72 research outputs found
Diabetes influences cancer risk in patients with increased carotid atherosclerosis burden
Background and aims: Atherosclerosis and cancer share several risk factors suggesting that at least in part their pathogenesis is sustained by common mechanisms. To investigate this relation we followed a group of subjects with carotid atherosclerosis at baseline up for malignancy development.Methods and results: we carried out an observational study exploring cancer incidence (study endpoint) in subjects with known carotid atherosclerosis at baseline (n = 766) without previous cancer or carotid vascular procedures. During the follow-up (160 +/- 111 weeks) 24 cancer occurred, corresponding to an overall annual incidence rate of 0.11%. 10 diagnosis of cancer occurred in individuals with a carotid stenosis >50% (n = 90) whereas 14 in patients with a carotid stenosis <50% patients (n = 676) (p < 0.001). Respect to patients without cancer, diabetes was markedly more common in subjects with cancer diagnosis during the FU (37.3%vs75.0%, p < 0.001). After controlling for classic risk factors, carotid stenosis >50% (HR = 2.831, 95%CI = 1.034-5.714; p = 0.036) and diabetes (HR = 4.831, 95%CI = 1.506-15.501; p = 0.008) remained significantly associated with cancer diagnosis.Conclusions: to our knowledge this is the first study reporting a significant risk of cancer development in subjects with diabetes and high risk of cerebrovascular events, highlighting the need of a carefully clinical screening for cancer in diabetic patients with overt carotid atherosclerosis. (C) 2019 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved
Ultrasonography for the Diagnosis of Pneumothorax after Transbronchial Lung Cryobiopsy in Diffuse Parenchymal Lung Diseases
New PRSS1 and common CFTR mutations in a child with acute recurrent pancreatitis, could be considered an "Hereditary" form of pancreatitis ?
<p>Abstract</p> <p>Background</p> <p>acute recurrent pancreatitis is a complex multigenic disease, the diagnosis is even more difficult when this disease develops in a child.</p> <p>Case Presentation</p> <p>a 6-years old boy, hospitalized with epigastric pain radiating to the back showed high serum levels of serum amylase, lipase, CRP and erythrosedimentation rate. Several similar milder episodes of pain, followed by quick recovery and complete disappearance of symptoms were reported during the previous 13 months. The child was medically treated and after 7 days with normal clinic and laboratory tests was discharged with a hypolipidic diet. All the known aetiologic hypotheses were excluded by anamnestic investigation, clinical observation and biochemical evaluation, whereas, anatomic abnormality were excluded by a secretin stimulated magnetic resonance (MRI). At the last follow-up visit, (11 months later), the child showed a normal body weight and anthropometric profile, without further abdominal pain. Mutation screening for coding regions of <it>PRSS1, SPINK1, CFTR </it>and the new hereditary pancreatitis-associated chymotrypsin C (<it>CTRC</it>) genes showed a novel variation, c.541A > G (p.S181G), in the exon 4 of PRSS1 gene and the classical CF p.F508del mutation in the <it>CFTR. </it>Both mutations were present in his clinically normal mother and absent in the patient's father.</p> <p>Conclusions</p> <p>this report extend the spectrum of PRSS1 mutations, however, the absence of family history of pancreatitis leaves the present case without the hallmark of the hereditary origin of pancreatitis. At the present knowledge it can be only stated that the combined genotype CFTR (F508del)/PRSS1 (S181G) is associated to a mild phenotype of acute recurrent pancreatitis in this child without any further conclusion on its pathogenetic role or prediction on the course of the disease.</p
Quantitative analysis of lung elastic fibers in idiopathic pleuroparenchymal fibroelastosis (IPPFE): comparison of clinical, radiological, and pathological findings with those of idiopathic pulmonary fibrosis (IPF)
Demographic, clinical, and pathological features of early onset pancreatic cancer patients.
BACKGROUND: Early onset pancreatic cancer (EOPC), i.e. pancreatic ductal adenocarcinoma (PDAC) occurring in patients below 50 years of age, is rare and there is limited information regarding risk factors, molecular basis and outcome. This study aimed to determine the demographic and clinicopathological features and survival figures for EOPC. METHODS: A retrospective analysis of patients treated at the Royal London Hospital for PDAC between September 2004 and September 2015 was performed. Data on demographics, risk factors, presentation, pathological features, treatment and survival outcome were compared in EOPC and older PDAC patients. RESULTS: Of 369 PDAC cases identified, 35 (9.5%) were EOPC. Compared to older patients, EOPC patients were more frequently male (71% vs 54%, p = 0.043) and less commonly of British origin (37% vs 70%, p = 0.002). There was no significant difference regarding the prevalence of any of the risk factors known to be associated with older PDAC patients. Fewer EOPC patients presented with resectable disease (23% vs 44%, p = 0.015) and more received adjuvant chemo/radiotherapy (60% vs 46%, p = 0.008). The overall median survival and stage specific survival did not differ significantly between the two groups, although a longer survival for localized disease was seen in EOPC patients (25 months (12.9-37, 95%CI) vs 13 months (10.5-15.5 95%CI) for older PDAC patients). CONCLUSIONS: The EOPC patients had different demographics and were more likely than their older PDAC counterparts to be male. Typically they presented with more advanced disease, received more aggressive treatment, and had on overall similar survival outcome
Current Status of Idiopathic Nonspecific Interstitial Pneumonia
Pulmonary pathologists were aware of cases of idiopathic interstitial
pneumonia (IIP) that morphologically did not fit Liebow's classification
scheme. These cases were labeled as ``cellular interstitial
pneumonia'' or ``chronic interstitial pneumonia not otherwise
specified.'' The term nonspecific interstitial pneumonia (NSIP) was
first used in relation to a pattern of lung interstitial inflammation
seen in association with human immunodeficiency virus (HIV) infection.
In 1994 NSIP was used to indicate a group of subacute or chronic
interstitial pneumonias characterized morphologically by interstitial
inflammation or fibrosis or both, with preservation of the lung
architecture and the absence of typical findings for any of the other
main categories of IIP (mainly usual interstitial pneumonia,
desquamative interstitial pneumonia, and bronchiolitis obliterans
organizing pneumonia). Although these patients presented with
``nonspecific'' lung histology (categorized as cellular and fibrotic
variants), and with a broad spectrum of associated clinical conditions,
such as connective tissue diseases (CTDs), environmental exposure, and
previous acute lung injury, they showed some peculiar clinical aspects,
including favorable response to corticosteroid treatment and overall
good prognosis.
The clinical and radiographic profiles were better defined in the last
decade. The NSIP pattern is the histological background of a
subacute/chronic interstitial pneumonitis that may be observed in many
conditions, including CTD, drug-induced lung disease, hypersensitivity
pneumonitis, slowly healing diffuse alveolar damage (DAD), relapsing
organizing pneumonia, occupational exposure, immunodeficiency (mainly
HIV infection), graft versus host disease (GVHD), familial pulmonary
fibrosis, immunoglobulin G4 (IgG4)-related sclerosing disease, with or
without overlap features with Rosai-Dorfman disease, multicentric
Castleman disease, and myelodysplastic syndrome. Rarely, NSIP is the
histology recognized in patients with idiopathic interstitial
pneumonitis, in whom efforts to find potential causative exposures are
futile. This entity occurs mostly in middle-aged, never-smoker women,
with a likely association with an autoimmune background. High-resolution
computed tomographic (HRCT) scans typically demonstrate ground-glass
attenuation with a bibasilar distribution, or in the fibrotic variant,
ground-glass attenuation along with reticular lines and traction
bronchiectasis. The prognosis is good compared with idiopathic pulmonary
fibrosis (IPF), and therapeutic options include mainly corticosteroids
and immunosuppressive agents. Recently a more precise definition of
clinical profiles and radiographic findings of idiopathic NSIP allows
consideration of less invasive diagnostic procedures (bronchoalveolar
lavage, transbronchial lung biopsy). Better understanding of
pathogenetic mechanisms might widen the therapeutic horizon giving a
role to new therapeutic options in more severe cases
Diffuse alveolar damage
A clinico-pathological and radiological discussion od Diffuse alveolar damag
Recurrent biliary acute pancreatitis is frequent in a real-world setting
Background: Data about recurrent acute pancreatitis (RAP) are limited. Aims: To evaluate the rate of RAP and associated factors. Methods: Single-centre prospective study of consecutive patients at first episode of acute pancreatitis (AP) being followed-up. Results: Of 266 consecutive AP patients, (47% biliary, 15.4% alcoholic, 14.3% idiopathic) 66 (24.8%) had RAP in a mean follow-up of 42 months; 17.9% of recurrences occurred within 30 days from discharge. Age, gender, smoking and severity of first AP were not associated with RAP risk. The rate of biliary RAP was 31.3% in patients who did not receive any treatment, 18% in those treated with ERCP only, 16% in those who received cholecystectomy only, and 0% in those treated both with surgery and ERCP. Patients with biliary AP who received cholecystectomy had a significantly longer time of recurrence-free survival and reduced recurrence risk (HR = 0.45). In patients with alcoholic AP, the rate of recurrence was lower in those who quit drinking (5.8% vs 33%; p = 0.05). The alcoholic aetiology was associated with a higher risk of having >2 RAP episodes. Conclusion: RAP occurs in about 25% of cases, and failure to treat biliary aetiology or quitting drinking is associated with increased recurrence risk
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