1
|
De Sanctis V, Abbasciano V, Soliman AT, Soliman N, Di Maio S, Fiscina B, Kattamis C. The juvenile fibromyalgia syndrome (JFMS): a poorly defined disorder. Acta Biomed 2019; 90:134-148. [PMID: 30889168 PMCID: PMC6502146 DOI: 10.23750/abm.v90i1.8141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/20/2019] [Indexed: 12/31/2022]
Abstract
Juvenile fibromyalgia syndrome (JFMS) is a chronic condition characterized by symptoms of chronic diffuse musculoskeletal pain and multiple painful tender points on palpation. It is often accompanied by fatigue, disorders of sleep, chronic headaches, irritable bowel syndrome, and subjective soft tissue swelling. The complexity of the presenting clinical picture in JPFS has not been sufficiently defined in the literature. Similarities to adult fibromyalgia syndrome in JFMS are often difficult to compare, because many of the symptoms are "medically unexplained" and often overlap frequently with other medical conditions. However, a valid diagnosis of JFMS often decreases parents' anxiety, reduces unnecessary further investigations, and provides a rational framework for a management plan. The diagnostic criteria proposed by Yunus and Masi in 1985 to define JFMS were never validated or critically analyzed. In most cases, the clinical diagnosis is based on the history, the physical examination that demonstrates general tenderness (muscle, joints, tendons), the absence of other pathological conditions that could explain pain and fatigue, and the normal basic laboratory tests. Research and clinical observations defined that JFMS may have a chronic course that impacts the functional status and the psychosocial development of children and adolescents. This paper briefly reviews the existing knowledge on JFMS focusing on the diagnosis, clinical and the epidemiological characteristics in children and adolescents for better understanding of this disorder.
Collapse
Affiliation(s)
- Vincenzo De Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy.
| | | | | | | | | | | | | |
Collapse
|
2
|
Tombesi P, Postorivo S, Catellani M, Tassinari D, Abbasciano V, Sartori S. Percutaneous ultrasonography-guided core needle biopsy of gastrointestinal lesions: what's its actual role in clinical practice? A retrospective study for safety and effectiveness. Ultraschall Med 2011; 32 Suppl 1:S62-S67. [PMID: 20235004 DOI: 10.1055/s-0029-1245241] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Endoscopic biopsy is commonly performed to obtain a pathological diagnosis of gastrointestinal (GI) lesions. When the lesions are submucosal, subserosal, or exophytic, endoscopic biopsy is often unsuccessful, and endoscopic ultrasound (EUS)-guided biopsy is considered the procedure of choice in these cases. Nevertheless, in some patients both endoscopic and EUS-guided biopsy are not indicated, or yield inconclusive cyto-histological results. The aim of this study was to assess the efficacy and safety of percutaneous ultrasonography (US)-guided biopsy of GI wall lesions, and to define its actual role in clinical practice. MATERIALS AND METHODS A retrospective study was conducted on 45 consecutive US-guided biopsies of GI lesions. All biopsies were performed in patients unsuitable for endoscopic or EUS-guided biopsy, or with lesions inaccessible to endoscopic techniques, or with inconclusive results from endoscopic or EUS-guided biopsy. Biopsies were performed with an 18 or 20-gauge Tru-cut needle under US guidance. Biopsy results were compared with the final diagnosis that was based on surgical pathological findings or clinical instrumental follow-up of at least 20 months. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overall accuracy, and complication rate of the procedure were calculated. RESULTS One biopsy specimen (2.2 %) was inadequate for cyto-histologic examination. In the remaining 44 cases, US-guided biopsy correctly identified 39 / 40 (97.5 %) malignant lesions, and 4 / 4 (100 %) benign lesions. One case resulted in a false negative (2.2 %). The sensitivity, specificity, PPV, NPV, and overall diagnostic accuracy were 97.5 %, 100 %, 100 %, 80 % and 97.7 %, respectively. Including also the inadequate specimen into the analysis, they were 95.1 %, 100 %, 100 %, 66.7 % and 95.6 %, respectively. No procedure-related complications were observed. In ten cases (22.2 %), US-guided biopsy results made it possible to avoid unnecessary surgical exploration. CONCLUSION Percutaneous US-guided core biopsy of GI wall lesions is an accurate and safe technique that makes it possible in select cases to obtain a correct pathological diagnosis and prevent unnecessary surgical exploration. Although it has been replaced by EUS-guided biopsy as the procedure of choice to sample submucosal or subserosal GI lesions, US-guided biopsy can still play a useful role in the diagnostic workup of GI lesions when endoscopy or EUS is unsuccessful for various reasons or yields inconclusive cyto-histological results.
Collapse
Affiliation(s)
- P Tombesi
- Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara, Italy
| | | | | | | | | | | |
Collapse
|
3
|
Bononi A, Lanza F, Ferrari L, Gusella M, Gilli G, Abbasciano V, Campioni D, Russo A, Menon D, Albertini F, Stievano L, Barile C, Crepaldi G, Toso S, Ferrazzi E, Pasini F. Predictive value of hematological and phenotypical parameters on postchemotherapy leukocyte recovery. Cytometry 2009; 76:328-33. [DOI: 10.1002/cyto.b.20476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
4
|
Tombesi P, Nielsen I, Tassinari D, Trevisani L, Abbasciano V, Sartori S. Transthoracic ultrasonography-guided core needle biopsy of pleural-based lung lesions: prospective randomized comparison between a Tru-cut-type needle and a modified Menghini-type needle. Ultraschall Med 2009; 30:390-395. [PMID: 19544230 DOI: 10.1055/s-0028-1109442] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE The diagnostic yield of the different types of cutting needles used to perform transthoracic biopsy is scarcely investigated. Aim of the study was to compare a Tru-cut-type (TCT) needle and a modified Menghini-type needle (MMT) in ultrasonography (US)-guided biopsy of pulmonary lesions. MATERIALS AND METHODS 307 subjects (191 males and 116 females, mean age 58 years) with peripheral lung lesions selected to undergo US-guided biopsy were randomized to undergo biopsy by using an 18-gauge TCT or MMT needle. The specimens were imprinted on two to three slides for cytology and then put into a formalin solution for histology. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated. Fisher's exact test was used to compare histology recovery rate (HRR), diagnostic accuracy, and diagnostic yield of the combination of cytology and histology in comparison with cytology alone and histology alone. RESULTS 155 biopsies were performed using the MMT needle, 152 using the TCT needle. HRR was 112 / 155 (72.3 %) and 144 / 152 (94.7 %), respectively (p < 0.0001). Sensitivity, specificity, PPV, and NPV were 81.6 %, 100 %, 100 %, and 62 % for the former, respectively, and 93.6 %, 100 %, 100 %, and 86 % for the latter. A correct diagnosis was achieved in 133 / 155 biopsies (85.8 %) performed with the MMT needle, and in 145 / 152 biopsies (95.4 %) performed with the TCT needle (p = 0.0041). The combination of cytology and histology had a higher diagnostic yield than cytology alone (p < 0.001) and histology alone (p < 0.001). CONCLUSION The TCT needle performs better than the MMT needle, and improves the diagnostic accuracy of US-guided transthoracic biopsy of superficial lung lesions.
Collapse
Affiliation(s)
- P Tombesi
- Internal Medicine - Section of Interventional Ultrasound, St. Anna Hospital, corso Giovecca 203, 44100 Ferrara
| | | | | | | | | | | |
Collapse
|
5
|
Trevisani L, Cifalà V, Sartori S, Tombesi P, Matarese V, Pezzoli A, Abbasciano V. [Screening for colorectal cancer in high-risk and intermediate-risk subject: what's the best tool?]. Recenti Prog Med 2009; 100:68-72. [PMID: 19350797] [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: 05/27/2023]
Abstract
Although several screening tests are now available, at present none of them has been proven the best one. Colonoscopy is usually used in high-risk subjects (family history of either colorectal cancer [CRC] or adenomas). In intermediate-risk subjects, fecal occult blood test (FOBT) is preferred, and colonoscopy is performed only when FOBT results positive. The aim of this study is to better define the role of colonoscopy in a screening program. Three groups of subjects were retrospectively reviewed. RSP (Regional Screening Program), FDR (First Degree Relatives), and Control-groups included 362, 581, and 300 subjects, respectively. Adenoma or carcinoma were more frequent in RSP-group than in FDR- and Control-group (53%, 23.7%, and 20%, respectively; p < 0.001). CRC rate was 11.6% in RSP-group, 2.2% in FDR-group (p < 0.001), 6% in Control-group (p < 0.05). Adenoma rate was 41.4% in RSP-group, 21.5% in FDR-group (p < 0.05), 14% in Control-group (p < 0.01). Our results showed that colonoscopy probably can not be regarded as a first-line tool for the screening of CRC in FDR of patients with CRC or adenoma. Some stratification or scoring system for the risk of CRC should be adopted. As an alternative, FOBT could be used also in these subjects.
Collapse
Affiliation(s)
- Lucio Trevisani
- Centro di Endoscopia Digestiva, Dipartimento di Medicina, Azienda Ospedaliero-Universitaria S. Anna, Ferrara.
| | | | | | | | | | | | | |
Collapse
|
6
|
Sartori S, Tombesi P, Macario F, Nielsen I, Tassinari D, Catellani M, Abbasciano V. Subcapsular liver tumors treated with percutaneous radiofrequency ablation: a prospective comparison with nonsubcapsular liver tumors for safety and effectiveness. Radiology 2008; 248:670-9. [PMID: 18519740 DOI: 10.1148/radiol.2482071690] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To assess the safety and effectiveness of percutaneous radiofrequency (RF) ablation of subcapsular liver tumors. MATERIALS AND METHODS The study protocol was approved by the institutional review board, and all patients gave written informed consent. One hundred eighty-one patients (79 men, 102 women; age range, 36-85 years) underwent ultrasonographically (US) guided percutaneous RF ablation of 361 primary or secondary (metastatic) liver tumors. Forty-four patients had one or more subcapsular nodules (group 1), and 137 had nonsubcapsular nodules only (group 2). Overall, 80 nodules were subcapsular and 281 were nonsubcapsular. The completeness of the ablation was assessed with contrast material-enhanced computed tomography (CT) 1 month after RF ablation. If residual tumor was documented, RF ablation was repeated. All patients in whom the ablation was complete after the first or second ablation session were monitored with CT or contrast-enhanced US every 3 months. Major complication, complete ablation, and local tumor progression rates were compared by using the chi(2) test or Fisher exact test. RESULTS Three (7%) major complications (intraperitoneal bleeding, skin burn, and tumor seeding) occurred in group 1, and two (1.5%) cases of tumor seeding occurred in group 2 (P = .093). No RF ablation-related deaths occurred. The complete ablation rate was 98% (43 of 44 patients) in group 1 and 98.5% (135 of 137 patients) in group 2 (P = .756). The local tumor progression rate after a median follow-up of 25 months (range, 13-54 months) was 16% (seven of 43 patients) in group 1 and 9.6% (13 of 135 patients) in group 2 (P = .355). CONCLUSION The difference in major complication rate between the subcapsular and nonsubcapsular liver tumors was not significant. The safety of RF ablation of subcapsular tumors seems acceptable, and the effectiveness is comparable to that of RF ablation of nonsubcapsular tumors.
Collapse
Affiliation(s)
- Sergio Sartori
- Department of Internal Medicine, Section of Interventional Ultrasound, St Anna Hospital, Corso Giovecca 203, 44100 Ferrara, Italy.
| | | | | | | | | | | | | |
Collapse
|
7
|
Tombesi P, Catellani M, Abbasciano V, Sartori S, Tassinari D. Impact of contrast-enhanced ultrasonography in a tertiary clinical practice. J Ultrasound Med 2008; 27:991-992. [PMID: 18499863 DOI: 10.7863/jum.2008.27.6.991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
8
|
Trevisani L, Cifalà V, Tombesi P, Sartori S, Abbasciano V. [Physicians working in internal medicine's ward: a survey on their role in the management of the gastrointestinal endoscopy services in Emilia Romagna]. Recenti Prog Med 2007; 98:568. [PMID: 18044407] [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: 05/25/2023]
Abstract
We carried out a survey on the role played by the Wards of Internal Medicine in the management of the Gastrointestinal Endoscopy (G.E.) Services operating in Emilia Romagna. 45 G.E. Services were censored, for a total of 225 endoscopists: 105 out of them (46.7%) were gastroenterologists and 84 (37.3%) were surgeons, whereas just 35 (15.6%) were working in Internal Medicine's Ward and 1 (0.4%) was working in a Division of Geriatrics. A significant difference was observed analyzing the composition of the G.E. staffs on the basis of the size and activity of G.E. Services (p < 0.001). Physicians working in Wards of Internal Medicine represented 9.2% and 24.5% of the endoscopists in the hospitals with or without a Gastroenterology Unit, respectively (p = 0.003). Based on these results, the physicians working in Internal Medicine's Ward seem to play a secondary role in G.E. Services. Their role is greater in small hospitals, but they are often compelled to operate under suboptimal circumstances.
Collapse
Affiliation(s)
- Lucio Trevisani
- Centro di Endoscopia Digestiva, Azienda Ospedaliero-Universitaria, Corso Giovecca, 203 - 44100 Ferrara
| | | | | | | | | |
Collapse
|
9
|
Trevisani L, Cifalà V, Fusetti N, Gilli G, Tombesi P, Torchiaro M, Boccia S, Abbasciano V. Diagnostic accuracy of a rapid fecal test to confirm H pylori eradication after therapy: Prospective comparison with a laboratory stool test. World J Gastroenterol 2007; 13:4484-8. [PMID: 17724805 PMCID: PMC4611582 DOI: 10.3748/wjg.v13.i33.4484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical performances of rapid stool test (ImmunoCard STAT HpSA, Meridian Diagnostic Inc.) in the evaluation of eradication therapy of H pylori and to compare it with a well-known and validated laboratory stool test (Amplified IDEA Hp StAR, Dako).
METHODS: Stool samples of 122 patients were evaluated after eradication therapy of H pylori. H pylori status was assessed by 13C-urea breath test (UBT). Stool specimens were tested using either the rapid immunoassay kit or the laboratory immunoassay kit.
RESULTS: Forty-three patients were infected and 79 non-infected. Sensitivity and specificity of ImmunoCard STAT and Hp StAR were 58.14% and 76.4%, and 97.47% and 98.73%, respectively (P > 0.05). Overall agreement between the two tests was 92.6% (113 of 122 cases).
CONCLUSION: ImmunoCard STAT seems to have rather low performances, and it cannot be regarded as a reliable tool in the post-treatment setting. Also Hp StAR cannot be recommended to confirm H pylori eradication after treatment.
Collapse
Affiliation(s)
- Lucio Trevisani
- Centro di Endoscopia Digestiva, Azienda Ospedaliero-Universitaria Arcispedale S Anna, C so Giovecca 203, Ferrara, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Abbasciano V, Candiotto M, Guglielmini C, Sartori S, Trevisani L, Salemi A. [A peculiar case of hypomagnesemia]. Recenti Prog Med 2007; 98:279-80. [PMID: 17580518] [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
An old man with previous resections of small intestine for infarction and sigmoid for adenocarcinoma presented vomit, vertigo, visual impairment, fatigue, serum non detectable, reduced cellular magnesium, no ECG alterations. For the lack of symptoms proportionate to this alteration, an adaptation to progressive decrease in cellular magnesium is hypothesized.
Collapse
|
11
|
Trevisani L, Cifalà V, Sartori S, Gilli G, Matarese G, Abbasciano V. Unsedated ultrathin upper endoscopy is better than conventional endoscopy in routine outpatient gastroenterology practice: A randomized trial. World J Gastroenterol 2007; 13:906-11. [PMID: 17352021 PMCID: PMC4065927 DOI: 10.3748/wjg.v13.i6.906] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: to compare the feasibility and patients’ tolerance of esophagogastroduodenoscopy (EGD) using a thin endoscope with those of conventional oral EGD and to determine the optimal route of introduction of small-caliber endoscopes.
METHODS: One hundred and sixty outpatients referred for diagnostic EGD were randomly allocated to 3 groups: conventional (C)-EGD (9.8 mm in diameter), transnasal (TN)-EGD and transoral (TO)-EGD (5.9 mm in diameter). Pre-EGD anxiety was measured using a 100-mm visual analogue scale (VAS). After EGD, patients and endoscopists completed a questionnaire on the pain, nausea, choking, overall discomfort, and quality of the examination either using VAS or answering some questions. The duration of EGD was timed. Blood oxygen saturation (SaO2) and heart rate (HR) were monitored during EGD.
RESULTS: Twenty-one patients refused to participate in the study. The 3 groups were well-matched for age, gender, experience with EGD, and anxiety. EGD was completed in 91.1% (41/45), 97.5% (40/41), and 96.2% (51/53) of cases in TN-EGD, TO-EGD, and C-EGD groups, respectively. TN-EGD lasted longer (3.11 ± 1.60 min) than TO-EGD (2.25 ± 1.45 min) and C-EGD (2.49 ± 1.64 min) (P < 0.05). The overall tolerance was higher (P < 0.05) and the overall discomfort was lower (P < 0.05) in TN-EGD group than in C-EGD group. EGD was tolerated “better than expected” in 73.2% of patients in TN-EGD group and 55% and 39.2% of patients in TO-EGD and C-EGD groups, respectively (P < 0.05). Endoscopy was tolerated “worst than expected” in 4.9% of patients in TN-EGD group and 17.5% and 23.5% of patients in TO-EGD and C-EGD groups, respectively (P < 0.05). TN-EGD caused mild epistaxis in one case. The ability to insufflate air, wash the lens, and suction of the thin endoscope were lower than those of conventional instrument (P < 0.001). All biopsies performed were adequate for histological assessment.
CONCLUSION: Diagnostic TN-EGD is better tolerated than C-EGD. Narrow-diameter endoscope has a level of diagnostic accuracy comparable to that of conventional gastroscope, even though some technical characteristics of these instruments should be improved. Transnasal EGD with narrow-diameter endoscope should be proposed to all patients undergoing diagnostic EGD.
Collapse
Affiliation(s)
- Lucio Trevisani
- Centro di Endoscopia Digestiva, Azienda Ospedaliera-Universitaria Arcispedale S. Anna, C.so Giovecca 203, Ferrara 44100, Italy.
| | | | | | | | | | | |
Collapse
|
12
|
Sartori S, Tombesi P, Trevisani L, Nielsen I, Tassinari D, Abbasciano V. Accuracy of Transthoracic Sonography in Detection of Pneumothorax After Sonographically Guided Lung Biopsy: Prospective Comparison with Chest Radiography. AJR Am J Roentgenol 2007; 188:37-41. [PMID: 17179343 DOI: 10.2214/ajr.05.1716] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [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: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to prospectively evaluate the accuracy of transthoracic sonography in the detection of pneumothorax after transthoracic sonographically guided lung biopsy. SUBJECTS AND METHODS Transthoracic sonography was performed on 285 patients after transthoracic sonographically guided lung biopsy. Disappearance of the sliding lung and comettail artifacts and appearance of reverberation artifacts were considered evidence of pneumothorax. Upright chest radiography was performed within 30 minutes of transthoracic sonography. If a discrepancy between transthoracic sonographic and chest radiographic findings occurred, CT was performed. When it was diagnosed, pneumothorax was sonographically monitored. After visualization of resolution of pneumothorax, chest radiography was performed to confirm the resolution. RESULTS Pneumothorax occurred in eight (2.8%) of the patients. Transthoracic sonography depicted all cases of pneumothorax and excluded pneumothorax in the other cases. Chest radiography did not depict one case of pneumothorax, which was confirmed on CT. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were all 100% for transthoracic sonography and 87.5%, 100%, 100%, 99.6%, and 99.6%, respectively, for chest radiography. The 95% confidence intervals (CI) of the differences in sensitivity, negative predictive value, and overall accuracy were -10% to 35%, -0.1 to 0.9%, and -0.1 to 0.9%. Transthoracic sonographic visualization of resolution of pneumothorax was always confirmed with chest radiography. CONCLUSION These preliminary results suggest that transthoracic sonography is as effective as chest radiography in the detection of pneumothorax after transthoracic sonographically guided lung biopsy and may become the method of choice for excluding, diagnosing, and monitoring pneumothorax after transthoracic sonographically guided biopsy. Chest radiography may be needed only for assessment of the extent of pulmonary collapse after transthoracic sonographic diagnosis of pneumothorax or in the presence of discrepancy between transthoracic sonographic findings and clinical presentation.
Collapse
Affiliation(s)
- Sergio Sartori
- Section of Interventional Ultrasound, Department of Internal Medicine, St. Anna Hospital, corso Giovecca 203, 44100 Ferrara, Italy.
| | | | | | | | | | | |
Collapse
|
13
|
Abbasciano V, Trevisani L, Di Todaro F, Guglielmini C, Marzola A, Sartori S, Salemi A. [Primary biliary cirrhosis and autoimmune hepatitis overlap syndrome. An early case]. Recenti Prog Med 2006; 97:28-31. [PMID: 16535927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
A 21-year old asymptomatic woman had accidental report of increased transaminases. Serologic tests were negative, autoimmune profile was positive for anti-nuclear, antimitochondrial antibodies and rheumatoid factor. Histology of the liver biopsy showed severe necro-inflammatory activity both in biliary epithelium and in intralobular area, suggesting primary biliary cirrhosis/autoimmune hepatitis overlap syndrome.
Collapse
Affiliation(s)
- Vincenzo Abbasciano
- Istituto di Medicina Interna, Geriatria e Gerontologia, Dipartimento di Medicina Clinica e Sperimentale, Azienda Ospedaliera-Universitaria S. Anna, Ferrara.
| | | | | | | | | | | | | |
Collapse
|
14
|
Trevisani L, Simone L, Matarese V, Cifalà V, Sartori S, Abbasciano V. [Stool antigen test for diagnosis of Helicobacter pylori infection. Merely a research opportunity, or an effective diagnostic tool?]. Recenti Prog Med 2005; 96:271-7. [PMID: 16078754] [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: 05/03/2023]
Abstract
Since Helicobacter pylori (H. pylori) infection was recognized as a major cause of peptic ulcer disease and an important risk factor for gastric malignancy, several strategies have been used to diagnose it. These methods are split up along two lines: 1) direct detection of the bacteria, and 2) detection of antigen-antibody assay against H. pylori, or anyhow detection of H. pylori by indirect methods. In this review of literature about the methods to diagnose H. pylori infection, we focused in particular on the non-invasive tests based on H. pylori antigens detection in faeces. Some meta-analyses showed that immunoenzymatic stool tests can be considered reliable in untreated patients, whereas further confirmations are needed before extending their use also in anti-H. pylori treated patients. As it concerns cost-analysis, immunoenzymatic stool test is the most cost-effective among the tests today available. Finally, a newly developed office-based stool test has been evaluated. It does not require laboratory assay, and the results are available within 10 minutes. Preliminary data about its clinical usefulness are promising, but further and wider confirmations are needed, as it has been put on the market quite recently.
Collapse
Affiliation(s)
- Lucio Trevisani
- Centro di Endoscopia Digestiva, Dipartimento di Medicina, Azienda Ospedaliera-Universitaria Arcispedale S. Anna, Ferrara.
| | | | | | | | | | | |
Collapse
|
15
|
Trevisani L, Sartori S, Rossi MR, Bovolenta R, Scoponi M, Gullini S, Abbasciano V. Degradation of polyurethane gastrostomy devices: what is the role of fungal colonization? Dig Dis Sci 2005; 50:463-9. [PMID: 15810627 DOI: 10.1007/s10620-005-2459-2] [Citation(s) in RCA: 24] [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: 12/09/2022]
Abstract
The aim of this study was to evaluate polyurethane percutaneous endoscopic gastrostomy (PEG) tube degradation and the role played by fungi. The inner surfaces of 20 used polyurethane tubes were brushed, and the brushing end was incubated for 7 days in Saburaud broth and cultured if fungal growth occurred. Three tubes used for 12 (sample 12w), 17 (sample 17w), and 96 (sample 96w) weeks and two new tubes were cut to produce several 4-cm-long equal halves. Six samples from the new tubes were considered control samples (Co sample), seven were incubated in Saburaud broth (Co sample + Sa.), and seven in the broth supplemented with Candida albicans (Co sample + Sa. + Ca). All samples underwent morphological examination by electron microscopy and differential scanning calorimetry measurements (DSC). All tubes had fungal colonization. DSC showed deterioration in all tubes including the new ones; adding Candida albicans had no additional effects. Morphological examination by electron microscopy showed a regular pattern in the Co sample, and thick biofilm, holes, and crevices in samples 12w, 17w, and 96w. The more the tubes had been used, the more severe were the changes. The Co sample + Sa and the Co sample + Sa + Ca showed no changes in the inner surface, but cryogenically fractured surfaces had holes and crevices. Yeasts constantly colonize PEG tubes and are likely to contribute to polyurethane deterioration. The impairment of new PEG tubes incubated in Saburaud broth suggests that other factors also play a role in polyurethane deterioration.
Collapse
Affiliation(s)
- Lucio Trevisani
- Digestive Endoscopy Centre, Department of Internal Medicine, S Anna Hospital, Ferrara, Italy.
| | | | | | | | | | | | | |
Collapse
|
16
|
Trevisani L, Sartori S, Rossi MR, Ruina M, Matarese V, Gullini S, Abbasciano V. Evaluation of a new rapid immunoassay for the detection of Helicobacter pylori in faeces: a prospective pilot study. Aliment Pharmacol Ther 2005; 21:485-9. [PMID: 15710001 DOI: 10.1111/j.1365-2036.2005.02355.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [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: 12/22/2022]
Abstract
BACKGROUND Detection of Helicobacter pylori antigen in faeces is a valid method to diagnose H. pylori infection. Presently available stool tests are performed in the laboratory, and diagnostic report is delayed. AIM To evaluate a new rapid stool test in a pre-treatment setting and to compare it with a validated laboratory stool test. METHODS A total of 105 patients underwent gastroscopy with brush cytology, and biopsies for histology and rapid urease test, to assess H. pylori presence. Helicobacter pylori-status was considered positive if at least two tests were positive; negative if all tests were negative; indeterminate if one test was positive and two negative. Stool specimens were tested using either a rapid immunoassay kit (ImmunoCard STAT) or a laboratory enzyme immunoassay kit (Hp StAR). RESULTS Sixty patients were infected with H. pylori, 44 non-infected, one indeterminate. The sensitivity and specificity of ImmunoCard STAT were 85 and 93%; those of Hp StAR were 88 and 100% (not significant). CONCLUSIONS ImmunoCard STAT seems a reliable method for detecting H. pylori in untreated patients. It could replace laboratory stool tests, as it is easy and can be performed quickly. These characteristics might be a breakthrough for diagnosing H. pylori in the doctor's office.
Collapse
Affiliation(s)
- L Trevisani
- Digestive Endoscopy Centre, Medical Department, S. Anna Hospital, Ferrara, Italy.
| | | | | | | | | | | | | |
Collapse
|
17
|
Trevisani L, Sartori S, Gaudenzi P, Gilli G, Matarese G, Gullini S, Abbasciano V. Upper gastrointestinal endoscopy: Are preparatory interventions or conscious sedation effective? A randomized trial. World J Gastroenterol 2004; 10:3313-7. [PMID: 15484307 PMCID: PMC4572302 DOI: 10.3748/wjg.v10.i22.3313] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: The fears and concerns are associated with gastroscopy (EGD) decrease patient compliance. Conscious sedation (CS) and non-pharmacological interventions have been proposed to reduce anxiety and allow better execution of EGD. The aim of this study was to assess whether CS, supplementary information with a videotape, or presence of a relative during the examination could improve the tolerance to EGD.
METHODS: Two hundred and twenty-six outpatients (pts), scheduled for a first-time non-emergency EGD were randomly assigned to 4 groups: Co-group (62 pts): throat anaesthesia only; Mi-group (52 pts): CS with i.v. midazolam; Re-group (58 pts): presence of a relative throughout the procedure; Vi-group (54 pts): additional information with a videotape. Anxiety was measured using the "Spielberger State and Trait Anxiety Scales". The patients assessed the overall discomfort during the procedure on an 100-mm visual analogue scale, and their tolerance to EGD answering a questionnaire. The endoscopist evaluated the technical difficulty of the examination and the tolerance of the patients on an 100-mm visual analogue scale and answering a questionnaire.
RESULTS: Pre-endoscopy anxiety levels were higher in the Mi-group than in the other groups (P < 0.001). On the basis of the patients' evaluation, EGD was well tolerated by 80.7% of patients in Mi-group, 43.5% in Co-group, 58.6% in Re-group, and 50% in Vi-group (P < 0.01). The discomfort caused by EGD, evaluated by either the endoscopist or the patients, was lower in Mi-group than in the other groups. The discomfort was correlated with "age" (P < 0.001) and "groups of patients" (P < 0.05) in the patients' evaluation, and with "gender" (females tolerated better than males, P < 0.001) and "groups of patients" (P < 0.05) in the endoscopist's evaluation.
CONCLUSION: Conscious sedation can improve the tolerance to EGD. Male gender and young age are predictive factors of bad tolerance to the procedure.
Collapse
Affiliation(s)
- Lucio Trevisani
- Digestive Endoscopy Service, Department of Internal Medicine, S. Anna Hospital, Ferrara, Italy.
| | | | | | | | | | | | | |
Collapse
|
18
|
Sartori S, Tombesi P, Tassinari D, Ceccotti P, Nielsen I, Trevisani L, Abbasciano V. Sonographically guided small-bore chest tubes and sonographic monitoring for rapid sclerotherapy of recurrent malignant pleural effusions. J Ultrasound Med 2004; 23:1171-1176. [PMID: 15328431 DOI: 10.7863/jum.2004.23.9.1171] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate the role of sonographically guided small-bore chest catheters and sonographically based monitoring of fluid evacuation in rapid sclerotherapy of malignant pleural effusions. METHODS In 50 patients with recurrent malignant pleural effusions, a 9F catheter was inserted into the pleural space under sonographic guidance. When sonography documented complete fluid evacuation, bleomycin (0.75 mg/kg) was injected via the tube. Fluid drainage was monitored for 12 hours; if fluid output was less than 100 mL, the pleural catheter was removed; otherwise, a second dose of bleomycin was administered after 24 hours. If loculations or fluid reaccumulations due to tube malfunctioning were detected, they were evacuated by sonographically guided thoracentesis, and bleomycin (1.5 mg/100 mL of fluid) was injected through the thoracentesis needle. All patients were monitored for fluid recurrence with thoracic sonography. RESULTS Twenty-nine patients received 1 dose of bleomycin, and 21 received 2 doses. In 11 patients with residual loculations, sonographically guided thoracentesis was performed, and bleomycin was injected into the loculations. In 29 patients, pleurodesis was completed within 24 hours; in 21, it was completed within 48 hours. The 30-day response was 84%; the long-term response was 60%. No complications or serious side effects were observed. CONCLUSIONS Rapid pleurodesis can be accomplished within 24 to 48 hours, with good short- and long-term responses. Thoracic sonography plays a pivotal role. It guides placement of the pleural catheter and is valuable in the monitoring of fluid evacuation for determining the right time for sclerosing agent administration and in the detection and treatment of loculations or residual pleural fluid due to tube malfunctioning.
Collapse
Affiliation(s)
- Sergio Sartori
- Section of Interventional Ultrasound, Department of Internal Medicine, St Anna Hospital, Corso Giovecca 203, I-44100 Ferrara, Italy.
| | | | | | | | | | | | | |
Collapse
|
19
|
Abbasciano V, Guglielmini C, DeToma D. Importance of cellular measurement in experimental studies on serum and tissue magnesium. Magnes Res 2004; 17:115. [PMID: 15319144] [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: 04/30/2023]
|
20
|
Sartori S, Tassinari D, Ceccotti P, Tombesi P, Nielsen I, Trevisani L, Abbasciano V. Prospective Randomized Trial of Intrapleural Bleomycin Versus Interferon Alfa-2b via Ultrasound-Guided Small-Bore Chest Tube in the Palliative Treatment of Malignant Pleural Effusions. J Clin Oncol 2004; 22:1228-33. [PMID: 15051770 DOI: 10.1200/jco.2004.09.164] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To compare bleomycin pleurodesis and immunotherapy with intrapleural interferon alfa-2b (IFN) in the palliation of malignant pleural effusions. Patients and Methods One hundred sixty patients with rapidly recurrent malignant pleural effusion were randomly assigned to intrapleural bleomycin (83 patients) or IFN (77 patients). A 9-French intrapleural catheter was placed under sonographic guidance, and pleural effusion was completely drained before starting the treatment. Bleomycin 0.75 mg/kg was administered as a single dose. An additional dose was given if daily fluid output did not drop to less than 100 mL/d within 3 days. IFN 1 million units/10 kg was administered for six courses at 4-day intervals. Thirty-day and long-term responses were evaluated under the intention-to-treat principle. Results Thirty-day response was 84.3% in the bleomycin arm and 62.3% in IFN arm (P = .002). Median time to progression was 93 days (range, 12 to 395 days) in bleomycin group, and 59 days (range, 7 to 292 days) in the IFN group (P < .001). Median survival was 96 days (range, 15 to 395) and 85 days (range, 16 to 292) in the bleomycin and IFN groups, respectively. Twenty-three patients received two doses of bleomycin, as their daily fluid output remained higher than 100 mL after the first dose. Thirteen of them had complete response, which lasted until death. Conclusion Intrapleural bleomycin is more effective than IFN and is a valid option for the palliative treatment of massive, rapidly recurrent malignant pleural effusions. The administration of a second dose of bleomycin to patients not responding to the first one can remarkably improve the overall outcome of the treatment.
Collapse
Affiliation(s)
- Sergio Sartori
- Department of Internal Medicine, St Anna Hospital, Ferrara, Italy.
| | | | | | | | | | | | | |
Collapse
|
21
|
Sartori S, Nielsen I, Trevisani L, Tombesi P, Ceccotti P, Abbasciano V. Contrast-enhanced sonography as guidance for transthoracic biopsy of a peripheral lung lesion with large necrotic areas. J Ultrasound Med 2004; 23:133-136. [PMID: 14756362 DOI: 10.7863/jum.2004.23.1.133] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Sergio Sartori
- Section of Interventional Ultrasound and Department of Internal Medicine, St Anna Hospital, Ferrara, Italy.
| | | | | | | | | | | |
Collapse
|
22
|
Abbasciano V, Sartori S, Trevisani L, Girometti R, Ranzini M, Nielsen I, Mazzotta D, Vecchiatti G, Bononi A, Guglielmini C. Comparison of magnesium concentration in serum, erythrocytes and gastric tissue in two groups of patients affected by chronic gastritis, Helicobacter pylori negative and positive. Magnes Res 2003; 16:281-6. [PMID: 14979638] [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: 04/29/2023]
Abstract
UNLABELLED Magnesium seems to be an important factor both for acid gastric secretion regulation (together with Ca2+) and for Helicobacter pylori survival and virulence. It can therefore be useful to evaluate if Helicobacter pylori (HP) infection is accompanied by variations in the host Mg availability. In this study serum, erythrocytary and gastric tissue Mg concentration was measured in 36 patients affected by chronic antral gastritis. Based on the presence of Helicobacter pylori infection, the patients were subdivided in two groups: group A: Helicobacter pylori negative, n = 23; group B: Helicobacter pylori positive, n = 13. RESULTS While no differences were found between the two groups for serum Mg (group A 0.81 +/- 0.07 mm/L, group B 0.81 +/- 0.11 mm/L), both erythrocytary Mg (EMg) and gastric tissue Mg were found significantly lower in the HP positive subjects (erythrocytary Mg: 2.14 +/- 0.55 vs. 1.81 +/- 0.34 mm/L; gastric tissue Mg: 729.2 +/- 333.8 vs. 510.6 +/- 178.8 microg/g of dried tissue for group A and B respectively, p < 0.001 for both determinations). Erythrocytary Mg reduction is a clue of the whole body reduction in Mg availability (and consequently in gastric cells as well); the erythrocytary Mg reduction detected in the present paper for Helicobacter pylori positive patients can weaken gastric cells by impairing their metabolism. The hypothesis submitted is to impair Mg utilization in Helicobacter pylori, in order to improve eradication treatment, and in the meantime to preserve Mg homeostasis in infected cells.
Collapse
Affiliation(s)
- Vincenzo Abbasciano
- Dipartimento di Medicina Clinica e Sperimentale, Sezione di Medicina Interna II, Università degli Studi di Ferrara, Ferrara, Italia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Sartori S, Trevisani L, Nielsen I, Tassinari D, Ceccotti P, Abbasciano V. Longevity of silicone and polyurethane catheters in long-term enteral feeding via percutaneous endoscopic gastrostomy. Aliment Pharmacol Ther 2003; 17:853-6. [PMID: 12641508 DOI: 10.1046/j.1365-2036.2003.01538.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [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: 12/12/2022]
Abstract
BACKGROUND As percutaneous endoscopic gastrostomy (PEG) is often used for many months or years, the longevity of the feeding tubes plays an important role in the global outcome and costs of PEG. AIM A retrospective study to evaluate the longevity of silicone and polyurethane PEG catheters. METHODS The records of 297 patients who were fed via PEG for over 90 days were evaluated. The material of the PEG catheter, duration of follow-up, local complications, need to remove PEG because of tube deterioration or local complications and time from PEG placement to PEG removal were recorded and compared. RESULTS Two hundred and twenty-eight patients had polyurethane and 69 had silicone PEG catheters. The follow-up ranged from 116 to 3207 days for the polyurethane group and from 98 to 1861 days for the silicone group. No differences were observed in either local complications or PEG removal because of local complications. Tube deterioration causing PEG removal occurred in 36 of the 228 polyurethane PEG catheters and in 25 of the 69 silicone PEG catheters (P = 0.0005). Tube deterioration occurred significantly earlier in the 25 silicone catheters than in the 36 polyurethane catheters. The mean time from PEG placement to PEG removal was 287 days (95% confidence interval, 239-335) for silicone tubes and 573.9 days (95% confidence interval, 425-723) for polyurethane tubes (P = 0.0024). CONCLUSION Polyurethane PEG catheters seem to be more resistant to deterioration than silicone PEG catheters, and at present they should be preferred for long-term enteral feeding via PEG.
Collapse
Affiliation(s)
- S Sartori
- Department of Internal Medicine, St Anna Hospital, Ferrara, Italy.
| | | | | | | | | | | |
Collapse
|
24
|
Sartori S, Nielsen I, Trevisani L, Tassinari D, Ceccotti P, Barillani M, Abbasciano V. Sonographically guided peritoneal catheter placement in the palliation of malignant ascites in end-stage malignancies. AJR Am J Roentgenol 2002; 179:1618-20. [PMID: 12438065 DOI: 10.2214/ajr.179.6.1791618] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Sergio Sartori
- Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, 44100 Ferrara, Italy
| | | | | | | | | | | | | |
Collapse
|
25
|
Sartori S, Nielsen I, Trevisani L, Ceccotti P, Abbasciano V, Tassinari D. Sonographically guided biopsy of bone and soft tissue tumors. J Ultrasound Med 2002; 21:1056. [PMID: 12216755 DOI: 10.7863/jum.2002.21.9.1056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
|
26
|
Trevisani L, Chiamenti CM, Gaudenzi P, Alvisi V, Sartori S, Abbasciano V. [Endoscopic hemostasis in the treatment of bleeding peptic ulcer]. Recenti Prog Med 2002; 93:498-504. [PMID: 12355989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Upper gastrointestinal bleeding is still an important clinical problem, even though about 80% of bleedings due to peptic lesions stop spontaneously. Starting from 1970, a lot of endoscopic hemostatic procedures has been developed and employed with good results, but, at present, the key problem is represented by the selection and management of the patients at highest risk of rebleeding. This work reviews both techniques and devices most commonly used, but at present none of them can be considered actually better than the other ones. According to the SIED (Società Italiana di Endoscopia Digestiva) guidelines, the techniques of choice should be cheap, effective, safe and easy to perform, the pivotal role in determining the success rate of endoscopic hemostasis being played by the endoscopist's experience.
Collapse
Affiliation(s)
- Lucio Trevisani
- Dipartimento di Medicina, Azienda Ospedaliera, Universitaria Arcispedale S. Anna, Ferrara.
| | | | | | | | | | | |
Collapse
|
27
|
Sartori S, Galeotti R, Calia N, Gualandi M, Nielsen I, Trevisani L, Ceccotti P, Abbasciano V. Sonographically guided biopsy and sonographic monitoring in the diagnosis and follow-up of 2 cases of sarcoidosis with hepatic nodules and inconclusive thoracic findings. J Ultrasound Med 2002; 21:1035-1039. [PMID: 12216751 DOI: 10.7863/jum.2002.21.9.1035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To report 2 cases in which abdominal sonography played a useful role in diagnosing sarcoidosis with early nodular hepatosplenic manifestations. METHODS In the first case, an asymptomatic woman with increased liver enzyme values underwent sonography, which showed multiple hypoechoic nodules in the liver and spleen. Computed tomography confirmed the hepatosplenic findings and showed micronodular infiltrates of both lung fields, without hilar and mediastinal lymphadenopathy. In the second case, in a woman with a cough, dyspnea, and increased liver enzyme levels, thoracic computed tomography showed right pleural effusion causing partial atelectasis of the lower and middle lobes and mediastinal lymphadenopathy. RESULTS Sonography and computed tomography showed multiple nodules of the liver and spleen and retroperitoneal lymphadenopathy. In both cases, bronchoscopy, bronchial and bronchioloalveolar lavages, and transbronchial and mediastinal biopsies had negative results. Sonographically guided biopsy of the hepatic nodules was carried out and sarcoid granulomas were detected in the portal areas. After 3 months of steroid therapy, liver enzyme values nearly normalized, and sonography showed the disappearance of all abdominal lesions. The first patient underwent control computed tomography, which confirmed the regression of the disease; the second patient refused control computed tomography. CONCLUSIONS Sarcoidosis can occur with atypical onset, and in selected cases sonography may play a useful role in its diagnosis and follow-up.
Collapse
Affiliation(s)
- Sergio Sartori
- Department of Internal Medicine, St Anna Hospital, Ferrara, Italy
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Trevisani L, Sartori S, Putinati S, Gaudenzi P, Chiamenti CM, Gilli G, Grassi L, Abbasciano V. [Assessment of anxiety levels in patients during diagnostic endoscopy]. Recenti Prog Med 2002; 93:240-4. [PMID: 11989128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Patients with increased pre-endoscopic anxiety take advantage of the use of conscious sedation. However, the habit of using premedication varies according to the type of endoscopic examination. Aims of this study were: to evaluate whether different endoscopic procedures may have different effects on patient anxiety; and whether anxiety affects patient tolerance. 163 consecutive outpatients undergoing endoscopy (75 gastroscopy, 51 colonoscopy and 37 bronchoscopy) were interviewed to evaluate pre-endoscopy anxiety, by using the Spielberger State-Trait Anxiety Inventory. After endoscopy, endoscopists rated patient cooperation on a 10-cm visual analogue scale. Females had state and trait anxiety levels higher than males (50.49 +/- 1.37 vs 45.07 +/- 1.20, p < 0.01; and 44.46 +/- 1.06 vs 38.48 +/- 1.01, p < 0.01). Anxiety levels were not related with the type of endoscopic procedure. A direct relationship was observed between state and trait anxiety (p < 0.001). Patient cooperation to endoscopy was inversely related with both trait (p < 0.05) and state anxiety (p < 0.01). In conclusion, gastroscopy, colonoscopy and bronchoscopy seem to induce similar pre-endoscopy anxiety levels. Therefore, the different frequency in the use of intravenous sedation between bronchial and gastrointestinal endoscopy does not seem justified.
Collapse
Affiliation(s)
- Lucio Trevisani
- I Divisione di Medicina Generale, Dipartimento di Medicina, Azienda Ospedaliera Universitaria Arcispedale S. Anna, Ferrara.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Trevisani L, Chiamenti CM, Gaudenzi P, Sartori S, Pezzoli A, Gullini S, Abbasciano V. [Endoscopic treatment of upper gastrointestinal non-variceal bleeding]. Minerva Med 2002; 93:129-34. [PMID: 12032444] [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: 02/25/2023]
Abstract
BACKGROUND Endoscopic hemostasis is the method of choice for the treatment of bleeding peptic ulcers. This retrospective study was carried out to evaluate its effectiveness in routine endoscopic practice. METHODS The records of all patients with gastrointestinal bleeding undergoing esophagogastroduodenoscopy (EGDS) at the Endoscopy Center of Ferrara in the last year were retrospectively evaluated. For each patient with peptic lesions, the following data were recorded: demographic characteristics, use of NSAIDs, co-morbidity, hemodynamic conditions, blood transfusions before EGDS, time between onset of symptoms and EGDS, endoscopic findings, method of endoscopic haemostasis carried out, Rockall score and outcome. If re-bleeding occurred, the data concerning the second therapeutic intervention were recorded as well. RESULTS Seventy-six males and 45 females (age 34-92 years) entered the study. In 22% of cases no co-morbidity was present. Active bleeding was observed in 38% of cases, features consistent with recent bleeding in 54% of cases, and no sign of bleeding in 6.6% of cases. Peptic ulcer was observed in 89% of cases. Hemostasis was carried out in 81 patients (76 had adrenalin infiltration, 2 had argon plasma coagulator [APC], and 3 had both treatments); 26 patients had re-bleeding. The probability of re-bleeding was related to female gender (p<0.05; OR: 3.74), time between onset of symptoms and EGDS >24 hours (p<0.01; OR: 8.67), and presence of non-ulcer peptic pathology (p<0.05; OR: 0.15). Seven re-bleeding patients underwent surgery, 19 had endoscopic treatment. In 11 of these patients second hemostasis was resolutive, 8 bled again. CONCLUSIONS Endoscopic hemostasis of bleeding peptic lesions is effective also in routine clinical practice. Adrenalin infiltration is safe, easy to perform, cheap and repeatable, and in our opinion it should be considered the technique of first choice in endoscopic hemostasis.
Collapse
Affiliation(s)
- L Trevisani
- Centro di Endoscopia Digestiva, Dipartimento di Medicina, Azienda Ospedaliera Università, S. Anna, Ferrara, Italy.
| | | | | | | | | | | | | |
Collapse
|
30
|
Sartori S, Nielsen I, Tassinari D, Trevisani L, Abbasciano V, Malacarne P. Evaluation of a standardized protocol of intracavitary recombinant interferon alpha-2b in the palliative treatment of malignant peritoneal effusions. A prospective pilot study. Oncology 2002; 61:192-6. [PMID: 11574774 DOI: 10.1159/000055374] [Citation(s) in RCA: 24] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Several schedules with variable doses of intracavitary interferon have been proposed for the management of metastatic peritoneal effusions. This prospective pilot study evaluated the efficacy of a standardized schedule of intraperitoneal interferon alpha(2b). METHODS In 41 cancer patients with malignant ascites a 9-french intraperitoneal catheter was placed under sonographic guidance, and ascites was drained until abdominal ultrasound showed complete absence of effusion. Interferon alpha(2b), 6 or 9 million units (body weight <or= or >50 kg, respectively), was then administered via the tube, which was clamped for 6 h. 6 courses were given at 4-day intervals. In comparison with pretreatment levels, the 30-day response was classified as complete (CR) = no fluid recurrence, partial (PR) = fluid recurrence <50% and no response (NR) = >50%. Responders were monitored until fluid recurrence requiring paracentesis. RESULTS 12 patients had CR, 15 PR, 14 NR. Global response (GR) was 65.9%. In ovarian cancer, GR was 75% and was not influenced by the quantity of the pretreatment daily fluid production. In the other cancers, a pretreatment fluid production <or=500 ml/day was associated with a significantly higher response (p < 0.05). Patients not showing response within the first 3 courses did not respond after the next courses. 60-day GR was 41.5%, 90-day GR was 26.8%. The mean time to fluid reaccumulation was 70.5 +/- 75.3 versus 11.4 +/- 4.4 days before treatment (p < 0.001). The survival of responders was 38-394 days (mean 131), and the average duration of response was 101 days. CONCLUSION This protocol could be reasonably applied to ovarian cancer patients and to patients with other cancers having a fluid production of <or=500 ml/day, and it should be stopped if no response is observed after 3 courses of treatment.
Collapse
Affiliation(s)
- S Sartori
- Dipartimento di Medicina Interna e Servizio di Oncologia, Azienda Ospedaliera S. Anna, Ferrara, Italia.
| | | | | | | | | | | |
Collapse
|
31
|
Migliori MV, Ciaschini AM, Discepoli G, Abbasciano V, Barbato M, Pannone E. Distal trisomy of 10q. Report of a new case of duplication 10q25.2-25.3-->qter defined by FISH. Ann Genet 2002; 45:9-12. [PMID: 11934383 DOI: 10.1016/s0003-3995(02)01102-4] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In the present work, we report on a 2.5-year-old male patient with typical clinical features of partial trisomy of the distal third of chromosome 10 long arm. The karyotype was: 46,XY, dir dup(10)(q25.2-25.3-->qter). The identification of the duplicated segment was carried out by the fluorescence in situ hybridization technique using region-specific probes. The proband's phenotype is compared with previously reported cases.
Collapse
|
32
|
Trevisani L, Sartori S, Gilli G, Chiamenti CM, Gaudenzi P, Alvisi V, Pazzi P, Abbasciano V. Appropriateness of upper gastrointestinal endoscopy: a hospital-based study. Dig Dis Sci 2001; 46:2695-9. [PMID: 11768262 DOI: 10.1023/a:1012775429096] [Citation(s) in RCA: 17] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Aims of this study were to evaluate: (1) whether upper gastrointestinal endoscopy (UGE) is used appropriately according to the American Society for Gastrointestinal Endoscopy (ASGE) and British Society of Gastroenterology (BSG) guidelines in a hospital setting and (2) whether there is any relationship between appropriateness of UGE and the presence of lesions detected by endoscopy. Indications and endoscopic findings for 734 consecutive UGE performed in 697 inpatients were retrospectively evaluated using ASGE and BSG guidelines to determine appropriateness of referrals. UGE showing endoscopic findings that had direct therapeutic or prognostic consequences were classified as "positive"; the other UGEs were classified as "negative." In all, 46% of UGEs were "positive," 54% "negative," and 61.7% and 23.2% of UGEs were inappropriate according to ASGE and BSG guidelines, respectively (P < 0.001). The probability of finding a positive endoscopy was significantly higher in UGE rated as appropriate than in those rated as inappropriate on the basis of ASGE guidelines (P < 0.001), but not on the basis of BSG guidelines. Endoscopies rated as inappropriate according to ASGE and BSG criteria showed a positive finding in 37.3% and 42.3% of cases, respectively (not significant difference). Multivariate analysis showed that the positive finding is directly related to age (P < 0.05), male gender (P < 0.001), prior UGE (P < 0.05), hematemesis (P < 0.001), and inversely related with upper abdominal pain (P < 0.01) and dyspepsia (P < 0.05). In hospitalized patients, UGE is frequently used for inappropriate indications, according to both ASGE and BSG guidelines. However, the actual clinical usefulness of appropriateness criteria, such as those proposed by ASGE and BSG, is questionable, as their strict observance could lead to missing a large number of significant endoscopic findings.
Collapse
Affiliation(s)
- L Trevisani
- Department of Internal Medicine, Arcispedale S. Anna, Ferrara, Italy
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Bononi A, Lanza F, Dabusti M, Gusella M, Gilli G, Menon D, Toso S, Crepaldi G, Marenda B, Abbasciano V, Ferrazzi E. Increased myeloperoxidase index and large unstained cell values can predict the neutropenia phase of cancer patients treated with standard dose chemotherapy. Cytometry 2001; 46:92-7. [PMID: 11309818 DOI: 10.1002/cyto.1070] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study was to better understand neutropenia induced by standard dose chemotherapy and to verify if there are any hematological parameters for defining the phase and possibly the duration of neutropenia. METHODS The kinetics of large unstained cells (LUCs) and lymphocytes was evaluated in 324 blood counts of 56 chemotherapy cycles through the use of a Technicon H2 or an ADVIA 120 hematology analyzer. Blood samples collected during the neutropenia phase were also studied by flow cytometry using a large panel of monoclonal antibodies. Parametric and nonparametric statistics were employed to compare the different variables analyzed. A linear regression between each variable before and after nadir and a simple linear correlation among the same variables in the neutropenic and recovery phase were performed. RESULTS The percentage of LUCs reaches the higher value at nadir and the difference between the mean value of prenadir and nadir is statistically significant (P <.01). The number of LUCs increases during the pre and postnadir phase. Lymphocytes number appears stable in the prenadir phase. The MPXI index increases in the prenadir phase and falls at nadir and this difference is statistically significant(P <.01). LUCs are correlated with blasts and CD34+ cells in the pre and postnadir phase, with CD3+/CD4+ cells in the prenadir phase, and with CD2+/CD56+ in the postnadir phase. CONCLUSIONS Our data have shown that the estimation of both percentage of LUCs and MPXI can predict the neutropenia phase and orient for its duration. The lymphocyte number may be regarded as a parameter of risk of fever after day 5 of chemotherapy and the number of blood CD34+ cells may be predicted by LUC count.
Collapse
Affiliation(s)
- A Bononi
- Medical Oncology Unit, Regional Hospital of Rovigo, Rovigo, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Pieroni G, Russo M, Bolli V, Abbasciano V, Fabrizzi G. [Ocular ultrasonography in pediatrics: persistence of hyperplastic primary vitreous]. Radiol Med 2001; 101:270-4. [PMID: 11398058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
AIM OF THE STUDY To assess the diagnostic viability of ultrasound and color Doppler ultrasound in a particular segment of paediatric ophthalmology-persistent primary hyperplastic vitreous, in the presence of leucocoria, retrospectively evaluated in patients observed over the last two years. MATERIAL AND METHODS We re-evaluated four patients (two new-born, one unweaned and one nine-years-old) who at ophthalmoscopic examination were suspected having persistent primitive hyperplastic vitreous. The follow-up included an ultrasound examination, basic color-Doppler ultrasound and re-evaluation during sedation both using an operative microscope and ultrasound. The examinations were performed with linear 7.5 Mhz probes and a Doppler frequency of 3.7 Mhz, while the sedation examination was performed with an anular 13 Mhz probe. The scans were sagittal and axial to correctly localize the lesion with respect to the lens, to ciliary bodies and to the optic nerve head. RESULTS In the first patient ultrasound revealed a hyperechogenic inhomogeneous structure bilaterally in the vitreous structure; this extended from the posterior wall of the lens to the optic nerve head and retina, and was found to be highly vascolarized at the subsequent color-Doppler ultrasound. In the second patient there was an echogenic band extending from the posterior wall of the lens to the optic nerve head and to the retina, as the fourth patient showed a series of echogenic bands extending from the temporal ciliar of bodies to the temporal retina; in both cases no significant vascolarization was found by color Doppler ultrasound. In the third patient ultrasound showed a lesion involving nearly all of the vitreous body, with inhomogeneous structure with small calcifications and intense vascolarization. DISCUSSION AND CONCLUSIONS Ultrasound supplies essential information for the diagnosis of persistent hyperplastic primary vitreous as it determines the presence of the lesion, its extension and retinal and optic nerve head involvement. As confirmed by operative microscopy the first patient had bilateral lesions involving the optic nerve head, as well as the retina, the latter which appeared raised. The second and fourth patients had typically posterior lesions; the lesion of the third patient was difficult to interpret even by operative microscopy. To conclude,Ultrasound proved to have an optimal sensitivity and specificity for precisely locating the site and extension of the lesion. By contrast, the difficulties and need for sedation with color Doppler ultrasound unlikely to be useful with paediatric patients.
Collapse
Affiliation(s)
- G Pieroni
- Dipartimento dei Servizi, Azienda Ospedaliera G. Salesi, Ancona, Italy
| | | | | | | | | |
Collapse
|
35
|
Sartori S, Trevisani L, Nielsen I, Tassinari D, Panzini I, Abbasciano V. Randomized trial of omeprazole or ranitidine versus placebo in the prevention of chemotherapy-induced gastroduodenal injury. J Clin Oncol 2000; 18:463-7. [PMID: 10653861 DOI: 10.1200/jco.2000.18.3.463] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Anticancer drugs may induce acute mucosal injury to stomach and duodenum. This study was planned to evaluate the efficacy of omeprazole or ranitidine in preventing such an injury. PATIENTS AND METHODS Two hundred twenty-eight cancer patients with normal stomach and duodenum or with less than three erosions, who were selected to be treated with cyclophosphamide, methotrexate, and fluorouracil (90 breast carcinoma patients) or fluorouracil alone (138 colon carcinoma patients), were randomly assigned to treatment with omeprazole 20 mg, ranitidine 300 mg, or one placebo tablet a day. Seven days after the second course of chemotherapy (CT), the patients underwent a further esophagogastroduodenoscopy to evaluate the mucosal injury. Endoscopic findings were quantified on the basis of an arbitrary score, and the occurrence of epigastric pain or heartburn was assessed weekly. RESULTS A significant difference was found among the three groups (P =.0032), as well as between pre- and postCT endoscopic findings (P =.00001). Endoscopic scores after CT were significantly higher than pretreatment scores in the placebo (P =.003) and ranitidine (P =.003) groups but not in the omeprazole group (P =.354). Acute ulcers were significantly less frequent in patients receiving omeprazole or ranitidine than in those receiving placebo (P =.0001 and P =.0315, respectively). Epigastric pain and/or heartburn were significantly less frequent in patients receiving omeprazole (P =.00124) or ranitidine (P =.038) than in those receiving placebo. CONCLUSION Omeprazole is effective in preventing chemotherapy-induced gastroduodenal injury. Ranitidine is effective in reducing the frequency of ulcers and upper gastrointestinal symptoms but is not effective in preventing the global endoscopic worsening caused by chemotherapy. The different efficacy of omeprazole and ranitidine can be explained by their different pharmacodynamics.
Collapse
Affiliation(s)
- S Sartori
- Divisione di Medicina Interna e Oncologia Medica, Azienda Ospedaliera S Anna, Italy.
| | | | | | | | | | | |
Collapse
|
36
|
Sartori S, Nielsen I, Trevisani L, Tassinari D, Abbasciano V. Subcutaneous seeding after ultrasound-guided placement of intrapleural catheter. An unusual complication of the intracavitary palliative treatment of pleural mesothelioma. Support Care Cancer 1999; 7:362-4. [PMID: 10483823 DOI: 10.1007/s005200050276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Intrapleural catheters are useful in the palliative treatment of malignant effusions. Complications are infrequent and of little importance. We report a case of subcutaneous implantation metastasis along the course of intrapleural catheter, which had been placed under sonographic guidance in a patient with pleural mesothelioma. After drainage of the effusion, cisplatin plus cytarabine was administered via the chest tube, achieving complete remission of the pleural effusion. Subcutaneous metastasis became evident 3 months later and was the only sign of disease progression for 2 months. The seeding of cancer cells was probably caused by a small leakage of fluid around the chest tube that occurred during the placement procedure as a result of the increased intrapleural pressure caused by the large quantity of fluid that had accumulated in the pleural space.
Collapse
Affiliation(s)
- S Sartori
- Dipartimento di Medicina Interna e Oncologia Medica, Azienda Ospedaliera, Ferrara, Italy
| | | | | | | | | |
Collapse
|
37
|
Abbasciano V, Sartori S, Trevisani L, Nielsen I, Ferrazzi E, Bononi A, Toso S, Crepaldi G, Bianchi MP, Gilli G, Zavagli G. Neuron-specific enolase, thymidine kinase, and tissue polypeptide-specific antigen in diagnosis and response to chemotherapy of small-cell lung cancer. Cancer Detect Prev 1999; 23:309-15. [PMID: 10403902 DOI: 10.1046/j.1525-1500.1999.99031.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The clinical usefulness of neuron-specific enolase (NSE), thymidine kinase (TK), and tissue polypeptide-specific antigen (TPS) was investigated in 41 patients (53-80 years old) with recently discovered small-cell lung cancer (SCLC). Eleven patients exhibited limited disease (LD) and 30 extensive disease (ED). Serum samples for NSE, TPS (immunoradiometric assay), and TK (radioenzymatic assay) evaluations were drawn from all patients at the time of diagnosis and before each cycle of chemotherapy in the treated patients. Therapy consisted of i.v. carboplatin 300 mg/m2 on the first day and i.v. etoposide 120 mg/m2 from the first to the third day every 3 weeks. Nine patients refused or were not eligible for chemotherapy. Five patients received only one course and showed no response (NR); 9 patients received two courses; 18 patients received three or more courses. In the last group, complete remission (CR) was obtained in 9 cases, partial remission (PR) in 18 cases. The tumor markers studied did not show any significant difference in distinguishing LD from ED. NSE and TPS were significantly more often abnormal than TK, either at the time of diagnosis (p < 0.05) or in PR or NR patients (p < 0.05). In relation to chemotherapy response, NSE and TPS serum patterns were shown to be more reliable than TK in PR (p < 0.05) and NR patients (computed error between 10% and 15%). No significant difference was observed between serum NSE and TPS patterns. Serum NSE and TPS seem to be more useful in the diagnosis and follow-up of SCLC patients undergoing chemotherapy. Further trials are necessary to ascertain whether the associated assessment of NSE and TPS can add useful information to that provided by the assessment of NSE alone.
Collapse
Affiliation(s)
- V Abbasciano
- Istituto di Medicina Interna II, Università di Ferrara, Ferrara, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Trevisani L, Sartori S, Galvani F, Ruina M, Caselli M, Verdianelli G, Abbasciano V. Evaluation of a new ultrashort triple therapy for Helicobacter pylori disease. Aliment Pharmacol Ther 1998; 12:1269-72. [PMID: 9882037 DOI: 10.1046/j.1365-2036.1998.00430.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [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: 12/08/2022]
Abstract
BACKGROUND 1-week proton pump inhibitor-based triple therapies are considered the most effective and convenient drug combinations for curing Helicobacter pylori infection. Short therapies, lasting less than 1 week have been investigated rarely. AIM To assess the efficacy and tolerability of a 3-day lansoprazole triple therapy after 1 day of lansoprazole pre-treatment. METHODS Seventy H. pylori-positive (rapid urease test and histology) patients received LAzT3 regimen (lanzoprazole 30 mg b.d. and azithromycin 500 mg o.m. for 3 days; tinidazole 2000 mg o.m. on day 1 and 1000 mg o.m. on days 2-3) after 1 day of lansoprazole pretreatment. Patients with active ulcer received lansoprazole 30 mg o.m. for an additional 4 weeks. Follow-up gastroscopy was carried out 4-6 weeks after completion of therapy. Eradication was defined as negative histology and rapid urease test. RESULTS Four patients failed to attend the follow-up endoscopy. One patient complained of minor side-effects. H. pylori was eradicated in 57 of 66 patients suitable for evaluation, with a per-protocol cure rate of 86.3% (95%CI: 76-94%), and an intention-to-treat cure rate of 81.4% (95%CI: 70-90%). CONCLUSIONS This new ultrashort triple therapy including lansoprazole, azithromycin and tinidazole seems to be effective in eradicating H. pylori. It is safe and well-tolerated, and may be taken into consideration as a valid alternative to the better known and widely used 1-week proton pump inhibitor-based triple therapies.
Collapse
Affiliation(s)
- L Trevisani
- Medical Department, S. Anna Hospital, Ferrara, Italy
| | | | | | | | | | | | | |
Collapse
|
39
|
Trevisani L, Sartori S, Galvani F, Caselli M, Ruina M, Abbasciano V, Grandi E. Usefulness of brushing urease test for diagnosis of Helicobacter pylori infection. Ital J Gastroenterol Hepatol 1998; 30:599-601. [PMID: 10076780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND AIMS Gastric brushing cytology is an accurate technique for rapidly detecting Helicobacter pylori infection, but it is not routinely employed since the presence of personnel experienced in this field, is necessary in the endoscopy suite. To evaluate the diagnostic usefulness of rapid urease test carried out on cytological brushing. PATIENTS A total of 143 consecutive patients with suspected Helicobacter pylori infection, referred for elective gastroscopy. METHODS For each patient, 2 brushings were carried out and 4 biopsies were taken from antral mucosa during gastroscopy. The former brushing was smeared on a slide, and stained by a rapid staining set for blood smears. The latter was used for rapid urease test, by shaking the brush into the urea broth. Two biopsies were used for rapid urease test and two for histologic examination. Histology was considered as the gold standard. RESULTS Of 143 patients, 73 were diagnosed as Helicobacter pylori infected using histology. Six brushing slides were inadequate due to insufficient cytology material. Biopsy-rapid urease test and brushing-rapid urease test had similar sensitivity (87.3% vs 83.5%), specificity (98.4% vs 96.8%) and overall accuracy (92.3% vs 89.5%). In 62 Helicobacter pylori infected patients, both rapid urease test techniques were positive. Brushing-rapid urease test became positive in a significantly shorter time than biopsy-rapid urease test (22 +/- 54 minutes vs 39 +/- 63 minutes; p < 0.01). CONCLUSIONS Brushing-rapid urease test is as accurate as biopsy-rapid urease test in detecting Helicobacter pylori infection, but it is significantly faster. Special care should be taken to carry out brushing adequately, to minimize the occurrence of false negatives.
Collapse
Affiliation(s)
- L Trevisani
- Medical Department, S. Anna Hospital and Ferrara University, Italy
| | | | | | | | | | | | | |
Collapse
|
40
|
Sartori S, Trevisani L, Nielsen I, Tassinari D, Abbasciano V. Intracavitary bleomycin vs interferon in the management of malignant pleural effusions. Chest 1998; 113:1145-6. [PMID: 9554669 DOI: 10.1378/chest.113.4.1145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
41
|
Trevisani L, Sartori S, Caselli M, Ruina M, Verdianelli G, Abbasciano V. A four-day low dose triple therapy regimen for the treatment of Helicobacter pylori infection. Am J Gastroenterol 1998; 93:390-3. [PMID: 9517646 DOI: 10.1111/j.1572-0241.1998.00390.x] [Citation(s) in RCA: 16] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The current guidelines recommend 1-wk triple therapy regimens for eradicating H. pylori infection. Until now, shorter regimens have scarcely been investigated. Azithromycin is a new generation macrolide antibiotic with unusual and favorable pharmacokinetics, and seems to be a very promising agent for innovative anti-H. pylori regimens. We assessed the efficacy and tolerability of a new 4-day low dose triple therapy in comparison with a well established 1-wk triple therapy in the treatment of Helicobacter pylori infection. METHODS One hundred-sixty consecutive patients with biopsy-proven H. pylori infection were randomized to receive lansoprazole 30 mg b.i.d. on days 1-4, azithromycin 500 mg u.i.d. on days 2-4, and tinidazole 2000 mg u.i.d. on day 3 (LAT group), or 7 days of triple therapy of omeprazole 20 mg u.i.d., clarithromycin 250 mg b.i.d., and tinidazole 500 mg b.i.d. (OCT group). Patients with gastric or duodenal active ulcer received proton pump inhibitors for an additional 4 wk. H. pylori eradication was defined as negative of both rapid urease test and histology on biopsies taken from the gastric body and antrum at least 1 month after the end of treatment. RESULTS Seven patients in the LAT group and four in the OCT group were lost to follow-up. No significant difference in either efficacy or tolerability was observed between the two regimens. Active ulcers healed in 97.8% of cases with LAT and in 100% of cases with OCT. The eradication rate was 80.8% in the LAT group and 85.5% in the OCT group, considering the per-protocol results, and 73.3% and 81.2%, respectively, considering the intention-to-treat results. Side effects occurred in one LAzT patient and in two OCT patients; they were mild and did not interfere with compliance. CONCLUSION The new proposed ultrashort triple therapy, including lansoprazole, low dose azithromycin for 3 days, and a single dose of tinidazole, appears to be a very effective anti-H. pylori regimen, a simpler, cheaper, well-tolerated, and equally effective alternative to 1-wk triple therapy.
Collapse
Affiliation(s)
- L Trevisani
- Department of Internal Medicine, S. Anna Hospital, Ferrara, Italy
| | | | | | | | | | | |
Collapse
|
42
|
Tassinari D, Sartori S, Drudi G, Panzini I, Gianni L, Pasquini E, Abbasciano V, Ravaioli A, Iorio D. Cardiac arrhythmias after cisplatin infusion: three case reports and a review of the literature. Ann Oncol 1997; 8:1263-7. [PMID: 9496393 DOI: 10.1023/a:1008231521553] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- D Tassinari
- III Department of Internal Medicine, City Hospital, Rimini, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
|
44
|
Trevisani L, Sartori S, Ruina M, Caselli M, Abbasciano V, Grandi E, Forini E. Touch cytology. A reliable and cost-effective method for diagnosis of Helicobacter pylori infection. Dig Dis Sci 1997; 42:2299-303. [PMID: 9398809 DOI: 10.1023/a:1018874919571] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 02/05/2023]
Abstract
A variety of reliable methods are available for detecting Helicobacter pylori (Hp) during upper gastrointestinal endoscopy. We evaluated the clinical utility and cost-effectiveness of rapid urease test (RUT), touch cytology (TC), and histology (H). Two hundred thirty-eight consecutive patients (178 without previous medical treatment and 60 formerly treated with anti-Hp therapy) were tested for Hp infection by RUT, TC, and H (H&E stain). The infection status for each patient was established by a concordance of two test results. The time to carry out the three tests and their cost were also calculated. Sensitivity of TC (100%) was significantly higher than that of RUT (86.8%; P < 0.001), but not than that of H (94.9%). RUT was significantly more specific than H (100% vs 95.6%; P < 0.05), but not than TC (96.4%). Hp infection was more frequent in the patients with chronic active gastritis than in those with chronic nonactive gastritis (P < 0.001). No Hp infection was detected in absence of chronic antral inflammation. RUT resulted the cheapest method and H the most expensive; TC is faster and cheaper than H. When additional information about the severity of mucosal damage or the presence of cell atypias is not necessary, histologic examination can be omitted, and a cost-effective strategy for assessing Hp status might consist in taking two antral biopsies, the former for performing RUT and the latter for preparing a slide by TC, which should be stained and examined only when the RUT result is negative.
Collapse
Affiliation(s)
- L Trevisani
- Department of Internal Medicine, S. Anna Hospital, Ferrara, Italy
| | | | | | | | | | | | | |
Collapse
|
45
|
Sartori S, Nielsen I, Trevisani L, Tassinari D, Abbasciano V. 665 Neuron-specific enolase, thymidine, kinase and tissue polypeptide specific antigen in small cell lung cancer. Lung Cancer 1997. [DOI: 10.1016/s0169-5002(97)80045-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
46
|
Trevisani L, Sartori S, Putinati S, Stabellini G, Abbasciano V. Antibiotics in acute bronchitis and exacerbations of chronic bronchitis: what is general practitioners' habit? Chest 1997; 111:1788-9. [PMID: 9187222 DOI: 10.1378/chest.111.6.1788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|
47
|
Sartori S, Trevisani L, Nielsen I, Tassinari D, Abbasciano V. Misoprostol and omeprazole in the prevention of chemotherapy-induced acute gastroduodenal mucosal injury. A randomized, placebo-controlled pilot study. Cancer 1996. [PMID: 8839554 DOI: 10.1002/(sici)1097-0142(19961001)78:7<1477::aid-cncr15>3.0.co;2-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chemotherapy (CT) may induce acute mucosal injury to the stomach and duodenum, but its prevention has been scarcely investigated. METHODS One hundred and eighty-two cancer patients with normal stomach and duodenum or having fewer than 3 erosions, selected to be treated with cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) (77 breast carcinoma patients) or 5-fluorouracil (5-FU) (105 colon carcinoma patients), were randomly assigned to prophylactic treatment with misoprostol, 400 micrograms twice a day; omeprazole, 20 mg once a day; or placebo, 1 tablet twice a day. Seven days after the end of the second source of CT, all patients underwent control esophagogastroduodenoscopy. Endoscopic findings were quantified on the basis of an arbitrary score: 0 = normal; 1 = less than 3 erosions; 2 = 3-15 erosions; 3 = more than 15 erosions or ulcer; 4 = giant ulcer (greatest dimension of more than 2 cm) or multiple ulcers with cumulative greatest dimension exceeding 2 cm. RESULTS Mean score increased significantly in the placebo and misoprostol groups, either after CMF (P < 0.001 and P < 0.05, respectively) or after 5-FU (P < 0.001 for both), whereas it did not in the omeprazole group. Gastric and duodenal ulcers were significantly less frequent in patients receiving omeprazole than in those receiving placebo (P < 0.05 after both CMF and 5-FU). No significant difference was observed between placebo and misoprostol. Omeprazole was significantly more effective than placebo and misoprostol in reducing the frequency and degree of the endoscopic worsening, either after CMF or after 5-FU (P < 0.05 for both CT regimens). Epigastric pain and/or heartburn were significantly less frequent in patients receiving omeprazole than in those receiving placebo (P < 0.01) or misoprostol (P < 0.001). CONCLUSIONS The strong and prolonged inhibition of gastric acid production induced by omeprazole seems to be effective in preventing chemotherapy-induced gastroduodenal mucosal injury. Further trials are necessary to verify whether such a prevention of endoscopically observed injury can translate into prevention of clinically significant injury.
Collapse
Affiliation(s)
- S Sartori
- Dipartimento di Medicina e Oncologia Medica, Osp. S. Anna, Ferrara, Italy
| | | | | | | | | |
Collapse
|
48
|
Sartori S, Trevisani L, Nielsen I, Tassinari D, Abbasciano V. Misoprostol and omeprazole in the prevention of chemotherapy-induced acute gastroduodenal mucosal injury. A randomized, placebo-controlled pilot study. Cancer 1996; 78:1477-82. [PMID: 8839554 DOI: 10.1002/(sici)1097-0142(19961001)78:7<1477::aid-cncr15>3.0.co;2-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Chemotherapy (CT) may induce acute mucosal injury to the stomach and duodenum, but its prevention has been scarcely investigated. METHODS One hundred and eighty-two cancer patients with normal stomach and duodenum or having fewer than 3 erosions, selected to be treated with cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) (77 breast carcinoma patients) or 5-fluorouracil (5-FU) (105 colon carcinoma patients), were randomly assigned to prophylactic treatment with misoprostol, 400 micrograms twice a day; omeprazole, 20 mg once a day; or placebo, 1 tablet twice a day. Seven days after the end of the second source of CT, all patients underwent control esophagogastroduodenoscopy. Endoscopic findings were quantified on the basis of an arbitrary score: 0 = normal; 1 = less than 3 erosions; 2 = 3-15 erosions; 3 = more than 15 erosions or ulcer; 4 = giant ulcer (greatest dimension of more than 2 cm) or multiple ulcers with cumulative greatest dimension exceeding 2 cm. RESULTS Mean score increased significantly in the placebo and misoprostol groups, either after CMF (P < 0.001 and P < 0.05, respectively) or after 5-FU (P < 0.001 for both), whereas it did not in the omeprazole group. Gastric and duodenal ulcers were significantly less frequent in patients receiving omeprazole than in those receiving placebo (P < 0.05 after both CMF and 5-FU). No significant difference was observed between placebo and misoprostol. Omeprazole was significantly more effective than placebo and misoprostol in reducing the frequency and degree of the endoscopic worsening, either after CMF or after 5-FU (P < 0.05 for both CT regimens). Epigastric pain and/or heartburn were significantly less frequent in patients receiving omeprazole than in those receiving placebo (P < 0.01) or misoprostol (P < 0.001). CONCLUSIONS The strong and prolonged inhibition of gastric acid production induced by omeprazole seems to be effective in preventing chemotherapy-induced gastroduodenal mucosal injury. Further trials are necessary to verify whether such a prevention of endoscopically observed injury can translate into prevention of clinically significant injury.
Collapse
Affiliation(s)
- S Sartori
- Dipartimento di Medicina e Oncologia Medica, Osp. S. Anna, Ferrara, Italy
| | | | | | | | | |
Collapse
|
49
|
Sartori S, Trevisani L, Nielsen I, Tassinari D, Abbasciano V. Percutaneous endoscopic gastrostomy placement using the pull-through or push-through techniques: is the second pass of the gastroscope necessary? Endoscopy 1996; 28:686-8. [PMID: 8934086 DOI: 10.1055/s-2007-1005577] [Citation(s) in RCA: 17] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND STUDY AIMS The pull-through and push-through techniques widely used for placing a percutaneous endoscopic gastrostomy (PEG) require two passes of the gastroscope. The second pass is considered necessary to assess the correct positioning of the internal bumper. The aim of the present study was to verify whether the second pass is in fact necessary, or whether it could be omitted in most cases. PATIENTS AND METHODS Eighty patients undergoing pull-through or push-through PEG placement were included in this prospective study, and were randomly assigned to two groups. In the first group, two passes of the gastroscope were carried out, while in the second group the second pass was omitted and the position of the internal bumper was manually assessed by finger palpation of the abdominal wall after the feeding tube had been pulled out through the abdomen. If finger palpation was not considered satisfactory, a control gastroscopy was carried out. In the other cases, plain radiographs of the abdomen were carried out within six hours of the procedure. RESULTS Thirty-nine patients underwent two-pass PEG placement, and 41 received one-pass PEG placement. In one patient who had a one-pass procedure, the finger palpation was not considered satisfactory; however, a control gastroscopy showed that the internal bumper was correctly placed. In all other one-pass PEG patients, plain radiography of the abdomen showed that the internal bumper was at an adequate distance from the abdominal wall. No major or minor complications associated with the procedure were observed in either group. Bowel sounds reappeared within 24 hours of the procedure in all patients except for one in the two-pass group, in whom they reappeared after 36 hours. One wound infection, treated with systemic antibiotics, occurred in each group within 30 days of the PEG placement. The procedure time saved in the one-pass PEG group averaged 1.5 minutes. CONCLUSIONS One-pass PEG placement appears to be as safe as the classic pull-through and push-through PEG methods, and can be used routinely to make the procedure quicker and reduce the discomfort for the patient, as well as reducing the risks and costs associated with the second pass of the gastroscope. A control gastroscopy can be reserved for patients with morbid obesity, or for cases in which finger palpation is not considered satisfactory.
Collapse
Affiliation(s)
- S Sartori
- Second Medical Division, St. Anna Hospital, Ferrara, Italy
| | | | | | | | | |
Collapse
|
50
|
|