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Spiezia AL, Scalia G, Petracca M, Caliendo D, Moccia M, Fiore A, Cerbone V, Lanzillo R, Brescia Morra V, Carotenuto A. Effect of siponimod on lymphocyte subsets in active secondary progressive multiple sclerosis and clinical implications. J Neurol 2024:10.1007/s00415-024-12362-9. [PMID: 38632126 DOI: 10.1007/s00415-024-12362-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Circulating immune cells play a pathogenic role in multiple sclerosis (MS). However, the role of specific lymphocyte subpopulations is not unveiled yet, especially in progressive stages. We aimed to investigate lymphocyte changes during siponimod treatment in active secondary progressive MS (aSPMS) and their associations with clinical outcomes. METHODS We enrolled 46 aSPMS patients starting on siponimod treatment with at least 6 months of follow-up and two visits within the scheduled timeframes and 14 sex- and age-matched healthy controls (HCs). Clinical and laboratory data were collected retrospectively at baseline, 3rd, 6th, 12th, and 24th month for MS patients, and at baseline for HCs. RESULTS At baseline SPMS patients presented with increased naïve regulatory T lymphocytes (p = 0.02) vs. HCs. Over time, SPMS patients showed decreased T CD4+ (coeff. range = -24/-17, 95% CI range = -31.60 to -10.40), B lymphocyte (coeff. range = -3.77/-2.54, 95% CI range = -6.02 to -0.35), memory regulatory B cells (coeff. range = -0.78/-0.57, 95% CI range = -1.24 to -0.17) and CD4/CD8 ratio (coeff. range = -4.44/-0.67, 95% CI range = -1.61 to -0.17) from month 3 thereafter vs. baseline, and reduced CD3+CD20+ lymphocytes from month 12 thereafter (coeff. range = -0.32/-0.24, 95% CI range = -0.59 to -0.03). Patients not experiencing disability progression while on siponimod treatment showed B lymphocyte reduction from month 3 (coeff. range = -4.23/-2.32, 95% CI range = -7.53 to -0.15) and CD3+CD20+ lymphocyte reduction from month 12 (coeff. range = -0.32/-0.24, 95% CI range = -0.59 to -0.03) vs. patients experiencing progression. CONCLUSIONS Patients treated with siponimod showed a T and B lymphocyte reduction, especially CD4+, CD3+CD20+ and naïve regulatory T cells and memory regulatory B cells. Disability progression while on siponimod treatment was associated with a less pronounced effect on B and CD3+CD20+ lymphocytes.
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Affiliation(s)
- Antonio Luca Spiezia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Giulia Scalia
- Clinical and Experimental Cytometry Unit, Centre for Advanced Biotechnology Franco Salvatore, CEINGE, Naples, Italy
| | - Maria Petracca
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Daniele Caliendo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Marcello Moccia
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - Antonia Fiore
- Clinical and Experimental Cytometry Unit, Centre for Advanced Biotechnology Franco Salvatore, CEINGE, Naples, Italy
| | - Vincenza Cerbone
- Clinical and Experimental Cytometry Unit, Centre for Advanced Biotechnology Franco Salvatore, CEINGE, Naples, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Antonio Carotenuto
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
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Andolfo I, Monaco V, Cozzolino F, Rosato BE, Marra R, Cerbone V, Pinto VM, Forni GL, Unal S, Iolascon A, Monti M, Russo R. Proteome alterations in erythrocytes with PIEZO1 gain-of-function mutations. Blood Adv 2023; 7:2681-2693. [PMID: 36595486 PMCID: PMC10333744 DOI: 10.1182/bloodadvances.2022008673] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023] Open
Abstract
Gain-of-function mutations in PIEZO1 cause dehydrated hereditary stomatocytosis (DHS) or hereditary xerocytosis, an autosomal dominant hemolytic anemia characterized by high reticulocyte count, a tendency to macrocytosis, and mild jaundice, as well as by other variably penetrant clinical features, such as perinatal edema, severe thromboembolic complications after splenectomy, and hepatic iron overload. PIEZO1 mutations in DHS lead to slowed inactivation kinetics of the ion channel and/or facilitation of channel opening in response to physiological stimuli. To characterize the alterations of red blood cell proteome in patients with mutated PIEZO1, we used a differential approach to compare the proteome of patients with DHS (16 patients from 13 unrelated ancestries) vs healthy individuals. We identified new components in the regulation of the complex landscape of erythrocytes ion and volume balance mediated by PIEZO1. Specifically, the main impaired processes in patients with DHS were ion homeostasis, transmembrane transport, regulation of vesicle-mediated transport, and the proteasomal catabolic process. Functional assays demonstrated coexpression of PIEZO1 and band 3 when PIEZO1 was activated. Moreover, the alteration of the vesicle-mediated transport was functionally demonstrated by an increased vesiculation rate in patients with DHS compared with healthy controls. This finding also provides an explanation of the pathogenetic mechanism underlying the increased thrombotic rate observed in these patients. Finally, the newly identified proteins, involved in the intracellular signaling pathways altered by PIEZO1 mutations, could be used in the future as potential druggable targets in DHS.
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Affiliation(s)
- Immacolata Andolfo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Napoli, Italy
- CEINGE Biotecnologie Avanzate, Franco Salvatore, Napoli, Italy
| | - Vittoria Monaco
- CEINGE Biotecnologie Avanzate, Franco Salvatore, Napoli, Italy
- Dipartimento di Scienze Chimiche, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - Flora Cozzolino
- CEINGE Biotecnologie Avanzate, Franco Salvatore, Napoli, Italy
- Dipartimento di Scienze Chimiche, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - Barbara Eleni Rosato
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Napoli, Italy
- CEINGE Biotecnologie Avanzate, Franco Salvatore, Napoli, Italy
| | - Roberta Marra
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Napoli, Italy
- CEINGE Biotecnologie Avanzate, Franco Salvatore, Napoli, Italy
| | | | - Valeria Maria Pinto
- Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, EO Ospedali Galliera, Genoa, Italy
| | - Gian Luca Forni
- Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, EO Ospedali Galliera, Genoa, Italy
| | - Sule Unal
- Research Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes, Department of Pediatric Hematology, Hacettepe University, Ankara, Turkey
| | - Achille Iolascon
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Napoli, Italy
- CEINGE Biotecnologie Avanzate, Franco Salvatore, Napoli, Italy
| | - Maria Monti
- CEINGE Biotecnologie Avanzate, Franco Salvatore, Napoli, Italy
- Dipartimento di Scienze Chimiche, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - Roberta Russo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Napoli, Italy
- CEINGE Biotecnologie Avanzate, Franco Salvatore, Napoli, Italy
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Capasso N, Palladino R, Cerbone V, Spiezia AL, Covelli B, Fiore A, Lanzillo R, Carotenuto A, Petracca M, Stanziola L, Scalia G, Brescia Morra V, Moccia M. Ocrelizumab effect on humoral and cellular immunity in multiple sclerosis and its clinical correlates: a 3-year observational study. J Neurol 2023; 270:272-282. [PMID: 36048265 PMCID: PMC9813008 DOI: 10.1007/s00415-022-11350-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE We aim to evaluate 3-year effects of ocrelizumab (humanized anti-CD20 monoclonal antibody for the treatment of multiple sclerosis (MS)) on lymphocytes, neutrophils and immunoglobulins: (1) when compared with pre-infusion assessment; (2) over the course of treatment; and (3) possible clinical correlates of the observed immunological modifications. METHODS This real-world observational cohort study has been conducted on prospectively collected data from 78 MS patients (mean age 47.8 ± 10.5 years; females 48.7%) commencing on ocrelizumab from 2018, with mean follow-up of 36.5 ± 6.8 months. Clinical data and blood samples were collected every three months. Total lymphocyte count and subpopulations were assessed on peripheral blood using flow cytometry. Serum immunoglobulins were evaluated with nephelometry. RESULTS When compared with pre-infusion values, we observed reduction of total, CD19 and CD20 lymphocyte counts; however, after the first infusion, their levels remained substantially stable. Over time we observed a progressive reduction of CD8 lymphocytes, while no changes were observed for CD4, CD27, CD3CD27, and CD19CD27. After the first infusion, we observed reduction in IgG, which further decreased during the follow-up. Higher probability of EDSS progression was associated with reduced modulation of CD8 lymphocytes. INTERPRETATION Ocrelizumab affects both humoral and cellular immune responses. Disability progression over the follow-up was associated with lower CD8 cytotoxic T-lymphocyte reduction. Changes in humoral response are immediate and sustained, while modulation of cellular immunity occurs progressively through regular re-treatment, and is related to clinical stability.
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Affiliation(s)
- Nicola Capasso
- Multiple Sclerosis Unit, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Raffaele Palladino
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | | | - Antonio Luca Spiezia
- Multiple Sclerosis Unit, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Bianca Covelli
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Antonia Fiore
- Centre for Advanced Biotechnology (CEINGE), Naples, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Unit, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Antonio Carotenuto
- Multiple Sclerosis Unit, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Maria Petracca
- Multiple Sclerosis Unit, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Lucia Stanziola
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Giulia Scalia
- Centre for Advanced Biotechnology (CEINGE), Naples, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Unit, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Marcello Moccia
- Multiple Sclerosis Unit, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy.
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
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Spiezia AL, Cerbone V, Molinari EA, Capasso N, Lanzillo R, Carotenuto A, Petracca M, Novarella F, Covelli B, Scalia G, Brescia Morra V, Moccia M. Changes in lymphocytes, neutrophils and immunoglobulins in year-1 cladribine treatment in multiple sclerosis. Mult Scler Relat Disord 2021; 57:103431. [PMID: 34871857 DOI: 10.1016/j.msard.2021.103431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/15/2021] [Accepted: 11/27/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Antonio Luca Spiezia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | | | | | - Nicola Capasso
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Antonio Carotenuto
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Maria Petracca
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Federica Novarella
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Bianca Covelli
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Giulia Scalia
- Centre for Advanced Biotechnology (CEINGE), Naples, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Marcello Moccia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy.
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5
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Alfano R, Palladino R, Risitano A, De Pascale T, Raia M, Castrianni D, Scamardo MS, Cerbone V, Schiavone D, D'Onofrio G, Buonocore G, Triassi M, Del Vecchio L, Rubba F. [Network references for rare diseases: state of the art for the paroxysmal nocturnal hemoglobinuria]. Epidemiol Prev 2018; 42:333-343. [PMID: 30370735 DOI: 10.19191/ep18.5-6.p333.102] [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: 06/08/2023]
Abstract
BACKGROUND recently, healthcare network models have been proposed to improve general awareness of rare diseases for patients and specific knowledge about diagnosis, treatment, and management for healthcare services. Paroxysmal nocturnal hemoglobinuria (PNH) is a rare haematological disease that still has no framing in an official network. OBJECTIVES to describe the use of network models in diagnosis, treatment, and management of PNH patients both in Italy and abroad and its impact on patients and healthcare service. DISEGN: literature search was performed using the keywords "Hemoglobinuria", "Network", "PHN", and "Screening" in both MedLine and EMBASE. Search was restricted to the articles published in the last 5 years and written in English, French or Italian language. RESULTS from the total 251 articles of the initial search, only 21 were finally included in our review. None of the included study explicitly described a network model. In general, we were able to identify two different kind of networks implicitly described in the studies: laboratory networks for diagnostic harmonization or screening of the population at risk of PNH (10/21 studies) and PNH registry as network of clinical information to be use for better understanding of the natural history of the disease and to assess therapeutic effectiveness (11/21 studies). CONCLUSIONS few network approaches in PNH diagnosis, treatment, and management are described in literature. Despite the scarce application of the networks, our review highlights the positive impact that networks have in both patients and healthcare services.
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Affiliation(s)
- Rossella Alfano
- Dipartimento di sanità pubblica, Azienda ospedaliero-universitaria "Federico II", Napoli
| | - Raffele Palladino
- Dipartimento di sanità pubblica, Azienda ospedaliero-universitaria "Federico II", Napoli
| | - Antonio Risitano
- UOC ematologia, Azienda ospedaliero-universitaria "Federico II", Napoli
| | - Teresa De Pascale
- Dipartimento di sanità pubblica, Azienda ospedaliero-universitaria "Federico II", Napoli
| | - Maddalena Raia
- Centro di ricerca CEINGE - Biotecnologie Avanzate, Azienda ospedaliero-universitaria "Federico II", Napoli
| | - Davide Castrianni
- Dipartimento di sanità pubblica, Azienda ospedaliero-universitaria "Federico II", Napoli
| | - Marina Silvia Scamardo
- Dipartimento di sanità pubblica, Azienda ospedaliero-universitaria "Federico II", Napoli
| | - Vincenza Cerbone
- Centro di ricerca CEINGE - Biotecnologie Avanzate, Azienda ospedaliero-universitaria "Federico II", Napoli
| | | | | | | | - Maria Triassi
- Dipartimento di sanità pubblica, Azienda ospedaliero-universitaria "Federico II", Napoli
| | - Luigi Del Vecchio
- Centro di ricerca CEINGE - Biotecnologie Avanzate, Azienda ospedaliero-universitaria "Federico II", Napoli
| | - Fabiana Rubba
- Dipartimento di sanità pubblica, Azienda ospedaliero-universitaria "Federico II", Napoli;
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6
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Cosimato V, Scalia G, Raia M, Gentile L, Cerbone V, Visconte F, Statuto T, Valvano L, D'Auria F, Calice G, Graziano D, Musto P, Del Vecchio L. Surface endoglin (CD105) expression on acute leukemia blast cells: an extensive flow cytometry study of 1002 patients. Leuk Lymphoma 2018; 59:2242-2245. [PMID: 29334284 DOI: 10.1080/10428194.2017.1416366] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | | | | | | | | | - Teodora Statuto
- b Laboratory of Clinical Research and Advanced Diagnostics , IRCCS-CROB, Referral Cancer Center of Basilicata , Rionero in Vulture (Pz) , Italy
| | - Luciana Valvano
- b Laboratory of Clinical Research and Advanced Diagnostics , IRCCS-CROB, Referral Cancer Center of Basilicata , Rionero in Vulture (Pz) , Italy
| | - Fiorella D'Auria
- b Laboratory of Clinical Research and Advanced Diagnostics , IRCCS-CROB, Referral Cancer Center of Basilicata , Rionero in Vulture (Pz) , Italy
| | - Giovanni Calice
- b Laboratory of Clinical Research and Advanced Diagnostics , IRCCS-CROB, Referral Cancer Center of Basilicata , Rionero in Vulture (Pz) , Italy
| | - Daniela Graziano
- c Antonio Cardarelli Hospital , Unit of Transfusional Medicine , Naples , Italy
| | - Pellegrino Musto
- d Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata , Rionero in Vulture (Pz) , Italy
| | - Luigi Del Vecchio
- a CEINGE Biotecnologie Avanzate , Naples , Italy.,e Department of Molecular Medicine and Medical Biotechnologies (DMMBM) , Federico II University , Naples , Italy
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Abstract
The problems deriving from the anatomic differences between the two harvested kidneys make the bench surgery necessary to solve some technical difficulties in transplantation. This condition is particularly real in the case of right kidney transplantation, especially in presence of arterial anomalies. In this study, we focused our attention on venous reconstruction in cases of short renal right veins. In 3 years, we performed 55 consecutive cadaveric renal transplants in patients with an end-stage chronic renal insufficiency. The right kidney was used in 30 patients, eight of whom had two or more arteries attached to a single aortic patch, and 22 had a single artery. In these right transplanted kidneys, the elongation of renal vein was performed end-to-side to the external iliac vein, reconstructing a "T-patch" (angular reconstruction) in 28 patients and a "linear" one in two cases. The vascular anastomoses had no thrombotic problems. We have followed the progress of the patients for more than 2 years; no one has lost the graft due to chronic rejection or other complications. In conclusion, elongation of the right renal vein with a T-patch constitutes a feasible, physiological procedure without vascular complications or apparent reverberations for graft blood flow.
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Affiliation(s)
- G Valeriani
- AOU San Giovanni di Dio and Ruggi D'Aragona Hospital, Salerno, Italy
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8
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Russo E, Sciano D, Cerbone V, Valeriani G, Barbato G, De Rosa P. Low limb and allograft rescue with iliofemoral graft for external iliac artery dissection: case report. Transplant Proc 2010; 42:1365-6. [PMID: 20534303 DOI: 10.1016/j.transproceed.2010.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The technical difficulties in performing a transplantation can often be joined by an accident that demands an urgent solutions, putting the life of the patient in serious risk. In our case we were forced to perform an iliofemoral PTFE graft substitution to save the vascularization of the right lower limb. The cause was constituted by a dissection in the external iliac artery wall immediately after upstream declamping. Fortunately quick understanding of the complication made us stop the lesion downstream before it involved the femoral district. In addition the renal artery was already not declamped and the organ not perfused. Successively we anastomosed the renal artery to the PTFE graft with an end-to side anastomosis. Our first target was obviously to preserve the low limb vascularization but, with this solution we managed also to save the allograft. Actually renal function is conserved and with an optimal state of the vascular graft.
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Affiliation(s)
- E Russo
- Department of General Surgery and Renal Transplantation, San Giovanni di Dio and Ruggi D'Aragona Hospital, Salerno, Italy
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9
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Aiello C, Santoro GA, Cerbone V, de Werra C, Gentile M, Bucci L. [Treatment of recto-urethral fistulas in Crohn's disease]. MINERVA CHIR 1997; 52:1129-34. [PMID: 9432589] [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: 02/05/2023]
Abstract
We report the thirteenth case of a rectourethral fistula in Crohn's disease. The patient, a 37 year-old-white male, had a 20 year history of intestinal Crohn's disease and had undergone numerous bowel resections. His symptoms were fecaluria, urorrhea and passing of urine from an orifice just outside the base of the scrotum. He had urinary infection and severe ileocolitis. He underwent a diagnostic evaluation that revealed a fistula comprising the membranous urethra, the rectum, the perineum and the scrotum. We performed medical therapy with metronidazole (20 mg/kg/day/12 months). We present in this article a review of the literature on the management of rectourethral fistulas in Crohn's disease. Surgeons have successfully used several approaches in the repair of this disorder, but no single procedure had proved to be best or even universally applicable. We emphasize, as the literature suggests, that management must be individualized. Medical therapy with metronidazole has an important role in a patient with rectourethral fistula and concomitant proctitis, ileocolitis, urinary sepsis and multiple previous surgeries.
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Affiliation(s)
- C Aiello
- II Facoltà di Medicina e Chirurgia, II Divisione di Chirurgia Generale, Università degli Studi di Napoli Federico II, Napoli
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10
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Saviano G, Borrelli G, Cerbone V. [Non-tuberculous bacterial infections of the respiratory system]. Arch Monaldi Mal Torace 1991; 46:7-9. [PMID: 1845432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- G Saviano
- VIII Divisione di Broncopneumotisiologia Ospedale V. Monaldi, Napoli
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11
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Saviano G, Balsamo F, Cerbone V, De Simone G, Guarino C, Strocchia S, Borrelli G. [Pulmonary tuberculosis today. The findings over a 5-year period in a ward for women]. Arch Monaldi Mal Torace 1990; 45:211-21. [PMID: 1669275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The authors studied the cases of pulmonary tuberculosis they had the opportunity to observe during a five-year period from 1985 to 1989 carrying out the phenomenon. As a result they pointed out that the worst affected subjects belonged to the age bands included between the second and the third decade, followed by the fifth decade and over. They concluded that the 234 cases they examined do not represent the real number of affected subjects and that elderly patients to the most serious cases.
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Affiliation(s)
- G Saviano
- VIII Divisione, Ospedale V. Monaldi, U.S.L. 41
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12
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Saviano G, Borrelli G, Cerbone V, Ferrera P, La Gala F, Cuccurullo S, Corsi G. [Bacterial flora in nontuberculous infections of the respiratory tract (findings relevant to the year 1988)]. Arch Monaldi Mal Torace 1988; 43:475-85. [PMID: 3155011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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13
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Saviano G, Borrelli G, Cerbone V, Guarino C, Montella L, Langella L, Balsamo F. [Concerning primary tuberculosis]. Arch Monaldi Mal Torace 1988; 43:183-96. [PMID: 3270488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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