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Di Giuseppe J, Delli Carpini G, Giannella L, Terenzi T, Fichera M, Ragno F, Campanati A, Boero V, Caia C, Pesce E, Vercellini P, Gardella B, Dominoni M, Spinillo A, Sopracordevole F, Clemente N, Del Fabro A, Rossi R, Corazza M, Borghi A, Martinello R, Greco P, Rizzo G, Criscuolo AA, Mappa I, Matteini E, Botti E, Campione E, Bianchi L, Ciavattini A. A Longitudinal Multiinstitutional Study of Vulvar Lichen Sclerosus: From Childhood to Perimenopause. J Low Genit Tract Dis 2024:00128360-990000000-00110. [PMID: 38661348 DOI: 10.1097/lgt.0000000000000816] [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: 04/26/2024]
Abstract
OBJECTIVE The main outcome of this study was the evaluation of clinical characteristics, comorbidities, and therapeutic approaches in patients with vulvar lichen sclerosus (VLS) aged from childhood to perimenopause. Secondly, it was intended to compare these characteristics according to the menarchal status. METHODS Patients less than 45 years of age with a diagnosis of VLS from January 2002 to June 2022 in 10 referral centers were included in this retrospective longitudinal study. The univariate analysis compared the dependent variables according to menarchal status. RESULTS One hundred eighty-six patients met the inclusion criteria. At diagnosis, between 25% and 40% of premenarchal patients reported signs related to subepithelial hemorrhage. A significantly greater presence of bleeding (p < .005), easy bruising (p = .028), fissures (p = .008), petechiae/splinter hemorrhages (p < .001), and bleeding/blistering or open sores (p = .011) was observed in premenarchal patients with respect to the postmenarchal group. The perineum (p = .013) and the perianal region (p < .001) were significantly more involved in the premenarchal group. Topical calcineurin inhibitors were more used in the premenarchal population (p = .004), whereas vitamin E oil and moisturizers were more used in the postmenarchal population (p = .047). CONCLUSIONS Vulvar lichen sclerosus is a chronic condition that can cause vulvar changes that result in severe morbidity and affects sexual function and quality of life, even before menopause. Vulvar lichen sclerosus continues to be misdiagnosed in this population. This may lead to an average delay from symptom onset to diagnosis. Evaluating clinical manifestations of VLS in premenarchal and postmenarchal age allowed us to find different clinical characteristics between the 2 periods suggestive of the diagnosis.
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Affiliation(s)
- Jacopo Di Giuseppe
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Giovanni Delli Carpini
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Giannella
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Tomas Terenzi
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Mariasole Fichera
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Federica Ragno
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Anna Campanati
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Veronica Boero
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlotta Caia
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Pesce
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Barbara Gardella
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Mattia Dominoni
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Arsenio Spinillo
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesco Sopracordevole
- Gynecological Oncology Unit, IRCCS CRO - Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Nicolò Clemente
- Gynecological Oncology Unit, IRCCS CRO - Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Anna Del Fabro
- Gynecological Oncology Unit, IRCCS CRO - Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Riccardo Rossi
- Preventive Gynecological Oncology Section, European Medical Center, Florence, Italy
| | - Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Alessandro Borghi
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ruby Martinello
- Obstetrics and Gynaecology Clinic, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Pantaleo Greco
- Obstetrics and Gynaecology Clinic, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Policlinico Tor Vergata, Università Roma Tor Vergata, Rome Italy
| | - Anna Angela Criscuolo
- Department of Obstetrics and Gynecology, Policlinico Tor Vergata, Università Roma Tor Vergata, Rome Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Policlinico Tor Vergata, Università Roma Tor Vergata, Rome Italy
| | - Enrico Matteini
- U.O.C. Dermatology, Policlinico Tor Vergata, Università Roma Tor Vergata, Rome, Italy
| | - Elisabetta Botti
- U.O.C. Dermatology, Policlinico Tor Vergata, Università Roma Tor Vergata, Rome, Italy
| | - Elena Campione
- U.O.C. Dermatology, Policlinico Tor Vergata, Università Roma Tor Vergata, Rome, Italy
| | - Luca Bianchi
- U.O.C. Dermatology, Policlinico Tor Vergata, Università Roma Tor Vergata, Rome, Italy
| | - Andrea Ciavattini
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
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Delli Carpini G, Giannella L, Di Giuseppe J, Montik N, Montanari M, Fichera M, Crescenzi D, Marzocchini C, Meccariello ML, Di Biase D, Vignini A, Ciavattini A. Homozygous C677T Methylenetetrahydrofolate Reductase (MTHFR) Polymorphism as a Risk Factor for Endometriosis: A Retrospective Case-Control Study. Int J Mol Sci 2023; 24:15404. [PMID: 37895084 PMCID: PMC10607746 DOI: 10.3390/ijms242015404] [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: 09/05/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
This study was conducted to evaluate the role of methylenetetrahydrofolate reductase (MTHFR) C677T homozygous polymorphism as a risk factor for endometriosis. A retrospective case-control study was conducted from January 2020 to December 2022 on all patients attending the gynecological outpatient clinic of our institution who had performed an MTHFR polymorphisms test. Patients with endometriosis were considered cases, while those without endometriosis were considered controls. The presence of an MTHFR C677T homozygous polymorphism was defined as exposure. Risk factors for endometriosis were considered confounders in a binomial logistic regression, with endometriosis diagnosis as the dependent variable. Among the 409 included patients, 106 (25.9%) cases and 303 (74.1%) controls were identified. A higher rate of MTHFR C677T homozygous polymorphism was found in patients with endometriosis (24.5% vs. 15.8%, p = 0.0453), with an adOR of 1.889 (95% CI 1.076-3.318, p = 0.0269) at the binomial logistic regression. A history of no previous pregnancy was associated with an endometriosis diagnosis (adOR 2.191, 95% CI 1.295-3.708, p = 0.0035). An MTHFR C677T homozygous polymorphism could be considered a risk factor for endometriosis. Epigenetic modifications may be the most important mechanism explaining the observed association through the processes of altered DNA methylation and reduced activity of antioxidant systems.
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Affiliation(s)
- Giovanni Delli Carpini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60213 Ancona, Italy; (G.D.C.); (L.G.); (J.D.G.); (N.M.); (M.M.); (M.F.); (D.C.); (C.M.); (M.L.M.); (D.D.B.)
| | - Luca Giannella
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60213 Ancona, Italy; (G.D.C.); (L.G.); (J.D.G.); (N.M.); (M.M.); (M.F.); (D.C.); (C.M.); (M.L.M.); (D.D.B.)
| | - Jacopo Di Giuseppe
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60213 Ancona, Italy; (G.D.C.); (L.G.); (J.D.G.); (N.M.); (M.M.); (M.F.); (D.C.); (C.M.); (M.L.M.); (D.D.B.)
| | - Nina Montik
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60213 Ancona, Italy; (G.D.C.); (L.G.); (J.D.G.); (N.M.); (M.M.); (M.F.); (D.C.); (C.M.); (M.L.M.); (D.D.B.)
| | - Michele Montanari
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60213 Ancona, Italy; (G.D.C.); (L.G.); (J.D.G.); (N.M.); (M.M.); (M.F.); (D.C.); (C.M.); (M.L.M.); (D.D.B.)
| | - Mariasole Fichera
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60213 Ancona, Italy; (G.D.C.); (L.G.); (J.D.G.); (N.M.); (M.M.); (M.F.); (D.C.); (C.M.); (M.L.M.); (D.D.B.)
| | - Daniele Crescenzi
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60213 Ancona, Italy; (G.D.C.); (L.G.); (J.D.G.); (N.M.); (M.M.); (M.F.); (D.C.); (C.M.); (M.L.M.); (D.D.B.)
| | - Carolina Marzocchini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60213 Ancona, Italy; (G.D.C.); (L.G.); (J.D.G.); (N.M.); (M.M.); (M.F.); (D.C.); (C.M.); (M.L.M.); (D.D.B.)
| | - Maria Liberata Meccariello
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60213 Ancona, Italy; (G.D.C.); (L.G.); (J.D.G.); (N.M.); (M.M.); (M.F.); (D.C.); (C.M.); (M.L.M.); (D.D.B.)
| | - Donato Di Biase
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60213 Ancona, Italy; (G.D.C.); (L.G.); (J.D.G.); (N.M.); (M.M.); (M.F.); (D.C.); (C.M.); (M.L.M.); (D.D.B.)
| | - Arianna Vignini
- Section of Biochemistry, Biology and Physics, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy;
| | - Andrea Ciavattini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60213 Ancona, Italy; (G.D.C.); (L.G.); (J.D.G.); (N.M.); (M.M.); (M.F.); (D.C.); (C.M.); (M.L.M.); (D.D.B.)
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Delli Carpini G, Giannella L, Di Giuseppe J, Fioretti M, Franconi I, Gatti L, Sabbatini K, Montanari M, Marconi C, Tafuri E, Tibaldi L, Fichera M, Pizzagalli D, Ciavattini A. Inter-rater agreement of CDC criteria and ASEPSIS score in assessing surgical site infections after cesarean section: a prospective observational study. Front Surg 2023; 10:1123193. [PMID: 37675248 PMCID: PMC10477579 DOI: 10.3389/fsurg.2023.1123193] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 08/07/2023] [Indexed: 09/08/2023] Open
Abstract
Objective To assess and compare the inter-rater agreement of the CDC criteria and the ASEPSIS score in identifying surgical site infections after cesarean section. Methods Prospective observational study including 110 patients subjected to a cesarean section at our institution. Surgical wounds were managed according to standard care and were photographed on the third, seventh, and thirtieth postoperative day or during any evaluation in case of complications. Three expert surgeons reviewed the prospectively gathered data and photographs and classified each wound using CDC criteria and the ASEPSIS score. The inter-rater agreements of CDC criteria and ASEPSIS score were determined with Krippendorff's Alpha with linear weights and compared with a confidence interval approach. Results The weighted α coefficient for CDC criteria was 0.587 (95%CI, 0.411-0.763, p < 0.001, "moderate" agreement according to Altman's interpretation of weighted agreement coefficient), while the weighted α coefficient for the ASEPSIS score was 0.856 (95%CI, 0.733-0.980, p < 0.001, "very good" agreement). Conclusion ASEPSIS score presents a "very good" inter-rater agreement for surgical site infections identification after cesarean, resulting in a more objective method than CDC criteria ("moderate" inter-rater agreement). ASEPSIS score could represent an objective tool for managing and monitoring surgical site infections after cesarean section, also by photographic evaluation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Andrea Ciavattini
- Obstetrics and Gynecologic Section, Department of Odontostomatological and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
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Sopracordevole F, Azzalini G, Clemente N, Del Fabro A, Giorda G, Fichera M, Gigante M, Bogani G, Canzonieri V. Primary intestinal-type adenocarcinoma of the vulva. A case report and review of the literature. Gynecol Oncol Rep 2023; 47:101193. [PMID: 37138644 PMCID: PMC10149392 DOI: 10.1016/j.gore.2023.101193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 05/05/2023] Open
Abstract
Background Primary non-squamous cell carcinomas of the vulva are rare entities including various tumor types. Among these, primary vulvar intestinal-type adenocarcinoma (vPITA) is extremely rare. Until 2021, less than twenty-five cases have been reported in the literature. Case presentation We report a case of vPITA in a 63 years old woman with a histopathological diagnosis of signet-ring cell intestinal type adenocarcinoma at vulvar biopsy. Accurate clinical and pathological work-up excluded secondary metastatic localization, and vPITA was diagnosed. The patient was treated with radical vulvectomy and bilateral inguinofemoral dissection. Adjuvant chemo-radiotherapy was performed because of a positive lymph node. At 20 months follow-up the patient was alive and free of disease. Conclusion The prognosis of this very rare disease is unclear and optimal treatment is not well established. About 40% of clinical early-stage diseases reported in literature had positive inguinal nodes, more than in vulvar squamous cell carcinomas. A proper histopathologic and clinical diagnosis is mandatory to exclude secondary disease and to recommend an adequate treatment.
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Affiliation(s)
- Francesco Sopracordevole
- Gynecological Oncology Unit, IRCCS CRO - Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Giulia Azzalini
- Gynecological Oncology Unit, IRCCS CRO - Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Nicolò Clemente
- Gynecological Oncology Unit, IRCCS CRO - Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
- Corresponding author at: Gynecological Oncology Unit, Centro di Riferimento Oncologico (CRO) IRCCS, Via F Gallini 2, Aviano (PN), Italy.
| | - Anna Del Fabro
- Gynecological Oncology Unit, IRCCS CRO - Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Giorgio Giorda
- Gynecological Oncology Unit, IRCCS CRO - Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Mariasole Fichera
- Gynecological Oncology Unit, IRCCS CRO - Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Marco Gigante
- Radiation Oncology Department, IRCCS CRO - Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Giorgio Bogani
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Vincenzo Canzonieri
- Pathology Unit, IRCCS CRO - Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
- Pathology Unit, Health and Medical Science Department, University of Trieste, Italy
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Delli Carpini G, Giannella L, Carboni M, Fichera M, Pizzagalli D, Segnalini N, Conti C, Tafuri E, Giuliani L, Ragno F, Mancusi C, Giannubilo SR, Ciavattini A. Cervical pessary for preterm birth prevention after an episode of arrested preterm labor: a retrospective cohort study with targeted maximum likelihood estimation of the average treatment effect. Eur Rev Med Pharmacol Sci 2023; 27:1058-1068. [PMID: 36808353 DOI: 10.26355/eurrev_202302_31202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To evaluate whether cervical pessary effectively reduces the preterm birth < 37 weeks rate in patients who have not delivered after an episode of arrested preterm labor. PATIENTS AND METHODS Retrospective cohort study was conducted on singleton pregnant patients admitted to our institution between January 2016 and June 2021 for threatened preterm labor and who had a cervical length < 25 mm. Women in whom a cervical pessary was placed were considered as exposed, while women in whom expectant management was preferred were considered as unexposed. The primary outcome was the rate of preterm birth before 37 weeks. A targeted maximum likelihood estimation was used to estimate the average treatment effect of cervical pessary by adjusting for a-priori-defined confounders. RESULTS A cervical pessary was placed in 152 (36.6%) patients (exposed), while the remaining 263 (63.4%) were managed expectantly (unexposed). The adjusted average treatment effect was -14% (-18 to -11%), -17% (-20 to -13%), and -16% (-20 to -12%) for preterm birth < 37 weeks, < 34 weeks, and < 32 weeks, respectively. The average treatment effect for adverse neonatal outcomes was -7% (-8 to -5%). No difference in gestational weeks at delivery between exposed and unexposed emerged when gestational age at first admission was > 30.1 gestational weeks. CONCLUSIONS The positioning of a cervical pessary placement may be evaluated to reduce the risk of a subsequent preterm birth after an episode of arrested preterm labor in pregnant patients with onset of symptoms before 30 gestational weeks.
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Affiliation(s)
- G Delli Carpini
- Department of Odontostomatologic and Specialized Clinical Sciences, Obstetrics and Gynecology Section, Università Politecnica delle Marche, Ancona, Italy.
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6
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Clemente N, Ciavattini A, Valenti G, Zannier F, Di Giuseppe J, Delli Carpini G, Fichera M, Del Fabro A, Giorda G, Goteri G, Canzonieri V, Sopracordevole F. Extramammary Paget's Disease of the Vulva and Concomitant Premalignant/Malignant Vulvar Lesions: A Potential Challenge in Diagnosis and Treatment. Curr Oncol 2023; 30:959-966. [PMID: 36661722 PMCID: PMC9857742 DOI: 10.3390/curroncol30010073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
The aim of the present study was to evaluate the incidence of concomitant vulvar cancers or premalignant lesions in women surgically treated for extramammary Paget's disease of the vulva (EMPDV) through a multicenter case series. The medical records of all women diagnosed with and treated for EMPDV from January 2010 to December 2020 were retrospectively analyzed. Women with EMPDV and synchronous vulvar cancer, vulvar intraepithelial neoplasia (VIN) and/or lichen sclerosus (LS) at the histology report were included in the study. A total of 69 women eligible for the present study were considered. Concomitant vulvar lesions occurred in 22 cases (31.9%). A total of 11 cases of synchronous VIN (50%) and 14 cases (63.6%) of concomitant LS were observed. One patient (4.5%) had synchronous vulvar SCC (FIGO stage 1B). Women with EMPDV and concomitant premalignant/malignant vulvar lesions had a significantly higher rate of invasive EMPDV and wider lesions with an extravulvar involvement. The specific meaning of the association between EMPDV, VIN, SCC and LS remains unclear. The potential overlapping features between different vulvar lesions highlight the importance of dedicated gynecologists and pathologists in referral centers.
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Affiliation(s)
- Nicolò Clemente
- Gynecological Oncology Unit, Centro di Riferimento Oncologico—National Cancer Institute, IRCCS, 33081 Aviano, Italy
| | - Andrea Ciavattini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60123 Ancona, Italy
| | - Gaetano Valenti
- Gynecological Oncology Unit, Centro di Riferimento Oncologico—National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Unit of Gynecology and Obstetrics, Department of Women’s and Children’s Health, Umberto I Hospital, 94100 Enna, Italy
| | - Federica Zannier
- Pathology Unit, Centro di Riferimento Oncologico—National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Pathology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Jacopo Di Giuseppe
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60123 Ancona, Italy
| | - Giovanni Delli Carpini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60123 Ancona, Italy
| | - Mariasole Fichera
- Gynecological Oncology Unit, Centro di Riferimento Oncologico—National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60123 Ancona, Italy
| | - Anna Del Fabro
- Gynecological Oncology Unit, Centro di Riferimento Oncologico—National Cancer Institute, IRCCS, 33081 Aviano, Italy
| | - Giorgio Giorda
- Gynecological Oncology Unit, Centro di Riferimento Oncologico—National Cancer Institute, IRCCS, 33081 Aviano, Italy
| | - Gaia Goteri
- Division of Pathological Anatomy, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60123 Ancona, Italy
| | - Vincenzo Canzonieri
- Pathology Unit, Centro di Riferimento Oncologico—National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Department of Medical, Surgical, and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Francesco Sopracordevole
- Gynecological Oncology Unit, Centro di Riferimento Oncologico—National Cancer Institute, IRCCS, 33081 Aviano, Italy
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7
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Ciavattini A, Di Giuseppe J, Marconi C, Giannella L, Delli Carpini G, Paolucci M, Fichera M, De Vincenzo RP, Scambia G, Evangelista MT, Bogani G, Bertolina F, Raspagliesi F, Gardella B, Spinillo A, Dominoni M, Monti E, Liverani CA, Vercellini P, Iorio M, Vitobello D, Portuesi R, Bresciani G, Origoni M, Cantatore F, Pellegri AM, Moriconi L, Serri M, Chiari A, Sopracordevole F, Barbero M, Parazzini F. Hysterectomy for cervical intraepithelial neoplasia: A retrospective observational multi-institutional study. Int J Gynaecol Obstet 2022; 159:679-688. [PMID: 35474511 PMCID: PMC9790541 DOI: 10.1002/ijgo.14233] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/04/2022] [Accepted: 04/21/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To analyze the clinical management, the outcomes, and the trend in hysterectomy rates (HR) in patients who underwent this procedure for cervical intraepithelial neoplasia (CIN). METHODS Multicentric retrospective observational study conducted on 242 patients who underwent hysterectomy for CIN between 2010 and 2020 in nine Italian institutions. Hysterectomy for invasive or micro-invasive neoplasia, sub-total hysterectomy, or trachelectomy were excluded. RESULTS A significant increase in the trend of HR for CIN was recorded (P = 0.002, r = 0.81; C.I. 95%: 0.415-0.949); HR increased from 0.46% in the year 2010 to 3.32% in 2020. The mortality rate was 0.4%, and 5% had operative complications. On definitive histopathology examination, a CIN of any grade was recorded in 71.5% of cases, and an occult invasive cancer in 1.24%. No pathology or CIN1 was found in 26.8% of cases, suggesting over treatment. During follow-up, a vaginal lesion was recorded in 5% of cases. CONCLUSION A significant increase in the number of hysterectomies performed for CIN in the last 10 years was recorded. Hysterectomy for CIN can lead to complications, risk of the onset of vaginal lesions, and risk of overtreatment, and remains, in the first instance, an unacceptable treatment, to be proposed only after adequate counseling.
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Affiliation(s)
- Andrea Ciavattini
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical SciencesUniversità Politecnica delle MarcheAnconaItaly
| | - Jacopo Di Giuseppe
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical SciencesUniversità Politecnica delle MarcheAnconaItaly
| | - Chiara Marconi
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical SciencesUniversità Politecnica delle MarcheAnconaItaly
| | - Luca Giannella
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical SciencesUniversità Politecnica delle MarcheAnconaItaly
| | - Giovanni Delli Carpini
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical SciencesUniversità Politecnica delle MarcheAnconaItaly
| | - Michela Paolucci
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical SciencesUniversità Politecnica delle MarcheAnconaItaly
| | - Mariasole Fichera
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical SciencesUniversità Politecnica delle MarcheAnconaItaly
| | - Rosa Pasqualina De Vincenzo
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public HealthFondazione Policlinico Universitario A. Gemelli, IRCCSRomeItaly
- Dipartimento di Scienze della Vita e Sanità PubblicaUniversità Cattolica del Sacro CuoreRomeItaly
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public HealthFondazione Policlinico Universitario A. Gemelli, IRCCSRomeItaly
- Dipartimento di Scienze della Vita e Sanità PubblicaUniversità Cattolica del Sacro CuoreRomeItaly
| | - Maria Teresa Evangelista
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public HealthFondazione Policlinico Universitario A. Gemelli, IRCCSRomeItaly
| | - Giorgio Bogani
- Gynecologic Oncology UnitFondazione IRCCS Istituto Nazionale dei Tumori di MilanoMilanItaly
| | - Francesca Bertolina
- Gynecologic Oncology UnitFondazione IRCCS Istituto Nazionale dei Tumori di MilanoMilanItaly
| | - Francesco Raspagliesi
- Gynecologic Oncology UnitFondazione IRCCS Istituto Nazionale dei Tumori di MilanoMilanItaly
| | - Barbara Gardella
- Department of Obstetrics and GynecologyIstituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Foundation Policlinico San Matteo and University of PaviaPaviaItaly
| | - Arsenio Spinillo
- Department of Obstetrics and GynecologyIstituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Foundation Policlinico San Matteo and University of PaviaPaviaItaly
| | - Mattia Dominoni
- Department of Obstetrics and GynecologyIstituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Foundation Policlinico San Matteo and University of PaviaPaviaItaly
| | - Ermelinda Monti
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | | | - Paolo Vercellini
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Maria Iorio
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | | | | | | | - Massimo Origoni
- Vita Salute San Raffaele University School of Medicine ‐ Department of Gynecology & ObstetricsMilanItaly
| | - Francesco Cantatore
- Vita Salute San Raffaele University School of Medicine ‐ Department of Gynecology & ObstetricsMilanItaly
| | - Antonio Maurizio Pellegri
- Vita Salute San Raffaele University School of Medicine ‐ Department of Gynecology & ObstetricsMilanItaly
| | - Lorenzo Moriconi
- Obstetrics and Gynecologic Unit, A.S.U.RBenedetto del Tronto (AP)Italy
| | - Matteo Serri
- Obstetrics and Gynecologic Unit, A.S.U.RBenedetto del Tronto (AP)Italy
| | - Andrea Chiari
- Obstetrics and Gynecologic Unit, A.S.U.RBenedetto del Tronto (AP)Italy
| | | | | | - Fabio Parazzini
- Department of Clinical Sciences and Community HealthUniversità degli Studi di Milano Facoltà di Medicina e ChirurgiaMilanItaly
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Delli Carpini G, Giannella L, Di Giuseppe J, Montanari M, Fichera M, Pizzagalli D, Meccariello ML, Palazzo P, Valenza C, Francucci A, Ciavattini A. Effect of the mode of delivery on the risk of endometriosis recurrence: a retrospective cohort study. Fertil Steril 2022; 118:1080-1087. [PMID: 36243596 DOI: 10.1016/j.fertnstert.2022.08.849] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 03/08/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate the risk of endometriosis recurrence according to the mode of delivery (cesarean section vs. vaginal birth) in patients who had become pregnant with a live birth after surgery for endometriosis. DESIGN A retrospective cohort study. A Cox proportional-hazards regression was performed to evaluate the risk factors for endometriosis recurrence at 36 months of follow-up after the last pregnancy. SETTING Academic hospital. PATIENT(S) Patients who have had ≥1 pregnancy with a live birth following conservative surgery for ovarian endometriosis performed from January 2009 to December 2016 at our institution. INTERVENTION(S) Patients who underwent ≥1 cesarean section after surgery for endometriosis. MAIN OUTCOME MEASURES The recurrence rate of endometriosis after live-birth pregnancies obtained after the first surgery for endometriosis. RESULTS Patients with a history of ≥1 cesarean section after surgery for endometriosis have a higher risk of endometriosis recurrence than the patients who have had a vaginal birth, with an adjusted hazard ratio of 2.25 (95% confidence interval, 1.27-3.96). CONCLUSION A cesarean section after surgery for endometriosis is associated with a twofold high risk of endometriosis recurrence with respect to vaginal birth. A different follow-up approach may be needed in those patients, and avoiding inappropriate indications for cesarean sections in pregnant patients with a history of surgery for endometriosis is necessary.
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Affiliation(s)
- Giovanni Delli Carpini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Giannella
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Jacopo Di Giuseppe
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Michele Montanari
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Mariasole Fichera
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Davide Pizzagalli
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Maria Liberata Meccariello
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Paola Palazzo
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Carmine Valenza
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Alessio Francucci
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Ciavattini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy.
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Giannella L, Di Giuseppe J, Delli Carpini G, Grelloni C, Fichera M, Sartini G, Caimmi S, Natalini L, Ciavattini A. HPV-Negative Adenocarcinomas of the Uterine Cervix: From Molecular Characterization to Clinical Implications. Int J Mol Sci 2022; 23:ijms232315022. [PMID: 36499345 PMCID: PMC9735497 DOI: 10.3390/ijms232315022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
Cervical cancer is the fourth most common cancer in women. It is the leading cause of female deaths in developing countries. Most of these cervical neoplasms are represented by squamous lesions. Cervical adenocarcinoma causes about a quarter of cervical cancers. In contrast to squamous lesions, cervical glandular disease is HPV-negative in about 15-20% of cases. HPV-negative cervical adenocarcinomas typically present in advanced stages at clinical evaluation, resulting in a poorer prognosis. The overall and disease-free survival of glandular lesions is lower than that of squamous lesions. Treatment options require definitive treatments, as fertility-sparing is not recommended. Moreover, the impact of HPV vaccination and primary HPV screening is likely to affect these lesions less; hence, the interest in this challenging topic for clinical practice. An updated review focusing on clinical and molecular characterization, prognostic factors, and therapeutic options may be helpful for properly managing such cervical lesions.
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Sopracordevole F, Clemente N, Papiccio M, Del Fabro A, Serri M, Fichera M, Buttignol M, Giorda G, Delli Carpini G, Ciavattini A. Histopathological findings in hysterectomy for cervical stenosis in postmenopausal women: A retrospective case series. Medicine (Baltimore) 2022; 101:e29586. [PMID: 35866770 PMCID: PMC9302241 DOI: 10.1097/md.0000000000029586] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To analyze the histopathological findings in postmenopausal women who underwent hysterectomy for postsurgical cervical stenosis, evaluating the incidental findings of preinvasive or invasive uterine and cervical disease. METHODS Retrospective case series of postmenopausal women who underwent hysterectomy for postsurgical cervical stenosis at Gynecological Oncology Unit of Istituto di Ricovero e Cura a Carattere Scientifico Centro di Riferimento Oncologico Aviano-National Cancer Institute from January 2014 to January 2021. RESULTS During the study period, 36 women underwent hysterectomy for postsurgical cervical stenosis at our institution. Cervical stenosis occurred 10.2 ± 5.6 years from the onset of menopause. In particular, 26 (72.2%) patients underwent a single loop electrosurgical excision procedure or carbon dioxide (CO2)-laser conization before the onset of stenosis. The remaining 10 (27.8%) women had multiple surgical excision before the onset of stenosis. At the final histopathological analysis, 17 (47.2%) patients had a preinvasive or invasive gynecological disease. In particular, 9 cases of cervical disease (including 1 case of endocervical squamous cell carcinoma pT1a) and 6 cases of endometrial hyperplasia emerged. Also, 2 cases of tubo-ovarian diseases were found. CONCLUSIONS Postsurgical cervical stenosis is a challenging clinical condition, especially in women treated for cervical intraepithelial neoplasia or microinvasive cervical cancer. As shown, cervical stenosis can prevent an adequate gynecological follow-up and a prompt diagnosis of malignancies. Therefore, postmenopausal women with cervical stenosis should be carefully counseled, and hysterectomy could be a reasonable option, especially in those cases in which a conservative approach is not feasible, failed, or is not accepted by the patient.
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Affiliation(s)
| | - Nicolò Clemente
- Gynecological Oncology Unit - CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Maria Papiccio
- Gynecological Oncology Unit - CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Anna Del Fabro
- Gynecological Oncology Unit - CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Matteo Serri
- Gynecologic Section, Department of Odontostomatological and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Mariasole Fichera
- Gynecological Oncology Unit - CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
- Gynecologic Section, Department of Odontostomatological and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Monica Buttignol
- Gynecological Oncology Unit - CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Giorgio Giorda
- Gynecological Oncology Unit - CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Giovanni Delli Carpini
- Gynecologic Section, Department of Odontostomatological and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
- *Correspondence: Giovanni Delli Carpini, Gynecologic Section, Department of Odontostomatological and Specialized Clinical Sciences, Università Politecnica delle Marche, Via F. Corridoni 11 – 60123 Ancona, Italy (e-mail: )
| | - Andrea Ciavattini
- Gynecologic Section, Department of Odontostomatological and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
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Giannella L, Marconi C, Di Giuseppe J, Delli Carpini G, Fichera M, Grelloni C, Giuliani L, Montanari M, Insinga S, Ciavattini A. Malignant Transformation of Postmenopausal Endometriosis: A Systematic Review of the Literature. Cancers (Basel) 2021; 13:4026. [PMID: 34439184 PMCID: PMC8394809 DOI: 10.3390/cancers13164026] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 07/23/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: This study aimed to systematically review the existing literature on malignant transformation of postmenopausal endometriosis to provide information about patient characteristics, hormonal replacement therapy (HRT) use, and outcomes over a period of 52 years (1969-2021). Methods: According to PRISMA guidelines, we searched for (endometriosis OR endometriotic) AND (cancer OR malignancy OR malignant transformation) AND (menopause OR menopausal OR postmenopause OR postmenopausal) in Pubmed (all fields) (accessed on 12 February 2021) and Scopus (Title/Abstract/Keywords) (accessed on 12 February 2021) databases. The only filter used was the English language. Relevant articles were obtained in full-text format and screened for additional references. Eligibility/inclusion criteria: studies including full case description of malignant transformation of endometriosis-related lesions in postmenopause. Results: 75 studies, including 90 cases, were retrieved. The mean age was 55.8 ± 8.5 years. Overall, about 65% of women had a positive personal history of endometriosis/adenomyosis, and 64% of women underwent previous hysterectomy ± bilateral salpingo-oophorectomy. Forty-nine of 74 women used HRT (66.2%). Among the women who used HRT, estrogen-only treatment was taken by approximately 75%. Duration of HRT was longer than five years in 63.3% of cases. About 70% of subjects had histology of endometrioid adenocarcinoma or clear cell carcinoma. Follow-up outcome, available for 61 women, showed a survival rate of 78.7%, recurrence of 9.8%, death of 11.5%. The duration of follow-up had a median of 12 months (interquartile range, 6.75-25 months). Interestingly, over the years of case publication there was a significant inverse correlation with previous history of endometriosis (r = -0.28, p = 0.007), HRT use (r = -0.31, p = 0.006), and previous definitive surgery (r = -0.42, p < 0.001). Conclusions: In the malignant transformation of postmenopausal endometriosis, there are some recurrent clinical conditions: previous endometriosis, major definitive surgery before menopause, and estrogen-only HRT for a relatively long time. However, these clinical conditions have shown a drastic decrease over time. This could likely be the consequence of different attitudes and management of gynecologists linked to up-to-date scientific evidence about the use of major surgery in gynecological pathologies. Malignant transformation of postmenopausal endometriosis is a clinical challenge to be explored further.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Andrea Ciavattini
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Via Filippo Corridoni, 16, 60123 Ancona, Italy; (L.G.); (C.M.); (J.D.G.); (G.D.C.); (M.F.); (C.G.); (L.G.); (M.M.); (S.I.)
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Gelibter S, Fichera M, Giordano A, Chieffo R, Comi G, Leocani L. 52. Lower limbs motor evoked potentials intra-session reliability: A coil comparison study. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.09.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fichera M, Chieffo R, Gelibter S, Giordano A, Nuara A, Volonté M, Martinelli V, Comola M, Comi G, Leocani L. 53. Sham repetitive transcranial magnetic stimulation with H-coil as symptomatic treatment in functional disorder. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.09.060] [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]
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Nuara A, Chieffo R, Fichera M, Esposito F, Martinelli Boneschi F, Radaelli M, Comola M, Comi G, Leocani L. 72. Corticospinal reserve and disability predict efficacy of repetitive transcranial stimulation on walking abilities in people with progressive multiple sclerosis undergoing rehabilitation. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.10.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fichera M, Maffei A, Comi G, Leocani L. 33. Effects of global proprioceptive resonance on resting state EEG in healthy subjects. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.10.045] [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: 10/20/2022]
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Fichera M, Houdayer E, Avantaggiato F, Chieffo R, Comi G, Volonté M, Leocani L. 61. Patients with progressive supranuclear palsy show abnormal response to conditioned and unconditioned TMS stimuli compared to patients with Parkinson’s disease and healthy subjects. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.09.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fichera M, Houdayer E, Avantaggiato F, Chieffo R, Comi G, Volonté M, Leocani L. ID 278 – Motor cortical disinhibition is more pronounced in Progressive Supranuclear Palsy than in Parkinson’s disease: Evidence from TMS. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.11.412] [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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Fichera M, Spagnolo F, Chieffo R, Houdayer E, Coppi E, Nuara A, Di Maggio G, Ferrari L, Libera DD, Velikova S, Bianco M, Straffi L, Zangen A, Comi G, Volontè M, Leocani L. 85. Deep repetitive transcranial magnetic stimulation with H-coil for motor symptoms in Parkinson’s disease: A randomized, double blind, placebo-controlled study. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nuara A, Saraceno L, Houdayer E, Chieffo R, Di Maggio G, Coppi E, Fichera M, Martinelli-Boneschi F, Esposito F, Zangen A, Comola M, Comi G, Leocani L. 108. Corticospinal reserve predicts walking improvement after intensive rehabilitation and deep rTMS with H-coil in progressive multiple sclerosis. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Houdayer E, Spagnolo F, Fichera M, Chieffo R, Dalla Libera D, Straffi L, Coppi E, Nuara A, Ferrari L, Di Maggio G, Bianco M, Velikova S, Zangen A, Comi G, Leocani L. P309: Motor planning improvement in Parkinson’s disease after excitatory deep repetitive transcranial magnetic stimulation with H-coil: evidence from sensorimotor rhythms event-related desynchronization. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50430-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nuara A, Saraceno L, Elise H, Chieffo R, Di Maggio G, Coppi E, Fichera M, Vacchi L, Martinelli Boneschi F, Esposito F, Zangen A, Comola M, Comi G, Leocani L. P569: Corticospinal reserve predicts the effect of deep repetitive brain stimulation with h-coil and neurorehabilitation on walking impairment in progressive multiple sclerosis: results from two randomized, double blind studies. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50663-3] [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]
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Fichera M, Spagnolo F, Houdayer E, Chieffo R, Dalla Libera D, Straffi L, Coppi E, Nuara A, Ferrari L, Di Maggio G, Bianco M, Velikova S, Zangen A, Comi G, Volonté M, Leocani L. P308: Deep rTMS-induced clinical and neurophysiological effect in Parkinson’s disease. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50429-4] [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]
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Leocani L, Spagnolo F, Fichera M, Chieffo R, Houdayer E, Coppi E, Nuara A, Di Maggio G, Ferrari L, Dalla Libera D, Velikova S, Bianco M, Straffi L, Zangen A, Volonté M, Comi G. P1084: Motor effects of deep repetitive transcranial magnetic stimulation with H-coil in Parkinson’s disease: a randomized, double blind, placebo-controlled study. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)51112-1] [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: 11/12/2022]
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Spagnolo F, Volonté M, Fichera M, Chieffo R, Houdayer E, Bianco M, Coppi E, Nuara A, Straffi L, Di Maggio G, Ferrari L, Dalla Libera D, Velikova S, Comi G, Zangen A, Leocani L. Excitatory Deep Repetitive Transcranial Magnetic Stimulation With H-coil as Add-on Treatment of Motor Symptoms in Parkinson's Disease: An Open Label, Pilot Study. Brain Stimul 2014; 7:297-300. [DOI: 10.1016/j.brs.2013.10.007] [Citation(s) in RCA: 27] [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] [Received: 05/24/2013] [Revised: 10/24/2013] [Accepted: 10/27/2013] [Indexed: 11/28/2022] Open
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Houdayer E, Spagnolo F, Fichera M, Chieffo R, Libera DD, Straffi L, Coppi E, Nuara A, Ferrari L, Maggio GD, Bianco M, Velikova S, Zangen A, Comi G, Volonté M, Leocani L. 26. Excitatory deep repetitive transcranial magnetic stimulation with H-coil improves motor control in Parkinson’s disease: A pilot study. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.053] [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: 11/30/2022]
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Fichera M, Spagnolo F, Houdayer E, Chieffo R, Libera DD, Straffi L, Coppi E, Nuara A, Ferrari L, Maggio GD, Bianco M, Velikova S, Zangen A, Comi G, Volonté M, Leocani L. 50. Clinical and neurophysiological effect of deep rTMS with H-COIL in Parkinson’s disease. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fichera M, Rinaldi N, Tarascio M, Taschetta S, Caldaci LM, Catavorello A, La Rosa B, Panella MM. [Indications and controindications of hormone replacement therapy in menopause]. Minerva Ginecol 2013; 65:331-344. [PMID: 23689177] [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: 06/02/2023]
Abstract
Menopause is a physiological event of women's life that is the end of menstrual cycles and the end of the fertile period. Normally the age at which women reach menopause is between 50 and 52 years, as the world average. Menopause occurs when the functional ovarian reserve is exhausted or can be induced by surgical removal of the ovaries. What follows, however, is the establishment of a state of hypoestrogenism, which potentially affects various organs and systems (genito-urinary system, cardiovascular system, skeleton, skin, brain) and quality of life of women (varying degrees of vasomotor symptoms, vaginal atrophy, osteoporosis). Hormone replacement therapy (HRT), it is based on estrogen or estrogen and progesterone, can be used to compensate for estrogen deficiency and to prevent or limit the damages that may result. During the years, there have been several observational studies designed to identify the risks and benefits arising from the use of postmenopausal hormone replacement therapy, in spontaneous and surgical menopause. In fact, although several studies have shown that women treated with estrogen enjoyed a better overall level of health, over the last decade have raised doubts about the safety of hormone replacement therapy long term. In our study we try to discuss, based on a review of the literature and evidence available to date, what are the present indications and controindications to the use of hormone replacement therapy.
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Affiliation(s)
- M Fichera
- Sezione di Scienze Ostetriche e Ginecologiche, Dipartimento Materno Infantile e Scienze Radiologiche, Azienda Ospedaliero-Universitaria Policlinico Gaspare Rodolico, Università degli Studi di Catania, Catania, Italia.
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Concolino D, Iembo M, Moricca M, Rapsomaniki M, Marotta R, Galesi O, Fichera M, Romano C, Strisciuglio P. A de novo 8q22.2-24.3 duplication in a patient with mild phenotype. Eur J Med Genet 2012; 55:67-70. [DOI: 10.1016/j.ejmg.2011.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 09/10/2011] [Indexed: 10/17/2022]
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Abstract
We describe a mentally retarded 24-year-old man followed by our group since age 18 months who exhibited nearly continuous stereotypic movements while awake. These movements, which have persisted over many years, consist of synchronous lateral flexion at the neck and waist. Movements could be partially voluntarily suppressed and disappeared in sleep. The patient has drug-resistant seizures and a constellation of dysmorphic features, including coarse face, large nose, large thin lips, brachicephaly, marked hirsutism on the face, and limbs proportionally smaller than the trunk, which suggests that the unusual stereotypic movements described may be part of a syndrome. Routine and full metabolic serum and urine analyses, full ophthalmological examination, internal organs ultrasound examination, full skeletal survey, standard karyotype and array-CGH analysis yielded normal results.
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Affiliation(s)
- P Pavone
- Department of Pediatrics, University of Catania, Italy
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Buoni S, Zannolli R, Hayek J, Elia M, Fichera M, Falco M. CDKL5 MUTATIONS IN BOYS WITH SEVERE ENCEPHALOPATHY AND EARLY-ONSET INTRACTABLE EPILEPSY. Neurology 2009; 73:76-7; author reply 77. [DOI: 10.1212/wnl.0b013e3181ab9bb6] [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] Open
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Fichou Y, Bieth E, Bahi-Buisson N, Nectoux J, Girard B, Chelly J, Chaix Y, Bienvenu T, Elia M, Falco M, Fichera M. CDKL5 MUTATIONS IN BOYS WITH SEVERE ENCEPHALOPATHY AND EARLY-ONSET INTRACTABLE EPILEPSY. Neurology 2009; 73:77-8; author reply 78. [DOI: 10.1212/01.wnl.0000349658.05677.d7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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van Bon BWM, Mefford HC, Menten B, Koolen DA, Sharp AJ, Nillesen WM, Innis JW, de Ravel TJL, Mercer CL, Fichera M, Stewart H, Connell LE, Ounap K, Lachlan K, Castle B, Van der Aa N, van Ravenswaaij C, Nobrega MA, Serra-Juhé C, Simonic I, de Leeuw N, Pfundt R, Bongers EM, Baker C, Finnemore P, Huang S, Maloney VK, Crolla JA, van Kalmthout M, Elia M, Vandeweyer G, Fryns JP, Janssens S, Foulds N, Reitano S, Smith K, Parkel S, Loeys B, Woods CG, Oostra A, Speleman F, Pereira AC, Kurg A, Willatt L, Knight SJL, Vermeesch JR, Romano C, Barber JC, Mortier G, Pérez-Jurado LA, Kooy F, Brunner HG, Eichler EE, Kleefstra T, de Vries BBA. Further delineation of the 15q13 microdeletion and duplication syndromes: a clinical spectrum varying from non-pathogenic to a severe outcome. J Med Genet 2009; 46:511-23. [PMID: 19372089 DOI: 10.1136/jmg.2008.063412] [Citation(s) in RCA: 210] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Recurrent 15q13.3 microdeletions were recently identified with identical proximal (BP4) and distal (BP5) breakpoints and associated with mild to moderate mental retardation and epilepsy. METHODS To assess further the clinical implications of this novel 15q13.3 microdeletion syndrome, 18 new probands with a deletion were molecularly and clinically characterised. In addition, we evaluated the characteristics of a family with a more proximal deletion between BP3 and BP4. Finally, four patients with a duplication in the BP3-BP4-BP5 region were included in this study to ascertain the clinical significance of duplications in this region. RESULTS The 15q13.3 microdeletion in our series was associated with a highly variable intra- and inter-familial phenotype. At least 11 of the 18 deletions identified were inherited. Moreover, 7 of 10 siblings from four different families also had this deletion: one had a mild developmental delay, four had only learning problems during childhood, but functioned well in daily life as adults, whereas the other two had no learning problems at all. In contrast to previous findings, seizures were not a common feature in our series (only 2 of 17 living probands). Three patients with deletions had cardiac defects and deletion of the KLF13 gene, located in the critical region, may contribute to these abnormalities. The limited data from the single family with the more proximal BP3-BP4 deletion suggest this deletion may have little clinical significance. Patients with duplications of the BP3-BP4-BP5 region did not share a recognisable phenotype, but psychiatric disease was noted in 2 of 4 patients. CONCLUSIONS Overall, our findings broaden the phenotypic spectrum associated with 15q13.3 deletions and suggest that, in some individuals, deletion of 15q13.3 is not sufficient to cause disease. The existence of microdeletion syndromes, associated with an unpredictable and variable phenotypic outcome, will pose the clinician with diagnostic difficulties and challenge the commonly used paradigm in the diagnostic setting that aberrations inherited from a phenotypically normal parent are usually without clinical consequences.
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Affiliation(s)
- B W M van Bon
- Department of Human Genetics, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands
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Scuderi C, Fichera M, Calabrese G, Elia M, Amato C, Savio M, Borgione E, Vitello GA, Musumeci SA. Posterior fossa abnormalities in hereditary spastic paraparesis with spastin mutations. J Neurol Neurosurg Psychiatry 2009; 80:440-3. [PMID: 19289482 DOI: 10.1136/jnnp.2008.154807] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hereditary spastic paraparesis (HPS) linked to mutations in the spastin gene (SPG4) is considered to be a pure form of spastic hereditary paraparesis. However, in this disease also other signs of central nervous system involvement are frequently found. METHODS Clinical, genetical and neuroradiological investigations were carried out in a large family with autosomal dominant spastic paraparesis and in a sporadic case with spastic paraparesis. RESULTS Additional clinical and molecular data are provided, studying other members of the same pedigree, as already described, with a five-base deletion in exon 9 of the SPG4 gene (1215-1219delTATAA) whose members show MRI anomalies that fall within the Dandy-Walker continuum. Furthermore, an unrelated female patient with hypoplasia of the cerebellar vermis is indicated, carrying a de novo previously reported mutation of the SPG4 gene (c.1741C>T p.R581X). CONCLUSIONS Spastin may play an important role in the development of the central nervous system and in particular in the development of the structures of posterior fossa.
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Affiliation(s)
- C Scuderi
- Unità Operativa di Malattie Neuromuscolari, IRCCS Oasi Maria SS, Troina, EN, Italy.
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Nicholas AK, Swanson EA, Cox JJ, Karbani G, Malik S, Springell K, Hampshire D, Ahmed M, Bond J, Di Benedetto D, Fichera M, Romano C, Dobyns WB, Woods CG. The molecular landscape of ASPM mutations in primary microcephaly. J Med Genet 2008; 46:249-53. [PMID: 19028728 PMCID: PMC2658750 DOI: 10.1136/jmg.2008.062380] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Autosomal recessive primary microcephaly (MCPH) is a model disease to study human neurogenesis. In affected individuals the brain grows at a reduced rate during fetal life resulting in a small but structurally normal brain and mental retardation. The condition is genetically heterogeneous with mutations in ASPM being most commonly reported. Methods and results: We have examined this further by studying three cohorts of microcephalic children to extend both the phenotype and the mutation spectrum. Firstly, in 99 consecutively ascertained consanguineous families with a strict diagnosis of MCPH, 41 (41%) were homozygous at the MCPH5 locus and all but two families had mutations. Thus, 39% of consanguineous MCPH families had homozygous ASPM mutations. Secondly, in 27 non-consanguineous, predominantly Caucasian families with a strict diagnosis of MCPH, 11 (40%) had ASPM mutations. Thirdly, in 45 families with a less restricted phenotype including microcephaly and mental retardation, but regardless of other neurological features, only 3 (7%) had an ASPM mutation. This report contains 27 novel mutations and almost doubles the number of MCPH associated ASPM mutations known to 57. All but one of the mutations lead to the use of a premature termination codon, 23 were nonsense mutations, 28 deletions or insertions, 5 splicing, and 1 was a translocation. Seventeen of the 57 mutations were recurrent. There were no definitive missense mutations found nor was there any mutation/phenotype correlation. ASPM mutations were found in all ethnic groups studied. Conclusion: This study confirms that mutations in ASPM are the most common cause of MCPH, that ASPM mutations are restricted to individuals with an MCPH phenotype, and that ASPM testing in primary microcephaly is clinically useful.
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Affiliation(s)
- A K Nicholas
- Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, CB2 0XY, UK
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Elia M, Falco M, Ferri R, Spalletta A, Bottitta M, Calabrese G, Carotenuto M, Musumeci SA, Lo Giudice M, Fichera M. CDKL5 mutations in boys with severe encephalopathy and early-onset intractable epilepsy. Neurology 2008; 71:997-9. [PMID: 18809835 DOI: 10.1212/01.wnl.0000326592.37105.88] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [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] Open
Abstract
OBJECTIVE To search for CDKL5 gene mutations in boys presenting with severe early-onset encephalopathy and intractable epilepsy, a clinical picture very similar to that already described in girls with CDKL5 mutations. METHODS Eight boys (age range 3-16 years, mean age 8.5 years, SD 4.38) with severe or profound mental retardation and early-onset intractable seizures were selected for CDKL5 gene mutation screening by denaturing high-performance liquid chromatography analysis. RESULTS We found three unrelated boys carrying three different missense mutations of the CDKL5 gene: c.872G>A (p.C291Y), c.863C>T (p.T288I), and c.533G>C (p.R178P). They presented early-onset, polymorphous, and drug-resistant seizures, mostly myoclonic and tonic or spasms. EEG showed epileptiform abnormalities which were multifocal during wakefulness, and pseudoperiodic bisynchronous during sleep. CONCLUSIONS This study describes three boys carrying CDKL5 missense mutations and their detailed clinical and EEG data, and indicates that CDKL5 gene mutations may represent a cause of severe or profound mental retardation and early-onset intractable seizures, also in boys. Screening for CDKL5 mutations is strongly recommended in individuals with these clinical features.
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Affiliation(s)
- M Elia
- Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Via Conte Ruggero 73, 94018 Troina (EN), Italy.
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Libertino S, Fichera M, Aiello V, Lombardo S, Scandurra A, Renis M, Sinatra F. Electrical Characterization of Biological Molecules Deposition in MOS Capacitors. ACTA ACUST UNITED AC 2008. [DOI: 10.1166/sl.2008.424] [Citation(s) in RCA: 8] [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] [Indexed: 11/23/2022]
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37
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Greco D, Romano C, Reitano S, Barone C, Benedetto DD, Castiglia L, Fichera M, Galesi O, Zingale M, Buono S, Uliana V, Caselli R, Canitano R, Hayek G, Renieri A. Three new patients with dup(17)(p11.2p11.2) without autism. Clin Genet 2008; 73:294-6. [PMID: 18218042 DOI: 10.1111/j.1399-0004.2007.00959.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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De Gregori M, Ciccone R, Magini P, Pramparo T, Gimelli S, Messa J, Novara F, Vetro A, Rossi E, Maraschio P, Bonaglia MC, Anichini C, Ferrero GB, Silengo M, Fazzi E, Zatterale A, Fischetto R, Previderé C, Belli S, Turci A, Calabrese G, Bernardi F, Meneghelli E, Riegel M, Rocchi M, Guerneri S, Lalatta F, Zelante L, Romano C, Fichera M, Mattina T, Arrigo G, Zollino M, Giglio S, Lonardo F, Bonfante A, Ferlini A, Cifuentes F, Van Esch H, Backx L, Schinzel A, Vermeesch JR, Zuffardi O. Cryptic deletions are a common finding in "balanced" reciprocal and complex chromosome rearrangements: a study of 59 patients. J Med Genet 2007; 44:750-62. [PMID: 17766364 PMCID: PMC2652810 DOI: 10.1136/jmg.2007.052787] [Citation(s) in RCA: 217] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Using array comparative genome hybridisation (CGH) 41 de novo reciprocal translocations and 18 de novo complex chromosome rearrangements (CCRs) were screened. All cases had been interpreted as "balanced" by conventional cytogenetics. In all, 27 cases of reciprocal translocations were detected in patients with an abnormal phenotype, and after array CGH analysis, 11 were found to be unbalanced. Thus 40% (11 of 27) of patients with a "chromosomal phenotype" and an apparently balanced translocation were in fact unbalanced, and 18% (5 of 27) of the reciprocal translocations were instead complex rearrangements with >3 breakpoints. Fourteen fetuses with de novo, apparently balanced translocations, all but two with normal ultrasound findings, were also analysed and all were found to be normal using array CGH. Thirteen CCRs were detected in patients with abnormal phenotypes, two in women who had experienced repeated spontaneous abortions and three in fetuses. Sixteen patients were found to have unbalanced mutations, with up to 4 deletions. These results suggest that genome-wide array CGH may be advisable in all carriers of "balanced" CCRs. The parental origin of the deletions was investigated in 5 reciprocal translocations and 11 CCRs; all were found to be paternal. Using customized platforms in seven cases of CCRs, the deletion breakpoints were narrowed down to regions of a few hundred base pairs in length. No susceptibility motifs were associated with the imbalances. These results show that the phenotypic abnormalities of apparently balanced de novo CCRs are mainly due to cryptic deletions and that spermatogenesis is more prone to generate multiple chaotic chromosome imbalances and reciprocal translocations than oogenesis.
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Affiliation(s)
- M De Gregori
- Biologia Generale e Genetica Medica, Universitè di Pavia, Pavia, Italy
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Failla P, Romano C, Alberti A, Vasta A, Buono S, Castiglia L, Luciano D, Di Benedetto D, Fichera M, Galesi O. Schizophrenia in a patient with subtelomeric duplication of chromosome 22q. Clin Genet 2007; 71:599-601. [PMID: 17539913 DOI: 10.1111/j.1399-0004.2007.00819.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Alberti A, Romano C, Falco M, Calì F, Schinocca P, Galesi O, Spalletta A, Di Benedetto D, Fichera M. 1.5 Mb de novo 22q11.21 microduplication in a patient with cognitive deficits and dysmorphic facial features. Clin Genet 2007; 71:177-82. [PMID: 17250668 DOI: 10.1111/j.1399-0004.2007.00750.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The 22q11.2 microduplication syndrome is caused by non-allelic homologous recombination mediated by misalignments of low copy repeats located in the region deleted in the DiGeorge syndrome (DGS)/velocardiofacial syndrome (VCFS). The variable phenotype of such condition, consisting in a combination of dysmorphic facial features, cognitive deficits, velopharyngeal insufficiency, congenital heart defects and immunologic derangement, is caused usually in 90% of cases by a 3 Mb deletion or in a minority of cases (7%) by a 1.5 Mb deletion. The most common reciprocal event of deletion is the 3 Mb duplication, reported more recently with a variable phenotype, ranging from multiple defects to normality. In this study, we report a 2.5-year-old girl with cognitive deficits and dysmorphic facial features such as superior placement of eyebrows, upslanting palpebral fissures, widely spaced eyes, broad nasal bridge and epicanthal folds. Fluorescent in situ hybridization for DGS/VCFS region on metaphase chromosomes did not show any apparent anomaly. Subsequent array comparative genomic hybridization study, confirmed by multiplex ligation-dependent probe assay and microsatellite analysis, disclosed a 1.5 Mb de novo 22q11.21 duplication concerning the same chromosomal region deleted in a minority of patients with DGS. These findings identify the minimal duplicated region leading to this emerging syndrome.
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Affiliation(s)
- A Alberti
- Unit of Pediatrics and Medical Genetics, Department for Mental Retardation, Oasi Institute (IRCCS), Troina, Province of Enna, Sicilia, Italy
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Musumeci SA, Elia M, Fichera M, Amato C, Ferri R, Romano C, Federico A. Nail aplasia, microcephaly, severe mental retardation and MRI abnormalities: report of two unrelated cases. Neurol Sci 2006; 27:425-31. [PMID: 17205229 DOI: 10.1007/s10072-006-0724-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Accepted: 11/17/2006] [Indexed: 10/23/2022]
Abstract
We present the clinical and laboratory features of two unrelated mentally retarded females with sporadic bilateral periventricular nodular heterotopia (BPNH), hypoplastic/absent nails and other malformative features. Clinical examination, MRI scanning, EEG recording, karyotyping and neuropsychological testing were performed. From a molecular genetic point of view, direct sequencing analysis, X-inactivation assay and telomere analysis were carried out in one patient. The two patients showed convincing similarities from clinical and neuroradiological points of view with BPNH, mental retardation, microcephaly and hypoplastic/absent nails of fingers and toes. Our two unrelated mentally retarded females may be affected by complex malformative syndromes sharing some common features such as BPNH, mental retardation and hypoplastic/absent nails. Further genetic studies are needed to better understand the pathogenetic bases of this neurological disease. These two cases widen the spectrum of BPNH-associated syndromes.
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Affiliation(s)
- S A Musumeci
- Department of Neurology, Oasi Institute for Research on Mental Retardation and Brain Aging, IRCCS, Via Conte Ruggero 73, I-94018 Troina, Italy.
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43
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Castiglia L, Fichera M, Romano C, Galesi O, Grillo L, Sturnio M, Failla P. Narrowing the candidate region for congenital diaphragmatic hernia in chromosome 15q26: contradictory results. Am J Hum Genet 2005; 77:892-4; author reply 894-5. [PMID: 16252246 PMCID: PMC1271395 DOI: 10.1086/497082] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Fichera M, Falco M, Lo Giudice M, Castiglia L, Guarnaccia V, Calì F, Spalletta A, Scuderi C, Avola E. Skewed X-inactivation in a family with mental retardation and PQBP1 gene mutation. Clin Genet 2005; 67:446-7. [PMID: 15811016 DOI: 10.1111/j.1399-0004.2005.00436.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fichera M, Lo Giudice M, Falco M, Sturnio M, Amata S, Calabrese O, Bigoni S, Calzolari E, Neri M. Evidence of kinesin heavy chain (KIF5A) involvement in pure hereditary spastic paraplegia. Neurology 2004; 63:1108-10. [PMID: 15452312 DOI: 10.1212/01.wnl.0000138731.60693.d2] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [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: 11/15/2022] Open
Abstract
Hereditary spastic paraplegias (HSPs) are characterized by progressive lower extremity spasticity due to an axonal degeneration of motor and sensory neurons. We report a four-generation pedigree segregating an autosomal dominant phenotype for HSP and showing a linkage to the SPG10 locus, coding for Kinesin family member 5A. Subsequent to a denaturing high performance liquid chromatography (dHPLC) mutation screening we found a new missense mutation 838C>T (R280C) at an invariant arginine residue in a region involved in the microtubule binding activity.
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Affiliation(s)
- M Fichera
- Genetic Diagnostic Laboratory, IRCCS Oasi M. SS. Troina, Italy.
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46
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Fisichella S, Alberghina G, Amato ME, Fichera M, Mantarro D, Palermo A, Savarino A, Scarlata G. Conformational studies of wheat flour high relative molecular mass glutenin subunits by circular dichroism spectroscopy. Biopolymers 2002; 65:142-7. [PMID: 12209464 DOI: 10.1002/bip.10211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 11/08/2022]
Abstract
Conformational studies of 1Dx2, 1Bx7, and 1Dy12 high relative molecular mass glutenin subunits, extracted from Alisei 1 flour, are reported. Circular dichroism (CD) spectroscopy is employed to study their conformational polymorphism induced by urea and by urea in the presence of 1% sodium dodecyl sulfate (SDS). The CD spectra indicate that SDS promotes ordered structures. The addition of urea to the SDS-acetate solution of 1Dx2, 1Bx7, and 1Dy12 subunits eliminates the effect of SDS. Its addition to the acetate solution of proteins induces conformational transitions to form a poly-L-proline II-like structure. All the changes induced by urea follow a multistep transition process that is typical of proteins consisting of different domains.
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Affiliation(s)
- S Fisichella
- Dipartimento di Scienze Chimiche, Università di Catania, V. le A. Doria 6, 95125 Catania, Italy.
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Calogero AE, Garofalo MR, Barone N, Longo GA, De Palma A, Fichera M, Rappazzo G, D'Agata R, Vicari E. Spontaneous transmission from a father to his son of a Y chromosome microdeletion involving the deleted in azoospermia (DAZ) gene. J Endocrinol Invest 2002; 25:631-4. [PMID: 12150339 DOI: 10.1007/bf03345088] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [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: 11/24/2022]
Abstract
Microdeletions of the so-called azoospermia factor (AZF) locus of the Y chromosome long arm (Yq) have been recognized as an etiological factor of severe oligozoospermia or azoospermia. Because of this, patients affected are generally infertile unless assisted reproductive techniques are used. We report the case of an oligozoospermic patient (proband) who inherited an extensive Yq microdeletion from his father through a spontaneous pregnancy. Leukocyte DNA was extracted using a commercially available kit. A total of 22 pairs of sequence-tagged site (STSs) based primers, spanning the entire AZF region, were used for the screening. Both the proband and his father carried a Yq microdeletion of the most distal AZF subregion (AZFc) where the deleted in azoospermia (DAZ) gene is located. The proband's father was a sixty-nine-yr-old man who had 3 other children, 2 females and 1 male. This case adds further evidence that the deletion of the DAZ gene is associated with different phenotypic expressions, including normal fertility.
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Affiliation(s)
- A E Calogero
- Department of Biomedical Sciences, University of Catania, Italy.
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Chamayou S, Alecci C, Ragolia C, Giambona A, Siciliano S, Maggio A, Fichera M, Guglielmino A. Successful application of preimplantation genetic diagnosis for beta-thalassaemia and sickle cell anaemia in Italy. Hum Reprod 2002; 17:1158-65. [PMID: 11980733 DOI: 10.1093/humrep/17.5.1158] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In Italy, the autosomal recessive diseases beta-thalassaemia and sickle cell anaemia are so widespread that in some regions they can be defined as 'social diseases'. In this study, nine clinical applications of preimplantation genetic diagnosis (PGD) were performed for beta-thalassaemia and sickle cell anaemia on seven Sicilian couples and carriers of beta-globin gene mutations. METHODS AND RESULTS The studied mutations were: Cd39, HbS, IVS1 nt1, IVS1 nt6 and IVS1 nt110. ICSI was performed with partner's sperm on 131 out of 147 retrieved oocytes, and this resulted in 72 zygotes; 32 embryos were successfully biopsied on day 3. The biopsied blastomeres were lysed and the beta-globin alleles amplified by nested PCR. The mutation diagnosis was performed by restriction enzyme digestion and reverse dot-blot. The amplification efficacy was 97.2%. The genotype study of non-transferred and surplus embryos showed that the allele drop-out rate was 8.6%. Seventeen embryos were transferred in utero on day 4. All couples received an embryo transfer; of the four pregnancies obtained, three resulted in live births and one miscarried at 11 weeks. Prenatal diagnosis at the 11th week and miscarriage material analysis confirmed the PGD results. CONCLUSIONS These studies represent the first successful application of PGD for beta-thalassaemia and sickle cell anaemia in Italy.
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Affiliation(s)
- S Chamayou
- Unità di Medicina della Riproduzione, Associazione HERA, Catania, Italy.
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Fichera M, Borgione E, Avola E, Amata S, Sturnio M, Romano C, Ragusa A. A new MRXS locus maps to the X chromosome pericentromeric region: a new syndrome or narrow definition of Sutherland-Haan genetic locus? J Med Genet 2002; 39:276-80. [PMID: 11950858 PMCID: PMC1735085 DOI: 10.1136/jmg.39.4.276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- G Peruz
- Department of Biomedical Sciences, University of Catania, Italy
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