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Bruno Rotoli

Publications and source records attributed to Bruno Rotoli.

59 records · Page 4Linked to original sources
PubMed2002

Color ultrasound-guided fine needle cutting biopsy for the characterization of diffuse liver damage in critical bone marrow transplanted patients.

BACKGROUND AND OBJECTIVES: The optimal method for liver biopsy in patients with simultaneous bone marrow and liver impairment has not yet been established. New approaches (e.g. imaging-guided methods) for this procedure are needed. In spite of coagulopathy, immunosuppression, anemia or ascites, we histologically characterized liver damage in a series of bone marrow transplanted patients using color-Doppler ultrasonography, which permits very keen visualization (and assessment) of hepatic parenchyma and vessels, and a fine needle for percutaneous biopsy. DESIGN AND METHODS: We performed percutaneous liver biopsy using a Menghini-type automatic very fine cutting needle (1.2 mm, 18G) under color ultrasound guidance in 16 bone marrow transplanted adult patients consecutively seen in our units from 1998 to 2001. The patients had clinically defined diffuse serious liver damage; liver biopsy was performed between 3 and 10 months after allogeneic (n= 11) or autologous (n= 5) transplantation. RESULTS: Fifteen patients tolerated the procedure well and had no discomfort, while one patient developed intrahepatic hemorrhage. All liver biopsies were suitable for histologic examination and informative, revealing the specific etiology of liver damage: graft-versus-host disease in six patients, drug toxicity in five, hepatitis C virus acute reactivation in two, and in one each vanishing bile duct syndrome, nodular regenerative hyperplasia and hemochromatosis. Biopsy detected potentially injurious concomitant factors, e.g., occult intrahepatic hepatitis B virus infection and reactivation. Histology radically changed the presumptive clinical diagnosis in 10 of the 16 patients and led to successful treatment changes in six. INTERPRETATION AND CONCLUSIONS: Percutaneous biopsy with a small cutting needle under color ultrasound guidance carries a low risk of complications and provides reliable information regarding liver histology in critically ill patients, in the early stage after bone marrow transplantation. We suggest including this imaging-guided mini-invasive procedure to the standard work-up of post-transplant liver damage.

Adult↗
PubMed2002

High prevalence of hepatitis G virus infection in Hodgkin's disease and B-cell lymphoproliferative disorders: absence of correlation with hepatitis C virus infection.

BACKGROUND AND OBJECTIVES: During the last decade an epidemiological association between hepatitis C virus (HCV) and B-cell lymphoproliferative disorders (B-LPD) has been reported; the same association has not been observed for Hodgkin's disease (HD). Hepatitis G virus (HGV) shares genetic and biological features with HCV, thus it might also be involved in lymphomagenesis. DESIGN AND METHODS: The aim of this study was to compare the prevalence of HCV and HGV infection in patients at diagnosis of B-LPD or HD. RESULTS: We tested 227 consecutive untransfused patients (127 with B-LPD and 100 with HD) and 110 healthy controls. The prevalence of HCV infection was significantly higher in B-LPD patients than in controls (17.3% vs. 1.8%, p<0.002 ), whereas it was the same in HD patients as in controls. In contrast, the prevalence of HGV was significantly higher in patients, both those with B-LPD (7.8% vs. 0.9%, p<0.03) and those with HD (13% vs. 0.9%, p<0.002), than in controls. Among the various B-LPD tested, HGV infection was more frequent in B-NHL (11.5%). INTERPRETATION AND CONCLUSIONS: Our data support the hypothesis that HGV infection may play a role in lymphomagenesis and that this role is different and separate from that of HCV.

Adolescent↗
PubMed2002

Complete remission induced by high dose erythropoietin and granulocyte colony stimulating factor in acute erythroleukemia (AML-M6 with maturation).

Alternative therapeutic approaches with low dose chemotherapy and differentiative-maturative treatment by growth factors are under consideration for elderly patients with acute leukemia. Two patients with AML-M6 with maturation, one refractory to standard chemotherapy and the other ineligible for cytoxic treatment, obtained complete remission from leukemia using high dose recombinant erythropoietin and granulocyte colony-stimulating factor.

Acute Disease↗
PubMedDate not supplied

Estrogen-progestin therapy in women after stem cell transplant: our experience and literature review.

Women undergoing stem cell transplantation (SCT) are mostly young and have more than 90% probability of ovarian failure, which is often permanent. A woman's age, use of radiotherapy and alkylating chemotherapy, and the allogeneic type of transplant are associated with a higher rate of premature ovarian failure and worse residual ovarian function. Premature ovarian failure has serious systemic and psychological effects that may need treatment and should be managed by practitioners trained to treat this particular population of women. Ultrasonographic evidence of ovarian follicles is often associated with a future resumption of cycles, but there are no serum markers to predict the return of ovarian function in these patients. In our center, the rate of ovarian function recovery was 7% after allogeneic SCT and 25% after autologous SCT (P<0.05). There are no guidelines on how to manage premature ovarian failure induced by myeloablative treatments followed by SCT. Because of the likelihood of the need for long-lasting estrogen plus progestin therapy (EPT) and the increased risk of secondary neoplasia after SCT, the EPT should be as physiological as possible. In our experience, the cyclical sequential combination of estradiol (2 mg daily) plus dydrogesterone (10 mg for 14 d/mo) was associated with excellent compliance because of its simple administration and few adverse effects. Such a treatment led to a dramatic improvement in vasomotor, urogenital, and psychological symptoms related to estrogen deficiency. However, in the allogeneic transplantation setting, up to 25% of women may suffer from gynecological chronic graft-versus-host disease, which may become apparent as hematocolpometra after introduction of EPT. Thus, accurate pretreatment evaluation and frequent monitoring during treatment are required. Moreover, EPT absorption may be reduced in patients who received allotransplants and have gastrointestinal or skin chronic graft-versus-host disease.

Drug Therapy, Combination↗