Eugenio Ciancia

Human Atherosclerotic Plaques Contain Gamma-Glutamyl Transpeptidase Enzyme Activity

During the last decade, growing evidence has shown that serum gamma-glutamyl transpeptidase (GGT) is an independent prognostic marker for cardiac death and reinfarction, both in unselected populations and in patients with coronary artery disease. Clinical and epidemiological evidence indicates that the prognostic value of GGT is largely independent of other risk factors for cardiovascular disease and alcohol consumption. The catalytic activity of GGT, which is present on the surface of cell membranes and in serum, is …

Helicobacter pylori Eradication: A Randomized Prospective Study of Triple Therapy Versus Triple Therapy Plus Lactoferrin and Probiotics

OBJECTIVES:Helicobacter pylori is causally associated with gastritis and peptic ulcer diseases. Recent data (meta-analysis) have demonstrated that triple therapy with amoxicillin, clarithromycin, and a proton pump inhibitor has an eradication rate of only 74–76% and new therapeutic protocols may be necessary. The aim of this study was to examine whether adding bovine lactoferrin (bLf) and probiotics (Pbs) to the standard triple therapy for H. pylori infection could improve the eradication rate and reduce side effects.METHODS:H. pylori infection was diagnosed in 206 patients: in 107 based on an upper endoscopy exam and a rapid urease test, and in 99 by means of the H. pylori stool antigen-test and the C13 urea breath test (C13 UBT). The patients were randomized into two groups: 101 patients (group A) underwent standard triple eradication therapy (esomeprazole, clarithromycin, amoxicillin), while 105 patients (group B) underwent a modified eradication therapy (standard triple eradication therapy plus bLf and Pb). Successful eradication therapy was defined as a negative C13 UBT 8 wk after completion of the treatment. Results were evaluated by intention-to-treat (ITT) and per-protocol (PP) analysis. Data were evaluated and considered positive when P < 0.05.RESULTS:At the end of the study 175/206 patients showed negative C13 UBT results. According to intention-to-treat analysis, the infection was eradicated in 73/101 patients from Group A and in 93/105 from Group B. PP analysis showed 73/96 patients from Group A and 93/101 from Group B to have been successfully treated. More patients from group A than from group B reported side effects from their treatment (P < 0.05).CONCLUSIONS:The results of our study suggest that the addition of bLf and Pbs could improve the standard eradication therapy for H. pylori infection—bLf serving to increase the eradication rate and Pbs to reduce the side effects of antibiotic therapy.

SV40 Enhances the Risk of Malignant Mesothelioma among People Exposed to Asbestos: A Molecular Epidemiologic Case-Control Study

We conducted a case-control study on asbestos exposure and presence of SV40 in tumor samples of malignant mesotheliomas (MMs) and bladder urotheliomas (BUs). PCR analysis revealed the presence of SV40 DNA (SV40+) in eight (42.1%) MMs and 6 (33.3%) BUs. The odds ratio for MM Asb- and SV40+ was 0.4 [95% confidence interval (95% CI), 0.03-4.0], for Asb+ and SV40- was 3.6 (95% CI, 0.6-21.0), and for Asb+ and SV40+ was 12.6 (95% CI, 1.2-133.9). Our results suggest that SV40 increases the risk of MM among individuals exposed to asbestos.

2CdA chemotherapy and rituximab in the treatment of marginal zone lymphoma

Standard chemotherapic approach for MZL is missing. We are presenting our monocenter experience with 2CdA+/-rituximab. Patients received 2CdA, 5mg/m(2), weekly, for 6 weeks. Patients receiving rituximab underwent to antibody administration in association with 2CdA, or after the end of chemotherapy. Global ORR was 89.3%, with 53.6% CR, with 60 months of median of TTF. 2CdA and rituximab led to 96.5% ORR, with 60.3% CR, while 2CdA alone to 73.1% ORR, with 38.5% CR. TTF median was reached at 35 months with 2CdA alone; not reached yet in the combination arm. Considering subgroups of MZL, combination therapy has a more favorable outcome in SMZL and NMZL, while MALT does not differ. However, all subgroups present a delayed relapse. Considering minimal residual disease (MRD), adding of rituximab converted 65.0% to negativity versus 15.4% of 2CdA alone, with TTF in positive patients reached after 34 months; not reached yet in negatives. Concomitant use of rituximab with 2CdA allowed an ORR of 98.0%, with 68% CR and 56.3% of MRD conversion, while consequent use 100%, 54.6%, and 70.8%, respectively. TTF does not differ. 2CdA therapy is effective in the treatment of MZL. Adding rituximab allows increasing ORR and CR, prolonging TTF.

Vascular Endothelial Growth Factor Polymorphisms in Mantle Cell Lymphoma

In this study, we determined the allele and genotype frequencies of vascular endothelial growth factor (VEGF) G+405C, C–460T, C+936T and C–2578A single nucleotide polymorphisms (SNPs) in 32 patients affected by mantle cell lymphoma (MCL) and 58 healthy controls. Real-time PCR combined with melting curve analysis was used for the determination of SNP alleles. A significant difference in the allele frequency of VEGFC–460T and C+936T SNPs in MCL and healthy cases was not observed. On the contrary, VEGF G+405C and C–2578A SNP allele distribution was significantly lower in the patient group than among normal controls (p = 0.014, p = 0.001). This observation suggests that further investigation is warranted, both in vitro and in a larger series of patients, to further examine the role of VEGF polymorphisms in the pathogenesis of MCL. In addition, the use of quantitative real-time PCR combined with a melting curve analysis method in the detection of the 4 VEGF SNPs may have the potential to replace older and more time-consuming PCR-RFLP methods and bears further investigation.

Randomised clinical trial: twice daily esomeprazole 40 mg vs. pantoprazole 40 mg in Barrett's oesophagus for 1 year

Aliment Pharmacol Ther 2011; 33: 1019–1027

Gamma-glutamyltransferase in fine-needle liver biopsies of subjects with chronic hepatitis C

Summary.  Serum gamma‐glutamyltransferase (GGT) is considered as a sensitive but rather nonspecific marker of hepatobiliary disease, including chronic hepatitis C virus (HCV) infection. Although its increase in HCV infection is associated with poor response to interferon‐α (IFN‐α) and poor prognosis, there is little knowledge of the reasons of its increase during disease.

Discordant lymphoma consisting of splenic mantle cell lymphoma and marginal zone lymphoma involving the bone marrow and peripheral blood: a case report

IntroductionDiscordant lymphomas are rare entities characterized by the simultaneous presence of two distinct types of lymphomas in different anatomic sites. We describe a very rare case of simultaneous occurrence of splenic mantle cell lymphoma and marginal zone lymphoma involving the bone marrow and peripheral blood.Case presentationWe report the case of a 60-year-old asymptomatic Caucasian woman in whom discordant lymphomas were discovered when a slight lymphocytosis and a conspicuous splenomegaly were observed. The different morphological, immunophenotypical and immunohistochemical features found in the different pathologic samples obtained from peripheral blood, bone marrow and spleen sections made it possible to differentiate two types of non-Hodgkin B-cell lymphomas: a mantle cell lymphoma infiltrating the spleen and a marginal zone lymphoma involving both the bone marrow and peripheral blood. Since a similar IgH gene rearrangement was found both in the bone marrow and in the spleen, the hypothesis of a common origin, followed by a different clonal selection of the neoplastic lymphocytes may be taken into consideration.ConclusionOur case emphasizes the usefulness of investigating simultaneous specimens from different anatomic sites from the same patient and the relevant diagnostic role of splenectomy.

Osteoid osteoma mimicking monoarticular juvenile idiopathic arthritis in a girl

Osteoid osteoma (OO) is a benign osteogenic neoplasm, usually affecting children and young adults, that is typically characterized by nocturnal pain and response to non‐steroidal anti‐inflammatory drugs. OO is frequently misdiagnosed because it mimics juvenile idiopathic arthritis (JIA), bone infection or malignancy. Herein we report the case of a girl who presented with chronic monoarthritis of the knee mimicking JIA. After 1 year, OO of the femoral distal metaphysis was diagnosed. OO was treated with computed tomography‐guided radiofrequency ablation with disappearance of the symptoms and resolution of the neoplasm. No recurrences have been observed 3 years after the treatment. This case highlights that intra‐articular or juxta‐articular OO should be suspected in the case of misleading symptoms and signs, such as swelling, lack of typical pain and synovial thickening on ultrasound; needle biopsy of the lesion is necessary in the case of confusing imaging.

Outcome of patients with mantle cell lymphoma is not influenced by vascular endothelial growth factor polymorphisms.

Notwithstanding the most recent and effective therapeutic strategies, in the majority of patients mantle cell lymphoma (MCL) is still aggressive, with median overall survival (OS) ranging from 26 to 57 months, when patients are stratified according to the mantle cell lymphoma international prognostic index (MIPI) [1,2]. Thus, several immunochemotherapy combinations have been explored to improve outcome, such as R-Hyper-CVAD (rituximab plus hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate, cytarabine) [2], R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone) [3], maxi-CHOP [4], bortezomib plus R-CHOP [5], and mTOR (mammalian target of rapamycin) inhibitors [6]. Moreover, also autologous transplant still remains a valid therapeutic option for young patients responsive to dose-intensified induction chemotherapy, with 6-year overall survival and progression-free survival of 70% and 66%, respectively [7]. In MCL, angiogenesis is a relevant prognostic factor and represents a valid target for treatment; higher vascular endothelial growth factor (VEGF) expression has been reported to correlate with shorter overall survival [8], and drugs able to inhibit VEGF seem to offer promising results in this malignancy. Bevacizumab at 10 mg/kg every 2 weeks offered a median duration of response or stable disease of 5 months to patients in first or second relapse with diffuse large B-cell or mantle cell lymphoma [9]. It has been previously reported that Gþ 405C and C72578A polymorphisms determine different values of VEGF protein, the highest values being associated with the þ 405GG and 72578CC genotypes [10,11]. In a previous study [12] where we evaluated these two single nucleotide polymorphisms (SNPs), the mutant þ 405G was detected in 93.8% of patients versus 72.4% of controls (p5 0.05), and the 72578C in 82.8% of cases of MCL versus 45.7% of controls (p5 0.05). Thus, in the present study we investigated whether these polymorphisms would significantly affect response to treatment or survival in 30 patients with MCL treated at our institution according to RHyper-CVAD (20 cases) or R-CHOP therapy (10 cases). The criterion for the choice of the regimen was chronological (first 10 cases receiving R-CHOP); the mean age of patients receiving R-CHOP was higher than that of patients receiving R-HyperCVAD (66 vs. 60 years), but not statistically different; both MIPI high-risk cases received RHyper-CVAD. Sex, bone marrow infiltration, b2microglobulin values, proliferation index Ki-67, and molecular status at diagnosis were comparable