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Morbini P.,University of Pavia | Inghilleri S.,IRCCS Foundation Policlinico S. Matteo
International Journal of Surgical Pathology | Year: 2011

One of the main differential diagnostic issues in pulmonary large-cell carcinomas is that involving neuroendocrine (NE) and basaloid histotypes. The differential diagnosis of basaloid versus large-cell NE carcinoma requires immunohistochemical determination of NE markers because of morphological overlap between the 2 entities. The authors report a unique case of lung carcinoma with basaloid architecture and NE immunohistochemical features observed in a 64-year-old male smoker who underwent upper left lobectomy for a neoplastic stenosis of the lobar bronchus. The patient died 14 months after surgery. Histological examination showed multiple peripheral nodules of moderately enlarged neoplastic cells with irregular nuclei, with granular chromatin and frequent nucleoli, and diffuse in situ neoplasia involving bronchi, peribronchial glands, and small airways. Immunohistochemistry documented diffuse expression of CD56 in neoplastic cells and isolated cell groups immunoreactive for basal cell markers. The reported case was considered an as-yet-undescribed tumor showing both basaloid and NE differentiation. © The Author(s) 2011. Source


Bugada D.,University of Parma | Bugada D.,SIMPAR Group Study in Multidisciplinary Pain Research | De Gregori M.,SIMPAR Group Study in Multidisciplinary Pain Research | Compagnone C.,SIMPAR Group Study in Multidisciplinary Pain Research | And 22 more authors.
Trials | Year: 2015

Background: Inflammatory response is one of the key components of pain perception. Continuous infusion (CWI) of local anesthetics has been shown to be effective in controlling pain and reducing postoperative morphine consumption, but the effect of adding a potent anti-inflammatory drug (such as a steroid) has never been addressed. In our study, we want to investigate the effect of CWI with local anesthetic + methylprednisolone on acute and persistent pain, correlating clinical data with biomarkers of inflammation and genetic background. Methods/Design: After approval by their institutional review board, three hospitals will enroll 120 patients undergoing major abdominal surgery in a randomized, double-blind, phase III study. After a 24-h CWI of ropivacaine 0.2 % + methylprednisolone 1 mg/kg, patients will be randomly assigned to receive either ropivacaine + steroid or placebo for the next 24 h. Then, patient-controlled CWI with only ropivacaine 0.2 % or placebo (according to the group of randomization) is planned after 48 h up to 7 days (bolus 10 ml, lock-out 1 h, maximum dose of 40 ml in 4 h). Morphine equivalent consumption up to 7 days will be analyzed, together with any catheter- or drug-related side effect. Persistent post-surgical pain (PPSP) incidence will also be investigated. Our primary endpoint is analgesic consumption in the first 7 days after surgery; we will evaluate, as secondary endpoints, any catheter- or drug-related side effect, genotype/phenotype correlations between some polymorphisms and postoperative outcome in terms of morphine consumption, development of the inflammatory response, and incidence of PPSP. Finally, we will collect, in a subgroup of patients, wound exudate samples by micro-dialysis, blood samples, and urine samples up to 72 h to investigate local and systemic inflammation and oxidative stress. Discussion: This is a phase III trial to evaluate the safety and efficacy of wound infusion with steroid and local anesthetic. The study is aimed also to evaluate how long this infusion has to be maintained in order to maximize effectiveness. Our data are intended to quantify the amount of ropivacaine and methylprednisolone needed by patients undergoing major abdominal surgery, to be stored in a new nanotechnology device for sustained pain treatment after surgery. We also aim to clarify the roles of inflammatory response, oxidative stress, and genetic background on postoperative and persistent pain after major abdominal surgery. Trial registration: The trial was registered on ClinicalTrials.gov (NCT02002663) on 24 Oct. 2013. © 2015 Bugada et al. Source

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