UO Medicina Interna

Montecatini Val di Cecina, Italy

UO Medicina Interna

Montecatini Val di Cecina, Italy

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Di Ciaula A.,UO Medicina Interna | Gennaro V.,International Society of Doctors for Environment ISDE Italia | Gennaro V.,Instituto Nazionale per la Ricerca sul Cancro IST
Epidemiologia e Prevenzione | Year: 2016

The recent finding of asbestos fibres in drinking water (up to 700.000 fibres/litres) in Tuscany (Central Italy) leads to concerns about health risks in exposed communities. Exposure to asbestos has been linked with cancer at several levels of the gastrointestinal tract, and it has been documented, in an animal model, a direct cytotoxic effect of asbestos fibres on the ileum. It has been recently described a possible link between asbestos and intrahepatic cholangiocarcinoma, and asbestos fibres have been detected in humans in histological samples from colon cancer and in gallbladder bile. Taken together, these findings suggest the possibility of an enterohepatic translocation of asbestos fibres, alternative to lymphatic translocation from lungs. In animal models, asbestos fibres ingested with drinking water act as a co-carcinogen in the presence of benzo(a) pyrene and, according to the International Agency for Research on Cancer (IARC ), there is evidence pointing to a causal effect of ingested asbestos on gastric and colorectal cancer. The risk seems to be proportional to the concentration of ingested fibres, to the extent of individual water consumption, to exposure timing, and to the possible exposure to other toxics (i.e., benzo(a)pyrene). Furthermore, the exposure to asbestos by ingestion could explain the epidemiological finding of mesothelioma in subjects certainly unexposed by inhalation. In conclusion, several findings suggest that health risks from asbestos could not exclusively derive from inhalation of fibres. Health hazards might also be present after ingestion, mainly after daily ingestion of drinking water for long periods. In Italy, a systemic assessment of the presence of asbestos fibres in drinking water is still lacking, although asbestos-coated pipelines are widely diffused and still operating. Despite the fact that the existence of a threshold level for health risks linked to the presence of asbestos in drinking water is still under debate, the precautionary principle should impose all possible efforts in order to revise health policies concerning this topic, and a systematic monitoring of drinking water to quantify the presence of asbestos is certainly needed in all regions. Further epidemiological studies aimed to the identification of exposed communities and to an adequate health risk assessment in their specific geographical areas are urgently needed.


Di Ciaula A.,UO Medicina interna | Romagnoli C.,Programmazione epidemiologica | Ridolfi R.,International Society of Doctors for Environment ISDE Forli Cesena
Epidemiologia e prevenzione | Year: 2015

Studies from SENTIERI project have been crucial to show high-risk levels (mortality and morbidity) in communities living close to polluted sites. Despite the presence of some methodological limits, these studies represent a strong invitation towards primary prevention, also considering a possible underestimation of the health risk. The same pollutants responsible for the results showed in the SENTIERI studies are able to induce diseases (i.e., endocrine-metabolic diseases, spontaneous abortion, foetal malformations, autism, neurologic diseases) still unevaluated or not evaluable considering the actually available tools. SENTIERI illustrated only part of the health risk involving about 6 millions of Italians exposed since decades to environmental toxics, generated by legally approved plants. The well-documented health effects (avoidable since years) should be wider if a more extensive concept of «polluted site» was considered, according to the European Environment Agency (EEA) indications. It is ethically unacceptable to drive a model of public health based on damage recording in large communities living since decades in risky areas, absolutely neglecting preventive risk analysis. The clear results from SENTIERI did not induce great attention in politicians, who should be the main drivers of primary prevention measures. Our Country is not structured to act primary prevention actions, an unfeasible target in the short-medium term. Remediation measures were not effectively started or concluded in any of the examined sites; in some of these, additional polluting plants were realised, delaying the risk reduction. Health and environmental policies have not travelled on capable ways, until now. It is crucial to open collaborative and participative path to epidemiologists and experts skilled in environmental medicine to draw plans for prevention, which could be rapidly and effectively useful.


Botti F.,University of Milan | Losco A.,UO Medicina VI Epatologia e Gastroenterologia | Vigano C.,UO Medicina Interna | Oreggia B.,UOC Chirurgia Generale e d'Urgenza | And 2 more authors.
Journal of Ultrasound | Year: 2015

Crohn’s disease is a chronic inflammatory disease which may involve any segment of the gastrointestinal tract, most frequently the terminal ileum, the large intestine, and the perianal region. The symptoms of perianal Crohn’s disease include skin disorders, hemorrhoids, anal ulcers, anorectal stenosis, perianal abscesses and fistulas, rectovaginal fistulas and carcinoma of the perianal region. The perianal manifestations of Crohn’s disease cause great discomfort to the patient and are among the most difficult aspects to treat. Management of perianal disease requires a combination of different imaging modalities and a close cooperation between gastroenterologists and dedicated surgeons. © 2013, Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).


PubMed | UO Medicina Interna, UO Medicina VI Epatologia e Gastroenterologia, UOC Chirurgia Generale e dUrgenza and University of Milan
Type: Journal Article | Journal: Journal of ultrasound | Year: 2015

Crohns disease is a chronic inflammatory disease which may involve any segment of the gastrointestinal tract, most frequently the terminal ileum, the large intestine, and the perianal region. The symptoms of perianal Crohns disease include skin disorders, hemorrhoids, anal ulcers, anorectal stenosis, perianal abscesses and fistulas, rectovaginal fistulas and carcinoma of the perianal region. The perianal manifestations of Crohns disease cause great discomfort to the patient and are among the most difficult aspects to treat. Management of perianal disease requires a combination of different imaging modalities and a close cooperation between gastroenterologists and dedicated surgeons.


Ippoliti G.,UO Medicina Interna | Ippoliti G.,The Surgical Center | D'Armini A.M.,The Surgical Center | Lucioni M.,University of Pavia | And 2 more authors.
Biologics: Targets and Therapy | Year: 2012

The development of new immunosuppressive drugs for kidney transplantation resulted both in better short-term outcomes and in decreased metabolic, cardiovascular, and nephrotoxicity risk. Belatacept belongs to a new class of immunosuppressive drugs that selectively inhibits T-cell activation by preventing CD28 activation and by binding its ligands B7-1 and B7-2. The result is an inactivation of costimulatory pathways. A comparative analysis of the BENEFIT and BENEFIT-EXT datasets showed belatacept regimens resulted in better cardiovascular and metabolic risk profiles than did cyclosporin A (CsA) regimens: belatacept likewise outperformed CsA in terms of lower blood pressure and serum lipids and less new onset diabetes after transplantation. About 20% of belatacept-treated patients developed adverse effects which included anemia, pyrexia, neutropenia, diarrhea, urinary tract infection, headache, and peripheral edema. At present, belatacept does not seem to predispose patients to a higher rate of infection than CsA maintenance immunosuppression. The risk of posttransplant lymphoproliferative diseases was higher in Epstein-Barr virus (EBV)-seronegative patients than in EBV-seropositive patients, but the risk may be reduced by use of a less intensive regimen and avoidance of EBV-negative patients and of patients whose pretransplant EBV serology is unknown. Belatacept provides a new option for immunosuppressive therapy in kidney transplantation, but needs further evaluation in terms of the late effects that may derive from prolonged blockage of the costimulatory system and the induction of tolerance status. © 2012 Ippoliti et al, publisher and licensee Dove Medical Press Ltd.


Graziani A.,UO Medicina Interna | Quercia O.,Ambulatorio Alta Specializzazione in Allergologia | Girelli F.,Servizio di Reumatologia Ospedale GB Morgagni | Martelli A.,UO Medicina Interna | And 2 more authors.
European Annals of Allergy and Clinical Immunology | Year: 2014

Eosinophilic Granulomatosis with Polyangiitis (EGPA), formerly named Churg Strauss Syndrome, is a multisystem disorder characterized by chronic rhinosinusitis, asthma, and prominent peripheral blood eosinophilia; it is classified as a vasculitis of the small and medium sized arteries, although the vasculitis is often not clinically apparent in the initial phases of the disease. We present the case of a woman with EGPA who was frequently treated with high dose steroid therapy during hospital admission for refractory asthma. After December 2008, the date when we started Omalizumab, we observed a significative reduction of circulating eosinophils and IgE serum level, and the patient was no more hospitalized for respiratory failure or asthma attacks. © 2014, EDRA LSWR. All rights reserved.


Landini G.,UO Medicina Interna | Masotti L.,UO Medicina Interna
Italian Journal of Medicine | Year: 2013

The new oral direct anticoagulants (DOACs) could represent a new frontier for management of thromboembolic diseases. However, the new drugs have limitations that need to be considered. Despite the fact that their efficacy and safety profile are at least not inferior to comparators, bleeding risk represents the most feared complication, as for all the antithrombotic drugs. Bleeding risk increases with conditions that interfere with pharmacokinetics, in addition to the risk strictly linked to patients or their co-morbidities. Since all DOACs are excreted from kidneys (even though at different percentages according to the different molecules), renal impairment represents one of the leading causes of DOACs accumulation and bleeding risk. Moderate renal failure is the main condition in which dose adjustment of DOACs could be required, while severe renal impairment represents an absolute contraindication for their use. Renal function must, therefore, be carefully monitored before prescription and during assumption. The older population is at higher bleeding risk, and dose adjustment of DOACs could be required. Although to a lesser degree than oral anticoagulant vitamin K antagonists, DOACs can have drug interactions, especially with P-glycoprotein and cytochrome P3A4 inducers or inhibitors, and these interactions must be taken into account in real practice to avoid accumulation or under dosage. The concomitant use of other drugs, especially antithrombotics, may expose the patients to bleeding risk by reducing the hemostatic properties. ©Copyright G. Landini and L. Masotti, 2013 Licensee PAGEPress.


PubMed | International Society of Doctors for Environment ISDE Forli Cesena., UO Medicina interna and Programmazione epidemiologica
Type: Journal Article | Journal: Epidemiologia e prevenzione | Year: 2015

Studies from SENTIERI project have been crucial to show high-risk levels (mortality and morbidity) in communities living close to polluted sites. Despite the presence of some methodological limits, these studies represent a strong invitation towards primary prevention, also considering a possible underestimation of the health risk. The same pollutants responsible for the results showed in the SENTIERI studies are able to induce diseases (i.e., endocrine-metabolic diseases, spontaneous abortion, foetal malformations, autism, neurologic diseases) still unevaluated or not evaluable considering the actually available tools. SENTIERI illustrated only part of the health risk involving about 6 millions of Italians exposed since decades to environmental toxics, generated by legally approved plants. The well-documented health effects (avoidable since years) should be wider if a more extensive concept of polluted site was considered, according to the European Environment Agency (EEA) indications. It is ethically unacceptable to drive a model of public health based on damage recording in large communities living since decades in risky areas, absolutely neglecting preventive risk analysis. The clear results from SENTIERI did not induce great attention in politicians, who should be the main drivers of primary prevention measures. Our Country is not structured to act primary prevention actions, an unfeasible target in the short-medium term. Remediation measures were not effectively started or concluded in any of the examined sites; in some of these, additional polluting plants were realised, delaying the risk reduction. Health and environmental policies have not travelled on capable ways, until now. It is crucial to open collaborative and participative path to epidemiologists and experts skilled in environmental medicine to draw plans for prevention, which could be rapidly and effectively useful.


PubMed | International Society of Doctors for Environment ISDE Italia. and UO medicina interna
Type: Journal Article | Journal: Epidemiologia e prevenzione | Year: 2016

The recent finding of asbestos fibres in drinking water (up to 700.000 fibres/litres) in Tuscany (Central Italy) leads to concerns about health risks in exposed communities. Exposure to asbestos has been linked with cancer at several levels of the gastrointestinal tract, and it has been documented, in an animal model, a direct cytotoxic effect of asbestos fibres on the ileum. It has been recently described a possible link between asbestos and intrahepatic cholangiocarcinoma, and asbestos fibres have been detected in humans in histological samples from colon cancer and in gallbladder bile. Taken together, these findings suggest the possibility of an enterohepatic translocation of asbestos fibres, alternative to lymphatic translocation from lungs. In animal models, asbestos fibres ingested with drinking water act as a co-carcinogen in the presence of benzo(a) pyrene and, according to the International Agency for Research on Cancer (IARC ), there is evidence pointing to a causal effect of ingested asbestos on gastric and colorectal cancer. The risk seems to be proportional to the concentration of ingested fibres, to the extent of individual water consumption, to exposure timing, and to the possible exposure to other toxics (i.e., benzo(a)pyrene). Furthermore, the exposure to asbestos by ingestion could explain the epidemiological finding of mesothelioma in subjects certainly unexposed by inhalation. In conclusion, several findings suggest that health risks from asbestos could not exclusively derive from inhalation of fibres. Health hazards might also be present after ingestion, mainly after daily ingestion of drinking water for long periods. In Italy, a systemic assessment of the presence of asbestos fibres in drinking water is still lacking, although asbestos-coated pipelines are widely diffused and still operating. Despite the fact that the existence of a threshold level for health risks linked to the presence of asbestos in drinking water is still under debate, the precautionary principle should impose all possible efforts in order to revise health policies concerning this topic, and a systematic monitoring of drinking water to quantify the presence of asbestos is certainly needed in all regions. Further epidemiological studies aimed to the identification of exposed communities and to an adequate health risk assessment in their specific geographical areas are urgently needed.


PubMed | Ambulatorio Alta Specializzazione in Allergologia, UO Medicina Interna and Servizio di Reumatologia Ospedale GB Morgagni
Type: Case Reports | Journal: European annals of allergy and clinical immunology | Year: 2014

Eosinophilic Granulomatosis with Polyangiitis (EGPA), formerly named Churg Strauss Syndrome, is a multisystem disorder characterized by chronic rhinosinusitis, asthma, and prominent peripheral blood eosinophilia; it is classified as a vasculitis of the small and medium sized arteries, although the vasculitis is often not clinically apparent in the initial phases of the disease. We present the case of a woman with EGPA who was frequently treated with high dose steroid therapy during hospital admission for refractory asthma. After December 2008, the date when we started Omalizumab, we observed a significative reduction of circulating eosinophils and IgE serum level, and the patient was no more hospitalized for respiratory failure or asthma attacks.

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