rubrica

Registri di patologia

  • Emanuele Crocetti1

  1. UO Epidemiologia clinica e descrittiva, ISPO Firenze
Emanuele Crocetti -

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Ricerca bibliografica periodo 02 aprile 2011 – 1 giugno 2011

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Database: Pubmed/MEDline
Stringa: (("registries"[MeSH Terms] OR "registries"[All Fields] OR "registry"[All Fields]) OR ("registries"[MeSH Terms] OR "registries"[All Fields])) AND (("italy"[MeSH Terms] OR "italy"[All Fields]) OR italian[All Fields]) NOT “animals”[MeSH Terms] AND ("2011/04/02"[PDat] : "2011/06/01"[PDat])

Di ogni articolo è disponibile l'abstract. Per visualizzarlo basta cliccare sul titolo.

1. Maule M, Scélo G, Pastore G, Brennan P, Hemminki K, Olsen JH, Tracey E, Pukkala E, Weiderpass E, Brewster DH, Tamaro S, Chia KS, Pompe-Kirn V, Kliewer EV, Tonita JM, Martos C, Jonasson JG, Merletti F, Boffetta P. Second malignancies after childhood non-central nervous system solid cancer: Results from 13 cancer registries. Int J Cancer. 2011 Apr 25. doi: 10.1002/ijc.26135. [Epub ahead of print]
Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, CPO Piemonte, CeRMS, University of Turin, Turin, Italy. milena.maule@cpo.it.
Abstract
BACKGROUND.: Children diagnosed with non-central nervous system solid cancers (NCNSSC) experience several adverse late effects, including second malignant neoplasm. The aim of this study was to assess the risk of specific second malignancies after a childhood NCNSSC.
METHODS.: Diagnosis and follow-up data on 10,988 cases of NCNSSC in children (0-14 years) were obtained from 13 registries. Standardized incidence ratios (SIRs) with 95% confidence intervals (CI) and cumulative incidence of second malignancies were computed.
RESULTS.: We observed 175 second malignant neoplasms, yielding a SIR of 4.6, 95%CI: 3.9-5.3. When considering second cancers with at least 10 occurrences, highest relative risks were found for second malignant bone tumors (SIR=26.4, 16.6-40.0), soft tissue sarcomas (SIR=14.1, 6.7-25.8), and myeloid leukemia (SIR=12.7, 6.3-22.8). Significant increased risks for all malignancies combined were observed after sympathetic nervous system tumors (SIR=11.4, 5.2-21.6), retinoblastomas (SIR=7.3, 5.4-9.8), renal tumors (SIR=5.7, 3.8-8.0), malignant bone tumors (SIR=5.6, 3.7-8.2), soft tissue sarcomas (SIR=4.7, 3.2-6.8), germ-cell, trophoblastic and other gonadal neoplasms (SIR=2.5, 1.1-4.9), carcinomas and other malignant epithelial neoplasms (SIR=2.2, 1.4-3.3). The highest risk of a second malignancy of any type occurred 5 to 9 years after NCNSSC (SIR=9.9, 6.8-13.9). The cumulative incidence of second malignancies 10 years after the first neoplasm was 8 times higher among NCNSSC survivors than in the general population, with the absolute difference between observed and expected cumulative incidence still increasing after 50 years of follow-up.
CONCLUSIONS.: Children who survived a NCNSSC experience a large increased risk of developing a new malignancy, even many years after their initial diagnosis.

Breve commento a cura di Emanuele Crocetti
Questo studio multicentrico affronta il problema dell’incidenza di secondi tumori primitivi in una coorte molto numerosa di pazienti pediatrici con tumori solidi diversi da quelli del SNC. Lo studio basato su dati di registri di popolazione (australiani, canadesi, europei e asiatici) e su un periodo di incidenza estremamente lungo (dal 1943 al 2000) mostra un rischio sostanzialmente più elevato dell’atteso che si protrae anche a decenni di distanza dalla diagnosi del primo tumore. I dati sono coerenti con quelli statunitensi della coorte SEER 1973-2002. Nonostante non fossero disponibili informazioni relative al trattamento ricevuto è ipotizzabile che i risultati siano influenzati dai trattamenti utilizzati in passato. Per quanto riguarda la radioterapia si sono ridotte nel tempo sia le dosi che i campi di irradiazione, è quindi ipotizzabile che questi protocolli più recenti corrispondano a una riduzione del rischio di tumori radio-indotti.. Al contrario i regimi chemioterapici attuali sono più intensi rispetto al passato e questo fa immaginare una stabilità o un incremento del rischio nel futuro ad esempio per le leucemie.

2. Motta M, Del Vecchio A, Attuati L, Picozzi P, Perna L, Franzin A, Bolognesi A, Cozzarini C, Calandrino R, Mortini P, di Muzio N. Gamma Knife Radiosurgery for Treatment of Cerebral Metastases from Non-Small-Cell Lung Cancer. Int J Radiat Oncol Biol Phys. 2011 Apr 27. [Epub ahead of print]
Radiotherapy Department, San Raffaele Scientific Institute, Milan, Italy.
Abstract
PURPOSE: To evaluate clinical and physico-dosimetric variables affecting clinical outcome of patients treated with Gamma Knife radiosurgery (GKRS) for brain metastases from non-small cell lung cancer (NSCLC).
METHODS AND MATERIALS: Between 2001 and 2006, 373 patients (298 men and 75 women, median age 65 years) with brain metastases from NSCLC underwent GKRS. All of them had KPS ≥ 60%, eight or fewer brain metastases, confirmed histopathological diagnosis and recent work-up (<3 months). Thirty-five patients belonged to recursive partitioning analysis (RPA) Class I, 307 patients were in RPA Class II, 7 patients were in RPA Class III. Median tumor volume was 3.6 cm(3). Median marginal dose was 22.5 Gy at 50% isodose.; median 10 Gy and 12 Gy isodose volumes were 30.8 cm(3) and 15.8 cm(3), respectively. Follow-up with MRI was performed every 3 months. Overall survival data were collected from internal database, telephone interviews, and identifying registries.
RESULTS: Mean follow-up after GKRS was 51 months (range, 6 to 96 months); mean overall survival was 14.2 months. Of 373 patients, 29 were alive at time of writing, 104 had died of cerebral progression, and 176 had died of systemic progression. In 64 cases it was not possible to ascertain the cause. Univariate and multivariate analysis were adjusted for the following: RPA class, surgery, WBRT, age, gender, number of lesions, median tumor volume, median peripheral dose, and 10 Gy and 12 Gy volumes. Identified RPA class and overall tumor volume >5 cc were the only two covariates independently predictive of overall survival in patients who died of cerebral progression.
CONCLUSIONS: Global volume of brain disease should be the main parameter to consider for performing GKRS, which is a first-line therapy for patient in good general condition and controlled systemic disease.
3. Zani C, Pasquale L, Bressanelli M, Puoti M, Paris B, Coccaglio R, Lascioli I, Pieriacci G, Donato F. The epidemiological pattern of chronic liver diseases in a community undergoing voluntary screening for hepatitis B and C.. Dig Liver Dis. 2011 Apr 28. [Epub ahead of print]
Department of Experimental and Applied Medicine, Institute of Hygiene, Epidemiology and Public Health, University of Brescia, Italy.
Abstract
BACKGROUND: Vallecamonica-Sebino is a community in Northern Italy (99,776 inhabitants) with one of the highest mortality rates for primary liver cancer and cirrhosis in Italy, and voluntary screening for HCV and HBV is widespread. The aim of this study was to estimate the prevalence of chronic liver diseases and their aetiology in the area.
METHODS: We used the following sources of data, linked at an individual level: (1) hospital discharge data; (2) local Viral Hepatitis Services; (3) tests for anti-HCV antibodies and HBsAg from local laboratories; (4) Local Health Authority registry of chronic liver disease patients; (5) drug prescriptions for HBV and HCV treatment; (6) archives of Alcohol Units.
RESULTS: 3.5% of the residents had chronic liver disease, mainly chronic hepatitis (61.6%), followed by cirrhosis (14.0%) and alcoholic liver disease (11.2%). HCV was the main cause of chronic liver disease in females (46.3%) and males (29.8%), followed by alcohol abuse in males (22.9%) and HBV (10.9% males and 9.2% females). Prevalence of anti-HCV positivity was 3.2%, and increased with age to 8.8% in subjects aged 65 years and over.
CONCLUSION: This study shows that an epidemiologic pattern of the prevalence of chronic liver diseases and their aetiology can be obtained using routinely collected data.
4. Vogelzangs N, Beekman AT, Boelhouwer IG, Bandinelli S, Milaneschi Y, Ferrucci L, Penninx BW. Metabolic depression: a chronic depressive subtype? findings from the InCHIANTI study of older persons. J Clin Psychiatry. 2011 Apr 5. [Epub ahead of print]
Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, AJ Ernststraat 1187, 1081 HL Amsterdam, The Netherlands. n.vogelzangs@vumc.nl.
Abstract
OBJECTIVE: Several studies report a cross-sectional association between metabolic syndrome and depression. Possibly, metabolic syndrome promotes onset or chronicity of depression. However, such a longitudinal link has not yet been confirmed. This study examines whether metabolic syndrome or its components are associated with onset and chronicity of depression.
METHOD: Secondary analyses were performed on data from 823 participants (≥ 65 years of age) in the InCHIANTI study, a prospective, population-based cohort study of older persons. From 1998 to 2000, the study sample was randomly selected from the population registry of 2 sites in Italy using a multistage stratified sampling method. Baseline data collection consisted of a home interview and a medical evaluation at the study clinic. Follow-up for each participant occurred after 3 years and 6 years. Metabolic syndrome at baseline was defined as ≥ 3 of the following: abdominal obesity, high triglycerides, low high-density lipoprotein cholesterol, high blood pressure, and high fasting glucose. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale (CES-D) at baseline and after 3 and 6 years. Sample characteristics were compared between persons with and without depression at baseline using χ2 and t statistics. Logistic regression analyses were conducted separately in persons with and without depression at baseline to test whether metabolic syndrome at baseline could predict onset and chronicity of depression at follow-up.
RESULTS: At baseline, 235 persons had metabolic syndrome, and 168 were depressed (CES-D score ≥ 20). Among persons not depressed at baseline, 26.0% developed depression. Higher waist circumference increased the odds of depression onset (adjusted OR per SD increase = 1.28; 95% CI, 1.05-1.56), but there was no association between other metabolic syndrome components and onset of depression. Among persons depressed at baseline, depression had a chronic character in 69.0% of persons without and 88.5% of persons with metabolic syndrome. Metabolic syndrome was associated with an almost 3-fold increase in the odds of chronicity of depression (adjusted OR = 2.66; 95% CI, 1.01-7.00), with almost every metabolic syndrome component contributing to this association.
CONCLUSION: In late life, waist circumference, but not metabolic syndrome, predicted onset of depression. Depressed persons with metabolic syndrome were more likely to have persistent or recurrent depression. The latter may suggest that depression with metabolic abnormalities, which could be labeled metabolic depression, identifies a chronic subtype of depression.
5. Didoni A, Sequi M, Panei P, Bonati M; on behalf of the “Lombardy ADHD Registry Group”. One-year prospective follow-up of pharmacological treatment in children with attention-deficit/hyperactivity disorder. Eur J Clin Pharmacol. 2011 May 3. [Epub ahead of print]
Department of Public Health and of the Laboratory for Mother and Child Health, "Mario Negri" Pharmacological Research Institute, Via Giuseppe La Masa 19, 20156, Milan, Italy.
Abstract
OBJECTIVES: To delineate the safety and tolerability profile of methylphenidate and atomoxetine in children and adolescents with attention deficit hyperactivity disorder (ADHD) monitored for more than 1 year.
DESIGN: A cohort study analyzing data from the national ADHD register on patients from the Lombardy Region treated with MPH or atomoxetine.
PARTICIPANTS: A total of 229 children (median age 11 years, range 6-17), enrolled in 15 regional centers between June 2007 and May 2010. RESULTS: The prevalence rate of pharmacological treatment for ADHD was 0.23%, whereas the estimated ADHD prevalence in the population was 0.95%. In total, 73.8% of patients had been treated with atomoxetine (10-90 mg daily) or MPH (10-75 mg daily); 22% of patients also received an additional psychotropic drug. Of the treated children, 26.9% discontinued the drug prior to 1 year of treatment, mostly because of adverse effects (28.6%). No new or unexpected adverse events (rate 39.2%) were encountered. Decreased appetite, headache, and unstable mood were the leading events. The most severe events occurred in two boys: one experienced absence seizures for the first time with MPH, the other experienced hallucinations with atomoxetine. Therapy was discontinued in ten male patients (7.7%) because of adverse events. All patients with adverse effects recovered well.
CONCLUSIONS: A very low rate of ADHD prevalence was estimated in Italian children compared to that reported in other countries. Although the medications for ADHD are generally well tolerated, with only mild or minor adverse effects in most cases, their rational use can only be guaranteed by disseminating and monitoring evidence-based practices and by monitoring the safety and efficacy of treatments in both the short and long terms with appropriate tools and approaches.
6. Cacciapaglia F, Navarini L, Menna P, Salvatorelli E, Minotti G, Afeltra A. Cardiovascular safety of anti-TNF-alpha therapies: Facts and unsettled issues. Autoimmun Rev. 2011 Apr 22. [Epub ahead of print]
Internal Medicine and Rheumatology, "N. Melli" Hospital, San Pietro V.co, Brindisi, Italy; Integrated Research Center, Campus Bio-Medico University, Rome, Italy.
Abstract
Tumor necrosis factor alpha (TNFa) plays a central role in the pathogenesis of both rheumatoid arthritis (RA) and heart failure (HF). Over the last years RA could benefit from TNFa inhibitors that mitigated disease activity, decreased structural damage, and prevented cardiovascular events. Contraindications to clinical use of TNFa inhibitors may include infections, autoimmune disorders, demyelinating disease, cancer, and heart failure. Overall, these pathological conditions do not appear to increase significantly during treatment with TNFa antagonists compared to placebo. Clinical trials probed these drugs in non RA HF patients produced disappointing results and formed the basis to contraindicate TNFa inhibitors in patients with moderate-severe HF. Although National Registries provide apparently encouraging data about HF safety of anti-TNFa therapies, they cannot adequately assess the actual risk, as these drugs are administered to patients with no cardiac dysfunction. These findings introduced a "rheumatological dilemma" in the clinical management of RA with anti-TNFa. Probably, in RA patients anti-TNFa agents would intercept TNFa and prevent its toxic effects on heart function, while in patients with advanced heart damage (NYHA class III-IV HF), anti-TNFa agents would interfere with the beneficial preconditioning effects of TNFa.
7. Caggegi A, Capodanno D, Capranzano P, Chisari A, Ministeri M, Mangiameli A, Ronsivalle G, Ricca G, Barrano G, Monaco S, Di Salvo ME, Tamburino C. Comparison of One-Year Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Unprotected Left Main Coronary Artery Disease and Acute Coronary Syndromes (from the CUSTOMIZE Registry). Am J Cardiol. 2011 May 3. [Epub ahead of print]
Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
Abstract
Uncertainty surrounds the optimal revascularization strategy for patients with left main coronary artery disease presenting with acute coronary syndromes (ACSs), and adequately sized specific comparisons of percutaneous and surgical revascularization in this scenario are lacking. The aim of this study was to evaluate the incidence of 1-year major adverse cardiac events (MACEs) in patients with left main coronary artery disease and ACS treated with percutaneous coronary intervention (PCI) and drug-eluting stent implantation or coronary artery bypass grafting (CABG). A total of 583 patients were included. At 1 year, MACEs were significantly higher in patients treated with PCI (n = 222) compared to those treated with CABG (n = 361, 14.4% vs 5.3%, p <0.001), driven by a higher rate of target lesion revascularization (8.1% vs 1.7%, p = 0.001). This finding was consistent after statistical adjustment for MACEs (adjusted hazard ratio [HR] 2.7, 95% confidence interval [CI] 1.2 to 5.9, p = 0.01) and target lesion revascularization (adjusted HR 8.0, 95% CI 2.2 to 28.7, p = 0.001). No statistically significant differences between PCI and CABG were noted for death (adjusted HR 1.1, 95% CI 0.4 to 3.0, p = 0.81) and myocardial infarction (adjusted HR 4.8, 95% CI 0.3 to 68.6, p = 0.25). No interaction between clinical presentation (ST-segment elevation myocardial infarction or unstable angina/non-ST-segment elevation myocardial infarction) and treatment (PCI or CABG) was observed (p for interaction = 0.68). In conclusion, in patients with left main coronary artery disease and ACS, PCI is associated with similar safety compared to CABG but higher risk of MACEs driven by increased risk of repeat revascularization.
8. Parabiaghi A, Franchi C, Tettamanti M, Barbato A, D'Avanzo B, Fortino I, Bortolotti A, Merlino L, Nobili A. Antidepressants utilization among elderly in Lombardy from 2000 to 2007: dispensing trends and appropriateness. Eur J Clin Pharmacol. 2011 May 7. [Epub ahead of print]
Mario Negri Institute for Pharmacological Research, Via La Masa 19, 20156, Milan, Italy, alberto.parabiaghi@marionegri.it.
Abstract
PURPOSE: To investigate the prevalence and incidence of antidepressant (AD) use in the elderly during an 8-year period and to evaluate AD treatment appropriateness.
METHODS: A population-based dispensation study on community-dwelling elderly of a large area in Lombardy was performed. Data were drawn from the regional administrative database and from a general practice registry. For each year, prevalence of AD use (i.e., at least one recorded dispensation) and AD treatment (i.e., at least four recorded dispensations) was compared.
RESULTS: The prevalence of AD use and treatment doubled and tripled, respectively. The greatest shift occurred between 2000 and 2002 and was entirely due to SSRIs. The most pronounced increase was seen in females who accounted for 72% of all dispensations. The increase in prevalence was not mirrored by incident use, which slightly decreased (OR: 0.98; 95% CI: 0.98-0.98). The proportion of those who received a minimally adequate AD treatment grew over the years (OR: 1.63; 95% CI: 1.59-1.68). The increase in prevalence of AD treatment was most pronounced among older age groups (ORs between 1.02 and 1.06 for age classes ≥75 years relative to the 65-69 age class; P < 0.001) and was proportional to that of depressive disorders.
CONCLUSIONS: A dramatic rise in dispensations was observed. The increasing prevalence of minimally adequately treated subjects and a possible decrease in untreated depression may reflect an improvement in the pharmacological treatment of depression. The increase in prevalence and not in the incidence of dispensations could be related to an inappropriate prolongation of treatment duration.
9. Gana S, Sainati L, Frau MR, Monciotti C, Poli F, Cannioto Z, Comelli M, Danesino C, Minelli A. Shwachman-Diamond Syndrome and Type 1 Diabetes Mellitus: More Than a Chance Association? Exp Clin Endocrinol Diabetes. 2011 May 6. [Epub ahead of print]
Medical Genetics, University of Pavia, Pavia, Italy.
Abstract
Shwachman-Diamond syndrome is a rare clinical condition consisting of exocrine pancreatic dysfunction, various degree of pancytopenia, and metaphyseal dysplasia. The majority of Shwachman-Diamond syndrome cases result from mutations in the Shwachman-Bodian-Diamond Syndrome gene. To date, type 1 diabetes mellitus has only been reported in 4 independent cases presenting with Shwachman-Diamond syndrome, 3 of them with molecular confirmation of the diagnosis. We describe 2 unrelated patients with clinical and molecular features typical of Shwachman-Diamond syndrome and type 1 diabetes mellitus. In addition, we report the occurrence rate of type 1 diabetes mellitus in the Italian registry for Shwachman-Diamond syndrome, which is low (3.23%) but increased at least 30-fold over the type 1 diabetes mellitus occurrence rate in the general population. No evidence of a direct correlation between Shwachman-Diamond syndrome and type 1 diabetes mellitus have been reported, therefore the presence of both diseases in the same patient might be a chance association, however we suggest that the defects in immune regulation of Shwachman-Diamond syndrome might play a role in the development of type 1 diabetes mellitus.
10. Racca F, Berta G, Sequi M, Bignamini E, Capello E, Cutrera R, Ottonello G, Ranieri VM, Salvo I, Testa R, Wolfler A, Bonati M; on behalf of the “LTV Pediatric Italian Network”.Long-term home ventilation of children in Italy: A national survey. Pediatr Pulmonol. 2011 Jun;46(6):566-572. doi: 10.1002/ppul.21401. Epub 2010 Dec 30.
Department of Anesthesiology and Intensive Care Medicine, San Giovanni Battista-Molinette Hospital, University of Turin, Turin, Italy.
Abstract
BACKGROUND: Improved technology, as well as professional and parental awareness, enable many ventilator-dependent children to live at home. However, the profile of this growing population, the quality and adequacy of home care, and patients' needs still require thorough assessment.
OBJECTIVES: To define the characteristics of Italian children receiving long-term home mechanical ventilation (HMV) in Italy.
METHODS: A detailed questionnaire was sent to 302 National Health Service hospitals potentially involved in the care of HVM in children (aged <17 years). Information was collected on patient characteristics, type of ventilation, and home respiratory care.
RESULTS: A total of 362 HMV children was identified. The prevalence was 4.2 per 100,000 (95% CI: 3.8-4.6), median age was 8 years (interquartile range 4-14), median age at starting mechanical ventilation was 4 years (1-11), and 56% were male. The most frequent diagnostic categories were neuromuscular disorders (49%), lung and upper respiratory tract diseases (18%), hypoxic (ischemic) encephalopathy (13%), and abnormal ventilation control (12%). Medical professionals with nurses (for 62% of children) and physiotherapists (20%) participated in the patients' discharge from hospital, though parents were the primary care giver, and in 47% of cases, the sole care giver. Invasive ventilation was used in 41% and was significantly related to young age, southern regional residence, longer time spent under mechanical ventilation, neuromuscular disorders, or hypoxic (ischemic) encephalopathy.
CONCLUSIONS: Care and technical assistance of long-term HMV children need assessment, planning, and resources. A wide variability in pattern of HMV was found throughout Italy. An Italian national ventilation program, as well as a national registry, could be useful in improving the care of these often critically ill children. Pediatr. Pulmonol. 2011; 46:566-572. © 2011 Wiley-Liss, Inc.
11. Corona G, Rastrelli G, Monami M, Melani C, Balzi D, Sforza A, Forti G, Mannucci E, Maggi M. Body Mass Index Regulates Hypogonadism-Associated CV Risk: Results from a Cohort of Subjects with Erectile Dysfunction. J Sex Med. 2011 May 11. doi: 10.1111/j.1743-6109.2011.02292.x. [Epub ahead of print]
Sexual Medicine and Andrology Unit, University of Florence, Florence, Italy Azienda, Azienda Usl di Bologna-Maggiore-Bellaria Hospital, Bologna, Italy Department of Clinical Physiopathology, University of Florence, Florence, Italy Diabetes Section Geriatric Unit, Epidemiological Unit, University of Florence, Florence, Italy.
Abstract
Obesity is an independent cardiovascular (CV) risk factor.Introduction. Testosterone (T) is inversely related to body mass index (BMI) in males. There is substantial evidence suggesting that low T could play a role as a moderator of CV This study is designed to assess the possible interactionmortality in men. Aim. between T and obesity in predicting major CV events (MACE) in a sample of A consecutive series of 1,687subjects with erectile dysfunction. Methods. patients were studied. Different clinical, biochemical, and instrumental parameters were evaluated. According to BMI, subjects were divided into normal kg/m(2) ), and25.0-29.9=kg/m(2) ), overweight (BMI18.5-24.9=weight (BMI kg/m(2) ). Hypogonadism was defined as total T below30.0≥obese (BMI nmol/L. Information on MACE was obtained through the City of Florence10.4 Information on MACE was obtained throughRegistry Office. Main Outcome Measures. Among the patients studied, 39.8%the City of Florence Registry Office. Results. had normal weight, whereas 44.1% and 16.1% were overweight and obese, respectively. Unadjusted analysis in the whole sample showed that while hypogonadism and obesity were significantly associated with an increased risk of MACE, their interaction term was associated with a protective effect. In a Cox regression model, adjusting for confounders, hypogonadism showed a significant increased risk of MACE in normal weight subjects, whereas it was associated with Hypogonadism-associated CV riska reduced risk in obese patients. Conclusions. depends on the characteristics of subjects, being more evident in normal weight than in obese patients. Further studies are advisable to clarify if low T in obese patients is a (positive) consequence of a comorbid condition (i.e., to save energy) or if it represents a pathogenetic issue of the same illness. Hence, possible misuse/abuse of T treatment in obese subjects must be avoided. Corona G, Rastrelli G, Monami M, Melani C, Balzi D, Sforza A, Forti G, Mannucci E, and Maggi M. Body mass index regulates hypogonadism-associated CV risk: Results from a cohort of subjects with erectile dysfunction.
12. Viviani L, Bossi A, Assael BM; On behalf of the Italian Registry for Cystic Fibrosis Collaborative Group. Absence of a gender gap in survival. An analysis of the italian registry for cystic fibrosis in the paediatric age. J Cyst Fibros. 2011 Apr 22. [Epub ahead of print]
Dipartimento di Medicina del Lavoro "Clinica del Lavoro L.Devoto", Sezione di Statistica Medica e Biometria "G.A. Maccacaro", Università degli Studi di Milano. Via Venezia n 1, 20133 Milano, Italy.
Abstract
BACKGROUND: The existence of gender-related differences since childhood in survival of cystic fibrosis (CF) patients has been recently challenged.
METHODS: We evaluated the effect of gender on survival of 2293 CF patients born after 01/01/1988, followed up by 29 CF centres until 31/12/2004 and recorded in the Italian Registry for CF (IRCF).
RESULTS: We observed similar annual mortality rates in females (3.59‰) and males (4.00‰), similar survival curves (log-rank test p=0.64) and similar hazards of death (hazard ratio adjusted for presence of symptoms at diagnosis, meconium ileus, F508del mutation and age at diagnosis: 1.29, 95%CI: 0.60; 2.76). However, excess mortality due to CF was higher for females (5.9) than males (5.1).
CONCLUSIONS: In our population CF females do not experience higher mortality than males but, due to the disease, they lose the expected survival advantage occurring in the general population at this age. We do not exclude, however, that differences in mortality will establish after adolescence.
13. Papalia R, Del Buono A, Zampogna B, Maffulli N, Denaro V. Sport activity following joint arthroplasty: a systematic review. Br Med Bull. 2011 May 12. [Epub ahead of print]
Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, Rome, Italy.
Abstract
Introduction: Although the clinical and functional outcomes of patients undergoing knee arthroplasty have widely been investigated, there is little information on the postoperative sport activity status.
Sources of data: We performed a comprehensive search of CINAHL, Embase, Medline and the Cochrane Central Registry of Controlled Trials, from inception of the database to 25 February 2011, using various combinations of the keyword terms 'Knee arthroplasty', 'Knee replacement', 'Total Knee replacement', 'Unicondylar Knee replacement', 'Knee Prosthesis', 'Sport Activity', 'Return To Sport Activity Level' and 'Recreational Sporting Level'. Twenty-two articles published in peer-reviewed journals were included in this review.
Areas of agreement: Patients report improved outcomes, in terms of pain, symptoms, activities of daily living, sport activity and quality of life, compared with preoperative status. Only low-impact physical activities are recommended. The Coleman Methodology Score showed great heterogeneity in the study design, patients' characteristics, management methods and outcome assessment, and generally low methodological quality.
Areas of controversy Data: are too heterogeneous to allow for definitive conclusions on long-term outcomes of total knee arthroplasty. It is not possible to compare the post-operative sport activity status of the patients. Growing points Validated and standardized measures should be used to report outcomes of patients undergoing knee arthroplasty. Function surveys that better depict sport activities, and include actual physical function testing, should be used.
Research: There is a need to perform appropriately powered randomized clinical trials using standard diagnostic assessment, and a common and validated scoring system comparing reported outcomes and the duration of follow-up >2 years.
14. Sardella G, Conti G, Bisceglia T, Canali E, Mancone M, De Carlo C, Spedicato L, Morocutti G, Fedele F, Bernardi G. Long-term outcome after drug-eluting stent implantation in unselected population: ROME and UDINE Experience (The RUDI Registry). JCatheter Cardiovasc Interv. 2011 May 12. doi: 10.1002/ccd.23050. [Epub ahead of print]
Nephrologic and Respiratory Sciences Department, Cardiovascular, "Sapienza" University of Rome, Geriatric, Umberto I Hospital, Italy. rino.sardella@uniroma1.it.
Abstract
Objectives: The aim of our study is to evaluate the safety and efficacy of DES implantation in an unselected, "real world," high-risk population. Background: Several clinical trials showed that drug-eluting stents (DESs) implantation is safe and effective in selected population. In spite of these encouraging results, there are some concerns about "real world" utilization of these stents.
Methods: One thousand four hundred and fifty-five off-label patients have been included in our registry. Primary end-points were: long-term clinical incidence of major adverse cardiac and cerebrovascular events (MACCE) and thrombosis (ST). We detected the difference between uniDES vs. multiDES implantation in terms of MACCE, death, nonfatal-MI, the composite of death/nonfatal-MI and target lesion revascularization (TLR) and the difference between DES type in term of MACCE.
Results: At 36 months follow-up we found: cardiac death occurred in 20 patients (1.6%); 33 patients (2.6%) had a nonfatal MI and 81 patients (6.3%) had a TLR. We observed one (0.1%) acute, 9 subacute (0.6%), 6 late (0.6%), and 1 (0.5%) very late definite ST. No difference were found in terms of overall MACCE, MI, death and composite of death/nonfatal-MI between uni- and multiDES implantation but multiDES group had a higher incidence of TLR. No difference between DES type in term of MACCE was detected.
Conclusions: DES utilization shows their safety and efficacy in off-label patients with complex clinical and angiographic profile in terms of long-term incidence of MACCE. MultiDES implantation is associated with a higher risk of long-term TLR. No difference between DES type was found. © 2011 Wiley-Liss, Inc.
15. Amodio R, Zarcone M, Cusimano R, Campisi I, Dolcemascolo C, Traina A, Agostara B, Romano N. Target Therapy in HER2-Overexpressing Breast Cancer Patients. OMICS. 2011 Jun;15(6):363-7. Epub 2011 May 13.
Palermo Province Cancer Registry, Department of Science for the Promotion of Health "G.D. Alessandro," University of Palermo, Italy .
Abstract
The development of new therapeutic strategies, such as monoclonal antibodies directed against human epidermal growth factor receptor-2 (HER2), has offered new hopes for women with early breast cancer whose tumors overexpress HER2. We retrospectively analyzed the population-based data of Breast Cancer Registry of Palermo in 2004-2006, and selected 1401 invasive breast cancer cases, nonmetastatic at diagnosis, having HER2/neu oncogene expression determined. We have correlated this information to age, tumor stage at diagnosis (TNM), nodal involvement, and receptor status (ER and PgR). Survival analysis was conducted dividing the patients in two different groups according to date of diagnosis: one group diagnosed in 2004 and a second group in 2005-2006. In the 460 cases of 2004, nodal involvement, receptor status, age at diagnosis and TNM maintained a strong predictive value (p < 0.0001). In this group of patients, overall survival was significantly different according to the HER2 expression levels (p = 0.001). In the second group of patients (941 incident cases in 2005-2006) there was a statistically significant survival difference comparing patients with high levels of HER2 expression treated with trastuzumab versus those untreated (p = 0.006). Our data show that elevated levels of HER2 are a negative prognostic factor. In addition, patients overexpressing HER2 show a significant increase of overall survival when treated with trastuzumab.
16. Trimarchi S, Jonker FH, Hutchison S, Isselbacher EM, Pape LA, Patel HJ, Froehlich JB, Muhs BE, Rampoldi V, Grassi V, Evangelista A, Meinhardt G, Beckman J, Myrmel T, Pyeritz RE, Hirsch AT, Sundt Iii TM, Nienaber CA, Eagle KA. Descending aortic diameter of 5.5 cm or greater is not an accurate predictor of acute type B aortic dissection. J Thorac Cardiovasc Surg. 2011 May 16. [Epub ahead of print]
Policlinico San Donato IRCCS, Cardiovascular Center "E. Malan," University of Milano, Milan, Italy.
Abstract
OBJECTIVE: The risk of acute type B aortic dissection is thought to increase with descending thoracic aortic diameter. Currently, elective repair of the descending thoracic aorta is indicated for an aortic diameter of 5.5 cm or greater. We sought to investigate the relationship between aortic diameter and acute type B aortic dissection, and the utility of aortic diameter as a predictor of acute type B aortic dissection.
METHODS: We examined the descending aortic diameter at presentation of 613 patients with acute type B aortic dissection who were enrolled in the International Registry of Acute Aortic Dissection between 1996 and 2009, and analyzed the subset of patients with acute type B aortic dissection with an aortic diameter less than 5.5 cm.
RESULTS: The median aortic diameter at the level of acute type B aortic dissection was 4.1 cm (range 2.1-13.0 cm). Only 18.4% of patients with acute type B aortic dissection in the International Registry of Acute Aortic Dissection had an aortic diameter of 5.5 cm or greater. Patients with Marfan syndrome represented 4.3% and had a slightly larger aortic diameter than patients without Marfan syndrome (4.68 vs 4.32 cm, P = .121). Complicated acute type B aortic dissection was more common among patients with an aortic diameter of 5.5 cm or greater (52.2% vs 35.6%, P < .001), and the in-hospital mortality for patients with an aortic diameter less than 5.5 cm and 5.5 cm or greater was 6.6% and 23.0% (P < .001), respectively.
CONCLUSION: The majority of patients with acute type B aortic dissection present with a descending aortic diameter less than 5.5 cm before dissection and are not within the guidelines for elective descending thoracic aortic repair. Aortic diameter measurements do not seem to be a useful parameter to prevent aortic dissection, and other methods are needed to identify patients at risk for acute type B aortic dissection.
17. Massari FM, Tonella T, Tarsia P, Kirani S, Blasi F, Magrini F. [Tako-tsubo syndrome in a young man with amyotrophic lateral sclerosis. A case report]. [Article in Italian] G Ital Cardiol (Rome). 2011 May;12(5):388-91. doi: 10.1714/643.7506.
U.O. di Medicina Cardiovascolare, Dipartimento Toraco-Polmonare e Cardiocircolatorio, Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Universita degli Studi, Milano. ferdinando.massari@fastwebnet.it
Abstract
A 40-year-old man with amyotrophic lateral sclerosis undergoing home non-invasive ventilation, with no risk factors for coronary artery disease, was admitted with bilateral lung infiltrates. Given the lack of a favorable clinical response, transfer to our department was scheduled. During ambulance transport the patient experienced chest discomfort. Upon arrival at our department, a diagnosis of tako-tsubo syndrome was made. In this report, the clinical aspects are taken as a basis to highlight differences with common available findings, and an international registry is proposed to help piece together fractional information present in the literature.
18. Tomai F, Pesarini G, Castriota F, Reimers B, De Luca L, De Persio G, Spartà D, Aurigemma C, Pacchioni A, Spagnolo B, Cremonesi A, Ribichini F; FRIENDS (Finalized Research in Endovascular Strategies) Study Group.Early and long-term outcomes after combined percutaneous revascularization in patients with carotid and coronary artery stenoses. JACC Cardiovasc Interv. 2011 May;4(5):560-8.
Department of Cardiovascular Sciences, European Hospital, Rome, Italy.
Abstract
OBJECTIVES: This study sought to evaluate the 30-day and long-term clinical outcomes of patients with carotid obstructive disease (COD) and concomitant coronary artery disease (CAD) undergoing a combined percutaneous revascularization, in 4 high-volume centers skilled for the treatment of multilevel vascular disease.
BACKGROUND: The optimal management of patients with COD and concomitant CAD remains controversial. A variety of therapeutic strategies, including coronary artery bypass grafting, alone or in combination with carotid artery revascularization, have been reported.
METHODS: Between January 2006 and April 2010, 239 consecutive patients with COD (symptomatic carotid stenosis in 20.5%) and concomitant CAD were treated with staged or simultaneous carotid artery stenting and percutaneous coronary intervention, and enrolled in this prospective registry. The primary endpoint was the incidence of major cardiac and cerebrovascular events, including any death, myocardial infarction, or stroke occurring between the first revascularization procedure and 30 days after treatment of the second vascular territory affected.
RESULTS: The incidence of the primary endpoint at 30 days was 4.2% (95% confidence interval [CI]: 2.02 to 7.56). The rate of death, myocardial infarction, and stroke at long-term follow-up (median 520 days) was 4.2%, 2.1%, and 3.8%, respectively. At long-term follow-up, patients with previous cardiovascular disease had significantly higher rates of major cardiac and cerebrovascular events than did patients with a first clinical episode (17% vs. 6%, hazard ratio: 3.34; 95% CI: 1.46 to 7.63; p = 0.004).
CONCLUSIONS: In patients with COD and concomitant CAD, a combined percutaneous treatment compares favorably with previous surgical or hybrid experiences. Such strategy may be particularly suited to complex patients at high surgical risk.
19. Aspromonte N, Cruz DN, Valle R, Bonello M, Tubaro M, Gambaro G, Marchese G, Santini M, Ronco C. Metabolic and toxicological considerations for diuretic therapy in patients with acute heart failure. Expert Opin Drug Metab Toxicol. 2011 May 21. [Epub ahead of print]
San Filippo Neri Hospital, Cardiovascular Department , Rome , Italy naspromonte@yahoo.it.
Abstract
Introduction: Diuretics are widely recommended in patients with acute heart failure (AHF). However, loop diuretics predispose patients to electrolyte imbalance and hypovolemia, which in turn leads to neurohormonal activation and worsening renal function (WRF). Unfortunately, despite their widespread use, limited data from randomized clinical trials are available to guide clinicians with the appropriate management of this diuretic therapy.
Areas covered: This review focuses on the current management of diuretic therapy and discusses data supporting the efficacy and safety of loop diuretics in patients with AHF. The authors consider the challenges in performing clinical trials of diuretics in AHF, and describe ongoing clinical trials designed to rigorously evaluate optimal diuretic use in this syndrome. The authors review the current evidence for diuretics and suggest hypothetical bases for their efficacy relying on the complex relationship among diuretics, neurohormonal activation, renal function, fluid and sodium management, and heart failure syndrome.
Expert opinion: Data from several large registries that evaluated diuretic therapy in hospitalized patients with AHF suggest that its efficacy is far from being universal. Further studies are warranted to determine whether high-dose diuretics are responsible for WRF and a higher rate of coexisting renal disease are instead markers of more severe heart failure. The authors believe that monitoring congestion during diuretic therapy in AHF would refine the current approach to AHF treatment. This would allow clinicians to identify high-risk patients and possibly reduce the incidence of complications secondary to fluid management strategies.
20. Covello RD, Landoni G, Zangrillo A.. Anesthetic management of transcatheter aortic valve implantation. Curr Opin Anaesthesiol. 2011 May 19. [Epub ahead of print]
Anaesthesia and Intensive Care Medicine, Università Vita-Salute San Raffaele, Milan, Italy
Abstract
PURPOSE OF REVIEW: The revolution in transcatheter aortic valve implantation (TAVI) for the treatment of aortic stenosis has been well described by the large number of randomized trials, registries, and single and multicenter experiences published during 2010-2011. The aim of this review is to describe the challenges of the anesthetic management related to TAVI.
RECENT FINDINGS: Recent data show that TAVI is clinically effective in patients with inoperable aortic stenosis when compared with standard therapy. It can be accomplished in high-risk patients with favorable outcomes compared with surgery as predicted by standard estimates of mortality and is associated with functional and hemodynamic improvement. Currently, TAVI is targeted at high-risk patients, but may be extended to lower risk groups in the near future. Outstanding questions concerning TAVI are related to its long-term durability and to procedural complications.
SUMMARY: Preprocedural, multidisciplinary assessment of the patient is essential prior to TAVI and should include a full anesthetic evaluation, consideration of patient comorbidities, and determination of technical feasibility. The role of scoring systems for risk prediction requires further scrutiny. Multidevice/multiple access approaches allow for treatment of a wide range of patients. Anesthetic techniques and supportive measures vary depending on procedural concerns, patient comorbidity, and severe, often unstable cardiac disease. Echocardiography is fundamental to preoperative evaluation, procedure guidance, and assessment of complications. Planned bailout strategies should be discussed with all members of the medical team. Postoperative standardized monitoring and management protocols are essential.
21. Navarese EP, De Servi S, Politi A, Martinoni A, Musumeci G, Boschetti E, Belli G, D'Urbano M, Piccaluga E, Lettieri C, Klugmann S. Impact of primary PCI volume on hospital mortality in STEMI patients: does time-to-presentation matter? J Thromb Thrombolysis. 2011 May 24. [Epub ahead of print]
Department of Cardiovascular Diseases, Azienda Ospedaliera Ospedale Civile di Legnano, Legnano (Milan), Italy, eliano.navarese@alice.it.
Abstract
The exact relationship between primary percutaneous coronary intervention (PCI) volume and mortality remains unclear. No data are available on how this relationship could be affected by time-to-presentation. The primary aim of this study was to evaluate the impact of hospital primary PCI volume on in-hospital mortality in ST-elevation myocardial infarction (STEMI) patients depending on time-to-presentation. The impact of primary PCI volume on in-hospital mortality was investigated in a prospective registry of the Lombardy region in Northern Italy, deriving data on mortality rates and number of primary PCIs from a cohort of 2,558 patients. We also explored this relationship at different times-to-presentation (≤90 min, >90 min-180 min, >180 min) and risk profiles assessed with the TIMI Risk Index. A strong inverse relationship was found between primary PCI hospital volume and risk-adjusted mortality (r = -0.9; P < 0.001). High primary PCI volumes best predicted the improvement of survival when the time-to-presentation was ≤90 min (area under the curve = 0.73, P < 0.0001). At this time, the best primary PCI threshold to provide benefit was >66 primary PCIs/year (OR = 0.21 [95% CI 0.10-0.47], P < 0.001) and those with high TIMI Risk Index achieved the greatest benefit (P < 0.001). At >90 min-180 min, the model was less significant (P = 0.02) with a higher threshold of procedures (>145 primary PCIs/year) required to provide benefits. The model was not predictive of survival for time-to-presentation >180 min (P = 0.30). The reduction of mortality of STEMI patients treated at high-volume primary PCI centers is time-dependent and affected by risk profile. The greatest benefit was observed in high-risk patients presenting within 90 min from symptoms onset.
22. Aurelio MT, Aniasi A, Haworth SE, Colombo MB, Dimonopoli T, Mocellin MC, Poli F, Torelli R, Crespiatico L, Serafini M, Scalamogna M. Analysis of the motivation for hematopoietic stem cell donation. Transplant Proc. 2011 May;43(4):981-4.
Organ and Tissue Transplantation Immunology, Department of Regenerative Medicine, Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
Abstract
The Italian Bone Marrow Donor Register is the institutional organization for management of unrelated hematopoietic stem cell donors. The law requires only a donor's clinical history, but not a psychosocial profile for registration. We have studied the donor's motivation for enlistment on the donor registry and the medical staff's need for this information to interact correctly with the donor. For this purpose we distributed a questionnaire to new donors at the 20 centers in the Lombardy Region over a period of 1 year. The analysis of the responses revealed a prevalence of extrinsic motivations that would not ensure continued registration for donation. Therefore, it is necessary that the donor be well informed and better educated about all aspects of donation, in order to produce a shift to an intrinsic motivation. This objective can be facilitated via professional training of health workers in communication.
23. Saia F, Bordoni B, Marrozzini C, Ciuca C, Moretti C, Branzi A, Marzocchi A. Incidence, prognostic value and management of vascular complications with transfemoral transcatheter aortic valve implantation. Future Cardiol. 2011 May;7(3):321-31.
Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Via Massarenti 40138 Bologna, Italy.
Abstract
Inoperable or high-risk patients with severe aortic stenosis who undergo transcatheter aortic valve implantation (TAVI) have better outcomes compared with those treated with standard medical therapy. As for any other invasive procedure, peri-procedural complications may occur, reducing the procedural success rate and potentially affecting short- and mid-term outcomes. The transfemoral approach prevails over other possible access-site options in most registries. The use of large introducer sheaths and the need for double arterial vascular access can lead to higher rates of vascular complications in this elderly population, with a high prevalence of baseline peripheral artery disease. In this article, we review the results of recent clinical trials and major registries using the two different bioprosthesis currently available for TAVI, focusing on access site-related complications with transfemoral TAVI, their management and relationship with in-hospital and 30-day survival. Awareness of the mechanisms behind these complications might help in their prevention, recognition and management and may ultimately improve the clinical outcome of TAVI procedures.
24. Caldarella A, Crocetti E, Bianchi S, Vezzosi V, Urso C, Biancalani M, Zappa M.Female Breast Cancer Status According to ER, PR and HER2 Expression: A Population Based Analysis. Pathol Oncol Res. 2011 Apr 10. [Epub ahead of print]
Clinical and Descriptive Epidemiology Unit, Institute for Study and Cancer Prevention (ISPO), Via di San Salvi,12, 50135, Florence, Italy, a.caldarella@ispo.toscana.it.
Abstract
The aim of this study is to evaluate the prognostic values of some biological parameters in a population based series of female breast cancer patients. Through the Tuscan Cancer Registry all the invasive breast cancer cases diagnosed during the period 2004-2005 in the provinces of Florence and Prato, central Italy, were retrieved. Molecular subtypes were analyzed defined by immunohistochemical markers, by age, tumor size, lymph node status, histotype, grade of differentiation and proliferative marker. Out of 1487 patients 70.3% were luminal A subtype (ER/PR + HER2-), 15.6% luminal B (ER/PR + HER2+), 8.1% triple negative (ER/PR-HER2-), 6.0% HER2+ (ER/PR-HER2+); the 3 year survival rates were 93.3%, 89.5%, 86.3%, 82.7% respectively (p < 0.001). Analysis of survival by the Cox proportional hazards model showed an independent prognostic value of molecular classification. Our study revealed significant differences in clinicopathological characteristics among breast cancer molecular subtypes and confirmed their prognostic independent role.
25. Caldarella A, Crocetti E, Paci E.Distribution, Incidence, and Prognosis in Neuroendocrine Tumors: a Population Based Study from a Cancer Registry. Pathol Oncol Res. 2011 Apr 9. [Epub ahead of print]
Clinical and Descriptive Epidemiology Unit, Institute for Study and Cancer Prevention (ISPO), Via di San Salvi,12, Florence, 50135, Italy, a.caldarella@ispo.toscana.it.
Abstract
Neuroendocrine tumors are considered rare tumors: recently an increased incidence and an improvement in survival were described. We explore distribution, incidence and survival of neuroendocrine tumors using population based registry data. We extracted from the Tuscan Cancer Registry neuroendocrine tumors from 1985-2005, and we evaluated distribution, incidence ad survival according to sex, site of tumor, age and stage at diagnosis. 455 cases of neuroendocrine tumors were identified. The overall incidence increased over the study period from 0.7 per 100,000 per year to 1.6 among men (APC +3.6) and from 0.3 to 2.1 among women (APC +4.8). The anatomic distribution of tumors was lung 25.7%, small intestine 23.5%, appendix 10.9%, colon 10.3%, pancreas 9.4%, stomach 7.4%, and rectum 5.2%. Neuroendocrine tumors were more frequent among males and incidence rate increased with age. We observed increased incidence of neuroendocrine tumors, while survival did not change over time. Prognosis varied with age, stage and localization; females had better survival than males. The increase number of neuroendocrine tumors may be due, at least in part, to better registration and to improvement of diagnosis.

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