Publications by authors named "Salvatore Bruno"

13 Publications

  • Page 1 of 1

Intraoperative Digital Analysis of Ablation Margins (DAAM) by Fluorescent Confocal Microscopy to Improve Partial Prostate Gland Cryoablation Outcomes.

Cancers (Basel) 2021 Aug 30;13(17). Epub 2021 Aug 30.

Department of Urology and Organ Transplantation, University of Foggia, 71122 Foggia, Italy.

Partial gland cryoablation (PGC) aims at destroying prostate cancer (PCa) foci while sparing the unaffected prostate tissue and the functionally relevant structures around the prostate. Magnetic Resonance Imaging (MRI) has boosted PGC, but available evidence suggests that ablation margins may be positive due to MRI-invisible lesions. This study aimed at determining the potential role of intraoperative digital analysis of ablation margins (DAAM) by fluoresce confocal microscopy (FCM) of biopsy cores taken during prostate PGC. Ten patients with low to intermediate risk PCa scheduled for PGC were enrolled. After cryo-needles placement, 76 biopsy cores were taken from the ablation margins and stained by the urologist for FCM analysis. Digital images were sent for "real-time" pathology review. DAAM, always completed within the frame of PGC treatment (median time 25 min), pointed out PCa in 1/10 cores taken from 1 patient, thus prompting placement of another cryo-needle to treat this area. Standard HE evaluation confirmed 75 cores to be cancer-free while displayed a GG 4 PCa in 7% of the core positive at FCM. Our data point out that IDAAM is feasible and reliable, thus representing a potentially useful tool to reduce the risk of missing areas of PCa during PGC.
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http://dx.doi.org/10.3390/cancers13174382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8431702PMC
August 2021

Early and midterm outcomes of hybrid first line treatment in patients with chronic limb threatening ischemia.

Vascular 2021 Aug 20:17085381211040986. Epub 2021 Aug 20.

Department of vascular surgery, University Hospital and Trust of Verona, University of Verona-School of Medicine, Verona, Italy.

Objective: The aim of the study was to evaluate the outcome of first line hybrid treatment in patients with chronic limb threatening ischemia (CLTI) and to evaluate possible predictors of primary patency (PP) loss and limb clinical improvement (LCI).

Methods: This was a retrospective non-randomized study. All patients underwent one-stage hybrid common femoral artery (CFA) endarterectomy combined with an inflow and/or outflow endovascular revascularization procedure. Demographic, clinical, and lesion characteristics for each patient were reported. Primary patency analysis was performed using Kaplan-Meier life tables, and univariate and multivariate analysis was used to assess possible predictors of PP loss and clinical improvement.

Results: Complete data were obtained from 132 patients. Patients were divided into two groups according to their Rutherford's category (RC), group 1 (Rutherford 4) and group 2 (Rutherford 5 and 6). Technical success was 98%. The overall surgical peri-operative complication rate was 8%. At a mean follow-up of 32 ± 23 months, the rate of major adverse limb events (MALE) was 30%; only the rate of major amputation between two groups was significant statistically different ( = .006). Group 1 had significantly lower amputation rate at 36 months ( = .01). The presence of high iliac peripheral artery calcium scoring system (PACCS) grade (HR 9.43, 95% CI 2.40-36.9, = .001), the poor run-off of leg vessels (HR 0.15, 95% CI 0.02-0.92, = .04), and undergoing CFA endarterectomy combined with outflow endovascular revascularization procedure (HR 4.25, 95% CI 1.07-16.89, = .04) were independent predictors of PP loss, while severe iliac artery stenosis (OR 0.09, 95% CI 0.02-0.32, = <.001) and the presence of pre-operative patent leg vessels (OR 8.03, 95% CI 2015-29.95, = .002) were the significant independent predictors of LCI.

Conclusion: The use of hybrid first line approach in patients with CLTI is a safe and feasible technique. From the analysis of the current study, it is clear that any effort should be made to achieve as many patency leg vessels as possible in order to obtain better and longer lasting clinical outcomes.
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http://dx.doi.org/10.1177/17085381211040986DOI Listing
August 2021

Simultaneous Hybrid Treatment of Multilevel Peripheral Arterial Disease in Patients with Chronic Limb-Threatening Ischemia.

J Clin Med 2021 Jun 28;10(13). Epub 2021 Jun 28.

Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy.

Background: Hybrid treatments (HT) aim to reduce conventional open surgery invasiveness and address multilevel peripheral arterial disease (PAD). Herein, the simultaneous HT treatment in patients with chronic limb-threatening ischemia (CLTI) is reported.

Methods: Retrospective analysis, for the period from May 2012 to April 2018, of patients presenting multilevel PAD with CLTI addressed with simultaneous HT. The outcomes of these interventions were measured the following metrics: early technical successes (within 30 days following treatment) and late technical successes (30 days or more following treatment) and included mortality, morbidity symptoms recurrence, and amputation. Survival and patencies were estimated. The median follow-up was 43.77 months.

Results: In the 45 included patients, the HT consisted of femoral bifurcation patch angioplasty followed by an endovascular treatment in 38 patients (84.4%) and endovascular treatment followed by a surgical bypass in 7 patients (15.6%). Technical success was 100% without perioperative mortality. Eight (17.8%) patients presented early complications without major amputations. During the follow-up, seven (15.6%) deaths occurred and six patients (13.3%) experienced symptoms recurrence, with five of those patients requiring major amputation. An estimated survival time of 5 years, primary patency, and secondary patency was 84.4%, 79.2%, and 83.3% respectively.

Conclusions: Hybrid treatments are effective in addressing patients presenting with multilevel PAD and CLTI. The common femoral artery involvement influences strategy selection. Larger studies with longer-term outcomes are required to validate the hybrid approach, indications, and results.
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http://dx.doi.org/10.3390/jcm10132865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268200PMC
June 2021

PSA Density Help to Identify Patients With Elevated PSA Due to Prostate Cancer Rather Than Intraprostatic Inflammation: A Prospective Single Center Study.

Front Oncol 2021 20;11:693684. Epub 2021 May 20.

Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.

The association between PSA density, prostate cancer (PCa) and BPH is well established. The aim of the present study was to establish whether PSA density can be used as a reliable parameter to predict csPCa and to determine its optimal cutoff to exclude increased PSA levels due to intraprostatic inflammation. This is a large prospective single-center, observational study evaluating the role of PSA density in the discrimination between intraprostatic inflammation and clinically significant PCa (csPCa). Patients with PSA ≥ 4 ng/ml and/or positive digito-rectal examination (DRE) and scheduled for prostate biopsy were enrolled. Prostatic inflammation (PI) was assessed and graded using the Irani Scores. Multivariable binary logistic regression analysis was used to assess if PSA density was associated with clinically significant PCa (csPCa) rather than prostatic inflammation. A total of 1988 patients met the inclusion criteria. Any PCa and csPCa rates were 47% and 24% respectively. In the group without csPCa, patients with prostatic inflammation had a higher PSA (6.0 vs 5.0 ng/ml; p=0.0003), higher prostate volume (58 vs 52 cc; p<0.0001), were more likely to have a previous negative biopsy (29% vs 21%; p=0.0005) and a negative DRE (70% vs 65%; p=0.023) but no difference in PSA density (0.1 vs 0.11; p=0.2). Conversely in the group with csPCa, patients with prostatic inflammation had a higher prostate volume (43 vs 40 cc; p=0.007) but no difference in the other clinical parameters. At multivariable analysis adjusting for age, biopsy history, DRE and prostate volume, PSA density emerged as a strong predictor of csPCA but was not associated with prostatic inflammation. The optimal cutoffs of PSA density to diagnose csPCa and rule out the presence of prostatic inflammation in patients with an elevated PSA (>4 ng/ml) were 0.10 ng/ml in biopsy naïve patients and 0.15 ng/ml in patients with a previous negative biopsy. PSA density rather than PSA, should be used to evaluate patients at risk of prostate cancer who may need additional testing or prostate biopsy. This readily available parameter can potentially identify men who do not have PCa but have an elevated PSA secondary to benign conditions.
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http://dx.doi.org/10.3389/fonc.2021.693684DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173030PMC
May 2021

Validation of a Low-Cost Pavement Monitoring Inertial-Based System for Urban Road Networks.

Sensors (Basel) 2021 Apr 30;21(9). Epub 2021 Apr 30.

Department of Civil, Constructional and Environmental Engineering, Sapienza University, Via Eudossiana, 18-00184 Rome, Italy.

Road networks are monitored to evaluate their decay level and the performances regarding ride comfort, vehicle rolling noise, fuel consumption, etc. In this study, a novel inertial sensor-based system is proposed using a low-cost inertial measurement unit (IMU) and a global positioning system (GPS) module, which are connected to a Raspberry Pi Zero W board and embedded inside a vehicle to indirectly monitor the road condition. To assess the level of pavement decay, the comfort index defined by the ISO 2631 standard was used. Considering 21 km of roads with different levels of pavement decay, validation measurements were performed using the novel sensor, a high performance inertial based navigation sensor, and a road surface profiler. Therefore, comparisons between determined with accelerations measured on the two different inertial sensors are made; in addition, also correlations between , and typical pavement indicators such as international roughness index, and ride number were also performed. The results showed very good correlations between the values calculated with the two inertial devices (R = 0.98). In addition, the correlations between values and the typical pavement indices showed promising results (R = 0.83-0.90). The proposed sensor may be assumed as a reliable and easy-to-install method to assess the pavement conditions in urban road networks, since the use of traditional systems is difficult and/or expensive.
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http://dx.doi.org/10.3390/s21093127DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8125624PMC
April 2021

Does Multiparametric Magnetic Resonance of Prostate Outperform Risk Calculators in Predicting Prostate Cancer in Biopsy Naïve Patients?

Front Oncol 2020 8;10:603384. Epub 2021 Jan 8.

Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy.

Background: European Association of Urology (EAU) guidelines recommend using risk-calculators (RCs), imaging or additional biomarkers in asymptomatic men at risk of prostate cancer (PCa).

Objectives: To compare the performance of mpMRI, a RC we recently developed and two commonly used RC not including mpMRI in predicting the risk of PCa, as well as the added value of mpMRI to each RC.

Design Setting And Participants: Single-center retrospective study evaluating 221 biopsy-naïve patients who underwent prebiopsy mpMRI.

Outcome Measurements And Statistical Analysis: Patients' probabilities of any PCa and clinically significant PCa (csPC, defined as Gleason-Score ≥3 + 4) were computed according to mpMRI, European Randomized Study of Screening for Prostate Cancer RC (ERSPC-RC), the Prostate Biopsy Collaborative Group RC (PBCG-RC) and the Foggia Prostate Cancer RC (FPC-RC). Logistic regression, AUC, and Decision curve analysis (DCA) were used to assess the accuracy of tested models.

Results And Limitation: The FPC-RC outperformed mpMRI in diagnosing both any PCa (AUC 0.76 0.69) and csPCa (AUC 0.80 0.75). Conversely mpMRI showed a higher accuracy in predicting any PCa compared to the PBCG-RC and the ERSPC-RC but similar performances in predicting csPCa. At multivariable analysis predicting csPCa and any PCa, the addition of mpMRI findings improved the accuracy of each calculator. DCA showed that the FPC-RC provided a greater net benefit than mpMRI and the other RCs. The addition of mpMRI findings improved the net benefit provided by each calculator.

Conclusions: mpMRI was outperformed by the novel FPC-RC and showed similar performances compared to the PBCG and ERSPC RCs in predicting csPCa. The addition of mpMRI findings improved the diagnostic accuracy of each of these calculators.
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http://dx.doi.org/10.3389/fonc.2020.603384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7821426PMC
January 2021

Boosting Psychological Well-Being through a Social Mindfulness-Based Intervention in the General Population.

Int J Environ Res Public Health 2020 11 13;17(22). Epub 2020 Nov 13.

Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy.

The benefits of mindfulness meditation among clinical and non-clinical populations have been largely reported in literature. Existing mindfulness-based programs are particularly useful in targeting specific populations while researchers have pointed out the possibility of developing programs adapted to the audience and the context. In this two-groups pre-post experimental design we developed a mindfulness-based social intervention program to target individuals from the general population. Here we present a two-groups pre-post experimental design to investigate its effectiveness on participants' psychological functioning assessed by eight self-reported questionnaires (CORE-OM, FFMQ, SWLS, PANAS, PSS, SCS, WEMWBS, SHS) which encompass different domains of well-being, mindfulness and emotional functioning. Participants, recruited on voluntary basis, were randomly allocated to treated or passive control groups and were aware of group allocation. The intervention comprises a 12-week meditation training in a big group that represents the social aspect of meditation. Data were analysed via a linear mixed effect model and intention to treat. Statistically significant results were obtained for global score of CORE-OM (β = -0.20 [-0.30; -0.10], = 0.0002), FFMQ (β = 0.20 [0.12; -0.28], < 0.0001), SWLS (β = 1.43 [0.42; 2.45], = 0.006), positive PANAS (β = 1.99 [0.95; 3.04], = 0.0002), negative PANAS (β = -1.67 [-2.92; -0.43], = 0.009), PSS (β = -2.98 [-4.25; -1.71], < 0.0001), WEMWBS (β = 4.38 [2.93; 5.83], < 0.0001) and SHS (β = 1.43 [0.42; 2.45], = 0.006). Our intervention is causally associated with an improvement of the psychological functioning and hence can be considered as a preventive measure that may potentially reduce the risk of developing psychological problems and improve the subject's general well-being. Given the voluntary recruitment, our inference only applies to those individuals who have decided to experience meditation as a way to well-being and not to a random person from the general population.
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http://dx.doi.org/10.3390/ijerph17228404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7697027PMC
November 2020

Carotid Endarterectomy with Modified Eversion Technique: Results of a Single Center.

Ann Vasc Surg 2021 Apr 13;72:627-636. Epub 2020 Nov 13.

Department of Vascular Surgery, University Hospital and Trust of Verona, University of Verona - School of Medicine, Verona, Italy.

Background: Carotid endarterectomy (CEA) has a wide range of approaches based on personal expertise and preference. We evaluated our outcome with CEA with modified eversion technique (meCEA) under local anesthesia and whether the surgeon's experience could influence it.

Methods: at our Institution, 837 patients underwent CEA across 8 years. Although the surgical technique was standardized, 2 groups were considered further: meCEA performed by a single Senior Operator (Group A) and meCEA performed by 4 young Consultants (Group B).

Results: A selective shunting policy was needed in 5.1%, together with general anesthesia. Overall operative time was 63.9 ± 15.1 minutes (61.4 ± 12.5 and 66 ± 16.9 minutes in Group A and Group B respectively; P < 0.001) and cross-clamp time 19.3 ± 2.9 minutes (19.0 ± 3.2 vs. 19.5 ± 2.8, P = 0.009). At 30 days, 0.7% TIA and 0.8% strokes were recorded. No differences (p = N.S.) between the 2 study groups in terms of postoperative neurological complications, with postoperative ipsilateral strokes always < 1%. At a median imaging follow-up of 22.5 months, the overall percentage of restenosis was 3.7%, with no difference between the 2 groups (P = 0.954). Twenty-two patients (2.6%) underwent reintervention for significant restenosis, and none of them had an ipsilateral stroke or TIA. Freedom from reintervention for restenosis at 24 months was 97.9% in Group A and 95.9% in Group B, with no between-group difference (P = 0.14). At the median survival follow-up of 37 months, the overall survival rate at 24 months was 97.9%in Group A, and 97.9% in Group B, with no between-group difference (P = 0.070).

Conclusions: In our experience, CEA with a modified technique is safe and achieves comparable outcomes to those of other established techniques. The reported short cross-clamp time, also in less experienced hands, is an additional strength.
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http://dx.doi.org/10.1016/j.avsg.2020.09.047DOI Listing
April 2021

Short-Term Meditation Training Fosters Mindfulness and Emotion Regulation: A Pilot Study.

Front Psychol 2020 26;11:558803. Epub 2020 Oct 26.

Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.

The practice of meditation has been historically linked to beneficial effects, not only in terms of spirituality but also in terms of well-being, general improvement of psychophysiological conditions and quality of life. The present study aims to assess the beneficial effects of a short-term intervention (a combination of 12 practical 1-h sessions of meditation, called , and lectures on neuroscience of meditation) on psychological indicators of well-being in subjects from the general population. We used a one-group pretest-posttest quasi-experimental design, in which all participants ( = 41, 17 men and 24 women, with a mean age of 41.1 years) underwent the same intervention. Out of these, 24 had already experienced meditation practice, but only 12 in a continuative way. Effects were assessed by the standardized Italian version of three self-report questionnaires: Core Outcome in Routine Evaluation-Outcome Measure (CORE-OM), Five-Facet Mindfulness Questionnaire (FFMQ), and Emotion Regulation Questionnaire (ERQ). The questionnaires were filled in at baseline and immediately after the last meditation session. Linear mixed effect models were used to evaluate pre-post treatment changes on each outcome. Participants showed a general, close to a statistically significant threshold, improvement in the total score of CORE-OM and its different domains. The total score of FFMQ (β = 0.154, = 0.012) indicates a statistically significant increase in the level of mindfulness as well as in the domains (β = 0.212, = 0.024), and (β = 0.384, < 0.0001). Lastly, we observed a statistically significant improvement in the ERQ domain (β = 0.541, = 0.0003). Despite some limitations (i.e., small sample size, lack of a randomised control group and sole use of "soft" measurements, such as self-report questionnaires), this study offers promising results regarding the within-subject effectiveness of our intervention that includes a meditation practice on psychological indicators, thus providing interesting preliminary results.
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http://dx.doi.org/10.3389/fpsyg.2020.558803DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649763PMC
October 2020

Bioptic intraprostatic chronic inflammation predicts adverse pathology at radical prostatectomy in patients with low-grade prostate cancer.

Urol Oncol 2020 10 25;38(10):793.e19-793.e25. Epub 2020 Mar 25.

Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy.

Purpose: To determine the potential role of bioptic inflammation (Irani score) in predicting adverse pathology (AP) at radical prostatectomy (RP) in patients with low-grade (ISUP Gleason Group [ISUP GG] 1 and 2) prostate cancer (CaP).

Methods: After institutional review board-approval, we identified patients who underwent prostate biopsy, had bioptic Irani score assessment, were diagnosed with low-grade CaP (ISUP GG 1-2, prostate-specific antigen [PSA] <20 ng/ml), and underwent RP. The impact of standard clinicopathological variables and bioptic Irani Score (G = grade and A = aggressiveness) on AP at RP, defined as stage ≥T3 and/or ISUP GG ≥3, was assessed by univariate and multivariate logistic regression analysis.

Results: A total of 282 patients were eligible for this study. AP at RP occurred in 37 of 214 (17.3%) patients with ISUP GG 1, and 26 of 68 (38.2%) with ISUP GG 2. At univariate analysis, serum PSA, PSA density, bioptic ISUP GG, number of positive cores, total percentage of core involvement and Irani G score emerged as significant risk factors of AP. At multivariate analysis, however, only PSA density, bioptic ISUP GG, total percentage of core, and Irani G score kept statistical significance. The area under the curve for the resulting model was 0.75.

Conclusions: This is the first study demonstrating that low-grade inflammation is associated with a significantly increased risk of AP at RP. These findings would support the concept of prostatic inflammation being inversely correlated with presence and aggressiveness of CaP. Further studies are needed to externally validate the role of this readily available parameter in the decision-making process of patients with low-grade CaP.
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http://dx.doi.org/10.1016/j.urolonc.2020.02.025DOI Listing
October 2020

Cinical outcomes of Endurant II stent-graft for infrarenal aortic aneurysm repair: comparison of on-label versus off-label use.

Diagn Interv Radiol 2016 Sep-Oct;22(5):450-4

Vascular Surgery Unit, AOUP "P. Giaccone", University of Palermo, Palermo, Italy.

Purpose: We aimed to compare the outcomes of the Endurant II (Medtronic) stent-graft used under instructions for use versus off-label in high-risk patients considered unfit for conventional surgery.

Methods: Data from patients treated with the Endurant II stent-graft between December 2012 and March 2015 were retrospectively analyzed. Sixty-four patients were included. Patients were assigned to group A if treated under instructions for use (n=34, 53%) and to group B if treated off-label (n=30, 47%). Outcome measures included perioperative mortality and morbidity, survival, freedom from reintervention, endoleak incidence, in-hospital length of stay, and mean stent-graft component used. Mean follow-up was 22.61±12 months (median, 21.06 months; range, 0-43 months).

Results: One perioperative mortality (1.6%) and one perioperative complication (1.6%) occurred in group B. At two months follow-up, one iliac limb occlusion (1.6%) occurred in group A. No type I/III endoleaks were recorded. A type II endoleak was identified in three cases (4.7%). Overall survival at three years was 89% (97% for group A, 82% for group B; P = 0.428). Reintervention-free survival at three years was 97% for both groups (P = 0.991). A longer in-hospital stay was observed in group B (P = 0.012).

Conclusion: The Endurant II (Medtronic) new generation device was safe in off-label setting at mid-term follow-up. The off-label use of the Endurant II (Medtronic) is justified in patients considered unfit for conventional surgery. Larger studies are required in this subgroup of patients.
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http://dx.doi.org/10.5152/dir.2016.15418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5019849PMC
May 2017

Computer-Assisted Classification Patterns in Autoimmune Diagnostics: The AIDA Project.

Biomed Res Int 2016 3;2016:2073076. Epub 2016 Mar 3.

Ospedale Civico, 90121 Palermo, Italy.

Antinuclear antibodies (ANAs) are significant biomarkers in the diagnosis of autoimmune diseases in humans, done by mean of Indirect ImmunoFluorescence (IIF) method, and performed by analyzing patterns and fluorescence intensity. This paper introduces the AIDA Project (autoimmunity: diagnosis assisted by computer) developed in the framework of an Italy-Tunisia cross-border cooperation and its preliminary results. A database of interpreted IIF images is being collected through the exchange of images and double reporting and a Gold Standard database, containing around 1000 double reported images, has been settled. The Gold Standard database is used for optimization of a CAD (Computer Aided Detection) solution and for the assessment of its added value, in order to be applied along with an Immunologist as a second Reader in detection of autoantibodies. This CAD system is able to identify on IIF images the fluorescence intensity and the fluorescence pattern. Preliminary results show that CAD, used as second Reader, appeared to perform better than Junior Immunologists and hence may significantly improve their efficacy; compared with two Junior Immunologists, the CAD system showed higher Intensity Accuracy (85,5% versus 66,0% and 66,0%), higher Patterns Accuracy (79,3% versus 48,0% and 66,2%), and higher Mean Class Accuracy (79,4% versus 56,7% and 64.2%).
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http://dx.doi.org/10.1155/2016/2073076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794569PMC
December 2016

Neurobrucellosis associated with syndrome of inappropriate antidiuretic hormone with resultant diabetes insipidus and hypothyroidism.

J Clin Microbiol 2010 Oct 11;48(10):3806-9. Epub 2010 Aug 11.

Department of Infectious Diseases, G. Martino Hospital, University of Messina, Messina, Italy.

Neurological involvement of the central nervous system in brucellosis is uncommon. We describe a rare case of meningoencephalitis due to Brucella melitensis infection, associated with the syndrome of inappropriate antidiuretic hormone secretion and leading to diabetes insipidus and hypothyroidism. Neurobrucellosis, although rare, should be considered in cases of neurological disease of unknown etiology.
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http://dx.doi.org/10.1128/JCM.00721-10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953098PMC
October 2010
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