Niguarda caGranda Hospital

Milano, Italy

Niguarda caGranda Hospital

Milano, Italy
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Ussia G.P.,University of Catania | Ussia G.P.,ETNA Foundation | Barbanti M.,University of Catania | Ramondo A.,University of Padua | And 11 more authors.
Journal of the American College of Cardiology | Year: 2011

Objectives We appraised the incidence and clinical outcomes of patients who were treated with the valve-in-valve (ViV) technique for hemodynamically destabilizing paraprosthetic leak (PPL). Background Device malpositioning causing severe PPL after transcatheter aortic valve implantation is not an uncommon finding. It occurs after release of the prosthesis, leading to hemodynamic compromise. It can be managed successfully in selected cases with implantation of a second device inside the malpositioned primary prosthesis (ViV technique). Methods Consecutive patients (n = 663) who underwent transcatheter aortic valve implantation with the 18-F CoreValve ReValving System (Medtronic, Inc., Minneapolis, Minnesota) at 14 centers across Italy were included in this prospective web-based registry. We identified patients treated with the ViV technique for severe PPL and analyzed their clinical and echocardiographic outcomes. Primary end points were major adverse cerebrovascular and cardiac events and prosthesis performance at the 30-day and midterm follow-up. Results Overall procedural success was obtained in 650 patients (98.0%). The ViV technique was used in 24 (3.6%) of 663 patients. The 30-day major adverse cerebrovascular and cardiac event rates were 7.0% and 0% in patients undergoing the standard procedure and ViV technique, respectively (p = 0.185); the mortality rates were 5.6% versus 0% in patients undergoing the standard procedure and ViV technique, respectively (p = 0.238). There was an improvement in the mean transaortic gradient in all patients without significant difference between the 2 groups (from 52.1 ± 17.1 mm Hg and 45.4 ± 14.8 mm Hg [p = 0.060] to 10.1 ± 4.2 mm Hg and 10.5 ± 5.2 mm Hg, respectively [p = 0.838]). At 12 months, the major adverse cerebrovascular and cardiac event rates in the standard procedure and ViV technique groups were 4.5% and 14.1%, respectively (p = 0.158), and the mortality rates were 4.5% versus 13.7%, respectively (p = 0.230). Conclusions This large, multicenter registry provides important information about the feasibility, safety, and efficacy of the ViV technique with the third-generation CoreValve ReValving System. The clinical and echocardiographic end points compare favorably with those of patients undergoing the standard procedure. The ViV technique offers a viable therapeutic option in patients with acute significant PPL without recourse to emergent surgery. © 2011 American College of Cardiology Foundation.

Lesma A.,San Raffaele Scientific Institute | Bocciardi A.,Niguarda caGranda Hospital | Corti S.,San Raffaele Scientific Institute | Chiumello G.,San Raffaele Scientific Institute | And 2 more authors.
Journal of Urology | Year: 2014

Purpose: We assessed external genitalia sensitivity and sexual function in adults with congenital adrenal hyperplasia who had undergone Passerini-Glazel feminizing genitoplasty as children, and compared them to a control group of healthy counterparts. Materials and Methods: Inclusion criteria were congenital adrenal hyperplasia, Passerini-Glazel feminizing genitoplasty, adult age and penetrative vaginal intercourse. Thermal and vibratory sensitivity of the clitoris, vagina and labia minora were analyzed using the Genito Sensory Analyzer (Medoc Ltd., Minnetonka, Minnesota). Psychosexual outcome was assessed with the Beck Depression Inventory, Zung Self-Rating Anxiety Scale, Female Sexual Distress Scale and Female Sexual Function Index. Matched analyses were performed to compare outcomes in patients to controls (healthy medical students). All statistical tests were performed using SPSS®, version 18.0 Results: A total of 12 patients (10%) entered the study. Thermal and vibratory clitoral sensitivity was significantly decreased in all patients compared to healthy controls (p <0.01). There was no difference in thermal or vibratory vaginal sensitivity between patients and controls. On the Female Sexual Distress Scale 11 patients (91.6%) and 11 controls (91.6%) described a stable satisfactory relationship. All patients reported active sexual desire, good arousal, adequate lubrication and orgasm. No significant difference in Female Sexual Function Index global score or single domain scores was observed between patients and controls. Conclusions: Although clitoral sensitivity in sexually active patients with congenital adrenal hyperplasia treated with Passerini-Glazel feminizing genitoplasty is significantly reduced compared to controls, sexual function in those patients is not statistically or clinically significantly different from their healthy counterparts. Finally, 1-stage Passerini-Glazel feminizing genitoplasty seems to allow normal adult sexual function. © 2014 by American Urological Association Education Research, Inc.

Tamburino C.,Ferrarotto Hospital | Tamburino C.,ETNA Foundation | Capodanno D.,Ferrarotto Hospital | Capodanno D.,ETNA Foundation | And 14 more authors.
Circulation | Year: 2011

Background- There is a lack of information on the incidence and predictors of early mortality at 30 days and late mortality between 30 days and 1 year after transcatheter aortic valve implantation (TAVI) with the self-expanding CoreValve Revalving prosthesis. Methods and Results- A total of 663 consecutive patients (mean age 81.0±7.3 years) underwent TAVI with the third generation 18-Fr CoreValve device in 14 centers. Procedural success and intraprocedural mortality were 98% and 0.9%, respectively. The cumulative incidences of mortality were 5.4% at 30 days, 12.2% at 6 months, and 15.0% at 1 year. The incidence density of mortality was 12.3 per 100 person-year of observation. Clinical and hemodynamic benefits observed acutely after TAVI were sustained at 1 year. Paravalvular leakages were trace to mild in the majority of cases. Conversion to open heart surgery (odds ratio [OR] 38.68), cardiac tamponade (OR 10.97), major access site complications (OR 8.47), left ventricular ejection fraction <40% (OR 3.51), prior balloon valvuloplasty (OR 2.87), and diabetes mellitus (OR 2.66) were independent predictors of mortality at 30 days, whereas prior stroke (hazard ratio [HR] 5.47), postprocedural paravalvular leak2+ (HR 3.79), prior acute pulmonary edema (HR 2.70), and chronic kidney disease (HR 2.53) were independent predictors of mortality between 30 days and 1 year. Conclusions- Benefit of TAVI with the CoreValve Revalving System is maintained over time up to 1 year, with acceptable mortality rates at various time points. Although procedural complications are strongly associated with early mortality at 30 days, comorbidities and postprocedural paravalvular aortic regurgitation2+ mainly impact late outcomes between 30 days and 1 year. © 2011 American Heart Association. All rights reserved.

Evaluation of: Fisher K, Cramer P, Busch R et al. Bendamustine combined with rituximab in patients with relapsed and/or refractory chronic lymphocytic leukemia: a multicenter Phase 2 trial of the German Chronic Lymphocytic Leukemia Study Group. J. Clin. Oncol. 29(26), 3559-3566 (2011). First-line chemoimmunotherapy approaches offer prolonged disease-free survival in patients with chronic lymphocytic leukemia (CLL). Despite the improved results with purine analogs ± cyclophosphamide and rituximab (FCR) the disease remains incurable, and patients with CLL are destined to relapse after primary treatment. The prior therapy administered and the response, and duration of response to that therapy, are among the most important factors in determining the next therapy. Bendamustine, a bifunctional alkylating agent, combined with rituximab (BR) has been tested in patients with relapsed and/or refractory CLL in order to investigate the safety and efficacy of this combination. In conclusion, chemoimmunotherapy with BR showed interesting results, with the exception of patients carrying del(17p). Bendamustine appears to be a good choice for second-line therapy owing to its lack of significant cross-resistance with other alkylating agents or fludarabine. © 2012 Expert Reviews Ltd.

Talamonti G.,Niguarda CaGranda Hospital
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology | Year: 2011

A series of 231 consecutive patients with myelomeningocele was reviewed for what concerns the Chiari II malformation. This was present in 228 subjects (98.8%), but was symptomatic in 74 patients (31.5%) and required surgery just in 26 cases (11.4%). First treatment was addressed to hydrocephalus which was always associated. Shunting reverted the symptoms in 12 patients, but failed in 14 who required craniocervical decompression. Mortality consisted of two cases (one early and one delayed). All the remaining patients achieved satisfactory results.

Chiara O.,Niguarda CaGranda Hospital | Cimbanassi S.,Niguarda CaGranda Hospital | Boati S.,Niguarda CaGranda Hospital | Bassi G.,Niguarda CaGranda Hospital
Minerva Anestesiologica | Year: 2011

Background. The majority of intensive care physicians recognize the clinical significance of intra-abdominal hypertension on the outcome of critically ill patients. Abdominal compartment syndrome (ACS) is defined as an intra-abdominal pressure (IAP) >20 mmHg with ongoing organ failure. However, there is no consensus regarding the indications for surgical decompression. Methods. A review of personal data and the English literature from 1989 to 2010 focusing on surgical management of ACS. Results. Opening the abdomen is the most effective method to reduce IAP and is the treatment of choice for ACS when IAP is constantly higher than 30 mmHg with ongoing organ failure refractory to medical therapy. A vertical midline incision is the most popular method of surgical decompression, but bilateral subcostal incisions may be indicated in certain conditions. Surgical decompression always obtains a significant decrease in the IAP with physiological improvement, but the effects on organ function are controversial. Negative pressure devices are the most effective for temporary abdominal closure with a higher rate of primary fascial closure and lower risk of fistulas. When primary fascial closure is not feasible, a planned ventral hernia and spontaneous granulation with or without biologic mesh are the preferred methods for the reconstruction of abdominal wall integrity. Conclusion. Modern surgical techniques for opening the abdomen in patients with ACS refractory to medical therapy result in physiologic improvement with less treatment-related complications, but recuperation of organ dysfunction is variable.

Epis O.,Niguarda CaGranda Hospital | Bruschi E.,Niguarda CaGranda Hospital
Clinical and Experimental Rheumatology | Year: 2014

Over the last decades ultrasound-guided procedures have become increasingly diffused in rheumatology, mainly thanks to the technical advances achieved in the ultrasound (US) field, combined with the greater availability, good portability and reduced cost of US devices, compared to other imaging techniques already used in rheumatology units. The direct visualisation of the tissue under analysis and the realtime imaging performance enabled by US-guidance account for an improved accuracy and directness in needle placement in a number of rheumatology interventions such as tendon and intra-articular injections. Compared with blind procedures, US-guided injections are more accurate and safe and they result in better clinical outcome in terms of joints improvement in function and decreased risk of damages caused by needle misplacement. The accuracy in needle placement of US-guided injections has proven to be important not only in common intra-articular injections, but especially in case of complex anatomical areas like the hip, facet and atlanto-occipital joints, where blinded injections are deemed poorly accurate and thus highly risky. Moreover US guidance can be successfully employed in more complex procedures such as synovial biopsy, portal establishment or arthroscopy, where US can also be combined with other imaging techniques. Overall the employment of US-guided procedures is considered to be safe and well-tolerated, and increases the accuracy and therapeutic effectiveness of the interventions performed. This may pave the way for a more widespread employment of US-guidance in rheumatology units, and new studies could further explore the therapeutic advantages of these procedures. © Clinical and Experimental Rheumatology 2014.

Roghi A.,Niguarda CaGranda Hospital
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance | Year: 2011

The clinical presentation of pheochromocytoma is variable and many biochemical and imaging methods have been suggested to improve the diagnostic accuracy of what has been termed "the great masquerader". This case-report is of a middle-aged woman with a non-specific clinical presentation suggesting acute coronary syndrome or subacute myocarditis. Cardiovascular magnetic resonance (CMR) at presentation showed myocardial edema and intramyocardial late gadolinium enhancement (LGE). An adrenal mass was seen, which was confirmed as pheochromocytoma and surgically removed. Our case shows evidence for acute adrenergic myocarditis, with resolution of both the edema and the LGE after surgical excision.

Talamonti G.,Niguarda CaGranda Hospital | Zella S.,Niguarda CaGranda Hospital
Neurological Sciences | Year: 2011

A series of 231 consecutive patients with myelomeningocele was reviewed for what concerns the Chiari II malformation. This was present in 228 subjects (98.8%), but was symptomatic in 74 patients (31.5%) and required surgery just in 26 cases (11.4%). First treatment was addressed to hydrocephalus which was always associated. Shunting reverted the symptoms in 12 patients, but failed in 14 who required craniocervical decompression. Mortality consisted of two cases (one early and one delayed). All the remaining patients achieved satisfactory results. © 2011 Springer-Verlag.

Barosi A.,Niguarda CaGranda Hospital
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing | Year: 2011

Few data are available on the effects of cardiac resynchronization therapy (CRT) in candidates for cardiac surgery and affected by severe heart failure (HF). The aim of our analysis is to evaluate the percentage of patients who maintain indication for CRT after surgery and the efficacy of CRT in those patients subsequently implanted. We enrolled 124 HF patients with indication both to heart surgery and to CRT. During surgery, an epicardial left ventricular lead was implanted, tunneled to a subclavear pocket, and capped. Afterward, patients were periodically reassessed to confirm indication for CRT. CRT indication was confirmed within 1 month from surgery in 54 patients (group A) and in 33 patients within 6 months (group B). In group A and B, 63% and 71% of patients were considered responders according to an arbitrary five-point increase of left ventricular ejection fraction (LVEF), respectively. The assessment of clinical response at 1 year, based on the definitions proposed by Packer, identified 63% and 80% of responders in group A and B, respectively. Our data show that a remarkable percentage of patients maintain an indication for CRT after cardiac surgery (76%), while in the remaining 24% the lack of an indication is confirmed by a higher LVEF at last follow-up. In combination with surgery, CRT proved to be an effective therapy in those patients who were subsequently implanted. The suggested method is simple, without significant adjunctive risks, and allows easier CRT implantation with stable thresholds.

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