Lorenzo Fantini

University of Bologna, Bolonia, Emilia-Romagna, Italy

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Publications (31)41.6 Total impact

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    ABSTRACT: Pancreatic serous cystic tumors are considered to have a benign biological and clinical course with only few malignant cases. We retrospectively analyzed data from 26 patients affected by serous cystic tumors consecutively observed in our Pancreas Unit. We explored the different clinical pictures in operated and nonoperated patients. Eighteen of the 26 patients were female (69%), median age at diagnosis was 61.5 years and 20 patients (77%) underwent surgery. The median diameter of the tumors was greater in patients who underwent surgery than in those who did not (5.5 versus 2.3 cm, p < 0.001). Major pancreatic resections were carried out in 15 of the 20 operated patients (75%). Postoperative morbidity and mortality were 20 and 5%, respectively. During follow-up, there was no observed development of malignancy or any significant increase in the diameter of the lesion among nontreated patients. In asymptomatic patients with a clear imaging diagnosis of serous cystic tumor a wait and see management should be recommended, with a careful follow-up. Surgery should be suggested in symptomatic patients or when the preoperative diagnosis is doubtful.
    No preview · Article · Aug 2008 · Digestive surgery
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    ABSTRACT: To evaluate the adhesion molecule time course in the early phases of acute pancreatitis and to explore the usefulness of these proteins in assessing the severity of the disease. Fifteen consecutive acute pancreatitis patients (10 patients with the mild and 5 with the severe disease) admitted to the hospital within 6 hours after the onset of pain and 15 age- and sex-matched healthy subjects. Vascular cell adhesion molecule 1, intercellular adhesion molecule 1, E-selectin, P-selectin, and L-selectin were quantified on hospital admission and for the following 2 days. Acute pancreatitis patients had vascular cell adhesion molecule 1 and P-selectin concentrations significantly lower and L-selectin concentrations significantly higher than the healthy subjects. Only E-selectin was significantly higher in severe than in mild disease (P = 0.029); a value of E-selectin ranging from 3.83 to 3.92 ng/mL was the best cutoff value for differentiating severe from mild acute pancreatitis (sensitivity: 60.0%, specificity: 90.0%, cases correctly classified: 80%). E-selectin and P-selectin entered the multivariate logistic regression analysis, and a score was calculated showing a sensitivity of 93.3% and a specificity of 86.7% in identifying the patients with severe pancreatitis. This score seems to be useful for the early assessment of the severity of acute pancreatitis.
    Full-text · Article · Aug 2008 · Pancreas
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    ABSTRACT: The usefulness of stool calprotectin determination in diagnosis of inflammatory disease of the colon has been reported; information about its usefulness for patients with polyposis are scarce, however. To evaluate the significance of stool calprotectin concentrations for patients affected by colonic polyposis. Sixty-three consecutive patients (35 males, 28 females, mean age 60.3 years, range 39-78 years) were enrolled: 26 patients (41.3%) with polyps, 17 patients (27.0%) with asymptomatic diverticular disease, and 20 subjects (31.7%) with normal endoscopic appearance of the colon. Stool calprotectin concentrations were 17.4 +/- 24.5 microg g(-1) for patients with colonic polyposis, significantly higher than concentrations for patients with diverticulosis (7.1 +/- 5.7 microg g(-1); P = 0.026) or for patients with normal appearance of the colon (calprotectin 6.0 +/- 5.8 microg g(-1); P = 0.003). For patients with a single polyp, stool calprotectin concentrations were similar to those for patients with multiple polyps. Calprotectin fecal concentrations for patients with sessile polyps and those with flat polyps were not significantly different. Calprotectin concentrations were not significantly related to the size of the polyps. Our data show that colonic polyposis may cause an increase in stool calprotectin values and that these colonic lesions should be suspected when elevated stool calprotectin concentrations are found.
    Full-text · Article · Feb 2008 · Digestive Diseases and Sciences
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    ABSTRACT: SF-12 Health Survey, and European Organisation for Research and Treatment of Cancer Quality of life Questionnaire-C30 are the two main questionnaires proposed and validated for assessing the quality of life in chronic pancreatitis. To evaluate the role of the information furnished by both the SF-12 Health Survey and European Organisation for Research and Treatment of Cancer Quality of life Questionnaire-C30 questionnaires, and to determine which of these two questionnaires may be considered more efficacious, in clinical practice, in describing the quality of life of patients with chronic pancreatitis. We studied 163 consecutive patients with proven chronic pancreatitis. The Italian version of the SF-12 Health Survey and the Italian neutral version of the European Organisation for Research and Treatment of Cancer Quality of life Questionnaire-C30 Version 3.0 questionnaires were administered. Pancreatic pain was the only clinical variable able to significantly impair the SF-12 Health Survey component summaries as well as all domains of the European Organisation for Research and Treatment of Cancer Quality of life Questionnaire-C30, while body mass index was positively related to the physical component summary-12 and to the domains of the European Organisation for Research and Treatment of Cancer Quality of life Questionnaire-C30. A high level of reliability of the domains/scores of the two questionnaires in evaluating the quality of life in patients with chronic pancreatitis was found and two main factors were identified. These two factors were mainly related to the two SF-12 Health Survey summary components. From a practical point of view, the SF-12 Health Survey is more reliable and easier to use in routine clinical practice than the European Organisation for Research and Treatment of Cancer Quality of life Questionnaire-C30.
    No preview · Article · Jan 2008 · Digestive and Liver Disease
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    No preview · Article · Oct 2007 · Pancreas
  • R. Pezzilli · L. Fantini

    No preview · Chapter · Oct 2007
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    ABSTRACT: Fecal calprotectin determination has been demonstrated to be useful in diagnosing various inflammatory diseases of the gastrointestinal tract; however, data available for patients with pancreatic diseases are scarce. Our aim was to assess fecal calprotectin in order to evaluate the presence of intestinal inflammation in patients with pancreatic disease. Eligible patients with suspected pancreatic illness were enrolled, and in all of them fecal calprotectin and elastase-1, as well as serum amylase and lipase activities, were assayed using commercially available kits. A total of 90 subjects (47 men, 43 women, mean age 58.6 +/- 14.9 years) were enrolled: 20 (22.2%) had chronic pancreatitis; 15 (16.7%) had pancreatic cancer; six (6.7%) had chronic nonpathological pancreatic hyperenzymemia; 16 (17.8%) had nonpancreatic diseases; and 23 (25.6%) had no detectable diseases. Diarrhea was present in 19 patients (21.1%). In univariate analyses, the presence of diarrhea and low fecal elastase-1 concentrations were significantly associated (P = 0.019 and P = 0.002, respectively) with abnormally high fecal calprotectin concentration, and the multivariate analysis demonstrated that low fecal elastase-1 concentration was the only variable independently associated with a high fecal calprotectin concentration. Pancreatic insufficiency may cause intestinal inflammation, probably because of a modification of the intestinal ecology.
    Full-text · Article · Oct 2007 · Journal of Gastroenterology
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    ABSTRACT: There are no data available that evaluate the possible modifications of the quality of life during the clinical course of chronic pancreatitis. To evaluate the outcome for patients with chronic pancreatitis in a 2-year follow-up study. The Short Form 12 Health Survey Italian version questionnaire was used for the purpose of the study. The questionnaire generates 2 summary scores: the physical component summary (PCS-12) and the mental component summary (MCS-12). Eighty-three patients with chronic pancreatitis were studied with a mean (+/-SD) interval time of 2.3 +/- 0.2 years between the first and the second evaluation. There was a significant increase in the frequency of diabetes mellitus (P = 0.008), nonpancreatic surgery (P = 0.016), and comorbidities (P = 0.004). The PCS-12 (44.7 +/- 10.7) and MCS-12 (44.1 +/- 13.3) were not significantly different in comparison with the baseline evaluation (PCS-12, 43.7 +/- 9.8; MCS-12, 44.3 +/- 11.4). The PCS-12 score worsened in 17 (20.5%) patients, 44 (53.0%) had a stable PCS-12 score, and the remaining 22 (26.5%) improved their PCS-12 score. Regarding the mental score, 15 (18.1%) patients worsened, 52 (62.7%) had a stable MCS-12 score, and the remaining 16 (19.3%) improved their MCS-12 score. Only age at diagnosis was significantly related to the change of the MCS-12 score (P = 0.028, positive relationship). The information given by quality-of-life assessment should be routinely included in the work-up of patients affected by chronic pancreatitis to select those patients with severely impaired physical and mental scores, and to plan an intensive program of medical and psychological follow-up.
    No preview · Article · Apr 2007 · Pancreas
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    Raffaele Pezzilli · Lorenzo Fantini

    Full-text · Article · Feb 2007 · JOP: Journal of the pancreas
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    ABSTRACT: Human exhaled breath contains many molecules either present as gases or occurring in a soluble form in the vapor of the breath. This study was designed to evaluate the substances present in the exhaled breath of chronic pancreatitis (CP) patients. Thirty-one consecutive CP patients (11 with exocrine insufficiency) and 31 healthy subjects (HS) were studied. Ninety-eight different substances were analyzed using a mass spectrometer on a breath sample from all subjects and on each respective ambient air sample. H(2)S, NO and a substance having a molecular mass of 66 u (M66) were those which had significantly higher concentrations in CP patients than in HS after adjustment for the ambient air; the estimated increases attributable to the disease were 14% (p = 0.040) for H(2)S, 84% (p = 0.006) for M66 and 50% (p = 0.033) for NO, but the three volatile compounds showed poor diagnostic accuracy in differentiating CP patients from HS (AUC-ROC: 0.664, 0.715, and 0.602 for H(2)S, M66, and NO, respectively). Finally, no significant differences of H(2)S, M66, and NO were found between patients with and without alcoholic pancreatitis as well as between patients with and without pancreatic insufficiency. Exhaled breath analysis can rapidly and easily assess the presence of volatile compounds (H(2)S, NO and a substance having a molecular mass of 66 u) which may have properties capable of explaining, at least in part, the pathogenesis of CP.
    No preview · Article · Feb 2007 · Pancreatology
  • Raffaele PEZZILLI · Lorenzo FANTINI
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    ABSTRACT: Chronic pancreatitis is a benign disease often characterized by recurrent episodes of abdominal pain accompanied by progressive pancreatic exocrine and endocrine insufficiency; it sometimes requires multiple hospitalizations. This disease is frequently the result of chronic alcohol abuse, even if other factors such as genetic alterations, autoimmune disorders, and obstructive disease of the biliary tract and the pancreas may cause the disease. The pain can be considered the most important symptom; it significantly modifies the quality of life of patients with chronic pancreatitis and its control represents a challenge in the treatment of the disease. Among the several modalities for controlling the painful symptomatology, in addition to the use of high doses of analgesics, adding antioxidant substances to the patient's diet has been attempted. In this paper we review the most recent literature data about the use of antioxidants in alleviating the pancreatic pain. Özet: Kronik pankreatit pankreas›n ilerleyici ekzokrin ve endokrin yetmezlii ve tekrarlayan kar›n ar›s› ataklar› ile karekterize benign bir hastal›kt›r ve s›k s›k hastaneye yat›r›lmay› gerekli k›lar. Genetik deifliklikler, otoimmun hastal›klar ve safra yollar› ve pankreas›n t›kay›c› hastal›klar› sonucunda da oluflabilirse de s›kl›kla kronik alkol kullan›m› sonucunda oluflur. Kronik pankreatitli hastan›n yaflam kalitesini de etkileyen en önemli semptom ar›d›r ve ar›n›n kontrolü tedavideki en önemli basmakt›r. Ar›y› kontrol etmek için yüksek doz analjeziklerin kullan›m›na ek olarak, hastalar›n diyetlerine antioksidanlar›n eklenmesi de denenmifltir. Bu makalede pankreatik ar›n›n kontrolünde antioksidanlar›n kullan›m› ile ilgili literatürdeki son çal›flmalar gözden geçirilmifltir.
    No preview · Article · Feb 2007 · Turkish Journal of Medical Sciences
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    Full-text · Article · Feb 2007 · JOP: Journal of the pancreas
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    ABSTRACT: The aim of this paper was to review the data existing in the English literature on the quality of life in patients who undergo surgical resection of the pancreatic gland either for benign or for malignant diseases. MEDLINE, Web of Science, and ScienceDirect were browsed in order to select the data existing in the literature on quality of life and pancreatic surgery. Alerts received by e-mail were also taken into account. Only full text papers were selected. Of the 161 papers found, only 13 papers were evaluated for the purpose of this study: 11 focused on surgical resective procedures in chronic pancreatitis and two focused their interest on assessing the quality of life related to resective procedures in pancreatic neoplasms. Despite the scarcity of studies assessing the quality of life in patients who underwent pancreatic surgery, there is the need to routinely assess well-being in patients who have been operated on.
    Full-text · Article · Feb 2007 · JOP: Journal of the pancreas
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    ABSTRACT: The only potentially radical treatment for pancreatic cancer is the removal of the tumor which can be performed by total or subtotal surgical resection of the pancreas; this is possible in the early stages of the disease when the tumor is confined to the pancreatic gland without metastasis to the liver, lymph nodes and/or the peritoneum, or involvement of the vascular system such as the celiac trunk and its branches and the superior mesenteric artery. In this paper, we describe the accuracy of computed tomography and positron emission tomography in the diagnosis of exocrine pancreatic cancer.
    Full-text · Article · Feb 2007 · JOP: Journal of the pancreas
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    ABSTRACT: In 1961, Sarles et al. [I] reported the case of a non drinker patient suffering from pancreatitis associated with hypergamma-globulinemia. The authors hypothesized that the disease in this patient was ail autonomous pancreatic disease of autoimmune origin. After this report, other authors around the world reported similar cases and they named the disease in several manners: chronic pancreatitis with diffuse narrowing of the pancreatic duct, primary inflammatory pancreatitis, non-alcoholic duct destructive chronic pancreatitis, lymphoplasmacytic sclerosing pancreatitis. granulomatous pancreatitis, idiopathic tumefactive chronic pancreatitis, and sclerosing pancreatocholangitis [2,3]. In 1995, Yoshida et al. [4] Suggested the term "autoimmune pancreatitis" for this disease and, therefore, this term has become largely accepted for pancreatic disease of all autoimmune origin. In the last 10 years, there has been an increasing number of cases reported in Japan and Europe [5]. In this review article, we will briefly describe the main characteristics of autoimmune pancreatitis and then we will concentrate oil our aim, namely, evaluating the clinical characteristics of patients having recurrence of pain from the disease.
    Full-text · Article · Feb 2007 · Advances in Medical Sciences
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    ABSTRACT: In an era such as the present one in which there is a high demand for health services with the associated pressure of controlling spending, health care organizations are concerned about the cost-effectiveness of quality improvement interventions. On the other hand, the impact of the disease and the treatment on the patient's overall well-being and functioning has become a topic of growing interest not only in clinical research but also in practice. The clinical evaluation of the benefits of specific treatments for chronic, debilitating and incurable diseases should increasingly include formal assessment of patient activity and well-being. Thus, health-related quality of life as subjectively perceived by the patient, is becoming a major issue in the evaluation of any therapeutic intervention, mainly in patients with chronic or difficult diseases where the aim of the intervention is to keep patients either symptom-free and capable of living in the community for a long time or to reduce the discomfort caused by the disease. In this paper, we review the current knowledge on the quality of life assessment in chronic pancreatitis patients.
    Full-text · Article · Nov 2006 · World Journal of Gastroenterology
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    No preview · Article · Oct 2006 · Pancreas
  • Raffaele Pezzilli · Lorenzo Fantini
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    ABSTRACT: Acute pancreatitis represents the 0.15-1.5% of all diagnoses in the Emergency Room. Biliary diseases and alcohol abuse are the two mainly etiological factors of this illness in Italy. From a clinical point of view, the course of alcoholic and biliary acute pancreatitis is the same; however, because the endoscopic retrograde cholangiopancreatography associated with endoscopic sphincterotomy can prevent further complications in patients with severe biliary pancreatitis, it is important to early recognize the biliary origin of the disease. On the other hand, the identification of alcoholic origin of pancreatitis can prevent interventional procedures not useful in this kind of patients. In this paper we will assess the markers able to early identify the etiology of this acute illness such as the liver function tests and the lipase/amylase ratio.
    No preview · Article · Oct 2006 · Recenti progressi in medicina
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    Full-text · Article · Sep 2006 · Pancreas

  • No preview · Article · Apr 2006 · Digestive and Liver Disease

Publication Stats

256 Citations
41.60 Total Impact Points

Institutions

  • 2006-2008
    • University of Bologna
      • Department of Experimental, Diagnostic and Specialty Medicine DIMES
      Bolonia, Emilia-Romagna, Italy
    • University of Milan
      Milano, Lombardy, Italy
  • 2005-2007
    • Policlinico S.Orsola-Malpighi
      Bolonia, Emilia-Romagna, Italy