Simona Barberi

University of Milan, Milano, Lombardy, Italy

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Publications (24)40.89 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: Objectifs L’immunothérapie par voie sublinguale (ITSL) est un traitement efficace qui se heurte comme tous les traitements de fond à des problèmes d’adhérence de la part du patient. La mesure du No exhalé (FeNO) est un examen non invasiif qui permet de mesurer l’inflammation dans l’asthme. Le but de cette étude était d’évaluer si des mesures répétées du FeNO pouvaient augmenter l’adhérence au traitement. Patients et méthodes Quarante-quatre patients (23 hommes et 21 femmes, de moyenne d’âge 25,5 ± 12,9 ans) victimes d’une rhinite allergique et désensibilisés par ITSL aux acariens ont été inclus dans cette étude. Ils ont été randomisés en 2 groupes : patients effectuant au moins 2 mesures du FeNO (groupe FeNO), vs patients n’ayant jamais effectué de mesure ou FeNO ou uniquement à une seule occasion (groupe noFeNO). L’adhérence au traitement a été appréciée par le nombre de demandes de renouvellement des extraits allergéniques. Résultats Le groupe FeNO a effectué un plus grand nombre de demandes de renouvellement des extraits de désenbilisation comparé au groupe noFeNO, à la fois lors de la première année de traitement et pour toute la durée de l’ITSL. Conclusion Nous avons objectivé une corrélation entre les mesures du FeNO et l’adhérence à la SLIT basée sur le renouvellement du traitement. Ces résultats suggèrent que la surveillance de la maladie avec un paramètre numérique clair, tel que le FeNO, peut aider les patients à mieux comprendre leur état de santé et permet de les motiver pour poursuivre le traitement de fond.
    Revue Française d'Allergologie 01/2014; · 0.35 Impact Factor
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    ABSTRACT: Purpose: Thyroid malignancies can be treated by surgery followed by ablation of the remnant tissue with 131I. As iodide removal from the body occurs by renal extraction, in patients suffering from end-stage renal disease it is necessary to properly evaluate both timing and method of the extracorporeal treatment. Methods: We present two patients on regular hemodialysis, admitted in isolation to the Nuclear Medicine Department and treated with 131I for thyroid carcinoma diagnosed during the check-up for transplantation. Both patients underwent two hemodialysis sessions with a portable machine for CRRT (continuous renal replacement therapy), 24 and 48 hours after the administration of 50 mCi of 131I. The nursing staff were monitored with a dosimeter. Radioactivity of the patients, dialysate and urines were measured during hemodialysis. Results: The greater reduction was obtained with the first dialysis, but in both patients a further, though shorter, hemodialysis at 48 hours was necessary for reaching a patient's radioactivity compatible with discharge. Radioactivity measured in the dialysate demonstrated the almost total removal of radioiodine by dialysis alone. In both patients, follow-up exams revealed a complete ablation of thyroid tissue, without signs of local recurrence. The dose of radioactivity of the dialysis staff was below allowable limits. Conclusions: We conclude that a successful reduction of radioactivity, without dispersing its therapeutic efficacy, can be obtained with daily hemodialysis with a CRRT machine in patients in isolation treated with 131I. A therapeutic model is proposed.
    The International journal of artificial organs 05/2013; · 1.76 Impact Factor
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    ABSTRACT: Matrix-producing breast cancer (MPC) is a subtype of metaplastic carcinoma of the breast. It is a very rare tumor, which constitutes less than 1% of all malignant mammary tumors. The origin of this tumor is still unclear: there are molecular studies that suggest an origin from myoepithelial cells, whereas other studies underline the neoplastic transformation of a multipotent stem cell. Even the differential diagnosis of MPC and other breast neoplasms (phyllodes tumors and real sarcomas of the breast) is not always easy. In the literature, a certain chemoresistance has been demonstrated, and a standard treatment of this tumor does not exist at this time. We report the case of a 44-year-old, premenopausal, female patient with a 6-cm breast lump. Neither imaging nor fine needle aspiration biopsy was crucial in achieving a diagnosis. The patient underwent a simple mastectomy. In consideration of the negative lymph node status, the patient was not subjected to radiotherapy or adjuvant chemotherapy. Moreover, since the receptor status was negative, hormone therapy was not necessary. The patient has been disease free for 4 years now.
    Case Reports in Oncology 05/2013; 6(2):245-9.
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    ABSTRACT: Background: Anthracycline is very effective in treatment of breast cancer, however it can cause cardiac toxicity events. nPLD has greater safety profile and comparable efficacy than conventional anthracyclines. We evaluated safety and efficacy, in neoadjuvant setting, of nPLD in pts with LABC. Methods: 11 pts (median age 57 years). Their clinical stage was: stages IIA and IIB 1 pt respectively, IIIB 7 pts, IIIC 2 pts. 8 pts presented at diagnosis with cT4 disease. All pts were treated with nPLD (50 mg/mq, d1q21) plus Docetaxel (75 mg/mq, d1q21) and Cyclophosphamide (500 mg/mq, d1q21); only 1 pt received Cyclophosphamide, nPLD and Trastuzumab. At beginning of therapy, overall population had left ventricular ejection fraction (LVEF) ≥55%. Results: After a median of 4 chemotherapy cycles, we observed following clinical response: stable disease 2 pts (18%); partial response 7 pts (64%); complete response 2 pts (18%). 9 pts were evaluable for radiological response: objective response rate and clinical benefit were 78 % and 100% respectively. 8 pts underwent surgery, in 3 pts was performed breast-conserving surgery. At the definitive histological examination pathologic stage was: IA 4 pts (50%), IIIA 1 pts (12,5%), IIIB 2 pts (25%) and IIIC 1 pts (12,5%). 2 pts experienced cardiac toxicity: 1 pt had an atrial fibrillation G2 while 1 pt had an symptomatic decline of LVEF G3 after first cycle, causing interruption of treatment. Other pts not showed clinically significant reduction of LVEF (>5%). Conclusions: Despite small number of pts, our experience suggests a safety profile and efficacy of nPLD in neoadjuvant settings for LABC; breast conservation was possible in 3 pts, in other pts (73%) this was not possible mainly for the advanced stage (T4).
    2012 ASCO Annual Meeting, Chicago (US); 06/2012
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    ABSTRACT: Allergic rhinitis (AR) is characterized by Th2 polarized immune response. Specific immunotherapy modifies this arrangement restoring a physiologic Th1 profile. Sublingual immunotherapy (SLIT) is widely prescribed, but there is no early marker of response. The aim of this study is to investigate possible marker of SLIT effectiveness. Thirty children with mite allergy were studied: 15 were treated with drugs alone, 15 with SLIT and drugs on demand. The study lasted 2 years. Visual analogue scale (VAS) for symptoms and medication score were evaluated. Serum cytokines (IL-2, IL-4, IL-6, IL-8, IL-10, IFN-gamma, MCP-1, and TNF-alpha) were assessed by ELISA before and after 1 and 2 year SLIT. SLIT-treated children obtained a significant improvement of symptoms and a reduction of drug use, whereas children treated with a drug alone did not obtained any change. IL-10 significantly increased, whereas Th2-dependent and pro-inflammatory cytokines significantly decreased. In conclusion, the present study demonstrates that 2-year SLIT is capable of inducing immunologic hyporeactivity to mites.
    Journal of biological regulators and homeostatic agents 01/2011; 25(4):627-34. · 5.18 Impact Factor
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    ABSTRACT: Ovarian cancer is usually limited to the abdomen and frequently remains confined. The occurrence of extrabdominal mestastases is unusual. In this report we describe a rare case of axillary involvement at initial presentation of ovarian cancer in a 48-year-old woman. The axillary mass was the only clinical abnormality. Cytological and histological findings, performed on axillary lymph nodes, showed the presence of psammoma bodies and specific immunohistochemical tumor markers (OC-125 and WT1), supporting the evidence of a metastatic axillary lymphadenopathy from ovarian cancer. Subsequently, chest and abdominopelvic computed tomography showed a right ovarian complex mass of 30 x 25 mm and biochemical tests showed high levels of CA125. Surgical therapy was performed. Histology confirmed the diagnosis, evidencing a poorly differentiated serous-papillary carcinoma of the right ovary. In conclusion, cytological and histological findings can play a crucial role in suggesting the correct origin of a metastatic adenocarcinoma when the clinical presentation is atypical.
    European journal of gynaecological oncology 01/2011; 32(2):237-9. · 0.58 Impact Factor
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    ABSTRACT: A 54-year-old man with multiple myeloma underwent peripheral blood stem cell transplantation (PBSCT) with cells donated by his human leukocyte antigen (HLA)-identical sister. Eight months after PBSCT, the patient experienced chronic graft-versus-host disease with skin involvement (generalized erythema), mucosal ulceration, sicca syndrome, and elevated liver enzymes. Two years after PBSCT, the patient developed nephrotic syndrome with massive proteinuria, which required hospitalization. Physical examination, blood and urine analyses, liver function tests, 24 h urinary albumin excretion and renal biopsy. Focal segmental glomerulosclerosis as a complication of graft-versus-host disease. Prednisone, ciclosporin and an angiotensin-converting-enzyme inhibitor.
    Nature Reviews Nephrology 05/2009; 5(4):236-40. · 7.94 Impact Factor
  • G B Pajno, S Barberi
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    ABSTRACT: The sublingual route of administration of allergen (SLIT) has emerged as an effective treatment. Other non-injective route of administration of vaccines failed their goals; oral immunotherapy (OIT), local nasal immunotherapy (LNIT), local bronchial immunotherapy (LBIT) were reported as too expensive or unsafe or ineffective. Oral regimens were used in the first half of the 20th century but then they lost ground to injection immunotherapy. SLIT is suitable for home treatment and it has not to be regarded not only as a substitute of subcutaneous immunotherapy (SCIT), but also as a complementary or additional therapeutic tool in conventional medical practice. Currently, the balance sheet for SLIT is improving: with the steadily increasing number of patients with IgE mediated disorders, looking for a "cheap, safe and effective therapy" becomes a priority.
    International journal of immunopathology and pharmacology 01/2009; 22(4 Suppl):1-3. · 2.99 Impact Factor
  • Journal of Allergy and Clinical Immunology - J ALLERG CLIN IMMUNOL. 01/2009; 123(2).
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    ABSTRACT: Although atopy patch tests (APT) seem a valuable additional tool in the diagnostic work-up for food allergy in children with atopic eczema/dermatitis syndrome, the immunopathology and some technical aspects of testing remain controversial. Few published data are available on the reproducibility of APT with inhalants and only two studies include fresh food allergens. In this study we therefore investigated the reproducibility of duplicate APT (left versus right side of the back) with native and commercially available food (cow s milk, hen s egg, tomato, wheat flour) and with inhalant allergens (Dermatophagoides pteronyssinus and mixed grasses) in a large unselected population of children. We tested a population of 277 Italian school children with three APT allergens: fresh food (cow s milk, hen s egg, tomato and wheat flour), standardised food allergens in petrolatum (the same four foods) and standardised inhalant allergens routinely used for skin prick testing. For the four food allergens (applied in the natural form or as the standardised commercial preparation) from one- to three quarters of the APT gave positive results on one side and negative reactions on the opposite side (Cohen s K coefficient between 0.38, fresh tomato and 0.81, fresh cow s milk). Conversely, APT with inhalant allergens were invariably reproducible (Cohen s K = 1.00). The possible technical and immunologic reasons explaining why reproducibility of APT differed for the two types of allergens await an answer from extensive controlled studies.
    Journal of biological regulators and homeostatic agents 01/2008; 22(1):27-33. · 5.18 Impact Factor
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    ABSTRACT: Acute rhinosinusitis (ARS) is frequent in children. Patients with allergic rhinitis show signs of more impaired paranasal sinus functioning than normal subjects during viral colds. This study evaluated the effectiveness of administering antibiotics alone to treat ARS in both allergic and non-allergic children. We obtained informed consent from the parents of each patient enrolled in the study. 97 children, 55 males and 42 females aged between 4 and 9 years (46 of whom were allergic), suffering from ARS, were treated with amoxicilline-clavulanate (50 mg/Kg bid) for 14 days. Symptoms and endoscopic signs of illness were evaluated at baseline and immediately after treatment. Symptoms improved significantly (p<0.001) after treatment in 84 patients, equally distributed between allergic and non-allergic subjects. On the contrary, endoscopic signs disappeared only in 49 children, 9 of whom were allergic (OR 14.9, 95%CI 4.6-40.1, p<0.001). Slight to fair agreement was observed between clinical symptoms and endoscopic signs (agreement 64% , Kappa=0.28, McNemar test p<0.001). Antibiotic therapy alone in the treatment of ARS may be generally insufficient to resolve symptoms, mainly endoscopic signs. Moreover, in allergic children this issue appears to be more evident.
    International journal of immunopathology and pharmacology 01/2007; 20(1):97-101. · 2.99 Impact Factor
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    ABSTRACT: Breast cancer presents important differences in distribution of histopathologic factors between younger and older patients but it's less clear if reduction of survival which often occurs in cancer of the youth depends on the concomitant presence of negative prognostic factor or if age alone acts as a factor indicating more aggressiveness. Many studies seem to indicate that young age at diagnosis is an independent predictive factor mostly in patients with early stage of disease and negative nodes. Other studies assert that age can be considered as the most important predictive factor after nodes involvement.
    Recenti progressi in medicina 05/2006; 97(4):225-8.
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    ABSTRACT: We describe the case of a young woman with asthma and confirmed food allergy to sesame who had 2 severe systemic reactions after the inadvertent ingestion of tahini, a paste made with ground sesame seeds that is not generally known by physicians and patients as a sesame-containing food. A double-blind placebo-controlled food challenge confirmed the allergy to tahini in our patient. As new products and recipes are being introduced from around the world on a regular basis, it is essential that at-risk patients are able to obtain information about allergens used as ingredients and as potential contaminants. This should be applied not only to packaged food but also to freshly made foods, such as those served in restaurants.
    Journal of investigational allergology & clinical immunology: official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología 02/2006; 16(5):308-10. · 1.89 Impact Factor
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    ABSTRACT: A 72 year-old male, seven years later the first diagnosis of rectal adenocarcinoma, referred a trouble in hard palate. Clinical examination evidenced a whitish coloured projecting area, not painful at palpation and with the largest diameter of 2 cm. The first biopsy suggested a neoplastic lesion but it was not resolutive for diagnosis. Another biopsy was executed. The second histological report evidenced a neoplastic infiltration of poorly differentiated adenocarcinoma, with mucinous aspects and necrosis. Immunophenotype was compatible with diagnosis of metastasis of adenocarcinoma originated from large bowel. The pathological diagnosis was confirmed by a second pathologist.
    Oral Oncology Extra 01/2006; 42(5):206-209.
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    ABSTRACT: Smoking is harmful for respiratory function. In young to middle-aged men the damage is insidious and difficult to demonstrate. The respiratory impairment could increase under specific stressful conditions in the professional environment. On the hypothesis that exhaled markers are useful for assessing airway susceptibility to inhaled irritants, we measured exhaled markers and lung function in smoking and non-smoking engine-driver military coastguards before and after a patrol at sea. Eighteen men, mean age 39 yrs (range 23-58 yrs), 8 smokers, underwent spirometry, exhaled and nasal nitric oxide (eNO, nNO), exhaled carbon monoxide (CO) and exhaled breath condensate (EBC) for measures of hydrogen peroxide (H2O2), leukotriene B4 (LTB4), proteins (Prots), 8-isoprostanes (8-IsoPs), nitrite (NO2-) and nitrosothiols (RS-NOs) at baseline and after an 8-hour patrol navigation on board small, high-speed diesel-powered ships. At baseline, the smokers showed higher middle flows and CO levels, lower eNO and nNO than non-smokers, but similar levels of EBC markers; geometric means (95% confidence interval), CO: 23.6 (14.5 to 38.3) vs. 3.5 (2.5 to 5.3) ppm; eNO: 7.9 (4.8 to 12.9) vs. 26.7 (15.7 to 45.5) ppb, p=0.000. After navigation, Prots, 8-IsoPs and RS-NOs (but not lung function variables or other markers) significantly increased only in smokers; baseline vs post-navigation RS-NOs: 0.27 (0.11 to 0.65) vs. 1.30 (0.58 to 2.89) micromol, p=0.012. The respiratory consequences of a stressing environment in engine-driver military coastguards who actively smoke are better assessed by measuring EBC markers than by eNO, nNO or lung function. By increasing airway inflammation from oxidative-stress, tobacco smoking appears to interact with other chemical or physical factors elicited during sea navigation. Precisely what these factors are deserves further investigation.
    International journal of immunopathology and pharmacology 01/2006; 19(3):601-8. · 2.99 Impact Factor
  • The Breast Journal 01/2004; 10(6):554-7. · 1.83 Impact Factor
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    ABSTRACT: Financing health-care expenditure has become increasingly more difficult. Considering the high frequency of breast cancer, which affects one million women in the world each year, the reductions of medical expenditure for the treatment of this disease is highly desirable within the limits of medical efficiency and safety. One hundred and fifty patients with carcinoma of the breast underwent surgery in our department with one-day hospitalization. Patients were discharged with the drainage tube still in place and later treated in the out-patient setting, for dressing and checking the wound, and removing the stitches and drainage tube. Four cases of seroma were registered, all resolved by aspiration of the fluid in a single visit, 1 case of haematoma and 1 case of infection. Patients who underwent this short-stay treatment were amply satisfied. Our experience demonstrates that this type of treatment is both safe and effective. Moreover, it provides considerable benefits in terms of national health-care costs as well as being psychologically better for the patients.
    Chirurgia italiana 01/2004; 56(3):415-8.
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    ABSTRACT: Hypomagnesemia in renal transplant patients is almost always documented through total serum values (MgT), but it has recently become user-friendly to assay the biologically active, ionised fraction (Mg++). We verified the prevalence of true ionised magnesemia and the correspondence between total and ionised Mg assays in our transplanted patients, taking into account renal Mg excretion and the possible role of other reputed factors of hypomagnesemia (cyclosporine, secondary hyperparathyroidism and acid-base balance). Thirty-eight transplanted patients (25M/13F, aged 41 +/- 11 years) and 38 age and sex matched controls were enrolled. Blood chemistries included: ionised Mg and Ca, total Mg and Ca, phosphate, creatinine, albumin, bicarbonate, alkaline phosphatase, parathyroid hormone and, in patients, cyclosporine (CyA). A 24-h urine collection (for Ca and Mg) and a fasting spot sample (for pH, Mg, Ca, phosphate, creatinine) were also obtained. Patients with mild renal failure (creatinine: Cr=1.75 +/- 0.83 mg/dL), mild persistent secondary hyperparathyroidism and almost normal tubular acidification capacity had MgT lower than controls (0.76 +/- 0.08 vs 0.82 +/- 0.08 mmol/L; p<0.002), with 10 cases (26%) of total hypomagnesemia. Mg++ was also significantly low (0.51 +/- 0.08 vs 0.53 +/- 0.05 mmol/L; p<0.03), but there were only four cases (10%) of true ionised hypomagnesemia. MgT and Mg++, although correlated (with a low r value: =0.49; p<0.001), showed poor correspondence in individual patients and MgT was not useful to identify cases of true ionised hypomagnesemia. Neither assay correlated with renal function. Daily urinary excretion of Mg was normal (3.5 +/- 1.3 vs 3.0 +/- 0.24 mmol/day; n.s.), with no case of definite hypomagnesuria. Fasting excretion fraction (EF) of Mg, calculated with both assays, was increased in approximately 60% of patients (EF(MgT) 4.9 +/- 2.6 vs 2.32 +/- 0.7%; p<0.0001; EF(Mg++) 7.74 +/- 4.9 vs 3.63 +/- 1.18%; p<0.0001) and positively correlated with serum Cr (r=0.62; p<0.0001 with EF(MgT); and r=0.467; p<0.005 with EF(Mg++) but not with CyA. Neither Mg assay correlated with serum CyA, calcium, phosphate, PTH or bicarbonate. In long term renal transplant patients not taking diuretics, the prevalence of true ionised hypomagnesemia is low. Renal insufficiency, typically associated with Mg retention, is the major cause of increased EF(Mg) and, as such, plays an antagonistic role to CyA and other factors of renal Mg wasting. Because MgT and Mg++ are not closely related, assay of the ionised fraction seems advisable in case of total hypomagnesemia. However, because diagnosis of depletion can hardly rely on serum assay alone, a fuller evaluation (urinary excretion and other clinical and biochemical signs of hypomagnesemia) is suggested before diagnosis is made.
    Journal of nephrology 01/2002; 15(3):275-80. · 2.02 Impact Factor
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    ABSTRACT: The most recent studies on breast surgery have led us to radio-guided surgery which enables us to identify the sentinel lymph node and thus to remove just a single lymph node. As a result, we are moving in the direction of an increasingly conservative surgical technique which may be carried out in the day surgery setting. This kind of surgery requires both an extremely accurate and prompt diagnosis and a multidisciplinary breast unit, inasmuch as only the collaboration and teamwork of highly qualified staff are capable of furnishing a rapid, accurate diagnosis; in addition, during the operation it may be necessary to perform x-rays or ultrasonography on the surgical specimen. Obviously, nuclear medicine is essential for radio-guided surgery. We report here on our experience with 36,000 women with 1,147 carcinomas whose diameters were less than or equal to 2 cm in 78.64% of the cases, with the possibility of performing conservative surgery in such cases. Moreover, by way of confirmation of the good diagnostic accuracy, we report our findings in 954 lesions operated on under local anaesthesia, because they were presumed to be most probably or definitely benign, but which tended to increase in volume. During the final histological examination only 10 of these 954 lesions turned out to be malignant, with only a 1.05% incidence of diagnostic error.
    Chirurgia italiana 55(3):345-9.
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    ABSTRACT: In recent years, breast carcinoma diagnostics and therapy have evolved very considerably, allowing conservative surgery in most cases. These kinds of major operations have been greatly simplified since the introduction of the sentinel lymph node approach, with the possibility of a day surgery operation under local anaesthesia. The aim of this study, after thorough analysis of the axillary lymph nodes with ultrasound and cytological examinations, was to assess whether it would be possible to distinguish between negative and metastatic lymph nodes and whether the operation could be performed under local anaesthesia without hospitalisation. From January 2005 to January 2007, 54 breast carcinoma patients with negative axillary lymph nodes (after ultrasound examination) had a quadrantectomy and sentinel lymph node removal under local anaesthesia together with sedation where appropriate. Eight patients who presented micrometastases or isolated tumour cells in the sentinel lymph node underwent a subsequent lymphadenectomy. Our data show that, thanks to thorough analysis of the axillary cavity, it may be possible to use the sentinel lymph node approach with a good chance of the patient remaining free of distant metastases and of operating under local anaesthesia.
    Chirurgia italiana 60(3):391-4.