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PubMed | Istanbul Medeniyet University, Delta Hospital and Op. Dr. Ergun Ozdemir Gorele Devlet Hastanesi
Type: Journal Article | Journal: Northern clinics of Istanbul | Year: 2017

Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system. MS involves different regions of the central nervous system in different periods, and causes demyelination. MS is a neuromotor disorder which progresses with remissions and relapses. Symptoms of MS may regress completely or heal after the relapses leaving sequelae. Sudden sensorinerural hearing loss (SSHL) is hearing loss of 30 dB or more over at least three contiguous audiometric frequencies that develops over a period of a few hours to 3 days. In 4-10 % of the MS patients, sensorineural hearing loss occurs between relapses or remissions. In this case, audiotory brainstem response (ABR) test is the most appropriate test for the diagnosis of sensorineural hearing loss in MS patients. In this article, we will discuss a patient diagnosed as MS who presented with sudden sensorineural hearing loss during the remission of the disease.


Fiorentini G.,Oncology Unit | Aliberti C.,Instituto Oncologico Veneto IRCCS | Tilli M.,Delta Hospital | Mulazzani L.,Azienda Ospedaliera Ospedali Riuniti Marche Nord | And 7 more authors.
Anticancer Research | Year: 2012

Background: Metastases to the liver receive most of their blood supply from the arterial route, therefore for patients with hepatic metastases from large bowel cancer, hepatic arterial infusion adopting drug-eluting beads preloaded with irinotecan (DEBIRI) may offer a chance of cure. Patients and Methods: In a multi-institutional study, 74 patients were randomly assigned to receive DEBIRI (36) versus systemic irinotecan, fluorouracil and leucovorin (FOLFIRI, 38). The primary end-point was survival; secondary end points were response, recurrence, toxicity, quality of life, cost and influence of molecular markers. Results: At 50 months, overall survival was significantly longer for patients treated with DEBIRI than for those treated with FOLFIRI (p=0.031, log-rank). Median survival was 22 (95% Confidence Interval CI=21-23) months, for DEBIRI and 15 (95% CI=12-18) months for FOLFIRI. Progression-free survival was 7 (95% CI=3-11) months in the DEBIRI group compared to 4 (95% CI=3-5) months in the FOLFIRI group and the difference between groups was statistically significant (p=0.006, log-rank). Extrahepatic progression had occurred in all patients by the end of the study, at a median time of 13 (95% CI=10-16) months in the DEBIRI group compared to 9 (95% CI 5-13) months in the FOLFIRI group. A statistically significant difference between groups was not observed (p=0.064, log-rank). The median time for duration of improvement to quality of life was 8 (95% CI=3-13) months in the DEBIRI group and 3 (95% CI=2-4) months in the FOLFIRI group. The difference in duration of improvement was statistically significant (p=0.00002, log-rank). Conclusion: This study showed a statistically significant difference between DEBIRI and FOLFIRI for overall survival (7 months), progression-free survival (3 months) and quality of life (5 months). In addition, a clinically significant improvement in time to extrahepatic progression (4 months) was observed for DEBIRI, a reversal of the expectation for a regional treatment. This suggests a benefit of DEBIRI treatment over standard chemotherapy and serves to establish the expected difference between these two treatment options for planning future large randomized studies.


Campanile F.C.,AUSL Viterbo andosilla Hospital | Boru C.E.,Clinical Hospital N Malaxa | Rizzello M.,University of Rome La Sapienza | Puzziello A.,University of Catanzaro | And 3 more authors.
Langenbeck's Archives of Surgery | Year: 2013

Background: Development and widespread use of laparoscopic bariatric surgery exposes emergency room physicians and general surgeons to face acute or chronic surgical complications of bariatric surgery. Methods: The most common surgical emergencies after bariatric surgery are examined based on an extensive review of bariatric surgery literature and on the personal experience of the authors' practice in four high-volume bariatric surgery centers. Results: An orderly stepwise approach to the bariatric patient with an emergency condition is advisable. Resuscitation should follow the same protocol adopted for the non-bariatric patients. Consultation with the bariatric surgeon should be obtained early, and referral to the bariatric center should be considered whenever possible. The identification of the surgical procedure to which the patient was submitted will orient in the diagnosis of the acute condition. Procedure-specific complication should always be taken into consideration in the differential diagnosis. Acute slippage is the most frequent complication that needs emergency treatment in a laparoscopic gastric banding. Sleeve gastrectomy and gastric bypasses may present with life-threatening suture leaks or suture line bleeding. Gastric greater curvature plication (investigational restrictive procedure) can present early complications related to prolonged postoperative vomiting. Both gastric bypass and bilio-pancreatic diversion may cause anastomotic marginal ulcer, bleeding, or rarely perforation and severe stenosis, while small bowel obstruction due to internal hernia represents a surgical emergency, also caused by trocar site hernia, intussusceptions, adhesions, strictures, kinking, or blood clots. Rapid weight loss after bariatric surgery can cause cholecystitis or choledocholithiasis, which are difficult to treat after bypass procedures. Conclusions: The general surgeon should be informed about modern bariatric procedures, their potential acute complications, and emergency management. © 2013 Springer-Verlag Berlin Heidelberg.


Alboni P.,Ospedale Civile | Botto G.L.,S Anna Hospital | Boriani G.,University of Bologna | Russo G.,S Anna Hospital | And 6 more authors.
Heart | Year: 2010

Background: Pill-in-the-pocket treatment should be prescribed only if the administration of a loading oral dose of flecainide or propafenone has been proved safe in hospital, since major adverse effects have been reported in 5% of patients during in-hospital treatment. However, in emergency rooms, the oral administration of these drugs for the conversion of atrial fibrillation (AF) is very rarely used because it is time consuming. Objective: To investigate whether tolerance to intravenous administration of flecainide or propafenone might predict the safety of pill-in-the-pocket treatmentdthe out-of-hospital self-administration of these drugs after the onset of palpitationsdin patients with AF of recent onset. Methods: One hundred and twenty-two patients with AF of recent onset who were successfully treated (conversion of AF within 2 h without major adverse effects) in hospital with intravenous flecainide or propafenone were discharged on pill-in-the-pocket treatment. Results: During a mean follow-up of 11±4 months, 79 patients self-treated 213 arrhythmic episodes; treatment was successful in 201 episodes (94%). Major adverse events occurred in five patients (6%) and in four (5%) of these during the first oral treatment (one syncope, two presyncope, one sinus arrest). No patient reported symptoms attributable to bradyarrhythmia or hypotension during the self-treatment of arrhythmic recurrences when the first oral treatment was not accompanied by any major adverse effects. The study was prematurely terminated because of the high incidence of major adverse effects during the first out-of-hospital treatment. Conclusion: The patient's tolerance of intravenous administration of flecainide or propafenone does not seem to predict adverse effects during out-of-hospital self-administration of these drugs.


Valgimigli M.,University of Ferrara | Valgimigli M.,Cardiovascular Research Center | Campo G.,University of Ferrara | Monti M.,Academic Research Unit | And 18 more authors.
Circulation | Year: 2012

Background-The optimal duration of dual-antiplatelet therapy and the risk-benefit ratio for long-term dual-antiplatelet therapy after coronary stenting remain poorly defined. We evaluated the impact of up to 6 versus 24 months of dual-antiplatelet therapy in a broad all-comers patient population receiving a balanced proportion of Food and Drug Administration-approved drug-eluting or bare-metal stents. Methods and Results-We randomly assigned 2013 patients to receive bare-metal, zotarolimus-eluting, paclitaxel-eluting, or everolimus-eluting stent implantation. At 30 days, patients in each stent group were randomly allocated to receive up to 6 or 24 months of clopidogrel therapy in addition to aspirin. The primary end point was a composite of death of any cause, myocardial infarction, or cerebrovascular accident. The cumulative risk of the primary outcome at 2 years was 10.1% with 24-month dual-antiplatelet therapy compared with 10.0% with 6-month dual-antiplatelet therapy (hazard ratio, 0.98; 95% confidence interval, 0.74-1.29; P=0.91). The individual risks of death, myocardial infarction, cerebrovascular accident, or stent thrombosis did not differ between the study groups; however, there was a consistently greater risk of hemorrhage in the 24-month clopidogrel group according to all prespecified bleeding definitions, including the recently proposed Bleeding Academic Research Consortium classification. Conclusions-A regimen of 24 months of clopidogrel therapy in patients who had received a balanced mixture of drug-eluting or bare-metal stents was not significantly more effective than a 6-month clopidogrel regimen in reducing the composite of death due to any cause, myocardial infarction, or cerebrovascular accident. © 2012 American Heart Association, Inc.


Montagnani F.,S Giuseppe Hospital | Turrisi G.,S Giuseppe Hospital | Marinozzi C.,AUSL | Aliberti C.,Delta Hospital | Fiorentini G.,S Giuseppe Hospital
Gastric Cancer | Year: 2011

Background: Cisplatin has been largely used in the treatment of advanced, unresectable gastric cancer, mainly in combinations with fluoropyrimidines and anthracyclines. Oxaliplatin has been shown to be at least as effective as cisplatin for this disease, but with less toxicity and a better tolerability profile, especially for older patients. We performed a systematic review of the literature to address and quantify differences in the efficacy and the safety between oxaliplatin and cisplatin for the treatment of this disease. Methods: The literature was searched for randomized controlled trials (RCTs) comparing oxaliplatin to cisplatin. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to analyze dichotomous variables. Hazard ratios (HRs) for progression and death were combined with an inverse variance method based on logarithmic conversion. A fixed effect model and Mantel-Haenszel's (M-H) method were used. Heterogeneity was tested with the Q test and the I 2 value. Sensitivity analyses were performed. Results: Three RCTs were identified, involving a total of 1294 patients. Oxaliplatin significantly improved progression-free survival (HR = 0.88, p = 0.02) and overall survival (HR = 0.88, p = 0.04). Moreover, it was associated with less neutropenia (OR = 0.53, p < 0.01) and fewer thromboembolic events (OR = 0.42, p < 0.01), but it was also associated with increased neurotoxicity (OR = 6.91, p < 0.01). Conclusions: Our results support the existence of a small but significant survival benefit of oxaliplatin over cisplatin. Oxaliplatin is associated with less toxicity and better tolerability, especially in older patients and when used in two-drug, bi-weekly regimens. © 2011 The International Gastric Cancer Association and The Japanese Gastric Cancer Association.


PubMed | Delta Hospital
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

20010 Background: Exclusive LM occur in up to 40% of patients with UM associated with a median survival of 2-5 months; surgery and chemotherapy have poor results. Experimental efficacy of IRI on B16 melanoma cells was reported and studies with oral IRI showed interesting activity in melanoma patients. TACE seems effective in palliation of LM from different tumours.Between February 2006 and November 2007, nine patients with LM from UM (F/M = 4/5, median age 44 yrs, liver replacement (LR) 25% = 2 cases, 50% = 2 cases, 75% = 5), treated with surgery (3 cases) and chemo-immunotherapy (9) were enrolled into a pilot trial of TACE with DEBI. One patient had early death and two had early progression during staging and were not treated. TACE with DEBI (adopting beads with diameter of 300-500 in the first triplet of patients and 100-300 in the second triplet) preloaded with 200 mg of IRI was delivered every 4 weeks for 2 folds. Computed Tomography was performed 24h before and after treatment, then every month till progression. Before treatment intra-arterial lidocaine and from day 0 to 4 analgesic medications, antibiotics and intravenously hydration were administered Results: Six patients received 12 cycles (2 each patient). Right upper quadrant pain (RUQP) grade 2 short lasting, fever grade 2 lasting 3 days (range 2-7) and increases of liver enzymes grade 2-3 were reported by all patients. After 30 days, a reduction of 75% of the lesional contrast enhancement was observed in the first triplet of patients. A complete disappearance of enhancement was observed in the second triplet. Three patients with LR = 75% died at 64 days, 120, 155. Two patients with LR = 25% are alive at 188 and 431 days respectively. One with LR = 50% is alive at 147 days Conclusions: TACE with DEBI is feasible and safe in patients with LM from UM. Fever, RUQP, increases of liver enzymes are the side effects. Responses seem related to beads diameter. Survival is related to liver substitution. No significant financial relationships to disclose.


PubMed | Istanbul Medeniyet University, Gazi University and Delta Hospital
Type: Journal Article | Journal: Clinical and experimental otorhinolaryngology | Year: 2016

Gentamicin is a potent aminoglycoside antibiotic. Ototoxicity and nephrotoxicity are the main side effects which restrict the use of gentamicin. Garlic with its intrinsic antioxidant activity may prove beneficial in prevention from ototoxicity. S-allylmercaptocysteine (SAMC), diallyl disulfide (DD), and S-allylcysteine (SAC) are three active compounds found in garlic. In this study, we investigated the effect of SAMC, DD, and SAC on the ototoxicity induced by gentamicin in rats, by using brainstem evoked response audiometry (BERA).Thirty male Wistar rats with intact Preyers reflex initially weighing 220-260 g were randomly assigned to either the gentamicin injection with SAMC treatment group (Genta-w SAMC), DD treatment group (Genta-w DD), SAC treatment group (Genta-w SAC), gentamicin injection without any active compounds (AC) treatment groups (Genta-w/o AC), or control group (n=6 rats each group). Gentamicin was given 120-mg/kg body weight, intraperitoneally once daily for 25 days to subjects in all groups except the control group. SAMC 100-mg/kg, and DD 50-mg/kg body weight were given intragastrically, and SAC 250-mg/kg body weight was given intraperitoneally once daily to subjects in Genta-w SAMC, and Genta-w DD, and Genta-w SAC groups, respectively during the study. After 25 days hearing thresholds were evaluated by using BERA test.The mean amplitude of auditory thresholds (sensation level [SL]) measured by using BERA for the Genta-w SAMC, Genta-w DD, Genta-w SAC, Genta-w/o AC, and control groups were 228, 255, 309, 5411, and 107 dB SL, respectively (meanSD). The differences between every active compound group (Genta-w SAMC, Genta-w DD, and Genta-w SAC) and Genta-w/o AC were statistically significant (SAMC, DD, and SAC are derivative of garlic seems to attenuate aminoglycoside-induced hearing loss. The effect of SAMC and DD seems to be more prominent than that of SAC.


PubMed | San Giuseppe Hospital and Delta Hospital
Type: Journal Article | Journal: Journal of chemotherapy (Florence, Italy) | Year: 2016

The aim of this study was to investigate the role of magnetic resonance imaging (MRI) in the evaluation of response to radiofrequency ablation (RFA) and detect residual or recurrent tumor. After RFA, the target lesion shows a hyperintensive signal without increased T1-weighted, low on T2-weighted, non enhancing in gadolinium-enhanced MRI. In the long term follow-up the successfully treated lesions decrease in size. Signs of recurrence include new enhancement areas, the lesions size increase, and development of T1-weighted hypointense and T2 weighted hyperintense areas. The MRI is a reliable method to evaluate the effectiveness of RFA and detect residual tumor.


PubMed | Delta Hospital
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

4216 Background: GIST metastases are typically intra-abdominal and hypervascular. BR1 (Sonovue, Bracco, Milan, Italy) is a new blood pool second-generation contrast agent, which consists of stabilized microbubbles of a totally innocuous sulphur hexafluoride gas. We report preliminary results with angio-echography with BR1 (AE) to assess tumor response (TR) to imatinib treatment (IT) in patients (pts) with advanced GIST.Twelve consecutive pts with known advanced cKIT+ GIST were investigated prospectively. CT and AE were performed before IT and then at 1, 2, 4, 6, and then every 3 months during IT. A strict prospective evaluation with AE was performed in 2 pts at 1, 2, 4, 6, 8 weeks during IT.At a median follow-up of 12 months (range 4-18), in the 11 evaluable pts CT documented TR in 5 (46%) pts and stable disease (SD) in 4 (36%) RECIST criteria), while AE showed early TR in all these 9 (82%) cases. The median time to TR by RECIST criteria at CT was 4 months (range 1-9), while TR was observed at the first AE, and after 2 weeks in the 2 cases receiving strict AE evaluation. During IT, in 1 case CT showed increase of liver metastases, but AE demonstrated TR with intra-tumoral edema. Compared with CT, AE better depicted liver subcentimetric metastases. No differences between CT and AE were seen in the evaluation of extra-hepatic metastases.In large studies, CT (RECIST criteria) showed TR (54%) or SD (34%) associated with IT, which correlated closely with a finding of 50% decrease in FDG uptake on PET scan in 89% of pts. In our study, AE improved the display of tumor vascularity as well as the accuracy in differentiating between SD and TR. The effective TR to IT in GISTs might be superior to that showed by CT only, according to RECIST criteria. The close relation between clinical outcome and the findings on AE indicates that such scanning might be an useful complement to standard anatomical imaging for monitoring the therapeutic effect of imatinib in pts with GIST. Large prospective studies are warranted. No significant financial relationships to disclose.

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