Niguarda Hospital

Milano, Italy

Niguarda Hospital

Milano, Italy
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Tobaldini E.,Fondazione IRCSS Ca' Granda | Tobaldini E.,University of Milan | Costantino G.,Fondazione IRCSS Ca' Granda | Solbiati M.,Fondazione IRCSS Ca' Granda | And 7 more authors.
Neuroscience and Biobehavioral Reviews | Year: 2017

Sleep deprivation (SD) has become a relevant health problem in modern societies. We can be sleep deprived due to lifestyle habits or due to sleep disorders, such as insomnia, obstructive sleep apnea (OSA) and neurological disorders. One of the common element of sleep disorders is the condition of chronic SD, which has complex biological consequences. SD is capable of inducing different biological effects, such as neural autonomic control changes, increased oxidative stress, altered inflammatory and coagulatory responses and accelerated atherosclerosis. All these mechanisms links SD and cardiovascular and metabolic disorders. Epidemiological studies have shown that short sleep duration is associated with increased incidence of cardiovascular diseases, such as coronary artery disease, hypertension, arrhythmias, diabetes and obesity, after adjustment for socioeconomic and demographic risk factors and comorbidities. Thus, an early assessment of a condition of SD and its treatment is clinically relevant to prevent the harmful consequences of a very common condition in adult population. © 2016 Elsevier Ltd

Varotto G.,C Besta Neurological Institute Irccs Foundation | Varotto G.,Polytechnic of Milan | Tassi L.,Niguarda Hospital | Franceschetti S.,C Besta Neurological Institute Irccs Foundation | And 2 more authors.
NeuroImage | Year: 2012

In the context of focal and drug-resistant epilepsy, surgical resection of the epileptogenic zone may be the only therapeutic option for reducing or suppressing seizures. In many such patients, intracranial stereo-EEG recordings remain the gold standard for the epilepsy surgery work-up. Assessing the extent of the epileptogenic zone and its organisation is a crucial objective, and requires advanced methods of signal processing. Over the last ten years, considerable efforts have been made to develop signal analysis techniques for characterising the connectivity between spatially distributed regions.The aim of this study was to evaluate the changes in dynamic connectivity pattern under inter-ictal, pre-ictal and ictal conditions using signals derived from stereo-EEG recordings of 10 patients with Taylor-type focal cortical dysplasia. A causal linear multivariate method - partial directed coherence - and indices derived from graph theory were used to characterise the synchronisation property of the lesional zone (corresponding to the epileptogenic zone in our patients) and to distinguish it from other regions involved in ictal activity or not.The results show that a significantly different connectivity pattern (mainly in the gamma band) distinguishes the epileptogenic zone from other cortical regions not only during the ictal event, but also during the inter- and pre-ictal periods. This indicates that the lesional nodes play a leading role in generating and propagating ictal EEG activity by acting as the hubs of the epileptic network originating and sustaining seizures. Our findings also indicate that the cortical regions beyond the dysplasia involved in the ictal activity essentially act as "secondary" generators of synchronous activity. The leading role of the lesional zone may account for the good post-surgical outcome of patients with type II focal cortical dysplasia as resecting the dysplasia removes the epileptogenic zone responsible for seizure organisation. Furthermore, our findings strongly suggest that advanced signal processing techniques aimed at studying synchronisation and characterising brain networks could substantially improve the pre-surgical evaluation of patients with focal epilepsy, even in cases without an associated anatomically detectable lesion. © 2012 Elsevier Inc.

BACKGROUND—: Previous reports have suggested that despite their dramatic presentation, patients with fulminant myocarditis (FM) might have better outcome than those with acute non-fulminant myocarditis (NFM). In this retrospective study, we report outcome and changes in left ventricular ejection fraction (LVEF) in a large cohort of patients with FM compared with NFM. METHODS—: The study population consists of 187 consecutive patients admitted between May 2001 and November 2016 with a diagnosis of acute myocarditis (onset of symptoms <1 month) of whom 55 required inotropes and/or mechanical circulatory support (FM) whilst the remaining 132 patients were hemodynamically stable (NFM). We also performed a sub-analysis in 130 adult patients with acute viral myocarditis and viral prodrome within 2 weeks from the onset, which includes 34 FM vs. 96 NFM. Patients with giant-cell, eosinophilic myocarditis or cardiac sarcoidosis and subject <15 years of age were excluded from the latter sub-analysis. RESULTS—: In the whole population (n=187) in-hospital death or heart transplantation (HTx) was 25.5% vs. 0% in FM vs. NFM, respectively (p<0.0001). Long-term HTx free survival at 9 years was lower in FM than NFM (64.5% vs. 100%, Log Rank p<0.0001). Despite greater improvement in LVEF during hospitalization in FM vs. NFM forms (median: 32%, interquartile: 20-40% vs. 3%, 0-10%, respectively, p<0.0001), the proportion of patients with LVEF<55% at last follow up was higher in FM vs. NFM (29% vs. 9%, Relative risk 3.32, 95% confidence interval: 1.45-7.64, p=0.003). Similar results regarding survival and changes in LVEF in FM vs. NFM were observed in the subgroup (n=130) with viral myocarditis. None of the patients with NFM and LVEF≥55% at discharge had a significant decrease in LVEF at follow up. CONCLUSIONS—: Patients with FM have an increased mortality and need for HTx, compared to those with NFM. From a functional viewpoint, FM patients have a more severely impaired LVEF at admission that, despite steep improvement during hospitalization, remains lower than that in patients with NFM at long term follow up. These findings hold true also considering only the viral forms and are at odd with previous studies showing better prognosis in FM. © 2017 by the American College of Cardiology Foundation and the American Heart Association, Inc.

Locati E.T.,Niguarda Hospital | Vecchi A.M.,Niguarda Hospital | Vargiu S.,Niguarda Hospital | Cattafi G.,Niguarda Hospital | Lunati M.,Niguarda Hospital
Europace | Year: 2014

Aims: To assess the diagnostic yield of new external loop recorders (ELRs) in patients with history of syncope, pre-syncope, and sustained palpitations. Methods and results: Since 2005, we have established a registry including patients who consecutively received ELR monitoring for unexplained syncope or pre-syncope/palpitations. The registry included 307 patients (61 females, age 58 ± 19 years, range 8-94 years) monitored by high-capacity memory ELR of two subsequent generations: SpiderFlash-A® (SFA®, Sorin CRM), storing two-lead electrocardiogram (ECG) patient-activated recordings by loop-recording technique (191 patients, 54 patients with syncope, years 2005-09), and SpiderFlash-T® (SFT®), adding auto-trigger detection for pauses, bradycardia, and supraventricular/ventricular arrhythmias (116 patients, 38 patients with syncope, years 2009-12). All the patients previously underwent routine workup for syncope or palpitation, including one or more 24 h Holter, not conclusive for diagnosis. Mean monitoring duration was 24.1 ± 8.9 days. Among 215 patients with palpitations, a conclusive diagnosis was obtained in 184 patients (86 diagnostic yield for palpitation). Among 92 patients with syncope, a conclusive diagnosis was obtained in 16 patients (17 clinical diagnostic yield for syncope), with recording during syncope of significant arrhythmias in 9 patients, and sinus rhythm in 7 patients. Furthermore, asymptomatic arrhythmias were de novo detected in 12 patients (13), mainly by auto-trigger detection, suggesting an arrhythmic origin of the syncope. Conclusions: The diagnostic yield of ELR in patients with syncope, pre-syncope, or palpitation of unknown origin after routine workup was similar to implantable loop recorder (ILR) within the same timeframe, therefore, ELR could be considered for patients candidate for long-term ECG monitoring, stepwise before ILR. All rights reserved. © The Author 2013.

Piano M.,Niguarda Hospital | Valvassori L.,Niguarda Hospital | Quilici L.,Niguarda Hospital | Pero G.,Niguarda Hospital | Boccardi E.,Niguarda Hospital
Journal of Neurosurgery | Year: 2013

Object. The introduction of flow diverter devices is revolutionizing the endovascular approach to cerebral aneurysms. Midterm and long-term results of angiographic, cross-sectional imaging and clinical follow-up are still lacking. The authors report their experience with endovascular treatment of intracranial aneurysms using both the Pipeline embolization device and Silk stents. Methods. From October 2008 to July 2011 a consecutive series of 104 intracranial aneurysms in 101 patients (79 female, 22 male; average age 53 years) were treated. Three of the 104 aneurysms were ruptured and 101 were unruptured. Silk stents were implanted in 47 of the aneurysms and Pipeline stents in the remaining 57. In 14 cases a combination of flow diverter devices and coils were used to treat larger aneurysms (maximum diameter > 15 mm). Patients underwent angiographic follow-up examination at 6 months after treatment, with or without CT or MRI, and at 1 year using CT or MRI, with or without conventional angiography. Results. In all cases placement of flow diverter stents was technically successful. The mortality and morbidity rates were both 3%. Adverse events without lasting clinical sequelae occurred in 20% of cases. Angiography performed at 6 months after treatment showed complete aneurysm occlusion in 78 of 91 cases (86% of evaluated aneurysms) and subocclusion in 11 (12%); only in 2 cases were the aneurysms unchanged. Fifty-three aneurysms were evaluated at 1 year after treatment. None of these aneurysms showed recanalization, and 1 aneurysm, which was incompletely occluded at the 6-month follow-up examination, was finally occluded. Aneurysmal sac shrinkage was observed in 61% of assessable aneurysms. Conclusions. Parent artery reconstruction using flow diverter devices is a feasible, safe, and successful technique for the treatment of endovascular treatment of cerebral aneurysms. © AANS, 2013.

Lovaglio P.G.,University of Milan Bicocca | Monzani E.,Niguarda Hospital
Quality of Life Research | Year: 2012

Purpose To explore the internal structure of the Health of the Nation Outcome Scales (HoNOS-12), proposing a shorter one-dimensional version for routine use in community- oriented Mental Heath services. Methods A validation study involving four Mental Health Departments, located in the Province of Milan (Italy). Eligible patients were outpatients and residential inpatients rated on three occasions during the year 2009, with a range of mental illnesses and diagnoses. Methodologically, we use both exploratory factor analysis (EFA) with holdout validation and Rasch approaches and parallel analysis. Results EFA, Rasch analysis and parallel analysis demonstrate a large violation of unidimensionality. Both EFA (training sample) and Rasch analyses yield convergent results, generating the same unidimensional abbreviated version of the HoNOS-12, resulting in a six-item scale (HoNOS-6) which demonstrates unidimensionality, good item fit, a solid factor structure (strong loadings and communalities) and acceptable model fit, evaluated using confirmatory factor analysis on a validation sample. Conclusions The HoNOS-12 does not measure a single, underlying construct of mental health status. Nevertheless, the instrument can be utilized in a reduced version (HoNOS- 6), as a clinically acceptable outcome scale (measuring self-perceived clinical and social needs for community support, rather than global mental disorder) for routine use in a community setting population. © Springer Science+Business Media B.V. 2012.

This retrospective review reports on forty-five tibial non-unions who underwent docking site treatment for non-union using closed versus open and endoscopic strategies. In this cohort of patients, all but twelve were infected non-unions. Sixteen patients initially treated with single compression were compared to twenty-three patients treated with open revision of the docking site, and six endoscopic procedures. In the single compression group, an average of 6.4 cm of bone was resected and index lengthening was 2.01. In the open revision group, a mean of 9.4 cm was resected and the index lengthening was 1.72. In the endoscopic group, an average of 8.6 cm of bone was resected and index lengthening was 1.71. Consolidation at the docking site occurred in 41 cases out of 45 following the first procedure. There was no statistical difference between the three groups. Conclusive evidence of superiority of one modality of treatment over the other cannot be drawn from our data. The simple compression procedure requires less invasive surgery and is probably less demanding and more cost-effective in short transports, although the two cases of failure due to recurrence of sepsis were observed after this procedure. Further studies are desirable to investigate the effectiveness of open docking site grating procedures. © 2013 Elsevier Ltd. All Rights Reserved.

Sirtori C.R.,Niguarda Hospital | Sirtori C.R.,University of Milan
Pharmacological Research | Year: 2014

Statins, inhibitors of the hydroxymethylglutaryl-CoA (HMG-CoA) reductase enzyme, are molecules of fungal origin. By inhibiting a key step in the sterol biosynthetic pathway statins are powerful cholesterol lowering medications and have provided outstanding contributions to the prevention of cardiovascular disease. Their detection in mycetes traces back to close to 40 years ago: there were, originally, widely opposing views on their therapeutic potential. From then on, intensive pharmaceutical development has led to the final availability in the clinic of seven statin molecules, characterized by differences in bioavailability, lipo/hydrophilicity, cytochrome P-450 mediated metabolism and cellular transport mechanisms. These differences are reflected in their relative power (mg LDL-cholesterol reduction per mg dose) and possibly in parenchymal or muscular toxicities. The impact of the antagonism of statins on a crucial step of intermediary metabolism leads, in fact, both to a reduction of cholesterol biosynthesis as well as to additional pharmacodynamic (so called "pleiotropic") effects. In the face of an extraordinary clinical success, the emergence of some side effects, e.g. raised incidence of diabetes and cataracts as well as frequent muscular side effects, have led to increasing concern by physicians. However, also in view of the present relatively low cost of these drugs, their impact on daily therapy of vascular patients is unlikely to change. © 2014 Elsevier Ltd.

Baudo F.,Niguarda Hospital | Caimi T.,Niguarda Hospital | de cataldo F.,Niguarda Hospital
Haemophilia | Year: 2010

Acquired haemophilia (AH) is an autoimmune syndrome characterized by acute bleeding in patients with negative family and personal history, and factor VIII depletion. Its incidence is 1.6 × 106 population per year. AH is associated with autoimmune diseases, solid tumours, lymphoprolipherative diseases, pregnancy; 50% of the cases idiopathic. Spontaneous or after minor trauma severe bleeding associated with a prolonged activated partial thromboplastin time, not corrected by incubation with normal plasma, with a normal prothrombin time are the diagnostic hallmarks. The goals of management are the control of bleeding and the suppression of inhibitor. First-line haemostatic treatment includes recombinant factor VIIa and activated prothrombin complex concentrate. Prednisone ± cyclophosphamide and other immunosuppressive agents are the standard intervention for inhibitor eradication. © 2010 Blackwell Publishing Ltd.

Gentile M.G.,Niguarda Hospital
Nutrients | Year: 2012

Severe undernutrition nearly always leads to marked changes in body spaces (e.g., alterations of intra-extracellular water) and in body masses and composition (e.g., overall and compartmental stores of phosphate, potassium, and magnesium). In patients with severe undernutrition it is almost always necessary to use oral nutrition support and/or artificial nutrition, besides ordinary food; enteral nutrition should be a preferred route of feeding if there is a functional accessible gastrointestinal tract. Refeeding of severely malnourished patients represents two very complex and conflicting tasks: (1) to avoid -refeeding syndrome" caused by a too fast correction of malnutrition; (2) to avoid -underfeeding" caused by a too cautious rate of refeeding. The aim of this paper is to discuss the modality of refeeding severely underfed patients and to present our experience with the use of enteral tube feeding for gradual correction of very severe undernutrition whilst avoiding refeeding syndrome, in 10 patients aged 22 ± 11.4 years and with mean initial body mass index (BMI) of 11.2 ± 0.7 kg/m2. The mean BMI increased from 11.2 ± 0.7 kg/m2 to 17.3 ± 1.6 kg/m2 and the mean body weight from 27.9 ± 3.3 to 43.0 ± 5.7 kg after 90 days of intensive in-patient treatment (p < 0.0001). Caloric intake levels were established after measuring resting energy expenditure by indirect calorimetry, and nutritional support was performed with enteral feeding. Vitamins, phosphate, and potassium supplements were administered during refeeding. All patients achieved a significant modification of BMI; none developed refeeding syndrome. In conclusion, our findings show that, even in cases of extreme undernutrition, enteral feeding may be a well-tolerated way of feeding. © 2012 by the authors; licensee MDPI, Basel, Switzerland.

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