Vieri Boddi

Acute viral hepatitis increases liver stiffness values measured by transient elastography

Liver tissue alterations other than fibrosis may have an impact on liver stiffness measurement. In this study we evaluated 18 patients without a previous clinical history of liver disease, consecutively admitted for acute viral hepatitis. In each patient, aminotransferase determination and liver stiffness measurement were performed on the same study day, at 3 different points: (1) peak increase in aminotransferase; (2) aminotransferase 50% or less of the peak; (3) aminotransferase levels ≤2× the upper limit of normal. In all patients, the degree of liver stiffness at the time of the peak increase in aminotransferases exceeded the cutoff values proposed for the prediction of significant fibrosis or cirrhosis. A progressive significant reduction in liver stiffness values was observed (P < 0.0001) in the follow‐up period in parallel with the reduction of aminotransferase levels (P < 0.0001). Moreover, a statistically significant, positive correlation between aminotransferases and liver stiffness measurement (LSM) at the onset of acute viral hepatitis was found (r = 0.53, P = 0.02 and r = 0.51, P = 0.03 for alanine aminotransferase and aspartate aminotransferase, respectively). In conclusion, the extent of necroinflammatory activity needs to be carefully considered in future studies aimed at further validating transient elastography, particularly in patients with absent or low‐stage liver fibrosis (in other words, F0‐F2 METAVIR). LSM does not represent a reliable instrument to detect the presence of advanced fibrosis and cirrhosis in patients presenting with a clinical picture of acute hepatitis. (HEPATOLOGY 2007.)

Prognostic value of 6‐minute walk corridor test in patients with mild to moderate heart failure: comparison with other methods of functional evaluation

The study was designed to evaluate the prognostic value of the 6‐min walk test (6MWT) in patients with mild to moderate congestive heart failure (CHF).

Lymph node recovery from colorectal tumor specimens: recommendation for a minimum number of lymph nodes to be examined.

Lymph node involvement is the mostimportant prognostic factor for patients who have undergone radicalsurgery for colorectal carcinoma. An accurate examination of thesurgical specimens is mandatory for the correct assessment of the lymphnode status of the tumor. The risk of understaging is particularly highfor patients with tumors classified as Dukes B (TNM stage II). The aimof this study was to determine if a specified minimum number of lymphnodes examined per surgical specimen could have any effect on theprognosis of patients who had undergone radical surgery for Dukes Bcolorectal cancer. Between 1988 and 1995 a total of 140 patientsunderwent radical resection of Dukes B colorectal cancer by the samesurgeon (C.C.). The relation between clinicopathologic variables andsurvival was estimated using the Kaplan-Meier method. The Coxproportional hazard regression model was used to identify the variablesthat can independently influence survival. A median of 12 lymph nodes(range 3–38) was examined per tumor specimen. The 5-year survival rateof Dukes B patients who had had eight or fewer lymph nodes examinedafter surgery was 54.9%, whereas the survival rate for those who hadhad nine or more lymph nodes examined was 79.9% (p < 0.001). Cox regression analysis identified the number of lymph nodes asthe only independent prognostic factor (p = 0.01).Seventy patients with one to four metastatic lymph nodes (Dukes Cpatients) who had been operated on during the same period were includedin the survival analysis for comparison. The 5-year survival rate ofthe Dukes B patients with eight or fewer lymph nodes examined wassimilar to that of the 70 Dukes C patients (54.9% and 51.8%,respectively). Examination of eight or fewer lymph nodes in Dukes Bcolorectal patients may be considered a high risk factor for missingpositive lymph nodes in the surgical specimens. Our results suggestthat harvesting and examining a minimum of nine lymph nodes persurgical specimen may be sufficient for reliable staging of lymphnode-negative tumors.

The Role of Asymptomatic Bacteriuria in Young Women With Recurrent Urinary Tract Infections: To Treat or Not to Treat?

BACKGROUND Little is known about the role of asymptomatic bacteriuria (AB) treatment in young women affected by recurrent urinary tract infection (UTI). We aimed to evaluate the impact of AB treatment on the recurrence rate among young women affected by recurrent UTI. METHODS A total of 673 consecutive asymptomatic young women with demonstrated bacteriuria from January 2005 to December 2009 were prospectively enrolled. Patients were split into 2 groups: not treated (group A, n = 312) and treated (group B, n = 361). Microbiological and clinical evaluations were performed at 3, 6, and 12 months. Quality of life was also measured. Recurrence-free rate at the end of the entire study period was the main outcome measure. RESULTS At baseline, the 2 most commonly isolated pathogens were Escherichia coli (group A, 38.4%; group B, 39.3%) and Enterococcus faecalis (group A, 32.7%; group B, 33.2%). At the first follow-up visit, there was no difference between the 2 groups (relative risk [RR], 1.05; 95% confidence interval [CI], 1.01-1.10), whereas after 6 months, 23 (7.6%) in group A and 98 (29.7%) in group B showed recurrence with a statistically significant difference (RR, 1.31; 95% CI, 1.21-1.42; P < .0001). At the last follow-up, 41 (13.1%) in group A and 169 (46.8%) in group B showed recurrence (RR, 3.17; 95% CI, 2.55-3.90; P < .0001). One patient in group A and 2 patients in group B were found to have pyelonephritis. CONCLUSIONS This study shows that AB should not be treated in young women affected by UTI, suggesting it may play a protective role in preventing symptomatic recurrence.

Urinary symptoms, quality of life and sexual function in patients with benign prostatic hypertrophy before and after prostatectomy: a prospective study

To evaluate urinary symptoms, sexual dysfunction and quality of life in patients with benign prostatic hypertrophy (BPH) before and after open prostatectomy, using the International Prostate Symptom Score (IPSS), the International Continence Society (ICS)‐‘BPH’ (ICS‐male, ICS‐sex and ICS‐QoL) and International Index of Erectile Function (IIEF) questionnaires.

Restenosis after coronary stenting in current clinical practice

BACKGROUND Randomized trials have demonstrated that planned coronary stenting may lower restenosis rate in patients with de novo short lesions. In a prospective study we sought to determine the frequency of restenosis, reocclusion, and adverse cardiovascular events after coronary stenting in a series of 258 consecutive nonselected patients, including those with complex lesions not fulfilling past and ongoing randomized trial criteria for stent implantation. METHODS Criteria for stenting were as follows: (1) dissection associated with occlusion or threatened closure, (2) a residual percentage stenosis > 30% or nonocclusive dissection, (3) restenotic lesion or chronic total occlusion. RESULTS In most cases (89%) the target lesion had two or more unfavorable morphologic characteristics, whereas only 11% of target lesions could be classified as type A or B1 lesions. Overall, the 6-month restenosis rate was 23%. By use of subgroup analysis restenosis rate was found to range widely, from 11% to 46%. With multivariate analysis, only four variables were found to be independently related to restenosis: age > 63 years (odds ratio [OR] = 2.651, p = 0.011), female sex (OR = 3.807, p = 0.002), lesion length > 12 mm (OR 3.185, p = 0.002), and type C lesion (OR 2.527, p = 0.014). CONCLUSIONS Results from randomized trials on coronary stenting cannot be extrapolated to current clinical practice because most of the treated lesions do not fulfill the criteria adopted in these studies for stent implantation. The restenosis rate is nearly four times greater for long and complex lesions treated by multiple stent implantation as compared with simple lesions, and additional studies need to be performed to evaluate the efficacy of stenting on these lesions.

High-dose aprotinin: hemostatic effects in open heart operations.

Two groups of patients were prospectively studied to evaluate the hemostatic effects of high-dose aprotinin in open heart operations. Group A patients (n = 22) received aprotinin during the entire surgical procedure. Group B patients (n = 12) served as controls. The groups were homogeneous for base variables and for cardiopulmonary bypass duration. Postoperative bleeding was lower in group A (mean, 486 mL) than in group B (830 mL) (p less than 0.01). The need for banked blood decreased by approximately half in the aprotinin patients (mean: group A, 213 mL; group B, 409 mL). Hemoglobin levels were similar in the two groups (postoperative day 7: group A, 11.29 g/100 mL; group B, 11.26 g/100 mL; NS). Platelet count decreased at the end of operation in both groups (99,000 and 95,000/mL, respectively; NS) and then increased beyond baseline levels before discharge. No complications were observed that could be attributed to aprotinin. In conclusion, we believe that the use of high-dose aprotinin is safe and effective. It decreases blood loss and reduces the need for banked blood in cardiac operations, particularly in select groups of patients (eg, those undergoing reoperation, Jehovahs Witnesses, those with renal failure).

Cumulative prognostic value of p53 mutations and bcl-2 protein expression in head-and-neck cancer treated by radiotherapy

We investigated the prognostic significance of p53‐gene mutation (exon 5–9) and bcl‐2‐protein expression in primary squamous‐cell carcinoma of the head and neck (HNSCC) treated by curative radiotherapy (RT). Primary squamous‐cell carcinomas for analysis were obtained from 85 consecutive head‐and‐neck‐cancer patients, with complete follow‐up data. We detected bcl‐2 protein in 24% (20/85) of HNSCC studied; 38 (45%) of the 85 tumours had cells bearing p53 mutations. A strong association was observed between tobacco exposure and bcl‐2‐protein expression (p = 0.003), an association also evident in those patients who had a p53‐mutated carcinoma (p = 0.049). Moreover, we found that most of the bcl‐2‐positive cancers (70%) were also mutated in the p53 gene (p = 0.010). In univariate and in multivariate analyses, the simultaneous detection of bcl‐2 expression and a p53‐gene mutation in a tumour biopsy specimen was associated with greater risk of locoregional failure (p = 0.002 and 0.001 respectively) and worse survival (p = 0.045 and 0.033) within 5 years in HNSCC patients treated by RT. The present study shows a cumulative prognostic value of simultaneous detection of bcl‐2 over‐expression and p53‐gene aberration in some primary HNSCC treated with conventional RT, and provides further evidence for cross‐talk between p53 and bcl‐2, suggesting that these genes are important determinants of radiation‐induced apoptosis, thereby modulating resistance to RT. Int. J. Cancer (Pred. Oncol.) 84:573–579, 1999.

Rapid reduction of ST-segment elevation after successful direct angioplasty in acute myocardial infarction.

The aim of this study was to evaluate whether assessment of ST-segment changes in the 12-lead electrocardiogram from admission to 30 minutes after successful direct coronary angioplasty can predict myocardial damage and functional outcome in patients with acute myocardial infarction (AMI). Of 158 consecutive patients, 117 (92 men, aged 61 +/- 11 years) were prospectively classified into 2 groups: group 1, <50% reduction in ST-segment elevation in a single selected lead (42 patients); group 2, > or =50% reduction in ST-segment elevation (75 patients). Baseline characteristics were similar except for anterior wall AMI and Killip class >2, which were more prevalent in group 1. Peak creatine kinase was significantly higher in group 1 (3,690 +/- 2,809 vs 2,592 +/- 1,960 U/L; p = 0.018). One-month echocardiograms were obtained in 102 patients (87%). Infarct zone wall motion score index decreased in both groups, but this reduction was higher in group 2 (p <0.001). Functional recovery (>0.22 decrease in infarct zone wall motion score index) was observed in 34% of group 1 and in 78% of group 2 patients (p <0.001). One-month left ventricular ejection fraction was higher in group 2 (p <0.001). At multivariate analysis, reduction of ST-segment elevation was the only independent predictor of functional recovery (p <0.001). In conclusion, ST-segment analysis provides rapid and inexpensive information allowing identification of patients who are likely to benefit the most from myocardial reperfusion as early as 30 minutes after the last balloon inflation.

Can Early Single Dose Instillation of Epirubicin Improve Bacillus Calmette-Guerin Efficacy in Patients With Nonmuscle Invasive High Risk Bladder Cancer? Results From a Prospective, Randomized, Double-Blind Controlled Study

PURPOSE We evaluated the impact of epirubicin perioperative instillation in improving subsequent bacillus Calmette-Guerin instillation efficacy in high risk patients with nonmuscle invasive bladder cancer. MATERIALS AND METHODS Between January 2005 and June 2007, 161 patients affected by high risk nonmuscle invasive bladder cancer were enrolled in this prospective, randomized, controlled, double-blind study. A total of 80 patients were assigned to group A (perioperative epirubicin 80 mg/50 ml normal saline) plus delayed bacillus Calmette-Guerin instillations (5 x 108 colony-forming units in 50 ml saline) and 81 to group B (delayed bacillus Calmette-Guerin alone). The main outcome measures were time to first recurrence and recurrence rate. All data obtained from a median followup of 15.3 months in group A and 14.8 months in group B, were analyzed. RESULTS At the end of followup 46 of 80 patients in group A (57.5%) had no evidence of disease, just like 41 of 81 in group B (50.6%). No statistical difference was observed between the 2 groups in terms of recurrence rate (p = 0.82) or time to first recurrence (p = 0.095). Kaplan-Meier analysis of recurrence showed no significant differences between group A and group B (p = 0.0952). On multivariate analysis the early single dose instillation of epirubicin was not indicated as an independent prognostic factor (HR 0.50, 95% CI 0.32-1.18). CONCLUSIONS The present study showed no statistically significant differences in terms of disease-free time and recurrence rate between high risk patients with nonmuscle invasive bladder cancer who had undergone perioperative epirubicin instillation plus delayed bacillus Calmette-Guerin and those who had undergone delayed bacillus Calmette-Guerin alone.