Moriggia Pelascini Hospital

Sesto ed Uniti, Italy

Moriggia Pelascini Hospital

Sesto ed Uniti, Italy
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Frazzitta G.,Moriggia Pelascini Hospital | Frazzitta G.,S Isidoro Hospital | Maestri R.,Scientific Institute of Montescano | Bertotti G.,Scientific Institute of Montescano | And 8 more authors.
Neurorehabilitation and Neural Repair | Year: 2015

Background. Although physical exercise improves motor aspects of Parkinson's disease (PD), it is not clear whether it may also have a neuroprotective effect. Objective. In this 2-year follow-up study, we determined whether intensive exercise in the early stages of the disease slows down PD progression. Methods. Forty newly diagnosed patients with PD were treated with rasagiline and randomly assigned to 2 groups: MIRT Group (two 28-day multidisciplinary intensive rehabilitation treatments [MIRT], at 1-year interval) and Control Group (only drug). In both groups, Unified Parkinson's Disease Rating Scale Section II (UPDRS II), UPDRS III, 6-minute walking test (6MWT), Timed Up-and-Go test (TUG); PD Disability Scale (PDDS), and l-dopa equivalents were assessed at baseline (T0), 6 months (T1), 1 year (T2), 18 months (T3), and 2 years (T4) later. Results. Over 2 years, UPDRS II, UPDRS III, TUG, and PDDS differentially progressed in the 2 groups: In the MIRT Group, all scores at T4 were better than at T0 (all Ps <.03). No changes were noted in the Control Group. l-dopa equivalent dosages increased significantly only in the Control Group (P =.0015), with a decrease in the percentages of patients in monotherapy (T1 40%; T2, T3, and T4 20%). In the MIRT Group, the percentages of such patients remained higher (T1 and T2 100%; T3 89%; T4 75%). Conclusions. These results suggest that MIRT might slow down the progression of motor decay, it might delay the need for increasing drug treatment, and thus, it might have a neuroprotective effect. © The Author(s) 2014.

Frazzitta G.,Moriggia Pelascini Hospital | Frazzitta G.,S Isidoro Hospital | Maestri R.,S Maugeri Foundation Irccs | Ghilardi M.F.,CUNY Medical School | And 11 more authors.
Neurorehabilitation and Neural Repair | Year: 2014

Background. Exercise may decrease the risk of Parkinson's disease (PD) in humans and reduce PD symptoms in animal models. The beneficial effects have been linked to increased levels of neurotrophic factors. Objective. We examined whether intensive rehabilitation treatment reduces motor disability in patients in the early stages of PD and increases brain-derived neurotrophic factor (BDNF) serum levels. Methods. Thirty participants in the early stages of PD treated with rasagiline were randomly assigned to 3 hours of rehabilitation treatment that included aerobic exercise for 28 days (Group 1) or to not therapy (control; Group 2). BDNF serum levels were assessed at time T0 (baseline, before treatment), T1 (10 days), T2 (20 days), and T3 (28 days). At T0 and T3, we assessed the Unified Parkinson's Disease Rating Scale (UPDRS) III in both groups, as well as the UPDRS II and total, Berg Balance Scale, and 6-minute walking test only in Group 1. Results. BDNF levels significantly increased at T1 in Group 1, an increase that was maintained throughout the treatment period. At T3 compared to T0, UPDRS III scores significantly improved in Group 1 along with scores for UPDRS II, total, Berg Balance Scale, and 6-minute walking test. Conclusions. Intensive rehabilitation treatment increases the BDNF levels and improves PD signs in patients in the early stages of the disease. These results are in line with studies on animal models of PD and healthy subjects. © The Author(s) 2013.

Frazzitta G.,Moriggia Pelascini Hospital | Frazzitta G.,Scientific Institute of Montescano | Balbi P.,Scientific Institute of Milan | Maestri R.,Scientific Institute of Montescano | And 3 more authors.
American Journal of Physical Medicine and Rehabilitation | Year: 2013

In the last decade, a considerable number of articles has shown that exercise is effective in improving motor performance in Parkinson disease. In particular, recent studies have focused on the efficacy of intensive exercise in achieving optimal results in the rehabilitation of patients with Parkinson disease. The effects of intensive exercise in promoting cell proliferation and neuronal differentiation in animal models are reported in a large cohort of studies, and these neuroplastic effects are probably related to increased expression of a variety of neurotrophic factors. The authors outline the relation between intensive exercises and neuroplastic activity on animal models of Parkinson disease and discuss the clinical results of different intensive strategies on motor performance and disease progression in patients with Parkinson disease. Copyright © 2013 by Lippincott Williams & Wilkins.

Yamaguchi A.,Harasanshin General Hospital | Skolarikos A.,National and Kapodistrian University of Athens | Buchholz N.-P.N.,St. Bartholomew's Hospital | Chomon G.B.,Hospital General Universitario Gregorio Maranon | And 4 more authors.
Journal of Endourology | Year: 2011

Purpose: The study investigated factors that affect operating times and bleeding complications associated with percutaneous nephrolithotomy (PCNL) in the PCNL Global Study. Patients and Methods: All patients who underwent PCNL for primary or secondary treatment of kidney stone indications during the study period (November 2007-December 2009) were eligible for inclusion. PCNL procedures were performed according to local clinical guidelines and practices. Nephrostomy tract dilation was performed using balloon dilation, metal telescopic dilation, or Amplatz serial dilation. Hematologic complications assessed included bleeding rates, transfusion rates, and preoperative and postoperative hematocrit values. Results: The median operating time with balloon dilation (n=2277) was significantly longer than with telescopic/serial dilation (n=3260) at 94.0 vs 60.0 minutes, respectively (P<0.0001). In the balloon dilation group, there was significantly more bleeding (9.4% vs 6.7%, respectively; P<0.0001) and more transfusions (7.0% vs 4.9%, respectively; P=0.001) compared with the telescopic/serial dilator group. Univariate analysis showed that the probability of bleeding complications was higher with balloon vs telescopic/serial dilation (odds ratio [OR] 1.75; P=0.0001) and larger sheath size (OR 1.42; P=0.0001). By multivariate analysis, sheath size but not dilation method was predictive of bleeding complications. Other significant predictive factors included operating time, stone load, and caseload. Conclusion: This study shows that in PCNL, factors that are associated with bleeding/transfusion include sheath size, operating time, stone load, and caseload. © Copyright 2011, Mary Ann Liebert, Inc.

PubMed | Parkinson Institute, University of Bologna, Moriggia Pelascini Hospital, Sol et Salus Hospital and Nutrition and Dietetics Service
Type: | Journal: Clinical nutrition (Edinburgh, Scotland) | Year: 2016

Parkinsons disease (PD) patients can benefit considerably from appropriate nutritional care, particularly from diet. However, there is limited evidence on the eating habits of PD patients and their relationship with the features of the disease.We conducted a large case-control study. Consecutive PD patients (N=600) receiving systematic nutritional care and healthy controls (N=600) matched (1:1) for age, gender, education, physical activity level and residence were studied using a 66-item food frequency questionnaire. The relationship between dietary habits and the following features of PD were investigated in patients: body weight, energy balance, constipation, and levodopa therapy (dose) and its related motor complications.PD patients had lower BMI and reported higher food intake than controls. BMI was found to be inversely associated with disease duration and severity, and levodopa-related motor complications, whereas energy intake was positively associated with these variables. An increase in protein intake by 10g over physiological requirements (0.8g/kg/day) corresponded to a mean increase in levodopa dose of 0.7mg/kg/day. Constipation was also associated with higher levodopa requirements. Finally, protein intake and its distribution throughout the day influenced levodopa-related motor complications.The management of protein intake and the treatment of constipation should be considered to be an integral part of the care of PD patients. Attention should always be focused on energy intake also. This would result in the maintenance of nutritional status, the optimization of levodopa-therapy and the minimization of its related motor complications.

PubMed | CUNY Medical School, Le Terrazze Hospital, Moriggia Pelascini Hospital, New York University and 3 more.
Type: | Journal: Journal of clinical movement disorders | Year: 2016

Sleep disturbances are among the most common non-motor symptoms of Parkinsons disease (PD), greatly interfering with daily activities and diminishing life quality. Pharmacological treatments have not been satisfactory because of side effects and interactions with anti-parkinsonian drugs. While studies have shown that regular exercise improves sleep quality in normal aging, there is no definitive evidence in PD.In a retrospective study, we determined whether an intense physical and multidisciplinary exercise program improves sleep quality in a large group of patients with PD. We analyzed the scores of PD Sleep Scale (PDSS), which was administered twice, 28days apart, to two groups of patients with PD of comparable age, gender, disease duration and pharmacological treatment. The control group (49 patients) did not receive rehabilitation, The treated group (89 patients) underwent a 28-day multidisciplinary intensive rehabilitation program (three one-hour daily sessions comprising cardiovascular warm-up, relaxation, muscle-stretching, balance and gait training, occupational therapy to improve daily living activities).At enrolment, control and treated groups had similar UPDRS and PDSS scores. At re-test, 28days later, UPDRS and total PDSS scores improved in the treated (p<0.0001) but not in the control group. In particular, the treated group showed significant improvement in PDSS scores for sleep quality, motor symptoms and daytime somnolence. The control group did not show improvement for any item.These results suggest that multidisciplinary intensive rehabilitation treatment may have a positive impact on many aspects of sleep in PD.

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%.

Mangano F.,University of Insubria | Mortellaro C.,Health Science University | Mangano N.,Moriggia Pelascini Hospital | Mangano C.,Vita-Salute San Raffaele University
Mediators of Inflammation | Year: 2016

Aim. To investigate whether there is a correlation between early dental implant failure and low serum levels of vitamin D. Methods. All patients treated with dental implants in a single centre, in the period 2003-2015, were considered for enrollment in this study. The main outcome was early implant failure. The influence of patient-related variables on implant survival was calculated using the Chi-square test. Results. 822 patients treated with 1625 implants were selected for this study; 27 early failures (3.2%) were recorded. There was no link between gender, age, smoking, history of periodontitis, and an increased incidence of early failures. Statistical analysis reported 9 early failures (2.2%) in patients with serum levels of vitamin D > 30 ng/mL, 16 early failures (3.9%) in patients with levels between 10 and 30 ng/mL, and 2 early failures (9.0%) in patients with levels <10 ng/mL. Although there was an increasing trend in the incidence of early implant failures with the worsening of vitamin D deficiency, the difference between these 3 groups was not statistically significant (P = 0.15). Conclusions. This study failed in proving an effective link between low serum levels of vitamin D and an increased risk of early implant failure. Further studies are needed to investigate this topic. © 2016 Francesco Mangano et al.

Galassi A.R.,University of Catania | Tomasello S.D.,Moriggia Pelascini Hospital | Costanzo L.,University of Catania | Campisano M.B.,University of Catania | And 4 more authors.
Catheterization and Cardiovascular Interventions | Year: 2011

Background: Although the advancement of the equipment and the presence of innovative techniques, percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) continues to be affected by lower procedural success in comparison with non occluded vessel PCI. Objective: We describe a new technique for the treatment of coronary CTO which utilizes a new generation of polymeric wires. Methods and Result: From March 2009 to June 2010 different strategies were adopted as "bail out" after an initial attempt failed in 117 consecutive CTO lesions. Among these, conventional strategies (CS) such as parallel wire, sub-intimal tracking and re-entry (STAR), microchannel technique, intracoronary ultrasound guided revascularization and anchor balloon, were used in 75 cases (64.1%), while in the remaining a new technique, the "mini-STAR," was used (39.9%). Although no substantial differences were observed regarding the distribution of clinical features and angiographic lesions characteristics between the populations, mini-STAR was able to achieve a higher rate of procedural success in comparison with other CS (97.6% vs. 52%, P < 0.001) with lower contrast agent use (442 ± 259 cm 3 vs. 561 ± 243 cm 3, P = 0.01) and shorter procedural and fluoroscopy times (122 ± 61 vs. 157 ± 74 min, P = 0.009 and 60 ± 31 min vs. 75 ± 38 min, P = 0.03, respectively). No differences were observed in term of peri-procedural complications such as procedural myocardial infarction, coronary perforations, and contrast-induced nephropathy between mini-STAR and CS. Conclusion: The mini-STAR technique is a promising strategy for the treatment of CTO lesions, achieving a high procedural success rate and low occurrence of procedural adverse events. © 2011 Wiley Periodicals, Inc.

Volpe D.,S Raffaele Arcangelo Fatebenefratelli Hospital | Giantin M.G.,S Raffaele Arcangelo Fatebenefratelli Hospital | Maestri R.,Scientific Institute of Montescano | Frazzitta G.,Moriggia Pelascini Hospital
Clinical Rehabilitation | Year: 2014

Objective: Our aim was to evaluate the feasibility of a hydrotherapy treatment in patients with Parkinsons disease and the effectiveness of this treatment on balance parameters in comparison to a traditional landbased physical therapy. Design: A randomized single-blind controlled trial. Setting: Outpatients. Subjects: Thirty-four patients with Parkinsons disease in Hoehn-Yahr stage 2.5-3. Intervention: Group 1 hydrotherapy treatment, group 2 land-based rehabilitation treatment. The two groups underwent the same rehabilitation period (60 minutes of treatment, five days a week for two months). Main measures: The primary outcome measures were the centre of the pressure sway area recorded with open and closed eyes, using a stabilometric platform. Secondary outcome measures were Unified Parkinsons Disease Rating Scale II and III, Timed Up and Go Test, Berg Balance Scale, Activities-specific Balance Confidence Scale, Falls Efficacy Scale, Falls diary and Parkinsons Disease Questionnaire-39. Results: Hydrotherapy treatment proved to be feasible and safe. Patients in both groups had a significant improvement in all outcome variables. There was a better improvement in patients who underwent hydrotherapy than in patients treated with land-based therapy in the centre of pressure sway area closed eyes (mean SD change: 45.4 SD64.9 vs. 6.9 SD45.3, p = 0.05), Berg Balance Scale (51.2 SD3.1 vs. 6.0 SD3.1, p = 0.005), Activities-specific Balance Confidence Scale (16.8 SD10.6 vs. 4.1 SD5.4, p = 0.0001), Falls Efficacy Scale (-5.9 SD4.8 vs. -1.9 SD1.4, p = 0.003), Parkinsons Disease Quetionnaire-39 (-18.4 SD12.9 vs. -8.0 SD7.0, p = 0.006) and falls diary (-2.4 SD2.2 vs. -0.4 SD0.5, p = 0.001). Conclusion: Our study suggests that hydrotherapy may constitute a possible treatment for balance dysfunction in Parkinsonian patients with moderate stage of disease. © 2014 The Author(s).

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