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Cinquanta L.,Azienda Ospedaliera Universitaria | Tani M.,Servizio di Patologia Clinica ASST Garda | Sorrentino M.C.,ISMETT | Simula M.P.,Azienda Sanitaria Universitaria Integrata | And 3 more authors.
Rivista Italiana della Medicina di Laboratorio | Year: 2017

In Italy, the high occurrence of monoclonal gammopathies in adults and the high frequency of requests for serum protein electrophoresis have two consequences. On one hand it is relatively frequent in a person’s history to come across a serum monoclonal component; on the other it is necessary to correctly frame the laboratory data and, consequently, plan the appropriate targeted lab tests. In the last fifteen years, the international scientific publications (mainly by clinical hematologists) have shown the great importance of lab testing in the management of patients with monoclonal gammopathies. However these studies have not always given coherent and precise indications on the appropriate choice of laboratory tests in different clinical situations, or how to correctly perform and interpret them. In this regard, the Study Group “Proteins” of the Italian Society of Clinical Pathology and Laboratory Medicine (SIPMeL) has collected in a document a series of “advices” on the use of laboratory tests in the diagnosis, prognosis and follow-up of monoclonal gammopathies, in particular those included in the branch that studies the plasma protein assays. The appendix shows methodological notes concerning controversial analytical and pre-analytical aspects of the execution of the main laboratory tests described in the paper. © 2016, Società Italiana di Patologia Clinica e Medicina di Laboratorio.


Brisse H.J.,University Pierre and Marie Curie | McCarville M.B.,St Jude Childrens Research Hospital | Granata C.,Ospedale Gaslini | Krug K.B.,University of Cologne | And 15 more authors.
Radiology | Year: 2011

Neuroblastoma is an enigmatic disease entity; some tumors disappear spontaneously without any therapy, while others progress with a fatal outcome despite the implementation of maximal modern therapy. However, strong prognostic factors can accurately predict whether children have "good"or "bad" disease at diagnosis, and the clinical stage is currently the most significant and clinically relevant prognostic factor. Therefore, for an individual patient, proper staging is of paramount importance for risk assessment and selection of optimal treatment. In 2009, the International Neuroblastoma Risk Group (INRG) Project proposed a new staging system designed for tumor staging before any treatment, including surgery. Compared with the focus of the International Neuroblastoma Staging System, which is currently the most used, the focus has now shifted from surgicopathologic findings to imaging findings. The new INRG Staging System includes two stages of localized disease, which are dependent on whether image-defined risk factors (IDRFs) are or are not present. IDRFs are features detected with imaging at the time of diagnosis. The present consensus report was written by the INRG Imaging Committee to optimize imaging and staging and reduce interobserver variability. The rationales for using imaging methods (ultrasonography, magnetic resonance imaging, computed tomography, and scintigraphy), as well as technical guidelines, are described. Definitions of the terms recommended for assessing IDRFs are provided with examples. It is anticipated that the use of standardized nomenclature will contribute substantially to more uniform staging and thereby facilitate comparisons of clinical trials conducted in different parts of the world. © RSNA, 2011.


Papi A.,University of Ferrara | Nicolini G.,Chiesi Farmaceutici | Boner A.L.,University of Verona | Baraldi E.,University of Padua | And 3 more authors.
Italian Journal of Pediatrics | Year: 2011

Background: Few data are available on the usefulness of short term treatment with low-medium dose of inhaled corticosteroids (ICS) in pre-school children with wheezing exacerbations. Methods. To compare the efficacy of one week treatment with 400 g b.i.d. nebulized beclomethasone dipropionate (BDP), plus nebulized 2500 g prn salbutamol (BDP group), versus nebulized b.i.d. placebo, plus nebulized prn 2500 g salbutamol (placebo group), a post-hoc analysis was performed on data obtained in 166 pre-school children with multiple-trigger wheezing, recruited during an acute wheezing episode. Results: The percentage of symptom-free days (SFDs) was significantly higher in the BDP group (54.7%) than in the placebo group (40.5%; p = 0.012), with a 35% relative difference. Day-by-day analysis showed that the percentage of SFDs was already higher in the BDP group after 2 days (7.4%), the difference reaching statistical significance at day 6 (12.3%; p = 0.035). Cough score was also reduced in the BDP group (0.11) as compared with the placebo group (0.39; p = 0.048), the difference reaching statistical significance after 5 days of treatment (0.18 and 0.47 respectively; p = 0.047). The mean number of nebulizations per day of prn salbutamol was lower in the BDP group as compared to the placebo group (0.26 and 0.34, respectively), but the difference was not significant (p = 0.366). There were no differences in positive effects of BDP treatment between children with and without risk factors for asthma. Conclusions: A 1-week treatment with nebulized BDP and prn salbutamol is effective in increasing SFDs and improving cough in children with wheezing, providing a clinical rationale for the short term use of ICS in episodic wheeze exacerbations in pre-school children. Trial Registration. ClinicalTrials.gov (NCT00497523). © 2011 Papi et al; licensee BioMed Central Ltd.


Rodriguez-Nunez A.,Hospital Clinico Universitario Of Santiago Of Compostela | Rodriguez-Nunez A.,Hospital Clinico Universitario | Lopez-Herce J.,Hospital General Universitario Gregorio Maranon | Del Castillo J.,Hospital General Universitario Gregorio Maranon | And 41 more authors.
Resuscitation | Year: 2014

Objective: To analyze the results of cardiopulmonary resuscitation (CPR) that included defibrillation during in-hospital cardiac arrest (IH-CA) in children. Methods: A prospective multicenter, international, observational study on pediatric IH-CA in 12 European and Latin American countries, during 24 months. Data from 502 children between 1 month and 18 years were collected using the Utstein template. Patients with a shockable rhythm that was treated by electric shock(s) were included. The primary endpoint was survival at hospital discharge. Univariate logistic regression analysis was performed to find outcome factors. Results: Forty events in 37 children (mean age 48 months, IQR: 7-15 months) were analyzed. An underlying disease was present in 81.1% of cases and 24.3% had a previous CA. The main cause of arrest was a cardiac disease (56.8%). In 17 episodes (42.5%) ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) was the first documented rhythm, and in 23 (57.5%) it developed during CPR efforts. In 11 patients (27.5%) three or more shocks were needed to achieve defibrillation. Return of spontaneous circulation (ROSC) was obtained in 25 cases (62.5%), that was sustained in 20 (50.0%); however only 12 children (32.4%) survived to hospital discharge. Children with VF/pVT as first documented rhythm had better sustained ROSC (64.7% vs. 39.1%, p=0.046) and survival to hospital discharge rates (58.8% vs. 21.7%, p=0.02) than those with subsequent VF/pVT. Survival rate was inversely related to duration of CPR. Clinical outcome was not related to the cause or location of arrest, type of defibrillator and waveform, energy dose per shock, number of shocks, or cumulative energy dose, although there was a trend to better survival with higher doses per shock (25.0% with <2Jkg-1, 43.4% with 2-4Jkg-1 and 50.0% with >4Jkg-1) and worse with higher number of shocks and cumulative energy dose. Conclusion: The termination of pediatric VF/pVT in the IH-CA setting is achieved in a low percentage of instances with one electrical shock at 4Jkg-1. When VF/pVT is the first documented rhythm, the results of defibrillation are better than in the case of subsequent VF/pVT. No clear relationship between defibrillation protocol and ROSC or survival has been observed. The optimal pediatric defibrillation dose remains to be determined; therefore current resuscitation guidelines cannot be considered evidence-based, and additional research is needed. © 2013 Elsevier Ireland Ltd.


Bernardini F.P.,Ospedale Gaslini | Cetinkaya A.,Dunya Goz Hastanesi | Capris P.,Ospedale Gaslini | Rossi A.,Ospedale Gaslini | And 4 more authors.
Ophthalmic Plastic and Reconstructive Surgery | Year: 2016

Orbital and periorbital extension of congenital dacryocystoceles is rarely observed in neonatal infants. The authors describe 4 cases of congenital dacryocystocele that presented with extension to the orbital and periorbital regions. The first 3 newborns underwent marsupialization of the orbital and periorbital dacryocystoceles with aspiration of the purulent material followed by nasolacrimal duct probing after radiographic evidence of diffuse orbital or periorbital expansion. The fourth patient was successfully treated with an external dacryocystorhinostomy with excision of the enlarged cystic walls. Transconjunctival orbitotomy with sac marsupialization followed by nasolacrimal intubation can provide immediate and permanent resolutions of this unusual complication in most instances. External dacryocystorhinostomy may be required, however, when the orbital or periorbital dacryocystocele is complicated by acute or recurrent dacryocystitis. © Copyright 2015 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.


Conter V.,University of Milan Bicocca | Arico M.,Ospedale Meyer | Basso G.,University of Padua | Biondi A.,University of Milan Bicocca | And 17 more authors.
Leukemia | Year: 2010

We analyzed the long-term outcome of 4865 patients treated in Studies 82, 87, 88, 91 and 95 for childhood acute lymphoblastic leukemia (ALL) of the Italian Association of Pediatric Hematology and Oncology (AIEOP). Treatment was characterized by progressive intensification of systemic therapy and reduction of cranial radiotherapy. A progressive improvement of results with reduction of isolated central nervous system relapse rate was obtained. Ten-year event-free survival increased from 53% in Study 82 to 72% in Study 95, whereas survival improved from 64 to 82%. Since 1991, all patients were treated according to Berlin-Frankfurt-Muenster (BFM) ALL treatment strategy. In Study 91, reduced treatment intensity (25%) yielded inferior results, but intensification of maintenance with high-dose (HD)-L-asparaginase (randomized) allowed to compensate for this disadvantage; in high-risk patients (HR, 15%), substitution of intensive polychemotherapy blocks for conventional BFM backbone failed to improve results. A marked improvement of results was obtained in HR patients when conventional BFM therapy was intensified with three polychemotherapy blocks and double delayed intensification (Study 95). The introduction of minimal residual disease monitoring and evaluation of common randomized questions by AIEOP and BFM groups in the protocol AIEOP-BFM-ALL 2000 are expected to further ameliorate treatment of children with ALL. © 2010 Macmillan Publishers Limited All rights reserved.


Ciprandi G.,Azienda Ospedaliera Universitaria San Martino | Tosca M.A.,Ospedale Gaslini | Castellazzi A.M.,University of Pavia | Cairello F.,University of Pavia | And 3 more authors.
International Journal of Immunopathology and Pharmacology | Year: 2011

Allergic rhinitis and asthma are closely associated. Bronchial hyperreactivity (BHR) is a pathophysiological characteristic of asthma. Allergic inflammation is characterized by eosinophilic infiltrate and may by indirectly assessed by exhaled nitric oxide (FeNO). Forced expiratory flow between 25% and 75% of vital capacity (FEF25-75) may predict BHR in adult patients with allergic rhinitis. The aim of this study was to evaluate the presence of BHR in a large group of adolescents with allergic rhinitis and whether FEF25-75 might be related with BHR and FeNO. Methods 150 adolescents with allergic rhinitis were enrolled. Clinical examination, skin prick test, spirometry, methacholine challenge, and FeNO were performed in all patients. Results Severe BHR is quite frequent in allergic adolescents. Impaired FEF25-75 values (such as ≤ 65% of predicted) constitute a relevant predictive factor for severe BHR (OR 4.4). FeNO levels were significantly related with BHR. Conclusion This study provides evidence that impaired FEF25-75 values might predict severe BHR and BHR is related with FeNO in adolescents. Therefore, BHR should be suspected in adolescents with low FEF25-75 values. © SAGE Publications.


Del Giudice M.M.,The Second University of Naples | Marseglia G.L.,University of Pavia | Leonardi S.,University of Catania | Tosca M.A.,Ospedale Gaslini | And 3 more authors.
International Journal of Immunopathology and Pharmacology | Year: 2011

Exaled nitric oxide (FeNO) is considered a good noninvasive marker to assess airway inflammation in asthma and allergic rhinitis. In asthma, exhaled NO is very useful to verify adherence to therapy, and to predict upcoming asthma exacerbations. It has been also proposed that adjusting anti-inflammatory drugs guided by the monitoring of exhaled NO, could improve overall asthma control. Other studies showed increased FeNO levels in subjects with allergic rhinitis. © SAGE Publications.


Ciprandi G.,Azienda Ospedaliera Universitaria San Martino | Brambilla I.,University of Pavia | Tosca M.A.,Ospedale Gaslini | Arrigo T.,Messina University | And 4 more authors.
International Journal of Immunopathology and Pharmacology | Year: 2011

Several studies have outlined a possible relationship between an increased body mass index and respiratory allergic diseases, such as asthma and rhinitis. The aim of the study was to analyse the relationship between BMI and lung function, including bronchodilation test, in allergic children. The study included 153 children (103 males, mean age 12.8 years) with allergic rhinitis and mild asthma. All subjects were evaluated performing skin prick test, spirometry, and bronchodilalation test. BMI values were in the normal range as well as lung function. BMI significantly related with FEV1, FVC values and FEV1/FVC ratio both before and after bronchodilation. In conclusion, this study provides the first evidence that BMI is negatively related with bronchial reversibility in children with allergic rhinitis and asthma. As reversibility is related with bronchial inflammation, this finding might underline a link between overweight and allergic inflammation. © SAGE Publications.

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