BackgroundLong-term care for the elderly by their family members represents a serious burden in I... more BackgroundLong-term care for the elderly by their family members represents a serious burden in Italy. The physical and psychological health of informal caregivers is a growing public health issue. Old patients often seek urgent medical attention in the Emergency Department (ED) and hospitalisation is frequent event among the elderly.AimAim of the study was (1) to investigate the burden of care among the caregivers of old patients; (2) to examine the influence of the burden experienced by the caregivers on ED and hospital admissions of the elderly.MethodsWe conducted a descriptive study of patients aged 75 years or older and their caregiver admitted to the ED from 10/1/15 to 6/10/15 (77 patient-caregiver pairs). The caregivers were evaluated using the Caregiver Burden Inventory (CBI). A case manager collected the patient's data.ResultsCBI score is the highest among patients seeking ED evaluation due to caregiver's concern. The majority of the elderly admitted to the ED whose...
Multidimensional geriatric assessment is a functional, psychosocial and medical evaluation of an ... more Multidimensional geriatric assessment is a functional, psychosocial and medical evaluation of an elderly patient. Such an approach improves function and survival in frail older patients, mostly in an outpatient setting. New RCTs suggest that the application of a multidisciplinary approach to the elderly should be applied to all the patients admitted to acute care hospitals. A model of integrated geriatric care is proposed, starting in the emergency room (ER) in an acute care hospital. The project will be developed over a 3 year period. A nurse case manager will work in the ER, evaluating all the patients aged over 75. She will provide the ER physician with information on functional and psychosocial status of the patient using standardized tests, and will contact primary care physician and the social workers to gather further information. In case of hospitalization, the case manager will evaluate possible occurring complications during the hospital stay and the outcome. Given the huge amount of hospitalizations among the geriatric patients, it is mandatory that the physicians are familiar with the fundaments of geriatric culture and principles of geriatric assessment and management. This issue will be addressed through a formative plan designed for physicians and nurses. End point of the pilot study is to reduce complications of hospitalization, improve patients function at hospital discharge, decrease nursing home admissions, reduce hospital inappropriate admissions and readmissions, reduce the mean length of hospital stay and health care system costs. Project supported by grant RF-2009-1511459 Ministero della Salute assigned to Dr Alessandra Colantoni
A case of cryptogenic cirrhosis in a patient with Turner&... more A case of cryptogenic cirrhosis in a patient with Turner's syndrome is presented. The individual was admitted for upper gastrointestinal bleeding due to oesophageal varices. After failure of medical treatment, a transjugular intra-hepatic portal systemic shunt was used to control the bleeding. A liver biopsy revealed cirrhosis with minimal necro-inflammatory activity and no steatosis. Immunohistochemical staining for HCV, HBsAg and HBcAg was negative. No other risk factor for liver disease was recognized and none of the known causes of chronic liver disease was identified after a thorough evaluation for such. Turner's syndrome is a genetic disorder due to X chromosome monosomy in which a wide range of congenital anomalies can occur. Cardiac, renal and skeletal anomalies are all well recognized. The possible association of Turner's syndrome with cirrhosis is herein discussed along with a review of the published literature.
Journal of Burn Care Research Official Publication of the American Burn Association, 2007
In the hours immediately after burn injury, the body enters into an acute phase reaction characte... more In the hours immediately after burn injury, the body enters into an acute phase reaction characterized, in part, by the augmentation of cytokine and acute phase protein production. This reaction has been poorly characterized in the 24 hours immediately after injury. To better understand the early acute phase response, 8- to 10-week-old BALB/C female mice were subjected to a 15% total body surface area (TBSA). Hepatic levels of tumor necrosis factor-alpha, interleukin-1beta, and interleukin-6 were monitored. In addition, the circulating level of serum amyloid A, an acute phase protein, also was measured at the same time points. Tumor necrosis factor-alpha levels peaked 2 hours after burn injury, whereas interleukin-1beta had a biphasic response, increasing 2 hours after injury and again at 12 hours. Interleukin-6 and serum amyloid A were not increased until 12 hours after injury and began to decline at 24 hours. These results demonstrate that within the liver, the acute phase response after burn injury initially involves tumor necrosis factor-alpha and interleukin-1beta, whereas interleukin-6 is not involved until later and that systemic serum amyloid A levels are not increased until interleukin-6 is also increased.
Organ transplantation has become a practical and effective option for patients with acute and/or ... more Organ transplantation has become a practical and effective option for patients with acute and/or chronic irreversible organ disease. However, solid organ transplantation is associated with many different complications which depend upon the specific surgical procedure and/or confounding medical problems (e.g. rejection, infection, adverse effect of immunosuppressive agents) experienced by a given patient. Tacrolimus and cyclosporin A are immunosuppressive drugs used to prevent rejection following allogeneic solid organ transplantation. Adverse events are common with both drugs and include long-term organ dysfunction, opportunistic infections, haematopoietic alterations, nephrotoxicity and neurotoxicity. Neurological complications, both central and peripheral, occur in 10-42% of transplant recipients using either of these two immunosuppressive agents. Two cases of reversible posterior leukoencephalopathy manifested by headache, nausea and seizures associated with the use of immunosuppressive drugs following liver transplantation are reported.
In the immediate future, the number of geriatric patients will continue to rise; consequently we ... more In the immediate future, the number of geriatric patients will continue to rise; consequently we should expect an increase of colorectal cancer, a disease of the elderly population. Through the data of a Cancer Registry, we examined (a) the effect of ageing on the main features of colorectal cancer; (b) changes in management, especially for individuals older than 80 years; and (c) changes in prognosis and survival in subgroups of patients with different age. The Registry provided information on colorectal cancer up to 2010 (27 years). A total of 5293 patients were registered; these were divided into three groups: A (0-64 years), B (65-79) and C (80 or more). Three periods of observation were chosen: 1 (1984-1992), 2 (1993-2001) and 3 (2001-2010). Group A included 1571 patients (29 %), Group B 2539 (48 %) and Group C 1183 (22.3 %). The fraction of old individuals increased during the 27 years of the investigation. In these patients, tumours were predominantly localized to the right colon (42.6 %). The rate of surgery and ratio between curative and palliative approaches were similar among the three groups (p < 0.38). There was disparity (p < 0.002) in the administration of chemotherapy (5.8 % of the elderly vs 34.4 % in remaining patients). Survival increased over time in all three groups. In the elderly, average 5-year survival was 31 % in period 1 and 55 % in period 3. These data show that in Western countries, the standard of care for colorectal cancer diagnosed in geriatric patients has improved over the last 30 years.
Experimental and clinical evidence indicates that estrogens have a relevant role in the pathogene... more Experimental and clinical evidence indicates that estrogens have a relevant role in the pathogenesis of cancer of hormone-sensitive organs. Estrogen receptors (ERs) are present in liver cells. Normal liver expresses almost exclusively wild-type ERs derived from the full-length transcript of the gene. During progression of liver disease to hepatocellular carcinoma, variant forms of ERs have been demonstrated that greatly influence the course of the disease and the possibility of palliative treatment. Peritumoral cirrhotic tissue of patients with hepatocellular carcinoma, especially males, expresses a variant form of ER (vER) with an exon 5 deletion. In hepatocellular carcinoma, vER largely predominates and sometimes becomes the only form expressed. That the occurrence of vER alone is limited almost exclusively to males suggests that it could be one of the molecular events that eventually lead to the preferential development of hepatocellular carcinoma in males. In addition, the prese...
The prevalence of hepatitis C virus infection in the USA is higher among African-Americans than a... more The prevalence of hepatitis C virus infection in the USA is higher among African-Americans than among Caucasians. Despite this, little information is available on the course of hepatitis C virus infection in Blacks and in other minority groups. The aim of this retrospective case-control study was to determine the response rate to high dose interferon-alpha treatment in two racial groups with chronic hepatitis C virus infection. Thirty-one African-Americans and 62 Caucasians with chronic hepatitis C were considered in the study. The subjects were matched for gender, age, presence/absence of cirrhosis, histologic score, and viral genotype. All were treated with interferon-alpha (5 mU/day for 12 months). Three end-points (on-therapy, after 6 months of interferon-alpha, end-of-therapy, at the end of the 12 months of treatment, and off-therapy, 6 months after treatment) were chosen to describe the response to interferon-alpha treatment. African-Americans had a significantly reduced respo...
Liver transplantation (LTx) for chronic viral liver disease has evolved rapidly during the last t... more Liver transplantation (LTx) for chronic viral liver disease has evolved rapidly during the last two decades. The major problem in cases of LTx for viral hepatitis is the extremely high rate of recurrent viral infection in the liver allograft. While recurrent hepatitis C virus (HCV) infection typically causes a mild hepatitis and has a slow progression, hepatitis B virus (HBV) infection of the liver allograft has been reported to result in cirrhosis in as short a period of time as 1 year. The risk of graft infection is greatest for patients with actively replicating virus. The high rate of disease recurrence, and the accelerated course of both HBV and HCV related liver disease post LTx, is a consequence of the high viral loads experienced by the allograft and the life-long immunosuppression required to prevent allograft rejection. Thus, efforts to clear virus prior to LTx, in order to prevent disease recurrence, are extremely important. In cases where this is not possible, the use of...
Italian journal of gastroenterology and hepatology, 1997
Polymerase chain reaction is widely used in clinical practice as a reliable assay for the detecti... more Polymerase chain reaction is widely used in clinical practice as a reliable assay for the detection and quantitation of hepatitis C virus RNA in serum and tissue. Due to the high sensitivity of the test, both false positive and false negative results can occur. The presence of cryoglobulins in serum samples represents a variable that can influence the result of a polymerase chain reaction assay leading to false negative results. In cases of hepatitis C virus infection associated with cryoglobulinaemia, it is extremely important to very carefully process the samples to be tested in order to avoid cryoglobulin precipitation and the consequent removal of the virus from the sample.
Based upon all of the available data relating to the natural history, chemical course, and respon... more Based upon all of the available data relating to the natural history, chemical course, and response to therapy of HCV, the following recommendations are made: 1) The primary end point for HCV therapy should be HCV clearance from all tissue sites, eg plasma, liver and others 2) Therapy should be provided for patients with early infections as they have the best chance of achieving a virologic response 3) Therapy should be offered to patients with cirrhotic disease, as prevention of hepatic decompensation and degeneration to hepatic cancer is possible 4) End stage decompensated disease should be treated, particularly if liver transplantation is being considered, in an effort to either eliminate or ameliorate disease recurrence 5) Combination therapies are preferable to monotherapy as they enhance the likelihood of a therapeutic response. Some of these include agents that reduce the frequency of IFN-induced untoward events (NSAIDs) 6) The approach to HCV infection should be to view it a...
An estimated 3.5 million people in the United States have chronic hepatitis C. Each year, 8,000 t... more An estimated 3.5 million people in the United States have chronic hepatitis C. Each year, 8,000 to 10,000 of these chronically infected patients die of a liver-related complication of their infection. The introduction of effective blood screening assays has resulted in a remarkable decrease in the incidence of post-transfusion HCV infection. Nonetheless, hepatitis C remains an important clinical problem. Some important new treatment programs can help prevent the development and progression of compensated cirrhosis to either decompensated cirrhosis or HCC. Patients who present to the health care system with advanced chronic active hepatitis or cirrhosis have been treated with interferon. Of those studied, only IFN therapy has been shown to induce remissions of the hepatic inflammatory process and to eliminate viral infection in most treated cases. However, it is widely held assumption that cirrhotic individuals do not respond to IFN therapy and that the treatment of decompensated cir...
BackgroundLong-term care for the elderly by their family members represents a serious burden in I... more BackgroundLong-term care for the elderly by their family members represents a serious burden in Italy. The physical and psychological health of informal caregivers is a growing public health issue. Old patients often seek urgent medical attention in the Emergency Department (ED) and hospitalisation is frequent event among the elderly.AimAim of the study was (1) to investigate the burden of care among the caregivers of old patients; (2) to examine the influence of the burden experienced by the caregivers on ED and hospital admissions of the elderly.MethodsWe conducted a descriptive study of patients aged 75 years or older and their caregiver admitted to the ED from 10/1/15 to 6/10/15 (77 patient-caregiver pairs). The caregivers were evaluated using the Caregiver Burden Inventory (CBI). A case manager collected the patient's data.ResultsCBI score is the highest among patients seeking ED evaluation due to caregiver's concern. The majority of the elderly admitted to the ED whose...
Multidimensional geriatric assessment is a functional, psychosocial and medical evaluation of an ... more Multidimensional geriatric assessment is a functional, psychosocial and medical evaluation of an elderly patient. Such an approach improves function and survival in frail older patients, mostly in an outpatient setting. New RCTs suggest that the application of a multidisciplinary approach to the elderly should be applied to all the patients admitted to acute care hospitals. A model of integrated geriatric care is proposed, starting in the emergency room (ER) in an acute care hospital. The project will be developed over a 3 year period. A nurse case manager will work in the ER, evaluating all the patients aged over 75. She will provide the ER physician with information on functional and psychosocial status of the patient using standardized tests, and will contact primary care physician and the social workers to gather further information. In case of hospitalization, the case manager will evaluate possible occurring complications during the hospital stay and the outcome. Given the huge amount of hospitalizations among the geriatric patients, it is mandatory that the physicians are familiar with the fundaments of geriatric culture and principles of geriatric assessment and management. This issue will be addressed through a formative plan designed for physicians and nurses. End point of the pilot study is to reduce complications of hospitalization, improve patients function at hospital discharge, decrease nursing home admissions, reduce hospital inappropriate admissions and readmissions, reduce the mean length of hospital stay and health care system costs. Project supported by grant RF-2009-1511459 Ministero della Salute assigned to Dr Alessandra Colantoni
A case of cryptogenic cirrhosis in a patient with Turner&... more A case of cryptogenic cirrhosis in a patient with Turner's syndrome is presented. The individual was admitted for upper gastrointestinal bleeding due to oesophageal varices. After failure of medical treatment, a transjugular intra-hepatic portal systemic shunt was used to control the bleeding. A liver biopsy revealed cirrhosis with minimal necro-inflammatory activity and no steatosis. Immunohistochemical staining for HCV, HBsAg and HBcAg was negative. No other risk factor for liver disease was recognized and none of the known causes of chronic liver disease was identified after a thorough evaluation for such. Turner's syndrome is a genetic disorder due to X chromosome monosomy in which a wide range of congenital anomalies can occur. Cardiac, renal and skeletal anomalies are all well recognized. The possible association of Turner's syndrome with cirrhosis is herein discussed along with a review of the published literature.
Journal of Burn Care Research Official Publication of the American Burn Association, 2007
In the hours immediately after burn injury, the body enters into an acute phase reaction characte... more In the hours immediately after burn injury, the body enters into an acute phase reaction characterized, in part, by the augmentation of cytokine and acute phase protein production. This reaction has been poorly characterized in the 24 hours immediately after injury. To better understand the early acute phase response, 8- to 10-week-old BALB/C female mice were subjected to a 15% total body surface area (TBSA). Hepatic levels of tumor necrosis factor-alpha, interleukin-1beta, and interleukin-6 were monitored. In addition, the circulating level of serum amyloid A, an acute phase protein, also was measured at the same time points. Tumor necrosis factor-alpha levels peaked 2 hours after burn injury, whereas interleukin-1beta had a biphasic response, increasing 2 hours after injury and again at 12 hours. Interleukin-6 and serum amyloid A were not increased until 12 hours after injury and began to decline at 24 hours. These results demonstrate that within the liver, the acute phase response after burn injury initially involves tumor necrosis factor-alpha and interleukin-1beta, whereas interleukin-6 is not involved until later and that systemic serum amyloid A levels are not increased until interleukin-6 is also increased.
Organ transplantation has become a practical and effective option for patients with acute and/or ... more Organ transplantation has become a practical and effective option for patients with acute and/or chronic irreversible organ disease. However, solid organ transplantation is associated with many different complications which depend upon the specific surgical procedure and/or confounding medical problems (e.g. rejection, infection, adverse effect of immunosuppressive agents) experienced by a given patient. Tacrolimus and cyclosporin A are immunosuppressive drugs used to prevent rejection following allogeneic solid organ transplantation. Adverse events are common with both drugs and include long-term organ dysfunction, opportunistic infections, haematopoietic alterations, nephrotoxicity and neurotoxicity. Neurological complications, both central and peripheral, occur in 10-42% of transplant recipients using either of these two immunosuppressive agents. Two cases of reversible posterior leukoencephalopathy manifested by headache, nausea and seizures associated with the use of immunosuppressive drugs following liver transplantation are reported.
In the immediate future, the number of geriatric patients will continue to rise; consequently we ... more In the immediate future, the number of geriatric patients will continue to rise; consequently we should expect an increase of colorectal cancer, a disease of the elderly population. Through the data of a Cancer Registry, we examined (a) the effect of ageing on the main features of colorectal cancer; (b) changes in management, especially for individuals older than 80 years; and (c) changes in prognosis and survival in subgroups of patients with different age. The Registry provided information on colorectal cancer up to 2010 (27 years). A total of 5293 patients were registered; these were divided into three groups: A (0-64 years), B (65-79) and C (80 or more). Three periods of observation were chosen: 1 (1984-1992), 2 (1993-2001) and 3 (2001-2010). Group A included 1571 patients (29 %), Group B 2539 (48 %) and Group C 1183 (22.3 %). The fraction of old individuals increased during the 27 years of the investigation. In these patients, tumours were predominantly localized to the right colon (42.6 %). The rate of surgery and ratio between curative and palliative approaches were similar among the three groups (p < 0.38). There was disparity (p < 0.002) in the administration of chemotherapy (5.8 % of the elderly vs 34.4 % in remaining patients). Survival increased over time in all three groups. In the elderly, average 5-year survival was 31 % in period 1 and 55 % in period 3. These data show that in Western countries, the standard of care for colorectal cancer diagnosed in geriatric patients has improved over the last 30 years.
Experimental and clinical evidence indicates that estrogens have a relevant role in the pathogene... more Experimental and clinical evidence indicates that estrogens have a relevant role in the pathogenesis of cancer of hormone-sensitive organs. Estrogen receptors (ERs) are present in liver cells. Normal liver expresses almost exclusively wild-type ERs derived from the full-length transcript of the gene. During progression of liver disease to hepatocellular carcinoma, variant forms of ERs have been demonstrated that greatly influence the course of the disease and the possibility of palliative treatment. Peritumoral cirrhotic tissue of patients with hepatocellular carcinoma, especially males, expresses a variant form of ER (vER) with an exon 5 deletion. In hepatocellular carcinoma, vER largely predominates and sometimes becomes the only form expressed. That the occurrence of vER alone is limited almost exclusively to males suggests that it could be one of the molecular events that eventually lead to the preferential development of hepatocellular carcinoma in males. In addition, the prese...
The prevalence of hepatitis C virus infection in the USA is higher among African-Americans than a... more The prevalence of hepatitis C virus infection in the USA is higher among African-Americans than among Caucasians. Despite this, little information is available on the course of hepatitis C virus infection in Blacks and in other minority groups. The aim of this retrospective case-control study was to determine the response rate to high dose interferon-alpha treatment in two racial groups with chronic hepatitis C virus infection. Thirty-one African-Americans and 62 Caucasians with chronic hepatitis C were considered in the study. The subjects were matched for gender, age, presence/absence of cirrhosis, histologic score, and viral genotype. All were treated with interferon-alpha (5 mU/day for 12 months). Three end-points (on-therapy, after 6 months of interferon-alpha, end-of-therapy, at the end of the 12 months of treatment, and off-therapy, 6 months after treatment) were chosen to describe the response to interferon-alpha treatment. African-Americans had a significantly reduced respo...
Liver transplantation (LTx) for chronic viral liver disease has evolved rapidly during the last t... more Liver transplantation (LTx) for chronic viral liver disease has evolved rapidly during the last two decades. The major problem in cases of LTx for viral hepatitis is the extremely high rate of recurrent viral infection in the liver allograft. While recurrent hepatitis C virus (HCV) infection typically causes a mild hepatitis and has a slow progression, hepatitis B virus (HBV) infection of the liver allograft has been reported to result in cirrhosis in as short a period of time as 1 year. The risk of graft infection is greatest for patients with actively replicating virus. The high rate of disease recurrence, and the accelerated course of both HBV and HCV related liver disease post LTx, is a consequence of the high viral loads experienced by the allograft and the life-long immunosuppression required to prevent allograft rejection. Thus, efforts to clear virus prior to LTx, in order to prevent disease recurrence, are extremely important. In cases where this is not possible, the use of...
Italian journal of gastroenterology and hepatology, 1997
Polymerase chain reaction is widely used in clinical practice as a reliable assay for the detecti... more Polymerase chain reaction is widely used in clinical practice as a reliable assay for the detection and quantitation of hepatitis C virus RNA in serum and tissue. Due to the high sensitivity of the test, both false positive and false negative results can occur. The presence of cryoglobulins in serum samples represents a variable that can influence the result of a polymerase chain reaction assay leading to false negative results. In cases of hepatitis C virus infection associated with cryoglobulinaemia, it is extremely important to very carefully process the samples to be tested in order to avoid cryoglobulin precipitation and the consequent removal of the virus from the sample.
Based upon all of the available data relating to the natural history, chemical course, and respon... more Based upon all of the available data relating to the natural history, chemical course, and response to therapy of HCV, the following recommendations are made: 1) The primary end point for HCV therapy should be HCV clearance from all tissue sites, eg plasma, liver and others 2) Therapy should be provided for patients with early infections as they have the best chance of achieving a virologic response 3) Therapy should be offered to patients with cirrhotic disease, as prevention of hepatic decompensation and degeneration to hepatic cancer is possible 4) End stage decompensated disease should be treated, particularly if liver transplantation is being considered, in an effort to either eliminate or ameliorate disease recurrence 5) Combination therapies are preferable to monotherapy as they enhance the likelihood of a therapeutic response. Some of these include agents that reduce the frequency of IFN-induced untoward events (NSAIDs) 6) The approach to HCV infection should be to view it a...
An estimated 3.5 million people in the United States have chronic hepatitis C. Each year, 8,000 t... more An estimated 3.5 million people in the United States have chronic hepatitis C. Each year, 8,000 to 10,000 of these chronically infected patients die of a liver-related complication of their infection. The introduction of effective blood screening assays has resulted in a remarkable decrease in the incidence of post-transfusion HCV infection. Nonetheless, hepatitis C remains an important clinical problem. Some important new treatment programs can help prevent the development and progression of compensated cirrhosis to either decompensated cirrhosis or HCC. Patients who present to the health care system with advanced chronic active hepatitis or cirrhosis have been treated with interferon. Of those studied, only IFN therapy has been shown to induce remissions of the hepatic inflammatory process and to eliminate viral infection in most treated cases. However, it is widely held assumption that cirrhotic individuals do not respond to IFN therapy and that the treatment of decompensated cir...
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Papers by Alessandra Colantoni