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De Simone C, Mannino M, Sollena P, Deilhes F, Sibaud V, Peris K. Morphea-like changes in the setting of cancer immunotherapy. J Eur Acad Dermatol Venereol 2021; 35:e684-e685. [PMID: 34013609 DOI: 10.1111/jdv.17388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/23/2021] [Accepted: 05/07/2021] [Indexed: 11/29/2022]
Affiliation(s)
- C De Simone
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Mannino
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Sollena
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Deilhes
- Oncodermatology Department, Institut Universitaire du Cancer, Toulouse Oncopole, Toulouse, France
| | - V Sibaud
- Oncodermatology Department, Institut Universitaire du Cancer, Toulouse Oncopole, Toulouse, France
| | - K Peris
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
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Palumbo V, Mannino M, Teodoro M, Menconi G, Schembari E, Corsale G, Di Carlo I, Toro A. An extremely rare case of an oversized accessory spleen: case report and review of the literature. BMC Surg 2019; 19:45. [PMID: 31029135 PMCID: PMC6487026 DOI: 10.1186/s12893-019-0510-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/16/2019] [Indexed: 11/24/2022] Open
Abstract
Background The accessory spleen is a congenital defect characterized by a separated ectopic splenic parenchyma. The size is rarely more than 4 cm. The preoperative diagnosis is prohibitive preoperatively. The aims of the present manuscript were to present the case of a patient with a rare oversize accessory spleen and a review of the literature. Case presentation A 15-year-old boy was admitted to the emergency department following blunt abdominal trauma. The computed tomographic scan showed a traumatic rupture of the spleen and a 7-cm mass at the left side of the retroperitoneal space. Conservative treatment started and aborted after 4 h due to the onset of haemodynamic instability. Splenectomy was performed. An accessory spleen was discovered. A second large mass in the retroperitoneum was diagnosed as a second large accessory spleen that was also left in place. The postoperative course was uneventful, and the patient was discharged on the 7th postoperative day. Seven months later, the CT scan showed viability of both accessory spleens. Conclusion An accessory spleen can be variously located and the retroperitoneal position is extremely uncommon. Preoperative diagnosis is still difficult, especially in emergency and as in our case, the literature shows the difficulty of reaching a diagnosis before surgery. The main misdiagnosis is neoplastic disease and for this reason accessory spleen can be wrongly removed. An undiagnosed pre or intra operative retroperitoneal mass, closely to the spleen, have to be managed carefully. The diagnosis of accessory spleen needs to be ever considered as if found, represents a great possibility to conduct a normal life after splenectomy (of main spleen) for trauma.
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Affiliation(s)
- V Palumbo
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy
| | - M Mannino
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy
| | - M Teodoro
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy
| | - G Menconi
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy
| | - E Schembari
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy
| | - G Corsale
- Department of Radiology, Cannizzaro Hospital, Catania, Italy
| | - I Di Carlo
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy.
| | - A Toro
- Department of General Surgery, E. Muscatello Hospital, Augusta, (SR), Italy
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Sollena P, Mannino M, Laurenti L, De Simone C, Peris K. Ibrutinib‐associated palmo‐plantar fissures in a patient with Chronic Lymphocytic Leukaemia: a novel cutaneous adverse event. J Eur Acad Dermatol Venereol 2019; 33:e342-e344. [DOI: 10.1111/jdv.15632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- P. Sollena
- Department of Dermatology Fondazione Policlinico A. Gemelli – IRCCS Catholic University of the Sacred Heart Largo A. Gemelli, 8 00168 Rome Italy
| | - M. Mannino
- Department of Dermatology Fondazione Policlinico A. Gemelli – IRCCS Catholic University of the Sacred Heart Largo A. Gemelli, 8 00168 Rome Italy
| | - L. Laurenti
- Department of Hematology Fondazione Policlinico A. Gemelli – IRCCS Catholic University of the Sacred Heart Largo A. Gemelli, 8 00168 Rome Italy
| | - C. De Simone
- Department of Dermatology Fondazione Policlinico A. Gemelli – IRCCS Catholic University of the Sacred Heart Largo A. Gemelli, 8 00168 Rome Italy
| | - K. Peris
- Department of Dermatology Fondazione Policlinico A. Gemelli – IRCCS Catholic University of the Sacred Heart Largo A. Gemelli, 8 00168 Rome Italy
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Mannino M, Toro A, Teodoro M, Coccolini F, Sartelli M, Ansaloni L, Catena F, Di Carlo I. Open conversion for laparoscopically difficult cholecystectomy is still a valid solution with unsolved aspects. World J Emerg Surg 2019; 14:7. [PMID: 30820240 PMCID: PMC6380008 DOI: 10.1186/s13017-019-0227-4] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/10/2019] [Indexed: 12/24/2022] Open
Abstract
The difficult laparoscopic cholecystectomy remains a surgical challenge for surgeons who must decide between laparoscopic continuation and open conversion. The balance between the lack of open surgery training of young surgeons and the risk of maintaining the laparoscopic approach in difficult laparoscopic cholecystectomy is still an unresolved problem. Furthermore, the time that must be spent in an attempt to complete laparoscopic surgery before conversion is still controversial. The authors in this letter discuss about these and other questions that still require an answer.
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Affiliation(s)
- M Mannino
- 1Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", Cannizzaro Hospital, University of Catania, Via Messina, 829, 95126 Catania, Italy
| | - A Toro
- Department of Surgery, Augusta Hospital, Augusta, SR Italy
| | - M Teodoro
- 1Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", Cannizzaro Hospital, University of Catania, Via Messina, 829, 95126 Catania, Italy
| | - F Coccolini
- 3General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - M Sartelli
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | - L Ansaloni
- 3General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - F Catena
- 5Emergency Surgery, Parma Hospital, Parma, Italy
| | - I Di Carlo
- 1Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", Cannizzaro Hospital, University of Catania, Via Messina, 829, 95126 Catania, Italy
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Toro A, Stella G, Gueli A, Mannino M, Teodoro M, Schembari E, Palermo F, Di Carlo I. A new modified Mayo technique: should the surgeons need a new open technique for hernia repair in their armamentarium? G Chir 2018; 39:208-214. [PMID: 30039787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The Mayo technique is one of the most common techniques used to repair incisional, umbilical, and epigastric hernias. A high percentage of recurrences, together with the use of particular expensive types of meshes, are some of the most relevant problems in this surgical field. PATIENTS AND METHODS This study is a clinical prospective observational and involves all the patients who underwent procedures using a new modified Mayo technique from 2006 through 2013. The general criteria analyzed were age, sex, obesity, smoke abuse, diabetes, chronic diseases, type of hernia, operative time, morbidity and mortality. All the patients involved in this study were followed-up from 6 to 120 months. RESULTS The types of hernia were 5 epigastic hernia (20,8%), 8 umbilical hernia (33,3%), 11 midline incision hernia (45,9%). Ten patients (41,7%) presented non-complicated hernias; 8 patients (33,3%) presented strangulated hernias and 6 patients (25,0%) presented obstructed hernias. No intestinal resection was necessary in any of the patients. The mean operative time was 55 minutes (range 30-180). The mean hospital stay of the patients' after-post operative procedure was 4.5 days (range, 2 to 8 days). No major complications have been reported. Only one patient present a recurrence. CONCLUSION These preliminary results suggest that this modified Mayo technique could be useful in the armamentarium of surgeon to repair incisional, umbilical, and epigastric hernias. More studies are needed to validate the technique.
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Erfanian M, Jo Brout J, Edelstein M, Kumar S, Mannino M, Miller LJ, Rouw R, Rosenthal MZ. REMOVED: Investigating misophonia: A review of the literature, clinical implications and research agenda reflecting current neuroscience and emotion research perspectives. Eur Psychiatry 2017; 41S:S681. [PMID: 28859824 DOI: 10.1016/j.eurpsy.2017.01.1180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
This article has been removed: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been removed at the request of the authors due to errors in the author list.
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Affiliation(s)
- M Erfanian
- Maastricht University, Neuroscience and Psychology, Maastricht, The Netherlands
| | - J Jo Brout
- International Misophonia Research Network, Misophonia, New York, USA
| | - M Edelstein
- University of California, Brain and Cognition, San Diego, USA
| | - S Kumar
- Newcastle University, Neuroscience, Newcastle, United Kingdom
| | - M Mannino
- Florida Atlantic University, Complex Systems and Brain Sciences, Boca Raton, USA
| | - L J Miller
- STAR Institute for Sensory Processing Disorder, Sensory Processing Disorder, Greenwood Village, USA
| | - R Rouw
- Amsterdam University, Brain and Cognition, Amsterdam, The Netherlands
| | - M Z Rosenthal
- Duke University, Psychiatry and Behavioral Science, Durham, USA
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Spera A, Mannino M, Mortellaro G, Figlia V, Caminiti G, Iacoviello G, Luca N, Cuccia F, Mazzola R, Ferrera G. EP-1353: Phase I/II study of hypofractionated Tomotherapy with CTMRI planning for prostate cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32603-2] [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: 11/28/2022]
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Toro A, Stella G, Gueli A, Mannino M, Palermo F, Burrafato G, Di Carlo I. Modified Mayo Technique for Ventral Hernia Repair: An Experimental Study. Chirurgia (Bucur) 2015; 110:545-549. [PMID: 26713829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND To reduce the rate of recurrence of incisional hernia repair associated with open anatomic techniques, we present an experimental study, focusing on two different sutures, with the aim to apply clinically in a revised version of the Mayo technique. METHODS Thirteen biological tissue samples from adult pig central brawn and upper and lower fasciae were measured using two techniques defined as "unbroken suture thread" and "separated suture stitches" to test the breaking resistance of the two types of suture. RESULTS The t test results show that the two sets can be considered as different populations. The mean tensile stress max is greater (with reduced deviation) for the specimens of the set sutured with unbroken thread technique. Student's t-test performed on values obtained for each set of samples indicated that the unbroken thread suture technique corresponds to higher ultimate failure strength. CONCLUSION Considering these results, a modified Mayo technique with continuous closure could be suggested. Of course a valid clinical study is required to better clarify this experimental hypothesis.
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Toro A, Cappello G, Mannino M, Di Carlo I. Could the complications of megacolon be avoided by monitoring the risk patients? cases report. Chirurgia (Bucur) 2014; 109:550-554. [PMID: 25149623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 06/03/2023]
Abstract
We report 2 cases of megacolon associated with cerebrovascular accident and neuropsychiatric drug consumption. Case report 1: a 75-year-old woman with diabetes mellitus, hypertension, tachycardia with atrial fibrillation, bilateral pleural effusions and previous cerebral hemorrhage was admitted in our hospital. She presented clouded sensorium and abdominal distension, with closed alvus. The CT scan showed a distension of the colon, with severe fecal impaction. A volvulus of the sigma was found at surgical intervention.Case report 2: a 59-year-old man with a medical history of oligophrenia was admitted to our hospital for acute abdomen.He presented stupor and closed alvus with abdominal distension. The abdominal CT scan showed a dolichosigma, with fecal impaction. The patient was submitted to a laparotomy and a two millimetres perforation of the sigma was found.The sigma had a diameter of 28 cm and a length of 75 cm.Even if a clear correlation has not been found yet, anomalies of the regulation of the gastro-intestinal motility can occur at different levels in patients with psychiatric or cerebrovascular diseases and drug consumption with anticholinergic properties,and they should be carefully monitored. The purpose is an early diagnosis of colon function anomalies in order to avoid potentially fatal complications.
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Toro A, Li Destri G, Mannino M, Arcerito MC, Ardiri A, Politi A, Bertino G, Di Carlo I. Combined duodenal and pancreatic major trauma in high risk patients: can a partial reconstruction be safe? MINERVA CHIR 2014; 69:107-112. [PMID: 24847897] [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: 06/03/2023]
Abstract
Pancreatic trauma is an uncommon injury, occurring in only about 0.2% of blunt abdominal injuries, while duodenal injuries represent approximately 4% of all blunt abdominal injuries. When trauma of the pancreas and duodenum do not permit reparation, pancreatoduodenectomy (PD) is mandatory. In the reconstructive phase, the use of ductal ligation as an alternative to standard pancreaticojejunostomy has been reported by some authors. We report a case of polytrauma with pancreatic and duodenal injury in which the initial diagnosis failed to recognize the catastrophic duodenal and pancreatic situation. The patient was submitted for PD and the pancreatic stump was abandoned in the abdominal cavity after main pancreatic ductal ligation. This technique can minimize the morbidity and mortality of PD in patients with other organs or apparatus involved severely and extensively in trauma.
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Affiliation(s)
- A Toro
- Department of Surgery Taormina Hospital, Messina, Italy -
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Toro A, Mannino M, Di Carlo I. Thigh emphysema as a first sign of abdominal disease. Chirurgia (Bucur) 2013; 108:277-279. [PMID: 23618583] [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] [Accepted: 04/01/2013] [Indexed: 06/02/2023]
Abstract
Thigh infection is a rare complication of intra-abdominal sepsis that can present with emphysema. We report a case of infection in the thigh resulting from colonic perforation. A 61-year-old woman with cirrhosis, grade Child B6 and diabetes treated with oral hypoglycemic drugs was referred to the emergency department because of a persistent pain in her left thigh and also for some abdominal discomforts during the preceding few days. Ultrasonography identified the presence of gas and fluid in the thigh. The patient received fluids and antibiotics but on the day after she reported an increase in pain. For this reason the patient was submitted to a CT scan that showed a thigh emphysema due to intestinal perforation. The patient was submitted to laparotomy. A Hartmann's procedure was performed, with resection of about 15 cm of affected sigmoid colon. The left thigh wound did not require any treatment.
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Affiliation(s)
- A Toro
- Department of Surgical Sciences, Organ Transplantation, and Advanced Technologies, Cannizzaro Hospital, University of Catania, Italy
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Toro A, Cavallaro A, Mannino M, Cappello G, Politi A, Di Carlo I. Pancreatic injury in a blunt abdominal trauma treated by a conservative approach with Tachosil®. MINERVA CHIR 2012; 67:461-463. [PMID: 23232487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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13
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Toro A, Mannino M, Reale G, Cappello G, Di Carlo I. Primary anastomosis vs Hartmann procedure in acute complicated diverticulitis. Evolution over the last twenty years. Chirurgia (Bucur) 2012; 107:598-604. [PMID: 23116833] [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] [Accepted: 10/01/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND/AIMS Aim of this review is to assess the role and indications for primary sigmoidectomy with direct anastomosis for diverticulitis comparing it with the Hartmann's procedures. METHODS A literature search was performed using MEDLINE (PubMed), Google Scholar and The Cochrane Library and the articles from January 1990 until June 2011 were analyzed. All patients were divided into three groups: primary anastomosis (PA), primary anastomosis and stoma protection (SP) and Hartmann's procedure (HP). Number of patients, overall mortality and morbidity, the rate of fistulization, the rate of reversal after SP (RSP) and after HP (RHP) and the Hinchey classification have been considered. RESULTS The mortality was of 38/1010 patients (3.8%) for PA, 11/153 patients (7.2%) for SP and 139/800 patients (17.4%) for HP. The morbidity was reported in 103/325 patients (31.7%) in PA, in 23/97 patients (23.7%) in SP and in 290/586 patients (49.5%) in HP. Fistula formation was recorded in 35/625 patients (5.6%) for PA, in 10/149 patients (16.4%) for RSP and 11/426 patients (6.4%) for RHP. The intestinal continuity was restored in 82/628 patients (56.9%) who underwent SP and in 315/581 patients (54.2%) undergoing HP. A total of 790 patients (54.5%) were classified in class I-II Hinchey and total of 659 patients (45.5%) was classified in class III-IV Hinchey. CONCLUSION The PA has a lower morbidity and mortality in relation to the HP and except some limited indications, should be used as treatment of choice in the case of diverticulitis.
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Affiliation(s)
- A Toro
- Department of Surgical Sciences, University of Catania, Catania, Italy
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Martin S, Mannino M, Rostom A, Tait D, Donovan E, Eagle S, Haviland J, Yarnold J. Acute toxicity and 2-year adverse effects of 30 Gy in five fractions over 15 days to whole breast after local excision of early breast cancer. Clin Oncol (R Coll Radiol) 2008; 20:502-5. [PMID: 18556186 DOI: 10.1016/j.clon.2008.04.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 04/23/2008] [Accepted: 04/24/2008] [Indexed: 12/17/2022]
Abstract
AIMS A pilot study was undertaken with the aim of documenting acute skin reactions and 2-year late adverse effects of a five-fraction course of adjuvant whole breast radiotherapy delivered over 15 days after local tumour excision of early breast cancer. MATERIALS AND METHODS Thirty women with early invasive breast cancer aged>or=50 years with a pathological tumour size<3 cm, complete microscopic resection, negative axillary node status and no requirement for cytotoxic therapy were prescribed 30 Gy in five fractions over 15 days to the whole breast using tangential 6-10 MV X-ray beams and three-dimensional dose compensation with written informed consent. Post-surgical baseline photographs of the breasts were taken, and acute skin erythema and moist desquamation were each scored weekly for 7 weeks using four-point graded scales (grade 0=none, 1=mild, 2=moderate, 3=severe). This was followed by an annual clinical assessment, including repeat photographs at 2 years. RESULTS Nine patients (30%, 95% confidence interval 14.7-49.4%) developed grade 2 erythema, with the remaining 21 patients developing milder degrees of reaction. Four (13.3%, 95% confidence interval 3.7-30.7) patients developed moist desquamation, grade 1 in three women and grade 2 in the fourth. At 2 years after treatment, 23/30 (77%) patients scored no change in photographic breast appearance compared with the pre-treatment baseline; seven (23%, 95% confidence interval 9.9-42.3) scored a mild change in breast appearance, and none developed a marked change. After a mean follow-up of 3.1 years (standard deviation 0.37, range 2.1-3.9 years) there have been no ipsilateral local tumour relapses. CONCLUSIONS Further evaluation of a five-fraction regimen of adjuvant whole breast radiotherapy in a phase III randomised trial is justified, including a regimen delivered in a total of 5 days.
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Affiliation(s)
- S Martin
- Department of Radiotherapy, Royal Marsden Hospital, Downs Road, Sutton, UK
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Volanti P, Mannino M, Piccoli T, La Bella V. Carcinoma of the tongue and bulbar-onset amyotrophic lateral sclerosis: unusual differential diagnosis. Neurol Sci 2007; 28:151-3. [PMID: 17603768 DOI: 10.1007/s10072-007-0809-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Accepted: 04/12/2007] [Indexed: 10/23/2022]
Abstract
We present a 72-year-old woman with progressive dysphagia, dysarthria and tongue palsy who was initially diagnosed with bulbar-onset amyotrophic lateral sclerosis (ALS). However, the absence of atrophy or fasciculations in the tongue, as in other voluntary muscles, and the lack of reproducible neurophysiological evidence of denervation, prompted a revision of the diagnostic work-up, which eventually led to the discovery of a carcinoma of the tongue. This case report describes a relatively rare type of oropharyngeal carcinoma that, in its early stage, resembled a bulbar-onset ALS. This differential diagnosis is unusual, and it was fostered by the persistent lack of atrophy of the tongue and the absence of spreading of signs and symptoms of motor neuron degeneration.
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Affiliation(s)
- P Volanti
- ALS Clinical Research Center Department of Clinical Neurosciences, University of Palermo, Via G. La Loggia 1, I-90129, Palermo, Italy
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16
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Abstract
The relentless evolution of amyotrophic lateral sclerosis (ALS), a severe neurodegenerative disorder of the upper and lower motoneurons, leads to an increasing level of disability. Most patients, during the course of the disease, become unable to attend the tertiary clinical care center and are thus prevented from enrolling in clinical trials or benefiting from specialized care and management. The main objective of this study was to verify whether the ALS functional rating scale (ALSFRS) could be reliably administered by telephone to patients, when unable to attend the ALS clinic, or to their caregivers. ALSFRS is a validated instrument that assesses the functional status and the disease progression in ALS. We first administered the functional rating scale directly in the clinic to 30 patients, with definite or probable ALS, and to their respective caregivers, and found a very high agreement between the two groups for the total score and the majority of the rating items. Next, we showed, in both patients and caregivers, a high degree of correlation between the total score of the ALSFRS measured by telephone and that reported in the clinic. This indicates that ALSFRS is a reliable instrument for monitoring the disease progression in homebound patients, even when the person contacted by telephone is the caregiver. We also performed a telephone clinic, based on an unstructured interview, with 16 ALS patients at an advanced stage of the disease and unable to attend the ALS clinic. On some occasions, the person interviewed was the caregiver. The symptoms most frequently reported were a worsening of muscle strength, swallowing and breathing problems, constipation, and inability to clear lung secretions. Several patients asked for assistive and adaptive equipment. All patients and caregivers found the telephone clinic very useful and considered it a good complement to the management and care programme.
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Affiliation(s)
- M Mannino
- Department of Neurology and Psychiatry, ALS Clinical Research Centre, University of Palermo, Palermo, Italy
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Monastero R, Mannino M, Lopez G, Camarda C, Cannizzaro C, Camarda LKC, Ciccia F, Triolo G, Camarda R. Prevalence of headache in patients with Behçet's disease without overt neurological involvement. Cephalalgia 2003; 23:105-8. [PMID: 12603366 DOI: 10.1046/j.1468-2982.2003.00476.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [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
The aims of the present study were to evaluate the prevalence of headache and the frequency of different headache syndromes in patients with Behçet's Disease (BD) without neurological involvement and to investigate the relationship with other clinical, and behavioural variables. Twenty-seven BD patients and 27 control subjects underwent a validated semistructured questionnaire based on the International Headache Society criteria. Levels of anxiety and depression, disease activity, and current medication were collected. Headache occurred in 88.9% of BD patients. There was no difference in the prevalence of the different headache syndromes between BD patients and controls. Only migraine without aura (MwA) was significantly more frequent in BD patients than controls (44.4% vs. 11.1%, respectively, P= 0.013). No relationship was found between MwA and clinical, and behavioural variables. Among headache syndromes, MwA showed the highest frequency in BD. A vascular or neuronal subclinical dysfunction could justify this association. A careful interview for migraine might be included in the diagnostic work-up of BD.
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Affiliation(s)
- R Monastero
- Department of Neurology and Rehabilitation, Institute of Neuropsychiatry, University of Palermo, Italy
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Abstract
Drugs that selectively block D(2) receptors are known to provoke a rapid cell firing increase followed by A9 and A10 dopaminergic (DA) neuron inactivation (depolarization block). In this study, possible relationships between cell firing rapid increase and specific behavioral effects, linked to sensorimotor integration, were investigated in the rat. To this purpose, with the aid of a video camera apparatus and a frame-by-frame analysis, effects of sulpiride-induced blockade of DA D(2) receptors were analyzed on the orienting movement of the head induced by acoustic stimulation. In a control group of rats, during trials lasting 20 min, latency and duration of head turning (HT) were 186.15 +/- 51.66 ms and 266.87 +/- 47.49 ms, respectively. Sulpiride injection (20,40,100 mg/kg IP) provoked a dose-dependent increase of HT latency and duration; however, only latencies showed statistically significant variations. It is suggested that cell firing rapid increase, observed on A9 and A10 DA neurons, following sulpiride administration, may be correlated to rapid modifications of specific HT parameters linked to sensorimotor integration.
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Affiliation(s)
- G Crescimanno
- Institute of Human Physiology, University of Palermo, Corso Tukory 129, 90134 Palermo, Italy.
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Freudenberger R, Kalman J, Mannino M, Buchholz-Varley C, Ocampo O, Kukin M. Effect of race in the response to metoprolol in patients with congestive heart failure secondary to idiopathic dilated or ischemic cardiomyopathy. Am J Cardiol 1997; 80:1372-4. [PMID: 9388121 DOI: 10.1016/s0002-9149(97)00688-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We sought to determine the effect of race in response to metoprolol in patients with dilated cardiomyopathy. We found no difference in exercise, hemodynamic, and neurohormonal responses to metoprolol based on race in patients with cardiomyopathy.
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Affiliation(s)
- R Freudenberger
- Cardiovascular Institute, The Mount Sinai Medical Center, New York, New York, USA
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Kukin ML, Kalman J, Mannino M, Freudenberger R, Buchholz C, Ocampo O. Combined alpha-beta blockade (doxazosin plus metoprolol) compared with beta blockade alone in chronic congestive heart failure. Am J Cardiol 1996; 77:486-91. [PMID: 8629589 DOI: 10.1016/s0002-9149(97)89342-3] [Citation(s) in RCA: 34] [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: 02/01/2023]
Abstract
There has been growing evidence for the benefits of beta blockers, but alpha blockers have not shown sustained benefits in chronic congestive heart failure (CHF). Thirty patients with moderate to severe CHF (New York Heart Association class II to IV) were sequentially assigned to receive metoprolol 6.25 mg with the alpha-1 antagonist doxazosin 4 mg/day or metoprolol alone. The dose of metoprolol was gradually increased to a target dose of 50 mg orally twice daily. Hemodynamic measurements were obtained before drug therapy, 2 hours after the first dose of combined alpha-beta therapy or metoprolol alone, and after 3 months of continuous treatment. Nuclear ejection fraction, plasma norepinephrine, and submaximal and maximal exercise capacity were also measured before and after chronic therapy. With initial combined drug administration, mean arterial pressure, left ventricular filling pressure, and systemic vascular resistance decreased significantly compared with results after metoprolol alone. However, after 3 months of continuous therapy, both treatment groups showed similar and significant reductions in systemic vascular resistance and heart rate, with significant increases in cardiac index, stroke volume index, stroke work index, ejection fraction, and exercise capacity. Furthermore, the next dose of chronic combined medication no longer showed vasodilating effects. Chronic therapy with fixed-dose doxazosin and increasing doses of metoprolol produced identical effects as those seen in patients receiving metoprolol alone.
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Affiliation(s)
- M L Kukin
- Cardiovascular Institute-Department of Medicine, Mount Sinai Medical Center, New York, USA
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Mannino M, Marino C, Chawla K. Ruptured pyogenic Baker's cyst. J Natl Med Assoc 1988; 80:1018-9, 1022. [PMID: 3241311 PMCID: PMC2625860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The authors present the case of a patient who developed a ruptured Baker's cyst. Methods of diagnosis and treatment are discussed.
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