Publications by authors named "Daniele D"

38 Publications

Skin and lung toxicity in synchronous bilateral breast cancer treated with volumetric-modulated arc radiotherapy: a mono-institutional experience.

Clin Transl Oncol 2019 Nov 14;21(11):1492-1498. Epub 2019 Mar 14.

Radiation Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona-Lugano, Via Ospedale, 6500, Bellinzona, Switzerland.

Purpose: To evaluate acute and late skin/subcutaneous toxicities and radiation-induced lung fibrosis (RILF) in patients treated with adjuvant radiotherapy (RT) for synchronous bilateral breast cancers (SBBC), after conservative surgery.

Methods/patients: Twenty-five patients were treated with volumetric-modulated arc therapy (VMAT/RapidArc) on both breasts, and checked clinically for detecting RT toxicities during and after treatment. A high-resolution computed tomography (HRCT) was performed, for detecting RILF during follow-up.

Results: We registered acute Grade-1 skin toxicity in 18 patients (72%), while six patients (24%) experienced Grade-2 toxicity. No breath symptoms were reported during and after RT. Late Grade-1 subcutaneous toxicity and late Grade-2 skin toxicity were registered in four patients (16%) and one patient (4%), respectively, at a mean follow-up of 36 months. Grade-1 RILF was detected in six patients (30%). The median volume of fibrosis area was 6.5 cc (range 1.3-21.5 cc). The partial volumes receiving a specified dose (V20, V30, V40, and V50) in patients who developed lung fibrosis were significantly bigger than who did not (p < 0.01). We showed that the mean volume of the tumour boost of patients who developed fibrosis (77.7 cc) was not significantly different from the other patients (90.8 cc) (p = 0.5).

Conclusion: The clinical impact of this technique is favourable, and this is the first clinical study showing RILF by HRCT in a setting of SBBC. Further study with larger accrual is mandatory.
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http://dx.doi.org/10.1007/s12094-019-02077-zDOI Listing
November 2019

Interaction between clozapine and oxcarbazepine: a case report.

Ther Adv Psychopharmacol 2017 Feb 15;7(2):95-99. Epub 2016 Dec 15.

Department of Pharmacology and Toxicology, University Hospital of Caen, Caen, France.

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http://dx.doi.org/10.1177/2045125316681472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5315233PMC
February 2017

Morbidity burdens attributable to various illnesses and injuries in deployed (per Theater Medical Data Store [TMDS]) active and reserve component service members, U.S. Armed Forces, 2008-2014.

MSMR 2015 Aug;22(8):17-22

This report estimates illness and injury-related morbidity and the healthcare "burden" for service members during deployments to the CENTCOM and AFRICOM theaters of operation during 2008-2014. During the 7-year surveillance period, a total of 2,863,834 medical encounters occurred among 1,596,935 service members who were deployed. Four burden categories comprised 50% or more of the total healthcare burden among both male and female deployers: injury and poisoning, mental disorders, musculoskeletal diseases, and signs and symptoms. In both genders, injuries and poisonings, and signs and symptoms, were the top two categories that affected the most individuals. Both genders had the same top four hospitalization categories: injuries and poisonings, signs and symptoms, genitourinary diseases, and digestive diseases. The limitations of the data used in the analysis are discussed.
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August 2015

Incidence of gastroesophageal reflux disease (GERD), active component, U.S. Armed Forces, 2005-2014.

MSMR 2015 Jul;22(7):14-7

Gastroesophageal reflux disease (GERD) is a common condition among adults that can cause symptoms such as frequent heartburn, substernal chest pain, and regurgitation of food. During 2005-2014, a total of 137,081 active component service members had an incident (first-ever) diagnosis of GERD (incidence rate: 101.3 per 10,000 person-years). Incidence rates were higher than their respective counterparts among females, black and white non-Hispanics, service members in the Coast Guard and Air Force, officers, and those in healthcare occupations. Rates increased monotonically with increasing age groups. Most GERD cases (79.2%) were uncomplicated GERD; however, 20.8% were identified as having a symptom or complication linked to their GERD diagnosis. Lifestyle changes, medication, and prevention of serious complications should be emphasized among individuals diagnosed with GERD, particularly those at risk for severe disease.
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July 2015

Incidence of joint replacement among active component service members, U.S. Armed Forces, 2004-2014.

MSMR 2015 May;22(5):2-8

In the U.S., joint replacements have become more common and the average age of individuals who undergo joint replacements has decreased. Joint replacements among active component service members increased 10.5% during 2004-2009, then 61.9% during 2009-2014. Knees and hips were the most frequently replaced joints among service members. During the surveillance period (and particularly after 2009), incidence rates increased in each age group of service members 30 years or older. Relative to their respective counterparts, rates of joint replacement overall--and of the hip and knee specifically--were higher among service members who were black, non-Hispanic; officers; and healthcare workers. One year after joint replacement, 18.2% had retired; 5.2% had been medically disqualified from service; 6.3% had otherwise left service; and 70.3% were still in service. By 2 years post-joint replacement, 30.2% had retired; 13.0% had been medically disqualified; 10.0% had otherwise left service; and 46.8% were still in service. Service members aged 30-44 years were the most likely to remain in service post-joint replacement. Given the increases in the frequency of joint replacement among younger service members, the number of service members who remain in service post-joint replacement may continue to increase.
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May 2015

Measles and mumps among service members and other beneficiaries of the U.S. Military Health System, January 2007-December 2014.

MSMR 2015 Feb;22(2):14-8

Measles and mumps are highly communicable infectious diseases whose causative viruses are spread through airborne droplets and infected surfaces. Individuals at highest risk are infants and unvaccinated individuals. Despite effective vaccines, there have been recent increases in incidence in the U.S. of both infections. During the surveillance period, there were 14 confirmed measles cases and 99 confirmed mumps cases among U.S. military members and other beneficiaries of the U.S. Military Health System. Only one of the confirmed cases of measles was in a service member. Children aged 5 years and younger accounted for the greatest proportion of confirmed measles cases (50.0%); the greatest proportions of confirmed mumps cases were for children aged 1-5 years and adults aged 26-30 years (22.2% and 17.2%, respectively). California had more cases of both measles and mumps than any other state. Recent trends in measles and mumps in civilian populations in the U.S. highlight the importance of primary and booster vaccinations.
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February 2015

Bilateral optic neuropathy and intraretinal deposits after pars plana vitrectomy in amyloidosis.

Indian J Ophthalmol 2015 Jan;63(1):72-4

Department of Ophthalmology, University of Padua, Padua, Italy.

Pathological examination of material from a nonextensive pars plana vitrectomy (PPV) in the right eye provided a diagnosis of nonfamilial amyloidosis in a 68-year-old woman, who presented with bilateral glass wool-like vitreous opacities. Genetic testing revealed a Tyr114Cys mutation in the transthyretin gene. Six months after PPV, perimetry showed intense constriction with a temporal island and central scotoma in the right eye. An extensive PPV was performed in the left eye. Spectral domain optical coherence tomography evidenced bilateral epimacular amyloid deposits and unreported reflective spots within the inner retina. One year later, visual acuity had decreased to 20/400 in the left eye, with mild vitreous opacity, pale cupped optic disc and inferior altitudinal field defect. Bilateral diurnal intraocular pressure, transiently increased after PPV, never exceeded 16 mmHg with medication. Our patient presented optic nerve blood supply impairment, due to amyloidosis, which caused optic atrophy. Epiretinal and intraretinal deposit detection could aid in diagnosing patients with suspected amyloidosis.
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http://dx.doi.org/10.4103/0301-4738.151481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363966PMC
January 2015

Incidence of Salmonella infections among service members of the active and reserve components of the U.S. Armed Forces and among other beneficiaries of the Military Health System, 2000-2013.

MSMR 2015 Jan;22(1):11-5

This report reviews the incidence of cases of typhoidal and non-typhoidal Salmonella infections based on diagnoses recorded in healthcare records and reported through the Armed Forces reportable medical event (RME) system. During 2000-2013, there were 1,815 incident cases of non-typhoidal Salmonella and 456 incident cases of typhoidal Salmonella diagnosed in the active component force. The crude incidence rate for non-typhoidal Salmonella was 0.91 cases per 10,000 person years (p-yrs) and the rate for typhoidal Salmonella was 0.23 cases per 10,000 p-yrs. Among retirees and family members, children under 5 years of age and those aged 75 years or older comprised the greatest number of non-typhoidal Salmonella cases. Preventive measures for reducing the risk of infection with Salmonella are discussed.
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January 2015

Meningiomas after cranial radiotherapy for childhood cancer: a single institution experience.

J Cancer Res Clin Oncol 2015 Jul 22;141(7):1277-82. Epub 2015 Jan 22.

Transition Unit for Childhood Cancer Survivors, Department of Oncology, AOU Città della Salute e della Scienza di Torino, Via Cherasco 15, 10126, Turin, Italy.

Purpose: Childhood cancer survivors (CCS) treated with cranial radiation therapy (CRT) are at risk of developing meningiomas. The aim of this study was to evaluate the cumulative incidence of meningiomas in a cohort of CCS who previously underwent CRT.

Methods: We considered all CCS who received CRT and were followed up at the "Transition Unit for Childhood Cancer Survivors" in Turin. Even though asymptomatic, they had at least one brain computed tomography or magnetic resonance imaging performed at a minimum interval of 10 years after treatment for pediatric cancer.

Results: We identified 90 patients (median follow-up 24.6 years). Fifteen patients developed meningioma (median time from pediatric cancer, 22.5 years). In four patients, it was suspected on the basis of neurological symptoms (i.e., headache or seizures), whereas all other cases, including five giant meningiomas, were discovered in otherwise asymptomatic patients. Multiple meningiomas were discovered in four CCS. Ten patients underwent surgical resection. An atypical meningioma (grade II WHO) was reported in four patients. One patient with multiple meningiomas died for a rapid growth of the intracranial lesions. A second neoplasm (SN) other than meningioma was diagnosed in five out of the 15 patients with meningioma and in ten out of the 75 CCS without meningioma. Cox multivariate analysis showed that the occurrence of meningioma was associated with the development of other SNs, whereas age, sex, or CRT dose had no influence.

Conclusions: CCS at risk of the development of meningioma deserve close clinical follow-up, especially those affected by other SNs.
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http://dx.doi.org/10.1007/s00432-015-1920-7DOI Listing
July 2015

Canada: Federal Court upholds validity of patent for Escitalopram (CIPRALEX).

Authors:
Daniel Daniele

Health Law Can 2013 May;33(4):89-92

Norton Rose Canada LLP.

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May 2013

Canada: Federal Court dismisses prohibition application for quetiapine tablets (SEROQUEL XR).

Health Law Can 2013 May;33(4):87-9

Norton Rose Canada LLP.

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May 2013

[Workers' knowledge and perception regarding noise in the neonatal unit].

Rev Esc Enferm USP 2012 Oct;46(5):1041-8

Departamento de Enfermagem Pediátrica, Universidade Federal de São Paulo, São Paulo, Brasil.

The objective of the study was to assess the knowledge and perception of professionals working in a Neonatal Intensive Care Unit (NICU) regarding the repercussions of noise on the neonates, families and workers, prior to the implementation of an educational program. This qualitative descriptive study was conducted in a NICU of a São Paulo hospital with 101 professionals. A questionnaire was used for data collection, and chi-square and Student's t test were used to determine the association between variables. The workers described the NICU as very noisy (44.9%); they noticed the effects of noise during and after their work shift (67.4%) and used strategies to reduce noise. Despite not being familiar with legislation regarding noise in the hospital, the workers identify its repercussions on themselves, the neonates and families. Results indicate the need to teach the staff about legislation and noise prevention, as well as reorganize healthcare practices and Neonatal Intensive Care Unit facilities.
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http://dx.doi.org/10.1590/s0080-62342012000500002DOI Listing
October 2012

An unusual trilobate Stafne bone cavity.

Surg Radiol Anat 2013 May 28;35(4):351-3. Epub 2012 Nov 28.

Division of Maxillofacial Surgery, Head and Neck Department, San Giovanni Battista Hospital, University of Turin, Corso Dogliotti 14, 10126, Torino, Turin, Italy.

This report describes an unusual case of trilobate Stafne bone cavity in a 72-year-old male asymptomatic patient, presenting as a radiolucency in the left mandibular body with an irregular peripheral border and a central area of reduced density on panoramic radiograph.
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http://dx.doi.org/10.1007/s00276-012-1043-7DOI Listing
May 2013

Ultrasonographic diagnosis of syringohydromyelia and segmental hypoplasia of the lumbar spinal cord in a calf.

J Vet Intern Med 2012 Nov-Dec;26(6):1485-9. Epub 2012 Oct 5.

Department of Animal Medicine, Productions and Health, University of Padua, Legnaro, Padua, Italy.

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http://dx.doi.org/10.1111/j.1939-1676.2012.00989.xDOI Listing
May 2013

A new NOTCH3 mutation presenting as primary intracerebral haemorrhage.

J Neurol Sci 2012 Apr 27;315(1-2):143-5. Epub 2011 Dec 27.

Division of Neurology and Neurorehabilitation, San Giuseppe Hospital, IRCCS Istituto Auxologico Italiano, Piancavallo (VB), Italy.

Primary intracerebral haemorrhages (PICH) are defined as haemorrhages within the brain parenchyma in the absence of readily identifiable causes. CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) is a hereditary vascular disease and its mainly clinical manifestations are early-onset infarcts. Spontaneous lobar haematomas are a rare occurrence. We report a very unusual presentation of CADASIL in a 65 year-old man carrying a new NOTCH3 mutation. The clinical onset of the disease was related to an intracerebral haematoma following colon surgery and causing a delirium. In brief, our report suggests that CADASIL must be considered in patient with PICH.
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http://dx.doi.org/10.1016/j.jns.2011.12.003DOI Listing
April 2012

Primary cerebral myxofibrosarcoma: clinical, morphologic, immunohistochemical, molecular, and ultrastructural study of an infrequent tumor in an extraordinary localization.

J Pediatr Hematol Oncol 2011 Oct;33(7):e279-83

Department of Biomedicine, Careggi Hospital, Florence, Italy.

Herein, we describe an intracerebral primary low-grade myxofibrosarcoma occurring in a 9-year-old boy. The lesion measured 7 cm and occupied the left parieto-occipital region. A gross-total removal of the tumor was performed. Nine months later, radiologic follow-up revealed a local recurrence which was again surgically removed. The patient then underwent radiotherapy and chemotherapy. He was well and disease-free at 6 months follow-up. The tumor was composed of spindle, stellated, and multinucleated cells embedded in a myxoid background. Foci of increased cellularity, pleomorphism, and high mitotic rate were present. The tumor borders were sharply demarcated from the non-neoplastic nervous parenchyma. Immunohistochemical staining showed that the neoplastic cells were vimentine and CD34 positive. Fluorescence in-situ hybridization analyses did not show FUS and EWSR1 gene rearrangements. Primary intracranial myxofibrosarcomas are very rare (to the best of our knowledge, less than 10 published cases in the international literature). We believe each new case should be recorded to produce a better clinical, pathologic, molecular, prognostic, and therapeutic characterization of this lesion.
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http://dx.doi.org/10.1097/MPH.0b013e318211834eDOI Listing
October 2011

Prevention and treatment of pressure ulcers in a university hospital centre: a correlational study examining nurses' knowledge and best practice.

Int J Nurs Pract 2010 Apr;16(2):183-7

Centre hospitalier universitaire de Québec, 11 côte du Palais, Québec, Québec, Canada.

This descriptive correlational study had the goal of exploring if relationships existed between the level of knowledge of nurses concerning pressure ulcers, certain nurses' characteristics and the preventive care they applied. A multi-method approach was taken using a questionnaire to measure the level of knowledge of nurses (n = 256) and chart audits (n = 235) to identify the preventive care applied. The results show that the level of knowledge of the nurses is insufficient. They also show a correlation between a higher level of knowledge and (i) the sector of activities in which the nurses are working, (ii) the training periods provided by the university hospital centre, and a (iii) good perception by the nurses of their level of knowledge. However, training on its own cannot guarantee the provision of quality health care, as there is a wide discrepancy between what nurses know and what they put into practice.
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http://dx.doi.org/10.1111/j.1440-172X.2010.01828.xDOI Listing
April 2010

Mechanical thrombolysis using a solitaire stent.

Neuroradiol J 2010 Apr 20;23(2):199-204. Epub 2010 Apr 20.

Neuroscience Department, University of Turin; Turin, Italy -

Mechanical offers several advantages over drug thrombolysis: in particular, the haemorrhagic risk may be not significantly increased while working out the indications got intravenous drug thrombolysis. Available tools were in our hands inefficient, stiff and dangerous. We found a retrievable stent efficient and easy to handle for this purpose. This experience is described.
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http://dx.doi.org/10.1177/197140091002300209DOI Listing
April 2010

A family with autosomal dominant leukodystrophy linked to 5q23.2-q23.3 without lamin B1 mutations.

Eur J Neurol 2010 Apr 4;17(4):541-9. Epub 2009 Dec 4.

Department of Genetics, Biology and Biochemistry, University of Torino, and SCDU.Medical Genetics, AOU San Giovanni Battista, Torino, Italy.

Background And Purpose: Duplications of lamin B1 (LMNB1) at 5q23 are implicated in adult-onset autosomal dominant leukodystrophy (ADLD) having been described in six families with diverse ethnic background but with a homogeneous phenotype. In a large Italian family, we recently identified a variant form of ADLD characterized clinically by absence of the autonomic dysfunction at onset described in ADLD and, on MRI, by milder cerebellar involvement with sparing of hemispheric white matter. Aim of this study was to investigate the genetic basis of this variant form of ADLD.

Methods: We carried out a genome-wide linkage analysis using microsatellite markers, and the genes in the candidate region were screened for point mutations. LMNB1 was also screened for deletions/duplications by real-time PCR, multiplex ligation-dependent probe amplification and Southern blot.

Results: We mapped the variant ADLD locus to 5q23.2-q23.3, a genomic region containing 11 genes including LMNB1. Neither gene copy-number defects nor point mutations in the LMNB1 gene were found. We also excluded point mutations in the coding exons of the other ten genes in the candidate region. However, expression of lamin B1 evaluated in lymphoblastoid cells was higher in patients than in healthy controls, and was similar to the lamin B1 expression levels found in a patient with LMNB1 duplication.

Conclusions: This observation suggests that a mutation in an LMNB1 regulatory sequence underlies the variant ADLD phenotype. Thus, adult forms of ADLD linked to 5q23 appear to be more heterogeneous clinically and genetically than previously thought.
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http://dx.doi.org/10.1111/j.1468-1331.2009.02844.xDOI Listing
April 2010

Double step paraneoplastic brainstem encephalitis: a clinicopathological study.

J Neurol Neurosurg Psychiatry 2009 Jun;80(6):693-5

Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy.

A case of brainstem encephalitis in a man positive for both anti-Hu and anti-Ri antibodies is reported. This case had an unusual double step evolution and progressive involvement of different CNS subdivisions at MRI. Brainstem encephalitis developed abruptly, mimicking a posterior vascular deficit with vertigo and dizziness. These symptoms transiently remitted completely after a few days to relapse acutely 1 month later with sudden loss of consciousness, followed by confusion, disorientation, dysarthria, dysphagia and reduced thermic sensation on the right side. Within another few days, the patient developed acute respiratory failure and died some weeks later. MRI was negative at the beginning but later showed a progressive ascending involvement of the brainstem and thalamus. At autopsy, this picture corresponded to lymphocytic infiltration, preferentially B cells into the perivascular spaces and T cells in the brainstem parenchyma, confirming that T cells could be the effector of cytotoxicity, probably in the presence of cooperation with B cells that were well represented in this setting.
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http://dx.doi.org/10.1136/jnnp.2008.145961DOI Listing
June 2009

Reversible MRI abnormalities in a patient with recurrent status migrainosus.

Cephalalgia 2009 Jun 11;29(6):687-90. Epub 2009 Feb 11.

Neurology II-Headache Centre, Department of Neuroscience, University of Turin, Via Cherasco 15-10126 Torino, Italy.

Status migrainosus is a condition characterized by a migraine attack causing disability, with or without aura, lasting for > 72 h. The pathophysiological mechanisms underlying this complication of migraine remain a matter of debate. We describe a migraine without aura patient who presented two episodes of status migrainosus associated with recurrent and reversible brain magnetic resonance imaging abnormalities. These abnormalities, confirmed also by positron emission tomography, suggest that status migrainosus can be associated with a condition of vasogenic cerebral oedema.
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http://dx.doi.org/10.1111/j.1468-2982.2008.01803.xDOI Listing
June 2009

A novel family with Lamin B1 duplication associated with adult-onset leucoencephalopathy.

J Neurol Neurosurg Psychiatry 2009 Feb;80(2):237-40

Department of Genetics, Biology and Biochemistry, University of Torino, via Santena, 19-10126 Torino, Italy.

Background And Aims: Duplication of the lamin B1 gene (LMNB1) has recently been described in a rare form of autosomal dominant adult-onset leucoencephalopathy. The aim of the study was to evaluate the presence of LMNB1 gene defects in a series of eight patients with diffuse adult-onset hereditary leucoencephalopathy.

Methods: Clinical features of tested patients included a variable combination of pyramidal, cerebellar, cognitive and autonomic dysfunction. Neuroradiological data (MRI) showed symmetrical and diffuse white-matter lesions in six cases, and multifocal confluent lesions in two. LMNB1 full gene deletion/duplication and point mutations were searched using a TaqMan real-time PCR assay and direct sequencing of all coding exons.

Results: One patient carried a 140-190 kb duplication involving the entire LMNB1 gene, the AX748201 transcript and the 3' end of the MARCH3 gene. Clinical and neuroimaging data of this proband and an affected relative overlapped with the features already described in patients with LMNB1 duplication. Lamin B1 expression was found increased in lymphoblasts. No LMNB1 gene defect was identified in the remaining seven probands.

Conclusions: LMNB1 gene duplication appears characteristic of a subset of adult-onset autosomal dominant leucoencephalopathies, sharing autonomic dysfunction at onset, diffuse T2-hyperintensity of supra- and infratentorial white matter, sparing of U-fibres and optic radiations. The variable phenotypes in the remaining cases lacking LMNB1 defects (five with autosomal dominant transmission) suggest that adult-onset leucoencephalopathies are genetically heterogeneous.
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http://dx.doi.org/10.1136/jnnp.2008.147330DOI Listing
February 2009

Impending flop for brand antiretrovirals in the emerging markets?

Open AIDS J 2008 16;2:68-71. Epub 2008 Aug 16.

Access to Drugs: International Policies--Italian Network for International Fight against AIDS, Italian Society for Infectious and Tropical Diseases, Division of Infectious Diseases, Pistoia Hospital, Pistoia, Italy.

Forecasts from Country choices, South-South partnerships and Clinton Foundation-UNITAID coalition show that present policies for brand ARVs are at the risk of flop in emerging South markets such as India, China, Thailand and Brazil.The dynamics explored in this article highlight the risks the originator companies are running in the emerging markets, along with their interest in direct agreements with the generic industry for the manufacturing and marketing of ARVs.Resulting information here would suggest the brand enterprises:To look for fast registration of their ARVs by regulatory authorities in all countries enlisted for differential pricing.To secure all formulations differentiated prices.To align with the Clinton-UNITAID prices for the corresponding generics.To pursue flexible negotiations with the generic companies to secure both counterparts long-term advantages.
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http://dx.doi.org/10.2174/1874613600802010068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2556197PMC
December 2009

Vertebral artery dissection complicated by basilar artery occlusion successfully treated with intra-arterial thrombolysis: three case reports.

Neurol Sci 2008 Feb 1;29(1):51-5. Epub 2008 Apr 1.

Department of Neuroscience, University of Turin San Giovanni Battista Hospital, Via Cherasco 15, 10126 Turin, Italy.

Cervical artery dissection is an important cause of stroke in young patients and accounts of 10%-20% of stroke or TIA in patients aged less than 50 years. Basilar artery occlusion (BAO) is an infrequent cause of acute stroke, which invariably leads to death or long-term disability if not recanalized. We describe three patients with BAO caused by vertebral dissection, successfully treated with intra-arterial thrombolysis. The lysis of the occluding embolus was obtained by injection of the thrombolytic drug directly or near the thrombus without haemorrhagic complications. Our cases confirm the safety and efficacy of intra-arterial thrombolysis in patients with BAO due to a vertebral artery dissection.
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http://dx.doi.org/10.1007/s10072-008-0861-1DOI Listing
February 2008

Lacunes and other holes: diagnosis, pathogenesis, therapy.

Neuroradiol J 2008 Feb 18;21(1):35-52. Epub 2008 Feb 18.

Neuroscience-Neuroradiology Department, University of Turin; Turin, Italy -

Lacunar ischemic lesions are related to a pathology involving perforators, due to direct changes in the arteries or to an indirect mechanism, such as cardiac or artery to artery embolism, or to hypoperfusion in cases of cardiac failure, or proximal occlusion of large arteries. Changes involving the large intracranial arteries have progressively been taken into consideration as a cause of the disease. This latter aspect is interesting since possible endovascular treatment can be proposed in selected cases. In patients with lacunar syndrome an extended clinical and neuroradiological approach is indicated to choose the most appropriate therapy. Not all lesions recognizable on CT/MR are the expressions of ischemic lesions, this is another important aspect that should be considered in the differential diagnosis.
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http://dx.doi.org/10.1177/197140090802100105DOI Listing
February 2008

Periprocedural morbidity and mortality by endovascular treatment of cerebral aneurysms with GDC: a retrospective 12-year experience of a single center.

Neurosurg Rev 2007 Apr 11;30(2):117-25; discussion 125-6. Epub 2007 Jan 11.

Division of Neuroradiology, Department of Neuroscience, University of Torino, Via Cherasco 15, 10126 Torino, Italy.

Despite increasing experience and improved material, endovascular treatment of cerebral aneurysms still has risks linked to the technique itself and to the specificity of the pathology treated. The purpose of this report is to examine procedural technical and clinical negative events, even minimal ones, occurring in this type of treatment. We considered 557 procedures carried out from January 1994 to December 2005 in 533 patients harboring 550 aneurysms. Of the patients, 448 presented with SAH and 85 with unruptured aneurysms. All procedures were performed under general anesthesia. The GDC-10 system was routinely used. Additional devices like the balloon remodeling technique, Trispan and stents were also occasionally used. Every procedural complication occurring during or soon after treatment was registered. Endovascular treatment was completed in 539 out of 557 procedures. There were 18 failures (3.3%). Occlusion of the aneurysm was judged complete in 343 (64%), near complete in 184 (34%) and incomplete in 12 (2%). Procedural complications occurred in 72 (13%) of the cases. The most frequent negative events were thromboembolisms (6.6%) and ruptures (3.9%). Other types (coil migration, transient occlusions of the parent vessel, dissections and early rebleeding) were rarer (2.5%). In the majority of cases there were no clinical consequences. Procedural morbidity and mortality were 1.1 and 1.8%, respectively. Considering the 449 procedures performed in ruptured and the 90 in the unruptured aneurysms separately, morbidity and mortality were 1.1 and 2.2% in the former group and 1.1 and 0% in the latter. Many factors influence the risk of complications. Being progressively aware of this and with increasing experience, the frequency can be limited. Negative events linked to the procedure have more significant serious clinical consequences in patients admitted in a critical clinical condition after SAH, because of the already present changes involving the brain parenchyma and cerebral circulation.
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http://dx.doi.org/10.1007/s10143-006-0059-zDOI Listing
April 2007

Enlarging lesion of the upper eyelid.

J Oral Maxillofac Surg 2006 Jun;64(6):943-8

Division of Maxillofacial Surgery, San Giovanni Battista Hospital, Turin, Italy.

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http://dx.doi.org/10.1016/j.joms.2006.02.016DOI Listing
June 2006

Mechanical thrombolysis in ischemic stroke attributable to basilar artery occlusion as first-line treatment.

Stroke 2006 Jan 8;37(1):145-50. Epub 2005 Dec 8.

Neuroscience Department, S.G. Battista Hospital, University of Turin, Italy.

Background And Purpose: To report results of mechanical disruption or retrieval of thrombus as first-line treatment in patients with stroke attributable to occlusion of the basilar artery, in particular regarding efficiency and safety.

Methods: In 12 consecutive patients with acute stroke attributable to basilar occlusion, mechanical disruption or thrombus retrieval using various loop-shaped tools was tried before eventually starting local intra-arterial thrombolysis with recombinant tissue plasminogen activator (r-tPA). Main inclusion criteria were: National Institutes of Health Stroke Scale score >8 or Glasgow Coma Scale score <12; onset or worsening of symptoms <8 hours; no hemorrhages or large hypodensities on computed tomography scan; and occlusion of the basilar artery matching clinical symptoms. Efficiency included recanalization, procedure time, and r-tPA dose; safety was defined as rate of procedure-related complications. Outcome was evaluated at 3 months.

Results: Mechanical recanalization was successful in 6 patients. A single brain infarction, possibly attributable to distal embolization, occurred. Three patients had good outcomes. In 5 of 6 remaining patients, the artery was recanalized using r-tPA. A single asymptomatic hemorrhage occurred; 3 patients had good outcomes. Procedure time and r-tPA were significantly less in patients with successful mechanical thrombolysis (43.33 minutes and 13.33 mg versus 112.33 minutes and 55.83 mg, respectively).

Conclusions: Mechanical recanalization was effective in half of the patients and at least as safe as local intra-arterial thrombolysis. It allowed to save r-tPA and time. Although the low success rate remains a limit, the excellent and quick anatomical recanalization obtained after successful procedures makes this approach promising.
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http://dx.doi.org/10.1161/01.STR.0000195178.20019.dcDOI Listing
January 2006

[The nurse's role in the prevention of stomatitis in patients treated with chemo- and/or radiotherapy].

Authors:
Daniela Daniele

Suppl Tumori 2004 Jul-Aug;3(4):S125-6

Clinica Oncologica, Policlinico, Chieti.

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July 2004

Brain lesions due to cerebral venous thrombosis do not correlate with sinus involvement.

Neuroradiology 1999 Jun;41(6):419-24

Department of Neuroradiology, University of Turin, Ospedale Molinette, Italy.

Cerebral venous thrombosis may be well tolerated or lead to a brain lesion; availability of collateral venous pathways may explain the great variability of the lesions. This collateral circulation involves mainly medullary and cortical veins. These are difficult to assess neuroradiologically, particularly if thrombosed. Cerebral venous thrombosis is diagnosed usually based on thrombosis of dural sinuses and of the deep venous system. We tried to correlate the site and extent of dural sinus thrombosis with the location and the size of brain lesions in 26 consecutive patients with cerebral venous thrombosis, to investigate whether a simple causal relationship exists. No significant correlation between the extent and site of thrombosis in dural sinuses and the extent and location of brain lesions was found. In some cases a clear relationship between thrombosis of cortical and medullary veins and the lesions was evident. These data suggest that sinus thrombosis alone may be well tolerated in many cases, while involvement of cortical and medullary veins leads to a worse clinical situation.
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http://dx.doi.org/10.1007/s002340050775DOI Listing
June 1999