Giampiero Palmieri - Academia.edu (original) (raw)
Papers by Giampiero Palmieri
Gastroenterology, Apr 1, 2000
The ELAD artificial liver device is a hollow fiber cartridge utilizing immortalized C3A cells in ... more The ELAD artificial liver device is a hollow fiber cartridge utilizing immortalized C3A cells in a clinical trial to bridge patients to transplant in acute liver failure. Three patients have been supported continuously from 18 to 80 hours. Methods: During support, cartridges containing the hepatocytes are continuously monitored for oxygen utilization, glucose consumption and pH.. Following treatment all cartridges were immediately analyzed for glucose utilization (g/d/ELAD), galactose elimination (lamol/min/ELAD), and MEG-X production (~mol/min/ELAD) at the clinical site. After these studies were completed the cartridges were cooled to 40 C and sent back to the manufacturing facility and tested for additional metabolic function for 14 days. Results: Oxygen consumption, glucose utilization, A pH were normal and stable throughout the treatment period. The data regarding metabolic function prior to treatment, immediately after treatmem and after shipment is shown in the following Table. Pre Treatment Immediately' post Treatment After shipping Albumin 240.5 ND 236 (mg/d/ELAD) Transferrin I 17 ND 118 (mg/d/ELAD) AFP (mg/d/ELAD) 43.3 ND 45.5 Glucose Utilization 18.2
Journal of Crohn's and Colitis, 2020
Background: The role of histological activity in clinical management of ulcerative colitis (UC) i... more Background: The role of histological activity in clinical management of ulcerative colitis (UC) is under investigation. Primary aim was, in a prospective study, to assess the role of histological activity as predictor of clinical relapse in a cohort of UC patients (patients) undergoing colonoscopy and followed-up for 1 year. Secondary aim was to assess the correlation between clinical, endoscopic and histological activity scores. Methods: From February 2016 to February 2017 consecutive UC patients with clinical indication for colonoscopy were enrolled and clinically followed-up for 1 year. Inclusion criteria: (1) UC diagnosis; (2) Age > 18, ≤ 80 years; (3) regular follow-up; (4) indication for colonoscopy. During colonoscopy ≥2 biopsies was taken from ≥1 macroscopically involved and, possibly, from ≥1 uninvolved area. The day of colonoscopy clinical activity was assessed by the Mayo partial score, endoscopic activity by the Mayo endoscopic score, histological activity by the Geboes Simplified Score (GSS). Scores blindly assessed by three investigators. Statistical analysis: data expressed as mean [range], Spearman's correlation coefficients, Cox hazards regression model used for univariate and multivariate analyses to identify predictors of clinical relapse at 1 year (HR[95% CI]). Results: UC cohort included 77 UC patients. Characteristics of these 77 UC patients: 43 (55.8%) males, age 51 [24-80]; UC duration 14.7 [1-48] years. UC extent included n (%): 33 (42.8%) pancolitis, 24 (31.2%) left-sided, 20 (26%) proctitis. The day of colonoscopy, UC was clinically active in 15 (19.4%), inactive in 62 (80.6%) patients. Endoscopic activity was observed in 39 (50.6%) patients, histological activity (GSS≥ 3.1) in 37(48%) patients. Moderate correlations were observed between clinical and endoscopic scores (r = 0.439;p < 0.0001) clinical and histological scores (r = 0.32;p = 0.0045), endoscopic and histological scores (r = 0.653;p < 0.0001). During the clinical follow-up at 1 year, UC clinical relapse occurred in 24 (31%) patients, while 53 (69%) patients maintained clinical remission. At baseline colonoscopy, 11/24 (46%) UC patients were clinically active, 15/24 (63%) showed endoscopic activity and 16/24 (67%) patients histological activity. Univariate analysis identified clinical activity (HR 4.82 [2.15-10.82]; p < 0.001) and histological activity (HR 2.599 [1.11-6.08]; p < 0.027) as significant predictive factors for clinical relapse at 1 year. Multivariate model confirmed histological activity as predictive marker of clinical relapse (HR 2.44 [1.04-5.75]; p < 0.041). Conclusion: Histological activity provided independent information for clinical relapse in a cohort of UC patients prospectively followed up for 1 year. Histological activity had a significant correlation with the endoscopic and clinical activity scores.
Transplantation Proceedings, Dec 1, 1999
PubMed, Nov 27, 1999
Background: The usefulness of ursodeoxycholic acid after liver transplantation is controversial. ... more Background: The usefulness of ursodeoxycholic acid after liver transplantation is controversial. Tauroursodeoxycholic acid, the natural taurine-amidate, is a highly hydrophilic and cytoprotective bile salt currently under investigation. Aims: To investigate the clinical usefulness of tauroursodeoxycholic acid after liver transplantation. Patients: Thirty-three patients undergoing liver transplantation entered the study. Methods: Sixteen patients were randomized to receive tauroursodeoxycholic acid (250 b.i.d. for 12 months) and 17 served as controls. Tauroursodeoxycholic acid was given from day 5 after transplantation for one year. Results: Tauroursodeoxycholic acid treatment was safe and well tolerated. No drop outs occurred. Among the 29 patients undergoing long-term follow-up, five deaths occurred (3 of whom in the tauroursodeoxycholic acid group), none of which was related to treatment. The one-year actuarial survival was 78.6% in patients treated with tauroursodeoxycholic acid and 86.7% in controls (n.s.). No differences were observed with respect to early or late graft function and survival, nor to acute cellular rejection. Tauroursodeoxycholic acid therapy was associated with lower serum cholesterol levels (p < 0.02) during the early postoperative months; with milder cholestasis; with a drop in biliary cholates but no changes in endogenous hydrophobic bile salts. Conclusions: Long-term treatment with low dose tauroursodeoxycholic acid after liver transplantation is safe but does not affect graft function and survival.
Biology Direct, Oct 14, 2020
The identification of individual or clusters of predictive genetic alterations might help in defi... more The identification of individual or clusters of predictive genetic alterations might help in defining the outcome of cancer treatment, allowing for the stratification of patients into distinct cohorts for selective therapeutic protocols. Neuroblastoma (NB) is the most common extracranial childhood tumour, clinically defined in five distinct stages (1-4 & 4S), where stages 3-4 define chemotherapy-resistant, highly aggressive disease phases. NB is a model for geneticists and molecular biologists to classify genetic abnormalities and identify causative disease genes. Despite highly intensive basic research, improvements on clinical outcome have been predominantly observed for less aggressive cancers, that is stages 1,2 and 4S. Therefore, stages 3-4 NB are still complicated at the therapeutic level and require more intense fundamental research. Using neuroblastoma as a model system, here we herein outline how cancer prediction studies can help at steering preclinical and clinical research toward the identification and exploitation of specific genetic landscape. This might result in maximising the therapeutic success and minimizing harmful effects in cancer patients.
Ejso, Oct 1, 2012
A total of 10 (5 males; 5 females) patients with stage II and III rectal cancer consecutively tre... more A total of 10 (5 males; 5 females) patients with stage II and III rectal cancer consecutively treated at our department were selected. Diagnosis was established on the basis of clinical examination, colonoscopy and histology. Disease staging was carried out with computed tomography. Transrectal ultrasound was performed in all patients. The patients were enrolled in long-course NRCT. Post-treatment re-staging was performed in all patients. Standard surgery, including excision of the mesorectum and regional lymph nodes was performed by the same operator in all patients within 6 to 8 weeks after completion of the neoadjuvant program. An anterior resection of the rectum was performed in 5 patients and a Miles operation because of involved sphincter apparatus in 5 patients. The median duration of followup was 46.3 months (range, 1-92). Results: All patients are still alive with a good quality of life and without local recurrence. One patient reported sexual dysfunction and 2 patients reported impaired defecation. NRCT toxicity was observed in 3 patients. A pathologic complete response was observed in 4 patients (pT0N0); downstaging was observed in 4 patients; a no response at NRCT was observed in 2 patients. Conclusions: Preoperative radio-chemotherapy is an effective and safe treatment in rectal cancer patients and can reduce local recurrence. Downstaging can permit sphincter-saving surgery. Patients with pathologic complete response are currently being followed with a watch and wait policy. Ex vivo intra-arterial methylene blue dye injection augments pathology lymph node harvest following rectal cancer surgery E. Picone, G.
Nephrology Dialysis Transplantation, Mar 1, 1996
Acta Obstetricia et Gynecologica Scandinavica, 2007
Background. Evidence of vulvar human papillomavirus infection varies and the frequency of the dif... more Background. Evidence of vulvar human papillomavirus infection varies and the frequency of the different genotypes has not been adequately assessed. Methods. Fifty consecutive sexually active healthy patients with vulvodynia and suspected of human papillomavirus infection underwent a vulvoscopy and biopsy. Ten normal vulvar samples were also enrolled as control. Histological and vulvoscopic findings were compared in relation to human papillomavirus‐DNA presence and genotyping by a broad‐spectrum polymerase chain reaction and reverse hybridization line probe assay. Results. Although the clinical and histological diagnoses did not always coincide, a good association was found (p<0.0001). Human papillomavirus‐DNA was detected in 42% of all biopsies and in none of the controls, and less frequently in acetowhite‐positive patients (33.3%, p<0.03). Squamous papillomatosis (74%) was the most frequent histological diagnosis, followed by condyloma (20%). Condyloma (90%) but not squamous papillomatosis (29.7%) was significantly associated with human papillomavirus‐DNA presence. Out of the vulvoscopically normal patients, one (33%) was human papillomavirus‐DNA positive. Out of the recorded microscopic features, only koilocytosis was associated with human papillomavirus‐DNA presence. Eight different human papillomavirus genotypes were detected: high‐risk 16 (43%), 31 (19%), 52 (14.3%), 68, and 59 (4.8% each), and low‐risk types 6 (71.4%), 11, and 40 (4.8% each); 33.3% of infections were multiple, ranging from 2 to 4 genotypes. Out of the human papillomavirus‐DNA positive squamous papillomatosis, 72.7% showed a high‐risk type but the infection remained episomal. Conclusions. Our data confirm human papillomavirus as a frequent cause of vulvodynia and its frequent association with squamous papillomatosis or condyloma. The high‐risk human papillomavirus in squamous papillomatosis suggests screening for possible undiagnosed cervical infection.
Gastroenterology, May 1, 2012
constipation and incontinence. For the purpose of this study, we considered clinically relevant a... more constipation and incontinence. For the purpose of this study, we considered clinically relevant a WCS ≥5 and a FISI score ≥10. Data were compared to a matched control group with 1828. Results: A total of 32 anorexia patients (group A) accepted the study and 30 patients filled the questionnaires as matched control-group (group B). Overall, in group A mean BMI was 17±3 Kg/mq(2)(range 12-23); mean illness duration 5±3 (range 1-13); mean WCS was 10±5 (range 2-22), while mean FISI score was 6±8 (range 0-38). Overall, 90% of these patients reported DDs according to the above-mentioned scores. Thirty patients (94%) had WCS ≥5. Eleven patients (34%) had FISI score ≥10. While eleven patients (34%) reported combined abnormal scores. In Group B, mean BMI 21±3 (range 18-28); mean WCS was 3.8±3 (range 0-10), while FISI score was 0. Overall, 53% of these patients reported DDs according to the above-mentioned scores. Sixteen patients (53%) had WCS ≥5. None had FISI score ≥10. In group A, according to the illness duration (<5 years/>5 years) we found a statistical significance in terms of WCS ≥5 and FISI score ≥10 (p<0.0001, p<0.02). According to the WCS ≥5, we found a statistical significance between the two groups (p<0.0001). Conclusion: Defaecatory Disorders are common in anorexia nervosa patients compared to general population. The risk of DDs increases with anorexia nervosa duration.
Türk Patoloji Dergisi, 2019
Uterine leiomyomas are the most common benign tumors of the gynecological tract. Massive lymphocy... more Uterine leiomyomas are the most common benign tumors of the gynecological tract. Massive lymphocytic infiltration has been reported rarely in uterine leiomyomas and it has been described as a pathogenetic correlation with gonadotropin-releasing hormone agonists. Uterine leiomyomas with massive lymphoid infiltration have to be differentiated from non-Hodgkin lymphomas. We report a case of a woman without a history of gonadotropin-releasing hormone agonist treatment, who presented with a uterine leiomyoma that increased in size after the procedure of assisted in-vitro fertilization, and associated with massive nodular lymphoid infiltrate simulating, morphologically, a non-Hodgkin lymphoma. Uterine leiomyoma with massive lymphocytic infiltration is a very rare entity, probably of reactive significance, which has to be differentiated from diseases that need a systemic therapeutic approach.
Journal of Crohn's and Colitis, Jan 25, 2019
Journal of Digestive Diseases, 2021
The role of histology in inflammatory bowel disease (IBD) has not yet been well defined. Endoscop... more The role of histology in inflammatory bowel disease (IBD) has not yet been well defined. Endoscopic mucosal healing has been proposed as a predictor of the clinical course of IBD and it is indeed considered one of the main therapeutic targets. However, it does not necessarily imply histological healing. Histological remission has been reported to be associated with a better clinical outcome than endoscopic remission only in IBD patients. These observations support the view that histology plays a role as a potential therapeutic target in Crohn's disease and ulcerative colitis. Histological scores being able to quantify the degree of microscopic activity are needed for this purpose. In the era of biologics, indication for proper treatment may benefit from the assessment of clinical and endoscopic activity, as well as histological scores. Such scores may allow us to quantify the microscopic mucosal response to treatment and to define complete healing in IBD. A validated histological score in IBD may lead to the definition of microscopic activity in clinical practice, trials and investigational settings. Several attempts to develop such scores have been reported, but few are currently used and none is applied worldwide in clinical practice. The present review summarizes the main histological scores currently used for assessing IBD activity.
Journal of Clinical Medicine
Mixed neuroendocrine non-neuroendocrine neoplasms (MiNEN) are a peculiar entity that can occur th... more Mixed neuroendocrine non-neuroendocrine neoplasms (MiNEN) are a peculiar entity that can occur throughout the whole gastrointestinal trait, and pancreatic localization is rare. Their main characteristic is the presence of at least a neuroendocrine and an epithelial component, each accounting for at least 30% of the tumour mass. The presence of epithelial ductal component defines adeno-MiNEN. We report a case of a 59-year-old woman affected by pancreatic adeno-MiNEN with challenging diagnosis and successfully treated. A systematic literature review and pooled analysis was also performed, aiming to define the management and outcomes of pancreatic adeno-MiNEN. Out of 190 identified records, 15 studies including 28 patients affected by pancreatic-adeno-MiNEN were included in the analysis. Pancreatic adeno-MiNEN occurred mainly in males (82.8%) and at a mean age of 61.7 (range: 24–82) years. Pre-operative diagnosis was possible only in 14.2% of cases. At presentation, the majority had al...
Internal and Emergency Medicine
Open-access colonoscopy (OAC), whereby the colonoscopy is performed without a prior office visit ... more Open-access colonoscopy (OAC), whereby the colonoscopy is performed without a prior office visit with a gastroenterologist, is affected by inappropriateness which leads to overprescription and reduced availability of the procedure in case of alarming symptoms. The clinical care pathway (CCP) is a healthcare management tool promoted by national health systems to organize work-up of various morbidities. Recently, we started a CCP dedicated to colorectal cancer (CRC), including a colonoscopy session for CRC diagnosis and prevention. We aimed to evaluate the appropriateness, the quality, and the efficiency in the delivery of colonoscopy with the open-access system and a CCP program in the CRC. Quality indicators for colonoscopy in subjects in the CCP were compared to referrals by general practitioners (OAC) or by non-gastroenterologist physicians (non-gastroenterologist physician colonoscopy, NGPC). Attendance rate to colonoscopy was greater in the CCP group and NGPC group than in the O...
Annals of Oncology, 2020
NOS. Analysis: For the selected study population (N¼1,088; non-epithelial and neuroendocrine tumo... more NOS. Analysis: For the selected study population (N¼1,088; non-epithelial and neuroendocrine tumors excluded) crude rate (CR) cancer incidence was 7.32 cases per 100,000 inhabitants/year (7.43 men; 7.21 women). Regarding the ASR, results show an ASRE13 of 8.39 (95% CI 7.9; 8.9) and ASRW of 3.26(95% CI 3.0; 3.5). A slight nonstatistically significant decrease in the incidence of BTC cases over the study period was observed, with an EAPC of-0.18 (95% CI-1.09-; 0.73) per year. We analyzed trends in the incidence of epithelial BTC histologically confirmed (n¼722) and BTC with non-specified histology (n¼366) separately, finding an opposite behavior in each group: an increase of confirmed cases overtime (up to a 28% total increase at the end of the study period) and a concurrent decrease in the number of non-specified histology cases. Conclusion: Incidence rates of BTC in Girona are within the European average, and they have been stable in the last two decades. The study reflects a change in attitude towards BTC, leaving nihilism behind, shown by the decreasing proportion of nonhistology confirmed cases overtime, the first step to personalized treatment. Survival and subgroup analysis is ongoing and merits further research.
Methods of Information in Medicine, 1986
SummaryAmong the numerous existing computer-based systems for processing pathological data, none ... more SummaryAmong the numerous existing computer-based systems for processing pathological data, none contains sufficient space for encoding data on the basic cytological or histological changes of a certain organ or tissue, upon which the final diagnosis is based.An “analytical record” was constructed listing all the basic changes that can be encountered in the various pathological conditions of the vascular wall. The data collected on the “analytical record” were coded by means of an alphanumeric code and stored in an Apple II 48 K minicomputer.The advantages of this system include the computerization of the data by non-specialized personnel and the possibility to’ quantitatively analyze the histocytopathological parameters used for diagnosis in vascular pathology. This coding system may easily be adapted, with minor modifications, to the histopathological study of other organs and tissues.
Tumori
OLT in HIV infected patients still remains a challenging option requiring a careful monitoring of... more OLT in HIV infected patients still remains a challenging option requiring a careful monitoring of patients for HCV reinfection, drug interactions and antiretroviral toxicity. Severe adverse events due to HAART have been already reported for post exposure prophylaxis in HIV infected patients. Here we report a case of liver graft toxicity related to HAART in a HIV-HCV co-infected patient (46 yrs-male) with associated a small HCC transplanted with a marginal liver graft. The patient had pre-OLT plasma HIV 1-RNA levels undetectable and CD4+ T-cell count of > 200 cells/microL for 6 months. At day 2 a severe graft dysfunction was observed (AST 1570 U/L, ALT 2180 U/L, BIL tot 8.3 mg/dL, BIL Dir 6.6 mg/dL and PT 35%--INR 2.5). Doppler scan showed hepatic artery always patient. Later the postoperative in-hospital course was complicated by tense ascites and severe cholestasis. Serum bilirubin reached 42 mg/dL in day 12. Hypertransaminasemia ended at day 15 while cholestasis ended after 46 ...
Gastroenterology, Apr 1, 2000
The ELAD artificial liver device is a hollow fiber cartridge utilizing immortalized C3A cells in ... more The ELAD artificial liver device is a hollow fiber cartridge utilizing immortalized C3A cells in a clinical trial to bridge patients to transplant in acute liver failure. Three patients have been supported continuously from 18 to 80 hours. Methods: During support, cartridges containing the hepatocytes are continuously monitored for oxygen utilization, glucose consumption and pH.. Following treatment all cartridges were immediately analyzed for glucose utilization (g/d/ELAD), galactose elimination (lamol/min/ELAD), and MEG-X production (~mol/min/ELAD) at the clinical site. After these studies were completed the cartridges were cooled to 40 C and sent back to the manufacturing facility and tested for additional metabolic function for 14 days. Results: Oxygen consumption, glucose utilization, A pH were normal and stable throughout the treatment period. The data regarding metabolic function prior to treatment, immediately after treatmem and after shipment is shown in the following Table. Pre Treatment Immediately' post Treatment After shipping Albumin 240.5 ND 236 (mg/d/ELAD) Transferrin I 17 ND 118 (mg/d/ELAD) AFP (mg/d/ELAD) 43.3 ND 45.5 Glucose Utilization 18.2
Journal of Crohn's and Colitis, 2020
Background: The role of histological activity in clinical management of ulcerative colitis (UC) i... more Background: The role of histological activity in clinical management of ulcerative colitis (UC) is under investigation. Primary aim was, in a prospective study, to assess the role of histological activity as predictor of clinical relapse in a cohort of UC patients (patients) undergoing colonoscopy and followed-up for 1 year. Secondary aim was to assess the correlation between clinical, endoscopic and histological activity scores. Methods: From February 2016 to February 2017 consecutive UC patients with clinical indication for colonoscopy were enrolled and clinically followed-up for 1 year. Inclusion criteria: (1) UC diagnosis; (2) Age > 18, ≤ 80 years; (3) regular follow-up; (4) indication for colonoscopy. During colonoscopy ≥2 biopsies was taken from ≥1 macroscopically involved and, possibly, from ≥1 uninvolved area. The day of colonoscopy clinical activity was assessed by the Mayo partial score, endoscopic activity by the Mayo endoscopic score, histological activity by the Geboes Simplified Score (GSS). Scores blindly assessed by three investigators. Statistical analysis: data expressed as mean [range], Spearman's correlation coefficients, Cox hazards regression model used for univariate and multivariate analyses to identify predictors of clinical relapse at 1 year (HR[95% CI]). Results: UC cohort included 77 UC patients. Characteristics of these 77 UC patients: 43 (55.8%) males, age 51 [24-80]; UC duration 14.7 [1-48] years. UC extent included n (%): 33 (42.8%) pancolitis, 24 (31.2%) left-sided, 20 (26%) proctitis. The day of colonoscopy, UC was clinically active in 15 (19.4%), inactive in 62 (80.6%) patients. Endoscopic activity was observed in 39 (50.6%) patients, histological activity (GSS≥ 3.1) in 37(48%) patients. Moderate correlations were observed between clinical and endoscopic scores (r = 0.439;p < 0.0001) clinical and histological scores (r = 0.32;p = 0.0045), endoscopic and histological scores (r = 0.653;p < 0.0001). During the clinical follow-up at 1 year, UC clinical relapse occurred in 24 (31%) patients, while 53 (69%) patients maintained clinical remission. At baseline colonoscopy, 11/24 (46%) UC patients were clinically active, 15/24 (63%) showed endoscopic activity and 16/24 (67%) patients histological activity. Univariate analysis identified clinical activity (HR 4.82 [2.15-10.82]; p < 0.001) and histological activity (HR 2.599 [1.11-6.08]; p < 0.027) as significant predictive factors for clinical relapse at 1 year. Multivariate model confirmed histological activity as predictive marker of clinical relapse (HR 2.44 [1.04-5.75]; p < 0.041). Conclusion: Histological activity provided independent information for clinical relapse in a cohort of UC patients prospectively followed up for 1 year. Histological activity had a significant correlation with the endoscopic and clinical activity scores.
Transplantation Proceedings, Dec 1, 1999
PubMed, Nov 27, 1999
Background: The usefulness of ursodeoxycholic acid after liver transplantation is controversial. ... more Background: The usefulness of ursodeoxycholic acid after liver transplantation is controversial. Tauroursodeoxycholic acid, the natural taurine-amidate, is a highly hydrophilic and cytoprotective bile salt currently under investigation. Aims: To investigate the clinical usefulness of tauroursodeoxycholic acid after liver transplantation. Patients: Thirty-three patients undergoing liver transplantation entered the study. Methods: Sixteen patients were randomized to receive tauroursodeoxycholic acid (250 b.i.d. for 12 months) and 17 served as controls. Tauroursodeoxycholic acid was given from day 5 after transplantation for one year. Results: Tauroursodeoxycholic acid treatment was safe and well tolerated. No drop outs occurred. Among the 29 patients undergoing long-term follow-up, five deaths occurred (3 of whom in the tauroursodeoxycholic acid group), none of which was related to treatment. The one-year actuarial survival was 78.6% in patients treated with tauroursodeoxycholic acid and 86.7% in controls (n.s.). No differences were observed with respect to early or late graft function and survival, nor to acute cellular rejection. Tauroursodeoxycholic acid therapy was associated with lower serum cholesterol levels (p < 0.02) during the early postoperative months; with milder cholestasis; with a drop in biliary cholates but no changes in endogenous hydrophobic bile salts. Conclusions: Long-term treatment with low dose tauroursodeoxycholic acid after liver transplantation is safe but does not affect graft function and survival.
Biology Direct, Oct 14, 2020
The identification of individual or clusters of predictive genetic alterations might help in defi... more The identification of individual or clusters of predictive genetic alterations might help in defining the outcome of cancer treatment, allowing for the stratification of patients into distinct cohorts for selective therapeutic protocols. Neuroblastoma (NB) is the most common extracranial childhood tumour, clinically defined in five distinct stages (1-4 & 4S), where stages 3-4 define chemotherapy-resistant, highly aggressive disease phases. NB is a model for geneticists and molecular biologists to classify genetic abnormalities and identify causative disease genes. Despite highly intensive basic research, improvements on clinical outcome have been predominantly observed for less aggressive cancers, that is stages 1,2 and 4S. Therefore, stages 3-4 NB are still complicated at the therapeutic level and require more intense fundamental research. Using neuroblastoma as a model system, here we herein outline how cancer prediction studies can help at steering preclinical and clinical research toward the identification and exploitation of specific genetic landscape. This might result in maximising the therapeutic success and minimizing harmful effects in cancer patients.
Ejso, Oct 1, 2012
A total of 10 (5 males; 5 females) patients with stage II and III rectal cancer consecutively tre... more A total of 10 (5 males; 5 females) patients with stage II and III rectal cancer consecutively treated at our department were selected. Diagnosis was established on the basis of clinical examination, colonoscopy and histology. Disease staging was carried out with computed tomography. Transrectal ultrasound was performed in all patients. The patients were enrolled in long-course NRCT. Post-treatment re-staging was performed in all patients. Standard surgery, including excision of the mesorectum and regional lymph nodes was performed by the same operator in all patients within 6 to 8 weeks after completion of the neoadjuvant program. An anterior resection of the rectum was performed in 5 patients and a Miles operation because of involved sphincter apparatus in 5 patients. The median duration of followup was 46.3 months (range, 1-92). Results: All patients are still alive with a good quality of life and without local recurrence. One patient reported sexual dysfunction and 2 patients reported impaired defecation. NRCT toxicity was observed in 3 patients. A pathologic complete response was observed in 4 patients (pT0N0); downstaging was observed in 4 patients; a no response at NRCT was observed in 2 patients. Conclusions: Preoperative radio-chemotherapy is an effective and safe treatment in rectal cancer patients and can reduce local recurrence. Downstaging can permit sphincter-saving surgery. Patients with pathologic complete response are currently being followed with a watch and wait policy. Ex vivo intra-arterial methylene blue dye injection augments pathology lymph node harvest following rectal cancer surgery E. Picone, G.
Nephrology Dialysis Transplantation, Mar 1, 1996
Acta Obstetricia et Gynecologica Scandinavica, 2007
Background. Evidence of vulvar human papillomavirus infection varies and the frequency of the dif... more Background. Evidence of vulvar human papillomavirus infection varies and the frequency of the different genotypes has not been adequately assessed. Methods. Fifty consecutive sexually active healthy patients with vulvodynia and suspected of human papillomavirus infection underwent a vulvoscopy and biopsy. Ten normal vulvar samples were also enrolled as control. Histological and vulvoscopic findings were compared in relation to human papillomavirus‐DNA presence and genotyping by a broad‐spectrum polymerase chain reaction and reverse hybridization line probe assay. Results. Although the clinical and histological diagnoses did not always coincide, a good association was found (p<0.0001). Human papillomavirus‐DNA was detected in 42% of all biopsies and in none of the controls, and less frequently in acetowhite‐positive patients (33.3%, p<0.03). Squamous papillomatosis (74%) was the most frequent histological diagnosis, followed by condyloma (20%). Condyloma (90%) but not squamous papillomatosis (29.7%) was significantly associated with human papillomavirus‐DNA presence. Out of the vulvoscopically normal patients, one (33%) was human papillomavirus‐DNA positive. Out of the recorded microscopic features, only koilocytosis was associated with human papillomavirus‐DNA presence. Eight different human papillomavirus genotypes were detected: high‐risk 16 (43%), 31 (19%), 52 (14.3%), 68, and 59 (4.8% each), and low‐risk types 6 (71.4%), 11, and 40 (4.8% each); 33.3% of infections were multiple, ranging from 2 to 4 genotypes. Out of the human papillomavirus‐DNA positive squamous papillomatosis, 72.7% showed a high‐risk type but the infection remained episomal. Conclusions. Our data confirm human papillomavirus as a frequent cause of vulvodynia and its frequent association with squamous papillomatosis or condyloma. The high‐risk human papillomavirus in squamous papillomatosis suggests screening for possible undiagnosed cervical infection.
Gastroenterology, May 1, 2012
constipation and incontinence. For the purpose of this study, we considered clinically relevant a... more constipation and incontinence. For the purpose of this study, we considered clinically relevant a WCS ≥5 and a FISI score ≥10. Data were compared to a matched control group with 1828. Results: A total of 32 anorexia patients (group A) accepted the study and 30 patients filled the questionnaires as matched control-group (group B). Overall, in group A mean BMI was 17±3 Kg/mq(2)(range 12-23); mean illness duration 5±3 (range 1-13); mean WCS was 10±5 (range 2-22), while mean FISI score was 6±8 (range 0-38). Overall, 90% of these patients reported DDs according to the above-mentioned scores. Thirty patients (94%) had WCS ≥5. Eleven patients (34%) had FISI score ≥10. While eleven patients (34%) reported combined abnormal scores. In Group B, mean BMI 21±3 (range 18-28); mean WCS was 3.8±3 (range 0-10), while FISI score was 0. Overall, 53% of these patients reported DDs according to the above-mentioned scores. Sixteen patients (53%) had WCS ≥5. None had FISI score ≥10. In group A, according to the illness duration (<5 years/>5 years) we found a statistical significance in terms of WCS ≥5 and FISI score ≥10 (p<0.0001, p<0.02). According to the WCS ≥5, we found a statistical significance between the two groups (p<0.0001). Conclusion: Defaecatory Disorders are common in anorexia nervosa patients compared to general population. The risk of DDs increases with anorexia nervosa duration.
Türk Patoloji Dergisi, 2019
Uterine leiomyomas are the most common benign tumors of the gynecological tract. Massive lymphocy... more Uterine leiomyomas are the most common benign tumors of the gynecological tract. Massive lymphocytic infiltration has been reported rarely in uterine leiomyomas and it has been described as a pathogenetic correlation with gonadotropin-releasing hormone agonists. Uterine leiomyomas with massive lymphoid infiltration have to be differentiated from non-Hodgkin lymphomas. We report a case of a woman without a history of gonadotropin-releasing hormone agonist treatment, who presented with a uterine leiomyoma that increased in size after the procedure of assisted in-vitro fertilization, and associated with massive nodular lymphoid infiltrate simulating, morphologically, a non-Hodgkin lymphoma. Uterine leiomyoma with massive lymphocytic infiltration is a very rare entity, probably of reactive significance, which has to be differentiated from diseases that need a systemic therapeutic approach.
Journal of Crohn's and Colitis, Jan 25, 2019
Journal of Digestive Diseases, 2021
The role of histology in inflammatory bowel disease (IBD) has not yet been well defined. Endoscop... more The role of histology in inflammatory bowel disease (IBD) has not yet been well defined. Endoscopic mucosal healing has been proposed as a predictor of the clinical course of IBD and it is indeed considered one of the main therapeutic targets. However, it does not necessarily imply histological healing. Histological remission has been reported to be associated with a better clinical outcome than endoscopic remission only in IBD patients. These observations support the view that histology plays a role as a potential therapeutic target in Crohn's disease and ulcerative colitis. Histological scores being able to quantify the degree of microscopic activity are needed for this purpose. In the era of biologics, indication for proper treatment may benefit from the assessment of clinical and endoscopic activity, as well as histological scores. Such scores may allow us to quantify the microscopic mucosal response to treatment and to define complete healing in IBD. A validated histological score in IBD may lead to the definition of microscopic activity in clinical practice, trials and investigational settings. Several attempts to develop such scores have been reported, but few are currently used and none is applied worldwide in clinical practice. The present review summarizes the main histological scores currently used for assessing IBD activity.
Journal of Clinical Medicine
Mixed neuroendocrine non-neuroendocrine neoplasms (MiNEN) are a peculiar entity that can occur th... more Mixed neuroendocrine non-neuroendocrine neoplasms (MiNEN) are a peculiar entity that can occur throughout the whole gastrointestinal trait, and pancreatic localization is rare. Their main characteristic is the presence of at least a neuroendocrine and an epithelial component, each accounting for at least 30% of the tumour mass. The presence of epithelial ductal component defines adeno-MiNEN. We report a case of a 59-year-old woman affected by pancreatic adeno-MiNEN with challenging diagnosis and successfully treated. A systematic literature review and pooled analysis was also performed, aiming to define the management and outcomes of pancreatic adeno-MiNEN. Out of 190 identified records, 15 studies including 28 patients affected by pancreatic-adeno-MiNEN were included in the analysis. Pancreatic adeno-MiNEN occurred mainly in males (82.8%) and at a mean age of 61.7 (range: 24–82) years. Pre-operative diagnosis was possible only in 14.2% of cases. At presentation, the majority had al...
Internal and Emergency Medicine
Open-access colonoscopy (OAC), whereby the colonoscopy is performed without a prior office visit ... more Open-access colonoscopy (OAC), whereby the colonoscopy is performed without a prior office visit with a gastroenterologist, is affected by inappropriateness which leads to overprescription and reduced availability of the procedure in case of alarming symptoms. The clinical care pathway (CCP) is a healthcare management tool promoted by national health systems to organize work-up of various morbidities. Recently, we started a CCP dedicated to colorectal cancer (CRC), including a colonoscopy session for CRC diagnosis and prevention. We aimed to evaluate the appropriateness, the quality, and the efficiency in the delivery of colonoscopy with the open-access system and a CCP program in the CRC. Quality indicators for colonoscopy in subjects in the CCP were compared to referrals by general practitioners (OAC) or by non-gastroenterologist physicians (non-gastroenterologist physician colonoscopy, NGPC). Attendance rate to colonoscopy was greater in the CCP group and NGPC group than in the O...
Annals of Oncology, 2020
NOS. Analysis: For the selected study population (N¼1,088; non-epithelial and neuroendocrine tumo... more NOS. Analysis: For the selected study population (N¼1,088; non-epithelial and neuroendocrine tumors excluded) crude rate (CR) cancer incidence was 7.32 cases per 100,000 inhabitants/year (7.43 men; 7.21 women). Regarding the ASR, results show an ASRE13 of 8.39 (95% CI 7.9; 8.9) and ASRW of 3.26(95% CI 3.0; 3.5). A slight nonstatistically significant decrease in the incidence of BTC cases over the study period was observed, with an EAPC of-0.18 (95% CI-1.09-; 0.73) per year. We analyzed trends in the incidence of epithelial BTC histologically confirmed (n¼722) and BTC with non-specified histology (n¼366) separately, finding an opposite behavior in each group: an increase of confirmed cases overtime (up to a 28% total increase at the end of the study period) and a concurrent decrease in the number of non-specified histology cases. Conclusion: Incidence rates of BTC in Girona are within the European average, and they have been stable in the last two decades. The study reflects a change in attitude towards BTC, leaving nihilism behind, shown by the decreasing proportion of nonhistology confirmed cases overtime, the first step to personalized treatment. Survival and subgroup analysis is ongoing and merits further research.
Methods of Information in Medicine, 1986
SummaryAmong the numerous existing computer-based systems for processing pathological data, none ... more SummaryAmong the numerous existing computer-based systems for processing pathological data, none contains sufficient space for encoding data on the basic cytological or histological changes of a certain organ or tissue, upon which the final diagnosis is based.An “analytical record” was constructed listing all the basic changes that can be encountered in the various pathological conditions of the vascular wall. The data collected on the “analytical record” were coded by means of an alphanumeric code and stored in an Apple II 48 K minicomputer.The advantages of this system include the computerization of the data by non-specialized personnel and the possibility to’ quantitatively analyze the histocytopathological parameters used for diagnosis in vascular pathology. This coding system may easily be adapted, with minor modifications, to the histopathological study of other organs and tissues.
Tumori
OLT in HIV infected patients still remains a challenging option requiring a careful monitoring of... more OLT in HIV infected patients still remains a challenging option requiring a careful monitoring of patients for HCV reinfection, drug interactions and antiretroviral toxicity. Severe adverse events due to HAART have been already reported for post exposure prophylaxis in HIV infected patients. Here we report a case of liver graft toxicity related to HAART in a HIV-HCV co-infected patient (46 yrs-male) with associated a small HCC transplanted with a marginal liver graft. The patient had pre-OLT plasma HIV 1-RNA levels undetectable and CD4+ T-cell count of > 200 cells/microL for 6 months. At day 2 a severe graft dysfunction was observed (AST 1570 U/L, ALT 2180 U/L, BIL tot 8.3 mg/dL, BIL Dir 6.6 mg/dL and PT 35%--INR 2.5). Doppler scan showed hepatic artery always patient. Later the postoperative in-hospital course was complicated by tense ascites and severe cholestasis. Serum bilirubin reached 42 mg/dL in day 12. Hypertransaminasemia ended at day 15 while cholestasis ended after 46 ...