1
|
Pigliasco F, Cafaro A, Barco S, Stella M, Mattioli F, Riva A, Mancardi MM, Lattanzi S, Bandettini R, Striano P, Cangemi G. Innovative LC-MS/MS method for therapeutic drug monitoring of fenfluramine and cannabidiol in the plasma of pediatric patients with epilepsy. J Pharm Biomed Anal 2024; 245:116174. [PMID: 38703746 DOI: 10.1016/j.jpba.2024.116174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/25/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
We present a novel liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for quantifying fenfluramine (FFA), its active metabolite norfenfluramine (norFFA), and Epidyolex®, a pure cannabidiol (CBD) oral solution in plasma. Recently approved by the EMA for the adjunctive treatment of refractory seizures in patients with Dravet and Lennox-Gastaut syndromes aged above 2 years, FFA and CBD still do not have established therapeutic blood ranges, and thus need careful drug monitoring to manage potential pharmacokinetic and pharmacodynamic interactions. Our method, validated by ICH guidelines M10, utilizes a rapid extraction protocol from 100 µL of human plasma and a reversed-phase C-18 HPLC column, with deuterated internal standards. The Thermofisher Quantiva triple-quadrupole MS coupled with an Ultimate 3000 UHPLC allowed multiple reaction monitoring detection, ensuring precise analyte quantification. The assay exhibited linear responses across a broad spectrum of concentrations: ranging from 1.64 to 1000 ng/mL for both FFA and CBD, and from 0.82 to 500 ng/mL for norFFA. The method proves accurate and reproducible, free from matrix effect. Additionally, FFA stability in plasma at 4 °C and -20 °C for up to 7 days bolsters its clinical applicability. Plasma concentrations detected in patients samples, expressed as mean ± standard deviation, were 0.36 ± 0.09 ng/mL for FFA, 19.67 ± 1.22 ng/mL for norFFA. This method stands as a robust tool for therapeutic drug monitoring (TDM) of FFA and CBD, offering significant utility in assessing drug-drug interactions in co-treated patients, thus contributing to optimized patient care in complex therapeutic scenarios.
Collapse
Affiliation(s)
- Federica Pigliasco
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alessia Cafaro
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sebastiano Barco
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Manuela Stella
- Gaslini Trial Centre, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Pharmacology and Toxicology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Francesca Mattioli
- Pharmacology and Toxicology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy; Clinical Pharmacology Unit, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Antonella Riva
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | | | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Roberto Bandettini
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy; Paediatric Neurology and Muscular Disease Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giuliana Cangemi
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| |
Collapse
|
2
|
Cafaro A, Stella M, Mesini A, Castagnola E, Cangemi G, Mattioli F, Baiardi G. Dose optimization and target attainment of vancomycin in children. Clin Biochem 2024; 125:110728. [PMID: 38325652 DOI: 10.1016/j.clinbiochem.2024.110728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/09/2024]
Abstract
Vancomycin is a glycopeptide antibiotic that has been adopted in clinical practice to treat gram-positive infections for more than 70 years. Despite vancomycin's long history of therapeutic use, optimal dose adjustments and pharmacokinetic/pharmacodynamic (PK/PD) target attainment in children are still under debate. Therapeutic drug monitoring (TDM) has been widely integrated into pediatric clinical practice to maximize efficacy and safety of vancomycin treatment. Area under the curve (AUC)-guided TDM has been recently recommended instead of trough-only TDM to ensure PK/PD target attainment of AUC0-24h/minimal inhibitory concentration (MIC) > 400 to 600 and minimize acute kidney injury risk. Bayesian forecasting in pediatric patients allows estimation of population PK to accurately predict individual vancomycin concentrations over time, and consequently total vancomycin exposure. AUC-guided TDM for vancomycin, preferably with Bayesian forecasting, is therefore suggested for all pediatric age groups and special pediatric populations. In this review we aim to analyze the current literature on the pediatric use of vancomycin and summarize the current knowledge on dosing optimization for target attainment in special patient populations.
Collapse
Affiliation(s)
- Alessia Cafaro
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina, Gaslini, Genova, Italy
| | - Manuela Stella
- UOC Servizio di Sperimentazioni Cliniche Pediatriche, IRCCS Istituto Giannina Gaslini, Genova, Italy; Department of Internal Medicine, Pharmacology & Toxicology Unit, University of Genoa, Genova, Italy
| | - Alessio Mesini
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Elio Castagnola
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Giuliana Cangemi
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina, Gaslini, Genova, Italy.
| | - Francesca Mattioli
- Department of Internal Medicine, Pharmacology & Toxicology Unit, University of Genoa, Genova, Italy; Clinical Pharmacology Unit, Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Giammarco Baiardi
- Department of Internal Medicine, Pharmacology & Toxicology Unit, University of Genoa, Genova, Italy; Clinical Pharmacology Unit, Ente Ospedaliero Ospedali Galliera, Genova, Italy
| |
Collapse
|
3
|
Baiardi G, Cafaro A, Stella M, Caviglia MC, Poeta MG, Cangemi G, Mattioli F. Altered plasma levels of apixaban in major gastrointestinal tract surgery: a case report and review of the literature. Clin Biochem 2023; 118:110613. [PMID: 37451498 DOI: 10.1016/j.clinbiochem.2023.110613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
Altered direct oral anticoagulant (DOAC) plasma levels can lead either to spontaneous hemorrhagic or thrombotic complications. We describe a case of suspected altered apixaban disposition in a patient with an upper gastrointestinal cancer resection treated with apixaban for non-valvular atrial fibrillation. Diagnosis of ischemic stroke for left hemiparesis was confirmed due to recent emergence of a hypodense area in the posterior capsular nucleus of ischemic reference in a context of binuclear capsular lacunar lesions. Thus, apixaban underexposure was suspected from anamnestic data and oral anticoagulation was switched to parenteral at the next scheduled dose for stroke recurrence. Before switching apixaban pharmacokinetic analysis was performed and unexpectedly showed apixaban plasma overexposure. After 3 days from the switch, the patient experienced spontaneous bleeding complications, for which the risk-benefit profile of continuing anticoagulant treatment for stroke recurrences warranted treatment discontinuation. Unexpected DOAC plasma exposure may present in special patient populations with thrombotic and bleeding complications. Though universally recognized therapeutic ranges have yet to be established for DOACs, periodic drug monitoring may aid in guiding optimization of DOAC therapy and reduce the risk of adverse events in special patient populations.
Collapse
Affiliation(s)
- Giammarco Baiardi
- Clinical Pharmacology Unit, Ente Ospedaliero Ospedali Galliera, Genoa, Italy; Pharmacology & Toxicology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy.
| | - Alessia Cafaro
- Pharmacology & Toxicology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy; Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Manuela Stella
- Clinical Pharmacology Unit, Ente Ospedaliero Ospedali Galliera, Genoa, Italy; Pharmacology & Toxicology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Michela Cameran Caviglia
- Clinical Pharmacology Unit, Ente Ospedaliero Ospedali Galliera, Genoa, Italy; Pharmacology & Toxicology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | - Giuliana Cangemi
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Francesca Mattioli
- Clinical Pharmacology Unit, Ente Ospedaliero Ospedali Galliera, Genoa, Italy; Pharmacology & Toxicology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| |
Collapse
|
4
|
Ferrara C, Battaglia R, Caponnetto A, Barbagallo C, Stella M, Vento ME, Borzì P, Scollo P, Lunelio F, Barbagallo D, Pernagallo S, Ragusa M, Di Pietro C. P-064 MicroRNAs as potential biomarkers for male infertility related to Testicular Germ Cell Tumors. Hum Reprod 2023; 38. [DOI: 10.1093/humrep/dead093.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Abstract
Study question
Could microRNAs represent efficient biomarkers to evaluate male infertility and the tendency of develop testicular germ cell tumors (TGCTs)?
Summary answer
The up-regulation of miR-193a-5p, miR-93-5p and let-7c-5p in TGCT patients with impaired spermiogram could represent a molecular signature of male infertility related to TGCTs.
What is known already
Testicular germ cell tumors (TGCTs) are the most recurrent tumors in young men with the highest incidence between the ages of 20 and 40 years and represent more than 60% of all cancers diagnosed in this age range. Several studies have shown a correlation between TGCTs and infertility, not only because infertility could be a consequence of testicular damage due to TGCTs but also because infertility may represent a risk factor for TGCTs. Therefore, it is important to find valid biomarkers that could be used to specifically identify infertility related to an increased risk of developing TGCTs.
Study design, size, duration
From March 2021 to January 2023, we collected 44 seminal plasma samples: 17 from TGCT patients who were undergoing sperm cryopreservation prior to chemotherapy, 14 with impaired spermiogram (IS) and 3 with normal spermiogram (NS) and 27 from control patients, 16 with IS and 11 with NS, undergoing assisted fertilization techniques. We evaluated the potential role of miRNAs as non-invasive biomarkers, analyzing the differential expression of 84 miRNAs in relation to cancer, infertility and both.
Participants/materials, setting, methods
Semen samples were placed 30’/37 °C, seminal plasma was purified using density-gradient centrifugation and stored at -80 °C. RNA was purified by Qiagen miRNeasy Serum/Plasma Kit and analyzed by miRCURY LNA miRNA SYBR®Green PCR_SerumPlasma, 96-well plate. We applied the 2−ΔΔCT method and statistical significance was evaluated by Significance Analysis of Microarrays, screened by p-values ≤ 0.05. We performed a Pearson correlation analysis applying two-sided p-values. miRTarBASE, MIENTURNET and Cytoscape were used for bioinformatics analysis.
Main results and the role of chance
In the four comparisons, we found 9 differentially expressed microRNAs. In particular, miR-221-3p, miR-222-3p, miR-204-5p and miR-205-5p down regulation would appear to be related to infertility, regardless to the cancer. Conversely, all TGCT patients shown an up-regulation of miR-376c-3p. Interestingly, up-regulation of miR-193a-5p, miR-93-5p and let-7c-5p specifically discriminates the infertile cancer patients vs other categories. Moreover, these three miRNAs showed a significant positive correlation both in cancer patients with impaired spermiogram and in infertile controls. This correlation demonstrates that their expression changes in the same way in the single samples and strongly suggests their role as early biomarkers of TGCT patients with impaired spermiogram. From the KEGG pathway analysis has emerged that DE miRNAs are involved in several signaling pathway, such as MAPK, mTOR, p53, PI3K-Akt, AMPK, FoxO, JAK-STAT, Ras, Estrogen signaling pathways, as well as cell cycle and cellular senescence. Moreover, from the Diseases Ontology analysis we found than those miRNAs are involved in germ cell tumor, male reproductive organ cancer, prostate cancer, male infertility and azoospermia.
Limitations, reasons for caution
The data must be validated by single assays in higher number of samples. These experiments are currently ongoing.
Wider implications of the findings
Three of the DE miRNAs are overexpressed in TGCT with impaired spermiogram patients. Specifically, they are over-expressed in TGCT with impaired spermiogram compared to infertile controls, so they may represent specific biomarkers able to discriminate, among the young men with infertility, those with higher risk of develop testicular cancer.
Trial registration number
Not applicable
Collapse
Affiliation(s)
- C Ferrara
- University of Catania, Department of Biomedical and Biotechnological Science , Catania, Italy
| | - R Battaglia
- University of Catania, Department of Biomedical and Biotechnological Science , Catania, Italy
| | - A Caponnetto
- University of Catania, Department of Biomedical and Biotechnological Science , Catania, Italy
| | - C Barbagallo
- University of Catania, Department of Biomedical and Biotechnological Science , Catania, Italy
| | - M Stella
- University of Catania, Department of Biomedical and Biotechnological Science , Catania, Italy
| | - M E Vento
- Cannizzaro Hospital, IVF Unit , Catania, Italy
| | - P Borzì
- Cannizzaro Hospital, IVF Unit , Catania, Italy
| | - P Scollo
- Cannizzaro Hospital, IVF Unit , Catania, Italy
| | - F Lunelio
- Cannizzaro Hospital, IVF Unit , Catania, Italy
| | - D Barbagallo
- University of Catania, Department of Biomedical and Biotechnological Science , Catania, Italy
| | - S Pernagallo
- DESTINA Genomica S.L., Parque Tecnológico Ciencias de la Salud PTS , Granada, Spain
| | - M Ragusa
- University of Catania, Department of Biomedical and Biotechnological Science , Catania, Italy
| | - C Di Pietro
- University of Catania, Department of Biomedical and Biotechnological Science , Catania, Italy
| |
Collapse
|
5
|
Baiardi G, Calvini G, Panarello S, Fioravanti C, Stella M, Martelli A, Antonucci G, Mattioli F. Prescriptive Appropriateness: Inhospital Adherence to Proton Pump Inhibitors Deprescription Flow Chart. Pharmaceuticals (Basel) 2023; 16:ph16050635. [PMID: 37242418 DOI: 10.3390/ph16050635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/13/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
The prescriptive appropriateness of Proton Pump Inhibitors (PPIs) in polypharmacy is controversial. PPIs are often overprescribed and the risk of prescribing errors and adverse drug reactions increases for each additional drug added to therapy. Hence, guided deprescription should be considered and easily implementable in ward practice. This observational prospective study evaluated the implementation of a validated PPIs deprescription flow chart to real-life internal ward activity through the presence of a clinical pharmacologist as an enhancing additional factor by assessment of inhospital prescriber's adherence to the proposed flow chart. Patients' demographics and prescribing trends of PPIs prescriptions were analyzed by descriptive statistics. The final analysis of data included ninety-eight patients (forty-nine male and forty-nine female), aging 75.6 ± 10.6 years; 55.1% of patients had home-PPIs prescriptions, while 44.9% received inhospital-PPIs prescriptions. Evaluation of prescriber's adherence to the flow chart revealed that the percentage of patients with a prescriptive/deprescriptive pathway conforming to that of the flow chart was 70.4%, with low symptomatologic recurrences. The clinical pharmacologists' presence and influence in ward activity may have contributed to this finding, since continuous training of the prescribing physicians is deemed a success-related factor in the deprescribing strategy. Multidisciplinary management of PPIs deprescription protocols shows high adherence by prescribers in real-life hospital settings and low recurrence events.
Collapse
Affiliation(s)
- Giammarco Baiardi
- Clinical Pharmacology Unit, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa, Italy
- Pharmacology and Toxicology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 2, 16132 Genoa, Italy
| | - Giulia Calvini
- Clinical Pharmacology Unit, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa, Italy
- Pharmacology and Toxicology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 2, 16132 Genoa, Italy
| | - Serena Panarello
- Internal Medicine Unit, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa, Italy
| | - Chiara Fioravanti
- Internal Medicine Unit, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa, Italy
| | - Manuela Stella
- Clinical Pharmacology Unit, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa, Italy
- Pharmacology and Toxicology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 2, 16132 Genoa, Italy
| | - Antonietta Martelli
- Pharmacology and Toxicology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 2, 16132 Genoa, Italy
| | - Giancarlo Antonucci
- Internal Medicine Unit, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa, Italy
| | - Francesca Mattioli
- Clinical Pharmacology Unit, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa, Italy
- Pharmacology and Toxicology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 2, 16132 Genoa, Italy
| |
Collapse
|
6
|
Baiardi G, Clavarezza M, Stella M, Casazza S, De Censi A, Mattioli F. Precision fluoropyrimidines dosing in a compound heterozygous variant carrier of the DPYD gene: a case report. Cancer Chemother Pharmacol 2023; 91:435-439. [PMID: 36890284 DOI: 10.1007/s00280-023-04515-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/24/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Fluoropyrimidines (FPs) form still nowadays the backbone of chemotherapic schemes in colorectal cancer (CRC). Inter-patient variability of the toxicity profile of FPs may be partially accounted for by variable expression of dihydropyrimidine dehydrogenase (DPD). DPD rate activity is genetically determined by its extremely polymorphic coding gene DPYD. In spite of pharmacogenetic guideline-directed-dosing of FPs based regimens treating carrier of multiple variants of DPYD gene remains still challenging. CASE PRESENTATION We present a case of a 48-year-old Caucasian man, compound heterozygous variant carrier of the DPYD gene (HapB3 and c.2194G>A) who had a diagnosis of adenocarcinoma of the left colon and was safely treated with a pharmacogenetic-guided 25% dose reduction of the standard CAP adjuvant treatment. Compound heterozygosis may have been responsible for an earlier over exposure to CAP resulting into low-grade toxicity with an anticipated median time to toxicity of the c.2194G>A variant to the 4th vs. 6th cycles. Some haplotypes of DPYD variants may have an advantage in terms of survival compared to wild-type patients. Our patient may also have benefitted from compound heterozygosis, as shown by no evidence of disease (NED) at 6-month follow-up. CONCLUSION Pharmacogenetic-guided dosing of DPYD intermediate metabolizer compound heterozygous HapB3 and c.2194G>A variant carries should be managed by a multidisciplinary team with a dose reduction ranging from 25 to 50% to maintain effectiveness and close clinical monitoring for early detection of ADRs.
Collapse
Affiliation(s)
- Giammarco Baiardi
- Clinical Pharmacology Unit, Ente Ospedaliero Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy. .,Pharmacology & Toxicology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 2, 16132, Genoa, Italy.
| | - Matteo Clavarezza
- Medical Oncology Unit, Ente Ospedaliero Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy
| | - Manuela Stella
- Clinical Pharmacology Unit, Ente Ospedaliero Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy.,Pharmacology & Toxicology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 2, 16132, Genoa, Italy
| | - Stefania Casazza
- Pathology Unit, Ente Ospedaliero Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy
| | - Andrea De Censi
- Medical Oncology Unit, Ente Ospedaliero Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy
| | - Francesca Mattioli
- Clinical Pharmacology Unit, Ente Ospedaliero Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy.,Pharmacology & Toxicology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 2, 16132, Genoa, Italy
| |
Collapse
|
7
|
Cafaro A, Pigliasco F, Baiardi G, Barco S, Stella M, Bandettini R, Mattioli F, Faraci M, Cangemi G. Development and Validation of a Novel LC-MS/MS Method for a TDM-Guided Personalization of HSCT Conditioning with High-Dose Busulfan in Children. Biomedicines 2023; 11:biomedicines11020530. [PMID: 36831066 PMCID: PMC9953620 DOI: 10.3390/biomedicines11020530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/31/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Personalization of busulfan (Bu) exposure via therapeutic drug monitoring (TDM) is recommended for patients treated with high-dose conditioning regimens. Several laboratories' developed methods are available in the literature with a lack of standardization. The aim of this study is to develop a new standardized LC-MS/MS method and validate it according to the international ICH M10 (EMA) guidelines. Our method is based on rapid protein precipitation from 50 µL plasma followed by separation on a reversed-phase C-18 UHPLC column after the addition of deuterated internal standard and has been tested on real samples from pediatric patients treated with myeloablative conditioning regimens, including Bu, before autologous or allogeneic hematopoietic stem cell transplantation (HSCT). The validated LC-MS/MS method is linear over wide concentration ranges (125-2000 ng/mL), accurate, and reproducible in the absence of matrix effects, allowing for the specific and rapid quantification of Bu and allowing next-dose recommendations to be made in a timely fashion to answer clinicians' needs. Given the lack of data on the stability of Bu in real clinical samples, stability was assessed both on quality controls and on real samples to set up a robust protocol in real-life conditions. This novel LC-MS/MS method is suitable for application to the TDM-guided personalization of conditioning treatments with high-dose busulfan in pediatric patients undergoing HSCT.
Collapse
Affiliation(s)
- Alessia Cafaro
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Pharmacology & Toxicology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 2, 16132 Genoa, Italy
| | - Federica Pigliasco
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Giammarco Baiardi
- Pharmacology & Toxicology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 2, 16132 Genoa, Italy
- Clinical Pharmacology Unit, EO Ospedali Galliera, Mura delle Cappuccine, 14, 16128 Genoa, Italy
| | - Sebastiano Barco
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Correspondence: ; Tel.: +39-01056363289
| | - Manuela Stella
- Pharmacology & Toxicology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 2, 16132 Genoa, Italy
- Clinical Pharmacology Unit, EO Ospedali Galliera, Mura delle Cappuccine, 14, 16128 Genoa, Italy
| | - Roberto Bandettini
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Francesca Mattioli
- Pharmacology & Toxicology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 2, 16132 Genoa, Italy
- Clinical Pharmacology Unit, EO Ospedali Galliera, Mura delle Cappuccine, 14, 16128 Genoa, Italy
| | - Maura Faraci
- Hematopoietic Stem Cell Unit, Department of Pediatric Hematology and Oncology, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Giuliana Cangemi
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| |
Collapse
|
8
|
Chioma R, Amabili L, Ciarmoli E, Copetti R, Villani P, Stella M, Storti E, Pierro M. The importance of lung recruitability: A novel ultrasound pattern to guide lung recruitment in neonates. J Neonatal Perinatal Med 2022; 15:767-776. [PMID: 36189505 DOI: 10.3233/npm-221088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Lung Ultrasound (LUS)-guided Lung Recruitment Maneuver (LRM) has been shown to possibly reduce ventilator-induced lung injury in preterm infants. However, to avoid potential hemodynamic and pulmonary side effects, the indication to perform the maneuver needs to be supported by early signs of lung recruitability. Recently, a new LUS pattern (S-pattern), obtained during the reopening of collapsed parenchyma, has been described. This study aims to evaluate if this novel LUS pattern is associated with a higher clinical impact of the LUS-guided LRMs. METHODS All the LUS-guided rescue LRMs performed on infants with oxygen saturation/fraction of inspired oxygen (S/F) ratio below 200, were included in this cohort study. The primary outcome was to determine if the presence of the S-pattern is associated with the success of LUS-guided recruitment, in terms of the difference between the final and initial S/F ratio (Delta S/F). RESULTS We reported twenty-two LUS-guided recruitments, performed in nine patients with a median gestational age of 34 weeks, interquartile range (IQR) 28-35 weeks. The S-pattern could be obtained in 14 recruitments (64%) and appeared early during the procedure, after a median of 2 cmH2O (IQR 1-3) pressure increase. The presence of the S-pattern was significantly associated with the effectiveness of the maneuver as opposed to the cases in which the S-pattern could not be obtained (Delta S/F 110 +/- 47 vs 44 +/- 39, p = 0.01). CONCLUSIONS Our results suggest that the presence of the S-pattern may be an early sign of lung recruitability, predicting LUS-guided recruitment appropriateness and efficacy.
Collapse
Affiliation(s)
- R Chioma
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A Gemelli Istituto di Ricoveroe Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, RM, Italy
| | - L Amabili
- Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, Netherland
| | - E Ciarmoli
- Department of Pediatrics, ASST Vimercate, Vimercate Hospital, Vimercate, MB, Italy
| | - R Copetti
- Emergency Department, Latisana General Hospital, Udine, UD, Italy
| | - P Villani
- Department of Critical Care, Maggiore Hospital, Cremona, Cremona, CR, Italy
| | - M Stella
- Neonatal and Paediatric Intensive Care Unit, M.Bufalini Hospital, AUSL Romagna, Cesena, FC, Italy
| | - E Storti
- Department of Critical Care, Maggiore Hospital, Cremona, Cremona, CR, Italy
| | - M Pierro
- Neonatal and Paediatric Intensive Care Unit, M.Bufalini Hospital, AUSL Romagna, Cesena, FC, Italy
| |
Collapse
|
9
|
Marini V, Pinto VM, Stella M, Fucile C, Lantieri F, Luci G, Gianesin B, Bacigalupo L, Forni GL, Mattioli F. Effect of Aging on Deferasirox Therapy in Transfusion-dependent Patients. A prospective-retrospective, cohort-study. Curr Drug Metab 2022; 23:CDM-EPUB-128183. [PMID: 36503397 DOI: 10.2174/1389200224666221209144420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/24/2022] [Accepted: 11/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Iron-chelation therapy is life-saving in patients on a chronic transfusion regimen as it reduces organ damage related to iron deposition in the tissues. Deferasirox, an iron-chelator, is characterized by pharmacokinetics variability, and some patients may discontinue the treatment due to toxicities. OBJECTIVE Understanding whether deferasirox plasma levels are related to patients' specific characteristics could help optimize DFX dosage. METHODS We analyzed deferasirox plasma concentration in 57 transfusion-dependent anemic patients using the HPLC method in this prospective-retrospective cohort study. All outpatients (3 to 98 years) were treated with deferasirox (film-coated tablet) for at least one year (median dose, 16.5 mg/Kg once a day). Deferasirox plasma concentration was normalized for dose/Kg (C/dose) and corrected with a linear regression model that relates C/dose and the time of blood sampling (Cref/dose). RESULTS No significant differences in Cref/dose were found between males and females, either between different types of hemoglobinopathies or depending on the presence of the UGT1A1*28 polymorphism. Cref/dose has a positive and significant correlation with age, creatinine, and direct bilirubin. Cref/dose, instead, has a negative and significant correlation with Liver Iron Concentration (LIC), ferritin, and eGFR. Cref/dose was significantly different between three age categories <18yrs, 18-50yrs, and >50yrs, with Cref/dose median values of 1.0, 1.2, and 1.5, respectively. CONCLUSION The study evidenced that to ensure the efficacy of deferasirox in terms of control over LIC and, at the same time, a lesser influence on renal function, the dose of the drug to be administered to an elderly patient could be reduced.
Collapse
Affiliation(s)
- Valeria Marini
- Clinical Pharmacology Unit, EO Ospedali Galliera, Mura delle Cappuccine, n. 14. I-16128 Genoa, Italy
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2. I-16132 Genoa, Italy
| | - Valeria Maria Pinto
- Centro della Microcitemia, Anemie Congenite e Dismetabolismo del Ferro, EO Ospedali Galliera, Mura delle Cappuccine, n. 14. I-16128 Genoa, Italy
| | - Manuela Stella
- Clinical Pharmacology Unit, EO Ospedali Galliera, Mura delle Cappuccine, n. 14. I-16128 Genoa, Italy
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2. I-16132 Genoa, Italy
| | - Carmen Fucile
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi, n.10. I-56126 Pisa, Italy
| | - Francesca Lantieri
- Health Science Department, Biostatistics Unit, University of Genoa, Via Pastore, n. 1. I-16132 Genoa, Italy
| | - Giacomo Luci
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi, n.10. I-56126 Pisa, Italy
| | - Barbara Gianesin
- Centro della Microcitemia, Anemie Congenite e Dismetabolismo del Ferro, EO Ospedali Galliera, Mura delle Cappuccine, n. 14. I-16128 Genoa, Italy
- ForAnemia Foundation, Via Garibaldi, n. 7. I-16124 Genoa, Italy
| | - Lorenzo Bacigalupo
- Department of Diagnostic Imaging, Radiology and Nuclear Medicine, EO Ospedali Galliera, Mura delle Cappuccine, n. 14. I-16128 Genoa, Italy
| | - Gian Luca Forni
- Centro della Microcitemia, Anemie Congenite e Dismetabolismo del Ferro, EO Ospedali Galliera, Mura delle Cappuccine, n. 14. I-16128 Genoa, Italy
| | - Francesca Mattioli
- Clinical Pharmacology Unit, EO Ospedali Galliera, Mura delle Cappuccine, n. 14. I-16128 Genoa, Italy
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2. I-16132 Genoa, Italy
| |
Collapse
|
10
|
Stella M, Biassoni E, Fiorillo C, Grandis M, Mattioli F, Del Sette M. A case of anti-HMGCR myopathy triggered by sodium/glucose co-transporter 2 (SGLT2) inhibitors. Neurol Sci 2022; 43:4567-4570. [DOI: 10.1007/s10072-022-06046-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/27/2022] [Indexed: 01/10/2023]
|
11
|
Toscano D, Arena D, Cerchio S, Giuliano L, Sarzi L, Massazza G, Stella M. Static-progressive orthosis for hand closure. Burns Open 2021. [DOI: 10.1016/j.burnso.2021.08.003] [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: 11/17/2022] Open
|
12
|
Furlan R, Arena D, Toscano D, Alfero M, Trucco M, Depetris N, Sarzi L, Stella M, Massazza G. Comfort talk for the rehabilitation of burns patients. Burns Open 2021. [DOI: 10.1016/j.burnso.2021.08.005] [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] Open
|
13
|
Toscano D, Arena D, Sarzi L, Stella M, Depetris N, Massazza G. Scar taping. Burns Open 2021. [DOI: 10.1016/j.burnso.2021.08.013] [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: 11/16/2022] Open
|
14
|
Esposito S, Zona S, Vergine G, Fantini M, Marchetti F, Stella M, Valletta E, Biasucci G, Lanari M, Dodi I, Bigi M, Magista AM, Vaienti F, Cella A, Affanni P, Re MC, Sambri V, Principi N. How to manage children if a second wave of COVID-19 occurs. Int J Tuberc Lung Dis 2020; 24:1116-1118. [PMID: 33126950 DOI: 10.5588/ijtld.20.0543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- S Esposito
- Paediatric Clinic, Pietro Barilla Children´s Hospital, University of Parma, Parma, Italy
| | - S Zona
- Azienda Unità Sanitaria Locale (AUSL) di Modena, Modena, Italy
| | - G Vergine
- Department of Paediatrics, Infermi Hospital Rimini, ASL Romagna, Rimini, Italy
| | - M Fantini
- Unit of Microbiology, Greater Romagna Area Hub Laboratory, Pievesestina di Cesena (FC), Italy
| | - F Marchetti
- Department of Paediatrics, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - M Stella
- Paediatric Clinic, ASL Romagna, Cesena, Italy
| | - E Valletta
- Department of Paediatrics, AUSL Romagna, Forlì, Italy
| | - G Biasucci
- Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - M Lanari
- Emergency Paediatrics, Policlinico Sant´Orsola, University of Bologna, Bologna, Italy
| | - I Dodi
- General and Emergency Paediatrics, Pietro Barilla Children´s Hospital, Parma, Italy
| | - M Bigi
- Paediatric Community Unit, ASL Romagna, Rimini, Italy
| | - A M Magista
- Paediatric Community Unit, ASL Romagna, Ravenna, Italy
| | - F Vaienti
- Department of Paediatrics, AUSL Romagna, Forlì, Italy
| | - A Cella
- Paediatric Emergency Unit, Guglielmo da Saliceto City Hospital, Piacenza, Italy
| | - P Affanni
- Laboratory of Hygiene and Public Health, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - M C Re
- Microbiology Unit, Policlinico Sant´Orsola, University of Bologna, Bologna, Italy
| | - V Sambri
- Unit of Microbiology, Greater Romagna Area Hub Laboratory, Pievesestina di Cesena (FC), Italy
| | - N Principi
- Università degli Studi di Milano, Milan, Italy, ,
| |
Collapse
|
15
|
Stella M, Braat A, Lam M, de Jong H, van Rooij R. Quantitative 166Ho-microspheres SPECT derived from a dual-isotope acquisition with 99mTc-colloid is clinically feasible. EJNMMI Phys 2020; 7:48. [PMID: 32666401 PMCID: PMC7359973 DOI: 10.1186/s40658-020-00317-8] [Citation(s) in RCA: 7] [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: 04/02/2020] [Accepted: 07/03/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose Accurate dosimetry is essential in radioembolization. To this purpose, an automatic protocol for healthy liver dosimetry based on dual isotope (DI) SPECT imaging, combining holmium-166 (166Ho)-microspheres, and technetium-99 m (99mTc)-colloid was developed: 166Ho-microspheres used as scout and therapeutic particles, and 99mTc-colloid to identify the healthy liver. DI SPECT allows for an automatic and accurate estimation of absorbed doses, introducing true personalized dosimetry. However, photon crosstalk between isotopes can compromise image quality. This study investigates the effect of 99mTc downscatter on 166Ho dosimetry, by comparing 166Ho-SPECT reconstructions of patient scans acquired before (166Ho-only) and after additional administration of 99mTc-colloid (166Ho-DI). Methods The 166Ho-only and 166Ho-DI scans were performed in short succession by injecting 99mTc-colloid on the scanner table. To compensate for 99mTc downscatter, its influence was accounted for in the DI image reconstruction using energy window-based scatter correction methods. The qualitative assessment was performed by independent blinded comparison by two nuclear medicine physicians assessing 65 pairs of SPECT/CT. Inter-observer agreement was tested by Cohen’s kappa coefficient. For the quantitative analysis, two volumes of interest within the liver, VOITUMOR, and VOIHEALTHY were manually delineated on the 166Ho-only reconstruction and transferred to the co-registered 166Ho-DI reconstruction. Absorbed dose within the resulting VOIs, and in the lungs (VOILUNGS), was calculated based on the administered therapeutic activity. Results The qualitative assessment showed no distinct clinical preference for either 166Ho-only or 166Ho-DI SPECT (kappa = 0.093). Quantitative analysis indicated that the mean absorbed dose difference between 166Ho-DI and 166Ho-only was − 2.00 ± 2.84 Gy (median 27 Gy; p value < 0.00001), − 5.27 ± 8.99 Gy (median 116 Gy; p value = 0.00035), and 0.80 ± 1.08 Gy (median 3 Gy; p value < 0.00001) for VOIHEALTHY, VOITUMOR, and VOILUNGS, respectively. The corresponding Pearson’s correlation coefficient between 166Ho-only and 166Ho-DI for absorbed dose was 0.97, 0.99, and 0.82, respectively. Conclusion The DI protocol enables automatic dosimetry with undiminished image quality and accuracy. Clinical trials The clinical study mentioned is registered with Clinicaltrials.gov (NCT02067988) on 20 February 2014.
Collapse
Affiliation(s)
- M Stella
- Department of Radiology and Nuclear Medicine, University Medical Center, Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - Ajat Braat
- Department of Radiology and Nuclear Medicine, University Medical Center, Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Mgeh Lam
- Department of Radiology and Nuclear Medicine, University Medical Center, Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Hwam de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center, Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - R van Rooij
- Department of Radiology and Nuclear Medicine, University Medical Center, Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| |
Collapse
|
16
|
Stella M, Theeba M, Illani Z. Organic fertilizer amended with immobilized bacterial cells for extended shelf-life. Biocatalysis and Agricultural Biotechnology 2019. [DOI: 10.1016/j.bcab.2019.101248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
17
|
Giangaspero F, Pession A, Trerè D, Badiali M, Galassi E, Ceccarelli C, Cavazzana A, Betts CM, Paolucci P, Stella M. Establishment of a Human Medulloblastoma Cell Line (Bo-101) Demonstrating Skeletal Muscle Differentiation. Tumori 2018; 77:196-205. [PMID: 1862545 DOI: 10.1177/030089169107700303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/16/2022]
Abstract
A permanent cell line, BO-101, was derived from a classic vermian medulloblastoma in a 9-year-old child. This line grew in vitro in adherent cultures and grew in athymic mice as serially transplantable intracranial and subcutaneous xenografts. Intracranial neoplasms grew as masses of small cells, which focally showed large cells with intense immunoreactivity for desmin, myoglobin and α-striated actin. The rhabdomyoblastic nature of these cells was confirmed ultrastructurally. The primary neoplasm showed immunoreactivity for synaptophysin, neuron-specific enolase and vimentin. A large panel of monoclonal antibodies and antisera against neuronal and glial antigens failed to show glial and neuronal immunoreactivity in the cell culture and xenografts. Despite the marked genotypic and phenotypic differences, the original neoplasm and the cell line share a common chromosomal marker del (12) (p 13.1). The BO-101 line differs phenotypically and genotypically from previously established medulloblastoma cell lines and further supports the heterogeneous biologic proprieties of the cell populations that constitute these neoplasms.
Collapse
Affiliation(s)
- F Giangaspero
- Institute of Anatomic Pathology, University of Bologna, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Paradiso A, Marubini E, Verderio P, Cortese M, Pizzamiglio S, De Paola F, Silvestrini R, Simone G, Sarotto I, Carcangiu M, Menard S, Tagliabue E, Mottolese M, Benevolo M, Bisceglia M, Giardina E, Maiorano E, Napoli A, Querzoli P, Nenci I, Pedriali M, Rinaldi R, Bianchi S, Vezzosi V, Collecchi P, Bevilacqua G, Colombari R, Caneva A, Gasparin P, Rucca V, Morigi F, De Paola F, Dubini A, Gaudio M, Medri L, Padovani F, Saragoni L, Volpi A, Granato A, Marinaro E, Folicaldi S, Ghidoni D, Cortecchia S, Veronese S, Galli C, Gambacorta M, Stella M, Rizzo A, Nizzoli R, Bozzetti C, Guazzi A, Naldi N, Sidoni A, Bucciarelli E, Ludovini V, Pistola L, Bernardi L, Ghisolfi G, Pecchioni C, Sapino A, Bussolati G, Barbareschi M, Dalla Palma P, Leonardi E. Interobserver Reproducibility of Immunohistochemical Her-2/Neu Assessment in Human Breast Cancer: An Update from INQAT round III. Int J Biol Markers 2018. [DOI: 10.1177/172460080502000307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The clinical interest in HER-2/neu is related to trastuzumab, a drug used to treat patients with invasive breast carcinoma overexpressing the HER-2/neu protein. It is very important to correctly identify those patients who may benefit from trastuzumab by accurate assessment of the HER-2/neu status. Of the various methods available, the Dako Herceptest for immunohistochemical assay is considered the most reliable to reach this goal. The aim of this study was to investigate within a group of Italian laboratories the reproducibility of the results of HER-2/neu assessment by means of the Dako scoring system on slides stained with the Herceptest kit. This study was also conceived as the continuation of one of our previous studies, which was similar in its aims but different in the classification criteria adopted. Our results show that, whereas the intra-observer reproducibility was generally satisfactory, the interobserver reproducibility was not. Moreover, our findings confirm that the two extreme classes (0 and 3+) are more easy to identify than the other two and that the Herceptest does not allow to discriminate optimally between scoring classes 2+ and 3+. These findings are relevant in clinical practice where the treatment choice is based on categories defined by this assay, suggesting the need of adopting educational programs and/or new reference materials to improve the assay performance.
Collapse
Affiliation(s)
| | | | | | - P. Verderio
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan
| | - M.E. Cortese
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan
| | - S. Pizzamiglio
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan
| | | | - R. Silvestrini
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan
| | | | | | - M.L. Carcangiu
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan
| | - S. Menard
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan
| | - E. Tagliabue
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan
| | - M. Mottolese
- Istituto Regina Elena per lo Studio e la Cura dei Tumori, Rome
| | - M. Benevolo
- Istituto Regina Elena per lo Studio e la Cura dei Tumori, Rome
| | - M. Bisceglia
- IRCCS - Ospedale Casa Sollievo della Sof-ferenza, San Giovanni Rotondo
| | - E. Giardina
- Azienda Os-pedaliera e Università degli Studi di Bari, Bari
| | - E. Maiorano
- Azienda Os-pedaliera e Università degli Studi di Bari, Bari
| | - A. Napoli
- Azienda Os-pedaliera e Università degli Studi di Bari, Bari
| | | | - I. Nenci
- Università degli Studi di Ferrara, Ferrara
| | | | - R. Rinaldi
- Università degli Studi di Ferrara, Ferrara
| | - S. Bianchi
- Azienda Ospedaliera Careggi e Università degli Studi di Firenze, Florence
| | - V. Vezzosi
- Azienda Ospedaliera Careggi e Università degli Studi di Firenze, Florence
| | | | | | | | | | | | - V. Rucca
- Os-pedale Cazzavillan, Arzignano
| | | | - F. De Paola
- U.O. Anatomia Patologica Ospedale Mor-gagni-Pierantoni, Forlì
| | - A. Dubini
- U.O. Anatomia Patologica Ospedale Mor-gagni-Pierantoni, Forlì
| | - M. Gaudio
- U.O. Anatomia Patologica Ospedale Mor-gagni-Pierantoni, Forlì
| | - L. Medri
- U.O. Anatomia Patologica Ospedale Mor-gagni-Pierantoni, Forlì
| | - F. Padovani
- U.O. Anatomia Patologica Ospedale Mor-gagni-Pierantoni, Forlì
| | - L. Saragoni
- U.O. Anatomia Patologica Ospedale Mor-gagni-Pierantoni, Forlì
| | - A. Volpi
- U.O. Oncologia Medica, Os-pedale Morgagni-Pierantoni, Forlì
| | - A.M. Granato
- U.O. Oncologia Medica, Os-pedale Morgagni-Pierantoni, Forlì
| | | | | | | | | | | | - C. Galli
- Azienda Os-pedaliera Niguarda, Milan
| | | | | | | | | | | | | | | | - A. Sidoni
- Anatomia Patologica, Azienda Ospedaliera Policlinico Monteluce, Perugia
| | - E. Bucciarelli
- Anatomia Patologica, Azienda Ospedaliera Policlinico Monteluce, Perugia
| | - V. Ludovini
- Oncologia Medica, Azienda Os-pedaliera Policlinico Monteluce, Perugia
| | - L. Pistola
- Oncologia Medica, Azienda Os-pedaliera Policlinico Monteluce, Perugia
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Cavazzana A, Prayer-Galetti T, Tirabosco R, Macciomei M, Stella M, Lania L, Cannada-Bartoli P, Passerini-Glazel L, Pagano F. Bellini Duct Carcinoma. Eur Urol 2017. [DOI: 10.1159/000474193] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
20
|
Lavrentieva A, Depetris N, Kaimakamis E, Berardino M, Stella M. Monitoring and treatment of coagulation abnormalities in burn patients. an international survey on current practices. Ann Burns Fire Disasters 2016; 29:172-177. [PMID: 28149244 PMCID: PMC5266232] [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] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/04/2016] [Indexed: 06/06/2023]
Abstract
The magnitude of coagulation abnormalities, and the definition and treatment of coagulopathy in burn patients are inadequately understood and continue to be discussed in the literature. We aimed to analyse physicians' views on monitoring and treating coagulation abnormalities in burn patients. A total of 350 questionnaires were distributed electronically to burn ICU physicians. Participation was voluntary and anonymous. Responses were analysed electronically and comparisons were made according to the region of the ICU or the specialty of the physician. Of the 350 questionnaires distributed, 55 (15.7%) were returned. The majority of burn specialists consider sepsis-induced coagulopathy to be the most frequent coagulopathy in burn patients, and 74.5% declare that they do not use any specific definition/scoring system in their department to detect coagulopathy. The majority of specialists (70.8%) use standard coagulation tests. The most frequent indications for plasma transfusion are massive bleeding (32.8%) and Disseminated Intravascular Coagulation syndrome treatment (20%). The main specific factors reported in our study are cryoprecipitate (23.2%) and fibrinogen concentrate (18.9%). 21.1% of respondents state that they do not use any specific coagulation factor substitution in burn patients. Specific coagulation factor substitution is not a routine practice. The low response rate precludes the generalization of our results.
Collapse
Affiliation(s)
| | - N. Depetris
- Anaesthesia and ICU - Orthopaedic and Trauma Centre A.O., Città della Salute e della Scienza, Turin, Italy
| | - E. Kaimakamis
- Burn ICU, Papanikolaou Hospital, Thessaloniki, Greece
| | - M. Berardino
- Anaesthesia and ICU - Orthopaedic and Trauma Centre A.O., Città della Salute e della Scienza, Turin, Italy
| | - M. Stella
- Burn Centre - Orthopaedic and Trauma Centre A.O., Città della Salute e della Scienza, Turin, Italy
| |
Collapse
|
21
|
Lavrentieva A, Depetris N, Kaimakamis E, Stella M, Berardino M. Perioperative use of specific coagulation factors in burn patients. an international survey. Intensive Care Med Exp 2015. [PMCID: PMC4796388 DOI: 10.1186/2197-425x-3-s1-a854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
22
|
Bollero D, Malvasio V, Gangemi E, Giunta G, Collard B, Stella M. Saturday night burns: an increasing problem? Ann Burns Fire Disasters 2015; 28:67-70. [PMID: 26668565 PMCID: PMC4665186] [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] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 08/19/2014] [Indexed: 06/05/2023]
Abstract
In Italy the economic crisis has caused changes in behavior in daily as well as leisure activities. For instance, night clubs have changed both their scenography and what they can offer. From simply providing a place to dance, they can now offer more complex scenography with spectacular fireworks and lit cocktails. While this can be amazing for all of us it can also be another cause of burn injuries. We conducted a retrospective study of all burns patients admitted to the Accident and Emergency Department at CTO Hospital in Turin from 2009 to 2013, after a night clubbing. A total of five patients were identified with an average age of 20 years old: four were burned by flaming cocktails and one was burned by a firework. Two received outpatient treatment, while orotracheal intubation and admission were needed for three, and two required surgical debridement and resurfacing with split skin graft. All patients had permanent sequelae caused by pathologic scarring and/or dyschromia. Our findings show that the risk of burn injuries is higher at weekends, mainly in summer, if all correct safety procedures are not followed. Meanwhile it is important to highlight that the promotion of inappropriate behavior at night clubs during firework displays and the passing of flaming cocktails should be avoided.
Collapse
Affiliation(s)
- D. Bollero
- Department of Surgery, Division of Plastic and Reconstructive Surgery and Burn Center, AOU Città della Salute, CTO Hospital, Turin, Italy
| | - V. Malvasio
- Department of Surgery, Division of Plastic and Reconstructive Surgery and Burn Center, AOU Città della Salute, CTO Hospital, Turin, Italy
| | - E.N. Gangemi
- Department of Surgery, Division of Plastic and Reconstructive Surgery and Burn Center, AOU Città della Salute, CTO Hospital, Turin, Italy
| | - G. Giunta
- Department of Plastic Surgery, Royal Devon and Exeter Foundation Hospital, Exeter, UK
| | - B. Collard
- Department of Plastic Surgery, Royal Devon and Exeter Foundation Hospital, Exeter, UK
| | - M. Stella
- Department of Surgery, Division of Plastic and Reconstructive Surgery and Burn Center, AOU Città della Salute, CTO Hospital, Turin, Italy
| |
Collapse
|
23
|
Francavilla R, Cristofori F, Stella M, Borrelli G, Naspi G, Castellaneta S. Treatment of celiac disease: from gluten-free diet to novel therapies. Minerva Pediatr 2014; 66:501-516. [PMID: 24938882] [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: 06/03/2023]
Abstract
Gluten-free diet (GFD) is the cornerstone treatment for celiac disease (CD). This diet excludes the protein gluten a protein forum in in grains such as wheat, barley, rye and triticale. Gluten causes small intestines inflammation in patients with CD and eating a GFD helps these patients in controlling signs and symptoms and prevent complications. Following a GFD may be frustrating, however, it is important to know that plenty of foods are naturally gluten-free and nowadays is relatively easy to find substitutes for gluten-containing foods. Certain grains, such as oats, are generally safe but can be contaminated with wheat during growing and processing stages of production. For this reason, it is generally recommended avoiding oats unless they are specifically labelled gluten-free. Other products that may contain gluten include food additives, such as malt flavouring, modified food starch and some supplement and/or vitamins that use gluten as a binding agent. Cross-contamination occurs when gluten-free foods come into contact with foods that contain gluten. It can happen during the manufacturing process or if the same equipment is used to make a variety of products. Cross-contamination can also occur at home if foods are prepared on common surfaces or with utensils that have not been cleaned after being used to prepare gluten-containing foods (using a toaster for gluten-free and regular bread). Although safe and effective, the GFD is not ideal: it is expensive, of limited nutritional value, and not readily available in many countries. Consequently, a need exists for novel, non-dietary therapies for celiac disease. Advances in understanding the immunopathogenesis of CD have suggested several types of therapeutic strategies alternative to the GFD. Some of these strategies attempt to decrease the immunogenicity of gluten-containing grains by manipulating the grain itself or by using oral enzymes to break down immunogenic peptides that normally remain intact during digestion. Other strategies focus on preventing the absorption of these peptides, preventing tissue transglutaminase from rendering gluten peptides more immunogenic, or inhibiting their binding to CD-specific antigen-presenting molecules. Strategies that limit T cell migration to the small intestine or that re-establish mucosal homeostasis and tolerance to gluten antigens are also being explored.
Collapse
|
24
|
Schmiedeknecht G, Kebbel K, Sonnabend C, Wagner M, Gryczka M, Stella M, Ganjei K, Bosch M, Powers L. Process transfer of DCVax-l to Europe and initiation of a phase III clinical trial in UK and Germany. Cytotherapy 2014. [DOI: 10.1016/j.jcyt.2014.01.053] [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: 10/25/2022]
|
25
|
Catalano F, Mariano F, Maina G, Bianco C, Nuzzo J, Stella M. An unusual case of extensive self-inflicted cement burn. Ann Burns Fire Disasters 2013; 26:40-43. [PMID: 23966898 PMCID: PMC3741007] [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] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Indexed: 06/02/2023]
Abstract
Cement is a fine powder used to bind sand and stones into a matrix of concrete, making up the world's most frequently used building material in the construction industry. First described by Ramazzini in his book "De Morbis Artificia Diatriba" in 1700, the effect of cement on the skin was presumed to be due to contact dermatitis. The first cement burns case was published by Rowe and Williams in 1963. Cement handling has been found to be responsible for many cases of occupational burns (generally full-thickness) usually affecting a limited TBSA, rarely greater than 5%, with localization especially in the lower limbs. We describe an unusual case of a self-inflicted cement burn involving 75% TBSA. A 28-yr-old building worker attempted suicide by jumping into a cement mixer in a truck. Upon arrival at our burn centre, clinical examination revealed extensive burn (75% TBSA - 40% full-thickness) involving face, back, abdomen, upper limbs and circumferentially lower limbs, sparing the hands and feet. The patient was sedated, mechanically ventilated, and subjected to escharotomy of the lower limbs in the emergency room. The following day, the deep burns in the lower limbs were excised down to the fascia and covered with meshed allografts. Owing to probable intestinal and skin absorption of cement, metal toxicity was suspected and dialysis and forced diuresis were therefore initiated on day 3. The patient's clinical conditions gradually worsened and he died on day 13 from the multi-organ failure syndrome.
Collapse
Affiliation(s)
- F. Catalano
- Plastic Surgery Unit, Department of Surgical Specialties, Messina University Hospital, Messina, Italy
| | - F. Mariano
- Department of Medicine Area, Nephrology and Dialysis Unit, CTO Hospital, Turin, Italy
| | - G. Maina
- Department of Traumatology, Orthopaedic and Occupational Medicine, University of Turin, Turin, Italy
| | - C. Bianco
- Department of Traumatology, Orthopaedic and Occupational Medicine, University of Turin, Turin, Italy
| | - J. Nuzzo
- Department of Plastic Surgery, Burns Unit, CTO Hospital, Turin, Italy
| | - M. Stella
- Department of Plastic Surgery, Burns Unit, CTO Hospital, Turin, Italy
| |
Collapse
|
26
|
Biasini A, Fantini F, Neri E, Stella M, Arcangeli T. Communication in the neonatal intensive care unit: a continuous challenge. J Matern Fetal Neonatal Med 2012; 25:2126-9. [DOI: 10.3109/14767058.2011.648241] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
27
|
Locsey L, Seres I, Sztanek F, Harangi M, Padra J, Asztalos L, Paragh G, Hutchison CA, Bevins A, Langham R, Mancini E, Wirta O, Cockwell P, Hutchison CA, Keir R, Vigano M, Stella A, Evans N, Chappell M, Cockwell P, Fabbrini P, Onuigbo M, Onuigbo N, Onuigbo M, Kim S, Chang JH, Jung JY, Lee HH, Chung W, Zanoli L, Rastelli S, Marcantoni C, Tamburino C, Castellino P, Cho A, Choi H, Lee JE, Jang HR, Huh W, Kim YG, Kim DJ, Oh HY, Zanoli L, Rastelli S, Marcantoni C, Tamburino C, Castellino P, Garcia-Fernandez N, Martin-Moreno PL, Varo N, Nunez-Cordoba JM, Schlieper G, Kruger T, Kelm M, Floege J, Westenfeld R, Choi H, Cho AJ, Jang HR, Lee JE, Huh W, Kim YG, Oh HY, Kim DJ, Doganay S, Oguz AK, Ergun I, Bardachenko N, Kuryata O, Bardachenko L, Garcia-Fernandez N, Martin-Moreno PL, Varo N, Nunez-Cordoba JM, Choi H, Cho AJ, Jang HR, Lee JE, Huh W, Kim YG, Oh HY, Kim DJ, Ravani P, Malberti F, Pirelli S, Scolari F, Barrett B, Presta P, Lucisano G, Rubino A, Serraino F, Amoruso T, Renzulli A, Fuiano G, Kielstein JT, Tolk S, Heiden A, Kuhn C, Hoeper MM, Lorenzen J, Broll M, Kaever V, Burhenne H, Hafer C, Haller H, Burkhardt O, Kielstein J, Zahalkova J, Petejova N, Strojil J, Urbanek K, Bertoli S, Musetti C, Cabiati A, Assanelli E, Lauri G, Marana I, De Metrio M, Rubino M, Campodonico J, Grazi M, Moltrasio M, Marenzi G, Unarokov Z, Mukhoedova T, Fidalgo P, Coelho S, Rodrigues B, Fernandes AP, Papoila AL, Liano F, Soto K, Vanmassenhove J, Vanholder R, Glorieux G, Van Biesen W, Challiner R, Ritchie J, Hutchison A, Challiner R, Ritchie J, Hutchison A, Challiner R, Ritchie J, Hutchison A, Zaharie SI, Maria DT, Zaharie M, Vaduva C, Grauntanu C, Cana-Ruiu D, Mota E, Hayer M, Baharani J, Thomas M, Eldehni T, Selby N, McIntyre C, Fluck R, Kolhe N, Fagugli RM, Patera F, Shah PR, Kaswan KK, Kute VB, Vanikar AV, Gumber MR, Patel HV, Munjappa BC, Enginner DP, Sainaresh VV, Trivedi HL, Teixeira C, Nogueira E, Lopes JA, Almeida E, Pais de Lacerda A, Gomes da Costa A, Franca C, Mariano F, Morselli M, Bergamo D, Hollo' Z, Scella S, Maio M, Tetta C, Dellavalle A, Stella M, Triolo G, Cantaluppi V, Quercia AD, Bertinetto P, Giacalone S, Tamagnone M, Basso E, Karvela E, Gai M, Leonardi G, Anania P, Guarena C, Fenocchio CM, Pacitti A, Segoloni GP, Kim YO, Kim HG, Kim BS, Song HCS, Min JK, Kim SY, Park WD, Dalboni M, Narciso R, Quinto M, Grabulosa C, Cruz E, Monte J, Durao M, Cendoroglo M, Santos O, Batista M, Cho A, Choi H, Lee JE, Jang HR, Huh W, Kim YG, Kim DJ, Oh HY, Mancini E, Bellasi A, Giannone S, Mordenti A, Zanoni A, Santoro A, Presta P, Lucisano G, Rubino A, Serraino F, Renzulli A, Fuiano G, Lee JH, Ha SH, Kim JH, Lee GJ, Jung YC, Malindretos P, Koutroumbas G, Patrinou A, Zagkotsis G, Makri P, Togousidis I, Syrganis C, Li Cavoli G, Tortorici C, Bono L, Ferrantelli A, Giammarresi C, Zagarrigo C, Rotolo U, Kim H, Jun K, Choi W, Kim H, Jun K, Choi W, Krzesinski JM, Parotte MC, Vandevelde C, Keenan J, Dieterle F, Sultana S, Pinches M, Ciorciaro C, Schindler R, Schmitz V, Gautier JC, Benain X, Matchem J, Murray P, Adler S, Haase M, Haase-Fielitz A, Devarajan P, Bellomo R, Cruz DN, Wagener G, Krawczeski CD, Koyner JL, Murray PT, Zappitelli M, Goldstein S, Makris K, Ronco C, Martensson J, Martling CR, Venge P, Siew E, Ware LB, Ikizler A, Mertens PR, Lacquaniti A, Buemi A, Donato V, Lucisano S, Buemi M, Vanmassenhove J, Vanholder R, Glorieux G, Van Biesen W, Panagoutsos S, Kriki P, Mourvati E, Tziakas D, Chalikias G, Stakos D, Apostolakis S, Tsigalou C, Gioka T, Konstantinides S, Vargemezis V, Torregrosa I, Montoliu C, Urios A, Aguado C, Puchades MJ, Solis MA, Juan I, Sanjuan R, Blasco M, Pineda J, Carratala A, Ramos C, Miguel A, Niculae A, Checherita IA, Sandulovici R, David C, Ciocalteu A, Espinoza M, Hidalgo J, Lorca E, Santibanez A, Arancibia F, Gonzalez F, Park MY, Kim EJ, Choi SJ, Kim JK, Hwang SD, Lee KH, Seok SJ, Yang JO, Lee EY, Hong SY, Gil HW, Astapenko E, Shutov A, Savinova G, Rechnik V, Melo MJ, Lopes JA, Raimundo M, Viegas A, Camara I, Antunes F, Kim MJ, Kwon SH, Lee SW, Song JH, Lee JW. Acute kidney injury - Human studies. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.29] [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: 11/13/2022] Open
|
28
|
Derbel O, Limem S, Tassy L, Desseigne F, Rivoire M, Meeus P, Peyrat P, Stella M, Martel-Lafay I, De La Fouchardiere C. Clinical experience with neuroendocrine rectal tumors. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
611 Background: Carcinoids are heterogeneous neuroendocrine tumors with malignant potential. The rectum is the third most common location for gastrointestinal carcinoids after small bowel and colon. Due to their rarity, the characteristics and behavior of this unusual malignancy remain unclear. Methods: Retrospective review of the clinicopathologic features of patients treated for carcinoid tumors of the rectum. Results: A single institute's tumor registry was retrospectively queried, identifying nine patients with rectal carcinoid tumors over a 10-year period. The mean age at diagnosis was 57.6 years. Four of the nine patients were female. Presenting symptoms included abdominal pain in five patients, rectal bleeding in two patients and a change in bowel habits in one patient. As previously reported, no patient had symptoms consistent with carcinoid syndrome. The rectal tumor size was > 2 cm in five patients. The rectal tumor was located in the lower third of the rectum in three cases (< 5 cm from anal verge) whereas three were in the middle third (6-11 cm) and two in the upper third (11-15 cm). Four of the tumors were well differentiated tumors (grade 1), 1 was atypical carcinoid or moderately differentiated tumors (grade 2), and 4 were poorly differentiated tumors (grade 3) according to the SEER. Initially, 5/9 patients had distant metastasis. As an initial site of metastasis, the liver was the most common site (4/5 patients, 80%). Five patients underwent surgical treatment of their rectal tumor, two with endoscopic transanal resection whereas 3 patients had a low anterior resection (LAR). Three patients received chemotherapy treatment only in the metastatic setting and one patient received chemotherapy and radiotherapy as palliative treatment. Of the nine patients, five had progressive disease after initial treatment. With a median follow-up of 14 months, the overall survival of the entire population was 13.4 months. Conclusions: Neuroendocrine carcinomas of rectum are uncommon. Only small rectal carcinoids can be safely managed and surgery represents the treatment that can offer a greater chance of survival to these patients. Larger primary tumors have a high tendency to spread early. They are associated with aggressive behavior, resistance to chemotherapy and poor prognosis. No significant financial relationships to disclose.
Collapse
Affiliation(s)
| | - S. Limem
- Centre Léon Bérard, Lyon, France
| | - L. Tassy
- Centre Léon Bérard, Lyon, France
| | | | | | - P. Meeus
- Centre Léon Bérard, Lyon, France
| | | | | | | | | |
Collapse
|
29
|
Bollero D, Stella M, Gangemi EN, Spaziante L, Nuzzo J, Sigaudo G, Enrichens F. Purpura fulminans in meningococcal septicaemia in an adult: a case report. Ann Burns Fire Disasters 2010; 23:43-47. [PMID: 21991197 PMCID: PMC3188232] [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] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Indexed: 05/31/2023]
Abstract
Purpura fulminans is a rare and severe complication of meningococcal septicaemia. It presents as a petechial rash spreading rapidly in extent and depth, evolving into full-thickness skin necrosis. The condition is extremely uncommon in the adult population. We report the case of a 28-yr-old man with extensive meningococcal-related skin necrosis. The initial diagnosis was made and first treatment given in the emergency department of a local hospital, from where after 12 days he was transferred to our hospital. Our approach was based on the continuation of intensive treatment and on staged aggressive debridement. Temporary alloplastic skin grafts were used to prepare the wound bed and the wounds were closed with autologous skin grafts. The patient survived but subsequently, owing to chronic skin ulceration and scar instability, he underwent late bilateral below-the-knee amputation.The patient returned to normal deambulation with an orthopaedic prosthesis 18 months after the onset of meningococcal septicaemia.
Collapse
Affiliation(s)
- D Bollero
- Department of Plastic and Reconstructive Surgery, Burns Centre, Traumatological Hospital, Turin, Italy
| | | | | | | | | | | | | |
Collapse
|
30
|
Ostorero A, Castagnoli C, Fumagalli M, Alotto D, Cambieri I, Casarin S, Casimiri R, Stella M. Acellular glycerolised dermis supports keratinocyte growth and differentiation. Burns 2009. [DOI: 10.1016/j.burns.2009.06.045] [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: 11/15/2022]
|
31
|
Gangemi E, Berchialla P, Buja A, Gregori D, Stella M. Bayesian networks for pathological scarring due to burn injuries. Burns 2009. [DOI: 10.1016/j.burns.2009.06.081] [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: 11/16/2022]
|
32
|
Ciaramitaro P, Stella M, Castagnoli C, Risso D, Costa P, Faccani G, Isoardo G, Verrua R, Musso T, Alasia ST. Neurophysiological and clinical study of pain in postburn hypertrophic scars. Burns 2009. [DOI: 10.1016/j.burns.2009.06.044] [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]
|
33
|
Lupia E, Bosco O, Mariano F, Dondi AE, Goffi A, Spatola T, Cuccurullo A, Tizzani P, Brondino G, Stella M, Montrucchio G. Elevated thrombopoietin in plasma of burned patients without and with sepsis enhances platelet activation. J Thromb Haemost 2009; 7:1000-8. [PMID: 19317837 DOI: 10.1111/j.1538-7836.2009.03348.x] [Citation(s) in RCA: 36] [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: 12/26/2022]
Abstract
BACKGROUND Thrombopoietin (TPO) is a humoral growth factor that does not induce platelet aggregation per se, but enhances platelet activation in response to several agonists. Circulating levels of TPO are increased in patients with sepsis and are mainly related to sepsis severity. OBJECTIVES To investigate the potential contribution of elevated TPO levels in platelet activation during burn injury complicated or not by sepsis. METHODS We studied 22 burned patients, 10 without and 12 with sepsis, and 10 healthy subjects. We measured plasma levels of TPO, as well as leukocyte-platelet binding and P-selectin expression. The priming activity of plasma from burned patients or healthy subjects on platelet aggregation and leukocyte-platelet binding, and the role of TPO in these effects were also studied in vitro. RESULTS Burned patients without and with sepsis showed higher circulating TPO levels and increased monocyte-platelet binding compared with healthy subjects. Moreover, TPO levels, monocyte-platelet binding and P-selectin expression were significantly higher in burned patients with sepsis than in burned patients without sepsis. In vitro, plasma from burned patients without and with sepsis, but not from healthy subjects, primed platelet aggregation, monocyte-platelet binding and platelet P-selectin expression. The effect of plasma from burned patients with sepsis was significantly higher than that of plasma from burned patients without sepsis. An inhibitor of TPO prevented the priming effect of plasma from burned patients. CONCLUSIONS Increased TPO levels may enhance platelet activation during burn injury and sepsis, potentially participating in the pathogenesis of multi-organ failure in these diseases.
Collapse
Affiliation(s)
- E Lupia
- Department of Clinical Pathophysiology, University of Turin, Turin, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Frasca F, Nucera C, Pellegriti G, Gangemi P, Attard M, Stella M, Loda M, Vella V, Giordano C, Trimarchi F, Mazzon E, Belfiore A, Vigneri R. BRAF(V600E) mutation and the biology of papillary thyroid cancer. Endocr Relat Cancer 2008; 15:191-205. [PMID: 18310287 DOI: 10.1677/erc-07-0212] [Citation(s) in RCA: 180] [Impact Index Per Article: 11.3] [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: 11/27/2022]
Abstract
BRAF((V600E)) mutation is the most frequent genetic alteration in papillary thyroid carcinomas (PTCs) that are 80-90% of all thyroid cancers. We evaluated the relationship between BRAF((V600E)) and tumor, host, and environmental factors in PTCs from all geographical areas of Sicily. By PCR, BRAF((V600E)) was investigated in a series of 323 PTCs diagnosed in 2002-2005. The correlation between clinicopathological tumor, host, and environmental characteristics and the presence of BRAF((V600E)) were evaluated by both univariate and multivariate analyses. BRAF((V600E)) was found in 38.6% PTCs, with a 52% frequency in the classical PTCs and 26.4% in the tall cell variant. Univariate analysis indicated that BRAF((V600E)) was associated with greater tumor size (P=0.0048), extra-thyroid invasion (P<0.0001), and cervical lymph nodal metastases (P=0.0001). Multivariate logistic regression analysis confirmed that BRAF((V600E)) was an independent predictor of extra-thyroid invasion (P=0.0001) and cervical lymph nodal metastasis (P=0.0005). The association between BRAF((V600E)) and extra-thyroid invasion was also found in micro-PTCs (P=0.006). In 60 classical PTCs, BRAF((V600E)) was positively correlated with matrix metalloproteinase-9 expression (P=0.0047), suggesting a possible mechanism for BRAF((V600E)) effect on PTC invasiveness. No association was found between BRAF((V600E)) and patient age, gender, or iodine intake. In contrast, a strong association was found with residency in Eastern Sicily (P<0.0001 compared with Western Sicily). These results indicate that BRAF((V600E)) mutation is a marker of aggressive disease in both micro- and macro-PTCs. Moreover, for the first time, a possible link between BRAF((V600E)) mutation and environmental carcinogens is suggested.
Collapse
Affiliation(s)
- F Frasca
- Endocrinologia, Dipartimento di Medicina Interna e Medicina Specialistica, University of Catania, PO Garibaldi Nesima, Via Palermo 636, Catania, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Affiliation(s)
- M. Stella
- Multimedia University, Kuala Lumpur, Malaysia
| | - P.K. Dash
- College of Engineering, Bhubaneswar, India
| | - P.K. Rout
- College of Engineering, Bhubaneswar, India
| |
Collapse
|
36
|
Tarella C, Zanni M, Di Nicola M, Patti C, Calvi R, Pescarollo A, Zoli V, Fornari A, Novero D, Cabras A, Stella M, Comino A, Remotti D, Ponzoni M, Caracciolo D, Ladetto M, Magni M, Devizzi L, Rosato R, Boccadoro M, Bregni M, Corradini P, Gallamini A, Majolino I, Mirto S, Gianni AM. Prolonged survival in poor-risk diffuse large B-cell lymphoma following front-line treatment with rituximab-supplemented, early-intensified chemotherapy with multiple autologous hematopoietic stem cell support: a multicenter study by GITIL (Gruppo Italiano Terapie Innovative nei Linfomi). Leukemia 2007; 21:1802-11. [PMID: 17554382 DOI: 10.1038/sj.leu.2404781] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [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: 11/09/2022]
Abstract
A prospective multicenter program was performed to evaluate the combination of rituximab and high-dose (hd) sequential chemotherapy delivered with multiple autologous peripheral blood progenitor cell (PBPC) support (R-HDS-maps regimen) in previously untreated patients with diffuse large B-cell lymphoma (DLB-CL) and age-adjusted International Prognostic Score (aaIPI) score 2-3. R-HDS-maps includes: (i) three APO courses; (ii) sequential administration of hd-cyclophosphamide (CY), hd-Ara-C, both supplemented with rituximab, hd-etoposide/cisplatin, PBPC harvests, following hd-CY and hd-Ara-C; (iii) hd-mitoxantrone (hd-Mito)/L-Pam + 2 further rituximab doses; (iv) involved-field radiotherapy. PBPC rescue was scheduled following Ara-C, etoposide/cisplatin and Mito/L-Pam. Between 1999 and 2004, 112 consecutive patients aged <65 years (74 score 2, 38 score 3) entered the study protocol. There were five early and two late toxic deaths. Overall 90 patients (80%) reached clinical remission (CR); at a median 48 months follow-up, 87 (78%) patients are alive, 82 (73%) in continuous CR, with 4 year overall survival (OS) and event-free survival (EFS) projections of 76% (CI 68-85%) and 73% (CI 64-81%), respectively. There were no significant differences in OS and EFS between subgroups with Germinal-Center and Activated B-cell phenotype. Thus, life expectancy of younger patients with aaIPI 2-3 DLB-CL is improved with the early administration of rituximab-supplemented intensive chemotherapy compared with the poor outcome following conventional chemotherapy.
Collapse
Affiliation(s)
- C Tarella
- Dip Medicina-Oncologia Sperimentale, Divisione Universitaria di Ematologia, Torino, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
|
38
|
Stella M, Risso D, Bollero D, Capocelli R, Primiceri C, Castagnoli C. Treatment of extensive burns by means of skin allografts. Burns 2007. [DOI: 10.1016/j.burns.2006.10.355] [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]
|
39
|
Stella M, Cassano P, Cuccuru F, Ganem J, Gangemi E, Zingarelli E, Cairo M, Castagnoli C. Post-burn pathological scar management. Burns 2007. [DOI: 10.1016/j.burns.2006.10.151] [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]
|
40
|
Abstract
We report a case of a relapse of Henoch-Schönlein Purpura (HSP) associated with intake of paracetamol (also known as acetaminophene) and codeine. A 69-year-old man presented with fever, gross hematuria, acute renal failure, palpable purpuric skin rash over the legs, feet and arms, arthralgias and abdominal discomfort. 1 week before he had started therapy with co-efferalgan (association of paracetamol and codeine) for cervical arthrosis. Blood test revealed increase in serum creatinine levels (2.6 mg/dl), CRP (375 mg/dl), with no thrombocytopenia or hypocomplementemia. Co-efferalgan was discontinued. Gross hematuria resolved in 2 days, purpuric rash disappeared in 10 days, renal function returned to normal after 2 weeks and abdominal pain and arthralgias improved on the following 2 - 3 weeks. An objective causality assessment in accordance with the Naranjo algorithm, revealed that the adverse drug reaction was probable between paracetamol/codeine and Henoch-Schönlein purpura. To our knowledge, and based on a medline search (up to 2005), we believe that this could be considered the first case of Henoch-Schönlein purpura, associated with intake of paracetamol and codein. Although this event could be considered rare, clinicians should to be aware of possible associations between HUS and the intake of paracetamol and/or codeine to provide an early therapeutic intervention and a close monitoring.
Collapse
Affiliation(s)
- D Santoro
- Unit of Nephrology and Dialysis, San Vincenzo Hospital, Taormina ASL 5, Italy.
| | | | | |
Collapse
|
41
|
|
42
|
Fazii P, Neri M, Bucci E, Pistola F, Laterza F, Colagrande E, Cosentino L, Caldarella M, Clerico L, Stella M, Pelatti A, Riario Sforza G. DIAGNOSI E TERAPIA DELL’ANISAKIDOSI MEDIANTE ENDOSCOPIO. DESCRIZIONE DI TRE CASI IN ABRUZZO. Microbiol Med 2006. [DOI: 10.4081/mm.2006.3193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
43
|
Granata A, Stella M, Santoro D, Castellino S. [Acute renal failure secondary to retroperitoneal fibrosis as first manifestation of lupus nephritis]. G Ital Nefrol 2006; 23:86-9. [PMID: 16521080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Retroperitoneal fibrotic is a fibrous process of the retroperitoneum and can result in ureteral obstruction. Although the pathogenesis is unknown, it is suggested that an immunological mechanism plays a role. It can occur as an isolated finding or be associated with several conditions such as malignancies, infections, connective tissue disease and the action of drugs. However, a few cases of retroperitoneal fibrosis, associated with systemic lupus erythematosus (SLE) have been reported. We describe a case of a 23-year-old female with lupus nephritis who presented with bilateral obstructive nephropathy due to retroperitoneal fibrosis. Treatment with steroids improved both conditions. Our case and previously reported cases of SLE and retroperitoneal fibrosis support the hypothesis that this association is not fortuitous, but reflects a common immunological mechanism.
Collapse
Affiliation(s)
- A Granata
- U.O. di Nefrologia e Dialisi, A.O. Vittorio Emanuele, Catania
| | | | | | | |
Collapse
|
44
|
Fazii P, Pelatti A, Lococo A, Russi C, Pistola F, Stella M, Crescenzi C, Clerico L, Cosentino L, Casaccia M, Polilli E, Riario Sforza G. EMPIEMA PLEURICO CAUSATO DA BLASTO-SCHIZOMYCES CAPITATUS IN PAZIENTE CON SINDROME DI MOEBIUS. Microbiol Med 2005. [DOI: 10.4081/mm.2005.3545] [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: 11/23/2022] Open
|
45
|
Fazii P, Pelatti A, Civitarese C, Russi C, Pistola F, Stella M, Crescenzi C, Gattone M, Manes E, Colagrande E, Riario Sforza G. DESCRIZIONE DI UN CASO DI ASCESSO CUTANEO CAUSATO DA CHRYSEOMONAS LUTEOLA. Microbiol Med 2005. [DOI: 10.4081/mm.2005.3504] [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: 11/23/2022] Open
|
46
|
Stella M, Clemente A, Bollero D, Risso D, Arturi L. Temporal fascial flap: a versatile free flap for coverage of complex skin defects. Eur J Plast Surg 2005. [DOI: 10.1007/s00238-004-0703-1] [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: 10/25/2022]
|
47
|
Berardi A, Lugli L, Rossi K, Casa Mattini ED, Gallo C, Gargano G, Tridapalli E, Stella M, Ferrari F. 32 GBS Prevention Policies in a North Italian Area. Pediatr Res 2005; 58:359-359. [DOI: 10.1203/00006450-200508000-00061] [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: 09/18/2023]
|
48
|
Saccomani G, Durante V, Magnolia MR, Ghezzo L, Lombezzi R, Esercizio L, Stella M, Arezzo A. Combined endoscopic treatment for cholelithiasis associated with choledocholithiasis. Surg Endosc 2005; 19:910-4. [PMID: 15868278 DOI: 10.1007/s00464-003-9314-3] [Citation(s) in RCA: 23] [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] [Subscribe] [Scholar Register] [Received: 12/03/2003] [Accepted: 10/08/2004] [Indexed: 12/13/2022]
Abstract
BACKGROUND The advent of endoscopic techniques changed surgery in many ways. For the management of cholelithiasis, laparoscopic cholecystectomy (LC) is the treatment of choice. This has created a dilemma in the management of choledocholithiasis. Today a number of option exist, including endoscopic sphinterotomy (ES) before LC in patients with suspected common bile duct (CBD) stones, laparoscopic bile duct exploration, open CBD exploration, and postoperative endoscopic retrograde cholangiopancreatography (ERCP). Also, the alternative technique of peroperative ES is emerging. METHODS We report our experience of routine intraoperative cholangiography followed either by peroperative ERCP in one step or by transcystic drain and postoperative ERCP. In our technique, to facilitate Vater papilla cannulation we inserted a 450-cm transcystic guidewire that was caught by a duodenoscope. Papillotome was then inserted over the guidewire to ensure cannulation of the CBD. RESULTS Twenty-eight patients were treated successfully in one step and 24 in two steps. The mean operative time was 181 +/- 41 min for patients treated in one step and 131 +/- 30 min for patients treated in two steps. The mean hospital stay was 4.8 +/- 3.3 days for patients treated in one step and 9.6 +/- 4.0 days for patients treated in two steps. Five patients (18%) with positive intraoperative cholangiography for stones for whom peroperative ERCP was not available showed a normal postoperative transcystic cholangiogram and therefore ERCP was canceled. Fourteen of 25 patients treated in one step and none of 17 treated in two steps had raised serum amylase, which resolved spontaneously with no symptoms. No patient developed postoperative pancreatitis. Three (10%) ERCP complications were observed, consisting of mild bleeding of the papilla. All cases were managed by endoscopic adrenaline injection. There was no mortality. CONCLUSION We believe peroperative ERCP with the technique described should be considered as the treatment of choice for choledocholithiasis associated with cholelithiasis. When single-stage treatment is not possible, a two-step rendezvous technique should be preferred.
Collapse
Affiliation(s)
- G Saccomani
- Department of Surgery, Ospedale Santa Corona, p.zza XXV Aprile 128, 17027, Pietra Ligure, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Stella M, De Cian F, Mariani F, Quaglia F, Baldo S, Mithieux F, Meeus P, Kaemmerlen P, Rivoire M. [Cryosurgery with transpleurodiaphragmatic approach in the treatment of non-resectable and recurrent hepatic metastasis from the colorectum]. Suppl Tumori 2005; 4:S44. [PMID: 16437894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Cryotherapy allows the destruction of unresectable liver malignancies. The abdominal approach is uneasy for recurrent colorectal metastases located in the upper part of the liver and close to the inferior vena cava, the hepatic veins and the diaphragm. A transpleurodiaphragmatic access was employed. From 1999 to 2003, ten patients with recurrent colorectal liver metastases underwent transdiaphragmatic cryotherapy via a right thoracotomy. Median diameter was 30 mm. One to 4 cryoprobes were used, depending on the size and location of the metastasis. There were no operative deaths, and only 3 patients developed minor complications. Computerized tomography examination of the liver performed one week, three months after cryotherapy, assessed treatment completeness in all patients. At 14 months, 9 patients were alive and 6 were disease-free. Two patients had liver recurrences outside the cryolesion. A transthoracic access may represent the safest and easiest surgical approach for liver tumor cryoablation in selected patients with non resectable recurrent metastases of the upper liver.
Collapse
Affiliation(s)
- M Stella
- Dipartimento di Chirurgia, DICM, Università di Genova
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Baldo S, Rivoire M, Sobrero A, Comandini D, Civalleri D, Stella M, Quaglia F, Santoni R, Malerba M, Mariani F, DeCian F. [Surgical resection of gastrointestinal stromal tumor after treatment with imatinib: clinical case]. Suppl Tumori 2005; 4:S97. [PMID: 16437930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The stromal tumor is the most common mesenchymal tumor of the gastrointestinal tract. Surgical resection is the first-line therapy for operable lesions, however for inoperable imatinib is an effective therapy. In this setting a patient has been operated after a remarkable response to imatinib, used as both neoadjuvant and adjuvant. This approach led to a disease-free condition without toxicity and complications.
Collapse
Affiliation(s)
- S Baldo
- DICMI, Università degli Studi, Genova
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|