PubMed | Ospedale SantAntonio Abate, Ospedale di Bolzano., Ospedale Salesi, Ospedale Garibaldi and 47 more.
Type: Journal Article | Journal: Journal of pediatric surgery | Year: 2015
Our study aims at disclosing epidemiology and most relevant clinical features of esophageal atresia (EA) pointing to a model of multicentre collaboration.A detailed questionnaire was sent to all Italian Units of pediatric surgery in order to collect data of patients born with EA between January and December 2012. The results were crosschecked by matching date and place of birth of the patients with those of diagnosis-related group provided by the Italian Ministry of Health (MOH).A total of 146 questionnaires were returned plus a further 32 patients reported in the MOH database. Basing on a total of 178 patients with EA born in Italy in 2012, the incidence of EA was calculated in 3.33 per 10,000 live births. Antenatal diagnosis was suspected in 29.5% patients. 55.5% showed associated anomalies. The most common type of EA was Gross type C (89%). Postoperative complications occurred in 37% of type C EA and 100% of type A EA. A 9.5% mortality rate was reported.This is the first Italian cross-sectional nationwide survey on EA. We can now develop shared guidelines and provide more reliable prognostic expectations for our patients.
PubMed | Johannes Gutenberg University Mainz, University of Insubria, Ospedale Maggiore della Carita, Ospedale Civile di Livorno and Ospedale Fatebenefratelli
Type: | Journal: Internal and emergency medicine | Year: 2016
The decision concerning the introduction of primary and secondary prophylaxis of venous thromboembolism (VTE) in patients with solid brain neoplasms and brain metastases is often challenging due to the concomitant increasedrisk of intracranial hemorrhage and to limited evidence from available literature. A standardized questionnaire composed of nine multiple-choice questions regarding primary VTE prevention in non-surgical patients during high-risk conditions and VTE secondary prevention in patients with a solid brain neoplasm or cerebral metastases was sent via electronic mail to all the members (n=2420) of the Italian Federation of the Internal Medicine Hospital Executives Associations (FADOI) in June 2015. Three hundred and fifty two physicians (14.5%) returned it (participants median age 51years; females 46.9%). The majority of respondents prescribe primary thromboprophylaxis (usually with heparin) in non-surgical patients with solid brain neoplasms and brain metastases in concomitance with high-risk conditions. Full-dose anticoagulation with either low-molecular-weight heparin or fondaparinux is the preferred option for acute VTE (69.6%), while a reduced dose is chosen by 21.0% of physicians. The presence of a highly vascular brain neoplasm histotype mandates the prescription of a reduced-dose antithrombotic regimen in a minority of respondents. Vena cava filter placement is an option for the treatment of acute VTE in more than 6% of respondents. Anticoagulants are often prescribed for both VTE primary prevention and treatment. In conclusion, physicians managements are partially in contrast to recent guidelines, reinforcing the need for educational programs and other studies in this setting.
PubMed | Ospedali Riuniti, Ospedale Santa Corona, Ospedale Maria Vittoria, Ospedale Civico and 8 more.
Type: Journal Article | Journal: Indian pacing and electrophysiology journal | Year: 2016
AtrioVentricular (AV) and InterVentricular (VV) delay optimization can improve ventricular function in Cardiac Resynchronization Therapy (CRT) and is usually performed by means of echocardiography. St Jude Medical has developed an automated algorhythm which calculates the optimal AV and VV delays (QuickOpt) based on Intracardiac ElectroGrams, (IEGM), within 2min. So far, the efficacy of the algorhythm has been tested acutely with standard lead position at right ventricular (RV) apex. Aim of this project is to evaluate the algorhythm performance in the mid- and long-term with RV lead located in mid-septum.AV and VV delays optimization data were collected in 13 centers using both echocardiographic and QuickOpt guidance in CRTD implanted patients provided with this algorhythm. Measurements of the aortic Velocity Time Integral (aVTI) were performed with both methods in a random order at pre-discharge, 6-month and 12-month follow-up.Fifty-three patients were studied (46 males; age 6810y; EF 287%). Maximum aVTI obtained by echocardiography at different AV delays, were compared with aVTI acquired at AV delays suggested by QuickOpt. The AV Pearson correlations were 0.96at pre-discharge, 0.95 and 0,98at 6- and 12- month follow-up respectively. After programming optimal AV, the same approach was used to compare echocardiographic aVTI with aVTI corresponding to the VV values provided by QuickOpt. The VV Pearson Correlation were 0,92at pre-discharge, 0,88 and 0.90at 6-month and 12- month follow-up respectively.IEGM-based optimization provides comparable results with echocardiographic method (maximum aVTI) used as reference with mid-septum RV lead location.
Moya A.,Autonomous University of Barcelona |
Garcia-Civera R.,Hospital Clynico |
Croci F.,Arrhythmologic Center |
Menozzi C.,Arcispedale Santa Maria Nuova |
And 7 more authors.
European Heart Journal | Year: 2011
AimsAlthough patients with syncope and bundle branch block (BBB) are at high risk of developing atrio-ventricular block, syncope may be due to other aetiologies. We performed a prospective, observational study of the clinical outcomes of patients with syncope and BBB following a systematic diagnostic approach.Methods and resultsPatients with <1 syncope in the last 6 months, with QRS duration <120 ms, were prospectively studied following a three-phase diagnostic strategy: Phase I, initial evaluation; Phase II, electrophysiological study (EPS); and Phase III, insertion of an implantable loop recorder (ILR). Overall, 323 patients (left ventricular ejection fraction 56 ± 12) were studied. The aetiological diagnosis was established in 267 (82.7) patients (102 at initial evaluation, 113 upon EPS, and 52 upon ILR) with the following aetiologies: bradyarrhythmia (202), carotid sinus syndrome (20), ventricular tachycardia (18), neurally mediated (9), orthostatic hypotension (4), drug-induced (3), secondary to cardiopulmonary disease (2), supraventricular tachycardia (1), bradycardiatachycardia (1), and non-arrhythmic (7). A pacemaker was implanted in 220 (68.1), an implantable cardioverter defibrillator in 19 (5.8), and radiofrequency catheter ablation was performed in 3 patients. Twenty patients (6) had died at an average follow-up of 19.2 ± 8.2 months.ConclusionIn patients with syncope, BBB, and mean left ventricular ejection fraction of 56 ± 12, a systematic diagnostic approach achieves a high rate of aetiological diagnosis and allows to select specific treatment. © 2010 The Author.
Brignole M.,Arrhythmologic Center |
Occhetta E.,Ospedale Maggiore della Carita |
Bongiorni M.G.,Ospedale Cisanello |
Proclemer A.,Ospedale Santa Maria della Misericordia |
And 15 more authors.
Journal of the American College of Cardiology | Year: 2012
Objectives: The purpose of this study is to assess the effectiveness of defibrillation testing (DT) in patients undergoing implantable cardioverter-defibrillator (ICD) insertion. Background: Although DT is considered a standard procedure during ICD implantation, its usefulness has not been definitively proven. Methods: The SAFE-ICD (Safety of Two Strategies of ICD Management at Implantation) study is a prospective observational study designed to evaluate the outcome of 2 strategies: performing defibrillation testing (DT+) versus not performing defibrillation testing (DT-) during de novo ICD implants. No deviation from the centers' current practice was introduced. In all, 2,120 consecutive patients (836 DT+ and 1,284 DT-) age <18 years were enrolled at 41 Italian centers from April 2008 to May 2009 and followed up for 24 months until June 2011. The primary endpoint was a composite of severe complications at ICD implant and sudden cardiac death or resuscitation at 2 years. Results: The primary endpoint occurred in 34 patients: 12 intraoperative complications (8 in DT+ group; 4 in DT- group) and 22 during follow-up (10 in DT+ group; 12 in DT- group). Overall, the estimated yearly incidence (95% confidence interval) was DT+ 1.15% (0.73 to 1.83) and DT- 0.68% (0.42 to 1.12). The difference between the 2 groups was negligible: 0.47% per year (-0.15 to 1.10). Mortality from any cause was similar at 2 years (adjusted hazard ratio: 0.97 [0.76 to 1.23], p = 0.80). Conclusions: In this large cohort of new ICD implants, event rates were similar and extremely low in both groups. These data indicate a limited clinical relevance for DT testing, thus supporting a strategy of omitting DT during an ICD implant. (Safety of Two Strategies of ICD Management at Implantation [SAFE-ICD]; NCT00661037) © 2012 American College of Cardiology Foundation.
PubMed | Qatar University, University of Genoa, Ospedale Maggiore della Carita, University Sidi Mohammed Ben Abdellah and Qatar Orthopaedic and Sports Medicine Hospital
Type: | Journal: Frontiers in oncology | Year: 2016
Ramadan fasting represents one of the five pillars of the Islam creed. Even though some subjects (among which patients) are exempted from observing this religious duty, they may be eager to share this particular moment of the year with their family and peers. However, there are no guidelines or standardized protocols that can help physicians to properly address the issue of patients with cancer fasting in Ramadan and correctly advising them. Moreover, in a more interconnected and globalized society, in which more and more Muslim patients live in the Western countries, this topic is of high interest also for the general practitioner. For this purpose, we carried out a systematic review on the subject. Our main findings are that (1) very few studies have been carried out, addressing this issue, (2) evidence concerning quality of life and compliance to treatment is contrasting and scarce, and (3) generally speaking, few patients ask their physicians whether they can safely fast or not. For these reasons, further research should be performed, given the relevance and importance of this topic.
PubMed | Instituto Giannina Gaslini, Ospedale Maggiore della Carita and V Buzzi Childrens Hospital
Type: Journal Article | Journal: European radiology | Year: 2016
Prenatal features of isolated cerebellar haemorrhagic lesions have not been sufficiently characterised. We aimed to better define their MR imaging characteristics, documenting the location, extension, evolution stage and anatomic sequelae, and to better understand cerebellar haemorrhage pathophysiology.We screened our foetal MR imaging database (3200 cases) for reports of haemorrhagic lesions affecting only the cerebellum (without any supratentorial bleeding or other clastic lesions), defined as one of the following: T2-weighted hypointense or mixed hypo-/hyperintense signal; rim of T2-weighted hypointense signal covering the surface of volume-reduced parenchyma; T1-weighted hyperintensesignal; increased DWI signal.Seventeen cases corresponded to the selection criteria. All lesions occurred before the 26th week of gestation, with prevalent origin from the peripheral-caudal portion of the hemispheres and equal frequency of unilateral/bilateral involvement. The caudal vermis appeared affected in 2/3 of cases, not in all cases confirmed postnatally. Lesions evolved towards malformed cerebellar foliation. The aetiology and pathophysiology were unknown, although in a subset of cases intra- and extracranial venous engorgement seemed to play a key role.Onset from the peripheral and caudal portion of the hemispheres seems characteristic of prenatal cerebellar haemorrhagic lesions. Elective involvement of the peripheral germinal matrix is hypothesised. The cerebellum can be vulnerable to bleeding during foetal development. Isolated cerebellar haemorrhages can be seen on prenatal MRI. In our cohort, isolated foetal cerebellar haemorrhages occurred before the 26th gestational week. Haemorrhagic lesions happening in utero could look like malformations on post-natal MRI. Venous engorgement could have a role in causing cerebellar haemorrhagic lesions.
Boldorini R.,University of Piemonte Orientale |
Allegrini S.,University of Piemonte Orientale |
Miglio U.,University of Piemonte Orientale |
Nestasio I.,University of Piemonte Orientale |
And 4 more authors.
Journal of Medical Virology | Year: 2010
Given the conflicting results of the few published studies, the aim of this retrospective molecular-based study of 10 aborted fetuses that underwent complete autopsy and 10 placentas was carried out to determine whether BK polyomavirus (BKV) can be transmitted transplacentally. The interruption of pregnancy was due to a miscarriage (five cases) or a prenatal diagnosis of severe intrauterine malformations (five cases). Samples from the brain, heart, lung, thymus, liver, and kidney were taken from each fetus, and two samples were obtained from all of the placentas. The presence of BKV was investigated by means of PCR using primers specific for the transcription control region (TCR) and viral capsidic protein 1 (VP1) and DNA extracted from formalin-fixed, paraffin-embedded tissue. BKV genome was detected in 22 of 60 samples (36.6%) from seven fetuses (70%), regardless of the cause of abortion: VP1 was amplified in 12 samples (54%), TCR in seven (32%), and both in three (14%). VP1 was also detected in one placental sample. BKV sequences were most frequently detected in heart and lung (five cases), but sequence analyses of TCR and VP1 revealed a high degree of genomic variability among the samples taken from different organs and the placenta. These results indicate that BKV can cross the placenta during pregnancy and become latent in fetal organs other than the kidney and brain (previously considered the main targets of BKV latency). This may happen in early pregnancy and does not seem to be associated with an increased risk of abortion. J. Med. Virol. 82:2127-2132, 2010. © 2010 Wiley-Liss, Inc.
PubMed | Imperial College London, Ospedale Maggiore della Carita and University of Piemonte Orientale
Type: Journal Article | Journal: Internal and emergency medicine | Year: 2016
Compliance with validated guidelines is crucial to guide management of patients hospitalized with community-acquired pneumonia (CAP). Data describing real-life management and treatment of CAP are limited. We aimed to evaluate the compliance with guidelines over time, and to assess its impact on all-cause mortality and clinical outcomes. We retrospectively compared two cohorts of patients admitted to the hospital, throughout 2005, just after the implementation of a local clinical pathway based on CAP international guidelines, and 7years later over 2012. We included all patients with a diagnosis of pneumonia and/or related complications. 564 patients were included. The Pneumonia Severity Index calculation was better documented in 2012 (25.23%) compared to 2005 (17.70%; p=0.032), but compliance with guideline empirical antibiotic therapy was lower in 2012 (56.70%) than in 2005 (68.75%; p=0.004). Performance of guideline recommended urinary antigen tests was higher in 2012, and associated with 57.3% lower odds of in-hospital mortality (95% CI 15.0-78.5%) and with 65.9% lower odds of 30-day mortality (95% CI 31.5-83.0%). Compliance with empirical antibiotic therapy was associated with 2.9days lower mean length of hospital stay (95% CI -4.2 to -1.6days) and with 2.0days lower mean duration of antibiotic therapy (95% CI -3.3 to -0.7days). Compliance with guidelines changed over time, with some effects on mortality and with an apparent reduction in the length of hospital stay and the duration of antibiotic therapy. Specific clinical training and hospital control policies could achieve greater compliance with guidelines, and thus reduce a burden on hospital services.