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San Luca, Italy

Parati G.,Ospedale San Luca | Parati G.,University of Milan Bicocca | Krakoff L.R.,Mount Sinai Medical Center | Verdecchia P.,Clinical Research Unit Preventive Cardiology
Blood Pressure Monitoring | Year: 2010

Optimization of clinic blood pressure measurement, progress in measurement of blood pressure outside the clinic, at home or in ambulatory conditions over 24h, all concur to a better management of patients with hypertension. This study is aimed at briefly summarizing a few important issues in this context, and at emphasizing the work done by Tom Pickering in this field, as a tribute to his unique contributions to medical science and patient care. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Seravalle G.,Ospedale San Luca | Grassi G.,University of Milan Bicocca
High Blood Pressure and Cardiovascular Prevention | Year: 2015

A significant number of hypertensive subjects fail to achieve adequate blood pressure control despite adherence to maximal doses of several antihypertensive drugs. In the same way although medical and device therapies continue to improve the clinical course of heart failure patients, morbidity, mortality and healthcare costs remain high. Electrical stimulation of the carotid sinus is a new interesting approach for the treatment of resistant hypertension and heart failure. The purpose of this paper is to overview the argument starting from physiological background and evaluating the clinical results obtained with this approach in these pathophysiological conditions. © 2015, Springer International Publishing Switzerland.

Andrioli M.,EndocrinologiaOggi | Persani L.,Ospedale San Luca | Persani L.,University of Milan
Endocrine | Year: 2014

Thyroid nodules are very common with malignancies accounting for about 5 %. Fine-needle biopsy is the most accurate test for thyroid cancer diagnosis. Elastography, a new technology directly evaluating the elastic property of the tissue, has been recently added to the diagnostic armamentarium of the endocrinologists as noninvasive predictor of thyroid malignancy. In this paper, we critically reviewed characteristics and applications of elastographic methods in thyroid gland. Elastographic techniques can be classified on the basis of the following: source-of-tissue compression (free-hand, carotid vibration, ultrasound pulses), processing time (real-time, off-line), stiffness expression (qualitative, semi-quantitative, or quantitative). Acoustic radiation force impulse and aixplorer shear wave are the newest and most promising quantitative elastographic methods. Primary application of elastography is the detection of nodular lesions suspicious for malignancy. Published data show a high sensitivity and negative predictive value of the technique. Insufficient data are available on the possible application of elastography in the differential diagnosis of indeterminate lesions and in thyroiditis. Elastography represents a noninvasive tool able to increase the performance of ultrasound in the selection of thyroid nodules at higher risk of malignancy. Some technical improvements and definition of more robust quantitative diagnostic criteria are required for assigning a definite role in the management of thyroid nodules and thyroiditis to elastography. © 2014 Springer Science+Business Media.

Andrioli M.,EndocrinologiaOggi | Persani L.,Ospedale San Luca | Persani L.,University of Milan
Endocrine | Year: 2014

Synchronous metastasis of renal cell carcinoma (RCC) are extremely uncommon with only few sporadic cases published in the literature and data on their elastographic appearance are lacking. Here we described a case of woman with multinodular goiter bearing a RCC metastasis, in which exhaustive ultrasonographic and qualitative elastographic evaluation were performed. The metastatic lesion presented some suspicious ultrasonographic features but was mainly "soft" at qualitative elastographic evaluation, suggesting that RCC metastasis may represent a possible pitfall for the qualitative elastographic evaluation of thyroid nodules. © 2013 Springer Science+Business Media.

Nicolini P.,University of Milan | Ciulla M.M.,University of Milan | Malfatto G.,Ospedale San Luca | Abbate C.,University of Milan | And 6 more authors.
PLoS ONE | Year: 2014

Background: Mild cognitive impairment (MCI) is set to become a major health problem with the exponential ageing of the world's population. The association between MCI and autonomic dysfunction, supported by indirect evidence and rich with clinical implications in terms of progression to dementia and increased risk of mortality and falls, has never been specifically demonstrated. Aim: To conduct a comprehensive assessment of autonomic function in subjects with MCI by means of power spectral analysis (PSA) of heart rate variability (HRV) at rest and during provocative manoeuvres. Methods: This cross-sectional study involved 80 older outpatients (aged ≥65) consecutively referred to a geriatric unit and diagnosed with MCI or normal cognition (controls) based on neuropsychological testing. PSA was performed on 5-minute electrocardiographic recordings under three conditions - supine rest with free breathing (baseline), supine rest with paced breathing at 12 breaths/minute (parasympathetic stimulation), and active standing (orthosympathetic stimulation) - with particular focus on the changes from baseline to stimulation of indices of sympathovagal balance: normalized low frequency (LFn) and high frequency (HFn) powers and the LF/HF ratio. Blood pressure (BP) was measured at baseline and during standing. Given its exploratory nature in a clinical population the study included subjects on medications with a potential to affect HRV. Results: There were no significant differences in HRV indices between the two groups at baseline. MCI subjects exhibited smaller physiological changes in all three HRV indices during active standing, consistently with a dysfunction of the orthosympathetic system. Systolic BP after 10 minutes of standing was lower in MCI subjects, suggesting dysautonomia-related orthostatic BP dysregulation. Conclusions: Our study is novel in providing evidence of autonomic dysfunction in MCI. This is associated with orthostatic BP dysregulation and the ongoing follow-up of the study population will determine its prognostic relevance as a predictor of adverse health outcomes. © 2014 Nicolini et al.

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