Publications by authors named "Silvia Leone"

36 Publications

Pericarditis after SARS-CoV-2 Infection: Another Pebble in the Mosaic of Long COVID?

Viruses 2021 10 4;13(10). Epub 2021 Oct 4.

Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.

With the emerging success of the COVID-19 vaccination programs, the incidence of acute COVID-19 will decrease. However, given the high number of people who contracted SARS-CoV-2 infection and recovered, we will be faced with a significant number of patients with persistent symptoms even months after their COVID-19 infection. In this setting, long COVID and its cardiovascular manifestations, including pericarditis, need to become a top priority for healthcare systems as a new chronic disease process. Concerning the relationship between COVID-19 and pericardial diseases, pericarditis appears to be common in the acute infection but rare in the postacute period, while small pericardial effusions may be relatively common in the postacute period of COVID-19. Here, we reported a series of 7 patients developing pericarditis after a median of 20 days from clinical and virological recovery from SARS-CoV-2 infection. We excluded specific identifiable causes of pericarditis, hence we speculate that these cases can be contextualized within the clinical spectrum of long COVID. All our patients were treated with a combination of colchicine and either ASA or NSAIDs, but four of them did not achieve a clinical response. When switched to glucocorticoids, these four patients recovered with no recurrence during drug tapering. Based on this observation and on the latency of pericarditis occurrence (a median of 20 days after a negative nasopharyngeal swab), could be suggested that post-COVID pericarditis may be linked to ongoing inflammation sustained by the persistence of viral nucleic acid without virus replication in the pericardium. Therefore, glucocorticoids may be a suitable treatment option in patients not responding or intolerant to conventional therapy and who require to counteract the pericardial inflammatory component rather than direct an acute viral injury to the pericardial tissue.
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http://dx.doi.org/10.3390/v13101997DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8540566PMC
October 2021

Management of alcohol-related liver disease in liver transplant candidate patients.

Minerva Gastroenterol Dietol 2020 Sep 24;66(3):291-292. Epub 2020 Mar 24.

Unit of Gastroenterology, Molinette-S. Giovanni Antica Sede Hospital, Turin, Italy.

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http://dx.doi.org/10.23736/S1121-421X.20.02689-6DOI Listing
September 2020

Severe acute alcoholic hepatitis and liver transplantation: recent knowledge.

Minerva Gastroenterol Dietol 2020 Jun 24;66(2):87-89. Epub 2020 Mar 24.

Department of Internal Medicine, SS Annunziata Hospital, University of Ferrara, Cento, Ferrara, Italy.

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http://dx.doi.org/10.23736/S1121-421X.20.02688-4DOI Listing
June 2020

Heart disease in patients suffering from alcohol related liver disease.

Panminerva Med 2020 Mar 23. Epub 2020 Mar 23.

Unit of Gastroenterology, Molinette Hospital, Turin, Italy.

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http://dx.doi.org/10.23736/S0031-0808.20.03889-6DOI Listing
March 2020

Hospital readmission of patients with hepatic encephalopathy: Is the introduction of the formal caregiver useful in care management?

Dig Liver Dis 2020 03 23;52(3):358-359. Epub 2019 Dec 23.

Department of Internal Medicine, SS Annunziata Hospital, Cento, Ferrara, Italy; "G. Fontana" Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Medical and Surgical Science, University of Bologna, Italy.

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http://dx.doi.org/10.1016/j.dld.2019.12.002DOI Listing
March 2020

Management of addiction medicine: sharing medicine?

Minerva Med 2020 02 30;111(1):1-3. Epub 2019 Jul 30.

Unit of Addiction Medicine and Hepatology, Regional Alcohol Treatment Center, ASL3 Liguria, Genoa, Italy -

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http://dx.doi.org/10.23736/S0026-4806.19.06257-8DOI Listing
February 2020

Atrial fibrillation and alcoholic beverages.

Minerva Med 2019 Oct 14;110(5):471-472. Epub 2019 Feb 14.

Unit of Gastroenterology, Molinette Hospital, Turin, Italy.

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http://dx.doi.org/10.23736/S0026-4806.19.05958-5DOI Listing
October 2019

Inflammatory bowel disease and alcohol consumption.

Minerva Gastroenterol Dietol 2019 Jun 11;65(2):82-84. Epub 2019 Feb 11.

Unit of Gastroenterology, Molinette Hospital, Turin, Italy.

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http://dx.doi.org/10.23736/S1121-421X.19.02560-1DOI Listing
June 2019

Liver transplantation: a new era.

Minerva Gastroenterol Dietol 2019 06 11;65(2):163-164. Epub 2019 Feb 11.

Unit of Gastroenterology, Molinette Hospital, Turin, Italy.

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http://dx.doi.org/10.23736/S1121-421X.19.02555-8DOI Listing
June 2019

Alcoholic liver fibrosis: detection and treatment.

Minerva Med 2018 Dec 13;109(6):457-471. Epub 2018 Sep 13.

Unit of Gastroenterology, Molinette Hospital, Turin, Italy.

Alcohol consumption is one of the main risks to public health. Alcohol use disorders (AUDs) cause 80% of hepatotoxic deaths, and approximately 50% of cirrhosis is alcohol-related. The acceptable daily intake (ADI) for ethanol is 2.6 g/day, deduced from morbidity and mortality rates due to liver fibrosis. The relative risk of cirrhosis increases significantly for doses above 60 g/day for men and 20 g/day for women over a period of around 10 years. Twenty to 40% of steatosis cases will evolve into steatohepatitis/steatofibrosis, and 8 to 20% will evolve directly into liver cirrhosis. About 20 to 40% of steatohepatitis cases will evolve into cirrhosis, and 4 to 5% into hepatocellular carcinoma. This cascade of events evolves in 5 to 40 years, with the temporal variability caused by the subjects' genetic patterns and associated risk/comorbidity factors. Steatohepatitis should be considered "the rate limiting step:" usually, it can be resolved through abstinence, although for some patients, once this situation develops, it is not substantially modified by abstention and there is a risk of fibrotic evolution. Early detection of fibrosis, obtained by hepatic elastography, is a crucial step in patients with AUDs. Such strategy allows patients to be included in a detoxification program in order to achieve abstention. Drugs such as silybin, metadoxine, and adenosylmethionine can be used. Other drugs, with promising antifibrotic effects, are currently under study. In this review, we discuss clinical and pathogenetic aspects of alcohol-related liver fibrosis and present and future strategies to prevent cirrhosis.
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http://dx.doi.org/10.23736/S0026-4806.18.05844-5DOI Listing
December 2018

Hepatitis C virus, alcohol use disorders and hepatocellular carcinoma.

Panminerva Med 2020 06 10;62(2):123-124. Epub 2018 Jul 10.

Alcohological Regional Center, Ligurian Region, ASL3 San Martino Policlinic Hospital, Genoa, Italy.

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http://dx.doi.org/10.23736/S0031-0808.18.03515-2DOI Listing
June 2020

Addiction disorders: a need for change. Proposal for a new management. Position paper of SIA, Italian Society on Alcohol.

Minerva Med 2018 Oct 2;109(5):369-385. Epub 2018 Jul 2.

Italian Society on Alcohol, Bologna, Italy.

Various epidemiological and biological evaluations and the recent publication of the DSM-V (diagnostic and statistical manual of mental disorders) has imposed on the scientific community a period of reflection on the diagnosis and treatment of what in the DSM-IV was defined as "addiction". To date, the term "addiction" has been replaced by the DSM-5, because there is no global scientific consensus that has unequivocally characterized its clinical characteristics. This, we will talk about substance/alcohol use disorders (SUDs/AUDs) and disorders related to behavioral alterations (DBA) that can generate organic diseases, mental disorders, and social problems. In the first psychotic episode 40-70% of subjects meet the criteria of a SUDs/AUDs, excluding tobacco dependence. Substances can not only be the cause of a psychotic onset, but they can also disrupt a psychotic picture or interfere with drug therapy. The pharmacodynamic profiles of many substances are able to provoke the phenomenology of the main psychotic symptoms in a way that can be superimposed onto those presented by psychotic subjects without a history of SUDs/AUDs. The Department of Addictions (DAs) must not be absorbed by or incorporated into the Departments of Mental Health (DMH), with which, however, precise operational cooperation protocols will have to be defined and maintained, but it will have to maintain its own autonomy and independent connotation. Addiction Medicine is a discipline that brings together elements of public health, prevention, internal medicine, clinical pharmacology, neurology, and even psychiatry. The inclusion of the DAs in those of DMH refers purely to a problem of pathology that has to do with lifestyle, choices, and behaviors. These, over time, show their dysfunctionality and only then do related problems emerge. Moreover, epidemiological, social, and clinical motivations impose the creation of alcohological teams dedicated to alcohol-related activities. The collaboration with self-help-groups (SHGs) is mandatory. The action of SHGs is accredited in numerous international recommendations both on the basis of consensus and evidence in the literature.
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http://dx.doi.org/10.23736/S0026-4806.18.05741-5DOI Listing
October 2018

Alcoholic liver disease and vitamin D deficiency.

Minerva Med 2018 Oct 2;109(5):341-343. Epub 2018 Jul 2.

Institute for Biostructures and Bioimages (CNR), c/o Molecular Biotechnology Center, Turin, Italy.

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http://dx.doi.org/10.23736/S0026-4806.18.05732-4DOI Listing
October 2018

Alcohol use disorders, cardiomyopathy and heart transplantation: a new management.

Minerva Cardioangiol 2018 Dec 23;66(6):744-746. Epub 2018 May 23.

Unit of Gastroenterology and Hepatology, Molinette Hospital, Turin, Italy.

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http://dx.doi.org/10.23736/S0026-4725.18.04725-4DOI Listing
December 2018

Anorexia nervosa and alcohol use disorders: a change is necessary.

Minerva Endocrinol 2018 Dec 30;43(4):395-397. Epub 2018 Mar 30.

Unit of Gastroenterology, Molinette Hospital, Turin, Italy.

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http://dx.doi.org/10.23736/S0391-1977.18.02844-4DOI Listing
December 2018

The role of adenosyl-methionine in alcoholic liver disease and intrahepatic cholestasis.

Minerva Gastroenterol Dietol 2018 09 8;64(3):187-189. Epub 2018 Mar 8.

Unit of Gastroenterology, Molinette Hospital, Turin, Italy.

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http://dx.doi.org/10.23736/S1121-421X.18.02484-4DOI Listing
September 2018

Acute alcoholic hepatitis: a literature review and proposal of treatment.

Minerva Med 2018 Aug 7;109(4):290-299. Epub 2017 Nov 7.

Alcohological Regional Center, ASL 3 Genoa, San Martino Polyclinic, Genoa, Italy.

Severe acute alcoholic hepatitis (AAH) can lead to a clinical picture with a six-month mortality rate in more than 70% of cases. This clinical picture is characterized by: jaundice with a duration of less than three months, jaundice at the first failure event, serum bilirubin greater than 5 mg/dL, ratio AST/ALT>2/1, AST less than 500 IU/L, ALT<300 IU/L, neutrophil leukocytosis and a GGT increase. In addition, encephalopathy, fever, asthenia and coagulopathy may be present. Its onset may also be characterized by portal-hypertension-related complications, particularly bleeding and hepato-renal syndrome. In cases where there is an overlapping of an acute form characterized by an etiological factor other than that of the base hepatopathy, acute on chronic liver failure (ACLF) is obtained. This can result in systemic inflammation response syndrome (SIRS) with a multi-organ systemic involvement. Several indices are used to evaluate the prognosis, in particular Maddrey's discriminant function (mDF) and the model of end stage liver disease (MELD). In our clinical practice, we use the MELD routinely. In cases of ACLF, a consortium organ failure score (CLIF-COFs) is used. Therapy is characterized by abstention in cases of severe forms (mDF>32 and MELD>21); in the absence of contraindications, steroid therapy is possible. In cases of an unresponsive liver, transplantation is premature. In our view, this possibility, after proper selection, must be offered for both prognostic and ethical reasons.
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http://dx.doi.org/10.23736/S0026-4806.17.05431-3DOI Listing
August 2018

Alcohol and Liver Transplantation.

Alcohol Alcohol 2017 Jan 5;52(1):126. Epub 2016 Sep 5.

Department of Internal Medicine, University of Genova, Piazzale R. Benzi 10, 16132 Genova, Italy.

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http://dx.doi.org/10.1093/alcalc/agw056DOI Listing
January 2017

Hepatocellular carcinoma: diagnosis and proposal of treatment.

Minerva Med 2016 Dec 28;107(6):413-426. Epub 2016 Jun 28.

Alcohol Research Center of Liguria, San Martino Hospital and Scientific Research Institute, Genoa, Italy -

Hepatocellular carcinoma (HCC) ranks third among the causes of cancer deaths globally. The most frequent causes are the hepatitis C virus (HCV), a combination of alcohol/HCV and metabolic syndrome (MS). The introduction of new pharmaceutical drugs that inhibit protease will bring a relative increase in the number of cases of HCC that are linked to the consumption of alcohol and MS. The latest development in the diagnostic sector is the total recognition of the contrast-enhanced ultrasound diagnostic algorithm. In the treatment sector we are moving on from the Barcelona criteria. With nodules up to 3 cm in size and with favorable anatomical and clinical conditions, the first treatment choice is percutaneous ablation. The first choice for nodules that are 3-5 cm in size is still hepatic resection (HR). For cases that fall completely within the Milan criteria with portal hypertension and compromised liver function the first treatment choice, in the total absence of any contraindications, is certainly LT. Intermediate forms of HCC are the most complicated as the stratification of patients is particularly relevant. TACE certainly no longer represents the only choice. HR is preferable where possible. According to the individual case and during down-staging, LT may be proposed. In some cases both locoregional ablative approaches and sorafenib can be used. In advanced cases with preserved function, the best treatment is still sorafenib. The treatment of HCC is complex because of the extreme anatomic-clinical variability of the cases. The key to a successful and effective approach is the creation of a true multi-disciplinary group in which the various players have the opportunity to express their own opinion. This is an indispensable prerequisite for a successful synthesis.
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December 2016

Alcohol and liver transplantation: the 6-month abstinence rule is not a dogma.

Transpl Int 2016 Aug 23;29(8):953-4. Epub 2016 Jun 23.

Centro Alcologico Regionale-Regione Liguria, IRCCS AOU San Martino-IST, Genova, Italy.

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http://dx.doi.org/10.1111/tri.12790DOI Listing
August 2016

Treatment of alcohol use disorder patients affected by liver cirrhosis and/or hepatocellular carcinoma awaiting liver transplantation.

Minerva Med 2016 Aug 5;107(4):223-38. Epub 2016 May 5.

Centro Alcologico Regionale, Regione Liguria, IRCCS AOU San Martino-IST, Genoa, Italy -

Alcohol is one of the top three priority areas for public health worldwide. Alcohol is the second leading cause of liver disease, and 45-60% of cirrhosis deaths are alcohol related. In the United States it represents 30% of liver transplants and in Europe 50%. Twenty to 40% of cases of steatosis evolve into steatohepatitis, and l8-20% directly into liver cirrhosis; 20-40% of cases of steatohepatitis evolve into cirrhosis and 4-5% into hepatocellular carcinoma. This cascade of events takes 5 to 40 years. The temporal variability is related to the genetic pattern of the subject and the presence of associated risk factors. Thirty to 40% of patients with alcoholic liver disease (ALD) suffer from HCV, and 70% of HCV patients have a history of risky / harmful alcohol consumption. A severe clinical condition is certainly the overlap of acute alcoholic hepatitis (AAH) with a framework of HCV-related chronic hepatitis: acute chronic liver failure (ACLF). In the case of decompensated cirrhosis, severe AAH or ACLF non responder to medical therapy the indication, in selected patients, is certainly liver transplantation (LT). ALD treatment is important, but not very effective if abstention is not reached. In case of liver disease related or correlated to LT such as decompensated cirrhosis, severe AAH or ACLF the possibility of anticraving therapy is restricted to metadoxine and baclofen. In all alcohol use disorder patients with ALD psycho-social therapy and attendance at SHG groups it is mandatory, even in post-transplant period.
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August 2016

Alcoholic liver disease and the hepatitis C virus: an overview and a point of view.

Minerva Med 2016 Oct 24;107(5):300-13. Epub 2016 Mar 24.

Alcohologic Regional Centre, Liguria Region, IRCCS AOU San Martino-IST (National Institute for Research on Cancer), Genoa, Italy -

Alcoholic liver disease (ALD) and the hepatitis C virus (HCV) are two common diseases in the western world. 30-40% of patients with ALD suffer from HCV and 70% of HCV patients are heavy drinkers. The association between the two diseases accelerates the chain of events that leads to liver cirrhosis and hepatocellular carcinoma (HCC). The reason for this is that the two diseases have a synergistic effect on oxidative stress, the immune component, and the mechanisms of carcinogenesis. The relative risk of liver cirrhosis and HCC has increased very significantly. A clinical condition of particular seriousness is represented by acute-on-chronic liver failure (ACLF) characterized by the recurrent superposition of an episode of severe acute alcoholic hepatitis (AAH) on a framework of advanced HCV-related chronic liver disease. Currently the possible failure to respond to medical therapy involves liver transplantation in selected patients. Antiviral therapy with PEG-IFN and Ribavirin enables similar results in a group of patients without ALD. The need to eradicate the infection represents a significant motivational reason for the abstention. Ultrasonographic surveillance should take place every six months and should be continued following possible viral eradication. Other associated diseases, but also the potential oncology of ethanol even after a long period of abstention may be the cause of HCC. This attitude will be followed by the introduction of new antiviral drugs.
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October 2016

Antiviral therapy and hepatocellular carcinogenesis.

Cancer 2016 Jan 18;122(1):157-8. Epub 2015 Sep 18.

Alcohologic Regional Center-Ligurian Region, IRCCS AOU San Martino-IST, Genoa, Italy.

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http://dx.doi.org/10.1002/cncr.29696DOI Listing
January 2016

Alcohol and cancer.

Alcohol Clin Exp Res 2015 Nov 1;39(11):2261. Epub 2015 Sep 1.

Centro Alcologico Regionale-Regione Liguria, IRCCS AOU San Martino-IST, Genoa, Italy.

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http://dx.doi.org/10.1111/acer.12858DOI Listing
November 2015

Fibrosis progression in patients treated for hepatitis C recurrence.

Liver Int 2015 Dec 21;35(12):2624-5. Epub 2015 Sep 21.

Centro Alcologico Regionale - Regione Liguria, IRCCS AOU San Martino-IST (National Institute for Research on Cancer), Genova, Italy.

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http://dx.doi.org/10.1111/liv.12942DOI Listing
December 2015

Liver Disease and Hepatocellular Carcinoma in Alcoholics: The Role of Anticraving Therapy.

Curr Drug Targets 2016 ;17(2):239-51

Centro Alcologico Regionale - Regione Liguria, IRCCS AOU San Martino-IST, Genova, Italy.

Alcohol is the main risk factor for death and disability. The treatment of alcohol dependence (AD) is a complex activity as the variables are numerous; however, those which must necessarily be taken into account are the type of AD, the internal comorbidities and the presence of any psychiatric comorbidity. Liver problems are one of the most common causes of alcohol-related liver damage. 45% of deaths from cirrhosis are alcohol-related. Thus, the treatment of AD must often deal with a more or less severe liver disease, which influences the choice of anticraving drug. As chronic liver disease is often present, and as in a substantial proportion of cases, because there is a correlation with viral infections or with hepatocellular carcinoma (HCC), it is clear that hepatologists should make use of nonhepatotoxic molecules. In cases of mild liver disease, all available drugs might be used, but we recommend caution because the liver is usually fragile due to the harmful abuse of alcohol. In the advanced liver disease, the choice of treatment is reduced. A psychosocial approach such as attending support groups could be the first choice. In cases of compensated cirrhosis with or without HCC, or in cases of HCC without cirrhosis, metadoxine, acamprosate and baclofen can be used. In decompensated forms the only drug tested to date has been baclofen. In alcohol-related liver disease a professional team with hepato-alcohologists is also necessary, especially for liver transplantation programs.
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http://dx.doi.org/10.2174/1389450116666150518102204DOI Listing
October 2016

Alcohol and hepatocellular carcinoma: a review and a point of view.

World J Gastroenterol 2014 Nov;20(43):15943-54

Gianni Testino, Paolo Borro, Centro Alcologico Regionale-Regione Liguria, Alcoholic Unit, Department of General Internal and Specialist Medicine, IRCCS AOU San Martino-National Institute for Cancer Research-IST, 16100 Genova, Italy.

It is well recognized that one cause of chronic liver disease and hepatocellular carcinoma (HCC) is alcohol consumption. Research in Italy and the United States concludes that the most common cause of HCC (responsible for 32% to 45% of HCC) is alcohol. It has recently been shown that a significant relationship between alcohol intake, metabolic changes, and hepatitis virus infection does exist. Alcohol may be a factor in the development of HCC via direct (genotoxic) and indirect mechanisms (cirrhosis). There is only one way of diagnosing HCC, which is early identification through surveillance, when curative treatments become possible. After stopping alcohol intake the risk of liver cancer decreases by 6% to 7% a year, and an estimated time period of 23 years is also needed. Therefore, surveillance is also important in former drinkers and, in our opinion, independently from the presence of compensated cirrhosis. In cases of very early stage (VES) and early stage with portal hypertension, liver transplantation is the optimal option; and in cases of associated disease, percutaneous ethanol injections, radiofrequency and microwave ablation are the ideal treatments. Despite the possibility of detecting microvascular invasion with HR, several studies and some randomized controlled trials revealed that overall survival and DSF rates in patients with VES HCC are much the same after ablation and HR. Therefore, ablation can be regarded as a first-line choice for patients with VES HCC. It is important to emphasize that the choice of treatment should be weighed carefully in the context of a multidisciplinary cancer team.
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http://dx.doi.org/10.3748/wjg.v20.i43.15943DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4239482PMC
November 2014

Acute alcoholic hepatitis, end stage alcoholic liver disease and liver transplantation: an Italian position statement.

World J Gastroenterol 2014 Oct;20(40):14642-51

Gianni Testino, Paolo Borro, Alessandro Sumberaz, Ornella Ancarani, Regional Alcohologic Centre, Liguria Region, Alcohol Unit and Related Diseases, Department of Internal and Specialist Medicine, IRCCS AOU San Martino-IST National Institute for Cancer Research, 16100 Genova, Italy.

Alcoholic liver disease encompasses a broad spectrum of diseases ranging from steatosis steatohepatitis, fibrosis, and cirrhosis to hepatocellular carcinoma. Forty-four per cent of all deaths from cirrhosis are attributed to alcohol. Alcoholic liver disease is the second most common diagnosis among patients undergoing liver transplantation (LT). The vast majority of transplant programmes (85%) require 6 mo of abstinence prior to transplantation; commonly referred to as the "6-mo rule". Both in the case of progressive end-stage liver disease (ESLD) and in the case of severe acute alcoholic hepatitis (AAH), not responding to medical therapy, there is a lack of evidence to support a 6-mo sobriety period. It is necessary to identify other risk factors that could be associated with the resumption of alcohol drinking. The "Group of Italian Regions" suggests that: in a case of ESLD with model for end-stage liver disease < 19 a 6-mo abstinence period is required; in a case of ESLD, a 3-mo sober period before LT may be more ideal than a 6-mo period, in selected patients; and in a case of severe AAH, not responding to medical therapies (up to 70% of patients die within 6 mo), LT is mandatory, even without achieving abstinence. The multidisciplinary transplant team must include an addiction specialist/hepato-alcohologist. Patients have to participate in self-help groups.
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http://dx.doi.org/10.3748/wjg.v20.i40.14642DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4209530PMC
October 2014

Uncommon serum creatine phosphokinase and lactic dehydrogenase increase during diosmin therapy: two case reports.

J Med Case Rep 2014 Jun 16;8:194. Epub 2014 Jun 16.

Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV 2, Genoa I-16132, Italy.

Introduction: Short-term administration of diosmin is usually considered safe, with only minor side effects (stomach and abdominal pain, diarrhea, dermatological disorders, and headache) occasionally observed. Within a 4-year period, a general practitioner noticed 17 cases of mild, diosmin-induced side effects, two of which showed particular interest.

Cases Presentation: Case 1: A 55-year-old Caucasian woman presented with chronic leg venous insufficiency. She was prescribed diosmin 450 mg twice a day. After 5 days of therapy, she developed pain in the legs (myalgia), and diosmin therapy was suspended. She made a spontaneous attempt of drug rechallenge and her leg pain reappeared. Thus, she underwent blood analysis, which showed elevation of creatine phosphokinase levels. Creatine phosphokinase values normalized only after prolonged discontinuation of the therapy. Case 2: A 79-year-old Caucasian man, who was diagnosed with acute hemorrhoidal syndrome. After 21 days of continuous diosmin treatment, increased levels of serum lactic dehydrogenase were detected. In both cases a comprehensive analysis of all possible causes for enzyme elevation was made.

Conclusions: A feasible hypothesis to explain these rare effects could be that exaggerated adrenergic activity occurred on microcirculation, leading to an excessive peripheral vasoconstriction and subsequent ischemic damage. An individual predisposition is strongly suggested. A concurrence of events was probably responsible for the elevation of nonspecific tissue necrosis markers. Physicians and patients must be aware of these rare, but possible, adverse drug reactions.
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http://dx.doi.org/10.1186/1752-1947-8-194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4070635PMC
June 2014

[Alcohol, cardiovascular prevention and cancer].

Recenti Prog Med 2014 Apr;105(4):144-6

It is well known that light to moderate drinking (10-25 g/day) has a protective effect on ischaemic heart disease. This effect seems independent of the type of alcoholic beverage. Recently, the International Agency for Research on Cancer (World Health Organization) stated that alcoholic beverages are carcinogenic for human (oral cavity, pharynx, larynx, oesophagus, colorectum, liver and breast). There is a dose-response relationship between alcohol and cancer in that the risk of cancer increases proportionally with alcohol consumption. Low doses of alcohol (10 g/day) are associated with an increased risk for oral cavity, pharynx, larynx, oesophagus and breast cancer. Therefore, a physically active lifestyle and a healthy diet are more effective in preventing ischaemic heart disease than a low level of alcohol consumption.
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http://dx.doi.org/10.1701/1459.16121DOI Listing
April 2014
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