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L Sensi

Publications and source records attributed to L Sensi.

At least 19 recordsLinked to original sources
PubMed2006

Quadriceps-sparing versus mini-subvastus approach in total knee arthroplasty.

In a prospective randomized double-blind study we compared the postoperative recovery and early results of two groups of 30 patients having total knee arthroplasty with minimally invasive techniques using either a mini-subvastus or a modified "quadriceps-sparing" approach. All knees were implanted with the same posterior-stabilized prosthesis (LPS-Flex, Zimmer, Warsaw, IN) by the same surgeon with the same dedicated set of downsized instruments. Epidural anesthesia with the same postoperative analgesia and rehabilitation protocol was used in all patients. Evaluation was performed preoperatively, postoperatively in the first week, and at 1 and 3 months. In five cases in the "quadriceps- sparing" group, the incision was extended a few cm to facilitate exposure. Tourniquet time, estimated blood loss, and postoperative pain were similar in the two groups. Active straight leg raising was achieved half a day earlier, on average, in the mini-subvastus group (1.9 vs 1.4 days). Average maximum active flexion was similar in the two groups at each interval, and reached 117 degrees and 119 degrees at 3 months for the mini-subvastus and "quadriceps-sparing" group, respectively. We believe there was no difference between the mini-subvastus and "quadriceps-sparing" approach in relation to short term recovery or early results.

Aged↗
PubMed2006

Dose dependence of efficacy but not of safety in sublingual immunotherapy.

Sublingual immunotherapy (SLIT) currently represents, as indicated by meta-analysis of its efficacy and safety, a valid option to the generally used traditional subcutaneous immunotherapy (SCIT) for treating respiratory allergy. Regarding efficacy, recent studies demonstrated that, similar to what has already been observed in SCIT as well as in experimental and clinical studies about the magnitudo of allergen exposure, the effectiveness on both clinical symptoms and immunologic changes depends on the amount of allergen administered during treatment. In addition, in vitro studies addressed with the role of dendritic cells, currently considered to be of pivotal importance in orienting toward tolerance the immune response to allergens, showed that the internalisation of allergen molecules, which is followed by tolerogenic presentation to T cells, depends on the amount of allergen. However, such dose dependence is not apparent concerning the safety. In fact, the comparison of studies respectively conducted with high and low allergen doses did not show differences in the rate of systemic reactions, which in any case never had the presentation of anaphylaxis, and instead a significant difference in the rate of local reactions, following the oral and gastrointestinal contact with the allergen extract, in favour of high dose studies.

Administration, Sublingual↗
PubMed2005

Mini-subvastus versus medial parapatellar approach in total knee arthroplasty.

UNLABELLED: We compared short-term clinical results of the mini-subvastus approach with the standard parapatellar approach for total knee arthroplasty. Can one gain adequate access through the mini-subvastus approach without exceeding operating time, incurring additional complications, and maintaining correct implant geometry? In a prospective, observer-blinded study, 120 consecutive patients having total knee arthroplasty were operated on by one surgeon using either the mini-subvastus approach without patella eversion or the standard parapatellar approach with patella eversion. Patients were matched according to age, gender, body mass index, knee flexion, deformity, and pre-existing high tibial osteotomy. The mini-subvastus approach was technically more demanding. Reduced access and visibility prolonged the tourniquet time by an average of 15 minutes and led to two intraoperative complications. Patients in the mini-subvastus group lost on average 100 mL less blood and had better pain scores on day one [visual analogue scale (VAS): mean 2.4 versus 3.89]. They reached 90 degrees knee flexion earlier (2.8 versus 4.5 days), and an active straight-leg raise earlier (3.2 versus 4.1 days). Their average flexion at 30, 60 and 90 days was slightly better (100 degrees , 110 degrees , and 112 degrees versus 94 degrees , 106 degrees , and 109 degrees ). All patients including those with complications had good results with good component geometry and leg alignment. The mini-subvastus approach offers early but short-lived benefits for patients at the expense of a longer operation and a higher risk of complications. LEVEL OF EVIDENCE: Therapeutic study, Level II-1 (prospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.

Aged↗
PubMed2005

The safety of sublingual-swallow immunotherapy: an analysis of published studies.

BACKGROUND: As the main target of sublingual immunotherapy (SLIT) is to reduce at most the occurrence of adverse events (AE), safety represents a critical issue. This aspect deserves particular mention when a higher dose of allergen extract than traditional subcutaneous immunotherapy (SCIT) is required to be effective: that may be up to 500 times that employed for SCIT. OBJECTIVE: All published controlled studies concerning SLIT-swallow were analysed to evaluate AE rates. METHODS: Studies were subdivided in two groups: (i) studies using low allergen dose (LAD), i.e. ranging from 1 to 50 times the dose commonly administered with SCIT, and (ii) studies with high allergen dose (HAD), i.e. ranging from 50 to 500 times the dose administered with SCIT. RESULTS: Twenty-five studies were altogether analysed: 13 studies belonged to the low-dose group, 12 belonged to the high-dose group. We considered all patients with at least one AE. Local reactions were significantly more frequent in the LAD group than in the HAD group (P<0.0001), while there was no difference in the rate of systemic reactions. Severe systemic reactions were never reported. CONCLUSION: This study represents the first analysis of the safety of SLIT concerning the allergen dose employed in the treatment. There is evidence that AE occurrence is substantially not dose-dependent. This fact highlights two main clinical aspects: the elevated tolerability of SLIT in general and the safety of HAD regimen.

Administration, Sublingual↗
PubMed2005

Evaluation of food-pollen cross-reactivity by nose-mouth cross-challenge in pollinosis with oral allergy syndrome.

BACKGROUND: Oral allergy syndrome (OAS) is often associated with pollen-induced rhinitis, and there are preferential associations between causative substances. If OAS and rhinitis are both immunoglobulin (Ig)E-mediated and there are cross-reacting proteins, it is expected that similar reactions can be elicited in the nose and mouth. In order to test this hypothesis we performed a series of 'cross-challenges' with foods and pollens in both the nose and the mouth. METHODS: Nine patients with ascertained OAS due to vegetables and rhinitis due to pollens were studied. On the first day a nasal challenge with pollen extracts and an oral challenge with fresh food was carried out. After a week, washout nasal challenge with food and an oral challenge with pollens were performed. Immediate symptoms, mucosal tryptase and soluble eosinophil cationic protein (ECP) were assessed after each challenge. RESULTS: The administration of pollen into the nose and food into the mouth elicited symptoms as expected, but the cross-challenge had no clinical effect. In parallel, tryptase and ECP increased after nasal challenge with pollens, whereas foods did not elicit a measurable response. CONCLUSION: The cross-reactivity between foods and pollens, when evaluated at the shock organ, was not clinically evident. This data can be explained with a low concentration of cross-reagent epitopes in pollen extracts and food homogenized because of degradation. The different behaviour upon challenge suggests that different immunological mechanisms may act in the nose and mouth.

Adolescent↗
PubMed2005

Dose dependence of immunological response to sublingual immunotherapy.

BACKGROUND: Sublingual-swallow immunotherapy (SLIT) is an accepted treatment for allergic rhinitis but its optimal dosage is scantly investigated. We studied the dose dependence of clinical efficacy and immunological response to SLIT by administering two different dosages of the same allergen in rhinitic children monosensitized to grass pollen. METHODS: Seventy-one patients with comparable age and symptoms were randomized to receive SLIT by the same grass pollen extract from Stallergenes (Antony, France), 40 of them with the 100 IR and 31 with the 300 IR extract. All patients recorded diary cards for symptoms, medications and side-effects of the treatment, and had measurements of specific IgE and IgG4 in serum by the CAP System FEIA (Pharmacia, Uppsala, Sweden) and in nasal secretion by an in situ incubation method with the same reagents of CAP System FEIA. RESULTS: Symptom/medication scores during the pollen season were significantly higher in patients treated with the lower dosage compared with those treated with the 300 IR dosage. Side-effects occurred with a comparable rate (25.8%vs 27.5%) in the two groups. Serum-specific IgE and IgG4 had no significant changes after 3 months of SLIT in both groups, while a significant seasonal increase of nasal IgE (P = 0.015) and IgG4 (P = 0.019) was found only in patients treated with the lower dosage. CONCLUSIONS: A rise of specific IgG4 and a blunting of seasonal increase of specific IgE in serum was repeatedly reported during subcutaneous immunotherapy (SCIT) with pollen extracts. Our findings show such blunting of specific nasal IgE along with a low symptom/medication score in patients treated with SLIT with the higher dosage, but not a concomitant rise of specific nasal IgG4. This suggests a local immunological effect of SLIT, different from systemic mechanisms of SCIT.

Administration, Sublingual↗
PubMed2005

Three-year follow-up of clinical and inflammation parameters in children monosensitized to mites undergoing sub-lingual immunotherapy.

Parallel follow-up of clinical and inflammatory markers during sub-lingual immunotherapy (SLIT) is highly beneficial. Twenty-four children (age 4-16) monosensitized to house dust mite were randomized to receive either active or placebo SLIT for 1 yr in a double-blind placebo controlled design (Marcucci et al., Allergy 2003: 58: 657-62). Thereafter, for 2 yr they all received active treatment. Symptom scores for rhinitis, asthma, and drug usage were daily recorded. Eosinophil cationic protein (ECP) and tryptase in sputum and nasal secretions, serum and nasal mite-specific immunoglobulin E (IgE) were recorded before treatment and at 10-12 months intervals. Nasal ECP and nasal tryptase after specific nasal provocation tests were significantly reduced as compared to baseline values (p = 0.0043 and 0.0195, respectively) in the third year of active treatment. None of the other inflammatory parameters was increased. In placebo treated patients all these parameters tended to decrease only after switching to active treatment. Clinical scores did not improve in treated vs. placebo patients in the double-blind placebo-controlled phase of the study. In both cohorts a clinical benefit was observed as intra-group score reduction as compared to baseline. A significant difference was reached in patients treated for 2 yr for rhinitis and asthma (p = 0.0009 and 0.0019, respectively) but not for drug usage and in patients treated for 3 yr for rhinitis, asthma, and drug usage (p = 0.0105, 0.0048, and 0.02, respectively). SLIT in children monosensitized to mites reverted the spontaneous increase in nasal IgE and in local parameters of allergic inflammation. These outcomes were followed by a consolidated clinical improvement in the second and third year of treatment.

Administration, Sublingual↗
PubMed2005

Physical exercise does not favour adverse reactions to allergen immunotherapy by the sublingual route.

It is generally recommended in consensus documents on allergen immunotherapy to avoid any kind of physical exercise in the 24 hours following the administration of the allergen extract but such recommendation is not supported by scientific evidence. We evaluated the risk of developing adverse reactions in a group of patients submitted to sublingual immunotherapy by performing a controlled exercise test. Eleven patients were included in the study, 8 treated with grass pollen and 3 with Parietaria pollen extract by Staloral300 (Stallergénes, Antony, France), with the build-up phase in 11 days suggested by the manufacturer and a top dose of 300 IR. At the first maintenance dose, in all patients were measured heart rate, blood pressure, FEV1, and tryptase in blood. Then the maintenance dose was assumed and the physical exercise performed by cycloergometer maintaining a heart rate around 100 b/min and measuring again tryptase, blood pressure and FEV1. The results showed that no patient had adverse reaction following physical exercise, neither showed significant changes in FEV1, blood pressure, or tryptase level, which was 5.57 +/- 4.54 mcg/l before and 5.81 +/- 4.34 mcg/l after exercise. This suggests that there is no reason to advise against physical exercise, and particularly sporting activity, in patients treated with sublingual immunotherapy thus avoiding to interfere with the subject's lifestyle and consequently with his quality of life.

Abdominal Pain↗
PubMed2003

Effects on inflammation parameters of a double-blind, placebo controlled one-year course of SLIT in children monosensitized to mites.

BACKGROUND: Clinical documentation about effects on local markers of inflammation of sublingual immunotherapy (SLIT) in children is still poor. METHODS: Twenty-four children (age range 4-16 years, average 8.5 years) monosensitized to house dust mites (HDMs) were randomized to receive active or placebo SLIT for this allergen according to a double-blind, placebo-controlled design. Before treatment and 10-12 months later the following parameters were checked: ECP and tryptase in sputum and nasal secretion, serum and nasal mite-specific IgE (sIgE), allergen-specific nasal challenge test (sNCT), nasal symptoms and tryptase after sNCT. RESULTS: Nasal tryptase and nasal IgE in basal conditions were unchanged in treated children but significantly increased in untreated children (P = 0.0156 and P = 0.0313, respectively). The threshold for sNCT was unchanged in both groups of children, but the symptom score after sNCT was unchanged in the placebo group and significantly decreased in the active group (P = 0.0084). The nasal tryptase after sNCT was unchanged in the active group and significantly increased in the placebo group (P = 0.0218). Intergroup comparison showed a significant difference in oral tryptase and nasal tryptase after sNCT in favour of the active group. CONCLUSIONS: These interim results after only 1 year of treatment show that SLIT in children monosensitized to HDMs is able to avoid the spontaneous increase in both nasal sIgE antibodies and in local allergic inflammation in basal conditions. These outcomes are confirmed and supported by the decrease of symptoms in the active group combined with the increase of nasal tryptase only in the control group in both cases after sNCT.

Administration, Sublingual↗
PubMed2003

Long-lasting effect of sublingual immunotherapy in children with asthma due to house dust mite: a 10-year prospective study.

BACKGROUND: Subcutaneous immunotherapy for respiratory allergy has shown a long-lasting efficacy after its discontinuation, whereas this evidence is still lacking for sublingual immunotherapy, despite the fact that it is widely used. OBJECTIVE: We aimed to evaluate whether a long-lasting effect of SLIT occurs, in a prospective parallel group controlled study. METHODS: Sixty children (mean age 8.5 years) suffering from allergic asthma/rhinitis due to mites were subdivided into two matched groups: 35 underwent a 4- to 5-year course of SLIT with standardized extract and 25 received only drug therapy. The patients were evaluated at three time points (baseline, end of SLIT and 4 to 5 years after SLIT discontinuation) regarding presence of asthma, use of anti-asthma drugs, skin prick tests and specific IgE. RESULTS: We found that in the SLIT group there was a significant difference vs. baseline for the presence of asthma (P </= 0.001) and the use of asthma medications (P </= 0.01), whereas no difference was observed in the control group. The mean peak expiratory flow result was significantly higher in the active group than in the control group after 10 years. No change was seen as far as new sensitizations were concerned. Specific IgE showed a near-significant increase (baseline vs. 10 years, P = 0.06) only in the control group. CONCLUSION: Our study demonstrates that sublingual immunotherapy is effective in children and that it maintains the clinical efficacy for 4 to 5 years after discontinuation.

Administration, Sublingual↗
PubMed2003

A model for management of sublingual immunotherapy.

UNLABELLED: High dose sublingual immunotherapy (SLIT) is generally well tolerated, since most side effects are local reactions involving the oral or gastrointestinal mucosa. However, such reactions, if not adequately managed, may lead the patient to stop SLIT. OBJECTIVE: We introduce a method to manage side effects of SLIT, which was successfully applied on a group of children undergoing SLIT. METHODS: SLIT was performed with Staloral 300 (Stallergénes, Antony, France) by the schedule in 11 days indicated by the manufacturer with a tap dose of 8 pressures of the 300 IR concentration. The treatment was managed by flow charts suggesting adjustment of dose, regimen, or kind of assumption depending on the kind of reactions (oral, gastrointestinal, respiratory). RESULTS: An overall number of 200 children (120 males, 80 females, mean age 9 yrs, range 3-14 yrs) were treated. Of them, 155 (77.5%) had no reaction, while 45 (22.5%) had side effects, consisting of 20 oral itching or burning, 15 gastrointestinal symptoms and 10 rhinitis. No systemic reaction was observed. All side effects were successfully managed by the proposed method, thus reaching the maintenance dose in all patients but one, reporting repeated intense oral itching, who stopped SLIT. CONCLUSIONS: High dose SLIT is well tolerated in treated patients. In most patients with side effects, which are mainly oral itching or gastrointestinal disturbances due to contact with the allergen extract, a proper management allows to reach the maintenance dose with no further reactions.

Administration, Sublingual↗
PubMed2003

Long-term cetirizine treatment may reduce new sensitisations in allergic children: a pilot study.

Experimental data demonstrate that mite allergy is characterized by persistent chronic inflammation. This suggests that long-term continuous treatment may be included in the global strategy of allergy management as recently reported. Moreover, most of allergic subjects show polysensitisation. We conducted a study to investigate whether a long-term cetirizine treatment may reduce the occurence of new sensitisations in children with mite allergy. This study was initially double-blind, randomized, and placebo-controlled, with two parallel groups of 10 children with mite allergy receiving either cetirizine or placebo daily. All children could assume cetirizine as rescue medication (i.e. symptomatic treatment). After six months, parents of continuously-treated children decided to continue the treatment for 3 years. Other subjects continued to assume cetirizine on symptomatic basis. All children were prospectively followed for other 3 years. Outcome measure was skin prick test, yearly performed. Cetirizine-continuously-treated group showed a significant lower incidence of new sensitisations (p = 0.002). In conclusion, cetirizine administered daily for prolonged periods (i.e. 3 years) may decrease the development of new sensitisations in monosensitised children, showing a potential effect of tertiary prevention of allergy.

Animals↗
PubMed2003

Nasal cytokine modulation by montelukast in allergic children: a pilot study.

BACKGROUND: Allergic rhinitis and asthma are characterized by chronic inflammation due to a Th2 cytokine polarization. Leukotrienes receptor antagonists have been shown to be effective in both diseases. OBJECTIVE: Aim of the study was to evaluate the modulation by the antileukotriene montelukast on Th2 and Th1 cytokines in allergic rhinitis. METHODS: Fourteen school children affected by persistent allergic rhinitis (PAR) and exercise-induced asthma (EIA) underwent a nasal lavage before and after a two-week treatment with montelukast. A panel of cytokines, including IL4, IL13, and IFN gamma, was measured by immunoassay on nasal lavage samples. RESULTS: Montelukast treatment induced a significant decrease of IL4 and IL13 levels (p < 0.001, for both comparisons), and a significant increase of IFN gamma (p < 0.001). CONCLUSIONS: Montelukast treatment reversed a typical Th2 cytokine pattern (IL4 and IL13) toward a Th1 (IFN gamma) predominance in children with PAR and EIA. This effect could be considered relevant for long term allergic inflammation control and of interest when treating EIA with concomitant PAR.

Acetates↗
PubMed2001

Sublingual tryptase and ECP in children treated with grass pollen sublingual immunotherapy (SLIT): safety and immunologic implications.

BACKGROUND: The clinical safety of sublingual immunotherapy (SLIT) has been repeatedly confirmed; nevertheless, the possible onset of local oral symptoms is still a concern, and nothing is known about the pathogenesis of this effect. We aimed to determine whether the administration of SLIT in allergic children can evoke an IgE-mediated reaction, by measuring the levels of sublingual tryptase and ECP. METHODS: Thirty children (7-12 years old) with allergic rhinitis/asthma due to grass pollen were prescribed SLIT. In these children, an allergen-specific nasal challenge was performed, and nasal tryptase and ECP were measured before and after. Sublingual ECP and tryptase were also assessed before the SLIT, after 1 month, and after 6 months of treatment. Ten matched allergic children and 10 healthy ones served as controls for the baseline levels of sublingual ECP and tryptase. RESULTS: The levels of nasal tryptase and ECP significantly increased after nasal challenge (P<0.001), whereas no change during the SLIT course (at the beginning, after 1 month, and after 6 months) could be detected in sublingual tryptase either before or after SLIT administration. The sublingual ECP significantly decreased after 6 months of SLIT. The baseline levels of nasal tryptase and ECP were significantly higher in allergic subjects than in healthy controls, as was the level of sublingual ECP. CONCLUSIONS: In the presence of an IgE-mediated reaction (ASNC), a significant increase of tryptase and ECP can be seen. When SLIT is administered, such a phenomenon does not occur; therefore, SLIT does not elicit any IgE reaction in the mouth. It is noteworthy that allergic subjects display higher levels of nasal ECP and tryptase than healthy subjects, even when symptom-free, and these observations may indicate the presence of subclinical inflammation.

Administration, Sublingual↗
PubMed2000

Superior vena cava thrombosis secondary to thoracic outlet syndrome. Case report.

A case of superior vena cava thrombosis secondary to the thoracic outlet syndrome is reported. The diagnosis was revealed by CT-scan and confirmed by phlebography performed to insert a catheter for intrathrombotic infusion of urokinase. The thrombolytic treatment was followed by complete clot lysis. A hyperabduction manoeuvre confirmed costoclavicular compression as the cause of the subclavian-axillary vein thrombosis for which the patient underwent first rib resection. Axillary-subclavian vein thrombosis (or Paget-von Schroetter syndrome) is a relatively frequent complication of the thoracic outlet syndrome often treated with anticoagulants on the basis of a duplex examination. Involvement of the superior vena cava is not readily detected by duplex ultrasound so a partial thrombosis, with a possible fatal outcome could remain undiagnosed. Full investigation by phlebography or CT-scan is therefore recommended. In addition, transcatheter thrombolytic therapy has a lower incidence of follow-up complications than heparin.

Humans↗