Dario Conte

Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milano, Lombardy, Italy

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Publications (296)1746.77 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Appendiceal Goblet cell tumors (GCTs) are clinically more aggressive, and have a worse outcome than midgut neuroendocrine tumors (mNETs). Guidelines for management of GCTs are limited. A retrospective case-study analysis was performed in patients with a diagnosis of GCT, confirmed on histological review. Patients were evaluated clinically, biochemically, and radiologically. 48 patients were identified (TNM stage I-II: 27, stage III: 15, stage IV: 6). Median follow-up was 44 months and was complete in all patients. 68.8% presented with acute appendicitis. 44/48 patients had initial appendectomy, followed by prophylactic right hemicolectomy in 41. 10/48 patients had recurrent disease [median time to recurrence 28 months (range 4-159)]. Of those, 9 received systemic chemotherapy (FOLFOX/FOLFIRI), which was also given in 5/48 patients with disseminated disease at diagnosis. Partial response, stable disease and disease progression was noted in 22%, 22% and 56%, respectively. Adjuvant chemotherapy was also administered in 9/48 patients with stage III disease after right hemicolectomy, however in 3/9 the disease recurred. Median progression/disease-free-survival was 44 months (range 3-159) and overall 5-year survival rate was 41.6%. The clinical behaviour of GCTs is more similar to colorectal adenocarcinomas than to NETs. A prophylactic right hemicolectomy is recommended to reduce the risk of recurrence. Systemic chemotherapy, using colorectal adenocarcinoma regimens, is indicated for advanced or recurrent disease and has encouraging results. Prospective studies are needed to define the role of adjuvant chemotherapy and the optimal chemotherapy regimen. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Surgical oncology. 01/2015;
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    The American journal of gastroenterology. 01/2015; 110(1):200-2.
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    ABSTRACT: Background and Aims. Hepatic hemangioma (HH) has a widely ranging prevalence. The etiology is unclear; however, associations with autoimmune disorders have been described. We aimed at evaluating the prevalence of HH in celiac disease. Methods. Ninety-seven consecutive patients with celiac disease (18 M, 79 F, median age 41, and range 17-84 years) underwent liver ultrasound between January 2011 and 2012. The findings were compared with those of 1352 nonceliac patients (581 M, 771 F, median age 50, and range 16-94 years), without liver disease or previously detected HH, who underwent US in the same period. Results. Ultrasonographic findings consistent with HH were observed in 14 celiac patients (14.4%), a prevalence significantly higher than in controls (69 cases, 5.1%) (P = 0.0006). Subgroup analysis showed that, among women, the prevalence of HH was 16.4% in the celiac disease group (13/79) compared with 5.9% in controls (46/771) (P = 0.002). In celiac setting, HH had a median diameter of 1.3 cm and presented as a single lesion in 12 cases (86%). Conclusions. Our findings are consistent with a significantly higher prevalence of HH in celiac patients. Although mechanisms underlying this association remain unclear, autoimmune and metabolic processes, as well as alterations of gut-liver axis equilibrium, could play a role.
    Gastroenterology Research and Practice 01/2015; 2015:1-6. · 1.50 Impact Factor
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    ABSTRACT: Abnormalities in liver function tests, including transient and self-limiting hypertransaminasemia, cholestatic disease and hepatitis, can develop during treatment with anti-tumour-necrosis-factor (TNF) therapy. The optimal management of liver injury related to anti-TNF therapy is still a matter of debate. Although some authors recommend discontinuing treatment in case of both a rise of alanine aminotransferase more than 5 times the upper limit of normal, or the occurrence of jaundice, there are no standard guidelines for the management of anti-TNF-related liver injury. Bibliographical searches were performed in PubMed, using the following key words: inflammatory bowel disease (IBD); TNF inhibitors; hypertransaminasemia; drug-related liver injury; infliximab. According to published data, elevation of transaminases in patients with IBD treated with anti-TNF is a common finding, but resolution appears to be the usual outcome. Anti-TNF agents seem to be safe with a low risk of causing severe drug-related liver injury. According to our centre experience, we found that hypertransaminasemia was a common, mainly self-limiting finding in our IBD cohort and was not correlated to infliximab treatment on both univariate and multivariate analyses. An algorithm for the management of liver impairment occurring during anti-TNF treatment is also proposed and this highlights the need of a multidisciplinary approach and suggests liver biopsy as a key-point in the management decision in case of severe rise of transaminases. However, hepatic injury is generally self-limiting and drug withdrawal seems to be an exception.
    World journal of gastroenterology : WJG. 12/2014; 20(46):17352-17359.
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    ABSTRACT: Background/Aims: Plasma chromogranin A (CgA) is the most widely used biochemical biomarker in the diagnostic work-up and follow-up of gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NENs). Herein, we assessed the clinical utility of CgA in diagnosing and monitoring a large series of GEP-NENs. Patients and Methods: 181 GEP-NEN patients (87 males, 94 females), with pancreatic (81) and gastrointestinal (100) neoplasm, were included. 99 patients were G1 (Ki-67 ≤2%) NENs, 57 G2 (Ki-67 3-20%), 25 G3 (Ki-67 >20%). 81 patients were at TNM stage I, 14 at II, 17 at III, 69 at IV. For every patient, CgA values were assessed at diagnosis and during follow-up. Results: At diagnosis the CgA values were above the upper reference limit in 148 patients (82%): the median CgA levels were significantly higher in functioning than non-functioning tumors (295 vs. 43 U/l, p = 0.0001) and in patients with metastases than without (324.5 vs. 42 U/l, p = 0.0001). At logistic regression analysis the baseline CgA levels were significantly associated with the Ki-67 index (p < 0.0001) and the TNM stage (p < 0.0001), independently of the age and sex of the patient and the primary site of the tumor. The overall 5 and 10-year survival was 74% and 64.5%, respectively. The low Ki-67 index, the type of treatment and the early CgA decrease after treatment were positively correlated with the survival rate. After radical surgery, 15/95 patients relapsed and an increase in CgA values anticipated the clinical and objective disease recurrence after a period of 9-12 months. Conclusions: In GEP-NENs plasma CgA carries a significant prognostic meaning. © 2015 S. Karger AG, Basel.
    Neuroendocrinology 11/2014; · 4.93 Impact Factor
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    ABSTRACT: It has been suggested that multiple rapid swallowing should be added to oesophageal manometry. To prospectively evaluate whether 10 and 200mL multiple rapid swallowing provide different information concerning motor function. 30 consecutive patients with oesophageal symptoms, 13 achalasia patients after successful pneumatic dilation and 19 healthy subjects performed eight 5mL single swallows, two 10mL and one 200mL multiple rapid swallowing. Almost all of the healthy subjects and two-thirds of the patients with oesophageal symptoms showed motor inhibition during both 10 and 200mL multiple rapid swallowing. The oesophago-gastric pressure gradient was significantly higher during 200mL multiple rapid swallowing within each group (p<0.01), and significantly higher in the achalasia patients than in the other two groups (p<0.0001). Presence of a contraction and increased contraction strength in comparison with single swallows were both more frequent after 10mL than after 200mL multiple rapid swallowing in the healthy subjects and the patients (p<0.05). Motor inhibition could be similarly evaluated by means of 10 and 200mL multiple rapid swallowing; 10mL evaluated the after-contraction, whereas 200mL multiple rapid swallowing was more valuable in identifying increased resistance to outflow. Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. All rights reserved.
    Digestive and Liver Disease 11/2014; · 2.89 Impact Factor
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    ABSTRACT: The goal of this review is to provide a comprehensive picture of the role, clinical applications and future perspectives of the most widely used non-invasive techniques for the evaluation of hepatitis B virus (HBV) infection. During the past decade many non-invasive methods have been developed to reduce the need for liver biopsy in staging fibrosis and to overcome whenever possible its limitations, mainly: invasiveness, costs, low reproducibility, poor acceptance by patients. Elastographic techniques conceived to assess liver stiffness, in particular transient elastography, and the most commonly used biological markers will be assessed against their respective role and limitations in staging hepatic fibrosis. Recent evidence highlights that both liver stiffness and some bio-chemical markers correlate with survival and major clinical end-points such as liver decompensation, development of hepatocellular carcinoma and portal hypertension. Thus the non-invasive techniques here discussed can play a major role in the management of patients with chronic HBV-related hepatitis. Given their prognostic value, transient elastography and some bio-chemical markers can be used to better categorize patients with advanced fibrosis and cirrhosis and assign them to different classes of risk for clinically relevant outcomes. Very recent data indicates that the combined measurements of liver and spleen stiffness enable the reliable prediction of portal hypertension and esophageal varices development.
    World journal of gastroenterology : WJG. 10/2014; 20(40):14568-14580.
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    ABSTRACT: Case presentationDr. R E Rossi, Dr. C M GirelliIn December 2013, a 43-year-old man from northern Italy was referred to the gastrointestinal (GI) Unit at the Hospital of Busto Arsizio due to a sore throat with odynophagia, night sweats and loss of appetite leading to a consequent 5 kg weight loss over the previous 2 months. The man was married, with two children (aged 5 and 2 years, respectively), worked as a policeman and had been practicing body-building. His past medical history was unremarkable, but for a right renal colic at the age of 37 and chronic mild depression requiring on-going treatment with Sertralin. There was neither alcohol consumption, nor tobacco smoking. The patient denied any use of street drugs or unsafe sexual practices. He was reportedly a regular blood donor, with the last donation having been in July 2013.On the basis of the on-going symptoms, the patient was initially referred to an otorhinolaryngologist, who raised the possibility of gastro-esophageal reflux ...
    Internal and Emergency Medicine 09/2014; · 2.41 Impact Factor
  • The American Journal of Gastroenterology 07/2014; 109(7):1082-3. · 9.21 Impact Factor
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    ABSTRACT: In 2011 the three major Italian gastroenterological scientific societies (AIGO, the Italian Society of Hospital Gastroenterologists and Endoscopists; SIED, the Italian Society of Endoscopy; SIGE, the Italian Society of Gastroenterology) prepared their official document aimed at analysing medical care for digestive diseases in Italy, on the basis of national and regional data (Health Ministry and Lombardia, Veneto, Emilia-Romagna databases) and to make proposals for planning of care. Digestive diseases were the first or second cause of hospitalizations in Italy in 1999–2009, with more than 1,500,000 admissions/year; however only 5–9% of these admissions was in specialized Gastroenterology units. Reported data show a better outcome in Gastroenterology Units than in non-specialized units: shorter average length of stay, in particular for admissions with ICD-9-CM codes proxying for emergency conditions (6.7 days versus 8.4 days); better case mix (higher average diagnosis-related groups weight in Gastroenterology Units: 1 vs 0.97 in Internal Medicine units and 0.76 in Surgery units); lower inappropriateness of admissions (16–25% versus 29–87%); lower in-hospital mortality in urgent admissions (2.2% versus 5.1%); for patients with urgent admissions due to gastrointestinnal haemorrhage, in-hospital mortality was 2.3% in Gastroenterology units versus 4.0% in others. The present document summarizes the scientific societies’ official report, which constitutes the “White paper of Italian Gastroenterology”.
    Digestive and Liver Disease 07/2014; · 2.89 Impact Factor
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    ABSTRACT: Gastroenteropancreatic neuroendocrine tumors have occasionally been described in association with neurofibromatosis type 1, whereas an association with neurofibromatosis type 2 has never been reported.
    BMC Gastroenterology 06/2014; 14(1):110. · 2.11 Impact Factor
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    ABSTRACT: Introduction The indications for and efficacy of device-assisted enteroscopy is not standardised in coeliac disease (CD). We present the largest study to date to evaluate the clinical role of double-balloon enteroscopy (DBE) in complicated CD.Methods DBE findings in CD patients with suspected small bowel complications were retrospectively evaluated in two tertiary referral centres (Milan and Sheffield). Demographic data of the studied cohort were compared with a database of 1000 non complicated CD patients.Results Findings from 14 oral and seven anal DBE in 19 CD cases (11 males p = 0.003 vs control database) were reviewed. Mean age at CD diagnosis (37 ± 19 vs. 27 ± 18) and at small bowel evaluation (49 ± 15 vs. 38 ± 13) was significantly higher in the DBE group compared to controls (p < 0.001). Indications for DBE were the follow up of known refractory coeliac disease (RCD) (#7), suspicion of small bowel complications due to gastrointestinal symptoms (#4), severe iron deficiency anaemia (#6) and long standing poor dietary adherence (#2). All DBE were performed after small bowel capsule endoscopy, except for one case. 3 patients from the known RCD group had evidence of TCRg monoclonality on biopsy (type 2 RCD). One of these patients had jejunal ulceration whilst the other 2 cases had areas with small white raised patches. A further RCD case had evidence of jejunal ulceration however biopsies didn’t show any evidence of TCRg monoclonality. A single RCD case had distally worsening atrophy. Patchy small bowel atrophy was observed in all the non adherent patients and in 2 patients with persistent gastrointestinal symptoms who had only been on a gluten free diet for a short time. Two jejunal adenocarcinomas and an ileal neuroendocrine tumour were detected. All 3 of these patients presented with iron deficiency anaemia.Conclusion This is the largest international DBE outcomes study in CD patients. Even minor mucosal lesions seen at DBE may be associated with significant pathology. Evaluation of non-responsive/refractory symptoms by DBE was associated with older patients (p < 0.001) and a higher proportion of males (p = 0.003) than an uncomplicated CD population. Further studies are needed to better understand the clinical relevance of the small bowel endoscopic features and to optimise DBE indications.Disclosure of Interest None Declared.
    Gut 06/2014; 63(Suppl 1):A264. · 13.32 Impact Factor
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    ABSTRACT: Achalasia is a neurodegenerative disorder of the oesophagus. Alteration of motor activity induced by oesophageal distension has not been explored.
    United European gastroenterology journal. 04/2014; 2(2):84-90.
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    ABSTRACT: Both multiple endocrine neoplasia type 1 (MEN1)-related gastrinomas and gastrointestinal stromal tumors (GISTs) are rare neoplasms, and their association has been rarely reported. We describe an unusual association between a GIST and a MEN1-related gastrinoma. A 44-year-old man had undergone surgical removal of a pancreatic gastrinoma in 2004 and was then administered long-term somatostatin analogs, and diagnosed as having MEN1 syndrome. Following an uneventful follow-up, in April 2009, an upper gastrointestinal tract endoscopy showed esophageal narrowing, with evidence of a 2-cm solid mass on endoscopic ultrasonography. Histology revealed a tumor composed of elongated cells with plump cytoplasm arranged in a storiform pattern. The immunophenotype of the lesion was CD117 and Platelet Derived Growth Factor (PDGF) positive, whereas alpha-1 muscle actin and S-100 protein were negative. Due to morphological and immunohistochemical results, a final diagnosis of esophageal GIST was made. The association between GISTs and MEN1 could be casual, although a single case of the coexistence of a GIST and a MEN1-related gastrinoma has already been reported. A role of the MEN1 gene in the pathogenesis of GISTs could be hypothesized.
    Journal of Cancer Research and Therapeutics 04/2014; 10(2):443-5. · 0.95 Impact Factor
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    ABSTRACT: no abstract
    International Journal of Celiac Disease. 03/2014; 2(1):1-3.
  • Digestive and Liver Disease 03/2014; 46:S87-S88. · 2.89 Impact Factor
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    ABSTRACT: Diagnosis of acute appendicitis in pregnancy can be difficult, particularly in late pregnancy. This is evident from the high perforation rate, from 31% in the first and second trimester to 6 9% in the third [2] when the appendix is pushed out of the right lower quadrant by the gravid uterus. Of several diagnostic modalities available, including ultrasound, CT and magnetic resonance imaging (MRI), CT tends to be the last choice due to ionizing radiations, although it should be considered pre-operatively when MRI cannot be performed and prompt diagnosis is mandatory [3].
    Digestive and Liver Disease 02/2014; · 2.89 Impact Factor
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    Digestive and Liver Disease 02/2014; · 2.89 Impact Factor
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    ABSTRACT: Liver transient elastography (L-TE) is a reliable, noninvasive predictor of disease severity in chronic liver disease of viral aetiology (CLD). Owing to the relationships among severity of CLD, portal hypertension and spleen involvement, the assessment of splenic stiffness (S-TE) may have an added value in staging CLD. Of 132 CLD patients of viral aetiology, 48 with myeloproliferative disorders (MD) and 64 healthy volunteers (HV), were concurrently investigated by both L-TE and S-TE. Liver disease severity was staged by liver biopsy (LB; Metavir) taken concurrently with TE examination and upper gastrointestinal tract endoscopy for gastro-oesophageal varices. The S-TE inter-observer agreement was analysed by an intra-class correlation coefficient (ICC); L-TE and S-TE accuracy was evaluated by receiver operating characteristic (ROC) curve analysis. Logistic regression analysis assessed the independent effect of L-TE and S-TE as predictors of hepatic fibrosis stage. S-TE failed in 22 CLD (16.6%), 12 (25%) MD and 12 (18%) HV. In the three groups, the ICC was 0.89 (0.84-0.92), 0.90 (0.85-0.94) and 0.86(0.80-0.91), respectively. In the CLD group, L-TE and S-TE independently predicted significant fibrosis (OR 5.2 and 4.6) and cirrhosis (OR 7.8 and 9.1), but at variance from L-TE, S-TE was independent from liver necroinflammation and steatosis. The NPV of S-TE for gastro-oesophageal varices was 100% using a 48 kPa cut-off. In CLD, spleen stiffness alone or in combination with hepatic stiffness can be reliably and reproducibly assessed by TE with the added value of improving the noninvasive diagnosis of severe liver disease and excluding the presence of oesophageal varices.
    Journal of Viral Hepatitis 02/2014; 21(2):90-8. · 3.08 Impact Factor
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    ABSTRACT: Swallowing of cold liquids decreases amplitude and velocity of peristalsis in healthy subjects, using standard manometry. Patients with achalasia and non obstructive dysphagia may have degeneration of sensory neural pathways, affecting motor response to cooling. To elucidate this point, we used high-resolution manometry. Fifteen healthy subjects, 15 non-obstructive dysphagia and 15 achalasia patients, after pneumatic dilation, were studied. The 3 groups underwent eight 5 mL single swallows, two 20 mL multiple rapid swallows and 50 mL intraesophageal water infusion (1 mL/sec), using both water at room temperature and cold water, in a randomized order. In healthy subjects, cold water reduced distal contractile integral in comparison with water at room temperature during single swallows, multiple rapid swallows and intraesophageal infusion (ratio cold/room temperature being 0.67 [95% CI, 0.48-0.85], 0.56 [95% CI, 0.19-0.92] and 0.24 [95% CI, 0.12-0.37], respectively). A similar effect was seen in non-obstructive dysphagia patients (0.68 [95% CI, 0.51-0.84], 0.69 [95% CI, 0.40-0.97] and 0.48 [95% CI, 0.20-0.76], respectively), whereas no changes occurred in achalasia patients (1.06 [95% CI, 0.83-1.29], 1.05 [95% CI, 0.77-1.33] and 1.41 [95% CI, 0.84-2.00], respectively). Our data suggest impairment of esophageal reflexes induced by cold water in patients with achalasia, but not in those with non obstructive dysphagia.
    Journal of neurogastroenterology and motility 01/2014; 20(1):79-86. · 2.70 Impact Factor

Publication Stats

5k Citations
1,746.77 Total Impact Points

Institutions

  • 2006–2015
    • Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
      Milano, Lombardy, Italy
  • 1989–2014
    • University of Milan
      • • Department of Medical Sciences
      • • Department of Internal Medicine
      • • Istituto di Scienze Dermatologiche
      Milano, Lombardy, Italy
    • Azienda Ospedaliera Istituto Ortopedico Gaetano Pini
      Milano, Lombardy, Italy
  • 2013
    • Copenhagen Trial Unit
      København, Capital Region, Denmark
  • 2010–2012
    • Ospedale Valduce-Como
      Como, Lombardy, Italy
  • 2007
    • Azienda Ospedaliera della Provincia di Lecco
      Lecco, Lombardy, Italy
  • 1999–2004
    • Ospedale di San Raffaele Istituto di Ricovero e Cura a Carattere Scientifico
      Milano, Lombardy, Italy
  • 2002
    • Ospedali Riuniti di Bergamo
      Bérgamo, Lombardy, Italy
  • 2000–2002
    • Ospedale Maggiore di Lodi
      Lodi, Lombardy, Italy
  • 2000–2001
    • Ospedale Maggiore Carlo Alberto Pizzardi di Bologna
      Bolonia, Emilia-Romagna, Italy
  • 1998–2000
    • Università degli Studi del Sannio
      Benevento, Campania, Italy
    • Foundation of the Carlo Besta Neurological Institute
      Milano, Lombardy, Italy
  • 1995–1999
    • Istituto Nazionale Tumori "Fondazione Pascale"
      Napoli, Campania, Italy
  • 1985
    • University of Padova
      Padua, Veneto, Italy