Locatelli F.,Alessandro Manzoni Hospital |
Altieri P.,Azienda Ospedaliera G. Brotzu |
Andrulli S.,Alessandro Manzoni Hospital |
Sau G.,Alessandro Manzoni Hospital |
And 10 more authors.
Journal of the American Society of Nephrology | Year: 2010
Symptomatic intradialytic hypotension is a common complication of hemodialysis (HD). The application of convective therapies to the outpatient setting may improve outcomes, including intradialytic hypotension. In this multicenter, open-label, randomized controlled study, we randomly assigned 146 long-term dialysis patients to HD (n = 70), online predilution hemofiltration (HF; n = 36), or online predilution hemodiafiltration (HDF; n = 40). The primary end point was the frequency of intradialytic symptomatic hypotension (ISH). Compared with the run-in period, the frequency of sessions with ISH during the evaluation period increased for HD (7.1 to 7.9%) and decreased for both HF (9.8 to 8.0%) and HDF (10.6 to 5.2%) (P < 0.001). Mean predialysis systolic BP increased by 4.2 mmHg among those who were assigned to HDF compared with decreases of 0.6 and 1.8 mmHg among those who were assigned to HD and HF, respectively (P = 0.038). Multivariate logistic regression demonstrated significant risk reductions in ISH for both HF (odds ratio 0.69; 95% confidence interval 0.51 to 0.92) and HDF (odds ratio 0.46, 95% confidence interval 0.33 to 0.63). There was a trend toward higher dropout for those who were assigned to HF (P = 0.107). In conclusion, compared with conventional HD, convective therapies (HDF and HF) reduce ISH in long-term dialysis patients. Copyright © 2010 by the American Society of Nephrology.
Cortigiani L.,Ospedale S. Luca |
Rigo F.,Ospedale dellAngelo |
Gherardi S.,Cesena Hospital |
Bovenzi F.,Ospedale S. Luca |
And 2 more authors.
European Heart Journal Cardiovascular Imaging | Year: 2015
Aims Doppler-derived coronary flow velocity reserve (CFVR) of left anterior descending (LAD) artery is an effective tool to predict overall mortality. The aim was to investigate the capability of CFVR to predict outcome in an unselected cohort of patients older than 80 years having stress echo negative by wall motion criteria. Methods and results The study group refers to 369 patients aged >80 years (156 men; mean age 83±2 years) who had undergone dipyridamole stress echocardiography with CFVR assessment of LAD artery of known (n = 144) or suspected (n = 225) coronary artery disease. Stress echocardiography was negative for wall motion criteria in all cases. Mean CFVR was 2.07±0.53. During a median follow-up of 21 months, there were 62 major adverse cardiac events (MACEs; 45 deaths and 17 non-fatal myocardial infarctions). With a receiver operating characteristic analysis, a CFVR of ≤1.93 was the best cut-off for predicting mortality and MACE. At individual patient analysis, 152 (41%) subjects had a CFVR of ≤1.93. Annual mortality was 9.8% in patients with CFVR ≤ 1.93 and 3.7% in those with CFVR .1.93 (P = 0.001); an annual MACE rate was 14.8% in the former and 4.5% in the latter (P , 0.0001). Of 15 clinical and echocardiographic parameters analysed, CFVR ≤1.93 [hazard ratio (HR) = 2.17, 95% CI 1.14-4.10] and resting wall motion abnormality (RWMA; HR = 2.60; 95% CI 1.35-5.00) were multivariable indicators of mortality. Moreover, CFVR ≤1.93 (HR = 2.69, 95% CI 1.56-4.67), and RWMA (HR = 2.38; 95% CI 1.31-4.33) were also strong independent predictors of MACEs. At incremental analysis, CFR ≤1.93 added prognostic information over clinical evaluation and RWMAwhen both mortality and MACE were taken as clinical end points. Conclusions A reduced CFVR of LAD artery is a strong and independent indicator of both mortality and MACE, adding prognostic information over clinical evaluation and RWMA. Conversely, a preserved CFVR predicts a favourable outcome particularly in subjects with no RWMA. © 2015 The Author.
Valerio E.,University of Padua |
Cutrone M.,Ospedale dellAngelo
Pediatric Dermatology | Year: 2014
We describe three cases of split median raphe of the penis (SMR) from our hospital newborn records from 2004 to 2013. One case was associated with median raphe cyst, one with skin hypochromia, and one with a scar-like aspect of the region of interest. SMR is thought to be the result of defective fusion of ectodermal tissue in the urethra and scrotum area or of defective growth of the perineal mesoderm around the urethra during gestation. Although SMR associated with other major penile congenital defects (epispadias, hypospadias, penile torsion, bifid scrotum, chordee) is common, isolated SMR is probably an underdiagnosed (although not rare) malformative condition. Recognizing SMR in a newborn may be of educational value to neonatologists because it leads to the search for and exclusion of the above-mentioned pathologic conditions. © 2014 Wiley Periodicals, Inc.
Mohanty S.,The Texas Institute |
Mohanty P.,The Texas Institute |
Di Biase L.,The Texas Institute |
Di Biase L.,University of Texas at Austin |
And 15 more authors.
Circulation | Year: 2013
BACKGROUND-: This study examined the impact of different ablation strategies on atrial fibrillation (AF) recurrence and quality of life in coexistent AF and atrial flutter (AFL). METHODS AND RESULTS-: Three-hundred sixty enrolled patients with documented AF and AFL were blinded and randomized to group 1, AF±AFL ablation (n=182), or group 2, AFL ablation only (n=178). AF recurrence was evaluated with event recording and 7-day Holter at 3, 6, 9, and 12-month follow-ups. Quality of life was assessed at baseline and at the 12-month follow-up with 4 questionnaires: the Medical Outcome Study Short Form, the Hospital Anxiety and Depression Score, the Beck Depression Inventory, and the State-Trait Anxiety Inventory. Of the 182 patients in group 1, 58 (age, 63±8 years; 78% male; left ventricular ejection fraction, 59±8%) had AF+AFL ablation and 124 (age, 61±11 years; 72% male; left ventricular ejection fraction, 59±7%) had AF ablation only. In group 2 (age, 62±9 years; 76% male; left ventricular ejection fraction, 58±10%), only AFL was ablated by achieving bidirectional isthmus conduction block. Baseline characteristics were not different across groups. At 21±9 months of follow-up, 117 in group 1 (64%) and 34 in group 2 (19%) were arrhythmia free (P<0.001). In group 1, scores on most quality-of-life subscales showed significant improvement at follow-up, whereas group 2 patients derived relatively minor benefit. CONCLUSIONS-: In coexistent AF and AFL, lower recurrence rate and better quality of life are associated with AF ablation only or AF+AFL ablation than with lone AFL ablation. Furthermore, quality of life directly correlates with freedom from arrhythmia, as shown in this study for the first time in patients blinded to the procedure. CLINICAL TRIAL REGISTRATION-: URL: http://www.clinicaltrial.gov/. Unique identifier: NCT01439386. © 2013 American Heart Association, Inc.
Ronco C.,San Bortolo Hospital |
Ronco F.,Ospedale Dellangelo
Heart Failure Reviews | Year: 2012
The "Cardio-Renal Syndrome" (CRS) is a disorder of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. The general definition has been expanded to five subtypes reflecting the primacy of organ dysfunction and the time-frame of the syndrome: CRS type I: acute worsening of heart function (AHF-ACS) leading to kidney injury and/or dysfunction. CRS type II: chronic abnormalities in heart function (CHF-CHD) leading to kidney injury or dysfunction. CRS type III: acute worsening of kidney function (AKI) leading to heart injury and/or dysfunction. CRS type IV: chronic kidney disease (CKD) leading to heart injury, disease and/or dysfunction. CRS type V: systemic conditions leading to simultaneous injury and/ or dysfunction of heart and kidney. Different pathophysiological mechanisms are involved in the combined dysfunction of heart and kidney in these five types of the syndrome. © 2010 Springer Science+Business Media, LLC.
Cortigiani L.,Campo Of Marte Hospital |
Rigo F.,Ospedale dellAngelo |
Gherardi S.,Cesena Hospital |
Galderisi M.,University of Naples Federico II |
And 2 more authors.
Journal of the American Society of Echocardiography | Year: 2014
Background The prognostic value of Doppler-derived coronary flow velocity reserve (CFVR) of the left anterior descending coronary artery in patients with type 2 diabetes with preserved left ventricular systolic function and without flow-limiting stenoses on angiography remains undetermined. Methods The study sample consisted of 144 patients with type 2 diabetes (82 men; mean age 62 ± 10 years) with chest pain or angina-equivalent symptoms, no histories of coronary artery disease, and echocardiographic ejection fractions ≥ 50%. All patients underwent dipyridamole stress echocardiography with CFVR assessment of the left anterior descending coronary artery by transthoracic Doppler echocardiography and coronary angiography showing normal coronary arteries or nonobstructive coronary artery disease. Results Mean CFVR was 2.44 ± 0.57. On individual patient analysis, 109 patients (76%) had CFVR > 2, and 35 (24%) had CFVR ≤ 2. During a median follow-up period of 29 months (interquartile range, 14-44 months), 17 hard events (five deaths, 12 nonfatal myocardial infarctions) occurred. The annual hard-event rate was 13.9% in subjects with CFVR ≤ 2 and 2.0% in those with CFVR > 2. The annual event rate associated with CFVR ≤ 2 was significantly higher both in patients with left ventricular hypertrophy (P < 0001) and in those without left ventricular hypertrophy (P =.048). On Cox analysis, CFVR ≤ 2 (hazard ratio, 11.20; 95% confidence interval, 3.07-40.92), and male sex (hazard ratio, 7.80; 95% confidence interval, 1.74-34.97) were independent prognostic indicators, whereas nonobstructive coronary artery disease was not an independent predictor of outcomes. Conclusions Microvascular dysfunction before the occurrence of coronary artery involvement is a strong and independent predictor of outcomes in patients with type 2 diabetes. Vasodilator stress CFVR is a suitable tool to assess microvascular dysfunction in routine clinical practice. © 2014 by the American Society of Echocardiography.
Furukawa T.,Centro Aritmologico e Syncope Unit |
Maggi R.,Centro Aritmologico e Syncope Unit |
Bertolone C.,Centro Aritmologico e Syncope Unit |
Ammirati F.,Ospedale G.B. Grassi |
And 4 more authors.
Europace | Year: 2011
Aims: Recently, the remote transmission of data detected by implantable loop recorders (ILRs) has become available. The aim of this study was to evaluate effectiveness and acceptance of remote monitoring in the clinical management of syncope and palpitations in patients with ILR. Methods and results: Consecutive patients implanted with ILR (Reveal DX/XT Medtronic, Inc.) and followed up by means of remote monitoring (CareLink®) were included. The patients were requested to transmit the data stored in the ILR every week, via the CareLink system, or more frequently during the first period. Patient acceptance of ILR was evaluated by means of a questionnaire concerning physical and mental components. Forty-seven patients (27 males, average age 64 ± 19 years) were enrolled and followed up for 20 ± 13 weeks. Thirty-two patients (68%) had at least one ECG recording of a true relevant event. The mean time from ILR implantation to the first true relevant ECG was 28 ± 49 days, which was 71 ± 17 days less than in the clinical practice of 3-monthly in-office follow-up examinations. Thirty-eight patients (81%) had at least one false arrhythmic event, mainly false asystole and false fast ventricular tachycardia. In the absence of Carelink transmission, at least one episode of memory saturation of ILR would have occurred in 21 patients (45%) that would have limited the diagnostic yield. Patient compliance was good even though one-fifth had some minor psychological concern regarding the ILR implant. CareLink was well accepted and judged easy to use. Conclusion: Remote monitoring enhances the diagnostic effectiveness of Reveal, limiting the risk of memory saturation due to the high number of false detections and reducing the time to diagnosis. Both ILR and CareLink were well accepted and well tolerated by the patients, as they were considered useful. © The Author 2010.
Gaibazzi N.,University of Parma |
Rigo F.,Ospedale dellAngelo |
Reverberi C.,University of Parma
American Journal of Cardiology | Year: 2011
We reviewed patients with normal or near-normal coronary angiograms enrolled in the SPAM contrast stress echocardiographic diagnostic study in which 400 patients with chest pain syndrome of suspected cardiac origin with a clinical indication to coronary angiography were enrolled. Patients underwent dipyridamole contrast stress echocardiography (cSE) with sequential analysis of wall motion, myocardial perfusion, and Doppler coronary flow reserve before elective coronary angiography. Ninety-six patients with normal or near-normal epicardial coronary arteries were screened for the presence of 2 prespecified findings: severely tortuous coronary arteries and myocardial bridging. Patients were divided in 2 groups based on the presence (false-positive results, n = 37) or absence (true-negative results, n = 59) of reversible myocardial perfusion defects during cSE and compared for history and clinical and angiographic characteristics. Prevalence of severely tortuous coronary arteries (35% vs 5%, p <0.001) or myocardial bridging (13% vs 2%, p <0.05) was 7 times higher in patients who demonstrated reversible perfusion defects at cSE compared to those without reversible perfusion defects. No significant differences were found between the 2 groups for the main demographic variables and risk factors. Patients in the false-positive group more frequently had a history of effort angina (p <0.001) and ST-segment depression at treadmill electrocardiography (p <0.001). In conclusion, we hypothesize that patients with a positive myocardial perfusion finding at cSE but without obstructive epicardial coronary artery disease have a decreased myocardial blood flow reserve, which may be caused by a spectrum of causes other than obstructive coronary artery disease, among which severely tortuous coronary arteries/myocardial bridging may play a significant role. © 2011 Elsevier Inc. All rights reserved.
Bassan R.,Ospedale DellAngelo
Blood | Year: 2014
In this issue of Blood, Fielding et al demonstrate a significant enhancement of long-term outcomes for a large series of adult patients with Philadelphia-positive acute lymphoblastic leukemia (Ph1 ALL), who were prospectively treated in 2 sequential cohorts with an imatinib-containing protocol. © 2014 by The American Society of Hematology.
Ortolani C.,Ospedale dellAngelo
Flow Cytometry of Hematological Malignancies | Year: 2011
Flow Cytometry of Hematological Malignancies contains an array of graphical outputs produced by the technique in the study of the most (and the least) common diseases. The images included allow you to compare your own results with a third party reference pattern. There is a detailed description of the main leukocyte antigens, together with a description of their distribution amongst normal and abnormal blood cells. The book also provides a comprehensive description of the phenotype of every neoplastic blood disease recorded in the WHO classification system, including all the instructions needed to recognise and classify even the least common entity. Designed to be practical, the book is perfect for quick consultation and is divided into two main sections. Section I deals with the direct object of immunophenotyping, and Section II deals with the ultimate target of the analysis. More than 50 antigens are covered and every antigen is dealt with in three main parts: general features, cytometric features and practical hints. This authoritative and state-of-the-art reference will be invaluable for clinicians directly involved in the diagnosis and analysis of hematological diseases, including hematologists, hematopathologists, oncologists, pathologists and technicians working in diagnostic laboratories. © 2011 Claudio Ortolani.