Publications (7)16.14 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: The aim of our study was to assess the hemodynamic changes in hepatic and splenic circulation using B-mode ultrasonography and color Doppler ultrasonography, in a population of patients with metabolic syndrome divided with respect to the presence or absence of steatosis diagnosed by ultrasonography. One hundred forty-one patients were included in the study. The severity of non-alcoholic fatty liver disease was classified as mild, moderate or severe. Visceral fat thickness, longitudinal diameter of the spleen, diameter of the portal vein, mean maximum portal vein flow velocity, hepatic artery and splenic artery resistivity indexes and hepatic vein flow phasicity were measured. Non-alcoholic fatty liver disease was detected in 114 of 141 patients, with a prevalence of 80.8%. Patients with steatosis had significantly greater diameters of the portal vein, longitudinal diameters of the spleen, visceral fat thickness and hepatic artery and splenic artery resistivity indexes, whereas their portal vein flow velocities were significantly lower. Non-alcoholic fatty liver disease severity correlated positively with diameter of the portal vein, longitudinal diameter of the spleen and visceral fat thickness and negatively with hepatic artery and splenic artery resistivity indexes and reduced hepatic vein flow phasicity. Our patients with metabolic syndrome and non-alcoholic fatty liver disease had a flattened hepatic vein flow phasicity, greater portal vein diameter, reduction in portal vein flow velocity and intrahepatic arterial vasodilation. The vasodilation of the intrahepatic arterial system was likely activated both by the effect of insulin resistance and as a physiologic adaptation to restore hepatic flow. The increase in spleen volume might be related to the organomegaly typical of obese patients. Copyright © 2015 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.
- [Show abstract] [Hide abstract] ABSTRACT: Recently, a link between high levels of circulating IL-6 and hepatocellular carcinoma (HCC) has been proposed. In addition, single nucleotide polymorphisms (SNPs) in the promoter region of the IL-6 gene have been reported to be related to several inflammatory-related conditions, including cancer. The purpose of this article is: (1) to evaluate the frequencies of SNPs in the IL-6 promoter region at position -174 and IL-6 serum levels in a group of patients with HCC and underlying liver cirrhosis (LC), and compare them with a group of LC patients without HCC; (2) to determine whether a possible correlation exists between the allelic variations, IL-6 serum levels, and the risk of developing HCC. The study included 105 HCC and 95 LC patients. Genomic DNA was isolated using commercially available kits. DNA samples were typed for relevant SNPs of the IL-6 promoter region (-174 G>C, G allele being associated with higher levels of the cytokine). The Restriction Fragment Length Polymorphism (RFLP-PCR) method was used to type the SNPs. IL-6 serum levels were determined using an ultrasensitive commercially available ELISA kit. IL-6 serum levels were higher in G/G compared to C/C genotypes only in HCC (z=2; p=0.04) and G/G versus G/C (z=1.8; p<0.03). IL-6 serum levels in G carriers (G/G+G/C) were higher in HCC 4.8 (0.2-17.5) versus LC patients 2.2 (0.07-11.5) (z=2.8; p=0.004). There was no difference for genotype C/C. IL-6 serum levels in HCC correlated with G carriers (G/G+G/C) (ρ=0.25, p=0.05). A positive correlation was also found between sIL-6 levels and some parameters of liver function both in LC and in HCC patients.
- [Show abstract] [Hide abstract] ABSTRACT: Transarterial chemoembolization (TACE) is included among the wide therapeutic tools for the treatment of hepatocellular carcinoma (HCC), tumour with high frequency and malignancy. The approach is invasive and, beyond the discomfort for the patient, it is charged by a number of side effects and complications. In this study we report the case of renal acute failure of hypovolemic origin, as a consequence of a TACE in a patient suffering from HCC, occurred after one week of intervention. The different possible mechanisms involved in the pathogenesis of this complication are discussed.
- [Show abstract] [Hide abstract] ABSTRACT: Hepatic encephalopathy is a neuropsychiatric syndrome characterized by a wide spectrum of mental and motor disturbances. It may show as an overt encephalopathy, when it is clinically well defined, or as a minimal hepatic encephalopathy (MHE), which refers to a neuropsychiatric condition not revealed by routine clinical tests, but using specific psychometric and neurophysiological techniques. As a matter of fact MHE involves the fine cognitive functions that influence the essential daily activities of, such as the ability to drive and some visuospatial ability, pertaining, calculating and handling activities. The physiopathological bases of MHE depend on the changes occurring in the intestinal lumen, following the haemodynamic alterations of the splanchnic circulation that favourishes the bacterial growth and increases the ammonia load from the intestine. From a prognostic point of view, the presence of MHE is associated to a decrease of the quality of life and the ability to work with an increased mortality, at least in patients with a high Child-Pugh score. Moreover, MHE represents a risk factor for the development of an overt encephalopathy. The treatment of MHE improves the quality of life of cirrhotic patients, but the long term therapy points out serious concerns about compliance and tolerance. The main therapeutic aims are: to induce a reduction of ammonia load and toxins coming from the intestine, using cathartic drugs and the management of the potential triggering factors which lead to MHE.
Article: Rickettsiosis[Show abstract] [Hide abstract] ABSTRACT: Rickettsioses are infectious diseases with an acute course, epidemic or endemic diffusion in different areas of the world, characterized by fever and by a maculopapular or vescicular or petechial rash, provoked by schizomycetes belonging to Rickettsia species. Among the various different species, Rickettsia Conorii is the only one present in the Mediterranean basin and is responsible of the spotted Mediterranean fever, the sole endemic Rickettsiosis in Italy. It causes a disease with acute course but benign evolution, characterized by a maculopapular-nodular rash. Identified by Conor and Bruch in 1909 in Tunisia, it has been found for the first time in Italy in 1920 by Carducci. In this work the diffusion of spotted Mediterranean fever, from its inoculation in man with the canine tick bite until the complete development of the disease, was reviewed. Diagnosis relies on clinic and laboratory findings, and is based on the increase of antibody titre in at least two consecutive serum samples. Therapy still relies on the use of antibiotics, tetracycline and cloramphenicol, in the adults, and macrolides in pediatric age.
Università degli Studi di Palermo
Palermo, Sicily, Italy
- Department of internal medicine and medical specialties (DIMIS)