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Gravedona, Italy

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.

Tomasello S.D.,Moriggia Pelascini Hospital | Costanzo L.,University of Catania | Galassi A.R.,University of Catania
Interventional Cardiology | Year: 2011

Chronic heart failure (CHF) is a worldwide public health problem owing to its high prevalence and incidence (especially in industrialized countries). Although CHF may occur in different physiopathology scenarios, nowadays, atherosclerotic coronary artery disease represents the most common cause of heart failure. Data from observational studies suggest that patients with coronary disease and left ventricular dysfunction may have improved outcomes after both surgical and percutaneous revascularization. However, the selection of which patients might benefit from revascularization, the time of revascularization and the choice of treatment strategy in this subset of patients remains under debate. The aim of this article is to describe the effect revascularization strategy has on outcomes in CHF patients™ and to examine the role of noninvasive viability testing. It also aims to offer an evidence-based perspective that may differ from the current standard of practice. © 2011 Future Medicine Ltd.

Frazzitta G.,Moriggia Pelascini Hospital | Bertotti G.,Scientific Institute of Montescano | Uccellini D.,Tradate Hospital | Boveri N.,Scientific Institute of Montescano | And 3 more authors.
Parkinson's Disease | Year: 2013

Parkinson's disease (PD) is a neurodegenerative disease in which gait and balance disturbances are relevant symptoms that respond poorly to pharmacological treatment. The aim of this study was to investigate whether a 4-week inpatient multidisciplinary intensive rehabilitation treatment (MIRT) is effective in improving balance and gait and whether improvements persist at a one-year followup. We studied 20 PD inpatients (stage 3 Hoehn-Yahr) who underwent a MIRT. Outcome measures were UPDRS items for balance (30), falls (13), and walk (29), Berg Balance Scale, six-minute walking test, Timed Up and Go Test, and Comfortable-Fast gait speeds. Patients were evaluated at admission, at the end of the 4-week treatment, and at a 1-year followup. Pharmacological therapy was unchanged during MIRT and follow-up. All outcome measures improved significantly at the end of treatment. At 1-year follow-up control, UPDRS walk and Comfortable-Fast gait speeds still maintained better values with respect to admission (P = 0.009, P = 0.03, and P = 0.02, resp.), while the remaining scales did not differ significantly. Our results demonstrate that the MIRT was effective in improving balance and gait and that the improvement in gait performances was partially maintained also after 1 year. © 2013 Giuseppe Frazzitta et al.

Frazzitta G.,Moriggia Pelascini Hospital | Maestri R.,S. Maugeri Foundation I.R.C.C.S | Ghilardi M.F.,The New School | Riboldazzi G.,Macchi Foundation | And 9 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.

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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