Papers by Massimiliano Loreno
Italian Journal of Medicine, 2017
The aim of this study was to evaluate the management practices of internal medicine clinicians fo... more The aim of this study was to evaluate the management practices of internal medicine clinicians for patients with cardiovascular risk factors, with particular respect to treatment thresholds, medication choices and target goals. A sample of internists - representatives of Internal Medicine Units (IMUs) from all the regions in Italy - were identified by the cardiovascular medicine study group of the Italian Internal Medicine FADOI (Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti) Society and invited to fill out a questionnaire about hypertension, dyslipidemia and hyperuricemia. From the 101 questionnaires collected, it was found that despite large heterogeneity between IMUs in terms of patient management and adherence to guidelines, internists were experts in the management of patients with multiple cardiovascular risk factors and associated comorbidities. We hope that these data prompt the internal medicine community to consider the value of producing shared, real...
Minerva endocrinologica, Jan 13, 2018
Audit is a clinical instrument of government characterized by a whole process of evaluation inter... more Audit is a clinical instrument of government characterized by a whole process of evaluation inter pares to improve medical behaviors in the clinical practice. Different endocrinopathies are underestimated in the clinical and diagnostics practice but they can be a real problem in patients admitted in the departments of Internal Medicine. The Adrenal Incidentaloma (AI) is an accidental discovery with an incidence equal to 4% in radiologic studies but it's rarely considereted in the internal disorders. In the departments of Internal Medicine are hospitalized each year approximately 1.450.000 patients and 58.000 about them show a surrenalic lesion identified with CT or MRI as Adrenal Incidentaloma. Through a search in the radiological archives, were reviewed all abdominal CT performed in the year 2012 in 8 departments of Internal Medicine of 8 Italian public hospitals. They also examined all medical records of these patients to value clinical management of the adrenal masses and the...
Minerva gastroenterologica e dietologica, 2001
The aim of this study is to clarify the prevalence of gallbladder benign neoplasms, their ultraso... more The aim of this study is to clarify the prevalence of gallbladder benign neoplasms, their ultrasonographic appearance and their relationship with gallbladder lithiasis and cancer. This study was carried out on 9000 consecutive patients having ultrasound of upper abdomen. Only adenomas and papillomas are considered as true benign neoplasms of the gallbladder. Adenomiomatosis and cholesterol polyps, often erroneously labelled as benign neoplasms, were excluded. Patients were followed-up by ultrasound every three months up to two years. The prevalence of benign neoplasms was 1.19%. Papillomas were found more frequently than adenomas both in males (68.51%) and in females (94.33%). Gallstones were not concomitant with benign neoplasms in any case. Neither stones nor growth of gallbladder benign neoplasms were recorded within the two-year follow-up period. Papillomas were more frequent than adenomas. No gallstone was concurrent with gallbladder benign neoplasms in our series. However, whe...
Minerva medica, 1997
Urticarial vasculitis (UV) is a primary syndrome or a cutaneous vasculitic lesion occurring in th... more Urticarial vasculitis (UV) is a primary syndrome or a cutaneous vasculitic lesion occurring in the course of a collagen disease, as the systemic lupus erythematosus (LE). UV is a recently recognized disorder which affects most exclusively the female sex and may be differentiated from common (nonvasculitic) urticaria because it is characterized by inflammation and necrosis of blood vessels (vasculitis). UV and common urticaria may be induced by a variety of factors and pathogenetic mechanisms. It seems that a continuum exists, ranging from benign cutaneous lesions of urticaria to vasculitis with strong immunological involvement. On the basis of the clinical evaluation, two major groups of UV have been classified, the normocomplementemic, with a less severe clinical course, and the hypocomplementemic UV, a rare immune complex-mediated disorder related to LE as for as the similar pathogenesis and systemic involvement are concerned. A case of a young female patient with a unique syndrom...
Gastroenterology Research and Practice, 2009
Background and Aim. Gallbladder wall thickening and impaired contractility are currently reported... more Background and Aim. Gallbladder wall thickening and impaired contractility are currently reported in cirrhotic patients and often related to portal hypertension and hepatic failure. The purpose of this work was to evaluate, by ultrasonographic method, gallbladder wall thickness and gallbladder emptying after a standard meal in normal subjects and in patients with compensated liver cirrhosis without gallstones.Methods. Twenty-three patients with Child-Pugh class A liver cirrhosis and twenty healthy controls were studied. Gallbladder wall thickness (GWT), gallbladder fasting volume (FV), residual volume (RV), and maximum percentage of emptying (%E) were calculated. Measurements of mean portal velocity, portal vein flow, and serum albumin were performed too. Statistical analysis was assessed by Student's “ttest” for unpaired data.Results. GWT was cm in cirrhotic patients and cm in controls (). FV and RV were, respectively, and in cirrhotic patients, and in healthy volunte...
Transplantation Proceedings, 2008
Background. Up to 15% of liver transplant candidates have asymptomatic coronary artery diseases, ... more Background. Up to 15% of liver transplant candidates have asymptomatic coronary artery diseases, which increase the risk of cardiac complications during and after transplantation. The aim of this study was to prospectively investigate the usefulness of an integrated cardiological approach in cirrhotic patients undergoing liver transplantation. Methods. Twenty-four consecutive patients undergoing evaluation for liver transplantation were studied by assessing risk factors for coronary artery diseases, electrocardiogram with QTc interval determination, chest X-ray, echocardiography, 24-hour Holter monitor, myocardial perfusion scintigraphy 99mTc MIBI-GSPECT at rest and after dipyridamole infusion. Cardiac 123 I-metaiodobenzylguanidine (MIBG) scan and coronarography were performed in patients with myocardial perfusion defects. Twenty three of 24 patients underwent successful liver transplantation; one patient died on the waiting list. Results. Before liver transplantation, 29% of patients were diabetic and 41% were smokers. Eleven of 24 patients had a prolonged QTc interval, and 3/24 had positive myocardioscintigraphy after dipyridamole infusion: in two coronarography was negative, while the 123 I-MIBG washout was altered. No cardiac events were recorded during the short-and long-term follow-up after surgery. Conclusions. Predictive value of positive cardiac 99mTc MIBI-GSPECT in patients with liver cirrhosis is low, and this may be due to alterations of cardiac microvascular tone as showed by cardiac 123 I-MIBG scan.
Scandinavian Journal of Gastroenterology, 2004
The study of gastric emptying rate of solids using radiopaque indigestible solid markers has been... more The study of gastric emptying rate of solids using radiopaque indigestible solid markers has been a poorly employed technique because some kinds of markers do not leave the stomach at the same time as the meal but during the interdigestive migrating motor complex (IMMC). The aim of this study was to evaluate whether markers of particular shape and size can be successfully employed for this purpose. Twenty-eight non-ulcer dyspeptic (NUD) patients and 20 healthy volunteers received a standard solid meal (790 Kcal) together with 20 small polyethylene radiopaque cylinders (5 mm x 2 mm in diameter). Gastric emptying rate was evaluated by ultrasound while the emptying of markers was simultaneously followed by X-rays using a brilliance intensifier. Final emptying time (FET = time when the antrum area returns to fasting size) of digestible solids was 355+/-35 min in NUD patients versus 265+/-20 min in controls (P < 0.001). The gastric emptying curve of digestible solids correlated with emptying of markers both in NUD patients (r= +0.96) and in controls (r= +0.93). The assessment of gastric clearance of radiopaque cylinders of 2 mm x 5 mm in size is a reliable tool for the study of gastric emptying rate of digestible solids. This is a readily available and easily performed test in any radiology unit.
Liver Transplantation, 2009
Whether donor graft steatosis affects liver function and influences survival after liver transpla... more Whether donor graft steatosis affects liver function and influences survival after liver transplantation is still open to debate. The aim of this study was to assess the impact of donor graft steatosis on long-term liver histology after liver transplantation. One hundred sixteen consecutive liver transplants were performed in 56 hepatitis C virus-positive (HCVϩ) patients and 60 HCVϪ patients who had protocol liver biopsies at 6, 12, 24, and 36 months after liver transplantation. Liver biopsies were obtained from all grafts. No steatosis was seen in 50.9% of the biopsies taken at the back table before implantation, whereas steatosis was mild in 39.6% of the samples and moderate/severe in 9.5% of the samples. In the 56 HCVϩ recipients, fibrosis stage 3 was seen in 22.2% and stage 4 was seen in 2.2% of 45 biopsies at 36 months after liver transplantation. There was no correlation between donor graft steatosis and fibrosis after liver transplantation, regardless of the etiology of liver disease. No difference in 36-month survival after liver transplantation was seen, regardless of whether the etiology of the patient's liver disease was HCV-related or non-HCV-related (80.3% versus 75%; P ϭ 0.4) and whether the steatosis in the graft was reportedly absent, mild, or moderate/severe (79.7% versus 73.9% versus 81.1%; P ϭ 0.7). In conclusion, nearly one-quarter of HCVϩ recipients have precirrhosis/cirrhosis 3 years after liver transplantation. Steatotic grafts do not seem to exacerbate the progression of fibrosis in HCVϩ recipients, nor do they seem to negatively affect 3-year patient survival.
Journal of Hepatology, 2009
S175 Pegboard), executive function (Hooper) and memory (Auditory Verbal Learning). Results: 1. Sh... more S175 Pegboard), executive function (Hooper) and memory (Auditory Verbal Learning). Results: 1. Short-term post-LTx: The VV (cm3) increased by 8%. Fourteen patients exhibited FWML that decreased the volume by 20%, which can be explained by reversible brain edema in this areas. Neuropsychological tests improved indicating reversal of minimal hepatic encephalopathy. 2. Long-term post-LTx: The VV increased by 60% and the volume of FWML increased by 25%. Neuropsychological tests remained stable, except for memory that showed deterioration. Changes in VV or FWML were not associated with prior HE. Among patients with larger changes in FWML (>15%) pharmacological treatment for arterial hypertension was more common (88% vs. 33%, p = 0.05) and creatinine tended to be higher (1.37±0.21 vs. 1.19±0.15 mg/dl, p = 0.06). Conclusion: Following LTx patients develop a decrease in brain volume despite a successful outcome of liver function. The initial decrease probably reflects disappearance of brain edema related to HE. The decrease at long-term is part of a degenerative process in part caused by small-vessel cerebrovascular disease. Adequate control of vascular risk factors appears critical to prevent neurological deterioration following LTx.
Journal of Hepatology, 2000
Journal of Assisted Reproduction and Genetics, 2005
A 35-year-old woman experienced chronic antibody-mediated rejection (cAMR) after her first and se... more A 35-year-old woman experienced chronic antibody-mediated rejection (cAMR) after her first and second liver transplantations. After the second transplant with cAMR, belatacept was started, with normalization of her liver function. Two years later, she became pregnant. She was continued on belatacept together with low doses of slow-release tacrolimus, azathioprine, and steroids. Her
Digestive and Liver Disease, 2000
Aims: Gastrcesophageal variceal bleeding is a major complication of portal hypertension and is co... more Aims: Gastrcesophageal variceal bleeding is a major complication of portal hypertension and is considered a life-threatening emergency; for this reason a prompt and specific intervention are essential to stop the bleeding. Endoscopic intervention is the <<gold standard>> therapy and should be employed at de first line to control actually bleeding. Methods: In our department we have considered a report of 53 consecutive patients with esophageal variceal bleeding caused by advanced cirrhosis from March 1994 to December 1999. In tive patients with a too vigorous bleeding we employed balloon tamponade with a triple. lumen (Sengstaken-Blakemore) tube with oesophageal and gastric balloons. Two of these patients, successively, underwent to endoscopic legation of varices. 48 patients (90.4%) 21 males and 27 females (mean age 61 years) underwent to early diagnostic endoscopy evaluation with flexible videoscopy by the beginning. I" 3 cases no haemostatic intervention was necessary because of spontaneous stop of haunorrhage; in 45 cases (84.9%) endoscopic diagnosis was followed by the sclerosis of bleeding varices. In 8 patients (17.8%) the bleeding was tirst episode, whole in the remnant (82.2%) was recurrent. In 37 patients we observed F3 classified varices and in 6 we also found variccs in gastric bottom. To obtain homeostasis we used 1% polidocanolo in 41 cases (91.1%) and butilvcianoacrylate in 4 patients. Resultc: In 43 cases we attained a good control of haemorrhage. In 2 patients, because of an early relapse (< 12h), we performed a new endoseopic procedure using an acrylic glue. The most frequent complication was the oesophageus ulcer that we found in 4 cases and in only I case we caused a perforation. Conclusions: Over the past 15 years, endoswpic control of variceal bleeding has been extensively employed. After endoscopic identification of varices as the presumed source of bleeding, sclerotherapy and, more recently, endoswpic rubber bleeding of varices control acute bleeding in up to 80 percent of cases.
Aging Clinical and Experimental Research, 2006
Few studies in literature have investigated the gastric emptying of solids in elderly subjects. W... more Few studies in literature have investigated the gastric emptying of solids in elderly subjects. We assessed the differences between young and elderly subjects in the gastric emptying rate of solids by a radioisotopic method. Two groups of 15 elderly male subjects (mean age 68.20 years and 77.26 years, respectively) and a group of young male subjects (mean age 30.23 years) underwent a radioisotopic study of gastric emptying after eating a radiolabeled solid meal. Half-time of gastric emptying (T1/2) and emptying index (EI), i.e. rate of gastric emptying at 120 min, were measured with two opposing detectors connected to a computerized rate-meter. Results are expressed as means +/- SD. Significantly different values were obtained in the two groups both at T1/2 (183+/-88 and 195+/-75, respectively) and EI (0.40+/-0.3 and 0.36+/-0.4), compared with young subjects (T1/2=53+/-23; EI=1.10+/-0.3) (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001). Gastric emptying of solids is significantly delayed in elderly men; this variable must be taken into account when studies on gastric emptying rates are performed.
Digestive Diseases and Sciences, 2004
We assessed the ultrasonographic pattern of gastric emptying in patients with functional dyspepsi... more We assessed the ultrasonographic pattern of gastric emptying in patients with functional dyspepsia, evaluating its relationship with symptoms. Twenty dyspeptic patients, with slight (group A) and severe (group B) symptoms, and 10 controls (group C) underwent ultrasonographic study of gastric emptying by measuring postprandial variations of the antral area at regular intervals. The time at which the antral area returned to the basal value was assumed to be the final emptying time. The final emptying time was significantly longer in both group A (294 ± 42 min) and group B (340 ± 36 min) compared to controls (244 ± 21 min), but no significant difference was observed between them. A significantly (P < 0.05) greater dilation of the antral area was found at 50 min in group B compared to group A patients. A different pattern of antral motor function rather than a delay of gastric emptying correlates with the severity of symtoms in dyspeptic patients.
Clinical Neurology and Neurosurgery, 2007
Wilson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;am... more Wilson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease is a genetic disorder characterized by accumulation of copper in many organs and tissues. Phenotypic manifestations are wide-ranging from neuropsychiatric disorders, to severe liver disease requiring liver transplantation. Clinical presentation is not often related to the genetic defect and siblings may have different type of disease. Liver transplantation is indicated for all patients with Wilson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease and decompensated liver cirrhosis unresponsive to medical therapy, but its efficacy in resolving the neurological symptoms is still controversial, because as far now, very different outcomes have been reported. We describe here on the exceptional case of two homozygotic twins, both with liver cirrhosis due to Wilson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease, one of them with severe neuropsychiatric involvement, who both underwent liver transplantation and subsequently had very different outcome despite same genetic background. The presence of neurological clinical manifestations in Wilson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease should recommend caution indicating liver transplantation, because irreversible brain damage may exist.
Journal of Hepatology, 2002
Alpha1-antitrypsin (1-AT) deficiency is the most common genetic cause of liver disease in infants... more Alpha1-antitrypsin (1-AT) deficiency is the most common genetic cause of liver disease in infants and children. The major clinical manifestations include liver disease (primarily in children) and emphysema in adults. For patients who progress to cirrhosis and liver failure, liver transplantation provides a metabolic cure for the deficiency and presumably prevents the associated complications. Several case reports in the pediatric literature describe glomerulonephritis in the setting of severe 1-AT deficiency, but this association is less well documented in adults. End-stage chronic kidney disease is a rare finding in the literature and kidney transplantation is the treatment of choice. We report on a 15-year-old boy with 1-AT deficiency and consequent end-stage liver disease and membranoproliferative glomerulonephritis rapidly progressing to renal failure, who successfully underwent combined liver-kidney transplantation.
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Papers by Massimiliano Loreno