Marco Giustini

Systematic review: endoscopic dilatation in Crohn’s disease

Background  Endoscopic dilatation for Crohn’s disease has been evaluated only in some small and heterogeneous studies.

Effect of Italy’s motorcycle helmet law on traumatic brain injuries

Objectives: To evaluate the impact of a revised Italian motorcycle-moped-scooter helmet law on crash brain injuries. Design: A pre-post law evaluation of helmet use and traumatic brain injury (TBI) occurrence from 1999 to 2001. Setting: Romagna region, northeastern Italy, with a 2000 resident population of 983 534 persons. Participants: Motorcycle-moped rider survey for helmet use compliance and all residents in the region admitted to the Division of Neurosurgery of the Maurizio Bufalini Hospital in Cesena, Italy for TBI. Outcome measures: Helmet use compliance and change in TBI admissions and type(s) of brain lesions. Results: Helmet use increased from an average of less than 20% to over 96%. A comparison of TBI incidence in the Romagna region shows that there was no significant variation before and after introduction of the revised helmet law, except for TBI admissions for motorcycle-moped crashes where a 66% decrease was observed. In the same area TBI admissions by age group showed that motorcycle mopeds riders aged 14–60 years sustained significantly fewer TBIs. The rate of TBI admissions to neurosurgery decreased by over 31% and epidural hematomas almost completely disappeared in crash injured moped riders. Conclusions: The revised Italian mandatory helmet law, with police enforcement, is an effective measure for TBI prevention at all ages.

Peyronie’s Disease: Prevalence and Association with Cigarette Smoking

Objectives: We present a multicenter, population–based epidemiological survey aimed at assessing the prevalence of Peyronie’s disease (PD) and its potential risk factors in the general population. Methods: In each of the ten centers throughout Italy, a uroandrologist contacted all the men in the age range 50–69 years registered with a general practitioner (GP). The subjects recruited were evaluated on the basis of their medical history, including alcohol consumption and cigarette smoking. The following questionnaires were administered: IIEF, IIPSS symptom score, premature ejaculation and PD. Results: All the subjects registered with a GP were invited to participate in the study. Of the 1,180 subjects, 647 (53%) entered over survey. In this population, 46 cases of PD were identified, accounting for a prevalence of 7.1%. The prevalence rate increased with age even if the trend is not statistically significant. The multivariate analysis showed a significant correlation between cigarette smoking and PD, with an odds ratio (OR) of 4.6 (CL 95%) confidence limit 1.506– 14.287). Smoking as single variable had an OR of 7.2 (95% CL 2.34–24.93). No significant association was observed between PD and the other variables such as cardiovascular diseases, diabetes, hypertension and alcohol consumption. Conclusions: PD is a much more frequent condition in the general population than previously reported. According to our results, cigarette smoking may be considered a risk factor for developing PD. If further and more targeted studies confirm that giving up smoking may reduce the risk of developing PD, then there will be new prospects for primary and secondary prevention and for curbing the progression of the disease.

Renal Osteodystrophy in Predialysis and Hemodialysis Patients: Comparison of Histologic Patterns and Diagnostic Predictivity of Intact PTH

Background: Comparison of renal osteodystrophy in predialysis and hemodialysis has been rarely reported. Distinct patterns of renal osteodystrophy could be found in these conditions. In addition the use of parathyroid hormone (PTH) and other markers for noninvasive diagnosis may result in different predictive values in predialysis and hemodialysis patients. Methods: 79 consecutive patients with conservative chronic renal failure and 107 patients on hemodialysis were studied. All patients were subjected to bone biopsy for histological and histomorphometric evaluation. The patients had no exposure to aluminium before dialysis and relatively low exposure while on hemodialysis. Results: In the predialysis patients, bone biopsies showed 9 cases of adynamic bone disease (ABD) and 8 cases of osteomalacia (OM), 50 patients with mixed osteodystrophy and 2 cases of hyperparathyroidism. Among the hemodialysis patients 12 cases had ABD, 3 cases OM, 30 mixed osteodystrophy, and 61 patients hyperparathyroidism. In the predialysis patients with chronic renal failure, bone aluminium was on average 4.5 mg/kg dry weight, while in dialysis patients the average value was 35.4 mg/kg dry weight. Discriminant analysis of low turnover osteodystrophy (ABD and OM) by intact PTH showed higher accuracy in dialysis than in predialysis patients. Correlation studies of intact PTH versus bone formation rate, osteoblast surface/bone surface and osteoclast surface/bone surface showed significantly steeper slopes in dialysis than in predialysis patients, which indicates that bone resistance to PTH is more marked in predialysis patients. Conclusions: The prevalence of ABD and OM in the geographic area investigated is lower than in other reports. Aluminium exposure does not seem to be the cause of low turnover osteodystrophy in the present population. The predictive value of intact PTH in the noninvasive diagnosis of renal bone disease is higher in hemodialysis patients than in predialysis patients. Predialysis chronic renal failure, when compared to the dialysis stage, seems to be characterized by resistance of bone tissue to PTH.

A preliminary investigation of road traffic accident rate after severe brain injury

Primary objective: to investigate the road traffic accident rate in patients who have resumed driving after severe brain injury. Research design: a retrospective study conducted by means of telephone interviews. Methods and procedures: The caregivers of 90 patients suffering from severe brain injury were included. All of the patients had sustained severe brain injury and prolonged coma, i.e. lasting for at least 48 hours. The caregivers were interviewed by means of a Questionnaire that investigated several aspects of driving competence after coma and the incidence of road traffic accidents. Main outcomes and results: All patient outcomes were evaluated by means of the Glasgow Outcome Scale (GOS). The 90 caregivers reported that 29 patients (32%) had resumed driving and that 11 of the 29 (38%) were subsequently involved in road traffic accidents. During the total duration of our patient population risk exposure, we found 11 cases in our study group, against the 4.7 expected cases calculated in the normal population. The relative risk of road traffic accidents in severe brain injury patients versus uninjured individuals was 2.3. Conclusions: Our preliminary data show that a subject who has suffered from severe brain injury and coma lasting for at least 48 hours has a statistically significant higher risk of being involved in a road traffic accident.

Histomorphometric assessment of bone turnover in uraemic patients: comparison between activation frequency and bone formation rate

Histomorphometric assessment of bone turnover in uraemic patients: comparison between activation frequency and bone formation rate

Management and long-term follow-up of early stage H. pylori-associated gastric MALT-lymphoma in clinical practice: an Italian, multicentre study

BACKGROUND/AIM Data on management and long-term follow-up of Helicobacter pylori-associated MALT-lymphoma in clinical practice are scanty. We evaluate the long-term efficacy of H. pylori eradication on low-grade MALT-lymphoma, and the efficacy of further therapies in refractory patients. METHODS This study enrolled patients with stages I-II(1) MALT-lymphoma and H. pylori infection. H. pylori eradication was attempted in all patients. Patients with lymphoma persistence or progression following H. pylori treatments received further lymphoma treatments. Both 5-year and disease-free survivals were calculated. RESULTS Sixty patients (stage I/II(1): 50/10) were followed up for a median time of 65 months (range 7-156). H. pylori infection was successfully eradicated in 53 (88.3%) patients following three consecutive therapeutic attempts, and lymphoma regressed in 42 (79.2%) of these patients. Sixteen patients received anti-neoplastic treatments due to either lymphoma persistence or progression, and lymphoma was cured in 14 (87.5%) cases. At follow-up, lymphoma relapsed in 13/42 (30.9%) patients within a median time of 19 months (range 3-41), and all but 1 patient were cured with further therapies. Overall, lymphoma regression was achieved in 56 patients (93.3%). The 5-year and disease-free survivals were 94.7% and 74.6%, respectively. CONCLUSIONS In clinical practice, a conservative approach with antibiotic eradication seems to be appropriate management for early-stage MALT-lymphoma, with oncologic therapy being reserved for those patients who fail to respond to H. pylori therapy.

Return to Driving After Severe Traumatic Brain Injury: Increased Risk of Traffic Accidents and Personal Responsibility

Objective:To determine the frequency of road traffic accidents among individuals who start or resume driving after severe traumatic brain injury (TBI) and to investigate their responsibility for these accidents. Design:Observational/retrospective study. Participants:Sixty adults with severe TBI and their caregivers. Measures:Return to Driving Questionnaire and Glasgow Outcome Scale. Results:Thirty of the 60 participants started to drive or resumed driving after TBI. Nineteen (63%) of them were involved in traffic accidents, with personal responsibility in 26 of 36 after return to driving. Participants caused a significantly higher number of accidents after TBI than before. Conclusions:The ability to drive is frequently compromised after severe TBI. Specific rehabilitation of this complex activity should be a main goal of social reintegration programs in this population.

Clinical and histologic predictors of Helicobacter pylori infection recurrence

Factors influencing Helicobacter pylori infection recurrence still have not been fully clarified. The aim of this study was to determine whether, after eradication of H. pylori, any clinical or histologic features could yield information on infection relapse. We enrolled in the study 72 patients successfully treated for H. pylori infection by either dual (n = 49) or triple (n = 23) therapy. H. pylori eradication was defined as a negative bacterial finding by rapid urease test and histologic assessment at least 4 weeks after cessation of therapy. Upon eradication, gastritis grading was performed and patients were asked to return for an endoscopic control 6-8 months later. The recurrence of H. pylori infection was observed in 12 of 72 (16.7%) patients. The infection recurrence rate resulted significantly higher in nonulcer dyspepsia patients (p = 0.01 ) and in women (p = 0.03), whereas infection relapse did not differ between patients treated with dual or triple therapy. There was a strong (p = 0.0001 ) relationship between the persistence of chronic active gastritis after H. pylori eradication and recurrence of infection, whereas gastritis grade and metaplasia were not related to recurrence. In conclusion, this study found that H. pylori infection recurrence after successful dual or triple therapy is fairly high and that gastroduodenal disease, gender, and gastritis activity seem to affect infection relapse.

Urinary Deoxypyridinoline Excretion for the Evaluation of Bone Turnover in Chronic Renal Failure

Background: The urinary excretion of deoxypyridinoline (DPD) was evaluated in predialysis chronic renal failure (CRF), together with intact PTH and several classic markers of bone turnover in order to assess whether urine free and total DPD excretion are equivalent parameters of bone turnover in CRF, and to evaluate the relationship between urine DPD excretion, PTH and the other bone markers. Methods: The study was carried out in 94 patients with different degrees of renal failure due to various kidney diseases. Besides urinary DPD expressed as free DPD, total DPD, free/total DPD, free DPD/Cr and total DPD/Cr, the following determinations were made: intact PTH, bone alkaline phosphatase (BALP), total alkaline phosphatase (AP), osteocalcin (BGP), serum C-terminal telopeptide of collagen type I (ICTP) and hydroxyproline (OHpro). The patients were divided into 3 groups according to the increasing severity of renal failure (Ccr >40, 40–20, <20 ml/min). Results: The ratio free/total DPD decreased (NS) with advancing renal failure, and was inversely correlated with total DPD excretion. While PTH increased progressively to about four times the values observed in the Ccr >40 group, there was a parallel increase only in BGP and ICTP, parameters retained in the serum with decreasing renal function, while AP, BALP, total DPD and OHpro did not change. However, significant correlations between total DPD/Cr and PTH, BALP, BGP and ICTP were also found. Conclusions: In CRF free DPD is an unreliable index of bone turnover due to a probable interference in its production from the peptide-bound DPD. Total DPD or total DPD/Cr are better used. In spite of the significant correlations observed in advanced renal failure between PTH and most of the parameters examined, a resistance of bone tissue to PTH action in CRF must be considered.