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Castel Guelfo di Bologna, Italy

Pezzilli R.,Pancreas Unit
Journal of Gastroenterology and Hepatology Research | Year: 2014

The issue of pancreatic incidentaloma is relevant in clinical practice, and the correct management of these asymptomatic lesions found incidentally at imaging techniques requires prospective studies with adequate follow-ups. The current literature on this issue was reviewed and incidentalomas, both solid and cystic, are frequently diagnosed at an advanced age and the percentage of males ranged from 14.3 to 80.7%. The percentage of incidentalomas varies from 6% to 23% of the pancreatic resections performed for any cause. The prevalence of cystic incidentalomas diagnosed with imaging techniques varies from 1.2 to 2.6%. Further injury can be identified on the basis of biochemical or endoscopic examinations. Incidentalomas are found more frequently in examinations carried out for genito-urinary symptoms, chest pain or screening tests for cancer surveillance. Up to 50% of these lesions are solid and the vast majority are malignant or precancerous. Biopsy and analysis of the CEA and amylase in the cystic fluid obtained especially with an endoscopic ultrasonography is of particular importance. Given the imperfect diagnostic information available, it is necessary to evaluate the risk and benefit of a pancreatic resection when deemed appropriate because pancreatic resection involves high morbidity, and a surgical approach should be avoided for a benign condition. Solid incidentalomas generally seem to have a better prognosis than symptomatic lesions. © 2014 ACT. Source

Pezzilli R.,Pancreas Unit
Recent Patents on Inflammation and Allergy Drug Discovery | Year: 2015

Background: Alcohol is one of the etiological factors of chronic pancreatitis and there is evidence that acute pancreatitis is the first episode of preexisting chronic pancreatitis and is sometimes not evident from a clinical point of view. The diagnosis of acute pancreatitis is based on the presence of abdominal pain, serum increase of pancreatic enzymes or their presence in urine and/or the presence of alterations of the pancreas imaging. Aims: To revise actual knowledge on the relationship between alcohol use and pancreatic diseases benign as well as malignant. Results: In occasional drinkers, levels of serum amylase were found to be abnormally high in approximately 13% of subjects, while pancreatic isoamylase and lipase were found to be abnormally high in serum in only 2%. The reason might be related to the fact that alcohol can affect the salivary glands. In chronic alcoholics without abdominal pain, amylase and lipase in serum are elevated in 14% of subjects and, in patients with alcoholic acute pancreatitis, pancreatic amylase and isoamylase are elevated in 94% of cases and lipase is generally more sensitive (100% of cases). Conclusions: Chronic abuse of alcohol, but not occasional alcoholic intoxication, causes pancreatic damage. Regarding pancreatic neoplasms, the role of alcohol is under debate in ductal pancreatic adenocarcinoma as well as in pancreatic neuroendocrine tumors. Few relevant patents are also described in this review. © 2015 Bentham Science Publishers. Source

Pezzilli R.,Pancreas Unit
Immunotherapy | Year: 2014

Autoimmune pancreatitis is one of the few diseases of the pancreas characterized by the possibility of curing the illness using immunosuppressant drugs. In this paper, the therapeutic approach used to treat autoimmune pancreatitis patients and the clinical outcome related to each treatment modality were reviewed. Steroids are useful in alleviating the symptoms of the acute presentation of autoimmune pancreatitis, but some questions remain open, such as a shared definition of the disease's remission as well as autoimmune pancreatitis relapse, the dosage of steroids in the symptomatic phase of the disease and the duration of steroid therapy. Finally, it should be determined if other immunosuppressive nonsteroidal drugs could become first-line therapy in patients with autoimmune pancreatitis without jaundice and without atrophic pancreas. © 2014 Future Medicine Ltd. Source

Balzano G.,San Raffaele Scientific Institute | Balzano G.,Bocconi University | Capretti G.,San Raffaele Scientific Institute | Capretti G.,Bocconi University | And 6 more authors.
HPB | Year: 2016

Background: According to current guidelines, pancreatic cancer patients should be strictly selected for surgery, either palliative or resective. Methods: Population-based study, including all patients undergoing surgery for pancreatic cancer in Italy between 2010 and 2012. Hospitals were divided into five volume groups (quintiles), to search for differences among volume categories. Results: There were 544 hospitals performing 10 936 pancreatic cancer operations. The probability of undergoing palliative/explorative surgery was inversely related to volume, being 24.4% in very high-volume hospitals and 62.5% in very low-volume centres (adjusted OR 5.175). Contrarily, the resection rate in patients without metastases decreased from 86.9% to 46.1% (adjusted OR 7.429). As for resections, the mortality of non-resective surgery was inversely related to volume (p < 0.001). Surprisingly, mortality of non-resective surgery was higher than that for resections (8.2% vs. 6.7%; p < 0.01). Approximately 9% of all resections were performed on patients with distant metastases, irrespective of hospital volume group. The excess cost for the National Health System from surgery overuse was estimated at 12.5 million euro. Discussion.: Discrepancies between guidelines on pancreatic cancer treatment and surgical practice were observed. An overuse of surgery was detected, with serious clinical and economic consequences. © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved. Source

Barassi A.,University of Milan | Pezzilli R.,Pancreas Unit | Colpi G.M.,ISES Institute for the Infertility and Sexuality | Corsi Romanelli M.M.,University of Milan | And 2 more authors.
Journal of Sexual Medicine | Year: 2014

Introduction: Endothelial dysfunction has been demonstrated to play an important role in pathogenesis of erectile dysfunction (ED) and vitamin D deficiency is deemed to promote endothelial dysfunctions. Aim: To evaluate the status of serum vitamin D in a group of patients with ED. Methods: Diagnosis and severity of ED was based on the IIEF-5 and its aetiology was classified as arteriogenic (A-ED), borderline (BL-ED), and non-arteriogenic (NA-ED) with penile-echo-color-Doppler in basal condition and after intracaversous injection of prostaglandin E1. Serum vitamin D and intact PTH concentrations were measured. Main Outcome Measures: Vitamin D levels of men with A-ED were compared with those of male with BL-ED and NA-ED. Results: Fifty patients were classified as A-ED, 28 as ED-BL and 65 as NA-ED, for a total of 143 cases. Mean vitamin D level was 21.3ng/mL; vitamin D deficiency (<20ng/mL) was present in 45.9% and only 20.2% had optimal vitamin D levels. Patients with severe/complete-ED had vitamin D level significantly lower (P=0.02) than those with mild-ED. Vitamin level was negatively correlated with PTH and the correlation was more marked in subjects with vitamin D deficiency. Vitamin D deficiency in A-ED was significantly lower (P=0.01) than in NA-ED patients. Penile-echo-color-Doppler revealed that A-ED (PSV≤25cm/second) was more frequent in those with vitamin D deficiency as compared with those with vitamin >20ng/dL (45% vs. 24%; P<0.05) and in the same population median PSV values were lower (26 vs. 38; P<0.001) in vitamin D subjects. Conclusion: Our study shows that a significant proportion of ED patients have a vitamin D deficiency and that this condition is more frequent in patients with the arteriogenic etiology. Low levels of vitamin D might increase the ED risk by promoting endothelial dysfunction. Men with ED should be analyzed for vitamin D levels and particularly to A-ED patients with a low level a vitamin D supplementation is suggested. © 2014 International Society for Sexual Medicine. Source

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