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Genova, Italy

Molini L.,Galliera Hospital | Bianchi S.,Cabinet Imagerie Medicale CIM SA
Journal of Ultrasound | Year: 2014

Peroneal tendon injuries are common also due to the recent increase in sports participants involved in amateur activities. Clinical evaluation generally provides a diagnosis, but diagnostic imaging is often required to confirm a clinical suspicion and make correct management decisions. Ultrasound (US) imaging is the method of choice in the study of peroneal tendon injuries due to the high resolution of the images and the possibility of performing dynamic studies. US is furthermore non-invasive and inexpensive and provides the possibility of performing US-guided steroid infiltration of the tendon sheath or the surrounding tissues. The present paper will address the normal anatomy of the peroneal tendons and related structures, US imaging techniques and the various conditions and injuries which may affect this anatomic region. Also more expensive imaging techniques, such as computed tomography and magnetic resonance imaging, will be mentioned as well as their indications; however, they are required only in rare cases in which diagnosis remains uncertain or for pre-operative assessment. © 2014 Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB). Source

Becattini C.,University of Perugia | Agnelli G.,University of Perugia | Schenone A.,Galliera Hospital | Eichinger S.,Medical University of Vienna | And 7 more authors.
New England Journal of Medicine | Year: 2012

BACKGROUND: About 20% of patients with unprovoked venous thromboembolism have a recurrence within 2 years after the withdrawal of oral anticoagulant therapy. Extending anticoagulation prevents recurrences but is associated with increased bleeding. The benefit of aspirin for the prevention of recurrent venous thromboembolism is unknown. METHODS:In this multicenter, investigator-initiated, double-blind study, patients with first-ever unprovoked venous thromboembolism who had completed 6 to 18 months of oral anticoagulant treatment were randomly assigned to aspirin, 100 mg daily, or placebo for 2 years, with the option of extending the study treatment. The primary efficacy outcome was recurrence of venous thromboembolism, and major bleeding was the primary safety outcome. RESULTS:Venous thromboembolism recurred in 28 of the 205 patients who received aspirin and in 43 of the 197 patients who received placebo (6.6% vs. 11.2% per year; hazard ratio, 0.58; 95% confidence interval [CI], 0.36 to 0.93) (median study period, 24.6 months). During a median treatment period of 23.9 months, 23 patients taking aspirin and 39 taking placebo had a recurrence (5.9% vs. 11.0% per year; hazard ratio, 0.55; 95% CI, 0.33 to 0.92). One patient in each treatment group had a major bleeding episode. Adverse events were similar in the two groups. CONCLUSIONS: Aspirin reduced the risk of recurrence when given to patients with unprovoked venous thromboembolism who had discontinued anticoagulant treatment, with no apparent increase in the risk of major bleeding. (Funded by the University of Perugia and others; WARFASA ClinicalTrials.gov number, NCT00222677.) Copyright © 2012 Massachusetts Medical Society. Source

Ferrero S.,University of Genoa | Camerini G.,University of Genoa | Ragni N.,University of Genoa | Venturini P.L.,Institute G Gaslini | And 2 more authors.
Human Reproduction | Year: 2010

BACKGROUND: This pilot study evaluates the efficacy of norethisterone acetate in treating pain and gastrointestinal symptoms of women with colorectal endometriosis. METHODS: This prospective study included 40 women with colorectal endometriosis, who had pain and gastrointestinal symptoms. Patients received norethisterone acetate (2.5 mg/day) for 12 months; in case of breakthrough bleeding, the dose of norethisterone acetate was increased by 2.5 mg/day. The degree of patient satisfaction with treatment (primary end-point) and the changes in symptoms (secondary end-point) were evaluated. Side effects of treatment were recorded. RESULTS: Norethisterone acetate determined a significant improvement in the intensity of chronic pelvic pain, deep dyspareunia, dyschezia. Treatment determined the disappearance of symptoms related to the menstrual cycle (dysmenorrhea, constipation during the menstrual cycle, diarrhoea during the menstrual cycle and cyclical rectal bleeding). The severity of diarrhoea, intestinal cramping and passage of mucus significantly improved during treatment. On the contrary, the administration of norethisterone acetate did not determine a significant effect on constipation, abdominal bloating and feeling of incomplete evacuation after bowel movements. At the completion of treatment, 57 of the patients with diarrhoea or diarrhoea during the menstrual cycle continued the treatment with norethisterone acetate compared with 17 of the patients with constipation or constipation during the menstrual cycle. CONCLUSION: SIn some patients with bowel endometriosis, the administration of norethisterone acetate may determine a relief of pain and gastrointestinal symptoms. This therapy has greater benefits in patients with gastrointestinal symptoms related to the menstrual cycle, diarrhoea and intestinal cramping. Source

Binda G.A.,Galliera Hospital | Arezzo A.,University of Turin | Serventi A.,San Giacomo Hospital | Bonelli L.,Italian National Cancer Institute
British Journal of Surgery | Year: 2012

Background: The natural history of acute diverticulitis (AD) is still unclear. This study investigated the recurrence rate, and the risks of emergency surgery, associated stoma and death following initial medical or surgical treatment of AD. Methods: The Italian Study Group on Complicated Diverticulosis conducted a 4-year multicentre retrospective and prospective database analysis of patients admitted to hospital for medical or surgical treatment of AD and then followed for a minimum of 9 years. The persistence of symptoms, recurrent episodes of AD, new hospital admissions, medical or surgical treatment, and their outcome were recorded during follow-up. Results: Of 1046 patients enrolled at 17 centres, 743 were eligible for the study (407 recruited retrospectively and 336 prospectively); 242 patients (32A·6 per cent) underwent emergency surgery at accrual. After a mean follow-up of 10·7 years, rates of recurrence (17·2 versus 5·8 per cent; P < 0·001) and emergency surgery (6·9 versus 1·3 per cent; P = 0·021) were higher for medically treated patients than for those treated surgically. Among patients who had initial medical treatment, age less than 40 years and a history of at least three episodes of AD were associated with an increased risk of AD recurrence. There was no association between any of the investigated parameters and subsequent emergency surgery. The risk of stoma formation was below 1 per cent and disease-related mortality was zero in this group. The disease-related mortality rate was 0·6 per cent among patients who had surgical treatment. Conclusion: Long-term risks of recurrent AD or emergency surgery were limited and colectomy did not fully protect against recurrence. © 2011 British Journal of Surgery Society Ltd. Source

Merega E.,University of Genoa | Prisco S.D.,University of Genoa | Lanfranco M.,Italian Institute of Technology | Severi P.,Galliera Hospital | Pittaluga A.,University of Genoa
Journal of Neurochemistry | Year: 2014

Our study was aimed at investigating whether complement, a complex of soluble and membrane-associated serum proteins, could, in addition to its well-documented post-synaptic activity, also pre-synaptically affect the release of classic neurotransmitters in central nervous system (CNS). Complement (dilution 1: 10 to 1: 10000) elicited the release of preloaded [ 3H]-d-aspartate ([3H]d-ASP) and endogenous glutamate from mouse cortical synaptosomes in a dilution-dependent manner. It also evoked [3H]d-ASP release from mouse hippocampal, cerebellar, and spinal cord synaptosomes, as well as from rat and human cortical nerve endings, but left unaltered the release of GABA, [3H]noradrenaline or [ 3H]acetylcholine. Lowering external Na+ (from 140 to 40 mM) or Ca2+ (from 1.2 to 0.1 mM) ions prevented the 1: 300 complement-evoked [3H]d-ASP release from mouse cortical synaptosomes. Complement-induced releasing effect was unaltered in synaptosomes entrapped with the Ca2+ ions chelator 1,2-bis-(2-aminophenoxy) ethane-N,N,N',N', tetra-acetic acid or with pertussis toxin. Nifedipine,/ω-conotoxin GVIA/ω-conotoxin MVIIC mixture as well as the vesicular ATPase blocker bafilomycin A1 were also inefficacious. The excitatory amino acid transporter blocker DL-threo-ß-benzyloxyaspartic acid, on the contrary, reduced the complement-evoked releasing effect in a concentration-dependent manner. We concluded that complement-induced releasing activity is restricted to glutamatergic nerve endings, where it was accounted for by carrier-mediated release. Our observations afford new insights into the molecular events accounting for immune and CNS crosstalk. © 2014 International Society for Neurochemistry. Source

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