PubMed | Besancon University Hospital Center, University of Genoa, University of Verona, Paracelsus Medical University and 6 more.
Type: Journal Article | Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery | Year: 2016
Several single-centre experiences have reported significant operative mortality and morbidity after mitral valve surgery in redo scenarios (ReMVS). Several preoperative risk factors outlining high-risk categories have been reported, but scanty data on the impact of different operative techniques for these major challenging procedures have been analysed to date. The aim of the study is to investigate those intraoperative factors and postoperative events affecting early survival after redo mitral procedures.Operative mortality and major morbidity events from a large multicentre registry enrolling 832 consecutive redo mitral procedures were analysed. Intraoperative technical issues and postoperative complications impacting operative mortality were identified.ReMVS was associated with significant operative mortality (12.5%), acute myocardial infarction (AMI; 5.9%), stroke (4.9%), acute respiratory insufficiency (14.8%), pneumonia (7.0%), acute renal insufficiency (16.1%) and failure (12.6%), reintervention for bleeding (7.6%), massive transfusion (28.0%), need for permanent pacemaker (10.1%). Injury of a previous patent left internal mammary artery (LIMA) graft [odds ratio (OR) 4.2, 95% confidence interval (CI): 1.6-11.5; P = 0.005], major cardiovascular iatrogenic lesions at re-entry (OR 19.2, 95% CI: 9.2-39.9; P < 0.001), extracellular crystalloid cardioplegia (OR 7.3, 95% CI: 1.4-37.8; P = 0.018), and incremental cardiopulmonary bypass time (OR 1.1, 95% CI: 1.0-1.2; P = 0.001) independently predicted operative mortality, whereas combined antegrade + retrograde cardioplegia (OR 0.2, 95% CI: 0.09-0.4; P = 0.001) was the only protective factor against mortality. Among complications, AMI (OR 4.1, 95% CI: 1.8-9.6; P = 0.001), need for intra-aortic balloon pumping (IABP; OR 3.1, 95% CI: 1.5-6.1; P = 0.001), prolonged intubation >48 h (OR 5.3, 95% CI: 2.9-9.4; P = 0.001) and massive (>6 units) transfusions (OR 4.4, 95% CI: 2.4-8.0; P = 0.001) also predicted operative mortality.ReMVS still carries the risk of significant early mortality and major morbidity. Major lesion to cardiovascular structures is the most dreadful iatrogenic complication, and injury of a previous LIMA graft identifies patients at higher risk of operative mortality. Prolonged cross-clamp times, extracellular crystalloid cardioplegia and massive transfusions have profound impact on early outcome, as well as the development of perioperative AMI, eventually requiring IABP and prolonged intubation. The combination of antegrade and retrograde cardioplegia seems to offer a better myocardial protection in these high-risk patients.
PubMed | Mellino Mellini Hospital, Santa Maria degli Angeli Hospital, Imperial College London, Misericordia Hospital and 8 more.
Type: Journal Article | Journal: Respiratory care | Year: 2016
Previous physiological studies have identified factors that are involved in auto-PEEP generation. In our study, we examined how much auto-PEEP is generated from factors that are involved in its development.One hundred eighty-six subjects undergoing controlled mechanical ventilation with persistent expiratory flow at the beginning of each inspiration were enrolled in the study. Volume-controlled continuous mandatory ventilation with PEEP of 0 cm H2O was applied while maintaining the ventilator setting as chosen by the attending physician. End-expiratory and end-inspiratory airway occlusion maneuvers were performed to calculate respiratory mechanics, and tidal flow limitation was assessed by a maneuver of manual compression of the abdomen.The variable with the strongest effect on auto-PEEP was flow limitation, which was associated with an increase of 2.4 cm H2O in auto-PEEP values. Moreover, auto-PEEP values were directly related to resistance of the respiratory system and body mass index and inversely related to expiratory time/time constant. Variables that were associated with the breathing pattern (tidal volume, frequency minute ventilation, and expiratory time) did not show any relationship with auto-PEEP values. The risk of auto-PEEP 5 cm H2O was increased by flow limitation (adjusted odds ratio 17; 95% CI: 6-56.2), expiratory time/time constant ratio <1.85 (12.6; 4.7-39.6), respiratory system resistance >15 cm H2O/L s (3; 1.3-6.9), age >65 y (2.8; 1.2-6.5), and body mass index >26 kg/m(2) (2.6; 1.1-6.1).Flow limitation, expiratory time/time constant, resistance of the respiratory system, and obesity are the most important variables that affect auto-PEEP values. Frequency expiratory time, tidal volume, and minute ventilation were not independently associated with auto-PEEP. Therapeutic strategies aimed at reducing auto-PEEP and its adverse effects should be primarily oriented to the variables that mainly affect auto-PEEP values.
PubMed | Umberto I Hospital, University of Perugia, Santa Chiara Regional Hospital, University of Naples Federico II and 6 more.
Type: Journal Article | Journal: Sexual medicine | Year: 2016
Hyaluronic acid has been shown to be efficacious in decreasing scar formation, inflammation, and oxidative stress.To assess the efficacy of intralesional injection of hyaluronic acid in patients affected by Peyronies disease.In this prospective, single-arm, self-controlled, interventional, multicenter pilot study, 65 patients underwent a 10-week cycle of weekly intraplaque injections with hyaluronic acid (0.8% highly purified sodium salt hyaluronic acid 16 mg/2 mL; Sinovial, IBSA, Lodi, Italy). Patients were re-evaluated 2 months after the end of therapy.Plaque size (millimeters), penile curvature (degrees), International Index of Erectile Function (IIEF-5) score, visual analog scale (VAS) score for sexual satisfaction, and Patients Global Impressions of Improvement (PGI-I) score.Median age was 57 years (range= 23-70). At baseline, mean plaque size was 10 mm (range= 3-30 mm), mean penile curvature was 30 (range= 0-50), and mean IIEF-5 score was 20 (range= 0-25), with slight to moderate erectile dysfunction (IIEF score < 21) in 36 of 65 patients (55%). A median VAS score of 6(range= 2-10) was found. Mean follow-up was 12 months (range= 6-24 months). Statistically significant post-treatment improvements were detected for plaque size (before treatment= 10 mm [3-30 mm], after treatment= 8 mm [1-30 mm], P < .0001), penile curvature (before treatment= 30 [0-50], after treatment= 20 [0-40], P < .0001), IIEF-5 score (before treatment= 20 [11-25], after treatment= 21 [15-25], P < .0001), and VAS score (before treatment= 6 [2-10], after treatment 8 [2-10], P < .0001). After treatment, the rate of patients with an IIEF score lower than 21 decreased from 55% (36 patients) to 40% (25 patients). Overall improvement on the PGI-I questionnaire was 69%.Intralesional treatment with hyaluronic acid can improve plaque size, penile curvature, and overall sexual satisfaction and seems preferably indicated in the early (active) phase of the disease. Furthermore, it is easy to perform and well tolerated.
PubMed | Moriggia Pelascini Hospital, SantAndrea Hospital, Infermi Hospital, Santa Chiara Hospital and 6 more.
Type: Journal Article | Journal: Journal of cardiovascular electrophysiology | Year: 2016
Cardiac resynchronization therapy (CRT) device implantation guided by an electroanatomic mapping system (EAMS) is an emerging technique that may reduce fluoroscopy and angiography use and provide information on coronary sinus (CS) electrical activation. We evaluated the outcome of the EAMS-guided CRT implantation technique in a multicenter registry.During the period 2011-2014 we enrolled 125 patients (80% males, age 74 [71-77] years) who underwent CRT implantation by using the EnSite system to create geometric models of the patients cardiac chambers, build activation mapping of the CS, and guide leads positioning. Two hundred and fifty patients undergoing traditional CRT implantation served as controls. Success and complication rates, fluoroscopy and total procedure times in the overall study population and according to center experience were collected. Centers that performed 10 were defined as highly experienced.Left ventricular lead implantation was successful in 122 (98%) cases and 242 (97%) controls (P = 0.76). Median fluoroscopy time was 4.1 (0.3-10.4) minutes in cases versus 16 (11-26) minutes in controls (P < 0.001). Coronary sinus angiography was performed in 33 (26%) cases and 208 (83%) controls (P < 0.001). Complications occurred in 5 (4%) cases and 17 (7%) controls (P = 0.28). Median fluoroscopy time (median 11 minutes vs. 3 minutes, P < 0.001) and CS angiography rate (55% vs. 21%, P < 0.001) were significantly higher in low experienced centers, while success rate and complications rate were similar.EAMS-guided CRT implantation proved safe and effective in both high- and low-experienced centers and allowed to reduce fluoroscopy use by 75% and angiography rate by 70%.
Pracella D.,Cattinara Hospital |
Bonin S.,Cattinara Hospital |
Barbazza R.,Cattinara Hospital |
Sapino A.,University of Turin |
And 3 more authors.
Disease Markers | Year: 2013
In this study we investigate the clinical outcomes of 305 breast cancer (BC) patients, aged 55 years or younger, with long follow-up and according to intrinsic subtypes. The cohort included 151 lymph node negative (LN-) and 154 lymph node positive (LN+) patients. Luminal A tumors were mainly LN-, well differentiated, and of stage I; among them AR was an indicator of good prognosis. Luminal B and HER2 positive nonluminal cancers showed higher tumor grade and nodal metastases as well as higher proliferation status and stage. Among luminal tumors, those PR positive and vimentin negative showed a longer survival. HER2-positive nonluminal and TN patients showed a poorer outcome, with BC-specific death mostly occurring within 5 and 10 years. Only luminal tumor patients underwent BC death over 10 years. When patients were divided in to LN- and LN+ no differences in survival were observed in the luminal subgroups. LN- patients have good survival even after 20 years of follow-up (about 75%), while for LN+ patients survival at 20 years (around 40%) was comparable to HER2-positive nonluminal and TN groups. In conclusion, in our experience ER-positive breast tumors are better divided by classical clinical stage than molecular classification, and they need longer clinical follow-up especially in cases with lymph node involvement. © 2013 Danae Pracella et al.
Lucangelo U.,University of Trieste |
Vassallo F.G.,Cattinara Hospital |
Marras E.,University of Trieste |
Ferluga M.,University of Trieste |
And 4 more authors.
Critical Care Research and Practice | Year: 2012
During bronchoscopy hypoxemia is commonly found and oxygen supply can be delivered by interfaces fed with high gas flows. Recently, the high-flow nasal cannula (HFNC) has been introduced for oxygen therapy in adults, but they have not been used so far during bronchoscopy in adults. Forty-five patients were randomly assigned to 3 groups receiving oxygen: 40 L/min through a Venturi mask (V40, N = 15), nasal cannula (N40, N = 15), and 60 L/min through a nasal cannula (N60, N = 15) during bronchoscopy. Gas exchange and circulatory variables were sampled before (FiO 2 = 0.21), at the end of bronchoscopy (FiO 2 = 0.5), and thereafter (V40, FiO 2 = 0.35). In 8 healthy volunteers oxygen was randomly delivered according to V40, N40, and N60 settings, and airway pressure was measured. At the end of bronchoscopy, N60 presented higher PaO 2, PaO 2/FiO 2, and SpO 2 than V40 and N40 that did not differ between them. In the volunteers (N60) median airway pressure amounted to 3.6 cmH 2O. Under a flow rate of 40 L/min both the Venturi mask and HFNC behaved similarly, but nasal cannula associated with a 60 L/min flow produced the better results, thus indicating its use in mild respiratory dysfunctions. © 2012 Umberto Lucangelo et al.
Effects of the volume of processed plasma on the outcome, arterial pressure and blood procalcitonin levels in patients with severe sepsis and septic shock treated with coupled plasma filtration and adsorption
Berlot G.,Cattinara Hospital |
Agbedjro A.,Cattinara Hospital |
Tomasini A.,Cattinara Hospital |
Bianco F.,Trieste Hospital |
And 3 more authors.
Blood Purification | Year: 2014
Aims: To understand how coupled plasma filtration and adsorption (CPFA) could influence the time course of the advanced stages of sepsis, mean arterial pressure (MAP) and norepinephrine dosage. Methods: Patients with severe sepsis and septic shock with ≥2 organ failures not responding to volume resuscitation and vasopressor infusion were treated with CPFA within 8 h of admission to the intensive care unit. Results: Thirty-nine patients were treated (median age: 63 years, median SAPS II score: 45) and 28 survived advanced sepsis. In the latter, the median MAP increased and the norepinephrine dosage decreased significantly after CPFA, whereas in the nonsurvivors these values did not change significantly. The volume of treated plasma was significantly higher in survivors than nonsurvivors. Conclusion: These results suggest a possible existence of a dose-response effect for CPFA. Future studies are therefore recommended to evaluate the efficacy of this treatment and to determine its best timing and intensity. © 2014 S. Karger AG, Basel.
Quaia E.,University of Trieste |
Cabibbo B.,University of Trieste |
Sozzi M.,Cattinara Hospital |
Gennari A.G.,University of Trieste |
And 3 more authors.
Academic Radiology | Year: 2014
Rationale and Objectives: To define the best independent predictors for active inflammation in patients with Crohn disease (CD) examined by contrast-enhanced magnetic resonance (MR) enterography. Materials and Methods: Ninety-one patients (47 men and 44 women; aged 39.58±17.1 years) with a diagnosis of CD; CD activity index (CDAI) ≥150 (n=19 patients) or <150 (n=72) underwent MR enterography including T2-weighted half-Fourier acquisition single-shot turbo spin-echo, T2-weighted spectral fat presaturation with inversion recovery, T1-weighted balanced steady-state free precession, and T1-weighted breath-hold resolution isotropic high volume three-dimensional MR imaging sequences before and after administration of gadobenate dimeglumine during arterial (30seconds), portal venous (70seconds), and delayed phase (3 and 5minutes from contrast injection). Two readers analyzed the MR images in consensus. Reference standard was the Crohn's Disease Endoscopic Index of Severity (CDEIS) with deep mucosal biopsy or the histologic analysis of the surgical specimen in those patients (n=30) who underwent elective small-bowel resection. Univariate and multivariate logistic regression analyses were performed to assess CDAI, biochemical markers (C-reactive protein and fecal calprotectin levels) and MR imaging findings as potential predictors of inflammatory CD activity. Results: Patients revealed prevalently active (n=47 patients) or quiescent CD with mural fibrosis (n=44 patients). The bowel wall T2 hyperintensity (odds ratio [OR], 9.20; 95% confidence interval [CI], 2.71-31.19) and total length of disease (OR, 1.29; 95% CI, 1.11-1.49) were found as the best independent predictors of active CD. CDAI, C-reactive protein, and fecal calprotectin were not found independent predictors of active CD. Conclusions: The bowel wall T2 hyperintensity and the length of the involved bowel tract were predictors of active inflammation in patients with CD examined by contrast-enhanced MR enterography. © 2014 AUR.
Riscica F.,University of Trieste |
Lucangelo U.,Cattinara Hospital |
Ferluga M.,Cattinara Hospital |
Accardo A.,University of Trieste
Physiological Measurement | Year: 2011
High-frequency percussive ventilation (HFPV) may be defined as flow-regulated time-cycled ventilation that creates controlled pressure and delivers a series of high-frequency subtidal volumes in combination with low-frequency breathing cycles. In recent years, the usefulness of HFPV has been clinically assessed as an alternative to conventional mechanical ventilation. In the clinical practice, HFPV is not an intuitive ventilatory modality and the absence of real-time delivered volume monitoring produces disaffection among the physicians. For this purpose, it would be useful to develop a monitor able to realize a complete online characterization of high-frequency percussive ventilators and to identify the best combination of their parameters according to the specific pathological situation. This paper describes an innovative acquisition and elaboration system based on the use of new generation pressure transducers presenting high sensitivity and fast response. Such a system is compact and inexpensive, and it allows the user to carry out a more correct online characterization of high-frequency percussive ventilators. This output allowed best real-time ventilatory setting, minimizing the potential baro-volutrauma hazard. © 2011 Institute of Physics and Engineering in Medicine.
PubMed | Cattinara Hospital
Type: Journal Article | Journal: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association | Year: 2016
Stroke is one of the leading causes of disability and death in the world. The endocannabinoid (eCB) system is upregulated in several neurological diseases including stroke. A previous animal study demonstrated an increased expression of the endocannabinoid receptor 1 (CB1R) in the penumbra area surrounding the ischemic core, suggesting a crucial role in inflammation/reperfusion after stroke. Regarding the localization of CB1/CB2 receptors, animal studies showed that cortical neurons, activated microglia, and astroglia are involved. Our aim was to evaluate the cerebral expression of CB1R in the ischemic brain areas of 9 patients who died due to acute cerebral infarction in the middle cerebral artery territory.The cerebral autoptic tissue was collected within 48hours since death. Ischemic and contralateral normal-appearing areas were identified. After tissue preprocessing, 4-m-thick cerebral sections were incubated with the primary CB1R antibodies (Cayman Chemical Company, Ann Arbor, MI). Thereafter, all cerebral sections were hematoxylin treated. In each section, the total cell number and CB1R-positive cells were counted and the CB1R-positive cell count ratio was calculated. For statistical analysis, Students t-test was used.In normal tissue, CB1R-positive neurons were the majority; a few non-neuronal cells expressed CB1R. In the ischemic areas, a few neurons were detectable. A significant increase in total CB1R staining was found in the ischemic regions compared to contralateral areas.We found an increase in CB1R expression in the ischemic region (neuronal and non-neuronal cell staining), suggesting the inflammatory reaction to the ischemic insult. Whether such response might mediate neuroprotective actions or excitotoxicity-related detrimental effects is still unclear.