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Bossini N, Alberici F, Delbarba E, Valerio F, Manenti C, Possenti S, Econimo L, Maffei C, Pola A, Terlizzi V, Salviani C, Moscato M, Pasquali S, Zambetti N, Tonoli M, Affatato S, Pecchini P, Viola FB, Malberti F, Depetri G, Gaggiotti M, Scolari F. Kidney transplant patients with SARS-CoV-2 infection: The Brescia Renal COVID task force experience. Am J Transplant 2020; 20:3019-3029. [PMID: 32627319 PMCID: PMC7361317 DOI: 10.1111/ajt.16176] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 01/25/2023]
Abstract
The outcome of kidney transplant patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is still unclear. Here we describe the clinical characteristics, disease outcome, and risk factors for acute respiratory distress syndrome (ARDS) and death of a cohort of 53 kidney transplant patients with coronavirus disease 2019 (COVID-19). Eight of 53 have been handled as outpatients because of mild disease, on average with immunosuppression reduction and the addition of hydroxychloroquine and azithromycin; no patients required admission, developed ARDS, or died. Because of severe symptoms, 45/53 required admission: this cohort has been managed with immunosuppression withdrawal, methylprednisolone 16 mg/d, hydroxychloroquine, and antiviral drugs. Dexamethasone and tocilizumab were considered in case of ARDS. About 33% of the patients developed acute kidney injury, 60% ARDS, and 33% died. In this group, thrombocytopenia was associated to ARDS whereas lymphopenia at the baseline, higher D-dimer, and lack of C-reactive protein reduction were associated with risk of death. In the overall population, dyspnea was associated with the risk of ARDS and age older than 60 years and dyspnea were associated with the risk of death with only a trend toward an increased risk of death for patients on tacrolimus. In conclusion, SARS-CoV-2 infection may have a variable outcome in renal transplant patients, with higher risk of ARDS and death in the ones requiring admission.
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Affiliation(s)
- Nicola Bossini
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Federico Alberici
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy,Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy,Correspondence Federico Alberici
| | - Elisa Delbarba
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Francesca Valerio
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Chiara Manenti
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Stefano Possenti
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Laura Econimo
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Camilla Maffei
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alessandra Pola
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Vincenzo Terlizzi
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Chiara Salviani
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marianna Moscato
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Stefano Pasquali
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Nicole Zambetti
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Michela Tonoli
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Stefania Affatato
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Fabio B. Viola
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | | | - Mario Gaggiotti
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Francesco Scolari
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy,Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Alberici F, Delbarba E, Manenti C, Econimo L, Valerio F, Pola A, Maffei C, Possenti S, Zambetti N, Moscato M, Venturini M, Affatato S, Gaggiotti M, Bossini N, Scolari F. A single center observational study of the clinical characteristics and short-term outcome of 20 kidney transplant patients admitted for SARS-CoV2 pneumonia. Kidney Int 2020; 97:1083-1088. [PMID: 32354634 PMCID: PMC7142691 DOI: 10.1016/j.kint.2020.04.002] [Citation(s) in RCA: 265] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 02/06/2023]
Abstract
The outcome of SARS-CoV2 infection in patients who have received a kidney allograft and are being treated with immunosuppression is unclear. We describe 20 kidney transplant recipients (median age 59 years [inter quartile range 51-64 years], median age of transplant 13 years [9-20 years], baseline eGFR 36.5 [23-47.5]) with SARS-CoV2 induced pneumonia. At admission, all had immunosuppression withdrawn and were started on methylprednisolone 16 mg/day, all but one was commenced on antiviral therapy and hydroxychloroquine with doses adjusted for kidney function. At baseline, all patients presented fever but only one complained of difficulty in breathing. Half of patients showed chest radiographic evidence of bilateral infiltrates while the other half showed unilateral changes or no infiltrates. During a median follow-up of seven days, 87% experienced a radiological progression and among those 73% required escalation of oxygen therapy. Six patients developed acute kidney injury with one requiring hemodialysis. Six of 12 patients were treated with tocilizumab, a humanized monoclonal antibody to the IL-6 receptor. Overall, five kidney transplant recipients died after a median period of 15 days [15-19] from symptom onset. These preliminary findings describe a rapid clinical deterioration associated with chest radiographic deterioration and escalating oxygen requirement in renal transplant recipients with SARS-Cov2 pneumonia. Thus, in this limited cohort of long-term kidney transplant patients, SARS-CoV-2 induced pneumonia is characterized by high risk of progression and significant mortality.
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Affiliation(s)
- Federico Alberici
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy.
| | - Elisa Delbarba
- Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Chiara Manenti
- Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Laura Econimo
- Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Francesca Valerio
- Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Alessandra Pola
- Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Camilla Maffei
- Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Stefano Possenti
- Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Nicole Zambetti
- Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Marianna Moscato
- Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Margherita Venturini
- Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Stefania Affatato
- Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Mario Gaggiotti
- Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Nicola Bossini
- Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Francesco Scolari
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
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Vizzardi V, Bertoni D, Terlizzi V, Pola A, Tonoli MA, Moscato M, Scolari F. P1170ENCAPSULATING PERITONEAL SCLEROSIS: ARE CALCINEURIN INHIBITORS A RISK FOR PERITONEAL DIALYSIS PATIENTS UNDERGOING RENAL TRANSPLANTATION? Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1170] [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: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Encapsulating peritoneal sclerosis (EPS) is a rare but severe complication of peritoneal dialysis (PD). Its prevalence, ranging from 0.7 to 3.3%, and its reported mortality is 25-55%. Post-transplantation encapsulating peritoneal sclerosis (PT-EPS) usually occurs within two years from PD interruption due to kidney transplantation. Calcineurin inhibitors are thought to be involved in the pathogenesis of PT-EPS.
Method
This is a retrospective, single-center study: all the patients who received PD for 2 or more months before kidney transplantation between 1979 and 2018 in our unit were enrolled. All PD patients diagnosed with EPS after transplantation were identified, and their data were compared with those of non-transplanted PD patients (NT-PD).
Results
Data from a total of 1014 PD patients were examined; 215 underwent kidney transplantation and 799 remained on PD. PT-EPS occurred in 5/215 patients (2.3%), a prevalence not significantly different from that of NT-PD (21/799= 2.6%; P = 0.39) (Table 1). Calcineurin inhibitors were administered to 178/215 (83%) patients without EPS and all 5 patients with PT-EPS (P = 0.68). Calcineurin inhibitors were associated with corticosteroids (41%), mycophenolate mofetil (34%), or both (42%). Inhibitors of mammalian targets of rapamycin were used in association with calcineurin inhibitors in 25%, with calcineurin inhibitors and steroids in 24% and steroids alone in 7%. Mortality due to PT-EPS was 4.3% vs 1.2% in NT-PD (P = 0.38) (Figure 1).
Conclusion
The prevalence of PT-EPS was similar to that of EPS in NT-PD. Therapy with calcineurin inhibitors did not appear to be a crucial risk key in the development of PT-EPS.
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Affiliation(s)
- Valerio Vizzardi
- OU of Nephrology. ASST Civil Hospital of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health. University of Brescia, Brescia, Italy
| | - Diana Bertoni
- University of Brescia, Postgraduate School in Nephrology, Brescia, Italy
| | - Vincenzo Terlizzi
- University of Brescia, Postgraduate School in Nephrology, Brescia, Italy
| | - Alessandra Pola
- OU of Nephrology. ASST Civil Hospital of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health., Brescia, Italy
| | - MAttia Tonoli
- University of Brescia, Postgraduate School in Nephrology, Brescia, Italy
| | - Marianna Moscato
- University of Brescia, Postgraduate School in Nephrology, Brescia, Italy
| | - Francesco Scolari
- University of Brescia, Postgraduate School in Nephrology, Brescia, Italy
- OU of Nephrology. ASST Civil Hospital of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health., Brescia, Italy
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Moscato M, Schena E, Saccomandi P, Francomano M, Accoto D, Guglielmelli E, Silvestri S. A micromachined intensity-modulated fiber optic sensor for strain measurements: working principle and static calibration. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2012:5790-3. [PMID: 23367245 DOI: 10.1109/embc.2012.6347310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper describes an intensity-modulated fiber optic sensor for strain measurements. The sensing element is a polydimetilsiloxane (PDMS) micro-diffraction grating, 15 mm long, 2 mm thick, with channels 150 µm wide, spaced apart 200 µm. The working principle of the sensor can be summarized as follows: when the sensing element is strained perpendicularly to the grating plane, light passing through the grating undergoes a modulation caused by the phenomenon of diffraction. Since the grating is interposed between a laser source and a fiber optic, the coupled radiation intensity between these two optical elements can be considered as an indirect measure of strain. A static calibration of the measuring system has been performed, showing that the device, with measuring range of about 0.04, is capable to discriminate strain of 0.005 and it presents a sensitivity increase with strain in the whole range of measurements.
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Affiliation(s)
- M Moscato
- Unit of Measurements and Biomedical Instrumentation, Center for Integrated Research, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, Rome, Italy
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Di Cocco B, Colonna M, Salesi N, Moscato M, Calogero A, Pacini L, Veltri E. EGFR and K-ras status and clinical outcomes in patients with advanced NSCLC treated with erlotinib: Our experience. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18076] [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: 11/20/2022] Open
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Salesi N, Colonna M, Di Cocco B, Moscato M, Calogero A, Pacini L, Veltri E. Paclitaxel with bevacizumab (PB) as first-line therapy for metastatic breast cancer: Our experience. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e11013] [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: 11/20/2022] Open
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7
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Garfield D, Zampa G, Cadranel J, Bell DW, Moscato M, Normanno N. Effects of gefitinib (G) on bone metatases (BMs) in non-small cell lung cancer patients. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.17147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
17147 Background: Selected pts with advanced NSCLC might have particular benefit from EGFR tyrosine kinase (TK) inhibitor treatment. We have identified 4 NSCLC pts with BMs who had major responses to G. Methods: Pts characteristics: Pt 1, 62 y/o female, never-smoker (ns), NSCLC, brain and BMs with bone pain; pt 2, 51 y/o male, former smoker (fs), ADC and BMs; pt 3, 51 y/o male, ns, ADC and BMs; pt 4, 50 y/o male, fs, ADC, pleural effusion, BMs and bone pain. Pts 1 and 4 had mixed osteolytic-sclerotic BMs; pts 2 and 3 had osteolytic BMs. Pts were treated with 250 mg/day of G; the dose was increased to 375 mg/day in pt 1 for maximum CNS control. Pts 1 and 4 received G as first-line therapy, pts 2 and 3 as second-line following failure of platinum-containing therapy. Pts 1–3 also received zoledronic acid. Results: Pts 1 and 4 experienced significant decrease in bone pain with G, within hours in pt 1 and by day 3 in pt 4. Pts 1–3 developed rash. Objective regression of primary tumor was observed in all 4 pts. After 3 months of G the bone scan did not change in pt 1 but many lesions became more sclerotic. Bone scans became negative after one year of treatment in pts 2 and 3. Pt 2 had resection of the primary tumor with no recurrence, 26+ months (mos) from diagnosis, 9+ mos from surgery. Pt 1 has had disease control for 7+ mos, pt 3 for 15+ mos. Pt 1 had CNS regression with G. Pt 3 was found to have asymptomatic CNS mets at 6 mos of G, received whole-brain radiation, and remains on G at >1 year. Pt 4 died 6 weeks after starting G from unrelated causes but showed dramatic BMs response by PET. Tumor tissue was available for molecular analyses for pts 2 and 4, who respectively showed EGFR-TK domain G719C mutation in exon 18 and L858R mutation in exon 21. Both mutations have been previously described in NSCLC patients responding to G. Conclusions: G may be effective in the treatment of BMs in some NSCLC patients. [Table: see text]
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Affiliation(s)
- D. Garfield
- University of Colorado Health Sciences Center, Denver, CO; San Paolo Hospital, Civitavecchia, Italy; Hôpital Tenon, Paris, France; Massachusetts General Hospital Cancer Center, Charlestown, MA; Cell Biology and Preclinical Models Unit, Naples, Italy
| | - G. Zampa
- University of Colorado Health Sciences Center, Denver, CO; San Paolo Hospital, Civitavecchia, Italy; Hôpital Tenon, Paris, France; Massachusetts General Hospital Cancer Center, Charlestown, MA; Cell Biology and Preclinical Models Unit, Naples, Italy
| | - J. Cadranel
- University of Colorado Health Sciences Center, Denver, CO; San Paolo Hospital, Civitavecchia, Italy; Hôpital Tenon, Paris, France; Massachusetts General Hospital Cancer Center, Charlestown, MA; Cell Biology and Preclinical Models Unit, Naples, Italy
| | - D. W. Bell
- University of Colorado Health Sciences Center, Denver, CO; San Paolo Hospital, Civitavecchia, Italy; Hôpital Tenon, Paris, France; Massachusetts General Hospital Cancer Center, Charlestown, MA; Cell Biology and Preclinical Models Unit, Naples, Italy
| | - M. Moscato
- University of Colorado Health Sciences Center, Denver, CO; San Paolo Hospital, Civitavecchia, Italy; Hôpital Tenon, Paris, France; Massachusetts General Hospital Cancer Center, Charlestown, MA; Cell Biology and Preclinical Models Unit, Naples, Italy
| | - N. Normanno
- University of Colorado Health Sciences Center, Denver, CO; San Paolo Hospital, Civitavecchia, Italy; Hôpital Tenon, Paris, France; Massachusetts General Hospital Cancer Center, Charlestown, MA; Cell Biology and Preclinical Models Unit, Naples, Italy
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Cervellati S, Bettini N, Moscato M, Gusella A, Dema E, Maresi R. Surgical treatment of spinal deformities in Duchenne muscular dystrophy: a long term follow-up study. Eur Spine J 2004; 13:441-8. [PMID: 15108098 PMCID: PMC3476590 DOI: 10.1007/s00586-002-0515-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2001] [Revised: 08/28/2002] [Accepted: 11/07/2002] [Indexed: 10/26/2022]
Abstract
BACKGROUND Surgical treatment of spinal deformities in Duchenne muscular dystrophy (DMD) is influenced by a number of factors which have proven to be a difficult challenge. Each case should be carefully evaluated, considering not only the natural history of the spinal deformity, but also the patient's general condition. These should be thoroughly assessed through clinical and radiographic investigations together with other medical specialists. Life expectancy should be determined according to the cardio-respiratory function, and both preoperative and postoperative quality of life should be taken into consideration, trying to imagine the functional status of each patient after surgery. METHODS From February 1985 to February 2000, 58 patients with spinal deformity in DMD were surgically treated. Of 25 patients that were operated on between 1985 and 1995, only 20 were followed-up after 5 years because 5 of them had died during this time. Therefore, the present study focuses on the results obtained in 20 cases. The 20 cases reviewed presented with a mean angular value of scoliosis equal to 48 degrees (range 10-92 degrees). Spinal fusion with our modified Luque technique [6] was performed in 19 cases, whereas CD instrumentation was applied in only one case. RESULTS At the 5 year follow-up (range 5.6-10 years), the age ranged from 18 to 24 years and averaged 20.4 years. The postoperative angular value of scoliosis averaged 22 degrees (58%, range 0-43 degrees), the mean correction at follow-up was 28 degrees (range 0-60 degrees), and the mean loss of correction was equal to 6 degrees (range, 0-11 degrees). Vital capacity showed a slow progression, slightly inferior to its natural evolution in untreated patients. The severest complication was the death that occurred in one of the patients. CONCLUSIONS According to the present study, an early surgery (angular value lower than 35-40 degrees) dramatically reduces the rate of risk factors associated with spinal deformities in DMD, and its advantages far exceed the disadvantages, above all in terms of quality of life.
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9
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Bibas M, Zampa G, Moscato M. Feasibility of twice-weekly schedule of paclitaxel and carboplatin for solid tumors: A 119 patients study. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.2121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Bibas
- Ospedale San Giacomo Depts of Hematology and Oncology, Roma, Italy; Ospedale Civitavecchia di Roma, Roma, Italy
| | - G. Zampa
- Ospedale San Giacomo Depts of Hematology and Oncology, Roma, Italy; Ospedale Civitavecchia di Roma, Roma, Italy
| | - M. Moscato
- Ospedale San Giacomo Depts of Hematology and Oncology, Roma, Italy; Ospedale Civitavecchia di Roma, Roma, Italy
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10
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Tigani D, Gamberini G, Giovannini A, Ferrari D, Moscato M. Corrective osteotomy for the treatment of genu procurvatun. Surgery. Chir Organi Mov 1999; 84:87-92. [PMID: 11569020] [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: 02/21/2023]
Abstract
The authors present the method known as proximal tibial osteotomy for the treatment of genu procurvatum. The importance of an accurate preoperative study, particularly aimed at avoiding negative repercussions on the position of the patella, and of a correct anatomical exposure with isolation of the peroneal nerve for any iatrogenic lesions, must be emphasized; a condylic plate was used to stabilize osteotomy was stabilized, adapting well to the anatomy of the region, and allowing us to obtain correction of any associated deformities on the frontal plane.
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Affiliation(s)
- D Tigani
- Clinica Ortopedica dell'Università, Istituto Ortopedico Rizzoli, Bologna
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11
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Abstract
A 65-year-old male patient with an 8-year history of poliostotic Paget's disease complained of shoulder pain that started 6 months prior to admission. An extensive lytic area was identified in the right proximal humerus along with Paget's disease. There was cortical destruction and a soft tissue mass. Following an incisional biopsy, a diagnosis of grade 2 chondrosarcoma associated with Paget's disease was made. The histologic identification of chondrosarcoma associated with Paget's disease is rare. However, the presence of a calcified matrix in a destructive lesion associated with Paget's disease should alert the radiologist and the pathologist to the possibility of a chondromatous differentiation taking place in the sarcoma associated with Paget's disease. The histologic evaluation of the lesion will form the basis for the diagnosis.
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Affiliation(s)
- F Brandolini
- Department of Orthopedics Rizzoli Orthopedic Institute, Bologna, Italy
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12
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Abstract
From 1950 to 1994, 257 cases of benign bone tumors of the foot were treated at the Bone Tumor Center of the Rizzoli Institute. Aneurysmal bone cysts (ABC) and giant cell tumors (GCT) are rare and often they are misdiagnosed. To define the clinical and radiographic features useful for diagnosis, x-rays of 24 ABCs and 21 GCTs of the foot were reviewed. Adding our series to the cases reported in the literature, the only important clinical data that emerged was the average age of patients affected by ABC and GCT (15 and 27 years, respectively). ABCs localized in small tarsal bones were rare (6%), whereas 19% of GCTs were found in this site. The eccentric, round shape of a lytic lesion was more characteristic of GCT. An aggressive pattern of radiographic bone destruction was observed more frequently in GCT than in ABC (P = 0.01). Septation was seen in both tumors. Typical of ABC was a sharp and trabeculated margin, whereas GCT had an ill-defined edge with normal cancellous bone (P = 0.007). The growth of ABCs often expanded the cortex, while GCTs eroded, thinned, and broke the cortical bone (P = 0.001). A saucerized cortex was observed only in ABCs. A bony shelf was more characteristic of ABC than of GCT (P = 0.002). Pathologic fractures (67%) and joint involvement, evaluated by computed tomography and magnetic resonance imaging (83%), were more frequent in GCTs, whereas fluid levels were more frequently observed in ABCs (47%). The majority of the tumors were stage 2, but GCTs represented 70% of stage 3 aggressive lesions.
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Affiliation(s)
- R Casadei
- Bone Tumor Center, Istituto Ortopedico Rizzoli, Bologna, Italy
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13
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Tigani D, Donati D, Moscato M, De Iure F, Boriani S. Reconstruction by Grosse-Kempf nailing in resections for bone tumor. Chir Organi Mov 1996; 81:31-41. [PMID: 8791874] [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: 05/22/2023]
Abstract
The authors report 38 reconstruction by Grosse-Kempf nailing for resection of bone tumor; there were: intercalar resections: 16; arthrodeses of the knee: 13; arthrodesis of the ankle joint: 5; gyroplasty: 4. Massive homoplastic bone graft was used in 26 cases, in 3 of which autoplastic grafting was associated; autoplastic grafts were used exclusively in 7 cases, and a cement spacer was used in 1. Twenty-nine patients (76%) obtained satisfactory final results, but in 10 cases secondary surgery was performed for a total of 14 operations, of which 7 major (1 nail substitution and 6 vascularized fibula operations). There were 7 failures: mechanical complications: 6; infection: 1. The highest number of non-unions were observed where massive homoplastic grafting was used: intercalar reconstruction: 11; arthrodesis of the knee: 7. The results were evidently better and the incidence of complications low in cases in which autoplastic grafting was used or where gyroplasty was performed. Absolute stiffness and best possible contact are difficult to obtain with blocked intramedullary nailing. On the contrary, when autoplastic grafts are used or when gyroplasty is performed micromovements allowed the instrumentation are compatible with good consolidation.
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Affiliation(s)
- D Tigani
- Clinica Ortopedica dell'Università di Bologna, Istituti Ortopedici Rizzoli
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Moscato M, Tigani D, Andreoli I, De Iure F, Specchia L, Boriani S. Intramedullary osteosynthesis with Grosse-Kempf nailing for the treatment of distal fractures of the femur. Chir Organi Mov 1994; 79:205-11. [PMID: 7956522] [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: 01/28/2023]
Abstract
The authors report the results they obtained in a homogeneous series of fractures of the distal third of the femur treated by Grosse-Kempf nailing. Of the 67 fractures (58 closed, 9 exposed) treated with closed surgery (except for 1 case treated by nailing 35 days after trauma) non-union was never observed. The two cases of delay in consolidation (one related to an infection) did not require a change in method. Bone grafting was never necessary. Only in 3 cases (2 with multiple trauma, 1 treated by open reduction) was moderate reduction in range of movement of the knee observed.
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Affiliation(s)
- M Moscato
- 1a. Clinica Ortopedica, Università di Bologna
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15
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Chiarelli C, Moscato M. [Evaluation of a request for information in a sample of health workers at the Mantova U.S.S.L.47]. Prof Inferm 1992; 45:19-24. [PMID: 1494583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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16
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Moscato M, Sabetta E, Tigani D, Mignani G, Specchia L, Boriani S. Grosse-Kempf nailing in fractures of the tibia. Ital J Orthop Traumatol 1991; 17:313-20. [PMID: 1783543] [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: 12/28/2022]
Abstract
A series of 136 tibial fractures treated with locked Grosse-Kempf nailing is reviewed, evaluating the results according to rapidity of healing, functional recovery, and complications. Locked nailing proved so reliable that immediate mobilization was possible. There was only a 6% incidence of delayed union, including infections (3 cases, 2%) and nail breakage (2 cases, 1.5%). Several details of the operative technique that were decisive in the final result are discussed.
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Affiliation(s)
- M Moscato
- I Clinica Ortopedica dell'Università, Istituto Ortopedico Rizzoli, Bologna
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17
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Nigrisoli M, Moscato M, Padovani G. Syringomyelic arthropathy: a description of two cases and a review of the literature. Chir Organi Mov 1991; 76:237-44. [PMID: 1816984] [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: 12/28/2022]
Abstract
Neurogenous arthropatHy is a rare disease. Nonetheless, every orthopaedist will sooner or later be faced with the arthropathy before the neurologic disease has been diagnosed. The authors report their study on two cases of syringomyelic arthropathy, repropose its anatomopathological, clinical and radiographic features, and discuss the etiopathogenesis, differential diagnosis and treatment of the disease.
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Affiliation(s)
- M Nigrisoli
- I Clinica Ortopedica, Istituto Ortopedico Rizzoli, Bologna
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18
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Nigrisoli M, Colí A, Toni A, Lari S, Moscato M, Ciaroni D, Sudanese A, Bueno AL, Giunti A. An evaluation of the "quoad vitam" prognosis in the elderly patient with medial fracture of the femoral neck. Chir Organi Mov 1991; 76:263-71. [PMID: 1816986] [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: 12/28/2022]
Abstract
The authors analyzed 425 consecutive cases of medial fracture of the femoral neck with the purpose of establishing a simple and practical system, and one which is easy to use, in order to evaluate this type of lesion and to compare different series of cases. Based on these criteria the death rate occurring intra-hospital and 6 months after trauma, the influence of the age factor, the type of anesthesia used and the type of treatment carried out, were evaluated. The results were as follows: The classification devised by the American Society of Anesthesiology continues to be an effective system for the evaluation of vital risk. The death rate was always directly related to age, and it was not influenced by either the type of anesthesia or the type of surgery used; however, it doubled when non-surgical treatment was used.
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Affiliation(s)
- M Nigrisoli
- Clinica Ortopedica dell'Università, Istituto Ortopedico Rizzoli, Bologna
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19
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Mignani G, Mercuri M, Moscato M, Di Scioscio M, Caldora P, Padovani G, Del Prete G. Acute external capsuloligamentous lesions of the knee. Chir Organi Mov 1990; 75:239-44. [PMID: 2095329] [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: 12/30/2022]
Abstract
The authors discuss 18 cases of acute capsuloligamentous lesions of the external compartment of the knee submitted to surgical treatment. The results obtained by separately studying the progression of the various types of anatomical lesions revealed a relationship between the entity of the lesion and the results. Positive results were as follows: 100% in isolated lesions of the EC, 70% in lesions of the EC and ACL, 40% in lesions of the EC + ACL + PCL. In grade I distorsion trauma surgery is not indicated; in grade II lesions treatment is based on an objective examination in narcosis, and surgery should be performed when dynamic tests are positive; in grade III lesions surgery is always indicated. An objective examination in narcosis (rarely arthroscopy) is thus of essential importance to therapeutic indications.
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Affiliation(s)
- G Mignani
- I Clinica Ortopedica, Università Istituto Ortopedico Rizzoli, Bologna
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Tigani D, Sabetta E, Galli G, Moscato M, Boriani S. Grosse-Kempf nailing in the elderly. Chir Organi Mov 1990; 75:71-6. [PMID: 2369857] [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: 12/31/2022]
Abstract
The authors report on 30 fractures of the femur and tibia treated with the Grosse-Kempf locked nail in patients aged more than 60 years. Neither nonunion nor severe complications were observed; surgical trauma was well sustained. Functional results were particularly satisfactory; most patients began walking within the first week after fixation.
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Affiliation(s)
- D Tigani
- Istituto Ortopedico Rizzoli, Clinica Ortopedica dell'Università di Bologna
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Moscato M, Tigani D, Sabetta E, Specchia L, Boriani S. Problems related to blocked nailing in fractures of the proximal femur. Ital J Orthop Traumatol 1989; 15:281-5. [PMID: 2599847] [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: 01/01/2023]
Abstract
The modern treatment of fractures of the proximal femur in the adult usually involves surgery. Open plating has proved to be reliable, but often involves a high percentage of complications: axial deformity, delayed union, breakage of the plate and/or screws (the risk of which increases in relation to the degree of comminution). At this site, in fact, the plate is submitted to strong flexion stress. It therefore becomes essential to associate cancellous grafts (as proposed by the AO School) (Muller et al., 1981) or a homoplastic cortical craft (as in our experience) (Zinghi and Masetti, 1982). Furthermore, open osteosynthesis is time consuming and this means considerable blood loss and a risk of infection. There are thus many reasons for preferring closed surgery, but effective stabilisation can only be obtained with blocked nailing; in fact, only metadiaphyseal screwing is capable of neutralising the rotation or axial stresses which cause deviation, instability or telescoping of the fracture (Kempf et al., 1978; Tigani et al., 1986; Zinghi et al., 1984). Osteosynthesis with Grosse-Kempf nailing is thus an effective alternative to open nailing, particularly in those fractures which would require additional bone grafting with this method. The purpose of our study was to verify the effectiveness of intramedullary osteosynthesis with Grosse-Kempf blocked nailing, in particular analysing the problems encountered in the use of this method.
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Affiliation(s)
- M Moscato
- I Clinica Ortopedica dell'Università, Istituto Ortopedico Rizzoli, Bologna
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Mignani G, Di Scioscio M, Moscato M. [Diagnostico-differential problems in acute osteomyelitis and Ewing's sarcoma]. Chir Organi Mov 1988; 73:345-50. [PMID: 3251707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Moscato M, de Nardis A. Codages manipulatoires des marqueurs de position spatiale «à l'endroit», «à l'envers» et de leurs négations. enfan 1982. [DOI: 10.3406/enfan.1982.2779] [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: 11/12/2022]
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Moscato M, Beauchesne H, Gueroult C. [Certain aspects of language in cerebral palsy patients. Acquisition of "right side up", "upside down" and their opposite spatial position markers]. Acta Paedopsychiatr 1981; 47:155-66. [PMID: 7032193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Moscato M. Dépendance-Indépendance à L'égard Du Champ et Résolution De Syllogismes Linéaires. International Journal of Psychology 1980. [DOI: 10.1080/00207598008246997] [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: 10/22/2022]
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