Le retard constitutionnel de croissance et de puberté (RCCP) est une cause fréquente de petite ta... more Le retard constitutionnel de croissance et de puberté (RCCP) est une cause fréquente de petite taille où, après un ralentissement temporaire de la croissance, on atteint, selon la définition classique, une taille normale par rapport au potentiel génétique.Patients et méthodes. — Du fait de l'absence d'unanimité sur l'atteinte de la cible génétique de ces patients, nous avons jugé utile d'évaluer la taille définitive de 20 patients (11 garçons et neuf filles), suivis pour RCCP, en la mettant en rapport avec leur cible génétique et la prédiction de la taille définitive par la méthode de Bayley et Pinneau, avant la puberté. Ces enfants n'avaient jamais été traités.Résultats. — On a observé, chez tous les patients, une amélioration spontanée de la taille, de la puberté à l'âge adulte (de −2,9 ± 0,7 SDS à −1,3 ± 0,6 SDS chez les garçons et de −2,6 ± 0,6 SDS à −0,9 ± 0,3 SDS chez les filles; p < 0,001). Chez les garçons, la taille définitive (166,4 ± 4,1 cm) mesurée à l'âge moyen de 21 ans, était en harmonie avec la cible génétique (165,7 ± 3,9) et avec la prédiction staturale (167,3 ± 3,1). Chez les filles, la taille définitive atteinte (156,6 ± 2,0) mesurée à l'âge moyen de 20,4 ans, correspondait à la cible génétique (153,3 ± 4,2) et à la prédiction de taille précédemment effectuée (155,6 ± 2,3).Conclusion. — Dans notre étude, les patients avec RCCP ont la taille définitive prévue et atteignent leur potentiel familial sans traitement.Background. — Constitutional delay of growth and puberty (CDGP) is a frequent cause of short stature in childhood. Controversial results have been reported on the full achievement of these patients of their target height.Patients and methods. The final adult height of 20 patients with CDGP (11 male and 9 female), who did not received hormonal treatment, was compared with their target height and with the predicted adult height, by the Bayley-Pinneau method obtained before the onset of puberty.Results. — A spontaneous improvement of the stature from pre-puberty to adulthood was observed in all patients (from −2.9 ± 0.7 SDS to −1.3 ± 0.6 SDS in male and from −2.6 ± 0.6 SDS to −0.9 ± 0.3 SDS in female; P < 0.001). Adult height in male (166.4 ± 4.1 cm) at the mean age of 21 years was very close to the target height (165.7 ± 3.9 cm) and to the predicted adult height (167.3 ± 3.1 cm). Also in female, final height (156.6 ± 2.0 cm) did not differ from target height (153.3 ± 4.2 cm) and from predicted adult height (155.6 ± 2.3 cm).Conclusions. — In our experience, patients with CDGP reach their predicted adult height and achieve their genetic potential without medical treatment.
High Blood Pressure & Cardiovascular Prevention, 2014
Recent clinical and experimental studies suggest that vitamin D status could play a significant r... more Recent clinical and experimental studies suggest that vitamin D status could play a significant role in the pathogenesis of cardiometabolic disorders as well as in their clinical severity. In particular, low vitamin D levels appear to increase the risk of major cardiovascular events in apparently healthy individuals and to worsen the prognosis quoad vitam and quoad valetudinem following a cardiovascular event. The relevance of these observations is amplified by the high prevalence of vitamin D deficiency and insufficiency that affect over one billion individuals at all ages worldwide. Randomized controlled trials are currently underway in U.S., Europe and Oceania to demonstrate a cause-effect relationship by assessing the effects of vitamin D supplementation on various cardiovascular outcomes. Aim of this review is to point out the more recent advances in knowledge about the relationship between vitamin D status and the incidence, prevalence and pathogenesis of more common cardiometabolic disorders.
Dietary and lifestyle modifications, which are commonly proposed to overweight or obese youth, la... more Dietary and lifestyle modifications, which are commonly proposed to overweight or obese youth, lack efficacy in individuals who are severely obese. Early results with bariatric procedures in obese adolescents suggest that weight loss and safety are comparable or better than seen in adults. One of these procedures, laparoscopic sleeve gastrectomy, is commonly performed using multiple ports. We selected single-port sleeve gastrectomy (SPSG) as a minimally invasive surgery to be tested in severely obese adolescents. Prospective clinical and biochemical data were collected from 16 young severely obese patients who underwent SPSG. The setting was a university hospital. The mean age of the cohort was 17.8 years (12 girls, 4 boys). The individuals&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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; average weight was 125.5 kg and their average body mass index was 45.3 kg/m(2). All patients were insulin-resistant and 6 showed hypertriglyceridemia. The median operating time was 66 minutes, and there were no intraoperative complications. No conversion to open surgery was required. No patient required additional trocars and no patient had postoperative complications. The median hospital stay was 3 days. After a one-year follow-up, the average weight decrease was 40.3 kg, resulting in a decrease in excess weight loss by 70.61%. Insulin-resistance decreased in 16/16 patients and hypertriglyceridemia decreased in 5/6 patients. SPSG seems safe and effective in the short term in severely obese adolescents.
Right ventricular dysfunction during acute pulmonary embolism (PE) predisposes to hemodynamic ins... more Right ventricular dysfunction during acute pulmonary embolism (PE) predisposes to hemodynamic instability and cardiogenic shock. Aim of this case-control study was to determine the clinical, historical and diagnostic findings associated with right ventricular dysfunction in patients with acute PE involving the main or segmental pulmonary arteries (central PE) and without hemodynamic instability on admission to the Emergency Department (ED) (non-massive PE). From January 1, 2002 to December 31, 2005, 211 patients with central PE were admitted to the Department of Emergency Medicine of the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Antonio Cardarelli&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; Hospital (Naples, Italy). One hundred eighteen of them had echocardiographic evidence of right ventricular dysfunction on admission to the ED. A history of type 2 diabetes mellitus and chronic obstructive pulmonary disease were significantly associated with an increased risk of this PE-related complication. Compared to patients without right ventricular dysfunction, those with right ventricular dysfunction showed higher levels of markers of cardiac damage, and a significant impairment of respiratory function. Echocardiographic evidence of right ventricular dysfunction on admission to the ED was significantly associated with the occurrence of hemodynamic instability and cardiogenic shock during the PE clinical course. The study results indicate that a history of type 2 diabetes mellitus and chronic obstructive pulmonary disease are significantly associated with the occurrence of right ventricular dysfunction in patients with non-massive and central PE independent of age, gender and other historical and clinical variables detectable on admission to the ED.
Primary pachydermoperiostosis (PDP) is a rare syndrome, characterized by digital clubbing, perios... more Primary pachydermoperiostosis (PDP) is a rare syndrome, characterized by digital clubbing, periostosis, and pachydermia. We have evaluated biochemical bone turnover markers, including components of interleukin-6 (IL-6) and osteoprotegerin/receptor activator of nuclear factor (NF)-kappaB ligand (OPG/RANKL) systems, in an 18-year-old man affected by primary PDP. The acute phase of the disease was characterized in our patient by high serum levels of IL-6 and RANKL. The observed high serum levels of these parameters are associated with increased values in markers of bone resorption (degradation products of C-terminal telopeptides of type-I collagen and urinary hydroxyproline/creatinine ratio) and reduced serum levels of bone alkaline phosphatase, a marker of bone formation. Serum levels of osteotrophic hormones were in the normal range. Our data suggest that, despite the radiographic findings, the acute phase of primary PDP is characterized by increased bone resorption, probably mediated by IL-6 and RANKL.
Journal of Pediatric Gastroenterology and Nutrition, 2009
To determine the prevalence of metabolic syndrome (MS) in a primary care pediatric setting and to... more To determine the prevalence of metabolic syndrome (MS) in a primary care pediatric setting and to collect clinical and biochemical data, allowing for a prediction of its presence in a supposedly healthy population. Belonging to a pediatric population followed by pediatricians of the Italian National Health Service, 415 subjects with obesity as a unique selection criterion were enrolled. The entire cohort was screened for MS, which was defined as the presence of at least 2 other findings out of obesity: fasting hyperglycemia, low levels of high-density lipoproteins cholesterol, hypertriglyceridemia, and hypertension. The overall prevalence of MS was 30.8%. Major findings (out of obesity) were low high-density lipoproteins cholesterol levels (46.2%), hypertension (23.6%), hypertriglyceridemia (22.2%), and fasting hyperglycemia (16.6%). Waist-to-height ratio was the only clinical parameter directly related to MS, with the same predictive power of insulin resistance. Metabolic syndrome can be present in a significant percentage of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;healthy&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; obese children, and a simple clinical parameter could identify at-risk subjects. This observation justifies the development and implementation of pediatric networks for obesity screening programs.
Serum concentrations of interleukin-6 (IL-6), IL-6-soluble receptor (sIL-6R), IL-6 gp130-soluble ... more Serum concentrations of interleukin-6 (IL-6), IL-6-soluble receptor (sIL-6R), IL-6 gp130-soluble receptor (sgp130), ligand of receptor activator of nuclear factor (NF)-kappaB (RANKL), and osteoprotegerin (OPG) were determined in 42 patients with polyostotic Paget&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease of bone (PDB) and acquired resistance to clodronate (M/F ratio 23:19; mean age 58.5 +/- 9.4 years) in acute phase of disease and after oral risedronate treatment (30 mg/day for 8 weeks). At baseline, pagetic patients showed higher levels of OPG, sIL-6R, and IL-6 with lower levels of sgp130 compared to 24 age- and sex-matched controls (respectively, 4.69 +/- 1.27 vs. 2.87 +/- 0.54 pmol/L; 40.89 +/- 8.61 vs. 30.98 +/- 4.24 ng/ml; 3.59 +/- 0.97 vs. 1.8 +/- 0.9 pg/ml; 327.34 +/- 43.41 vs. 411.7 +/- 79.5 ng/ml). Response to treatment is related to a significant increase of OPG levels in all patients (from 4.69 +/- 1.27 to 5.48 +/- 1.31 pmol/L). The disease remission, that is, total alkaline phosphatase (tALP) levels within the normal range after therapy, was associated with a simultaneous increase in OPG and sgp130 levels. In patients with tALP higher than the normal range after therapy, the OPG increase was associated with a parallel increase in RANKL levels. Our data suggest that serum levels of components of RANKL/OPG and IL-6 systems, before and after treatment, may be used to better define a therapeutical strategy in pagetic patients.
Le retard constitutionnel de croissance et de puberté (RCCP) est une cause fréquente de petite ta... more Le retard constitutionnel de croissance et de puberté (RCCP) est une cause fréquente de petite taille où, après un ralentissement temporaire de la croissance, on atteint, selon la définition classique, une taille normale par rapport au potentiel génétique.Patients et méthodes. — Du fait de l'absence d'unanimité sur l'atteinte de la cible génétique de ces patients, nous avons jugé utile d'évaluer la taille définitive de 20 patients (11 garçons et neuf filles), suivis pour RCCP, en la mettant en rapport avec leur cible génétique et la prédiction de la taille définitive par la méthode de Bayley et Pinneau, avant la puberté. Ces enfants n'avaient jamais été traités.Résultats. — On a observé, chez tous les patients, une amélioration spontanée de la taille, de la puberté à l'âge adulte (de −2,9 ± 0,7 SDS à −1,3 ± 0,6 SDS chez les garçons et de −2,6 ± 0,6 SDS à −0,9 ± 0,3 SDS chez les filles; p < 0,001). Chez les garçons, la taille définitive (166,4 ± 4,1 cm) mesurée à l'âge moyen de 21 ans, était en harmonie avec la cible génétique (165,7 ± 3,9) et avec la prédiction staturale (167,3 ± 3,1). Chez les filles, la taille définitive atteinte (156,6 ± 2,0) mesurée à l'âge moyen de 20,4 ans, correspondait à la cible génétique (153,3 ± 4,2) et à la prédiction de taille précédemment effectuée (155,6 ± 2,3).Conclusion. — Dans notre étude, les patients avec RCCP ont la taille définitive prévue et atteignent leur potentiel familial sans traitement.Background. — Constitutional delay of growth and puberty (CDGP) is a frequent cause of short stature in childhood. Controversial results have been reported on the full achievement of these patients of their target height.Patients and methods. The final adult height of 20 patients with CDGP (11 male and 9 female), who did not received hormonal treatment, was compared with their target height and with the predicted adult height, by the Bayley-Pinneau method obtained before the onset of puberty.Results. — A spontaneous improvement of the stature from pre-puberty to adulthood was observed in all patients (from −2.9 ± 0.7 SDS to −1.3 ± 0.6 SDS in male and from −2.6 ± 0.6 SDS to −0.9 ± 0.3 SDS in female; P < 0.001). Adult height in male (166.4 ± 4.1 cm) at the mean age of 21 years was very close to the target height (165.7 ± 3.9 cm) and to the predicted adult height (167.3 ± 3.1 cm). Also in female, final height (156.6 ± 2.0 cm) did not differ from target height (153.3 ± 4.2 cm) and from predicted adult height (155.6 ± 2.3 cm).Conclusions. — In our experience, patients with CDGP reach their predicted adult height and achieve their genetic potential without medical treatment.
High Blood Pressure & Cardiovascular Prevention, 2014
Recent clinical and experimental studies suggest that vitamin D status could play a significant r... more Recent clinical and experimental studies suggest that vitamin D status could play a significant role in the pathogenesis of cardiometabolic disorders as well as in their clinical severity. In particular, low vitamin D levels appear to increase the risk of major cardiovascular events in apparently healthy individuals and to worsen the prognosis quoad vitam and quoad valetudinem following a cardiovascular event. The relevance of these observations is amplified by the high prevalence of vitamin D deficiency and insufficiency that affect over one billion individuals at all ages worldwide. Randomized controlled trials are currently underway in U.S., Europe and Oceania to demonstrate a cause-effect relationship by assessing the effects of vitamin D supplementation on various cardiovascular outcomes. Aim of this review is to point out the more recent advances in knowledge about the relationship between vitamin D status and the incidence, prevalence and pathogenesis of more common cardiometabolic disorders.
Dietary and lifestyle modifications, which are commonly proposed to overweight or obese youth, la... more Dietary and lifestyle modifications, which are commonly proposed to overweight or obese youth, lack efficacy in individuals who are severely obese. Early results with bariatric procedures in obese adolescents suggest that weight loss and safety are comparable or better than seen in adults. One of these procedures, laparoscopic sleeve gastrectomy, is commonly performed using multiple ports. We selected single-port sleeve gastrectomy (SPSG) as a minimally invasive surgery to be tested in severely obese adolescents. Prospective clinical and biochemical data were collected from 16 young severely obese patients who underwent SPSG. The setting was a university hospital. The mean age of the cohort was 17.8 years (12 girls, 4 boys). The individuals&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;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; average weight was 125.5 kg and their average body mass index was 45.3 kg/m(2). All patients were insulin-resistant and 6 showed hypertriglyceridemia. The median operating time was 66 minutes, and there were no intraoperative complications. No conversion to open surgery was required. No patient required additional trocars and no patient had postoperative complications. The median hospital stay was 3 days. After a one-year follow-up, the average weight decrease was 40.3 kg, resulting in a decrease in excess weight loss by 70.61%. Insulin-resistance decreased in 16/16 patients and hypertriglyceridemia decreased in 5/6 patients. SPSG seems safe and effective in the short term in severely obese adolescents.
Right ventricular dysfunction during acute pulmonary embolism (PE) predisposes to hemodynamic ins... more Right ventricular dysfunction during acute pulmonary embolism (PE) predisposes to hemodynamic instability and cardiogenic shock. Aim of this case-control study was to determine the clinical, historical and diagnostic findings associated with right ventricular dysfunction in patients with acute PE involving the main or segmental pulmonary arteries (central PE) and without hemodynamic instability on admission to the Emergency Department (ED) (non-massive PE). From January 1, 2002 to December 31, 2005, 211 patients with central PE were admitted to the Department of Emergency Medicine of the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Antonio Cardarelli&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; Hospital (Naples, Italy). One hundred eighteen of them had echocardiographic evidence of right ventricular dysfunction on admission to the ED. A history of type 2 diabetes mellitus and chronic obstructive pulmonary disease were significantly associated with an increased risk of this PE-related complication. Compared to patients without right ventricular dysfunction, those with right ventricular dysfunction showed higher levels of markers of cardiac damage, and a significant impairment of respiratory function. Echocardiographic evidence of right ventricular dysfunction on admission to the ED was significantly associated with the occurrence of hemodynamic instability and cardiogenic shock during the PE clinical course. The study results indicate that a history of type 2 diabetes mellitus and chronic obstructive pulmonary disease are significantly associated with the occurrence of right ventricular dysfunction in patients with non-massive and central PE independent of age, gender and other historical and clinical variables detectable on admission to the ED.
Primary pachydermoperiostosis (PDP) is a rare syndrome, characterized by digital clubbing, perios... more Primary pachydermoperiostosis (PDP) is a rare syndrome, characterized by digital clubbing, periostosis, and pachydermia. We have evaluated biochemical bone turnover markers, including components of interleukin-6 (IL-6) and osteoprotegerin/receptor activator of nuclear factor (NF)-kappaB ligand (OPG/RANKL) systems, in an 18-year-old man affected by primary PDP. The acute phase of the disease was characterized in our patient by high serum levels of IL-6 and RANKL. The observed high serum levels of these parameters are associated with increased values in markers of bone resorption (degradation products of C-terminal telopeptides of type-I collagen and urinary hydroxyproline/creatinine ratio) and reduced serum levels of bone alkaline phosphatase, a marker of bone formation. Serum levels of osteotrophic hormones were in the normal range. Our data suggest that, despite the radiographic findings, the acute phase of primary PDP is characterized by increased bone resorption, probably mediated by IL-6 and RANKL.
Journal of Pediatric Gastroenterology and Nutrition, 2009
To determine the prevalence of metabolic syndrome (MS) in a primary care pediatric setting and to... more To determine the prevalence of metabolic syndrome (MS) in a primary care pediatric setting and to collect clinical and biochemical data, allowing for a prediction of its presence in a supposedly healthy population. Belonging to a pediatric population followed by pediatricians of the Italian National Health Service, 415 subjects with obesity as a unique selection criterion were enrolled. The entire cohort was screened for MS, which was defined as the presence of at least 2 other findings out of obesity: fasting hyperglycemia, low levels of high-density lipoproteins cholesterol, hypertriglyceridemia, and hypertension. The overall prevalence of MS was 30.8%. Major findings (out of obesity) were low high-density lipoproteins cholesterol levels (46.2%), hypertension (23.6%), hypertriglyceridemia (22.2%), and fasting hyperglycemia (16.6%). Waist-to-height ratio was the only clinical parameter directly related to MS, with the same predictive power of insulin resistance. Metabolic syndrome can be present in a significant percentage of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;healthy&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; obese children, and a simple clinical parameter could identify at-risk subjects. This observation justifies the development and implementation of pediatric networks for obesity screening programs.
Serum concentrations of interleukin-6 (IL-6), IL-6-soluble receptor (sIL-6R), IL-6 gp130-soluble ... more Serum concentrations of interleukin-6 (IL-6), IL-6-soluble receptor (sIL-6R), IL-6 gp130-soluble receptor (sgp130), ligand of receptor activator of nuclear factor (NF)-kappaB (RANKL), and osteoprotegerin (OPG) were determined in 42 patients with polyostotic Paget&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease of bone (PDB) and acquired resistance to clodronate (M/F ratio 23:19; mean age 58.5 +/- 9.4 years) in acute phase of disease and after oral risedronate treatment (30 mg/day for 8 weeks). At baseline, pagetic patients showed higher levels of OPG, sIL-6R, and IL-6 with lower levels of sgp130 compared to 24 age- and sex-matched controls (respectively, 4.69 +/- 1.27 vs. 2.87 +/- 0.54 pmol/L; 40.89 +/- 8.61 vs. 30.98 +/- 4.24 ng/ml; 3.59 +/- 0.97 vs. 1.8 +/- 0.9 pg/ml; 327.34 +/- 43.41 vs. 411.7 +/- 79.5 ng/ml). Response to treatment is related to a significant increase of OPG levels in all patients (from 4.69 +/- 1.27 to 5.48 +/- 1.31 pmol/L). The disease remission, that is, total alkaline phosphatase (tALP) levels within the normal range after therapy, was associated with a simultaneous increase in OPG and sgp130 levels. In patients with tALP higher than the normal range after therapy, the OPG increase was associated with a parallel increase in RANKL levels. Our data suggest that serum levels of components of RANKL/OPG and IL-6 systems, before and after treatment, may be used to better define a therapeutical strategy in pagetic patients.
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Papers by Gianpaolo Filippo