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Ravaglia C.,GB Morgagni Hospital | Tomassetti S.,GB Morgagni Hospital | Gurioli G.,GB Morgagni Hospital | Piciucchi S.,GB Morgagni Hospital | And 7 more authors.
Sarcoidosis Vasculitis and Diffuse Lung Diseases | Year: 2014

Background: Idiopathic pulmonary fibrosis (IPF) has a sporadic occurrence in most instances, but can also occasionally occur in familial form. While clinical features of sporadic IPF are well defined, clinical presentation, complications, and outcome of familial IPF are still undefined. This retrospective study was undertaken to establish clinical parameters and survival time in a consecutive series of patients with familial IPF and to establish whether the phenomenon of anticipation could be observed. Methods: 30 patients had received a diagnosis of familial IPF at our institution over the period from January 2005 and December 2011; in 7 of them there was a parent-child relation. Clinical features and patient outcome were analyzed and contrasted to a well characterized cohort of 127 patients with non familial IPF. Results: there was no significant difference in presenting symptoms and the overall outcomes were quite similar in the two groups, but the familial group was much more enriched for females and we found a statistically significant lower age at onset in the younger generations (mean age 57,8 years versus 74,2 years, p 0,001). Conclusion: familial IPF seems indistinguishable from sporadic IPF with respect to most clinical and physiologic findings; however the age of onset was slightly lower among the familial cases than in the sporadic cases of IPF and the phenomenon of anticipation could be observed. © Mattioli 1885.


Fabbri C.,IRCCS Instituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRST | Galassi R.,Pierantoni Morgagni Hospital | Moretti A.,Pierantoni Morgagni Hospital | Sintuzzi E.,Nuclear Medicine Unit | And 5 more authors.
Physica Medica | Year: 2014

Purpose: We aimed to evaluate the Equivalent Doses (HTs) to highly exposed organs as well as the Effective Dose (ED) for 18F-fluorocholine PET/CT scan in the follow-up of prostate cancer patients. Methods: Fifty patients were administered with 18F-fluorocholine. The activities in organs with the highest uptake were derived by region-of-interest (ROI) analysis. OLINDA/EXM1.0 and Impact software were used to assess ED for the administered 18F-fluorocholine and CT scan, respectively, and the 18F-fluorocholine and CT-scan EDs summed to yield the total ED for the PET/CT procedure. Results: The calculated 18F-fluorocholine and CT scans EDs based on ICRP Publication 103 were 5.2mSv/300MBq and 6.7mSv, respectively. The 18F-fluorocholine HTs to the liver, kidneys, spleen and pancreas were about threefold higher than those from the CT, which contributed a greater proportion of the total ED than the 18F-fluorocholine did. Conclusions: For 18F-fluorocholine PET/CT procedures, about 40% of the ED is contributed by administered 18F-fluorocholine and 60% by the CT scan. The kidneys and liver were the highly exposed organs. Considering the large number of diagnostic procedures oncology patients undergo, radiation dosimetry is important in relation to the stochastic risk of such procedures. © 2013 Associazione Italiana di Fisica Medica.


PubMed | Nuclear Medicine Unit, IRCCS Instituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRST, Regina Elena Cancer Institute, Bufalini Hospital and Pierantoni Morgagni Hospital
Type: Journal Article | Journal: Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB) | Year: 2014

We aimed to evaluate the Equivalent Doses (HTs) to highly exposed organs as well as the Effective Dose (ED) for (18)F-fluorocholine PET/CT scan in the follow-up of prostate cancer patients.Fifty patients were administered with (18)F-fluorocholine. The activities in organs with the highest uptake were derived by region-of-interest (ROI) analysis. OLINDA/EXM1.0 and Impact software were used to assess ED for the administered (18)F-fluorocholine and CT scan, respectively, and the (18)F-fluorocholine and CT-scan EDs summed to yield the total ED for the PET/CT procedure.The calculated (18)F-fluorocholine and CT scans EDs based on ICRP Publication 103 were 5.2 mSv/300 MBq and 6.7 mSv, respectively. The (18)F-fluorocholine HTs to the liver, kidneys, spleen and pancreas were about threefold higher than those from the CT, which contributed a greater proportion of the total ED than the (18)F-fluorocholine did.For (18)F-fluorocholine PET/CT procedures, about 40% of the ED is contributed by administered (18)F-fluorocholine and 60% by the CT scan. The kidneys and liver were the highly exposed organs. Considering the large number of diagnostic procedures oncology patients undergo, radiation dosimetry is important in relation to the stochastic risk of such procedures.


Gurioli C.,Pierantoni Morgagni Hospital | Ravaglia C.,Pierantoni Morgagni Hospital | Romagnoli M.,Pierantoni Morgagni Hospital | Casoni G.,Pierantoni Morgagni Hospital | And 3 more authors.
Clinical Respiratory Journal | Year: 2012

Introduction: Transbronchial needle aspiration (TBNA) is an established method to diagnose hilar/mediastinal lymphadenopathies and/or masses. Real-time endobronchial ultrasound (EBUS) is a method that involves TBNA, and has been shown to increase the diagnostic yield in this context. Objectives: A descriptive study has been conducted to test real-time EBUS in the diagnosis of hilar-mediastinal lymphadenopathies/masses with a shorter diameter less then 2.5cm or with a previous negative 'blind' TBNA. Methods: Consecutive patients referred for EBUS-TBNA of hilar/mediastinal lymph nodes were included in the study, when a node or mass was detected on a chest computed tomography scan. The primary end point was the number of successful biopsy specimens. Lymph node stations were classified according to the American Thoracic Society scheme. Results: Ninety-four patients (66 males, 28 females) of mean age 62years (range: 17-86) underwent EBUS-TBNA: EBUS-TBNA could be performed in all patients. The procedure was diagnostic in 80 patients (89.4%); positive samples were 73 (52 lung cancer, 18 sarcoidosis and 3 tuberculosis), negative samples were 17, inadequate specimens were obtained in four patients (4.25%) and surgically proven false negative results were found in six cases (6.38%). Biopsy specimens were taken from lymph nodes in region 2L (1 case), 2R (5 cases), 4R (20 cases), 4L (7 cases), 7 (47 cases), 10R (9 cases), 10L (2 cases), 11R (6 cases) and 11L (3 cases). Sensitivity was 92.4%, and specificity was 100%. No complications occurred. Conclusions: EBUS-TBNA is a safe and reliable method for sampling mediastinal lymph nodes. © 2011 Blackwell Publishing Ltd.


Nazerian P.,University of Florence | Vanni S.,University of Florence | Volpicelli G.,University of Turin | Gigli C.,University of Florence | And 7 more authors.
Chest | Year: 2014

Background: Presenting signs and symptoms of pulmonary embolism (PE) are nonspecifi c, favoring a large use of second-line diagnostic tests such as multidetector CT pulmonary angiography (MCTPA), thus exposing patients to high-dose radiation and to potential serious complications. We investigated the diagnostic performance of multiorgan ultrasonography (lung, heart, and leg vein ultrasonography) and whether multiorgan ultrasonography combined to Wells score and D-dimer could safely reduce MCTPA tests. Methods: Consecutive adult patients suspected of PE and with a Wells score > 4 or a positive D-dimer result were prospectively enrolled in three EDs. Final diagnosis was obtained with MCTPA. Multiorgan ultrasonography was performed before MCTPA and considered diagnostic for PE if one or more subpleural infarcts, right ventricular dilatation, or DVT was detected. If multiorgan ultrasonography was negative for PE, an alternative ultrasonography diagnosis was sought. Accuracies of each single-organ and multiorgan ultrasonography were calculated. Results: PE was diagnosed in 110 of 357 enrolled patients (30.8%). Multiorgan ultrasonography yielded a sensitivity of 90% and a specifi city of 86.2%, lung ultrasonography 60.9% and 95.9%, heart ultrasonography 32.7% and 90.9%, and vein ultrasonography 52.7% and 97.6%, respectively. Among the 132 patients (37%) with multiorgan ultrasonography negative for PE plus an alternative ultrasonographic diagnosis or plus a negative D-dimer result, no patients received PE as a fi nal diagnosis. Conclusions: Multiorgan ultrasonography is more sensitive than single-organ ultrasonography, increases the accuracy of clinical pretest probability estimation in patients with suspected PE, and may safely reduce the MCTPA burden. © 2014 American College of Chest Physicians.


Contoli M.,Research Center on Asthma | Baraldo S.,University of Padua | Marku B.,Research Center on Asthma | Casolari P.,Research Center on Asthma | And 8 more authors.
Journal of Allergy and Clinical Immunology | Year: 2010

Background: Both smokers and patients with asthma can experience fixed airflow obstruction, which is associated with distinctive patterns of airway pathology. The influence of fixed airflow obstruction on the prognosis of these patients is unknown. Objective: We sought to investigate lung function decline and exacerbations in a 5-year prospective study of subjects with fixed airflow obstruction due to asthma or chronic obstructive pulmonary disease (COPD). We also sought to explore correlations between functional, pathological, and clinical features. Methods: Patients with fixed airflow obstruction due to asthma (n = 16) or COPD (n = 21) and a control group of asthmatic patients with fully reversible airflow obstruction (n = 15) were followed for 5 years. Results: The rates of decline in FEV1 were similar in patients with fixed airflow obstruction caused by asthma (-49.7 ± 10.6 mL/y) or COPD (-51.4 ± 9.8 mL/y) and were higher than in asthmatic patients with reversible airflow obstruction (-18.1 ± 10.1 mL/y, P < .01). Exacerbation rates were also higher in patients with fixed airflow obstruction caused by asthma (1.41 ± 0.26 per patient-year) or COPD (1.98 ± 0.3 per patient-year) compared with those seen in asthmatic patients with reversible airflow obstruction (0.53 ± 0.11 per patient-year, P < .01). Baseline exhaled nitric oxide levels and sputum eosinophil counts correlated with the FEV1 decline in asthmatic patients with fixed airflow obstruction. By contrast, baseline sputum neutrophil counts, emphysema scores, comorbidities, and exacerbation frequency correlated directly and pulmonary diffusion capacity correlated inversely with the FEV1 decline in patients with COPD. Conclusion: In both patients with asthma and those with COPD, fixed airflow obstruction is associated with increased lung function decline and frequency of exacerbations. Nevertheless, the decline in lung function entails the specific pathological and clinical features of the underlying diseases. © 2010 American Academy of Allergy, Asthma & Immunology.


Ravaglia C.,Pierantoni Morgagni Hospital | Gurioli C.,Pierantoni Morgagni Hospital | Tomassetti S.,Pierantoni Morgagni Hospital | Casoni G.L.,Pierantoni Morgagni Hospital | And 3 more authors.
Respiration | Year: 2012

Background: Pleural empyema can be subdivided into 3 stages: exudative, multiloculated, and organizing. In the absence of clear septation, antibiotics plus simple drainage of pleural fluid is often sufficient treatment, whereas clear septation often requires more invasive treatment. Objectives: The aim of this study was to report our experience and analyze the safety and efficacy of medical thoracoscopy in patients with multiloculated and organizing empyema. Methods: We performed a retrospective study reviewing the files of patients referred for empyema and treated by medical thoracoscopy at our department from July 2005 to February 2011. Results: A total of 41 patients with empyema were treated by medical thoracoscopy; empyema was free flowing in 9 patients (22%), multiloculated in 24 patients (58.5%), and organized in 8 patients (19.5%). Medical thoracoscopy was considered successful without further intervention in 35 of 41 patients (85.4%): all of the 9 patients with free-flowing fluid, 22 of the 24 patients with multiloculated empyema (91.7%), and only 4 of the 8 patients with organizing effusion (50%). Conclusions: Our study confirms that multiloculated pleural empyema could safely and successfully be treated with medical thoracoscopy while organizing empyema can be resistant to drainage with medical thoracoscopy, requiring video-assisted thoracic surgery or open surgical decortications; among this population, the presence of separate 'pockets' not in apparent communication with each other often leads to a surgical approach. Copyright © 2012 S. Karger AG, Basel.


Ulivi P.,Instituto Scientifico Romagnolo Per Lo Studio E La Cura Dei Tumori Irst | Romagnoli M.,Pierantoni Morgagni Hospital | Chiadini E.,Instituto Scientifico Romagnolo Per Lo Studio E La Cura Dei Tumori Irst | Casoni G.-L.,Pierantoni Morgagni Hospital | And 8 more authors.
International Journal of Oncology | Year: 2012

In non-small cell lung cancer (NSCLC) patients, somatic EGFR and K-ras mutations predict therapeutic effectiveness and resistance, respectively, to EGFR tyrosine kinase inhibitors (TKIs). Transesophageal ultrasound-guided fine needle aspiration (EUS-FNA) is a validated technique for diagnosis and staging of NSCLC. In the present study, we compared the feasibility and reliability of EGFR and K-ras gene mutation analysis in fixed and fresh mediastinal lymph nodes and extra-lymph nodal samples obtained by EUS-FNA in patients suspicious for NSCLC. Thirty-six patients were enrolled into the study. For each patient, DNA was extracted from both fresh samples and fixed cytological smears. Exons 18-21 of EGFR and exon 2 of K-ras were amplified by PCR and mutation status was determined by direct sequencing and pyrosequencing. All cases were eligible for analysis. NSCLC was diagnosed in 32 patients (25 adenocarcinomas and 7 squamous cell carcinomas) and 4 patients were free of malignancy. Of the 25 patients with adenocarcinoma, EGFR mutations were detected in 2 (8%) fresh tumor samples and in 3 (12%) fixed cytological smears. K-ras mutations were detected in 8 (32%) fresh samples, and in 9 (36%) fixed cytological smears. Fixed and stained cytological samples seem to be more reliable than fresh material for molecular analysis.


Talli P.M.,Pierantoni Morgagni Hospital | Fantaguzzi P.M.,Pierantoni Morgagni Hospital | Bendo E.,Pierantoni Morgagni Hospital | Pazzaglia A.,University of Bologna
European Journal of Ophthalmology | Year: 2016

Purpose: To evaluate the clinical outcome of surgical treatment for macular serous detachment associated with optic disc pit with pars plana vitrectomy (PPV) without laser photocoagulation on the temporal edge. Methods: Vitrectomy was performed in 8 eyes of 8 patients (mean age 27.25 years; range 12-57 years) with unilateral macular detachment associated with optic disc pit. All patients underwent pars plana vitrectomy (cases 1, 2, 3, and 4, PPV 20 G; cases 5, 6, 7, and 8, PPV 25 G), internal limiting membrane (ILM) peeling, and SF6 20% gas tamponade (case 1 was treated with silicone oil tamponade). Endolaser on the temporal margin of the optic disk was not performed. Every patient was observed for a follow-up period of 59.25 months after surgery. Statistical analysis was carried out using Student t test paired data. p Value <0.05 was considered to be significant. Results: Complete retinal reattachment was achieved in 7 of 8 patients. Case 8 was operated 11 months ago and he still has a small area of subretinal fluid not completely reabsorbed. Mean preoperative best-corrected visual acuity (BCVA) was 20/83 and the mean postoperative BCVA was 20/40. Mean preoperative foveal thickness was 973 μm and mean postoperative foveal thickness was 363.5 μm. Case 7 developed a macular hole after treatment. Conclusions: Pars plana vitrectomy, ILM peeling, and endotamponade (SF620% gas) without endolaser on the temporal edge of optic disc is an effective treatment. This procedure achieved successful anatomical and functional results. © 2015 Wichtig Publishing.


PubMed | Pierantoni Morgagni Hospital and University of Bologna
Type: Journal Article | Journal: European journal of ophthalmology | Year: 2016

To evaluate the clinical outcome of surgical treatment for macular serous detachment associated with optic disc pit with pars plana vitrectomy (PPV) without laser photocoagulation on the temporal edge.Vitrectomy was performed in 8 eyes of 8 patients (mean age 27.25 years; range 12-57 years) with unilateral macular detachment associated with optic disc pit. All patients underwent pars plana vitrectomy (cases 1, 2, 3, and 4, PPV 20 G; cases 5, 6, 7, and 8, PPV 25 G), internal limiting membrane(ILM) peeling, and SF6 20% gas tamponade (case 1 was treated with silicone oil tamponade). Endolaser on the temporal margin of the optic disk was not performed. Every patient was observed for a follow-up period of 59.25 months after surgery. Statistical analysis was carried out using Student t test paired data. p Value <0.05 was considered to be significant.Complete retinal reattachment was achieved in 7 of 8 patients. Case 8 was operated 11 months ago and he still has a small area of subretinal fluid not completely reabsorbed. Mean preoperative best-corrected visual acuity (BCVA) was 20/83 and the mean postoperative BCVA was 20/40. Mean preoperative foveal thickness was 973 m and mean postoperative foveal thickness was 363.5 m. Case 7 developed a macular hole after treatment.Pars plana vitrectomy, ILM peeling, and endotamponade (SF6 20% gas) without endolaser on the temporal edge of optic disc is an effective treatment. This procedure achieved successful anatomical and functional results.

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