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Carlucci A.,Instituto Scientifico Of Pavia | Guerrieri A.,SantOrsola Malpighi Hospital | Nava S.,SantOrsola Malpighi Hospital
European Respiratory Review | Year: 2012

The presence of acute or chronic respiratory failure is often seen as a terminal phase of chronic obstructive pulmonary disease. A great variability in end-of-life practice is observed in these patients mainly because physicians are not always able to correctly predict survival. There is a need for a clear discussion about decision making earlier than when acute respiratory failure ensues. Indeed, a perceived poor quality of life does not necessarily correlate with a clear willingness to refuse invasive or noninvasive mechanical ventilation. It has been suggested to start palliative care earlier, together with curative and restorative care, when there is an increased intensity of symptoms. The patients eligible for palliative care are those complaining of breathlessness, pain, fatigue and depression, which in some studies accounted for a prevalence much higher than 50%. Among comfort measures for palliation, oxygen is frequently prescribed even when the criteria for long-term home oxygen therapy are not met; however, when compared with air, no benefits on dyspnoea have been found. The only drug with a proven effect on dyspnoea is morphine, but not when it is delivered with a nebuliser. Finally, noninvasive ventilation may be used only as a comfort measure for palliation to maximise comfort by minimising adverse effects. © 2012.

Pezzilli R.,Pancreas Unit | Calculli L.,SantOrsola Malpighi Hospital
Pancreas | Year: 2015

Objectives: The majority of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are branch duct (BD) IPMNs, and these neoplasms are being diagnosed with increasing frequency; no data are also available on thewell-being (quality of life [QoL]) of these patients.We aimed to evaluate the 2-year follow-up results in consecutive patients with BD-IPMNs to assess symptoms at presentation and their morphological progression; the physical and psychological statuses of these patients were also evaluated. Methods: One hundred one patientswith BD-IPMN of the pancreaswere enrolled in the study (37.6%men and 62.4% women; mean [SD] age, 66.3 [10.4] years).Magnetic resonance imaging was used to evaluate the modification of the cystic lesions at baseline aswell as in the follow-up. The SF- 12 Health Survey, the State-Trait Anxiety Inventory Y-1 and Y-2, the 12-Item General Health Questionnaire, as well as the Beck Depression Inventory-II were used to evaluate the QoL once a year.Results: Themean (SD) basal size of themajor lesionwas 15.5 (8.9)mm, and in the follow-up period, the size remained stable. The QoL did not change during the follow-up period.Conclusions: Branch duct IPMNs are very slow-growing neoplasms, and they do not affect the QoL of affected patients. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

OBJECTIVE: This study aimed to assess the presence of pancreatic hyperenzymemia in patients with pancreatic cystic lesions as compared to other chronic diseases of the pancreas. METHODS: Ninety-one patients were studied: 32 had mucinous cystic lesions, 35 had chronic pancreatitis (CP), and 24 had pancreatic ductal adenocarcinoma (PDAC). Surgery was carried out in 10 of the 32 patients with mucinous cystic lesion (7 of them had severe dysplasia), in 5 patients with CP, and in 9 patients with PDAC. RESULTS: Abnormally high serum pancreatic isoamylase activity was present in 11 (34.4%) patients with mucinous cystic lesions, in 14 (40.0%) patients with CP, and none in patients with PDAC (P = 0.002); whereas serum lipase activity was abnormally high in 8 (25.0%) patients with mucinous cystic lesion, in 17 (48.6%) patients with CP, and in 3 (12.5%) patients with PDAC (P = 0.009). In 7 patients with mucinous cystic lesions and histologically confirmed severe dysplasia, abnormally high levels of both serum pancreatic amylase and lipase were present in 3 (42.9%) patients. CONCLUSIONS: High serum concentrations of pancreatic amylase and lipase were found in no more than half of the patients with mucinous cystic lesions. High levels of pancreatic enzymes were not associated with a greater risk of malignancy. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Pezzilli R.,Santorsola Malpighi Hospital
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.

Pezzilli R.,SantOrsola Malpighi Hospital | Pagano N.,SantOrsola Malpighi Hospital
World Journal of Gastroenterology | Year: 2013

The relationship between diabetes mellitus and the risk of pancreatic cancer has been a matter of study for a long period of time. The importance of this topic is due to two main causes: the possible use of recent onset diabetes as a marker of the disease and, in particular, as a specific marker of pancreatic cancer, and the selection of a population at risk for pancreatic cancer. Thus, we decided to make an in-depth study of this topic; thus, we carried out an extensive literature search in order to re-assess the current knowledge on this topic. Even if diabetes is found a decade before the appearance of pancreatic cancer as reported in meta-analytic studies, we cannot select those patients already having non detectable pancreatic cancer, at least with the imaging and biological techniques available today. We believe that more studies are necessary in order to definitively identify diabetes mellitus as a risk factor for pancreatic cancer taking into consideration that approximately 10 years are needed to diagnose symptomatic pancreatic cancer. At present, the answer to the as to whether diabetes and pancreatic cancer comes first similar to the adage of the chicken and the egg is that diabetes is the egg. © 2013 Baishideng. All rights reserved.

Pezzilli R.,SantOrsola Malpighi Hospital
Recent Patents on Inflammation and Allergy Drug Discovery | Year: 2014

Pain is the main clinical symptom of chronic pancreatitis at its early stages; then the pain tends to disappear during the progression of the disease. Several options have been proposed to treat pain and inflammation in chronic pancreatitis; medical, endoscopic or surgical treatments have been considered, and the controversy surrounding their efficacy is ongoing. One medical option is to use antioxidants for both preventing and curing the flare-ups of chronic pancreatitis. The data regarding this treatment are highly debated; some authors have reported their efficacy in reducing pain and inflammation whereas others have not. We have reviewed the current knowledge and recent patents on this topic and, at present, we do not recommend this therapeutic approach and additional studies are required for reconsidering this interesting therapeutic option. © 2014 Bentham Science Publishers.

Pezzilli R.,Santorsola Malpighi Hospital
Recent Patents on Inflammation and Allergy Drug Discovery | Year: 2014

Purpose: There are numerous studies in the literature regarding the involvement of intestinal as well as extra intestinal organs during the course of celiac disease, and there is accumulating evidence regarding the pancreatic changes caused by this pathology. Method: The literature on the relationship between celiac disease and pancreatic involvement has been extensively reviewed. Results: Exocrine pancreatic involvement regards both the function and the morphology of the exocrine pancreas, and superimposed or more severe clinical changes seem to be related to the nutritional disturbances caused by celiac disease or by the disease itself. Patients with celiac disease may also develop a chronic pancreatitis more frequently than in general population both the intestinal and the extraintestinal manifestations of celiac disease. Conclusions: Fecal elastase 1-determination in celiacs may be useful in detecting and curing exocrine pancreatic insufficiency especially in patients with a new diagnosis of celiac disease or in those with refractory diarrhea. Few patents on pancreatic extracts are also briefly described. © 2014 Bentham Science Publishers.

Pezzilli R.,SantOrsola Malpighi Hospital
Digestive and Liver Disease | Year: 2015

This Position Paper contains clinically oriented guidelines by the Italian Association for the Study of the Pancreas (AISP) for the diagnosis and treatment of severe acute pancreatitis. The statements were formulated by three working groups of experts who searched and analysed the most recent literature; a consensus process was then performed using a modified Delphi procedure. The statements provide recommendations on the most appropriate definition of the complications of severe acute pancreatitis, the diagnostic approach and the timing of conservative as well as interventional endoscopic, radiological and surgical treatments. © 2015 Editrice Gastroenterologica Italiana S.r.l.

Boldrini R.,SantOrsola Malpighi Hospital | Fasano L.,SantOrsola Malpighi Hospital | Nava S.,SantOrsola Malpighi Hospital
Current Opinion in Critical Care | Year: 2012

Purpose of Review: A critical review of the most recent literature regarding use and clinical indications of noninvasive mechanical ventilation (NIV). Recent Findings: According to several randomized controlled trials, NIV has gained acceptance as the preferred ventilatory modality to treat acute respiratory failure (ARF) due to chronic obstructive pulmonary disease exacerbations, cardiogenic pulmonary edema, respiratory failure in immunocompromised patients, and to decrease the intubation length and to improve weaning results in patients recovering from a hypercapnic respiratory failure.Observational studies suggest that NIV may also be used to treat other conditions like severe pneumonia (including H1N1 virus), severe asthma attack, cystic fibrosis, obesity hypoventilation, and to improve the respiratory outcome in postsurgical patients. Summary: NIV has radically changed the management of ARF. Recently the possible applications of NIV have increased, both in the hospital and extrahospital setting.NIV is no longer confined to the ICU, but has crossed over into the regular ward, Emergency Department and out-of-hospital environment. Current research is focusing on improving the quality and safety of the devices and establishing new ventilatory modes in order to extend even further the indications to NIV as well as its rate of success. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Nava S.,SantOrsola Malpighi Hospital | Pisani L.,SantOrsola Malpighi Hospital
Critical Care | Year: 2014

Patient-ventilator interaction represents an important clinical challenge during non-invasive ventilation (NIV). Doorduin and colleagues' study shows that non-invasive neurally adjusted ventilatory assist (NAVA) improves patient-ventilator interaction compared with pressure support ventilation in patients with chronic obstructive pulmonary disease. There is no doubt nowadays that NAVA is the most effective mode of improving the synchrony between patient and machine, but the key question for the clinicians is whether or not this will make a difference to the patient's outcome. The results of the study still do not clarify this issue because of the very low clinically important dyssynchrony, like wasted efforts, in the population studied. Air leaks play an important role in determining patient-ventilator interaction and therefore NIV success or failure. Apart from the use of a dedicated NIV ventilator or specific modes of ventilation like NAVA, the clinicians should be aware that the choice of interface, the humidification system and the appropriate sedation are key factors in improving patient-ventilator synchrony. © 2014 Nava and Pisani; licensee BioMed Central Ltd.

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