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Stefan G.,Dr Carol Davila Teaching Hospital of Nephrology | Stefan G.,Carol Davila University of Medicine and Pharmacy | Capusa C.,Dr Carol Davila Teaching Hospital of Nephrology | Capusa C.,Carol Davila University of Medicine and Pharmacy | And 9 more authors.
Journal of Nephrology | Year: 2014

Background: We aimed to evaluate the relationship between abdominal aortic calcification (AAC) and renal resistive index (RRI), parameters associated with cardiovascular outcome, in non-dialysis chronic kidney disease (CKD) patients. Methods: Seventy-seven stable patients mainly in CKD stages 3B and 4 (44 and 28 %), median age 69 years, with a positive history of systemic atherosclerosis were prospectively enrolled. RRI, carotid intima-media thickness (IMT), Kauppila score for AAC (AACs), cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) were assessed. Traditional and non-traditional atherosclerosis risk factors were also evaluated. Results: Vascular (50 %), diabetic (26 %) and primary glomerular nephropathies (8 %) were the main causes of CKD. AAC was highly prevalent (77 %). In the whole cohort, RRI was directly related to AACs (rs = 0.35, p < 0.001). AACs correctly identified patients with RRI >0.7 in 69 % (56-81 %) of cases, a cut-off of 5 resulting the best combination of sensitivity (65 %) and specificity (68 %). Compared to those with AACs <5, patients with AACs >5 were older, had higher serum cholesterol, C-reactive protein and IMT, lower ABI, but similar CAVI, estimated glomerular filtration rate, serum calcium and phosphate. In the whole cohort, AACs was negatively correlated with ABI (rs = -0.51, p < 0.001) and positively with IMT (rs = 0.27, p = 0.01), supporting a role for Kauppila score in integrating information on both intra- and extrarenal atherosclerosis. Conclusions: As Kauppila score correlates with RRI in non-dialysis CKD patients, it could be a fast, convenient and relatively inexpensive tool for estimating RRI, and consequently the intrarenal vascular status, but further research is warranted. © Italian Society of Nephrology 2014.

Latib A.,San Raffaele Scientific Institute | Latib A.,Interventional Cardiology Unit | Takagi K.,San Raffaele Scientific Institute | Takagi K.,Interventional Cardiology Unit | And 14 more authors.
Cardiovascular Revascularization Medicine | Year: 2014

Background/Objectives: Stent underexpansion is a risk factor for in-stent restenosis and stent thrombosis. Existing techniques to optimize stent expansion are sometimes ineffective. The aim of this study was to evaluate the effectiveness and feasibility of Excimer Laser Coronary Angioplasty (ELCA) in improving stent expansion when high-pressure non-compliant balloon inflation was ineffective. Methods and Results: ECLA ablation was performed at high energy during contrast injection and only within the underexpanded stent. The primary endpoint of successful laser dilatation was defined as an increase of at least 1mm2 in minimal stent cross-sectional area (MSA) on IVUS or an increase of at least 20% in minimal stent diameter (MSD) by QCA, following redilatation with the same non-compliant balloon that had been unsuccessful prior to ELCA. Secondary endpoints were cardiac death, myocardial infarction (MI) and target lesion revascularization. Between June 2009 and November 2011, 28 patients with an underexpanded stent despite high-pressure balloon inflation were included. The mean laser catheter size was 1.2±0.4 (range 0.9-2.0mm) and a mean of 62±12mJ/mm2 at 62±21hertz were required for optimal expansion. Laser-assisted stent dilatation was successful in 27 cases (96.4%), with an improvement in MSD by QCA (1.6±0.6mm at baseline to 2.6±0.6mm post-procedure) and MSA by IVUS (3.5±1.1mm2 to 7.1±1.9mm2). Periprocedural MI occurred in 7.1%, transient slow-flow in 3.6% and ST elevation in 3.6%. During follow-up, there were no MIs, there was 1 cardiac-death, and TLR occurred in 6.7%. Conclusions: The ELLEMENT study confirms the feasibility of ELCA with contrast injection to improve stent underexpansion in undilatable stented lesions. © 2014.

Sirbu A.,Carol Davila University of Medicine and Pharmacy | Gologan S.,Carol Davila University of Medicine and Pharmacy | Arbanas T.,Carol Davila University of Medicine and Pharmacy | Copaescu C.,Delta Hospital | And 5 more authors.
Growth Hormone and IGF Research | Year: 2013

Objective: Low IGF-I levels have been associated with obesity, insulin resistance, hepatic steatosis, and were shown to predict cardiovascular mortality. Adiponectin, on the other hand, was proved to have an important protective role against metabolic and cardiovascular diseases. This study investigates the relation between hepatic steatosis, adiponectin and IGF-I levels in a group of non-diabetic obese Romanian women. Design: This cross-sectional study included 201 obese non-diabetic women, with mean age of 41.1±11.9years and mean body mass index (BMI) of 44.1±8.3kg/m2, consecutively admitted to the Endocrinology Department of a University Hospital to be evaluated as candidates for bariatric surgery. Main measured parameters included total adiponectin (detected by ELISA method), insulin, C reactive protein (CRP), and IGF-I (all by chemiluminescence methods). Insulin sensitivity was assessed using the Quantitative Insulin Sensitivity Check Index (QUICKI). Patients were considered IGF-deficient if IGF-I z score was ≤2 standard deviations from mean for age. Hepatic ultrasound was used to determine the presence of significant steatosis (SS+). Results: Significant steatosis was observed in 60.7% of our patients and this feature was associated with reduced total adiponectin levels (p < 0.001) and lower IGF-I z scores (p < 0.001). IGF-I z score negatively correlated with BMI (r = - 0.283, p < 0.001), alanine aminotransferase (ALT) (r = - 0.130, p = 0.032), gamma glutamyltransferase (GGT) (r = - 0.158, p = 0.018) and logarithmic transformed (log) CRP (r = - 0.232, p = 0.001) and positively correlated with QUICKI (r = 0.148, p = 0.023) and log adiponectin (r = 0.216, p = 0.003). The relationship between IGF-I z score and log adiponectin remained significant after adjusting for age, BMI, ALT, QUICKI and log CRP (r = 0.183, p = 0.012). IGF-I deficiency was present in 33.3% of these obese women. In multivariate logistic analysis, BMI (p < 0.001), ALT (p = 0.003), log adiponectin (p < 0.001) and SS (p = 0.043) proved to be independently associated with IGF-I deficiency. Conclusions: Adiponectin is significantly correlated with IGF-I z scores and, along with BMI, ALT and significant steatosis, is independently associated with IGF-I deficiency in obese non-diabetic women. © 2012 Elsevier Ltd.

Sirbu A.,Carol Davila University of Medicine and Pharmacy | Stanca I.,University of Bucharest | Copaescu C.,Delta Hospital | Martin S.,Carol Davila University of Medicine and Pharmacy | And 3 more authors.
Journal of Endocrinological Investigation | Year: 2013

Background: Obesity is associated with various changes in cardiac geometry and this process involves both hemodynamic and non-hemodynamic factors, among which adipocitokines and growth factors may play an important role. The aim of this study was to identify the extent and pattern of cardiac remodeling in a group of severely obese patients and analyze the relationship between adiponectin, IGFI and cardiac parameters reflecting obesity-associated structural changes. Subjects and methods: Our study included 344 patients (104 men) with severe obesity [mean body mass index (BMI)= 45.7±8.5 kg/m2], extensively evaluated clinically and biologically (complete metabolic tests, serum adiponectin, and IGF-I measurements). Left ventricular (LV) mass index (LVMI), left atrium (LA) size, and LV geometry were determined by means of cardiac ultrasound. Results: The most prevalent pattern of LV geometry was eccentric hypertrophy (28.7% of patients). In a gender-, age-, BMI-, diabetes- and hypertension-adjusted general linear model, patients with concentric or eccentric hypertrophy had significantly lower values of adiponectin than those with normal geometry (6.75±0.41, 6.96±0.53, vs 9.04±0.42 mg/l, p<0.05). In multivariate analysis, independent determinants for LVMI were BMI (β=0.364, p<0.001), systolic blood pressure (BP) (β=0.187, p=0.004), age (β=0.246, p<0.001), adiponectin (β=-0.151, p=0.012), and IGF-I z-score (β=0.134, p=0.025) while factors independently related to LA size were systolic BP (β=0.218, p<0.001), BMI (β=0.194, p<0.001), age (β=0.273, p<0.001), gender (β=-0.195, p<0.001), and adiponectin (β=-0.180, p=0.005). Conclusions: In patients with severe obesity, IGF-I z score and adiponectin correlate with parameters of cardiac remodeling independently of anthropometric, hemodynamic or metabolic factors. ©2013, Editrice Kurtis.

Arezzo A.,University of Turin | Zornig C.,Israelitisches Krankenhaus | Mofid H.,Israelitisches Krankenhaus | Fuchs K.-H.,Agaplesion Markus Krankenhaus | And 18 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2013

Background: The EURO-NOTES Clinical Registry (ECR) was established as a European database to allow the monitoring and safe introduction of Natural Orifice Transluminal Endoscopic Surgery (NOTES). The aim of this study was to analyze different techniques applied and relative results during the first 2 years of the ECR. Methods: The ECR was designed as a voluntary database with online access. All members of the European Society for Gastrointestinal Endoscopy and the European Association for Endoscopic Surgery were requested to participate in the registry. Demographic and therapy data as well as data on the postoperative course are recorded in the ECR in an anonymous way. Results: A total of 533 patients who underwent NOTES procedures were included in the study. Four different hybrid techniques for 435 cholecystectomies were described, registering postoperative complications in 2.8 % of patients, addition of a single trocar in 5.3 %, and conversions to laparoscopy in 0.5 %. Both flexible endoscopic and rigid laparoscopic cholecystectomy techniques proved to be safe and effective with minor differences. There was a shorter operative time in the rigid laparoscopic group. Thirty-three appendectomies were reported by transgastric and transvaginal techniques, with transvaginal techniques scoring shorter operative time and hospital stay, but with a frequent need to add more trocars. Overall complications occurred in 14.7 % of patients but they did not differ significantly among the different techniques. One transvaginal and 31 transanal sigmoidectomies were included for prolapse and diverticulitis, with four postoperative complications (12.5 %), but none needing further treatment. Twenty peroral esophageal myotomies were included with three postoperative complications (15.0 %), but none needing further treatment. Conclusions: Five years since the introduction of NOTES into clinical practice, hybrid techniques have gained considerable clinical application. Several NOTES hybrid cholecystectomy and appendectomy techniques are practicable and safe alternatives to laparoscopic procedures. Also, sigmoidectomies and peroral esophageal myotomies were described, proving feasibility and safety. Nevertheless, the real benefit of NOTES for patients still needs to be assessed. © 2013 Springer Science+Business Media New York.

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