is scored according to completeness and level of assistance required. Eight areas of interest are evaluated (Resources, Consumer Skills, Public Transportation, Time Management, Money management, Leisure, Telephone Skills, Self-Care and Health). Subjects included 54 patients with dementia and 36 normal controls. RESULTS Total and partial FLSA scores significantly differed for the two groups (P<0.0001). Performance on FLSA could divide clinical dementia rating (CDR) 0 from CDR 1, CDR 2 e CDR 3 groups. Both sensitivity and specificity were 94%; inter-rater and test-retest reliability was good (P>0.9). Correction scores for education were calculated, while age influence was only marginally significant. Mini Mental State Examination (MMSE) and CDR highly influenced FLSA score (P< 0.0001); FLSA was highly correlated with another performance measure (the Direct Assessment of Functional Status; P=0.821), and with the Instrumental Activity of Daily Living (IADL) scale (P=-0.612), while no significant correlation was present with the Geriatric Depression Scale. CONCLUSION FLSA evidences construct, concurrent and discriminative validity. We suggest that this tool could be possibly useful when a high sensibility to different levels of functional impairment is needed, as evaluation of treatment efficacy (both non-pharmacological and pharmacological) identification of relatively intact functional areas to plan cognitive rehabilitation, and confirmation of dementia in the initial phase when there are doubts about functional decline.
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Affiliation(s)
- E Farina
- Neurorehabilitation Unit, IRCCS Don Gnocchi Foundation, University of Milan, Milan, Italy.
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Manzoni G. Commentary to "Original Koyanagi urethroplasty versus modified Hayashi technique: outcome in 57 patients". J Pediatr Urol 2009; 5:307. [PMID: 19362520 DOI: 10.1016/j.jpurol.2009.03.005] [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: 03/13/2009] [Accepted: 03/17/2009] [Indexed: 11/29/2022]
Affiliation(s)
- G Manzoni
- Via A. Panzini, 12 20145 Milan, Italy.
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Bellotto VR, De Brito PC, Manzoni G, Wegner E. Biomonitoramento ativo de metais traço e efeito biológico em mexilhões transplantados para área de influência de efluente de indústria de beneficiamento de aço - Fase I. ACTA ACUST UNITED AC 2005. [DOI: 10.14210/bjast.v9n2.p33-37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Borzellino G, Tasselli S, Zerman G, Pedrazzani C, Manzoni G. Laparoscopic approach to postoperative adhesive obstruction. Surg Endosc 2004; 18:686-90. [PMID: 15026903 DOI: 10.1007/s00464-003-9106-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2003] [Accepted: 10/02/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Some authors have assessed the feasibility of laparoscopy in the treatment of postoperative adhesive obstruction, but conclusions about its effectiveness are related to different selection criteria used for surgery. This paper reports on our experience in laparoscopic adhesiolysis and analyses the results on the basis of the selection criteria used. METHODS From January 1993 to December 2001, 65 patients were submitted to laparoscopic adhesiolysis for small bowel obstruction according to specific selection criteria. Of the 65 patients, 40 were admitted for acute obstruction and 25 for chronic or recurrent transit disturbances. Correlation between historical and clinical data and the results of surgical treatment were statistically analyzed. RESULTS The procedure was completed by laparoscopy in 52 patients (conversion rate: 20%). Mean postoperative stay was 4.4 days with a 12.3% morbidity and no mortality. Recurrence rate was 15.4%; a single correlation was found between recurrence and age. CONCLUSIONS Laparoscopic adhesiolysis in the treatment of small bowel obstructions seems to be effective; further studies are required to define selection criteria for surgery and confirm real advantages in terms of recurrences.
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Affiliation(s)
- G Borzellino
- I Divisione Clinicizzata di Chirurgia Generale, Università di Verona, Italia.
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Abstract
OBJECTIVE To assess the efficacy and safety of laparoscopically assisted ureterocystoplasty (LAU) in children. PATIENTS AND METHODS From 1999 to 2001, five patients (mean age 7 years, range 3.5-13) from four centres underwent LAU with laparoscopic mobilization of the small kidney and upper ureter combined with ureterocystoplasty, with exposure of the bladder through a Pfannenstiel incision. The details and outcomes are reviewed. RESULTS The LAU was successful in all five patients; there were no complications. A large midline incision was avoided and the LAU carried out through the better tolerated and less painful Pfannenstiel incision. CONCLUSION LAU is an appealing technique that is safe with the added benefit of a reduced abdominal incision and acceptable operative duration. This represents the first published report of LAU.
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Affiliation(s)
- B G Cilento
- Department of Urology, Children's Hospital, Harvard Medical School, Boston, MA, USA.
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Bussone G, Cerbo R, Martucci N, Micieli G, Zanferrari C, Grazzi L, Fabbrini G, Cavallini A, Granella F, Ambrosoli L, Mailland F, Poli A, Manzoni G. Alpha-dihydroergocryptine in the prophylaxis of migraine: a multicenter double-blind study versus flunarizine. Headache 1999; 39:426-31. [PMID: 11279920 DOI: 10.1046/j.1526-4610.1999.3906426.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This multicenter, double-blind, clinical study was designed to compare the efficacy and safety of alpha-dihydroergocryptine and flunarizine in the prophylaxis of migraine without aura. One hundred thirty-five patients fulfilling the diagnostic criteria of the International Headache Society were enrolled at five neurologic centers. The study design included a 1-month pretreatment phase with placebo; a 6-month, double-blind, double-dummy treatment phase with alpha-dihydroergocryptine (10 mg twice daily) or flunarizine (5 mg once daily); a further 3-month follow-up phase without treatment. Efficacy was assessed using the patient's diary. Laboratory tests, vital signs, and adverse events were monitored. Analysis of covariance for repeated measures was performed on the intent-to-treat sample. Both treatments led to a significant reduction in the frequency of migraine, days with headache, and use of relief medication. Overall, 51% of those treated with alpha-dihydroergocryptine and 49% of those treated with flunarizine were responders (50% or greater reduction in attack frequency), the average percentage of reduction being 64% with alpha-dihydroergocryptine and 51% with flunarizine. There was no significant difference between the two groups in terms of incidence of adverse events; dizziness and weight gain were the most frequent observed adverse events with alpha-dihydroergocryptine and flunarizine, respectively. Based on the overall improvement in migraine parameters, alpha-dihydroergocryptine can be recommended for use in migraine prophylaxis.
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Affiliation(s)
- G Bussone
- Headache Centre, C. Besta Neurological Institute, Via Celoria, 11, Milan, Italy
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Snodgrass W, Koyle M, Manzoni G, Hurwitz R, Caldamone A, Ehrlich R. RE: TUBULARIZED INCISED PLATE HYPOSPADIAS REPAIR FOR PROXIMAL HYPOSPADIAS. J Urol 1999. [DOI: 10.1016/s0022-5347(01)61667-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The Italian Collaborative Group for the Study of Psychopathological Factors in Primary Headaches, Puca F, Genco S, Prudenzano MP, Savarese M, Bussone G, D'Amico D, Cerbo R, Gala C, Coppola MT, GalIai V, Firenze C, Sarchielli P, Guazzelli M, Guidetti V, Manzoni G, Granella F, Muratorio A, Bonuccelli U, Nuti A, Nappi G, Sandrini G, Verri AP, Sicuteri F, Marabini S. Psychiatric comorbidity and psychosocial stress in patients with tension-type headache from headache centers in Italy. Cephalalgia 1999. [DOI: 10.1046/j.1468-2982.1999.019003159.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Puca F, Genco S, Prudenzano MP, Savarese M, Bussone G, D'Amico D, Cerbo R, Gala C, Coppola MT, Gallai V, Firenze C, Sarchielli P, Guazzelli M, Guidetti V, Manzoni G, Granella F, Muratorio A, Bonuccelli U, Nuti A, Nappi G, Sandrini G, Verri AP, Sicuteri F, Marabini S. Psychiatric comorbidity and psychosocial stress in patients with tension-type headache from headache centers in Italy. The Italian Collaborative Group for the Study of Psychopathological Factors in Primary Headaches. Cephalalgia 1999; 19:159-64. [PMID: 10234463 DOI: 10.1046/j.1468-2982.1999.1903159.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A multicenter study was carried out in 10 Italian Headache Centers to investigate the prevalence of psychosocial stress and psychiatric disorders listed by the IHS classification as the "most likely causative factors" of tension-type headache (TTH). Two hundred and seventeen TTH adult outpatients consecutively recruited underwent a structured psychiatric interview (CIDI-c). The assessment of psychosocial stress events was carried out using an ad hoc questionnaire. The psychiatric disorders that we included in the three psychiatric items of the fourth digit of the IHS classification were depressive disorders for the item depression, anxiety disorders for the item anxiety, and somatoform disorders for the item headache as a delusion or an idea. Diagnoses were made according to DSM-III-R criteria. At least one psychosocial stress event or a psychiatric disorder was detected in 84.8% of the patients. Prevalence of psychiatric comorbidity was 52.5% for anxiety, 36.4% for depression, and 21.7% for headache as a delusion or an idea. Psychosocial stress was found in 29.5% of the patients and did not differ between patients with and without psychiatric comorbidity. Generalized anxiety disorder (83.3%) and dysthymia (45.6%) were the most frequent disorders within their respective psychiatric group. The high prevalence of psychiatric disorders observed in this wide sample of patients emphasizes the need for a systematic investigation of psychiatric comorbidity aimed at a more comprehensive and appropriate clinical management of TTH patients.
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Affiliation(s)
- F Puca
- Clinica Neurologica I, University of Bari, Italy.
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Assael BM, Guez S, Marra G, Secco E, Manzoni G, Bosio M, Pelegatta A, Acerbi L, delli Agnola CA, Selvaggio G, Vegni M, Cecchetti V, Cucchi L. Congenital reflux nephropathy: a follow-up of 108 cases diagnosed perinatally. Br J Urol 1998; 82:252-257. [PMID: 9722762 DOI: 10.1046/j.1464-410x.1998.00735.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine: (i) the proportion of vesicoureteric reflux (VUR) associated with congenital renal damage and whether it can be severe enough to cause renal impairment from birth: (ii) to evaluate the distribution of males and females affected; and (iii) to describe the course of congenital damage in the first years of life. PATIENTS AND METHODS A total of 108 children (76 male and 32 female, M:F 2.3:1), whose VUR was diagnosed before any infection, were followed from birth for a mean (range) of 4.3 (1-10) years. Renal damage was defined by serum creatinine concentration, creatinine clearance and renal imaging (ultrasonography and renal scintigraphy) performed within the first month of life and periodically thereafter. RESULTS Of the 108 children, 58 had bilateral and 50 unilateral reflux (total number of refluxing units, 166). High-grade VUR (grade > or = 4) was found in 96 (58%) refluxing renal units (RRUs). Males had a prevalence of bilateral severe (> or = grade 4) reflux (M:F 5.2:1), while in those wit unilateral VUR, the M:F ration was 1.5:1. At birth, mild to moderate damage was present in 56 (36%) RRUs and only associated with VUR of grade > or = 3. Bilateral reflux of grade > or = 4 was associated with congenital moderate/severe renal failure in nine neonates (seven males). In infants with grade > or = 4 VUR who underwent surgical correction, VUR resolved in 92% of cases. In infants with VUR of grade > or = 4 followed medically, the reflux spontaneously resolved in 42% and ameliorated in 16% after 18 months. Serial renal scans during the follow-up showed no progression of renal damage. CONCLUSIONS VUR diagnosed at birth on prenatal ultrasonography is associated with congenital damage, with males affected more often than females. The damage involves both kidneys in a consistent proportion and is an important cause of chronic renal impairment from birth. It does not progress in the first years of life if infections are prevented. It is suggested that males with this condition may constitute a major group at risk of developing chronic renal failure in later life.
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Affiliation(s)
- B M Assael
- Department of Paediatrics and Neonatology, University of Milano, Italy
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Snodgrass W, Koyle M, Manzoni G, Hurwitz R, Caldamone A, Ehrlich R. Tubularized incised plate hypospadias repair for proximal hypospadias. J Urol 1998; 159:2129-31. [PMID: 9598557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE We report a multicenter experience using tubularized incised plate urethroplasty for proximal hypospadias. MATERIALS AND METHODS From August 1993 to December 1996 tubularized incised plate urethroplasty was performed in 27 boys 6 months to 3 years old with mid shaft and penoscrotal hypospadias. In 7 other boys complex reconstruction combined the tubularized incised plate technique for the glanular urethra with other repairs for the proximal urethra. RESULTS Tubularized incised plate surgery created a functional neourethra even in penoscrotal hypospadias. Complications of the primary repair developed in only 3 of 27 patients (11%). No complications were attributed to use of the technique for the glanular urethra in complex repairs. CONCLUSIONS Tubularized incised plate urethroplasty is a versatile operation that corrects proximal hypospadias defects with few complications and superior cosmetic results.
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Affiliation(s)
- W Snodgrass
- Methodist Children's Hospital, Lubbock, Texas, USA
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Abstract
PURPOSE We report a multicenter experience using tubularized incised plate urethroplasty for proximal hypospadias. MATERIALS AND METHODS From August 1993 to December 1996 tubularized incised plate urethroplasty was performed in 27 boys 6 months to 3 years old with mid shaft and penoscrotal hypospadias. In 7 other boys complex reconstruction combined the tubularized incised plate technique for the glanular urethra with other repairs for the proximal urethra. RESULTS Tubularized incised plate surgery created a functional neourethra even in penoscrotal hypospadias. Complications of the primary repair developed in only 3 of 27 patients (11%). No complications were attributed to use of the technique for the glanular urethra in complex repairs. CONCLUSIONS Tubularized incised plate urethroplasty is a versatile operation that corrects proximal hypospadias defects with few complications and superior cosmetic results.
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Affiliation(s)
- W Snodgrass
- Methodist Children's Hospital, Lubbock, Texas, USA
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Abstract
PURPOSE We report a multicenter experience using tubularized incised plate urethroplasty to correct distal hypospadias. MATERIALS AND METHODS A total of 148 patients underwent repair by 6 pediatric urologists at different institutions in the United States and Europe. RESULTS Tubularized incised plate repair created a functional neourethra with a vertically oriented meatus. Complications, including meatal stenoses and fistulas, occurred in 10 patients (7%). CONCLUSIONS Tubularized incised plate urethroplasty can be performed in most cases of distal hypospadias. Cosmetic results are superior to those of other popular techniques.
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Affiliation(s)
- W Snodgrass
- Methodist Children's Hospital, Lubbock, Texas, USA
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Docci D, Manzoni G, Baldrati L, Capponcini C, Neri L, Feletti C. Serum lipoprotein(a) as an independent cardiovascular risk factor for patients undergoing chronic hemodialysis. Nephron Clin Pract 1995; 69:195. [PMID: 7723916 DOI: 10.1159/000188452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Docci D, Manzoni G, Bilancioni R, Delvecchio C, Capponcini C, Baldrati L, Neri L, Feletti C. Serum lipoprotein(a) and coronary artery disease in uremic patients on chronic hemodialysis. Int J Artif Organs 1994; 17:41-5. [PMID: 8188398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
There is convincing clinical and experimental evidence to support the notion that lipoprotein(a) [Lp(a)] is atherogenic. Patients undergoing chronic hemodialysis have an increased risk of atherosclerotic cardiovascular complications. In the present study, we investigated the possible relation between the alteration, if any, in serum Lp(a) and coronary artery disease in such patients. The mean serum concentration of Lp(a) tended to be higher in the 64 hemodialysis patients than in the 30 normal controls (15.1 +/- 15.2 vs. 9.7 +/- 10.4 mg/dl). However the difference did not reach statistical significance. The prevalence of levels above 30 mg/dl was 14% (9/64) and 10% (3/10), respectively, and the difference was also not statistically significant. Eleven hemodialysis patients with coronary artery disease had a significantly higher mean serum concentration of Lp(a) than the unaffected 53 (33.7 +/- 18.4 vs. 11.1 +/- 11.2 mg/dl, p < 0.001). Elevated levels were present in 63.6% (7/11) and 3.8% (2/53), respectively (p < 0.01). Other parameters of lipid metabolism were not different between the two groups. We observed statistically significant positive correlations of Lp(a) to total cholesterol, LDL cholesterol and apolipoprotein B in controls, in hemodialysis patients as a whole and in those without coronary artery disease. No such correlations were obtained when hemodialysis patients with coronary artery disease were analysed separately. It is concluded that firstly, high serum levels of Lp(a) in hemodialysis patients are strongly associated with coronary artery disease, as well as in the general population; and secondly, abnormalities in the metabolism of Lp(a) may underlie atherogenesis in these patients, independently of alterations in other lipid constituents.
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Affiliation(s)
- D Docci
- Department of Nephrology and Dialysis, M. Bufalini Hospital, Cesena, Italy
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Docci D, Mambelli M, Manzoni G, Turci F, Salvi G. Acute renal failure secondary to sulfinpyrazone treatment after myocardial infarction. Nephron Clin Pract 1984; 37:213-4. [PMID: 6738772 DOI: 10.1159/000183248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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