Trinchieri A.,A Manzoni Hospital |
Maletta A.,A Manzoni Hospital |
Lizzano R.,Vivenda Spa |
Marchesotti F.,Santo Spirito Hospital
European Journal of Clinical Nutrition | Year: 2013
Objective:The potential renal acid load (PRAL) in diet may have a key role in renal stone formation through its effect on calcium and citrate metabolism. We examined the association between calcium renal stone formation and the PRAL in a population-based case-control study.Methods:A group of 123 calcium renal stone formers was compared with an equal number of age-and sex-matched controls. Dietary history was obtained by 24-h recall. Odds ratios (ORs) and 95% confidence intervals (CI) were calculated across quartiles of dietary intakes of PRAL.Results:Compared with those in the lowest quartiles of PRAL, we found an increased risk of renal stone formation for those in the highest quartile (Q4 OR=2.51, 95% CI 1.218-5.172). Regarding individual food patterns, we found a significant protection for a high consumption of vegetables (two or more servings/day; OR=0.526, 95% CI 0.288-0.962).Conclusions:A PRAL in diet and a reduced consumption of vegetables are associated with an increased risk of calcium renal stone formation. In renal stone formers consumption of plant foods should be encouraged in order to counterbalance the acid load derived from animal-derived foods. © 2013 Macmillan Publishers Limited.
Giunti S.,University of Turin |
Amione C.,University of Turin |
Gruden G.,University of Turin |
Ghezzo G.,Santo Spirito Hospital |
And 4 more authors.
Diabetes Care | Year: 2012
OBJECTIVE - To evaluate the predictive role of increased corrected QT (QTc) and QT interval dispersion (QTd) on all-cause and cardiovascular mortality in a large, unselected type 2 diabetic population. RESEARCH DESIGN AND METHODS - The prospective study included 1,357 type 2 diabetic patients from the Casale Monferrato Study. At baseline, QTc intervals >0.44 s and QTd intervals >0.08 s were considered abnormally prolonged. Both all-cause and cardiovascular mortality were assessed 15 years after the baseline examination. RESULTS - During the follow-up period, 862 subjects per 12,450 person-years died. Multivariate analysis showed that the hazard ratio (HR) of cardiovascular mortality was significantly increased in subjects with prolonged QTd (1.26 [95% CI 1.02-1.55]) and was only slightly reduced after multiple adjustments. Conversely, prolonged QTc did not increase the HRs for all-cause or cardiovascular mortality. CONCLUSIONS - Increased QTd predicts cardiovascular mortality after a long-term follow-up period in a large, unselected population of type 2 diabetic subjects. © 2012 by the American Diabetes Association.
N-terminal probrain natriuretic peptide is a stronger predictor of cardiovascular mortality than c-reactive protein and albumin excretion rate in elderly patients with type 2 diabetes: The casale monferrato population-based study
Bruno G.,University of Turin |
Landi A.,University of Turin |
Barutta F.,University of Turin |
Ghezzo G.,Santo Spirito Hospital |
And 6 more authors.
Diabetes Care | Year: 2013
OBJECTIVE-To study whether N-terminal probrain natriuretic peptide (NT-proBNP) is a short-term independent predictor of both all-cause and cardiovascular (CV) mortality in type 2 diabetic patients and to establish whether albuminuria and C-reactive protein (CRP) affect this relationship. RESEARCH DESIGN AND METHODS-The prospective study included 1,825 type 2 diabetic patients from the population-based cohort of the Casale Monferrato study. CV risk factors, preexisting CVD, and NT-proBNP levels were evaluated at baseline. All-cause and CV mortality were assessed 5.5 years after baseline examination. Multivariate Cox proportional hazards modeling was used to estimate mortality hazard ratios (HRs). RESULTS-During the follow-up period, 390 people died (175 for CVD) out of 9,101 personyears of observations. A significantly increased mortality risk by quartiles of NT-proBNP was observed (test for trend, P < 0.001). NT-proBN P values >91 pg/mL conferred HRs of 2.05 (95% CI 1.47-2.86) for all-cause and 4.47 (2.38-8.39) for CV mortality, independently of CV risk factors, including CRP and albumin excretion rate (AER). The association was also significant for modest rises in NT-proBNP levels and in patients without microalbuminuria and CVD at baseline (upper quartiles HRs 3.82 [95% CI 1.24-13.75]) and 3.14 [1.00-9.94]). Albuminuria andNT-proBNP had an additive effect onmortality, though the association was stronger for NT-proBNP. CONCLUSIONS-NT-proBNP is a strong independent predictor of short-term CV mortality risk in elderly people with type 2 diabetes, including those without preexisting CVD. This association is evident even in people with slightly increased values, is not modified by CRP, and is additive to that provided by AER. © 2013 by the American Diabetes Association.
Melchiorre K.,St George's, University of London |
Melchiorre K.,Santo Spirito Hospital |
Sharma R.,St George's, University of London |
Khalil A.,St George's, University of London |
Thilaganathan B.,St George's, University of London
Hypertension | Year: 2016
The aim of this study was to investigate cardiac functional status in pregnancy using a comprehensive approach taking into account the simultaneous changes in loading and geometry, as well as maternal age and anthropometric indices. This was a prospective cross-sectional study of 559 nulliparous pregnant women assessed at 4 time points during pregnancy and at 1 year postpartum. All women underwent conventional echocardiography and tissue Doppler velocities and strain rate analysis at multiple cardiac sites. Mean arterial pressure and total vascular resistance index significantly decreased (both P<0.001) during the first 2 trimesters of pregnancy and increased thereafter. Stroke volume index and cardiac index showed the opposite trend compared with mean arterial pressure and total vascular resistance index (both P<0.05). Myocardial and ventricular function were significantly enhanced in the first 2 trimesters but progressively declined thereafter. By the end of pregnancy, significant chamber diastolic dysfunction and impaired myocardial relaxation was evident in 17.9% and 28.4% of women, respectively, whereas myocardial contractility was preserved. There was full recovery of cardiac function at 1 year postpartum. Cardiovascular changes during pregnancy are thought to represent a physiological adaptation to volume overload. The findings of a drop in stroke volume index, impaired myocardial relaxation with diastolic dysfunction, and a tendency toward eccentric remodeling in a significant proportion of cases at term are suggestive of cardiovascular maladaptation to the volume-overloaded state in some apparently normal pregnancies. These unexpected cardiovascular findings have important implications for the management of both normal and pathological pregnancy states. © 2016 American Heart Association, Inc.
Melchiorre K.,University of London |
Melchiorre K.,Santo Spirito Hospital |
Sharma R.,University of London |
Thilaganathan B.,University of London
Current Opinion in Obstetrics and Gynecology | Year: 2012
Purpose of review: To review the published data on maternal cardiac adaptation to pregnancy. Recent findings: Normal pregnancy is characterized by significant changes in the cardiovascular system. Studies on systemic arterial system and heart remodelling in pregnancy provide somewhat uniform results. In normal pregnancy, left ventricle mass, cardiac output and arterial compliance increase, whereas total vascular resistance decreases. In contrast, findings on left ventricular systolic and diastolic chamber and myocardial function are conflicting. Summary: The major limitation of earlier studies on left ventricular systolic function is the use of ejection-phase indices that are dependent on loading conditions. Even when tissue Doppler velocity and deformation indices were measured, studies interpreted diastolic indices in isolation, rather than using validated diagnostic algorithms which account for the interdependency of cardiac events. Furthermore, the strong age-dependency of diastolic function indices was not accounted for in the majority of assessments and none of the studies diagnose or grade diastolic dysfunction. Future studies should aim to use appropriate control individuals, age-adjusted cutoff of cardiac diastolic indices and extended tissue Doppler velocity and deformation indices to provide objective information about chamber and myocardial function. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Cecinati V.,Santo Spirito Hospital |
Principi N.,University of Milan |
Brescia L.,Bambino Gesu Hospital |
Esposito S.,University of Milan
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2014
Bacterial infections are common in children with cancer and can lead to life-threatening complications. Infections in these patients mainly occur during neutropenic periods, and may be caused by Gram-positive or Gram-negative bacteria. The patients at highest risk of serious infections include those with acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML), and those undergoing myeloablative hematopoietic cell transplantation (HCT). This is a review with the main aim of making a critical appraisal of the literature, and summarising what is currently known and can be recommended. The most significant studies support the use of floroquinolones (mainly ciprofloxacin) as the most rational approach to treat pediatric patients with probably long-lasting neutropenia, although trimetoprim-sulphametoxazole and amoxicillin/clavulanate may theoretically be valid alternatives. No prophylaxis seems to be needed for children with cancer without severe neutropenia. However, a global evaluation of the studies of antibiotic prophylaxis in children with cancer indicates that there are not enough data to prepare definite guidelines for its use or avoidance in pediatric oncology, and so further studies are needed. It is not only important to define the best antibiotic regimens for the children in whom such prophylaxis is useful, but also to identify precisely those who do not need it. This would avoid the antibiotic misuse that probably occurs at the moment because many low-risk children with cancer are treated. As prophylaxis against infections requires long-term adherence to an antibiotic regimen, the attitudes and beliefs of stakeholders need to be fully considered. © 2013 Springer-Verlag Berlin Heidelberg.
Erra S.,Santo Spirito Hospital
Il Giornale di chirurgia | Year: 2010
Fine-needle aspiration cytology for breast lesions and cytopathologic correlations. An Italian peripheral hospital experience with 440 cases (from 2000 to 2007). S. Erra, D. Costamagna In the present study, we evaluate our experience with Fine-Needle Aspiration Cytology (FNAC) for the diagnosis of breast tumor. Our intent is to correlate the diagnostic accuracy of FNAC for breast lesions on the basis of their respective histopathologic results. We retrospectively examined 440 cases of breast lesions who underwent FNAC and subsequently had definitive histopathologic diagnosis. The patients were observed over a period of eight years (from January 2000 to December 2007) at the "Santo Spirito" Hospital of Casale Monferrato, a general peripheral hospital in the North-West Italy (Piemonte Region). The results of FNAC were expressed using the five diagnostic categories recommended by European Guidelines on breast tumors as follows: 159 C5 cases (36,1%), 88 C4 (20%), 51 C3 (11,6%), 42 C2 (9,5%), and 100 C1 (22,7%). The statistical analysis revealed these values: sensitivity 93.8% (C5+C4), specificity 79.6%, C5 positive predictive value 97.5%, C2 negative predictive value 83.3%, false positive fraction 2.5%, false negative fraction 16.6%, diagnostic accuracy 71.2%. In consideration to the low cost and the low disconfort for patients, we consider FNAC a safe and feasible procedure, in particular in the context of peripheral hospitals, where a sophisticated technology is not available. We remark the importance of a good selection of patients to obtain the best results from the procedure.
Perachino M.,Santo Spirito Hospital
Expert Review of Anticancer Therapy | Year: 2010
Agonistic analogs of luteinizing hormone-releasing hormones are indicated for the palliative treatment of metastatic prostate cancer. While the prognostic role of prostate-specific antigen in patients submitted to androgen-deprivation therapy has been extensively investigated in these patients, there is no consensus about the utility of serum testosterone measurements during follow-up and about their possible prognostic value. Recent reports have shown that testosterone levels might be directly related to survival and risk of death. These results need to be confirmed by further prospective studies. Given this concept, lowering testosterone as much as possible should be the goal of androgen-deprivation therapy in patients with metastatic prostate cancer, as this may have an impact on patient survival. © 2010 Expert Reviews Ltd.
Erra S.,Santo Spirito Hospital
Il Giornale di chirurgia | Year: 2011
Metastatic disease in the major salivary glands is rare and the parotid gland is most frequently involved. Secondary deposits in the submandibular gland are very uncommon. We report a case of a 50-year-old woman who developed a metastasis from breast cancer in the right submandibular gland, 9 years after primary surgery for G3 T1c N0 ipsilateral breast carcinoma. The peculiarity of the case was the unusual site of the metastatic disease and the difficulty in differential diagnosis with primitive ductal salivary carcinoma.
Rosati M.,Santo Spirito Hospital |
Bramante S.,Santo Spirito Hospital |
Conti F.,Santo Spirito Hospital
Current Opinion in Obstetrics and Gynecology | Year: 2014
Purpose of review: To provide an update on the outcomes and complications of laparoscopic (or robot-assisted) sacrocervicopexy with and without supracervical hysterectomy, and highlight the differences with sacrocolpopexy technique based on the most recent evidence. Recent findings: Laparoscopic and robot-assisted sacrocervicopexy with supracervical hysterectomy and sacrohysteropexy have good success rates, with a mean objective success rate of 96% (range 90-100%), subjective success rates of 80-95% and mean reoperation rate of 3%. Also, pelvic symptoms and quality of life improved after laparoscopic sacrocervicopexy. These results are similar to laparoscopic and abdominal sacrocolpopexy, and are confirmed by the results of two comparative studies. Mesh erosion risk is very low in patients treated with laparoscopic sacrocervicopexy. Studies that compare laparoscopic sacrocolpopexy with concomitant total hysterectomy and sacrocervicopexy with subtotal hysterectomy show that total hysterectomy is associated with a greater prevalence of vaginal mesh exposure when compared with a subtotal hysterectomy. In case of sacralpexy, if it is decided to proceed with a hysterectomy, it is recommended to limit this to a subtotal. Summary: The benefits of laparoscopic sacrocervicopexy with or without supracervical hysterectomy in terms of outcomes and reduced risk of mesh erosion in comparison with sacrocolpopexy and concomitant total hysterectomy have to be confirmed by randomized controlled trials. Moreover, standardization of surgical technique is mandatory. Copyright © 2014 Lippincott Williams & Wilkins.