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Caruso G, Marcoccia E, Brunelli R, Candelieri M, Schiavi MC, Zannini I, Perrone S, Capri O, Muzii L, Perrone G, Galoppi P. Immigration and Adverse Pregnancy Outcomes in an Italian Free Care Hospital. Int J Womens Health 2021; 13:911-917. [PMID: 34675689 PMCID: PMC8504550 DOI: 10.2147/ijwh.s322828] [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] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/04/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction The ever-increasing wave of immigration in Italy has posed demanding challenges in the management of the new multiethnic obstetric population. The aim of this study was to compare pregnancy and perinatal outcomes between immigrants and the native population in an Italian public hospital. Materials and Methods Singleton pregnant women (≥ 24 weeks of gestation) who delivered during a 3-year period in an Italian free care hospital were included. Long-term (≥ 2 years of residence) immigrant patients were divided into 4 groups according to their ethnic origin: Europeans, Asians, Latin Americans, and Africans. Perinatal indicators of obstetric outcomes were collected and compared between immigrants and Italians. Results Of the 3556 patients included, 1092 were immigrants and 2464 Italians. The immigrant cohort experienced a higher rate of macrosomia (1.8% vs 0.6%; p = 0.001), very low birth weight (1.3% vs 0.6%; p = 0.048), very early preterm delivery (1.4% vs 0.4%; p = 0.048), and gestational diabetes mellitus (1.8% vs 0.5%; p = 003) compared with the native population. The overall rate of cesarean sections was greater among Italians (56% vs 45.8%; p < 0.001). Among ethnic groups, Europeans and Latin Americans reported a higher rate of preterm delivery (20.2% and 19%, respectively; p < 0.001). Latin Americans carried also a greater risk of fetal macrosomia (3.6%; p < 0.008), while the rate of very low birth weight was higher among Europeans and Africans (2% and 1.8%, respectively; p < 0.04). Conclusion Obstetricians should pay special attention to the potential disparities in pregnancy outcomes between immigrants and the native population. Future efforts should focus on reducing preterm delivery and glucose dysmetabolism among pregnant immigrants.
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Affiliation(s)
- Giuseppe Caruso
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Eleonora Marcoccia
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy.,Department of Experimental Medicine, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Miriam Candelieri
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Michele Carlo Schiavi
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Ilaria Zannini
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Seila Perrone
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Oriana Capri
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Giuseppina Perrone
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Paola Galoppi
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
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Perrone S, Brunelli R, Perrone G, Zannini I, Galoppi P, Di Giacomo S, Morozzi C, Pisciotta L, Stefanutti C. A successful term pregnancy with severe hypertriglyceridaemia and acute pancreatitis. Clinical management and review of the literature. ATHEROSCLEROSIS SUPP 2019; 40:117-121. [PMID: 31818441 DOI: 10.1016/j.atherosclerosissup.2019.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Acute hyperlipidaemic pancreatitis (HP) may develop in pregnancy in patients with genetic predisposition. There are no accepted guidelines for the management of this rare but life-threatening condition in pregnancy. Plasma exchange (PEX) was suggested as a suitable option to treat HP in pregnancy; however, further evidence from case reports/case series are needed. METHODS Three PEX procedures (2000 ml of plasma replaced with 5% albumin) were performed in one week in a pregnant patient at 25 weeks of gestational age with severe HP. Triglyceride related genes (LPL, APOA5, APOE, GPIHBP1, GPD1, LMF1, CREB3L3) were screened by DNA sequencing. Medline and Embase databases were searched electronically in January 2018 using different combinations of the relevant medical subject headings for "pancreatitis in pregnancy" and "therapeutic apheresis". RESULTS Gene profiling assessed a combined heterozygous state for the variants pSer19Trp of the APOA5 gene and pCys130Arg of the APOE (allele E4) gene. PEX led to significant and progressive reduction of triglyceride plasma levels along with cholesterol and C-reactive protein. Meanwhile a fast improvement of pregnant clinical condition was observed. This allowed the delivery at term of a healthy newborn without gestational complications. An outcome hardly achievable in patients managed exclusively by a pharmacological approach. CONCLUSIONS PEX led to a positive maternal outcome in absence of foetal and gestational complications in a case of severe HP in pregnancy. As clinical trials are lacking, case reports still represent the best way to reasonably implement clinical management of this rare but life-threatening disease.
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Affiliation(s)
- Seila Perrone
- Department of Gynaecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, "Umberto I" Hospital, Rome, Italy.
| | - Roberto Brunelli
- Department of Gynaecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, "Umberto I" Hospital, Rome, Italy
| | - Giuseppina Perrone
- Department of Gynaecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, "Umberto I" Hospital, Rome, Italy
| | - Ilaria Zannini
- Department of Gynaecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, "Umberto I" Hospital, Rome, Italy
| | - Paola Galoppi
- Department of Gynaecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, "Umberto I" Hospital, Rome, Italy
| | - Serafina Di Giacomo
- Extracorporeal Therapeutic Techniques Unit, Lipid Clinic and Atherosclerosis Prevention Centre, Immunohematology and Transfusion Medicine, Department of Molecular Medicine, "Sapienza" University of Rome, "Umberto I" Hospital, Rome, Italy
| | - Claudia Morozzi
- Extracorporeal Therapeutic Techniques Unit, Lipid Clinic and Atherosclerosis Prevention Centre, Immunohematology and Transfusion Medicine, Department of Molecular Medicine, "Sapienza" University of Rome, "Umberto I" Hospital, Rome, Italy
| | - Livia Pisciotta
- Child Neuropsychiatry Unit, Institute Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Children's Sciences, University of Genoa, Genoa, Italy
| | - Claudia Stefanutti
- Extracorporeal Therapeutic Techniques Unit, Lipid Clinic and Atherosclerosis Prevention Centre, Immunohematology and Transfusion Medicine, Department of Molecular Medicine, "Sapienza" University of Rome, "Umberto I" Hospital, Rome, Italy
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Perrone S, Perrone G, Brunelli R, Di Giacomo S, Galoppi P, Flammini G, Morozzi C, Stefanutti C. A complicated pregnancy in homozygous familial hypercholesterolaemia treated with lipoprotein apheresis: A case report. ATHEROSCLEROSIS SUPP 2019; 40:113-116. [PMID: 31818440 DOI: 10.1016/j.atherosclerosissup.2019.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS During pregnancy total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) levels increase significantly and lipoprotein apheresis (LA) is considered the most effective therapy in homozygous familial hypercholesterolaemia (HoFH) for modulating lipid and lipoprotein levels and reducing maternal and foetal complications. CLINICAL CASE A primigravida 28 years old Caucasian female patient, previously diagnosed as to be HoFH, was admitted at our outpatient service at the beginning of pregnancy. METHODS The patient was continuously submitted to LA every two weeks without foetal complication. During pregnancy two methods have been utilised: selective apheresis, and later plasma exchange. At 33 weeks gestational age the patient developed progressively hypertension, associated to LDL-C levels increase. Weekly LA was favoured. RESULTS At 34 weeks +5 days patient suddenly experienced acute chest pain and abnormal electrocardiogram heart tracing and cardiac enzymes increase. An emergency caesarean section was performed without complications and the foetus was healthy. The patient was immediately transferred to Coronary Intensive Care Unit, where she was diagnosed non-ST elevation myocardial infarction (NSTEMI). Notwithstanding the patient improved in few days and was quickly discharged in fair clinical condition. CONCLUSIONS LA is a safe and effective tool in HoFH subjects even in pregnancy. Evidence based guidelines for the management of these patients during pregnancy are still lacking.
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Affiliation(s)
- Seila Perrone
- Department of Gynaecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, "Umberto I" Hospital, Rome, Italy
| | - Giuseppina Perrone
- Department of Gynaecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, "Umberto I" Hospital, Rome, Italy.
| | - Roberto Brunelli
- Department of Gynaecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, "Umberto I" Hospital, Rome, Italy
| | - Serafina Di Giacomo
- Extracorporeal Therapeutic Techniques Unit, Lipid Clinic and Atherosclerosis Prevention Centre, Immunohaematology and Transfusion Medicine, Department of Molecular Medicine, "Sapienza" University of Rome, "Umberto I" Hospital, Rome, Italy
| | - Paola Galoppi
- Department of Gynaecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, "Umberto I" Hospital, Rome, Italy
| | - Guendalina Flammini
- Department of Gynaecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, "Umberto I" Hospital, Rome, Italy
| | - Claudia Morozzi
- Extracorporeal Therapeutic Techniques Unit, Lipid Clinic and Atherosclerosis Prevention Centre, Immunohaematology and Transfusion Medicine, Department of Molecular Medicine, "Sapienza" University of Rome, "Umberto I" Hospital, Rome, Italy
| | - Claudia Stefanutti
- Extracorporeal Therapeutic Techniques Unit, Lipid Clinic and Atherosclerosis Prevention Centre, Immunohaematology and Transfusion Medicine, Department of Molecular Medicine, "Sapienza" University of Rome, "Umberto I" Hospital, Rome, Italy
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Maneschi F, Perrone S, Di Lucia A, Ianiri P. Shock parameters and shock index during severe post-partum haemorrhage and implications for management: a clinical study. J OBSTET GYNAECOL 2019; 40:40-45. [PMID: 31303082 DOI: 10.1080/01443615.2019.1603210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this study was to report the association between shock severity, laboratory parameters and treatment in patients with severe post-partum haemorrhage (PPH) requiring the transfusion of ≥4 blood unit. Patients were divided into two groups: (1) conservative therapy and (2) emergency post-partum hysterectomy. The aggressive decision was always shared by two consultants. Out of 26,094 deliveries, severe PPH occurred in 34 (0.13%) women, emergency post-partum hysterectomy was required in 13 (0.05%), while 21 (0.08%) were treated conservatively. Grade of shock, shock index (SI) and the number of blood units transfused were significantly higher in the hysterectomy group. No statistically significant difference among the two groups was observed for haemoglobin and coagulation results. The severity of shock was associated with the therapeutic choice in the treatment of severe PPH. Therefore, grade of shock and SI should be taken into consideration by the leading obstetrician in the decision making process toward the emergency hysterectomy.Impact StatementWhat is already known on this subject? Primary post-partum haemorrhage (PPH) is the leading cause of maternal death in developing and industrialised countries. Emergency post-partum hysterectomy is considered a life-saving procedure performed when the women is experiencing a life-threatening haemorrhage.What the results of this study add? Therapeutic dichotomy between conservative and aggressive approach in severe PPH has not been defined, in particular emergency post-partum hysterectomy timing. Shock index (SI) has been proposed as an indicator of adverse maternal outcome. However, the association between shock parameters and advanced treatment modalities has not yet been reported. In our study, grade of shock, SI and the number of blood units transfused were significantly higher in the patients which needed hysterectomy suggesting that it may have a role in the decision making among conservative and aggressive treatment. No statistically significant difference was observed for haemoglobin and coagulation results.What the implications are of these findings for clinical practice and/or further research? Grade of shock and SI should be taken into consideration in the decision making process toward the emergency hysterectomy in severe PPH. The choice between conservative and aggressive treatment should be based on hemodynamic parameters that may represent, in more accurate way, the severity of blood loss. Nevertheless, these data need further confirmation in a larger study.
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Affiliation(s)
- Francesco Maneschi
- Gynecologic and Obstetrics Unit, San Giovanni Addolorata Hospital, Roma, Italy
| | - Seila Perrone
- Department of Gynecological Obstetrical and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Alessandra Di Lucia
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Palmiero Ianiri
- Obstetrics and Gynecologic Unit, S. Maria Goretti Hospital, Latina, Italy
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Ferreri A, Sassone M, Angelillo P, Zaja F, Re A, Spina M, Di Rocco A, Fabbri A, Stelitano C, Frezzato M, Rusconi C, Zambello R, Arcari A, Bertoldero G, De Lorenzo D, Volpetti S, Calimeri T, Perrone S, Cecchetti C, Ciceri F, Ponzoni M. LONG-TERM EFFICACY AND SAFETY OF LENALIDOMIDE MAINTENANCE IN PATIENTS WITH RELAPSED DIFFUSE LARGE B-CELL LYMPHOMA WHO ARE NOT ELIGIBLE FOR AUTOLOGOUS TRANSPLANTATION (ASCT). Hematol Oncol 2019. [DOI: 10.1002/hon.65_2630] [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: 11/09/2022]
Affiliation(s)
- A.J. Ferreri
- Lymphoma Unit; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - M.C. Sassone
- Lymphoma Unit; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - P. Angelillo
- Lymphoma Unit; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - F. Zaja
- SC Ematologia; Azienda Sanitaria Universitaria Integrata; Trieste Italy
| | - A. Re
- Division of Hematology; Spedali Civili; Brescia Italy
| | - M. Spina
- Oncologia; Centro di Riferimento Oncologico; Aviano Italy
| | - A. Di Rocco
- Division of Hematology; University ”La Sapienza”; Rome Italy
| | - A. Fabbri
- Division of Hematology; Azienda Ospedaliera Università Senese; Siena Italy
| | - C. Stelitano
- Division of Hematology; Azienda Ospedaliera Bianchi-Melacrino-Morelli; Reggio Calabria Italy
| | - M. Frezzato
- Division of Hematology; San Bortolo Hospital; Vicenza Italy
| | - C. Rusconi
- Division of Hematology; Niguarda Hospital; Milan Italy
| | - R. Zambello
- Division of Hematology; Azienda Ospedaliera di Padua; Padua Italy
| | - A. Arcari
- Department of Oncology and Hematology; Guglielmo da Saliceto Hospital; Piacenza Italy
| | - G. Bertoldero
- U.O. di Oncologia ed Ematologia Oncologica; Ospedale di Mirano; Mirano Italy
| | - D. De Lorenzo
- Lymphoma Unit; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - S. Volpetti
- Clinica Ematologia; Azienda Sanitaria Universitaria Integrata, DAME; Udine Italy
| | - T. Calimeri
- Lymphoma Unit; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - S. Perrone
- Lymphoma Unit; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - C. Cecchetti
- Lymphoma Unit; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - F. Ciceri
- Onco-Hematology; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - M. Ponzoni
- Pathology; IRCCS San Raffaele Scientific Institute; Milan Italy
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Ferreri AJ, Calimeri T, Conte G, Ponzoni M, Fallanca F, Cattaneo D, Scarano E, Flavio C, Sassone M, Foppoli M, Perrone S, Cecchetti C, Lopedote P, Gritti G, Castellino C, Verga L, Olcese F, Mazza R, Ciceri F, Bordignon C, Anzalone N, Corti A. R-CHOP PRECEDED BY ENGINEERED TUMOR NECROSIS FACTOR (TNF) IN RELAPSED OR REFRACTORY PRIMARY DIFFUSE LARGE B-CELL LYMPHOMA OF THE CNS (rPCNSL): FINAL RESULTS OF THE INGRID TRIAL. Hematol Oncol 2019. [DOI: 10.1002/hon.115_2629] [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: 11/09/2022]
Affiliation(s)
- A. J. Ferreri
- Lymphoma Unit; IRCCS Ospedale San Raffaele; Milano Italy
| | - T. Calimeri
- Lymphoma Unit; IRCCS Ospedale San Raffaele; Milano Italy
| | - G. Conte
- Neuroradiology Unit; IRCCS Ospedale San Raffaele; Milano Italy
| | - M. Ponzoni
- Pathology Unit; IRCCS Ospedale San Raffaele; Milano Italy
| | - F. Fallanca
- Nuclear Medicine; IRCCS Ospedale San Raffaele; Milano Italy
| | - D. Cattaneo
- Unit of Clinical Pharmacology; ASTT Fatebenefratelli Sacco University Hospital; Milano Italy
| | - E. Scarano
- Lymphoma Unit; IRCCS Ospedale San Raffaele; Milano Italy
| | - C. Flavio
- Tumor Biology and Vascular Targeting Unit; DIBIT-1, 3A1, Lab. 6, IRCCS Ospedale San Raffaele; Milano Italy
| | - M. Sassone
- Lymphoma Unit; IRCCS Ospedale San Raffaele; Milano Italy
| | - M. Foppoli
- Lymphoma Unit; IRCCS Ospedale San Raffaele; Milano Italy
| | - S. Perrone
- Lymphoma Unit; IRCCS Ospedale San Raffaele; Milano Italy
| | - C. Cecchetti
- Lymphoma Unit; IRCCS Ospedale San Raffaele; Milano Italy
| | - P. Lopedote
- Lymphoma Unit; IRCCS Ospedale San Raffaele; Milano Italy
| | - G. Gritti
- Hematology Unit; Ospedale Papa Giovanni XXIII; Bergamo Italy
| | - C. Castellino
- Unit of Hematology; Ospedale Santa Croce E Carle; Cuneo Italy
| | - L. Verga
- Division of Hematology; "S Gerardo" Hospital University of Milano-Bicocca; Monza Italy
| | - F. Olcese
- S.c.Oncologia-Ematologia, ASL5 Liguria; La Spezia Italy
| | - R. Mazza
- Operative Unit of Medical Oncology and Hematology; Humanitas Cancer Center; Milano Italy
| | - F. Ciceri
- Hematology and BMT Unit, Department of Onco-Hematology; IRCCS Ospedale San Raffaele; Milano Italy
| | | | - N. Anzalone
- Neuroradiology Unit; IRCCS Ospedale San Raffaele; Milano Italy
| | - A. Corti
- Tumor Biology and Vascular Targeting Unit; DIBIT-1, 3A1, Lab. 6, IRCCS Ospedale San Raffaele; Milano Italy
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Ferreri A, Sassone M, Miserocchi E, Govi S, Cecchetti C, Corti M, Calimeri T, Perrone S, Mappa S, Ponzoni M, Modorati G. INTRALESIONAL RITUXIMAB SUPPLEMENTED WITH AUTOLOGOUS SERUM IN RELAPSED CD20+ INDOLENT LYMPHOMAS OF THE CONJUNCTIVA: ACTIVITY AND SAFETY RESULTS OF THE “IRIS” TRIAL. Hematol Oncol 2019. [DOI: 10.1002/hon.137_2629] [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: 11/10/2022]
Affiliation(s)
- A.J. Ferreri
- Lymphoma Unit; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - M. Sassone
- Lymphoma Unit; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - E. Miserocchi
- Ophthalmology Unit; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - S. Govi
- Lymphoma Unit; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - C. Cecchetti
- Lymphoma Unit; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - M.E. Corti
- Pharmacy Unit; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - T. Calimeri
- Lymphoma Unit; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - S. Perrone
- Lymphoma Unit; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - S. Mappa
- Lymphoma Unit; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - M. Ponzoni
- Pathology Unit; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - G. Modorati
- Ophthalmology Unit; IRCCS San Raffaele Scientific Institute; Milan Italy
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Brunelli R, Perrone S, Perrone G, Galoppi P, De Stefano MG, Maragno AM, Cesarini M, De Carolis A, Masselli G, Vernia P. New-onset ulcerative colitis in pregnancy associated to toxic megacolon and sudden fetal decompensation: Case report and literature review. J Obstet Gynaecol Res 2019; 45:1215-1221. [PMID: 31064034 DOI: 10.1111/jog.13996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/13/2018] [Accepted: 04/14/2019] [Indexed: 12/15/2022]
Abstract
Ulcerative colitis (UC) is a chronic inflammatory disease rarely arising during gestation. Because the available information is based on case reports or small retrospective studies, diagnosis may be difficult and treatment is still controversial. A case of toxic megacolon developing in late pregnancy associated to a sudden fetal decompensation is described. Diagnostic and clinical topics of acute UC onset in pregnancy are debated.A primipara, 34 years old, 33/0 weeks of gestation, was admitted with a diagnosis of preterm labor, associated to acute bloody diarrhea (up to 10 daily motions) and cramping abdominal pain. A diagnosis of new-onset early-stage UC was made by sigmoidoscopy. An intensive care regimen including hydrocortisone, antibiotics and parenteral nutrition was immediately started. Magnetic resonance imaging of maternal abdomen, fostered by the worsening patient conditions, evidenced dilatation of the entire colon and a severely hampered of fetal muscular tone.Toxic megacolon complicated by superimposed Clostridium difficile infection was associated to a sudden fetal decompensation diagnosed by chance during maternal abdominal magnetic resonance imaging. An emergency cesarean section was mandatory. According to a senior surgeon's decision, total colectomy was not immediately performed following cesarean section with reference to the absence of colonic perforation. We obtained a good short-term maternal outcome and an uncomplicated neonatal course. Counseling of those patients must be focused on timely and multidisciplinary intervention in order to improve the course of maternal disease and to prevent fetal distress.
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Affiliation(s)
- Roberto Brunelli
- Department of Gynecological Obstetrical and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Seila Perrone
- Department of Gynecological Obstetrical and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Giuseppina Perrone
- Department of Gynecological Obstetrical and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Paola Galoppi
- Department of Gynecological Obstetrical and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Maria G De Stefano
- Department of Gynecological Obstetrical and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Anna M Maragno
- Department of Gynecological Obstetrical and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Monica Cesarini
- Division of Gastroenterology, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Aurora De Carolis
- Division of Gastroenterology, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Gabriele Masselli
- Radiology Dea Department, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Piero Vernia
- Division of Gastroenterology, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
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9
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D'Ambrosio V, Vena F, Marchetti C, Di Mascio D, Perrone S, Boccherini C, Pizzuti A, Benedetti Panici P, Giancotti A. Midtrimester isolated short femur and perinatal outcomes: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2018; 98:11-17. [PMID: 30252939 DOI: 10.1111/aogs.13470] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 07/09/2018] [Accepted: 09/17/2018] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Fetal femur length below the expected value has been described as a marker of aneuploidy, skeletal dysplasia, intrauterine growth restriction and small-for-gestational-age neonate. The aim of this systematic review and meta-analysis was to evaluate the strength of association between isolated short femur length and intrauterine growth restriction or small-for-gestational-age, and perinatal adverse outcomes. MATERIAL AND METHODS PubMed, EMBASE and Medline were searched from the inception of each database to May 2018. Selection criteria included prospective and retrospective cohort studies of singleton pregnancies between 18 and 28 weeks of gestation, with sonographic finding of isolated short femur length, without any structural chromosomal abnormality. The meta-analysis was performed by computing odds ratios using both fixed and random-effects models. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale. RESULTS Six studies including 3078 cases of isolated short femur length (study group) and 222 303 normal femur length (control group) were included. The prevalence of intrauterine growth restriction or small-for-gestational-age in the study group was 14.2%, compared with 5.2% in the control group (odds ratio of 4.04, 95% confidence interval 3.63-4.50). Isolated short femur length was associated with a higher incidence of low birthweight (study group: 22.10% vs control group: 8.57%, odds ratio 3.24, 95% confidence interval 2.34-4.48), Apgar <7 at 5 minutes (study group: 3.98% vs control group: 1.79%, odds ratio 3.56, 95% confidence interval 1.87-6.77), preterm birth (study group: 12.16% vs control group: 8.16%, odds ratio 3.09, 95% confidence interval 1.57-6.08), fetal death (study group: 1.83% vs control group: 0.44%, odds ratio 6.48, 95% confidence interval 3.70-11.35) and neonatal intensive care unit admission (study group: 15.34% vs control group: 14.81%, odds ratio 2.11, 95% confidence interval 0.56-7.93). CONCLUSIONS There is a significant association between isolated short femur length and intrauterine growth restriction or small-for-gestational-age and poor perinatal outcome.
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Affiliation(s)
- Valentina D'Ambrosio
- Department of Gynecological, Obstetrical and Urological Sciences, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy.,Department of Experimental Medicine, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Flaminia Vena
- Department of Gynecological, Obstetrical and Urological Sciences, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Claudia Marchetti
- Department of Gynecological, Obstetrical and Urological Sciences, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Daniele Di Mascio
- Department of Gynecological, Obstetrical and Urological Sciences, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Seila Perrone
- Department of Gynecological, Obstetrical and Urological Sciences, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Chiara Boccherini
- Department of Gynecological, Obstetrical and Urological Sciences, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Antonio Pizzuti
- Department of Experimental Medicine, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Gynecological, Obstetrical and Urological Sciences, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Antonella Giancotti
- Department of Gynecological, Obstetrical and Urological Sciences, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
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Perrone S, Pallavicini EB, Tacconi F, Inzoli A, Malingher A, Bianchessi C, Sbalzarini G, Signaroldi A, Zanaletti F, Rovej R, Scanni A. Oxaliplatin in Hepatic Arterial Infusion (Hai) and Systemic Chemotherapy with Leucovorin plus 5-fluorouracil in Metastatic Colorectal Cancer Preliminary Data of a Multicenter Study. Tumori 2018. [DOI: 10.1177/030089160208800464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- S Perrone
- Ospedale Fatebenefratelli-Oftalmico, Milan, Italy
| | | | | | | | | | | | | | | | | | - R Rovej
- Ospedale Fatebenefratelli-Oftalmico, Milan, Italy
| | - A Scanni
- Ospedale Fatebenefratelli-Oftalmico, Milan, Italy
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11
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Ballarini C, Intra M, Ceretti AP, Prestipino F, Bianchi FM, Sparacio F, Berti E, Perrone S, Silva F. Gastrointestinal Stromal Tumors: A “Benign” Tumor with Hepatic Metastasis after 11 Years. Tumori 2018; 84:78-81. [PMID: 9619721 DOI: 10.1177/030089169808400117] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gastrointestinal stromal tumors (GIST) constitue the largest category of primary non-epithelial neoplasms of the stomach and small bowel. They are characterized by a remarkable cellular variability and their malignant potential is sometimes difficult to predict. Very recent studies, using mitotic count and tumor size as the best determinants of biological behavior, divide GISTs into three groups: benign, borderline and malignant tumors. We report on a male patient who underwent a right hepatectomy for a large metastasis 11 years after the surgical treatment of an antral-pyloric gastric neoplasm, histologically defined as leiomyoblastoma and with clinical, morphological and immunohistochemical features of benignity (low mitotic count, tumor size < 5 cm, low cellular proliferation index). Histological and immunohistochemical analysis of the hepatic metastasis showed the cellular proliferation index (Ki-67) to be positive in 25% of neoplastic cells, as opposed to the primary gastric tumor in which Ki-67 was positive in only 5% of neoplastic cells. In conclusion, although modern immunohistochemical techniques are now available to obtain useful prognostic information, the malignant potential of GISTs is sometimes difficult to predict: neoplasms clinically and histologically defined as benign could metastasize a long time after oncologically correct surgical treatment. Therefore, benign GISTs also require consistent, long-term follow-up.
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Affiliation(s)
- C Ballarini
- Seconda Divisione di Chirurgia, Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milan, Italy
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12
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Tomirotti M, Perrone S, Giè P, Canaletti R, Carpi A, Biasoli R, Lombardi F, Giovanninetti A, Mensi F, Villa S. Cisplatin (P) versus Cyclophosphamide, Adriamycin and Cisplatin (CAP) for Stage III-IV Epithelial Ovarian Carcinoma: A Prospective Randomized Trial. Tumori 2018; 74:573-7. [PMID: 3217992 DOI: 10.1177/030089168807400514] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 1982 a randomized trial was started to compare a cisplatin-containing polychemotherapy (CAP: cyclophosphamide - CPA 750 mg/m2, adriamycin - ADM 50 mg/m2, cisplatin - P 50 mg/m2 on day 1 every 21 days) with full-dose cisplatin as single agent (P 60 mg/m2/day on days 1 and 2 every 28 days) in 44 patients undergoing exploratory laparotomy or debulking sugery for stage III-IV epithelial ovarian carcinoma with residual disease > 5 cm. The response was evaluated at second-look surgery with random biopsies and peritoneal washing. On the basis of the final results the authors underline some data which, although merely indicative (because of the small number of patients) appear to be worth considering since they are in accordance with the latest reports: a) similar response rate (CR+PR=47%) to first-line treatment in the two groups; b) the CAP treatment may achieve a longer median duration of CRs than the P treatment (20 versus 11 months); c) overall survival seems similar in the two groups of patients (19 versus 18 months), whereas the survival of CRs seems longer in the CAP treated patients (> 32 versus 25 months). The authors also discuss some observations on a possible salvage therapy.
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Affiliation(s)
- M Tomirotti
- Servizio di Oncologia Medica e Chemioterapia, Ospedale Fatebenefratelli e Oftalmico, Milano, Italia
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13
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Lucchi L, Fiore GB, Guadagni G, Perrone S, Malaguti V, Caruso F, Fumero R, Albertazzi A. Clinical Evaluation of Internal Hemodiafiltration (iHDF): A Diffusive-Convective Technique Performed with Internal Filtration Enhanced High-Flux Dialyzers. Int J Artif Organs 2018; 27:414-9. [PMID: 15202820 DOI: 10.1177/039139880402700511] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim Efficiency in removing middle molecules such as ß2-microglobulin (ß2-MG) is one of the main purposes of modern dialytic therapy. In order to achieve this, techniques requiring complex machines and substitution fluid have been developed over recent years. Alternatively, the internal filtration / back filtration phenomenon can be used. The recent development of a so-called “internal filtration enhanced dialyser” prompted us to compare the removal of ß2-MG together with other small molecules when the dialyser was used either in standard hemodiafiltration (HDF) or internal hemodiafiltration (iHDF). Methods Ten stable, anuric, hemodialysis (HD) patients treated by thrice weekly standard bicarbonate HD using low-flux synthetic membrane entered the study. A new high-flux polysulfone dialyser designed with the specific aim of enhancing internal filtration (BS-1.6 UL, 1.6 m2, Toray Industries) was used. Post dilution HDF (2.5 l/hour of substitution fluid, dialysate flow 500 ml/min) was compared with iHDF (dialysate flow 750 ml/min), with blood flow at 300 ml/min. Samples were obtained at the start and at the end of the session in order to measure the % removal of urea, creatinine, uric acid, phosphate and ß2-MG (corrected for total protein concentration). In addition, after 20 min of dialysis the clearances of the same molecules were measured. A mathematical model has been developed for the description of the hydrodynamic phenomena taking place within the dialyser and of fluid filtration across the membrane. Results No significant differences have been observed in removal rate switching from HDF to iHDF except for ß2-MG removal, which was slightly higher in HDF than in iHDF. Phosphate clearance is significantly higher than those obtained with creatinine in both HDF (p<0.005) and iHDF (p<0.01) modalities. The total convection calculated with the model is reduced with respect to HDF only by 24% (4100 ml/h vs. 5400 ml/h on the average). Conclusions iHDF is a high flux dialysis method, which, if performed with a dialyser designed to enhance internal filtration, obtains a much higher removal rate in comparison with dialysers in traditional high flux dialysis, as previously reported in the literature. Provided that the dialyser is used on a dialysis machine working with ultra pure dialysate and UF control, this dialyser line can perform reliable internal HDF without the need for replacement solution. Considering the narrow difference in performance observed between iHDF and HDF, and the increasing number (and age) of patients leading to higher dialysis costs, iHDF represents a cost-effective alternative to other diffusive-convective techniques.
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Affiliation(s)
- L Lucchi
- Department of Internal Medicine, Division of Nephrology and Dialysis, University Hospital, Modena, Italy.
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14
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Calimeri T, Lopedote P, Repetto M, Vignati A, Sassone M, Cecchetti C, Perrone S, Foppoli M, Ciboddo G, Girlanda S, Peccatori J, Chiara A, Memoli M, Ferreri A. Safety and tolerability of chemotherapy (CT) containing high doses of methotrexate (HD-MTX) and cytarabine (Ara-C) in patients with primary central nervous system lymphoma (PCNSL) and hepatitis B virus (HBV) infection. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx373.028] [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] Open
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15
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Ferreri A, Cecchetti C, Kiesewetter B, Sassone M, Calimeri T, Perrone S, Ponzoni M, Raderer M. CLARITHROMYCIN AS a “REPURPOSING DRUG” AGAINST LYMPHOMAS: SAFETY AND EFFICACY PROFILES IN 55 PATIENTS WITH EXTRANODAL MARGINAL ZONE LYMPHOMA (EMZL). Hematol Oncol 2017. [DOI: 10.1002/hon.2437_74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A.J. Ferreri
- Onco-Hematology; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - C. Cecchetti
- Onco-Hematology; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - B. Kiesewetter
- Dept. of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - M. Sassone
- Onco-Hematology; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - T. Calimeri
- Onco-Hematology; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - S. Perrone
- Onco-Hematology; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - M. Ponzoni
- Onco-Hematology; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - M. Raderer
- Dept. of Internal Medicine I; Medical University of Vienna; Vienna Austria
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16
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Ferreri A, Calimeri T, Cecchetti C, Vignati A, Sassone M, Perrone S, Girlanda S, Ponzoni M, Foppoli M. Prophylaxis with high-dose methotrexate significantly reduces CNS dissemination in patients with diffuse large B-cell lymphoma (DLBCL) and high-risk CNS-IPI score. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_60] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- A.J. Ferreri
- Onco-Hematology; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - T. Calimeri
- Onco-Hematology; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - C. Cecchetti
- Onco-Hematology; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - A. Vignati
- Onco-Hematology; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - M. Sassone
- Onco-Hematology; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - S. Perrone
- Onco-Hematology; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - S. Girlanda
- Onco-Hematology; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - M. Ponzoni
- Onco-Hematology; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - M. Foppoli
- Onco-Hematology; IRCCS San Raffaele Scientific Institute; Milan Italy
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17
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Negro S, Boutsikou T, Briana DD, Tataranno ML, Longini M, Proietti F, Bazzini F, Dani C, Malamitsi-Puchner A, Buonocore G, Perrone S. Maternal obesity and perinatal oxidative stress: the strength of the association. J BIOL REG HOMEOS AG 2017; 31:221-227. [PMID: 28337896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Maternal obesity is a chronic inflammatory state, which has been shown to induce increased levels of free fatty acids, reactive oxygen species and inflammatory cells. Recent evidence reveals increased levels of lipid peroxidation products in the plasma of obese women during pregnancy. The aim of this study was to test the hypothesis that maternal overweight or obesity is associated with increased oxidative stress (OS) in offspring. Two hundred and forty-five pregnant women and their newborns were prospectively enrolled. Mothers were divided in two groups: lean control - LC (n=175, Group I); overweight or obese (n=70, Group II) according to BMI ≥ 25 before pregnancy. Cord blood F2-isoprostanes (F2-IsoPs), as reliable markers of OS, were measured in all newborns. Lower 1 minute APGAR score and higher weight at discharge were found in Group II neonates, compared to those of Group I (p less than 0.05). Small for gestational age (SGA) newborns of both groups showed increased levels of F2-IsoPs than appropriate (AGA) or large (LGA) for gestational age (GA) (p less than 0.01). SGA newborns of Group II had higher F2-IsoPs levels compared to SGA of Group I (p less than 0.01), which were significantly correlated to maternal BMI at the end of pregnancy (r=0.451, p less than 0.01). Multivariate regression analysis corrected for confounding factors, showed that maternal overweight or obesity was significantly associated with high F2-IsoPs levels in SGA offspring (p less than 0.01). Maternal overweight or obesity is associated with increased OS in their SGA newborns. Data suggest the need of antioxidant protection for both mothers during pregnancy and infants soon after birth.
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Affiliation(s)
- S Negro
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - T Boutsikou
- Department of Neonatology, Aretaieion University Hospital, University of Athens, Greece
| | - D D Briana
- Department of Neonatology, Aretaieion University Hospital, University of Athens, Greece
| | - M L Tataranno
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - M Longini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - F Proietti
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - F Bazzini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - C Dani
- Neonatal Intensive Care Unit, University of Florence, Florence, Italy
| | - A Malamitsi-Puchner
- Department of Neonatology, Aretaieion University Hospital, University of Athens, Greece
| | - G Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - S Perrone
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Maneschi F, Biccirè D, Santangelo G, Perrone S, Scaini A, Cosentino C. Implementation of the Four-Category Classification of Cesarean Section Urgency in Clinical Practice. A Prospective Study. Gynecol Obstet Invest 2016; 82:371-375. [PMID: 27684889 DOI: 10.1159/000449159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 08/16/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE This study is aimed at investigating the clinical efficacy of the 4-category classification of urgent cesarean section. METHODS Women giving birth from September 2012 to December 2014 were prospectively investigated. Urgency C-section categories were color-coded: red - maternal/fetal life threat; yellow - maternal/fetal compromise, not life-threatening; and green - early delivery necessary. Results were audited. RESULTS A total of 4,754 women gave birth in the period considered, 1,313 (27.6%) with C-section of which 867 were urgent. The code was red in 0.98% of women, and 91.5% of newborns were delivered ≤30'; yellow in 5.1%; and green in 11.7%. The mean decision-to-delivery interval (DDI) ± SD was 19.6 ± 9.5 min, 36.6 ± 15.3 (p < 0.01), and 80.3 ± 52.8 (p < 0.01), respectively; and mean umbilical pH was 7.24 ± 0.10, 7.29 ± 0.08 (p < 0.05), and 7.33 ± 0.04 (p < 0.01) in the red, yellow, and green groups, respectively. Two (4.2%) red and 4 (2.2%) yellow newborns were acidotic. Mean DDI ± SD decreased from 21.7 ± 9.7 min in the period September 2012 to February 2013 to 17.4 ± 9.7 min in the period February to December 2014 (p = NS). CONCLUSIONS Four-category classification led to achieving the target time in >90% of category 1 emergency C-sections, and stratified newborns with significantly different acidosis levels.
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Proietti F, De Bernardo G, Longini M, Sordino D, Scaramuzzini G, Tataranno ML, Belvisi E, Bazzini F, Perrone S, Buonocore G. Neonatal oxidative stress depends on oxygen blood pressure in umbilical artery. J BIOL REG HOMEOS AG 2016; 30:929-934. [PMID: 27655523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
With advancing gestation, partial pressure of oxygen (pO2) and pH fall significantly. Hypoxia is a main factor inducing free radical generation and thereby oxidative stress (OS). Placental and fetal tissue response when oxygen becomes restricted is complex and partially known. We tested the hypothesis that changes in umbilical artery and vein blood gas concentrations modulate OS occurrence in the newborn. Seventy umbilical artery and vein plasma samples were collected from healthy term newborns immediately after delivery. F2 Isoprostanes (F2-Isop) were measured in all samples as reliable markers of lipid peroxidation. Significantly lower pCO2 and higher pO2 and pH were found in umbilical vein than in artery, as expected. A positive correlation was detected between pH and pO2 only in umbilical artery (p=0.019). F2-Isop levels were no different between artery and vein in cord blood. Significant correlations were found between F2-Isop and pCO2 (p=0.025) as well as between F2-Isop and pH in umbilical vein (p=0.027). F2-Isop correlated with pCO2 (p=0.007) as well as with pO2 values (p=0.005) in umbilical artery blood. Oxidative stress (OS) in newborns depends on oxygen concentrations in umbilical artery. OS biomarkers significantly correlate with pO2 and in umbilical artery but not in umbilical vein. In normoxic conditions fetal-maternal gas exchanges occurring in placenta re-establish normal higher oxygen levels in umbilical vein than artery, with a normal production of free radicals without any deleterious effects.
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Affiliation(s)
- F Proietti
- Department of Molecular and Developmental Medicine, University of Siena, Italy
| | - G De Bernardo
- Department of Emergency UOC TIN-Neonatology AORN Santobono-Pausilipon Naples, Italy
| | - M Longini
- Department of Molecular and Developmental Medicine, University of Siena, Italy
| | - D Sordino
- Department of Emergency UOC TIN-Neonatology AORN Santobono-Pausilipon Naples, Italy
| | - G Scaramuzzini
- Neonatology and Obstetrics Nursing C.G. Ruesch, Naples, Italy
| | - M L Tataranno
- Department of Molecular and Developmental Medicine, University of Siena, Italy
| | - E Belvisi
- Department of Molecular and Developmental Medicine, University of Siena, Italy
| | - F Bazzini
- Department of Molecular and Developmental Medicine, University of Siena, Italy
| | - S Perrone
- Department of Molecular and Developmental Medicine, University of Siena, Italy
| | - G Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, Italy
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Gregorietti V, Perrone S, Machain A, Gamboa R, Tajer C, Estevez A, Aimone D, Sarmiento R. PS162 Integrating Pro-Bnp and Pedometer to the 6MWT in Patients With PH in Public Hospital Center of Argentina. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.138] [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: 10/21/2022] Open
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21
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Timperi E, Folgori L, Amodio D, De Luca M, Chiurchiù S, Piconese S, Di Cesare S, Pacella I, Martire C, Bonatti G, Perrone S, Boni T, Marcovecchio GE, Reale A, Parisi F, Dotta A, Barnaba V, Rossi P. Expansion of activated regulatory T cells inversely correlates with clinical severity in septic neonates. J Allergy Clin Immunol 2016; 137:1617-1620.e6. [PMID: 26792206 DOI: 10.1016/j.jaci.2015.10.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/01/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Eleonora Timperi
- Department of Internal Medicine and Medical Specialties, "Sapienza" Università di Roma, Policlinico Umberto I, Rome, Italy
| | - Laura Folgori
- University Department of Pediatrics, Bambino Gesù Children's Hospital, University of Rome "Tor Vergata," Rome, Italy
| | - Donato Amodio
- University Department of Pediatrics, Bambino Gesù Children's Hospital, University of Rome "Tor Vergata," Rome, Italy
| | - Maia De Luca
- University Department of Pediatrics, Bambino Gesù Children's Hospital, University of Rome "Tor Vergata," Rome, Italy
| | - Sara Chiurchiù
- University Department of Pediatrics, Bambino Gesù Children's Hospital, University of Rome "Tor Vergata," Rome, Italy
| | - Silvia Piconese
- Department of Internal Medicine and Medical Specialties, "Sapienza" Università di Roma, Policlinico Umberto I, Rome, Italy; Pasteur Institute-Cenci Bolognetti Foundation, Rome, Italy
| | - Silvia Di Cesare
- University Department of Pediatrics, Bambino Gesù Children's Hospital, University of Rome "Tor Vergata," Rome, Italy
| | - Ilenia Pacella
- Department of Internal Medicine and Medical Specialties, "Sapienza" Università di Roma, Policlinico Umberto I, Rome, Italy
| | - Carmela Martire
- Department of Internal Medicine and Medical Specialties, "Sapienza" Università di Roma, Policlinico Umberto I, Rome, Italy
| | - Giulia Bonatti
- University Department of Pediatrics, Bambino Gesù Children's Hospital, University of Rome "Tor Vergata," Rome, Italy
| | - Seila Perrone
- Department of Gynecological Obstetrics Sciences and Urological Sciences, "Sapienza" Università di Roma, Policlinico Umberto I, Rome, Italy
| | - Terenzio Boni
- Department of Gynecological Obstetrics Sciences and Urological Sciences, "Sapienza" Università di Roma, Policlinico Umberto I, Rome, Italy
| | - Genni Enza Marcovecchio
- University Department of Pediatrics, Bambino Gesù Children's Hospital, University of Rome "Tor Vergata," Rome, Italy
| | - Antonino Reale
- Emergency Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Parisi
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Vincenzo Barnaba
- Department of Internal Medicine and Medical Specialties, "Sapienza" Università di Roma, Policlinico Umberto I, Rome, Italy; Pasteur Institute-Cenci Bolognetti Foundation, Rome, Italy.
| | - Paolo Rossi
- University Department of Pediatrics, Bambino Gesù Children's Hospital, University of Rome "Tor Vergata," Rome, Italy.
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Maneschi F, Algieri M, Perrone S, Nale R, Sarno M. Cesarean 10-group classification: a tool for clinical management of the delivery ward. Minerva Ginecol 2015; 67:389-395. [PMID: 25588138] [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: 06/04/2023]
Abstract
AIM Aim of the present study was to evaluate 10-group Robson classification for delivery ward clinical management. METHODS To evaluate cesarean section (C-section) rate following the implementation firstly of recommendations, and then of 10-group reporting and medical audit, a retrospective cohort study was performed including all women who gave birth in the years 2001, 2006 and 2010. Data were analyzed by means of 10-group classification. RESULTS C-section rate was 27.5% in 2001, 31.1% in 2006, and 30.5% in 2010. Ten-group analysis showed that from 2001 to 2006 group 1-2 size increased from 27.6% to 42.5% (P<0.01), and contribution to the overall cesarean rate from 22.3% to 29.9% (P<0.01), whereas the group 1 C-section sub-rate was reduced from 19.6% to 13.5% (P<0.05). Previous cesarean increased from 9.2% to 11.6% (P<0.05). Delivery ward 10-group monitoring showed that from January to May 2010 the C-section rate was consistently above 30%. The audit was started and the causes were analyzed. Subsequently, C-section rate dropped to the actual 30.5%. CONCLUSION Ten-group analysis showed that the 2006 cesarean rate increase was related to a significant shift in obstetric population toward groups 5 to 9 at higher risk of C-section, whereas after recommendation implementation a significant reduction of C-section subrates was observed in groups 1, 2a, 3, 4a, and 10 which represented more than 80% of the hospital population. In 2010, 10-group monitoring of the cesarean subrates stabilized the C-section rate. Ten-group analysis should be implemented in clinical practice to control delivery ward clinical management. It only requires the involvement of a clinical manager and of a midwife for data collection.
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Affiliation(s)
- F Maneschi
- Division of Obstetrics and Gynecology, Santa Maria Goretti Hospital, Latina, Italy -
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23
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Tataranno ML, Oei JL, Perrone S, Wright IM, Smyth JP, Lui K, Tarnow-Mordi WO, Longini M, Proietti F, Negro S, Saugstad OD, Buonocore G. Resuscitating preterm infants with 100% oxygen is associated with higher oxidative stress than room air. Acta Paediatr 2015; 104:759-65. [PMID: 25966608 DOI: 10.1111/apa.13039] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 01/24/2015] [Accepted: 04/17/2015] [Indexed: 11/26/2022]
Abstract
AIM The starting fraction of inspired oxygen for preterm resuscitation is a matter of debate, and the use of room air in full-term asphyxiated infants reduces oxidative stress. This study compared oxidative stress in preterm infants randomised for resuscitation with either 100% oxygen or room air titrated to internationally recommended levels of preductal oxygen saturations. METHODS Blood was collected at birth, two and 12 hours of age from 119 infants <32 weeks of gestation randomised to resuscitation with either 100% oxygen (n = 60) or room air (n = 59). Oxidative stress markers, including advanced oxidative protein products (AOPP) and isoprostanes (IsoP), were measured with high-performance liquid chromatography and mass spectrometry. RESULTS Significantly higher levels of AOPP were found at 12 hours in the 100% oxygen group (p < 0.05). Increases between two- and 12-hour AOPP (p = 0.004) and IsoP (p = 0.032) concentrations were significantly higher in the 100% oxygen group. CONCLUSION Initial resuscitation with room air versus 100% oxygen was associated with lower protein oxidation at 12 hour and a lower magnitude of increase in AOPP and IsoP levels between two and 12 hours of life. Correlations with clinical outcomes will be vital to optimise the use of oxygen in preterm resuscitation.
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Affiliation(s)
- ML Tataranno
- Department of Molecular and Developmental Medicine; University of Siena; Siena Italy
| | - JL Oei
- School of Women's and Children's Health; University of New South Wales; Sydney NSW Australia
- Department of Newborn Care; The Royal Hospital for Women; Randwick NSW Australia
| | - S Perrone
- Department of Molecular and Developmental Medicine; University of Siena; Siena Italy
| | - IM Wright
- School of Paediatrics; University of Wollongong; Wollongong NSW Australia
| | - JP Smyth
- School of Women's and Children's Health; University of New South Wales; Sydney NSW Australia
- Department of Newborn Care; The Royal Hospital for Women; Randwick NSW Australia
| | - K Lui
- School of Women's and Children's Health; University of New South Wales; Sydney NSW Australia
- Department of Newborn Care; The Royal Hospital for Women; Randwick NSW Australia
| | - WO Tarnow-Mordi
- Australia Westmead International Network for Neonatal Education and Research; The University of Sydney; Camperdown NSW Australia
| | - M Longini
- Department of Molecular and Developmental Medicine; University of Siena; Siena Italy
| | - F Proietti
- Department of Molecular and Developmental Medicine; University of Siena; Siena Italy
| | - S Negro
- Department of Molecular and Developmental Medicine; University of Siena; Siena Italy
| | - OD Saugstad
- Department of Pediatric Research; Oslo University Hospital; University of Oslo; Oslo Norway
| | - G Buonocore
- Department of Molecular and Developmental Medicine; University of Siena; Siena Italy
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Iori A, Ferretti A, Gentile G, Gabrielli S, Perrone S, Barberi W, Torelli G, Natalino F, Scalzulli E, Totino V, Foà R, Cancrini G, Girmenia C. Strongyloides stercoralisinfection in allogeneic stem cell transplant: a case report and review of the literature. Transpl Infect Dis 2014; 16:625-30. [DOI: 10.1111/tid.12239] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 01/31/2014] [Accepted: 02/18/2014] [Indexed: 11/27/2022]
Affiliation(s)
- A.P. Iori
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa; Azienda Policlinico Umberto I; Sapienza University; Rome Italy
| | - A. Ferretti
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa; Azienda Policlinico Umberto I; Sapienza University; Rome Italy
| | - G. Gentile
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa; Azienda Policlinico Umberto I; Sapienza University; Rome Italy
| | - S. Gabrielli
- Dipartimento di Sanità Pubblica e Malattie Infettive; Azienda Policlinico Umberto I; Sapienza University; Rome Italy
| | - S. Perrone
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa; Azienda Policlinico Umberto I; Sapienza University; Rome Italy
| | - W. Barberi
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa; Azienda Policlinico Umberto I; Sapienza University; Rome Italy
| | - G.F. Torelli
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa; Azienda Policlinico Umberto I; Sapienza University; Rome Italy
| | - F. Natalino
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa; Azienda Policlinico Umberto I; Sapienza University; Rome Italy
| | - E. Scalzulli
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa; Azienda Policlinico Umberto I; Sapienza University; Rome Italy
| | - V. Totino
- Dipartimento di Sanità Pubblica e Malattie Infettive; Azienda Policlinico Umberto I; Sapienza University; Rome Italy
| | - R. Foà
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa; Azienda Policlinico Umberto I; Sapienza University; Rome Italy
| | - G. Cancrini
- Dipartimento di Sanità Pubblica e Malattie Infettive; Azienda Policlinico Umberto I; Sapienza University; Rome Italy
| | - C. Girmenia
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa; Azienda Policlinico Umberto I; Sapienza University; Rome Italy
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25
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Gatti M, Perrone S, Badii S, Becucci E, Turrisi G, Alagna M, Giacchi E, Buonocore G. LONG TERM NEURODEVELOPMENTAL OUTCOME IN A COHORT OF PRETERM INFANTS BORN AT GESTATIONAL AGE <32 WEEKS. ACTA ACUST UNITED AC 2013. [DOI: 10.4081/jsas.2013.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Anichini C, Lotti F, Longini M, Proietti F, Felici C, Perrone S, Buonocore G. Antioxidant effects of potassium ascorbate with ribose therapy in a case with Prader Willi Syndrome. Dis Markers 2013; 33:179-83. [PMID: 22960339 PMCID: PMC3810693 DOI: 10.3233/dma-2012-0922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Oxidative stress (OS) is involved in several human diseases, including obesity, diabetes, atherosclerosis, carcinogenesis, as well as genetic diseases. We previously found that OS occurs in Down Syndrome as well as in Beckwith-Wiedemann Syndrome (BWS). Here we describe the clinical case of a female patient with Prader Willi Syndrome (PWS), a genomic imprinting disorder, characterized by obesity, atherosclerosis and diabetes mellitus type 2, pathologies in which a continuous and important production of free radicals takes place. We verified the presence of OS by measuring a redox biomarkers profile including total hydroperoxides (TH), non protein-bound iron (NPBI), thiols (SH), advanced oxidation protein products (AOPP) and isoprostanes (IPs). Thus we introduced in therapy an antioxidant agent, namely potassium ascorbate with ribose (PAR), in addition to GH therapy and we monitored the redox biomarkers profile for four years. A progressive decrease in OS biomarkers occurred until their normalization. In the meantime a weight loss was observed together with a steady growth in standards for age and sex.
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Affiliation(s)
- C Anichini
- Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy
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Balduini W, Carloni S, Perrone S, Bertrando S, Tataranno M, Negro S, Proietti F, Longini M, Buonocore G. The use of melatonin in hypoxic-ischemic brain damage: an experimental study. J Matern Fetal Neonatal Med 2012; 25 Suppl 1:119-24. [DOI: 10.3109/14767058.2012.663232] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Buonocore G, Turrisi G, Kramer BW, Balduini W, Perrone S. New Pharmacological Approaches in Infants with Hypoxic-Ischemic Encephalopathy. Curr Pharm Des 2012:CPD-EPUB-20120227-019. [PMID: 22385055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Accepted: 12/20/2011] [Indexed: 05/31/2023]
Abstract
New knowledge of the pathophysiology and evolution of hypoxic-ischemic brain injuries has made feasible interventions to improve clinical outcomes for newborns surviving birth asphyxia. Brain injury following hypoxic-ischemic insult is a complex process evolving over hours to days, which provides a unique window of opportunity for neuroprotective treatment interventions. The specific pathologic processes preceding the onset of irreversible cerebral injury appear to be a combination of several mechanisms that are variable according to the severity and duration of the insult and to biochemical modifications in the brain. Advances in neuroimaging, brain monitoring techniques, and tissue biomarkers have improved the ability to diagnose, monitor, and care for newborn infants with neonatal encephalopathy, as well as to predict their outcome. The role of oxidative stress in newborn morbidity with respect to the higher risk of free radical damage in these babies is growing. However, challenges remain in early identification of infants at risk for neonatal encephalopathy, determination of timing and extent of hypoxic-ischemic brain injury, as well as optimal management and treatment duration. Potential neuroprotective strategies targeting different pathways leading to neuronal cell death in response to hypoxic-ischemic insult have been investigated: hypothermia, erythropoietin, iminobiotin, deferioxamine, magnesium, allopurinol, xenon, melatonin and statins. Hypothermia is currently the only recognized beneficial therapy. However, many infants still develop significant adverse outcomes. It is becoming evident that the association of moderate hypothermia with neuroprotective drugs may enhance the outcome. By virtue of their pleiotropic effects without toxic effects, melatonin and statins may act at different levels of the multiple mechanisms responsible for the progression of the neurodegenerative process and represent promising neuroprotectants, alone or as additional adjunctive therapy, for reducing brain injury and its long-term sequelae in infants. More clinical studies are needed to clarify the role of these potential neuroprotective drugs.
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Affiliation(s)
- G Buonocore
- Director of UOC Pediatria Neonatale, Policlinico S. Maria alle Scotte, AOUS, viale Bracci, 36, 53100 Siena, Italy.
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Maneschi F, Sarno M, Mosillo A, Parisella M, Gagliardi F, Algieri M, Perrone S. [Delivery induction with slow-release dinoprostone in clinical practice: results of a clinical protocol]. Minerva Ginecol 2012; 64:1-8. [PMID: 22334225] [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: 05/31/2023]
Abstract
AIM The aim of this paper was to evaluate the feasibility of a protocol for the induction of delivery with slow-release dinoprostone in women with unfavourable cervix. METHODS Indications for the induction were: pregnancy beyond 40 weeks, amniotic fluid index (AFI) <5, premature rupture of membranes, intrauterine growth retardation, or adverse maternal conditions. Eligibility criteria were: single pregnancy, cephalic presentation, Bishop Score <4, no previous uterine scar. Slow-release vaginal insert containing dinoprostone 10 mg was used to induce delivery according to a dedicated protocol agreed between clinicians and midwifes. Dinoprostone induction failure was defined as no cervical dilation >3 cm at the removal of the insert. RESULTS One-hundred-nineteen patients were enrolled. The onset of labour was obtained in 102 (85.7%) patients, 98 (82.3%) with the insert only, and in 4 (3.3%) after the sequential administration of prostaglandins and oxitocin. The mean interval between insert application and delivery was 16.85±11.48 hours. Vaginal delivery was reported in 87 (73.1%) women, whereas Cesarean was necessary in 32 (26.9%) patients [29 nulliparous]. Cesarean section was also required in 15/98 (15.3%) women who responded to prostaglandins and in 17/21 (80.9) non-responders. Protocol violations occurred in 11 (9.2%) patients. Uterine hyperstimulation occurred in 4 (3.3%) patients. CONCLUSION Induction of delivery with slow-release dinoprostone seems a feasible option, characterized by high efficacy, good adherence to protocol, low incidence of adverse events and easy management. In our opinion the high compliance of the gynecologists and midwifes is based on the insert handiness.
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Affiliation(s)
- F Maneschi
- Unità Operativa Complessa di Ginecologia e Ostetricia, Ospedale Santa Maria GorettiLatina, Italia.
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30
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Bellieni CV, Gabbrielli M, Tataranno ML, Perrone S, Buonocore G. [Which legal consequences for those who provoke pain to infants?]. Minerva Pediatr 2012; 64:41-45. [PMID: 22350043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The advances in perinatal care have led to a significant increase in neonatal survival rate but also to the rise of the number of invasive procedures. Several scientific studies show that newborns are able to feel pain more intensely than adults. Despite this evidence, neonatal pain and the right to an appropriate analgesia are systematically underestimated, ignoring ethical and moral principles of beneficence and non-maleficence. Infants are more susceptible to pain and the prolonged exposure to painful sensations can alter the neural development and the response to pain causing hyperalgesia. Anyone who caused pain without using any analgesic procedure due to negligence or incompetence, should be severely punished. The right to analgesia, fundamental principle, is fully incorporated in the Italian code of Medical deontology (article 3). The doctor who does not use analgesia for newborns' treatment can be indicted by the Italian penal code (art.582 and 583), aggravated by being the victim an infant, who is unable to defend himself. To avoid penal consequences, a careful education and attention are needed: "pediatric analgesia" should become a basic teaching in Universities and in specialization schools; analgesic treatments should be mandatory and annotated in the patient's file even for minor potentially painful procedures.
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Affiliation(s)
- C V Bellieni
- Dipartimento di Pediatria, Ostetricia e Medicina della Riproduzione Università di Siena, Siena, Italia.
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Bellieni CV, Bagnoli F, Tei M, De Filippo M, Perrone S, Buonocore G. Increased risk of brain injury in IVF babies. Minerva Pediatr 2011; 63:445-448. [PMID: 22075798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM The aim of this paper was to assess brain injury occurrence among in vitro fertilization (IVF) babies. METHODS We examined all babies born in our hospital in the triennium 2004-2006, comparing the presence of brain injuries between IVF babies and the rest of the population. RESULTS In IVF group (180 babies), brain injury was present in 4 babies, while in the rest of population (n=3602) it was present in 23 babies (P=0.042, RR: 3.18). IVF babies have a higher risk of being born with a birthweight less than 2 500 grams (P<0.0001; RR: 5.133). When we considered only babies born with a birth weight less than 2 500 grams, the difference of brain injury between the two groups was not significant. CONCLUSION In IVF babies, brain injury occurred more frequently than in the rest of population. This is probably due to a higher rate of premature births and low birth weight in IVF population. Anyway, this data should be disclosed to future parents to make an informed decision.
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Affiliation(s)
- C V Bellieni
- Department of Pediatrics Obstetrics and Reproduction Medicine, University of Siena, Siena, Italy.
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32
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Girmenia C, Guerrisi P, Frustaci AM, Fama A, Finolezzi E, Perrone S, Gentile G, Collerone F, Brocchieri S, Guerrisi V. New category of probable invasive pulmonary aspergillosis in haematological patients. Clin Microbiol Infect 2011; 18:990-6. [PMID: 21999366 DOI: 10.1111/j.1469-0691.2011.03685.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The European Organization for Research and Treatment of Cancer and the Mycosis Study Group (EORTC-MSG) radiological definitions of invasive pulmonary aspergillosis (IPA) may lack diagnostic sensitivity. We evaluated applying less restrictive radiological criteria, when supported by specific microbiological findings, to define IPA in acute myeloid leukaemia (AML), lymphoproliferative diseases (LD) and allogeneic stem cell transplant (allo-SCT) patients. Overall, 109 consecutive episodes of proven/probable IPA in 56 AML, 31 LD and 22 allo-SCT patients diagnosed from February 2006 through to January 2011 were considered. IPA was diagnosed with EORTC-MSG criteria (control group, 76 patients) or without prespecified radiological criteria (study group, 33 patients). The latter differed from the former by the inclusion of patients with pulmonary infiltrates not fulfilling the three EORTC-MSG IPA specific findings of dense, well-circumscribed lesions with or without halo sign, air crescent sign or cavity. All the analysed clinical and mycological characteristics, 3-month response to antifungal therapy and 1- and 3-month cumulative survival were comparable in the control and study groups in AML, LD and allo-SCT patients. Seventeen of 33 (51.5%) patients of the study group fulfilled EORTC-MSG radiological criteria at subsequent imaging performed a median of 15 days (range, 6-40 days) after documentation of the pulmonary infection. Our study seems to confirm the possibility of revising the EORTC-MSG criteria by extending the radiological suspicion of IPA to less specific chest computerized tomography scan findings when supported by microbiological evidence of Aspergillus infection in high-risk haematological patients.
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Affiliation(s)
- C Girmenia
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Sapienza University of Rome, Rome, Italy.
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Bagnoli F, Conte ML, Tomasini B, Bellieni CV, Borlini G, De Felice C, Perrone S, Zani S, Gatti MG. [Survival rates in a single neonatal intensive care unit (period 2002-2007). Neuro-developmental outcome and survival for infants born at 23-25 weeks of gestation]. Minerva Pediatr 2010; 62:29-41. [PMID: 20212396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM The aim of this study was to evaluate survival rates in a single Neonatal Intensive Care Unit (NICU) (period 2002-2007), with a special focus on the survival data and outcome at one-year of corrected age for infants born at 23-25 weeks of gestation. METHODS All infants who had evidence of heart activity at birth were actively resuscitated, regardless of birth weight or gestational age. Survival rate was calculated as a function of the following variables: birth weight and gestational category; gender in infants of birth weight < or = 1000 g ; appropriate (AGA) or small (SGA) weight for gestational age; inborn or outborn. Twenty-eight newborns (23-25 weeks of gestation) completed follow-up at one-year of corrected age. RESULTS During the examined period, no infants died in the delivery room; 833 newborns were admitted to the NICU. Overall survival rates were as following: <500 g (37%), 501-750 g (59%), 751-1,000 g (82%), 1,001-1,250 g (96%), 1251-1,500 g (97%), 1,501-2,000 g (100%), 2,001-2,500 g (98%), >2,500 g (99%); 23-25 weeks of gestation (50%); 26-27 weeks (77%), 28-32 weeks (90%); males < or = 1,000 g (68%), females < or = 1,000 g (68%); AGA < or = 1,000 g (63%), SGA < or = 1,000 g (79%), AGA < or =28 weeks (63%), SGA < or = 28 weeks (67%); inborn (54%), outborn (25%). A fraction of 64% (infants of 23-25 weeks of gestation) did not show handicap at one-year of corrected age, while 25% presented severe, 7% moderate, and 4% mild handicaps. CONCLUSION High rate of survival without handicap at one-year of corrected age at extremely low gestational age and the chance of improvements in neonatal care for newborn < or = 24 weeks, indicate the appropriateness for our strategy of resuscitating all newborns with evidence of heart activity in the delivery room.
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Affiliation(s)
- F Bagnoli
- Unità Operativa Complessa, Terapia Intensiva Neonatale, Dipartimento di Pediatria, Ostetricia e Medicina della Riproduzione, Azienda Ospedaliera Universitaria Senese, Siena, Italia.
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Bellieni CV, Iantorno L, Perrone S, Rodriguez A, Longini M, Capitani S, Buonocore G. Even routine painful procedures can be harmful for the newborn. Pain 2009; 147:128-31. [PMID: 19786323 DOI: 10.1016/j.pain.2009.08.025] [Citation(s) in RCA: 41] [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: 12/09/2008] [Revised: 07/15/2009] [Accepted: 08/26/2009] [Indexed: 11/26/2022]
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Bagnoli F, Conte ML, Magaldi R, Rinaldi M, De Felice C, Perrone S, Vezzosi P, Paffetti P, Borgogni P, Toti MS, Badii S. [Insulin and glucagon plasma levels in very low birth weight preterm infants of appropriate weight for gestational age]. Minerva Pediatr 2009; 61:469-475. [PMID: 19794372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Prematurity is a known risk factor for hypoglycaemia, hyperglycemia, neonatal sepsis and other common neonatal complications, possibly associated with glucoregolatory hormone (insulin and glucagon) alterations. Insulin and glucagon levels change also in relation to gender, mode of delivery and postnatal clinical severity. Because of the lack of reference range in literature, the aim of this study is to assess plasma insulin and glucagon levels in preterm appropriate for gestational age (AGA) infants of birth weight <1500 g (very low birth weight, VLBW) as a function of gestation, birth weight, gender and mode delivery. METHODS The authors examined 48 preterm AGA infants (mean birth weight 1 163+/-286 g, mean gestational age 28.2+/-2.4 weeks). The infant population was subdivided in relation to gestational age, weight, gender, mode of delivery and assisted ventilation at 5-7(th) days. Plasma glucose, insulin and glucagon levels were assessed in all newborns at birth and at 5-7(th) days of life. Data were analyzed using t-test. RESULTS A negative correlation between insulin and gestational age was observed (P<0.05). At birth, no significant differences regarding plasma glucose, insulin and glucagon levels were observed as a function of the examined category variables. At the 5-7(th) days of life, insulin levels were significantly higher in newborns with gestational age =or<27 weeks (P<0.02), in the female gender (P<0.02) and in the infants born to emergency Cesarean delivery (P<0.05). CONCLUSIONS These findings indicate potentially useful reference range values for plasma insulin and glucagon in the VLBW population.
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Affiliation(s)
- F Bagnoli
- Operative Unito f Neonatal Intensive Therapy, Department of Pediatrics, Obstetrics and Reproductive Medicine, Senese University Hospital, Siena, Italy.
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Gallet M, Vayssade M, Morra M, Verhoef R, Perrone S, Cascardo G, Vigneron P, Schols HA, Nagel MD. Inhibition of LPS-induced proinflammatory responses of J774.2 macrophages by immobilized enzymatically tailored pectins. Acta Biomater 2009; 5:2618-22. [PMID: 19398390 DOI: 10.1016/j.actbio.2009.03.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 11/18/2008] [Revised: 03/10/2009] [Accepted: 03/24/2009] [Indexed: 11/19/2022]
Abstract
The surface of an implant device can be modified by immobilizing biological molecules on it to improve its integration into the host tissue. We have previously demonstrated that enzymatically tailored plant pectins are promising nanocoatings for biomaterials. This study investigates whether a coating of modified hairy region (rhamnogalacturonan-I) from apple pectin (MHR-alpha) which has anti-adhesive properties can inhibit the generation of inflammatory mediators by lipopolysaccharide (LPS)-activated macrophages. For that purpose, J774.2 murine macrophages were cultured for 24h on MHR-alpha-coated Petri dishes and tissue culture polystyrene controls, with and without LPS. Cell morphology, cell growth, nitrite and TNF-alpha secretion were studied. The results indicate that MHR-alpha coating inhibits the LPS-induced activation of macrophages.
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Affiliation(s)
- M Gallet
- UMR CNRS 6600, Biomécanique et Bioingénierie, Université de Technologie de Compiègne, BP 20529, 60205 Compiègne Cedex, France
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Zuppa AA, Perrone S, Sindico P, Alighieri G, Antichi E, Carducci C, Romagnoli C. [Fetal and neonatal outcomes in infants of mothers with TSH receptor antibody positivity in pregnancy]. Pediatr Med Chir 2009; 31:72-77. [PMID: 19642499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVES To know the mother's frequency with TRAb (TSH receptor antibodies) positivity during pregnancy in the population afferent to Agostino Gemelli Hospital in the five years 2002-2007 and the itself antibodies's role determining fetal and neonatal symptoms. MATERIALS AND METHODS We performed a prospective analysis with maternal and neonatal variables detection in 16 couples mother-newborn with TRAb positivity during the pregnancy. The method to dose neonatal TRAb is ELISA (enzyme linked immunosorbant assay). RESULTS The prevalence of newborns of mothers with TRAb positivity during pregancy results 0.1 per thousand (16/16783). The prevalence of neonatal hyperthyroidism, clinical and biochemical, in the studied population results especially elevated equal to about 30% (5/16). The 5 newborns are born to mothers with Basedow disease with TRAb serum levels greater than TRAb levels of newborn without hyperthyroidism: 2 are showed the symptoms of clinical hyperthyroidism and 3 a transient biochemical hyperthirodism. 3 newborns with hyperthyroidism among 5 are born to mother undergo thyroidectomy with L-tiroxina teraphy during the pregnancy. Then the newborns of thyroidectomized mothers also many years before the pregnancy must be considered high risk of developing neonatal hyperthyroidism because of long-lasting persistence of mother's TRAb. The neonatal hyperthyroidism, clinical and biochemical, appears later in newborns of mothers using antithyroid drugs. The pharmacological treatment of neonatal hyperthyroidism was difficult to standardize and highly individualized. CONCLUSIONS Although the neonatal hyperthyroidism is a very rare disease it is essential to apply specific protocol assistance, both during pregnancy and the neonatal period, in the presence of maternal TRAb positive for the risk of serious cardiovascular complications.
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Affiliation(s)
- A A Zuppa
- Istituto di Pediatria, Dipartimento di Neonatologia, Università Cattolica del Sacro Cuore, Roma, Italia.
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Bellieni CV, Acampa M, Maffei M, Maffei S, Perrone S, Pinto I, Stacchini N, Buonocore G. Electromagnetic fields produced by incubators influence heart rate variability in newborns. Arch Dis Child Fetal Neonatal Ed 2008; 93:F298-301. [PMID: 18450804 DOI: 10.1136/adc.2007.132738] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [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 Incubators are largely used to preserve preterm and sick babies from postnatal stressors, but their motors produce high electromagnetic fields (EMFs). Newborns are chronically exposed to these EMFs, but no studies about their effects on the fragile developing neonatal structure exist. AIM To verify whether the exposure to incubator motor electric power may alter autonomous nervous system activity in newborns. MATERIAL AND METHODS Heart rate variability (HRV) of 43 newborns in incubators was studied. The study group comprised 27 newborns whose HRV was studied throughout three 5-minute periods: with incubator motor on, off, and on again, respectively. Mean HRV values obtained during each period were compared. The control group comprised 16 newborns with constantly unrecordable EMF and exposed to changes in background noise, similar to those provoked by the incubator motor. RESULTS Mean (SD) total power and the high-frequency (HF) component of HRV increased significantly (from 87.1 (76.2) ms2 to 183.6 (168.5) ms2) and the mean low-frequency (LF)/HF ratio decreased significantly (from 2.0 (0.5) to 1.5 (0.6)) when the incubator motor was turned off. Basal values (HF = 107.1 (118.1) ms2 and LF/HF = 1.9 (0.6)) were restored when incubators were turned on again. The LF spectral component of HRV showed a statistically significant change only in the second phase of the experiment. Changes in background noise did not provoke any significant change in HRV. CONCLUSION EMFs produced by incubators influence newborns' HRV, showing an influence on their autonomous nervous system. More research is needed to assess possible long-term consequences, since premature newborns may be exposed to these high EMFs for months.
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Affiliation(s)
- C V Bellieni
- Department of Paediatrics, Obstetrics and Reproductive Medicine, University of Siena, Italy.
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La Verde N, Borgonovo K, Garassino MC, Sburlati P, Pedretti D, Perrone S, Mihali D, Mantica C, Galassi B, Farina G. Osteonecrosis of the jaw (ONJ) in cancer patients (pts) treated with bisphosphonates (B): Results of a monoinstitutional monitoring program. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.19601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
19601 Background: B reduce bone metastases complications. ONJ is a serious adverse event during B treatment. Therefore, it's necessary to identify some procedures to reduce ONJ injures in a monitoring program. Patients and Methods: We retrospectively reviewed how an active program of prevention based on clinical oral cavity examination, dentists and pts education might improve ONJ outcome in pts receiving pamidronate (P) 90 mg monthly or zoledronate (Z) 4 mg monthly. Results: from October 2003 to October 2006, 154 consecutive pts were treated; 95 females, 59 males; primary tumors: 66 breast, 28 prostate, 26 lung, 9 myeloma, 4 NHL, 21 other. In June 2005 the monitoring program started on all our pts. ONJ was diagnosed in 15/154 (9.7%) pts, 8 before and 7 after June 2005; all pts were treated with Z (total 2,987 courses, range 8–43; median courses/pt 19.4) and 4 pts pretreated also with P (total 124 courses, range 12–43, median courses/pt 31. Tumors: 7 breast, 1 kidney, 2 lung, 1 head-neck, 1 thyroid, 1 NHL, 1 prostate, 1 sarcoma. Concomitant therapies: 14 pts chemotherapy; 7 hormonotherapy; 2 head-neck radiotherapy; 5 steroids. Significant anamnesis: 9 recent dentoalveolar procedures, 4 diabetes. First symptoms: multiple recurrent alveolar abscesses 9, pain 3, dental mobility 1, paresthesia of the lower lip 1, exposed bone 1. Main treatments were: antibiotics and antifungals 11, curettages 3, surgical resections 4 (1 partial maxillectomy, complicated by septic shock and oronasal communication, 2 partial mandibulectomies, 1 segmental mandibular resection). These last 4 pts, that had the worst prognosis, were diagnosed before starting the monitoring program, and they had been treated with aggressive dental procedures at the exordium. 7 new ONJ cases, diagnosed after June 2005 were successfully treated without aggressive dentist interventions, achieving a good control. Conclusions: We remark that ONJ B related is a frequent adverse event (9.7%), especially with Z. A monitoring program based on non- surgical treatment and patients and physicians education may improve its management. No significant financial relationships to disclose.
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Affiliation(s)
- N. La Verde
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - K. Borgonovo
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - M. C. Garassino
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - P. Sburlati
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - D. Pedretti
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - S. Perrone
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - D. Mihali
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - C. Mantica
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - B. Galassi
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - G. Farina
- Fatebenefratelli & Ophtalmic Hospital, Milan, Italy; Fondazione Ospedale Maggiore Policlinico, Milan, Italy
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Bellieni CV, Ceccarelli D, Rossi F, Buonocore G, Maffei M, Perrone S, Petraglia F. Is prenatal bonding enhanced by prenatal education courses? Minerva Ginecol 2007; 59:125-9. [PMID: 17505454] [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: 05/15/2023]
Abstract
AIM Prenatal education courses (PEC) are a way of allaying anxiety in pregnancy. PEC consist of a series of five 1-hour lessons in the first and second trimesters of pregnancy. Conducted by nurses or midwives, the course syllabus includes the basics of fetal physiology and development, singing sessions, dance sessions, massage-through-the-womb sessions. Here we investigated whether they can enhance feto-maternal bonding. METHODS We studied 77 pregnant women (mean age: 31.5+/-4.1 years), 36 of whom attended PEC. We used the Prenatal Attachment Inventory (PAI), a validated 21-item questionnaire, to score prenatal bonding and compared the scores of the two groups. Three months after delivery, we asked the mothers to fill in another questionnaire to assess infant and maternal well-being. RESULTS The PEC group showed a higher PAI score than the control group (65.5+/-6.9 vs. 59.9+/-6.1; P<0.05). Babies born to the PEC group had a higher frequency of unexplained crying. CONCLUSION PEC positively influenced prenatal attachment. More studies are needed to assess whether this may be useful for the development of the mother-infant relationship.
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Affiliation(s)
- C V Bellieni
- Department of Pediatrics, Obstetrics and Reproduction Medicine, University of Siena, Policlinico Le Scotte, Viale M. Bracci, 53100 Siena, Italy.
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Perrone S, Longini M, Bellieni CV, Centini G, Kenanidis A, De Marco L, Petraglia F, Buonocore G. Early oxidative stress in amniotic fluid of pregnancies with Down syndrome. Clin Biochem 2006; 40:177-80. [PMID: 17208212 DOI: 10.1016/j.clinbiochem.2006.10.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 10/12/2006] [Accepted: 10/13/2006] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Some evidence suggests that oxidative stress, due to an imbalance between oxidants and antioxidants, occurs in babies with Down syndrome (DS). This study tests the hypothesis that oxidative stress occurs early in DS pregnancies. DESIGN AND METHODS Isoprostanes (IPs), a new marker of free radical-catalyzed lipid peroxidation, were measured in amniotic fluid from pregnancies with normal, growth restricted and DS fetuses, diagnosed by karyotype analysis of amniotic cells cultured. RESULTS A nine-fold increase in IP concentrations was found in amniotic fluid of pregnancies with DS fetuses. This increase (595.15; 542.96-631.64 pg/ml, median; 95% CI), was greater than in pregnancies with fetal growth-restricted fetuses (155; 130.57-172.23 pg/ml, median; 95% CI) and normal fetuses (67; 49.82-98.38 pg/ml, median; 95% CI; p<0.0001). CONCLUSIONS The study reveals that oxidative stress occurs early in pregnancy and supports the idea of testing whether prenatal antioxidant therapy may prevent or delay the onset of oxidative stress diseases in the DS population.
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Affiliation(s)
- S Perrone
- Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico Le Scotte, V.le Bracci 36, 53100 Siena, Italy
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Sisto R, Bellieni CV, Perrone S, Buonocore G. Neonatal pain analyzer: development and validation. Med Biol Eng Comput 2006; 44:841-5. [PMID: 16983586 DOI: 10.1007/s11517-006-0101-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2006] [Accepted: 08/09/2006] [Indexed: 10/24/2022]
Abstract
We developed a pain analyzer (ABC analyzer) to perform automatic acoustic analysis of neonatal crying and to provide an objective estimate of neonatal pain. The ABC analyzer uses a validated pain scale (ABC scale) based on three acoustic parameters: pitch frequency, normalized RMS amplitude, and presence of a characteristic frequency- and amplitude-modulated crying feature, defined as "siren cry". Here we assessed the reliability of the analyzer. We enrolled 57 healthy neonates. Each baby was recorded with a video camera during heel prick. Pain intensity was evaluated using a validated scale [Douleur Aigue du Nouveau-Né (DAN) scale] and the analyzer and the two scores were compared. We found a statistically significant concordance between the DAN score and ABC analyzer score (p < 0.0001). The ABC analyser is a novel approach to cry analysis that should now have its properties carefully evaluated in a series of studies, just as is necessary in the development of any other pain measurement tool.
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Affiliation(s)
- R Sisto
- Department of Occupational Health, ISPESL, Monteporzio Catone, Rome, Italy
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Bellieni CV, Odent M, Cordelli FM, Cordelli DM, Bagnoli F, Perrone S, Buonocore G. Ante partum bed rest and unexplained infantile crying. Minerva Pediatr 2005; 57:163-6. [PMID: 16172594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
AIM The aim of this study was to assess whether bed rest during pregnancy is a risk factor for infantile colics. METHODS In a previous paper a questionnaire was administered to 86 women (43 of whom had stayed in bed during pregnancy for a mean of 3.4+/-1.2 months, and 43 were controls) about the clinical history and the present state of their 11-15 year old babies. In the present paper we traced these women and assessed the presence/absence of unexplained infant crying (UIC, infantile colic), diagnosed by a physician in the first year of life of these children. Forty mothers answered the inquiry, and we compared their answers with 40 control mothers. RESULTS Babies born after maternal bed rest during pregnancy had a higher incidence of UIC than the control group (26/40 vs 11/40; P=0.0015). No significant correlation was found between UIC and allergies or between UIC and maternal or artificial breast feeding. CONCLUSIONS Our retrospective study shows a possible association between bed rest and UIC: further studies, including other important variables (stress, drugs, smoking) are needed.
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Affiliation(s)
- C V Bellieni
- Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy.
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Grosso S, Gazzolo D, Longini M, Marzocchi B, Perrone S, Buonocore G. 157 Biological Markers of Oxidative Stress in Progressive Muscular Dystrophies: A Preliminary Study. Pediatr Res 2005; 58:381-381. [DOI: 10.1203/00006450-200508000-00186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
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Gazzolo D, Perrone S, Paffetti P, Longini M, Vezzosi P, Bruschettini M, Lituania M, Buonocore G. Non protein bound iron concentrations in amniotic fluid. Clin Biochem 2005; 38:674-7. [PMID: 16009144 DOI: 10.1016/j.clinbiochem.2005.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Revised: 03/14/2005] [Accepted: 03/21/2005] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To investigate whether amniotic fluid concentrations of non protein bound iron (NPBI) vary with growth in healthy fetuses and also offer a reference curve in the second trimester of pregnancy. DESIGN AND METHODS Amniotic fluid concentrations of NPBI were measured by HPLC in 118 women with physiological singleton pregnancies, who underwent amniocentesis for fetal karyotype between weeks 15 and 18 of gestation. RESULTS NPBI increased progressively from weeks 14--15 to weeks 15--16, peaking at 17--18 weeks of gestation. NPBI values regressed positively with gestational age (GA). Multiple linear regression analysis between NPBI, as dependent variable, and various fetal parameters, as independent variables, showed a statistically significant regression coefficient with GA, bi-parietal diameter and transverse cerebellar diameter. CONCLUSIONS The present data constitutes the first quantification of NPBI concentrations in amniotic fluid under physiological conditions. Correlations with GA and ultrasound fetal biometry suggest that NPBI may play a role in fetal growth.
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Affiliation(s)
- D Gazzolo
- Department Paediatrics G. Gaslini, Children's University Hospital, 16148 Genoa, Italy
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Perrone S, Vezzosi P, Longini M, Marzocchi B, Tanganelli D, Testa M, Santilli T, Buonocore G. Nucleated red blood cell count in term and preterm newborns: reference values at birth. Arch Dis Child Fetal Neonatal Ed 2005; 90:F174-5. [PMID: 15724047 PMCID: PMC1721864 DOI: 10.1136/adc.2004.051326] [Citation(s) in RCA: 25] [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: 11/04/2022]
Abstract
The prognostic value of nucleated red blood cell count at birth in relation to neonatal outcome has been established. However, reference values were needed to usefully interpret this variable. The normal range of reference values for absolute nucleated red blood cell count in 695 preterm and term newborns is reported.
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Affiliation(s)
- S Perrone
- Department of Paediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico Le Scotte, Via le Bracci 36, 53100 Siena, Italy
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Hare J, Perrone S, Eisen H, McCurry K, Hauptman P, Simonsen S, Crespo M, Arizon J, Kobashigawa J, Jarcho J. Everolimus in de novo cardiac transplant recipients: 48-month (M) follow-up. J Heart Lung Transplant 2005. [DOI: 10.1016/j.healun.2004.11.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Gonnelli S, Montagnani A, Gennari L, Martini S, Merlotti D, Cepollaro C, Perrone S, Buonocore G, Nuti R. Feasibility of quantitative ultrasound measurements on the humerus of newborn infants for the assessment of the skeletal status. Osteoporos Int 2004; 15:541-6. [PMID: 15052377 DOI: 10.1007/s00198-003-1558-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [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: 10/26/2022]
Abstract
Quantitative ultrasound (QUS), although widely used in adults has, so far, been scarcely employed in newborn infants and children. This study aimed to evaluate the feasibility of the use of QUS in newborn children and the factors influencing QUS parameters. In 140 consecutive healthy full-term newborn babies (76 male and 64 female; gestational age: 39.5 +/- 1.5 weeks) QUS parameters were assessed within 3 days of the child's birth at the distal diaphysis of the humerus by use of Bone Profiler, after an appropriate modification of caliper and software. In all subjects we evaluated the amplitude-dependent speed of sound (AD-SoS) (meters per second), the characterizing graphic trace parameters [signal dynamic (SDy), fast wave amplitude (FWA) and bone transmission time (BTT)], SoS (meters per second), that is, the speed of sound calculated on the first peak, and hBTT, that is, the interval time between the first peak of the ultrasound and when this reaches the speed of 1,570 m/s, which is the velocity of ultrasound in the soft tissue. This latter parameter allows one to measure bone tissue independently of soft tissue. QUS measurements were also performed at the phalanges on all mothers (age range 24-38 years), who also completed a self-report questionnaire on their obstetric history, smoking and dietary habits and family history of osteoporosis. In 73 mothers and their children QUS was repeated after 12 months. All QUS parameters were slightly higher in male than in female newborn infants but the difference was not significant. BTT and hBTT of neonates showed a significant relationship with birth weight (r = 0.20; P < 0.05 and r = 0.37; P < 0.01, respectively) and with cranial circumference (r = 0.22; P < 0.05 and r = 0.36; P < 0.01, respectively). In newborn infants none of the QUS parameters was significantly influenced by maternal QUS or by maternal smoking and calcium intake. In a model of multiple regression analysis the cranial circumference was the only parameter entered into the model, explaining approximately 15% of hBTT value. At month 12 AD-SoS and SoS were slightly lower than at birth (-11% and -0.1%, respectively), whereas both BTT and hBTT showed a significant (P < 0001) increase. The present study demonstrated the feasibility of the use of QUS, as assessed by a new measurement approach at the humerus, in the evaluation of skeletal status in neonates. BTT and, above all, hBTT, appears to be the best parameter for both evaluation of skeletal status at birth and monitoring of bone growth in the first year of life.
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Affiliation(s)
- S Gonnelli
- Department of Internal Medicine, Metabolic and Endocrinological Science and Biochemistry, Policlinico Le Scotte, University of Siena, Viale Bracci, 53100 Siena, Italy.
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Favaloro R, Diez M, Bertolotti A, Gomez C, Favaloro L, Abud J, Nagel C, Vigliano C, Klein F, Perrone S. Orthotopic heart transplantation in elderly patients: A 10-year experience at a single center. Transplant Proc 2004; 36:1692-4. [PMID: 15350455 DOI: 10.1016/j.transproceed.2004.06.061] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 10/26/2022]
Abstract
INTRODUCTION A consensus has not yet been reached regarding the indications for orthotopic heart transplantation (OHT) in elderly patients or the age limit contraindicating the procedure. The objective of this study was to assess OHT outcomes to determine whether elderly patients benefit from the procedure. METHODS From February 1993 to February 2003, 178 OHTs were performed on recipients of mean age 47.4 +/- 15 years (range, 4 to 74) including 80.3% men. The population was divided into two groups: group A included patients >/= 60 years, and group B those younger than that age. Survival was analyzed for the overall population and for both age groups during a 10-year follow-up period. RESULTS Group A included 36 patients (20.8%) and group B 142 patients (79.2%). Mean age was 63.7 +/- 2.9 years (60 to 74) in A, and 43 +/- 13.9 years (4 to 59) in B. In-hospital mortality was significantly higher among group A (n = 11, 31.4%) compared to B (n = 17, 12.1%, P =.008). Survival at 1, 5, and 10 years was 61.5% +/- 8%, 58.1% +/- 8.3%, and 49.8% +/- 10.5% group A; and 84.2% +/- 3%, 73.7% +/- 4.1%, and 69.9% +/- 4.7 for group B. Elderly patients showed a lower survival rate (49.8%) compared with the younger group (69.9%) at 10-year follow-up (P =.007). Conditional survival at 9 years failed to show significant differences (A 72.2% vs B 79.6%, P =.4). CONCLUSION In our population, elderly recipients showed a higher in-hospital mortality. However, when the first post-OHT year was excluded, we found similar survival rates for both age groups.
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Affiliation(s)
- R Favaloro
- Favaloro Foundation, Buenos Aires, Argentina.
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Rubegni P, Risulo M, Sbano P, Buonocore G, Perrone S, Fimiani M. Encephalocraniocutaneous lipomatosis (Haberland syndrome) with bilateral cutaneous and visceral involvement. Clin Exp Dermatol 2003; 28:387-90. [PMID: 12823300 DOI: 10.1046/j.1365-2230.2003.01329.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Encephalocraniocutaneous lipomatosis, or Haberland syndrome, is a rare congenital neurocutaneous disease. It is characterized clinically by unilateral lipomatous hamartomata of the scalp, eyelid, and outer globe of the eye, ipsilateral porencephalic cysts with cortical atrophy, cranial asymmetry, marked developmental delay and mental retardation. This syndrome should be distinguished from other mosaic neurocutaneous phenotypes such as as Delleman syndrome, Schimmelpenning syndrome, Goltz syndrome, Goldenhar syndrome and Proteus syndrome. Here we report a case of Haberland syndrome with bilateral involvement which underscores the extreme heterogeneity of clinical presentation of this and related syndromes.
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Affiliation(s)
- P Rubegni
- Department of Dermatology, University of Siena, Siena, Italy.
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