Academic literature on the topic 'Ospedali Riuniti di Bergamo'

Abstract Leukocytes contribute to the pathogenesis of thrombosis in essential thrombocythemia (ET) through recently discovered mechanisms of activation and interaction with platelets and endothelial cells. To evaluate whether an increased leukocyte count was associated with thrombosis and whether this effect can be modulated by therapy, we analyzed the clinical course of 439 patients with ET followed at the Ospedali Riuniti di Bergamo. The strength of the association was measured at diagnosis or before thrombotic events by multivariable analyses carried out using data at baseline as well as time-varying covariates. The results showed that (1) an increased leukocyte count at diagnosis was associated with thrombosis during follow-up (“baseline analysis,” relative risk [RR] 2.3, 95% confidence interval [CI] 1.4-3.9, P = .001); (2) hydroxyurea (HU) lowered leukocytosis and reduced the strength of the association between leukocytosis and thrombosis (“time-dependent analysis,” RR 1.6, 95% CI 0.9-2.0, not significant [NS]); (3) the association of leukocytosis and thrombosis was more evident in untreated low-risk patients (RR 2.7, 95% CI 1.2-6.4, P = .01) compared with HU-treated high-risk patients (RR 1.6, 95% CI 0.8-3.2, NS); and (4) the presence of JAK2 V617F was not identified as a risk factor for thrombosis during follow-up despite a significant association between the mutation and leukocytosis. We suggest validation of these findings in prospective clinical studies.

Abstract Introduction Since the landmark study of Omura et al. (Blood 1980;55:199), validating cranial irradiation as an adjunct to intrathecal (IT) methotrexate, no other randomized trial of CNS prophylaxis was performed in adult ALL. Although the risk of CNS relapse is now only 1-4%, irradiation contributes to cumulative CNS toxicity together with high-dose methotrexate/cytarabine (HD-M/A), or is logistically difficult, so that developing an effective radiation-free CNS prophylaxis remains an important clinical task. IT DepoCyte® (ITD) might be advantageous, the slow release of liposome-associated cytarabine allowing therapeutic concentrations in the cerebrospinal fluid for 14+ days. An open trial reported prohibitive CNS toxicity from ITD in 6/31 patients (Jabbour et al. Blood 2007;109:3214), but ITD to ITD and HD-M/A to ITD intervals were short (14 and 10 days, respectively) and no patient suffered from CNS relapse. Methods In a phase II randomized trial (ClinicalTrials.gov NCT-00795756) we evaluated toxicity and feasibility (as primary study endpoint) of ITD 50 mg in comparison with IT triple therapy (ITT: methotrexate 12,5 mg, cytarabine 50 mg, prednisone 40 mg). Stratification was by cell lineage and risk class. ITT was given on d1 of courses 1,2,4,6,8; d15 of courses 1,2,8; and d1 of maintenance cycles 2-5 (12x). ITD was given on d1 of courses 1,2,4,6,8; d15 of courses 1,8 (T-ALL only); and d1 of maintenance cycle 2 (6-8x). The shortest ITD to ITD interval was 14 days in T-ALL (courses 1-2 [3x] and 8 [2x]), otherwise it was 21 days between ITD and any prior/subsequent ITD and HD course. ALL therapy consisted of eight induction-consolidation courses followed by risk/minimal residual disease-oriented maintenance or stem cell transplantation (SCT). In HD courses 3,7 (M/A) and 5 (M/Asparaginase) M dosage was 2.5 g/m2 (Ph- B-ALL) and 5 g/m2 (T-ALL) up to 55 years, and A 2 g/m2. Imatinib was used with de-intensified chemotherapy in Ph+ ALL; selected high-risk subsets received early SCT. Results Between 2007-12 201 total patients were enrolled and 141 randomized to ITT (n=73) or ITD (n=68). Median age was 42 years (range 18-68) and risk subsets (ITT/ITD) were SR-B 27.4%/29.4%; HR-B Ph- 26%/25%, Ph+ 23.3%/22.1%, SR-T 5.5%/5.9%, HR-T 17.8%/17.7%. Complete remission was 89% (n=65)/89.7% (n=61). Rates of actual v planned IT injections during induction-consolidation cycles 1-8, after removal of study losses (resistance, early death, SCT, toxicity and relapse), were ITT 374/415 (90.1%) v ITD 219/245 (89.3%) (P=0.76). Although toxicity/medical reasons caused 5 ITD patients to discontinue permanently the study v none in ITT arm (P=0.02), toxicity-driven omissions of IT therapy were marginally increased in ITD arm (29/415 [6.9%] v 24/245 [9.8%]; P=0.20). Neurologic toxicity occurred in 20 (27.4%) ITT v 36 (53%) ITD patients, respectively (P=0.002). According to NCI CTC grading (G), neurotoxicity episodes were GI 7 v 10 (P=0.36), GII 13 v 32 (P=0.003), GIII 4 v 12 (P=0.04), GIV 1 v 5 (P=0.12). GIII-IV neurotoxicity developed in 5/73 (6.8%) ITT patients v 10/52 (19.2%) and 5/16 (31.2%) B- and T-ALL ITD patients, respectively (P= 0.01), correlating in T-ALL with the second/third q14d ITD at courses 1,2,8 (4/5 patients, 5/6 episodes). Apart from reversible headache/radicular pain, the most serious toxicity occurred in 3 (4.1%) ITT patients (seizures 1; leukoencephalopathy 1; loss of consciousness 1) v 5 (7.3%) ITD patients (loss of consciousness 4, 1 with seizures; cerebral oedema/pseudotumor cerebri 1) (P=0.48). Four-year overall and disease-free survival were 54% and 52.2% v 58.9% and 47.7% in ITT and ITD arms, respectively, and relapse rate was 32.3% v 24.6% (all P=NS). In ITT arm there were 2 (3%) CNS and 2 (3%) combined CNS/marrow relapses. In ITD arm only one poorly compliant subject not given any HD course had an isolated CNS relapse (1.6%); no other patient had a CNS recurrence. Conclusion A radiation-free CNS prophylaxis with six spaced ITD in conjunction with HD-M/A may be feasible and at least as effective as other regimens. Excluding reversible headache/radiculitis, serious CNS toxicity was not significantly increased compared with ITT regimen, although some patients were forced to discontinue IT prophylaxis. The occasionally severe CNS toxicity prompts the investigation of a lower ITD dosage (25 mg), also to limit GI-II side effects, and the tighter schedule used in T-ALL should be abandoned because too toxic. Disclosures: Bassan: Mundipharma Oncology; Sigma-Tau; Amgen: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding. Off Label Use: Liposome-encapsulated cytarabine (DepoCyte®) used in a prospective phase II randomized trial of CNS prophylaxis in ALL. Masciulli:Novartis: Research Funding; Ospedali Riuniti di Bergamo: Research Funding; AIFA (Italian Regulatory Agency): Research Funding; AMGEN S.p.A.: Research Funding; Genzyme Olanda: Research Funding; Gruppo Italiano Trapianti di Midollo Osseo (GITMO): Research Funding; Pierre Fabre Italia S.p.A.: Research Funding; Università Cattolica del Sacro Cuore, Roma: Research Funding; Università degli Studi di Firenze: Research Funding; Sigma-Tau: Research Funding; Myeloproliferative disorder Research Consortium: Research Funding; Celgene: Research Funding; Associazione Italiana Linfomi (AIL): Research Funding; Fondazione Italiana Linfomi (FIL): Research Funding; LaRoche: Research Funding. Gallamini:Millenium: Consultancy. Marfisi:Novartis: Research Funding; Ospedali Riuniti di Bergamo: Research Funding; AIFA (Italian Regulatory Agency: Research Funding; AMGEN S.p.A.: Research Funding; Genzyme Olanda: Research Funding; Gruppo Italiano Trapianti di Midollo (GITMO): Research Funding; Pierre Fabre Italia S.p.A.: Research Funding; Università Cattolica del Sacro Cuore-Roma: Research Funding; Università degli Studi di Firenze: Research Funding; Sigma-Tau: Research Funding; Myeloproliferative disorder Research Consortium: Research Funding; Celgene: Research Funding; Associazione Italiana Linfomi (AIL): Research Funding; Fondazione Italiana Linfomi (FIL): Research Funding; LaRoche: Research Funding. Marchioli:Associazione Italiana Linfomi (AIL): Research Funding; Celgene: Research Funding; Myeloproliferative disorder Research Consortium: Research Funding; Sigma-Tau: Research Funding; Università Cattolica del Sacro Cuore, Roma: Research Funding; Pierre Fabre Italia S.p.A.: Research Funding; Gruppo Italiano Trapianti di Midollo (GITMO): Research Funding; Genzyme Olanda: Research Funding; AMGEN S.p.A.: Research Funding; AIFA (Italian Regulatory Agency): Research Funding; Ospedali Riuniti di Bergamo: Research Funding; Novartis: Research Funding; Fondazione Italiana Linfomi (FIL): Research Funding; LaRoche: Research Funding; Università degli Studi di Firenze: Research Funding. Rambaldi:Italfarmaco: Honoraria; Sanofi: Honoraria; Novartis: Honoraria.

Abstract Abstract 305 Introduction: Non-Hodgkin's lymphoma (NHL) are malignant tumors usually sensitive to chemotherapy; this results in prolonged survival and possibly disease eradication in a large proportion of patients. However, despite the general improvement in treatment options, a variable number of patients still shows a refractory disease, i.e. poor or absent response to induction therapy. Prediction and management of refractory disease is a major issue in the biological and clinical research programs for NHL. The present study was undertaken to evaluate on a large series of NHL patients, managed at two Italian centers over the last three decades: i. the actual rate of refractory patients; ii. the main factors associated with refractory disease; iii. the long-term outcome of refractory vs. responsive patients. Patients and Methods: Data have been collected on a series of 3,952 NHL patients, referred and treated at the University Hematology of Torino (S. Giovanni B. and Mauriziano Hospitals) (864 cases) and at the Hematology Division of Ospedali Riuniti di Bergamo (3,088 cases), between 1984 and 2012. There were 1,819 (46%) female patients, 2,056 (52%) were aged less than 60 yrs, B-cell NHL were 3,633 (92%), with 318 (8%) patients diagnosed as T-NHL; main histological subtypes included: 1,809 (45.8%) Diffuse Large Cell Lymphoma (DLCL), 758 (19.2%) follicular lymphoma (FL), 210 (5.3%) mantle-cell lymphoma, the remaining 1,175 (29.7) had other histologies. According to Ann Arbor staging, 2,369 (62%) patients presented with advanced stage disease and 914 out of 2,174 evaluable patients (42%) had an intermediate-high IPI score. Overall, 1,430 out of 3,187 (44.9%) received conventional chemo-radiotherapy supplemented with rituximab. The criteria to identify refractory patients were: stable or progressive disease (fully refractory) or transient response with disease progression within 6 months (early relapse), following first-line chemotherapy. Results: Among 2,543 broadly analysed patients, treated during the last 28 yrs, 649 (25.5%) were classified as refractory, including 14% fully refractory and 11.5% with early relapse or disease progression. The overall incidence of refractory disease was similar in the two Centers, 24.1% in Torino and 26.3% in Bergamo. The rate of refractoriness was as high as 46.9% in the small T-cell subgroup, while the overall incidence was 23.6% for B-cell NHL (p<0.001), with refractory patients more frequently observed among DLCL (26.0%) than in FL (15.1%) (p<0.001). Besides T-cell histology, the following factors had the highest association (p<0.001) with treatment response: i. intermediate-high risk IPI presentation, with 38.5% refractory patients, compared to 16.7% for 0–2 IPI scores; ii. female gender, with a markedly lower incidence (22%) of refractoriness compared to males (28.4%); iii. rituximab addition, that cut the incidence of refractoriness to 19.2% compared to 28.8% for patients treated without rituximab. These factors maintained their independent predictive values in multivariate regression analysis. At a median follow-up of 5.4 yrs., 1,607 (61%) out of 2,543 patients are alive, 11.8% of them were refractory to their first line treatment. Indeed, among 649 refractory patients, 189 (29%) are presently alive, compared to 1,418 alive (75%) among 1,894 responsive patients. Lastly, the overall survival (OS) was significantly poorer for fully refractory (median survival: 1.1 yrs) compared to early relapse patients (2.09 yrs) (p<0.001); both these refractory subgroups had a definitely poorer OS compared to responsive patients, whose median survival was 22.2 yrs (see Figure 1). Conclusions: i. Overall, in this large series of NHL patients who received induction therapy both in the pre- and post-Rituximab era, approximately one fourth displays full refractoriness or early relapse/progression; ii. the introduction of rituximab has markedly reduced the risk of refractory disease, whose incidence is now around 19%; iii. a markedly higher rate of refractory disease is observed with T-subtypes compared to B-cell NHL; iv. intermediate-high IPI score is associated to refractoriness, while female gender significantly reduces the risk of refractory disease; iv. patients responsive to first-line therapy have a very prolonged life expectancy, with a median survival around 22 yrs, whereas the median survival for refractory patients does not exceed 2 yrs. Disclosures: Tarella: Hoffmann-La Roche: Consultancy, Honoraria. Rambaldi:Hoffmann-La Roche: Consultancy, Honoraria.

Abstract Philadelphia-negative Myeloproliferative Neoplasms (MPN) include Polycythemia Vera (PV), Essential Thrombocythemia (ET) and Myelofibrosis, both Primary (PMF) and secondary to PV or ET (PPV-MF and PET-MF). A MPN is frequently the underlying cause of splanchnic vein thrombosis (SVT), accounting for 31.5% of portal vein thrombosis (PVT) and 40.9% of Budd Chiari syndrome (BCS). In patients (pts) with MPN and SVT, splenomegaly can arise as the consequence of the hematological disease and/or blood flow abnormalities consequent to the thrombosis itself. Splenomegaly and the compensatory enlarged splanchnic vessels are responsible for several complications including esophageal and gastric varices. Splenomegaly may cause abdominal discomfort; furthermore pts may present symptomatic burden due to the MPN. Current treatment strategies for MPN pts with SVT include anticoagulants and cytoreductive therapy (ie hydroxyurea, interferon) that have little influence in the control of splenomegaly and symptoms and do not improve flow abnormalities. Ruxolitinib, a JAK1/2 inhibitor, was highly effective in reducing spleen volume and improving symptoms in patients with MF and PV in phase II and III studies. We hypothesized that the decrease of the enlarged spleen determined by Ruxolitinib could result in a reduction of the local pressure in splanchnic vessels, producing both symptomatic improvement of splenomegaly-related symptoms and of splanchnic circulation. We designed an investigator-initiated multicentre phase 2 study of Ruxolitinib in pts with splenomegaly due to an underlying MPN associated with SVT. The drug was provided free of charge by Novartis, that had no role in trial design nor in data analysis. The primary study objective was to evaluate the proportion of subjects achieving ≥ 50% reduction in spleen length from left costal margin (LCM) measured by palpation at any time from baseline to week 24 (w24) and at w24, or a ≥ 35% reduction in spleen volume by MRI or CT at week 24. The secondary objectives included: evaluation of safety of Ruxolitinib in MPN-associated SVT; assessment of splanchnic circulation through Doppler analysis, measurement of hyperdynamic arterial circulation by echocardiography and stiffness of hepatic/splenic parenchyma by fibroscan; status of esophageal varices at w24 compared to baseline. Quality of Life assessment was performed using MPN-SAF questionnaire. Exploratory objectives include evaluations of changes in JAK2V617F or MPLW515 allelic burden, association of baseline mutations with response to treatment, changes in cytokine and microRNAs profiles, quantification of circulating endothelial cells. At the time of abstract submission 7 out of 21 pts have been enrolled, of which 5 completed the 24 weeks of treatment; two additional pts are in screening phase. Three pts had PMF, two ET, one PV and one PPV-MF, associated to spleno-porto-mesenteric thrombosis (5 pts) and Budd Chiari syndrome (2 pts). All pts were under oral anticoagulation therapy. Initial dose of Ruxolitinib was 10 mg BID for PV, 25 mg BID for ET, 15 mg BID for MF pts with baseline platelet count of 100 to 200x109/L and 20 mg BID for those with baseline platelet count >200x109/L. A palpable splenomegaly greater than 5 cm below LCM was a criterion for enrollment; the 5 patients who completed the 24 weeks of treatment had a median splenomegaly of 8 cm below LCM at baseline, and obtained a median reduction of 69% measured by palpation at week 24, associated with a significant reduction in abdominal discomfort as measured by MPN-SAF questionnaire (median score at screening 5 vs 1.5 at week 24). The total symptom score calculated by using BFI and MPN-SAF was reduced from 50 at screening to 35 at week 24. Instrumental evaluations of splanchnic and systemic circulation showed that 3 pts obtained a reduction of the spleen stiffness from a median value of 66 to 49.6 kilopascals (KPa), 2 pts had a reduction of the liver stiffness from a median value of 23.85 to 18.2 KPa and 1 pt a reduction of the cardiac output from 5.871 to 4.6 L/min. Evaluation of esophageal varices at week 24 showed stabilization with neither worsening nor need of banding. Ruxolitinib was well tolerated, with no SAE reported; one pt developed anemia G2 and one G3 leading to dose reduction. Other adverse events include G1 asthenia and G≤2 AST/ALT increase in 3 pts, one case of Herpes Zoster and one case of abdominal pain both G1. Updated results will be presented at the meeting. Disclosures: Marchioli: Novartis: Research Funding; Ospedali Riuniti di Bergamo: Research Funding; AIFA (Italian Regulatory Agency): Research Funding; AMGEN S.p.A.: Research Funding; Genzyme Olanda: Research Funding; Gruppo Italiano Trapianti di Midollo (GITMO): Research Funding; Pierre Fabre Italia S.p.A.: Research Funding; Università Cattolica del Sacro Cuore, Roma: Research Funding; Sigma-Tau: Research Funding; Myeloproliferative disorder Research Consortium: Research Funding; Celgene: Research Funding; Associazione Italiana Linfomi (AIL): Research Funding; Fondazione Italiana Linfomi (FIL): Research Funding; LaRoche: Research Funding; Università degli Studi di Firenze: Research Funding. Vannucchi:NOVARTIS: Honoraria, Membership on an entity’s Board of Directors or advisory committees.

Introduction: The role of EBUS-TBNA in the diagnosis and staging of lung cancer is well established. EBUS-TBNA can be performed using different aspiration techniques. The most common aspiration technique is known as “suction”. One alternative to the suction technique is the slow-pull capillary aspiration. To the best of our knowledge, no studies have assessed the diagnostic yield of slow-pull capillary EBUS-TBNA in PD-L1 amplification assessment in NSCLC. Herein, we conducted a single-centre retrospective study to establish the diagnostic yield of slow-pull capillary EBUS-TBNA in terms of PD-L1 in patients with NSCLC and hilar/mediastinal lymphadenopathies subsequent to NSCLC. Materials and Methods: Patients with hilar and/or mediastinal lymph node (LN) NSCLC metastasis, diagnosed by EBUS-TBNA between January 2021 and April 2022 at Pulmonology Unit of “Ospedali Riuniti di Ancona” (Ancona, Italy) were enrolled. We evaluated patient characteristics, including demographic information, CT scan/ FDG-PET features and final histological diagnoses, including PD-L1 assessment. Results: A total of 174 patients underwent EBUS-TBNA for diagnosis of hilar/mediastinal lymphadenopathies between January 2021 and April 2022 in the Interventional Pulmonology Unit of the “Ospedali Riuniti di Ancona”. Slow-pull capillary aspiration was adopted in 60 patients (34.5%), and in 30/60 patients (50.0%) NSCLC was diagnosed. EBUS-TBNA with slow-pull capillary aspiration provided adequate sampling for molecular biology and PD-L1 testing in 96.7% of patients (29/30); in 15/29 (51.7%) samples with more than 1000 viable cells/HPF were identified, whereas in 14/29 (48.3%) samples contained 101–1000 viable cells/HPF. Conclusion: These retrospective study shows that slow-pull capillary aspiration carries an excellent diagnostic accuracy, almost equal to that one reported in literature, supporting its use in EBUS-TBNA for PD-L1 testing in NSCLC.

RIASSUNTOScopo — Lo studio QUALYOP si prefigge tre obiettivi: 1) descrivere la situazione dei 12 ex ospedali psichiatrici lombardi in relazione a caratteristiche strutturali e organizzative e all'andamento di ammisioni/dimissioni e decessi dei pazienti ricoverati; 2) descrivere la qualita di strutture, organizzazione e attivita dei reparti; 3) descrivere le caratteristiche socio-demografiche, cliniche e le potenzialita riabilitative della popolazione ricoverata. I dati presentati in questo articolo si riferiscono ai primi due obiettivi. Disegno - Studio descrittivo-valutativo. Gli ospedali sono stati vistitati nell'arco di sei mesi (luglio-novembre 1994) da un gruppo di ricercatori-rilevatori in una data concordata con i rispettivi direttori. Sono state utilizzate quattro fonti di informazione e documentazione: scheda ospedale, scheda reparto, scheda paziente, documentazione fotografica delle strutture. Setting - I 12 ex-ospedali psichiatrici pubblici della Regione Lombardia in funzione alia data della rilevazione (Bergamo, Brescia, Castiglione delle Stiviere, Codogno, Como, Cremona, Limbiate, Mantova, Milano, Sondrio, Varese, Voghera). Principali misure utilizzate - È stato utilizzato un gruppo di indicatori che forniva informazioni sulle strutture, sull'organizzazione della vita di reparto e sulle attività svolte. I giudizi di qualita sono stato espressi in relazione a criteri espicitati a priori. I reparti sono stati quindi raggruppati in tre tipologie a seconda del livello di adeguatezza delle strutture, dell'organizzazione e delle attività. Risultati - I 12 ospedali psichiatrici pubblici della Lombardia risultano costituiti da 63 reparti che accolgono complessivamente 2752 ricoverati. La situazione risulta estremamente eterogenea nei diversi ospedali che si differenziano per affollamento dei reparti, rapporto operatori-pazienti, decremento negli anni della popolazione ricoverata e numero di nuove ammissioni. La valutazione della qualita strutturale, organizzativa e delle attivita evidenzia che il 70% dei reparti e inadeguato o gravemente inadeguato dal punto di vista strutturale, mentre più del 70% è inadeguato o gravemente inadeguato dal punto di vista organizzativo e delle attività che vi si svolgono. Conclusioni - Lo studio dimostra la fattibilita di valutazioni di programmi di sanita pubblica utilizzando criteri non riferiti a dati di efficacia ma formulati a partire da valori etici, senso comune, eventi non ammissibili, risultati di studi quasi-sperimentali ed esperienza. I dati cosi raccolti permettono di concludere che le politiche di superamento dell'ospedale psichiatrico sono estremamente carenti nella maggior parte dei casi e che la ricoversione esclusivamente strutturale degli immobili, in molti casi assolutamente necessaria, non è tuttavia sufficiente a garantire un reale superamento. Molto più urgente sembra essere la necessita di formare e motivare il personale di assistenza e amministrativo.

Nel mondo circa 130 milioni di soggetti sono portatori di infezione cronica HCV; di questi circa 4-5 milioni sono contemporaneamente infettati con il virus HIV. Dal 1996, con l’introduzione della terapia antiretrovirale altamente attiva (HAART), si è assistito ad una riduzione significativa delle infezioni opportunistiche HIV correlate. D’altra parte la maggiore sopravvivenza ha determinato negli anni la progressione di malattie epatiche, soprattutto HCV correlate di cui questi soggetti sono affetti, verso la cirrosi epatica scompensata e l’epatocarcinoma. I diversi studi effettuati negli ultimi anni, sottolineano che, selezionando accuratamente il candidato, è possibile offrire l’opportunità del trapianto anche ai soggetti HIV positivi ottenendo buoni risultati. Con questo studio abbiamo voluto valutare i risultati ottenuti nel trapianto di fegato in soggetti HIV positivi con coinfezione HCV presso il Centro Trapianti di Ancona dopo 4 anni di attività; ponendoci, come obiettivo primario quello di confrontare la sopravvivenza nel gruppo degli HIV positivi con un gruppo di soggetti HIV negativi con infezione da HCV e come obiettivi secondari quelli di valutate le cause del decesso, il decorso della recidiva di HCV, la frequenza della recidiva di HCC e gli effetti del trapianto nell’evoluzione dell’infezione da HIV. La situazione viro-immunologica dei pazienti HIV positivi rientrava nei criteri previsti dal Programma Nazionale: nel pre-trapianto CD4+>200/mmc e viremia HIV non rilevabile. Questa analisi retrospettiva non ha evidenziato significative differenze in termini di sopravvivenza complessiva tra i pazienti HCV monoinfetti e i pazienti coinfetti HIV ed HCV. Nei pazienti deceduti il tempo intercorso tra trapianto e decesso risulta significativamente inferiore nei soggetti HIV positivi, tuttavia la maggior parte dei decessi sono riconducibili a complicanze non correlabili nè con l’infezione da HIV nè con la recidiva di epatite cronica da HCV. Per quanto riguarda invece la recidiva istologica di malattia, i pazienti coinfetti hanno una recidiva più rapida rispetto ai monoinfetti. Il rischio di recidiva di epatocarcinoma nella nostra casistica non sembra maggiore nei pazienti HIV positivi rispetto agli HIV negativi.
In the world about 130 million people are carriers of chronic HCV infection, of whom approximately 4-5 million are simultaneously infected with the HIV virus. Since 1996, with the introduction of highly active antiretroviral therapy (HAART), there has been a significant reduction of HIV related opportunistic infections. On the other hand, resulted in improved survival over the years the progression of liver disease, particularly HCV related to these subjects are affected, to the decompensated liver cirrhosis and hepatocellular carcinoma. The various studies conducted in recent years, point out that, by carefully selecting the candidate, you can also offer the opportunity of transplantation to HIV-positive subjects with good results. With this study we wanted to evaluate the results obtained in liver transplantation in HIV co-infection with HCV positive at the Transplant Center of Ancona after 4 years of activity by asking, as a primary objective to compare survival in the group of HIV positive with a group HIV-negative subjects with HCV infection and as secondary objectives to evaluate the cause of death, the course of recurrent HCV, the frequency of recurrence of HCC and the effect of transplantation in the evolution of HIV infection. The viro-immunological situation of HIV positive patients fell within the criteria of the National Programme: in the pre-transplant CD4> 200/mmc and HIV viral load undetectable. This retrospective analysis showed no significant differences in overall survival between HCV-monoinfected patients and HIV and HCV positive. In patients who died the time between transplantation and death was significantly lower in subjects infected with HIV, yet the majority of deaths are attributable to complications can not be correlated with either HIV infection or the recurrence of HCV chronic hepatitis. As for the histological recurrence of disease, co-infected patients have a relapse faster than monoinfected. The risk of recurrence of hepatocellular carcinoma in our series does not seem higher in HIV-positive patients than HIV-negative.

In the last few years a role of Lupus Anticoagulant (LAC) in the aetiology of repeated spontaneous abortions and intrauterine deaths has been repeatedly suggested. To quantify this association few da ta are available, since the published reports are generally based on uncontrolled and small clinical series. We have analyzed data from a case-control study conducted in Bergamo and Milan, two contiguous provinces in Lombardia, Italy. Cases were 63 women, mean age 30 years, range 23-40, with 2 or more "sine causa" spontaneous abortions (repeated abortions) admitted between March 1985 and December 1986 to the Ospedali Riuniti of Bergamo and Istituti Clinici di Perfezionamento of Milan. Controls were 63 women, mean age 32 years, range 20-49, with 1 or more live births and without spon taneous abortions, admitted to the same Institutions for neither gynaecological nor cardiovascular acute conditions. Informations were collected on sociodemographic factors, gynaecological and obstetrical data and related medical history. LAC was diagnosed according to the Working Party reccomandations (1983) and Systemic Lupus Erythematosus (SLE) according to the revised criteria of ihe American Rheumatism Association (1982). 11 out of 63 cases (17%) (95% confidence interval ranging from 9.5% to 34% based on the Poisson's approximation) were LAC positive, whereas in none of 63 controls this inhibitor was detected (X2 1adjusted for age = 10.1, p= 0.02). Similarly SLE was diagnosed in 4 cases (all having a Lupus Anticoagulant) and in none control (x2 1adjusted for age= 4.17, p=0.02). These findings confirm that LAC is associated with a positive history of repeated abortions, being present in about 10% of the cases. Conclusive estimate of relative risk is prevented by the small control gr'oup size (i.e. lack of positivity for LAC in controls), but very elevated risk (many tenfold increase) is sugge. sted.