Azienda Ospedaliero Universitaria di Cagliari

Cagliari, Italy

Azienda Ospedaliero Universitaria di Cagliari

Cagliari, Italy
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Bocchetta A.,University of Cagliari | Ardau R.,Azienda Ospedaliero Universitaria di Cagliari | Fanni T.,University of Cagliari | Sardu C.,University of Cagliari | And 3 more authors.
BMC Medicine | Year: 2015

Background: The effects of lithium treatment on renal function have been previously shown, albeit with discrepancies regarding their relevance. In this study, we examined glomerular filtration rate in patients treated with lithium for up to 33 years. Methods: All lithium patients registered from 1980 to 2012 at a Lithium Clinic were screened. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine concentration using the Modification of Diet in Renal Disease Study Group equation. A cross-sectional evaluation of the last available eGFR of 953 patients was carried out using multivariate regression analysis for gender, current age, and duration of lithium treatment. Survival analysis was subsequently applied to calculate the time on lithium needed to enter the eGFR ranges 45 to 59 mL/min/1.73 m2 (G3a) or 30 to 44 mL/min/1.73 m2 (G3b). Finally, 4-year follow-up of eGFR was examined in subgroups of patients who, after reduction to an eGFR lower than 45 mL/min/1.73 m2 either i) continued lithium at the same therapeutic range or ii) discontinued lithium or continued at concentrations below the therapeutic range (0.5 mmol/L). Results: In the cross-sectional evaluation, eGFR was found to be lower in women (by 3.47 mL/min/1.73 m2), in older patients (0.73 mL/min/1.73 m2 per year of age), and in patients with longer lithium treatment (0.73 mL/min/1.73 m2 per year). Half of the patients treated for longer than 20 years had an eGFR lower than 60 mL/min/1.73 m2. The median time on lithium taken to enter G3a or G3b was 25 years (95% CI, 23.2-26.9) and 31 years (95% CI, 26.6-35.4), respectively. Progression of renal failure throughout the 4-year follow-up after a reduction to an eGFR lower than 45 mL/min/1.73 m2 did not differ between the subgroup who continued lithium as before and the subgroup who either discontinued lithium or continued at concentrations below the therapeutic range. Conclusions: Duration of lithium treatment is to be added to advancing age as a risk factor for reduced glomerular filtration rate. However, renal dysfunction tends to appear after decades of treatment and to progress slowly and irrespective of lithium continuation. © 2015 Bocchetta et al.; licensee BioMed Central.


Saba L.,Azienda Ospedaliero Universitaria di Cagliari | Guerriero S.,Azienda Ospedaliero Universitaria di Cagliari | Sulcis R.,Azienda Ospedaliero Universitaria di Cagliari | Pilloni M.,Azienda Ospedaliero Universitaria di Cagliari | And 3 more authors.
Journal of Magnetic Resonance Imaging | Year: 2012

Purpose: To compare the diagnostic accuracy of MRI and "tenderness- guided" transvaginal ultrasonography (tg-TVUS) in the identification of recto-sigmoid endometriosis. Materials and Methods: Institutional Review Board approval for this study was obtained, and written informed consent was given by all patients. This study is compliant with the STARD (Standards for Reporting of Diagnostic Accuracy) method. Fifty-nine patients (mean age, 33 years; range, 21-44 years) with clinical suspicion of deep pelvic endometriosis were prospectively enrolled. They underwent tg-TVUS and MRI before surgery. The characteristics of the MRI signal were analyzed. Mapping of recto-sigmoid endometriosis was performed and tg-TVUS and MR imaging results were compared with surgical and pathological findings. Sensitivity, specificity, and the positive and negative likelihood ratio (LR+ and LR-) were calculated. Inter-technique concordance was assessed using the Cohen statistic, and receiver operating characteristic (ROC) curves were obtained. Logistic regression analysis was performed. Results: The prevalence of recto-sigmoid endometriosis was 51%. The specificity, sensitivity, and LR+ and LR- were 90%, 73%, 7.089 and 0.297, respectively, for MRI and 86%, 73%, 5.317 and 0.309, respectively, for tg-TVUS. The presence of a high T1 signal spot was an excellent specific finding (100%) but was associated with a low sensitivity (30%). Inter-technique concordance using the Cohen statistic indicated a kappa value of 0.658 (± 0.098 SD). According to the logistic regression equation obtained, the use of both tg-TVUS and MRI allows optimal diagnostic performance. Conclusion: MRI and tg-TVUS show similar results in the identification of recto-sigmoid endometriosis. The Cohen kappa value suggests that these methods may have complementary roles in the identification of recto-sigmoid endometriosis, depending on the site affected. © 2011 Wiley Periodicals, Inc.


Saba L.,Azienda Ospedaliero Universitaria di Cagliari | Sulcis R.,Azienda Ospedaliero Universitaria di Cagliari | Melis G.B.,Azienda Ospedaliero Universitaria di Cagliari | Ibba G.,Azienda Ospedaliero Universitaria di Cagliari | And 3 more authors.
European Radiology | Year: 2014

Objective: To assess the diagnostic confidence of multiple readers in the magnetic resonance imaging (MRI) diagnosis of endometriosis. Methods: Sixty-five patients (mean age 33; range 19-45 years) who had undergone MRI were retrospectively evaluated. Five regions were analysed and the presence of endometriosis was scored on a five-point scale in order to assess the diagnostic confidence. Statistical analysis included receiver operating characteristic (ROC) curve analysis, the Cohen weighted test and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, positive likelihood ratio (LR+) and negative likelihood ratio (LR-). Results: The areas under the curve (AUC) in the detection of ovarian endometrioma were 0.942, 0.893 and 0.883 for readers 1, 2 and 3, respectively; in the uterosacral ligament (USL) AUCs were 0.907, 0.804 and 0.842; in the vaginal fornix (VF) 0.819, 0.733 and 0.69; in the anterior compartment 0.916, 0.833 and 0.873; and in the rectum/sigma/pouch of Douglas (RSD) 0.936, 0.856 and 0.834. Conclusions: Diagnostic confidence of the observers is different according to the region of the nodules of endometriosis and it can be challenging in the VF and for the less experience readers also in the AC and RSD. Moreover the degree of uncertain diagnosis for the less expert readers may reach up to one third of the examinations. Key points: • Magnetic resonance imaging (MRI) is increasingly used to assess endometriosis • The diagnostic confidence of observers varies according to the location of endometriosis • The diagnosis is more difficult to establish by MRI in some anatomical locations • Specific training should be given concerning those locations that cause difficulty © 2013 European Society of Radiology.


Saba L.,Azienda Ospedaliero Universitaria di Cagliari | Potters F.,Erasmus Medical Center | Van Der Lugt A.,Erasmus Medical Center | Mallarini G.,Azienda Ospedaliero Universitaria di Cagliari
CardioVascular and Interventional Radiology | Year: 2010

In the last two decades, a substantial number of articles have been published to provide diagnostic solutions for patients with carotid atherosclerotic disease. These articles have resulted in a shift of opinion regarding the identification of stroke risk in patients with carotid atherosclerotic disease. In the recent past, the degree of carotid artery stenosis was the sole determinant for performing carotid intervention (carotid endarterectomy or carotid stenting) in these patients. We now know that the degree of stenosis is only one marker for future cerebrovascular events. If one wants to determine the risk of these events more accurately, other parameters must be taken into account; among these parameters are plaque composition, presence and state of the fibrous cap (FC), intraplaque haemorrhage, plaque ulceration, and plaque location. In particular, the FC is an important structure for the stability of the plaque, and its rupture is highly associated with a recent history of transient ischaemic attack or stroke. The subject of this review is imaging of the FC. © 2010 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).


Saba L.,Azienda Ospedaliero Universitaria di Cagliari | Raz E.,New York University | Raz E.,University of Rome La Sapienza | Anzidei M.,University of Rome La Sapienza | And 2 more authors.
American Journal of Roentgenology | Year: 2013

OBJECTIVE. The purpose of this study was to compare the type of plaque and the degree of stenosis in the carotid artery bifurcation and the carotid siphon to explore potential correlations between these parameters. MATERIALS AND METHODS. A total of 119 patients (87 men, 32 women; mean age, 69 years) were retrospectively studied using MDCT angiography. Component types of the carotid artery bifurcation and the carotid siphon plaque were defined according to attenuation values, and the volumes of each plaque component were calculated. The degree of stenosis was calculated according to the North American Symptomatic Endarterectomy Trial method. Data were compared using the Wilcoxon signed-rank test, Spearman correlation analysis, and receiver operating characteristic (ROC) analysis. RESULTS. The results of the Wilcoxon test showed a statistically significant difference (p = 0.0001) between the degree of stenosis at the carotid artery bifurcation and that at the carotid siphon. We observed a statistically significant difference (p = 0.0001) between the total volumes of the carotid artery bifurcation (mean value, 748 mm3) and the carotid siphon (mean value, 54 mm3) plaque. Moreover, the respective mean percentages of calcified, mixed, and lipid components of plaque were 17%, 56%, and 27% in the carotid artery bifurcation and 73%, 19%, and 8% in the carotid siphon, showing a statistically significant difference (p = 0.001). ROC analysis did not show association between carotid siphon plaque volume and previous cerebrovascular events (Az = 0.562; p = 0.149), whereas the total volume of the carotid artery bifurcation plaque - and, in particular, the volume of the lipid components - showed a statistically significant association (Az = 0.691, and Az = 0.758; p < 0.001). CONCLUSION. No significant association was found between presence of mixed and fatty components of plaque in the carotid artery bifurcation and presence of similar components in the carotid siphon. The carotid artery bifurcation total plaque volume (and, in particular, carotid artery bifurcation lipid volume) was associated with previous cerebrovascular events, whereas no association with the volume of carotid siphon plaque (and its subcomponents) was found. © American Roentgen Ray Society.


Guerriero S.,Azienda Ospedaliero Universitaria di Cagliari | Pilloni M.,Azienda Ospedaliero Universitaria di Cagliari | Alcazar J.L.,University of Navarra | Sedda F.,Azienda Ospedaliero Universitaria di Cagliari | And 4 more authors.
Ultrasound in Obstetrics and Gynecology | Year: 2013

Objectives To investigate differences in tissue characterization using three-dimensional sonographic mean gray value (MGV) between retrocervical and rectosigmoid deeply infiltrating endometriosis, and to assess intra- and interobserver concordance in MGV quantification. Methods In this retrospective study, stored ultrasound volumes from 50 premenopausal women (mean age, 32 years) with 57 histologically confirmed nodules of deep endometriosis were retrieved from our database for analysis. A single experienced operator had acquired all volumes. For each nodule, the MGV was evaluated using Virtual Organ Computer-aided AnaLysis (VOCAL) software with semiautomated sphere-sampling (1 cm3) from the central part of the nodule. In these patients the MGV was also quantified from the myometrium of the fundal part of the uterus. In addition, two observers calculated the MGV in a subset of 24 volumes in order to quantify inter- and intraobserver agreement using intraclass correlation coefficients (ICC). Results Mean MGV was significantly higher in rectosigmoid nodules (n = 34) than in nodules with a retrocervical location (n = 23) (23.863 vs 17.705; P < 0.001). MGV of the myometrium was significantly higher in comparison with that of nodules in both locations (P < 0.001 for both). Intra- and interobserver measurement reproducibility was excellent (ICC > 0.95). Conclusions Retrocervical and rectosigmoid endometriotic nodules display significantly different MGVs. Measurement of MGV is highly reproducible and its clinical value in the diagnosis and assessment of distribution of deep endometriosis should be assessed in future studies. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.


Sardu C.,University of Cagliari | Mereu A.,University of Cagliari | Sotgiu A.,University of Cagliari | Andrissi L.,University of Cagliari | And 2 more authors.
Clinical Practice and Epidemiology in Mental Health | Year: 2012

Background: The theory of salutogenesis entails that the ability to use resources for one's wellbeing is more important than the resources themselves. This ability is referred to as the Sense of Coherence (SOC). This paper present the cross-culturally adapted version of the Italian questionnaire (13 items), and the psychometric and statistical testing of the SOC properties. It offers for the first time a view of the distribution of SOC in an Italian sample, and uses a multivariate method to clarify the effects of socio-demographic determinants on SOC. Methods: The cross-cultural adaptation of the English SOC questionnaire was carried out according to the guidelines reported in literature. To evaluate the psychometric and statistical properties we assessed reliability, validity and frequency distribution of the collected data. A Generalised Linear Model was used to analyse the effects of socio demographic variables on SOC. Results: The Italian SOC scale demonstrates a good internal consistency (a = 0.825). The model obtained with factorial analysis is not related to the traditional dimensions of SOC represented in more than one factor. The multivariate analysis highlights the joint influence of gender, age and education on SOC. Conclusion: The validated Italian questionnaire is now available. Socio-demographic variables should be taken into account as confounders when SOC values among different populations are compared. Presenting data on SOC of the Italian population makes a control population available for comparisons with specific subgroups, such as patient populations. Now, the Italian challenge is to integrate the salutogenic approach into Public Health police. © Sardu et al.


Saba L.,Azienda Ospedaliero Universitaria di Cagliari | Mallarini G.,Azienda Ospedaliero Universitaria di Cagliari
European Journal of Radiology | Year: 2010

Purpose: NASCET and ECST systems to quantify carotid artery stenosis use percent diameter ratios from conventional angiography. With the use of Multi-Detector-Row CT scanners it is possible to easily measure plaque area and residual lumen in order to calculate carotid stenosis degree. Our purpose was to compare NASCET and ECST techniques in the measurement of carotid stenosis degree by using MDCTA. Methods and material: From February 2007 to October 2007, 83 non-consecutive patients (68 males; 15 females) were studied using Multi-Detector-Row CT. Each patient was assessed by two experienced radiologists for stenosis degree by using both NASCET and ECST methods. Statistic analysis was performed to determine the entity of correlation (method of Pearson) between NASCET and ECST. The Cohen kappa test and Bland-Altman analysis were applied to assess the level of inter- and intra-observer agreement. Results: The correlation Pearson coefficient between NASCET and ECST was 0.962 (p < 0.01). Intra-observer agreement in the NASCET evaluation, by using Cohen statistic was 0.844 and 0.825. Intra-observer agreement in the ECST evaluation was 0.871 and 0.836. Inter-observer agreement in the NASCET and ECTS were 0.822 and 0.834, respectively. Agreement analysis by using Bland-Altman plots showed a good intra-\inter-observer agreement for the NASCET and an optimal intra-\inter-observer agreement for the ECST. Conclusions: Results of our study suggest that NASCET and ECST methods show a strength correlation according to quadratic regression. Intra-observer agreement results high for both NASCET and ECST. © 2009 Elsevier Ireland Ltd. All rights reserved.


Saba L.,Azienda Ospedaliero Universitaria di Cagliari | Guerriero S.,Azienda Ospedaliero Universitaria di Cagliari | Sulcis R.,Azienda Ospedaliero Universitaria di Cagliari | Ajossa S.,Azienda Ospedaliero Universitaria di Cagliari | And 2 more authors.
Acta Radiologica | Year: 2010

Background: Magnetic resonance imaging (MRI) is a promising technique in the study of endometriosis, allowing a complete mapping of lesions before surgery. However, the value of MRI in the diagnosis of endometriosis in the bladder, in superficial peritoneal lesions, and in ovarian foci and uterosacral ligaments is still under debate. Purpose: To assess inter- and intra-observer agreement in the evaluation of endometriosis in different anatomical locations using MRI. Material and Methods: From June 2006 to February 2008, 83 female patients (mean age 39, range 1949 years) who had undergone MRI examination for suspected endometriosis were evaluated by two radiologists. MRI at 1.5 Tesla was performed with SE and TSE sequences, T1- and T2-weighted with and without fat suppression. Each examination was completed with gadolinium administration. Each dataset was independently evaluated by the radiologists for the presence or absence of endometriosis. The location (ovaries, uterosacral ligaments (USLs), pouch of Douglas, vagina, rectosigmoid, rectovaginal septum, and bladder) of suspected lesions was recorded. Cohen kappa statistical analysis was performed to calculate agreement between measurements. After 2 months the data were analyzed again by the two observers to assess intra-observer agreement. Results: Of the 83 MRI examinations performed, 12 patients demonstrated no evidence of endometriosis. In the remaining 71 studies, 157 endometriotic lesions ranging in size from 0.4 to 6.2 cm were detected. Of the 157 lesions, 53 (33.75% incidence) were smaller than 1 cm. In the ovaries, the inter-observer agreement was 92.77% and the kappa value was 0.802 (95% CI, 0.6950.91). In the bladder the inter-observer agreement was 96.39% and the kappa value was 0.553 (95% CI 0.0561). In the USLs the inter-observer agreement was 90.96% and the kappa value 0.583 (95% CI, 0.3810.784). In the rectovaginal septum the inter-observer agreement was 94.58% and the kappa value 0.739 (95% CI, 0.5720.905). In the rectovaginal pouch the inter-observer agreement was 88.55% and the kappa value 0.608 (95% CI, 0.4430.774). In the vaginal fornix the inter-observer agreement was 94.58% and the kappa value 0.726 (95% CI, 0.5520.901). In the rectosigmoid the inter-observer agreement was 89.76% and the kappa value 0.589 (95% CI, 0.3890.768). Conclusion: The results of our study indicate that MRI has a high inter- and intra-observer agreement in the identification of endometriosis located in the ovary, rectosigmoid, and rectovaginal septum, whereas the agreement is suboptimal for the identification of endometriosis located in the USLs. © 2010 Informa UK Ltd.


Saba L.,Azienda Ospedaliero Universitaria di Cagliari | Anzidei M.,University of Rome La Sapienza | Sanfilippo R.,Azienda Ospedaliero Universitaria di Cagliari | Montisci R.,Azienda Ospedaliero Universitaria di Cagliari | And 4 more authors.
Atherosclerosis | Year: 2012

In the study of carotid arteries, modern techniques of imaging allow to analyze various alterations beyond simple luminal narrowing, including the morphology of atherosclerotic plaques, the arterial wall and the surrounding structures. By using CTA and MRI it is possible to obtain three-dimensional rendering of anatomic structures with excellent detail for treatment planning. This paper will detail the role of various imaging methods for the assessment of carotid artery pathology with emphasis on the detection, analysis and characterization of carotid atherosclerosis. © 2011 Elsevier Ireland Ltd.

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