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Eur J Clin Invest 2010; 40 (9): 803–811 Abstract Background Adrenal incidentalomas (AI) have been associated with and an increased prevalence of metabolic and bone complications. The N363S and BclI polymorphisms of the glucocorticoid receptor (GR) have been associated with an increased sensitivity to glucocorticoid (GC). This observational study aims to evaluate whether BclI and N363S polymorphisms play a role in the development of complications in AI. Materials and methods We enrolled 100 patients with AI (66 F; 34M). The presence of diabetes, arterial hypertension (AH), dyslipidaemia, osteoporosis and vertebral fracture (Fx), waist circumference and the Body Mass Index (BMI) were assessed. DNA samples were genotyped. Patients with wild-type BclI, wild-type N363S and heterozygous BclI polymorphism were classified as carriers of haplotype 1 (H1; n = 86), patients with homozygous BclI and heterozygous N363S polymorphism of GR of haplotype 2 (H2; n = 14). Results We found no clinical or biochemical differences between haplotype 1 and 2 groups, but a higher prevalence of the simultaneous presence of Fx plus AH in H2 patients (H2 n = 7, H1 n = 16, P = 0·01). Logistic regression analysis showed that the presence of Fx and of AH and the combination of the presence of Fx plus AH were associated with the H2 genotype regardless of the degree of cortisol secretion, age, BMI and BMD (OR 4·88, 95%CI 1·47–18·40, P = 0·05; OR 8·25, 95%CI 0·98–69·52, P = 0·05; OR 7·25, 95%CI 1·57–35·78, P = 0·011; respectively). Conclusions In AI patients, the presence of the haplotype 2 of BclI and N363S is associated with the presence of AH, Fx and with the combination of Fx and AH.

Background: The role of adrenal scintigraphy (AS) in the diagnosis of subclinical hypercortisolism (SH) in adrenal incidentaloma (AI) is debated. Aim: To evaluate the possible role of AS in identifying SH in AI patients. Subjects and methods: In the retrospective phase (2000–2004), 102 AI patients [71 females (F)/31 males (M)] referred to our center were reevaluated for SH. In the prospective phase (2005–2006), 42 patients (32F/10M) with suspected SH were evaluated performing AS and biochemical assessment of cortisol secretion. We report data of the prospective phase of the study. In these patients AS was performed at baseline; the difference between the uptake of the affected and the controlateral gland [mean Δ uptake (MΔu)] was calculated. Cortisol secretion was evaluated in 3 different occasions. Patients were considered affected with SH if they presented at least twice 2 of the following criteria: urinary free cortisol >193 nmol/l, cortisol after 1 mg dexamethasone suppression test >83 nmol/l, ACTH levels

Aims: The persistent circulation of hepatitis A virus (HAV) in the Mediterranean area suggests the need for monitoring its presence in the environment. A reverse transcriptase-polymerase chain reaction (RT-PCR) was used to detect the presence of HAV in several consecutive raw sewage and final effluent samples, collected over an 8-month period from an activated sludge treatment plant in southern Italy. Methods and Results: Two distinct purification protocols, either based on antigen-capture with monoclonal antibody (AC) or RNA extraction, were compared. The possible influence of the antibody used in the AC phase was evaluated in preliminary experiments on HAV-spiked samples, using two different monoclonal antibodies. Hepatitis A virus RNA was detected in all but one sewage environmental sample examined. The contemporary presence of enteroviruses, reoviruses and phages was observed, while HAV growth in cell culture was hampered. Conclusions: The RT-PCR technique was confirmed to be a valuable tool for the rapid monitoring of HAV in sewage samples. In addition, this study demonstrated that application of different sample purification methods can result in different levels of sensitivity of the assay and that, in the antigen-capture method, the choice of antibody can have a crucial role. Significance and Impact of the Study: This work underlines the need for technical uniformity in environmental studies from different laboratories for a correct and useful comparison of the results.

The pilot investigation on the use of UV as an alternative disinfectant to NaOCI was started in 1992 at Trani (South Italy) municipal wastewater treatment plant (335 m3/h). The results collected after six months continuous operation enabled us to compare UV and NaOCl disinfection effectiveness on the basis of secondary effluent characteristics, quantify photoreactivation effects, evidence possible DBP formation and assess costs.

Background: BioEnterics Intragastric Balloon (BIB®) is a non-invasive, temporary and relatively safe procedure shown to be effective in the short-term treatment of obesity. Nowadays, BIB® does not show convincing evidence of significant long-term weight loss, as compared with conventional management, and data regarding changes in metabolic and nutritional parameters are lacking. Methods: Forty obese patients [11 males, 29 females, age 36.65±10.6 yr, body mass index (BMI) 44.9±8.9 kg/m2] were evaluated before and 3 and 6 months after BIB® placement by assessment of anthropometric and biochemical parameters as well as nutritional habits. Results: Patients showed a significant reduction in weight (−13.2±6.5%), BMI (−13.2%), waist circumference (−6.5 cm), and percentage of fat mass (−19.5%), but not fat-free mass. A significant improvement in insulin sensitivity but not in lipid pattern was seen. After BIB® insertion, a significant reduction in caloric intake was paralleled by a redistribution of nutrients; in particular, increased lipid (12.8%) and decreased carbohydrate (−11.7%) percentage, but not absolute intake was observed. Conclusion: These data show that BIB® improves anthropometric parameters, with reduction of fat mass and preservation of fat-free mass, as well as insulin resistance, but not other metabolic features. The observed change in dietary habits, with a relative increase in lipid intake, once BIB® is removed, might favor body weight regain and impact negatively on body weight composition and the other traits of the metabolic syndrome.

In this article, we discuss the case of a 42-year-old female diabetic patient who developed severe lactic acidosis, coma, shock, rhabdomyolysis, and renal and hepatic failure during metformin therapy after alcohol abuse. The APACHE II score of this patient was 38, which is associated with an estimated mortality rate >88%. Conventional treatment of acidosis with IV infusion of sodium bicarbonate (400 mmol) was ineffective in restoring a normal acid/base balance. Lactic acidosis was successfully treated with bicarbonate-buffered continuous veno-venous hemodiafiltration. The patient also had a complete recovery from all complications.

Background Macroprolactinaemia may represent a relevant cause of misdiagnosis, unnecessary investigation and inappropriate treatment. The aim of this study was to investigate the clinical and neuroradiological characteristics of patients with and without macroprolactinaemia and to evaluate the impact of macroprolactin determination on the diagnostic work-up of hyperprolactinaemic patients. Materials and methods Retrospective analysis in 135 consecutive hyperprolactinaemic patients (111 women and 24 men; mean age 37 ± 11·6 years) whose archived sera were subsequently tested for macroprolactin. Recoveries ≤ 40% after polyethylene glycol precipitation were indicative of macroprolactinaemia. Results Macroprolactin, entirely explaining biochemical hyperprolactinaemia, was found in 42·2% of patients, a third of whom presented with signs and symptoms of hyperprolactinaemia. Determination of macroprolactin changed the initial diagnosis in a consistent proportion of patients. In particular, idiopathic hyperprolactinaemia, initially diagnosed in 41 patients, was then excluded in 28 of them. Diagnosis of prolactin-secreting pituitary microadenoma shifted to non-secreting pituitary microadenoma in 10 of 49 patients, while in all patients with prolactin-secreting pituitary macroadenoma or hyperprolactinaemia due to stalk deafferentation the presence of macroprolactin was excluded and the initial diagnosis confirmed. Finally, macroprolactin was present in the majority of patients with magnetic resonance imaging (MRI) scans suggestive for primary empty sella (4 of 5 women) or pituitary hyperplasia (12 of 17 women, 3 of 3 men). Collectively, about half of subjects with macroprolactinaemia showed variable MRI abnormalities. Conclusions The presence of macroprolactin was a relevant cause of misdiagnosis in patients with hyperprolactinaemia. However, due to the unexpected high frequency of pituitary abnormalities observed in the present series, we suggest that the diagnostic algorithm of hyperprolactinaemic states should include both polyethylene glycol precipitation test and MRI imaging.

Background: With the evolution of laparoscopic surgery comes the need for specific instruments that apply traction to parenchymal tissue, like the spleen, without exposing the organ to the associated high risk of bleeding. To meet this need, we designed and developed a suction-cup grasper that allows easy grasping and manipulation of the spleen. Some of the difficulties usually encountered during laparoscopic splenectomy may be overcome by using this device. Materials: The instrument consists of a cone-shaped, silicone rubber suction cup designed with an antislip internal surface. The cup is connected to a support arm with a flexible distal end that can be rotated. Traction is exerted with a commonly available suction system. The device is inserted through a 12-mm-diameter guide sheath. Results: The two interventions performed with the atraumatic device were completed with laparoscopic technique. No complications arose during or after the operations. The average operating time was 110 min. The patients were discharged after 4 and 5 days postoperative, respectively. Conclusions: As a device specifically designed for grasping parenchymal organs, the atraumatic suction grasper affords the operator a faster and safer technique in laparoscopic splenectomy.

Context: The effects of chronic therapy with long-acting somatostatin analogs (SSTa) on metabolic and cardiovascular parameters have been partially elucidated in acromegalic patients. Objective: The objective of this study was to compare the long-term effects of SSTa treatment and successful surgery on GH/IGF-I secretion and cardiovascular risk parameters in acromegaly. Design, Patients, and Intervention: This was a retrospective study of 36 acromegalic patients treated with SSTa and evaluated after a median of 66 months and of 33 sex-, age-, and body mass index-matched cured patients evaluated after a similar period of remission, all from the Institute of Endocrine Sciences (Milan, Italy). Main Outcome Measures: The main outcome measures were fasting and post-oral load glucose homeostasis, hemoglobin A1c, insulin sensitivity and secretion by several indexes, lipid profile, and blood pressure. Results: Fasting and areas under the glucose response curve rose in patients controlled (n 29) and not controlled (n 7) by SSTa, becoming higher than those in cured subjects. A 1% hemoglobin A1c increase was observed in all nondiabetic SSTa patients, but not in cured subjects. Basal insulin secretion and resistance, evaluated by homeostasis model assessment, decreased in all SSTa patients, whereas oral glucose tolerance test-derived insulin secretion and resistance, evaluated by insulinogenic index and oral glucose tolerance test-derived insulin secretion, improved only in SSTa-treated controlled patients. Triglycerides did not change during SSTa, whereas high-density lipoprotein cholesterol increased in SSTa-treated controlledpatients.Atthelastvisit,thecontemporarypresenceofatleast three cardiovascular risk factors was more frequent in patients treated with SSTa than in cured subjects. Conclusions: SSTa therapy induces long-lasting disease control and improvement of insulin sensitivity and high-density lipoprotein cholesterol levels in responsive patients. The progressive glucose homeostasis alterations, observed independently from the degree of cure, suggest the need for glucose homeostasis and peripheral vascular complications monitoring during chronic SSTa treatment. (J Clin Endocrinol Metab 91: 121–128, 2006)

Background: To investigate adiponectin levels in an obese population with and without obstructive sleep apnea syndrome (OSAS) and the acute modifications in adiponectin after a whole-night control by auto continuous positive air pressure (CPAP). Methods: 46 obese subjects [22 males, 24 females, age 55.1±11.4 yr, body mass index (BMI) 38.9±6.5 kg/m2]: 11 OSAS with apnea/hypopnea index (AHI) from 10/h to 30/h, 14 OSAS with AHI >30/h and 21 without OSAS. Thirty-seven normal weight healthy subjects (20 males, 17 females, age 31.3±9.5 yr, BMI 21.5±1.8 kg/m2). Serum adiponectin levels, biochemical parameters, anthropometric measurements, pulmonary function, pulse-oxymetry and polisomnography. Results: The 3 groups of obese patients were comparable for gender, BMI, age, fat mass, fat free mass, hip and waist circumference, waist-to-hip ratio (WHR), systolic and diastolic blood pressure and glycometabolic parameters. Adiponectin levels were significantly reduced in obese patients compared to healthy normal weight subjects (8.1±3.5 vs 11.3±4.8 μg/ml p

30 citazioni su Scopus. 46 citazioni su GoogleScholar. ------ http://www.scopus.com/record/display.url?eid=2-s2.0-0347771343&origin=resultslist&sort=plf-f&src=s&sid=1BklTwBDkRxWaxt9FLi7YAz%3a70&sot=aut&sdt=a&sl=37&s=AU-ID%28%22Benassai%2c+Giacomo%22+6602920646%29&relpos=11&relpos=11&searchTerm=AU-ID(\"Benassai, Giacomo\" 6602920646) ------ An open-label prospective, randomized, parallel multicentre study was undertaken to compare the efficacy and tolerability of 1.5 g/day intravenous imipenem/cilastatin with 3 g/day intravenous meropenem in the treatment of intra-abdominal infections, A total of 287 patients mere enrolled; 201 patients, divided between the 2 treatment groups, were evaluable. Clinical outcome, bacteriological outcome, untoward microbiological effects, and clinical and laboratory adverse experiences mere evaluated, 98% of patients receiving imipenem/cilastatin therapy mere cured, with 96% showing eradication of infection, 95% of those on meropenem mere cured, with 98% showing eradication. These differences in clinical and bacteriological outcome between the 2 treatments were not statistically significant, Two patients receiving imipenem/cilastatin and 5 receiving meropenem had untoward microbiological effects. There mas a 0.7% frequency (1/139 patients) of possibly or probably drug-related clinical or laboratory adverse experiences with imipenem/cilastatin and a 2.7% frequency (4/148) with meropenem, The mean time to defervescence was significantly less for patients in the imipenem/cilastatin treatment group than for those receiving meropenem. This study shows that 1.5 g/day of imipenem/cilastatin is equivalent to 3.0 g/day meropenem in clinical and bacteriological outcome, as well as in incidence of side effects.