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Gaziev G.,University of Rome Tor Vergata | Topazio L.,University of Rome Tor Vergata | Iacovelli V.,University of Rome Tor Vergata | Asimakopoulos A.,Policlinico Casilino | And 3 more authors.
BMC Urology | Year: 2013

Background: Percutaneous Tibial Nerve Stimulation (PTNS) has been proposed for the treatment of overactive bladder syndrome (OAB), non-obstructive urinary retention (NOUR), neurogenic bladder, paediatric voiding dysfunction and chronic pelvic pain/painful bladder syndrome (CPP/PBS). Despite a number of publications produced in the last ten years, the role of PTNS in urinary tract dysfunctions remains unclear. A systematic review of the papers on PTNS has been performed with the aim to better clarify potentialities and limits of this technique in the treatment of OAB syndrome and in other above mentioned urological conditions. Methods. A literature search using MEDLINE and ISI web was performed. Search terms used were "tibial nerve" and each of the already mentioned conditions, with no time limits. An evaluation of level of evidence for each paper was performed. Results: PTNS was found to be effective in 37-100% of patients with OAB, in 41-100% of patients with NOUR and in up to 100% of patients with CPP/PBS, children with OAB/dysfunctional voiding and patients with neurogenic pathologies. No major complications have been reported.Randomized controlled trials are available only for OAB (4 studies) and CPP/PBS (2 studies). Level 1 evidence of PTNS efficacy for OAB is available. Promising results, to be confirmed by randomized controlled studies, have been obtained in the remaining indications considered. Conclusions: PTNS is an effective and safe option to treat OAB patients. Further studies are needed to assess the role of PTNS in the remaining indications and to evaluate the long term durability of the treatment. Further research is needed to address several unanswered questions about PTNS. © 2013 Gaziev et al.; licensee BioMed Central Ltd.


Romagnoli E.,Policlinico Casilino | Biondi-Zoccai G.,University of Rome La Sapienza | Sciahbasi A.,Policlinico Casilino | Politi L.,Meta Analysis and Evidence based Medicine Training in Cardiology | And 12 more authors.
Journal of the American College of Cardiology | Year: 2012

Objectives: The purpose of this study was to assess whether transradial access for ST-segment elevation acute coronary syndrome undergoing early invasive treatment is associated with better outcome compared with conventional transfemoral access. Background: In patients with acute coronary syndrome, bleeding is a significant predictor of worse outcome. Access site complications represent a significant source of bleeding for those patients undergoing revascularization, especially when femoral access is used. Methods: The RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) was a multicenter, randomized, parallel-group study. Between January 2009 and July 2011, 1,001 acute ST-segment elevation acute coronary syndrome patients undergoing primary/rescue percutaneous coronary intervention were randomized to the radial (500) or femoral (501) approach at 4 high-volume centers. The primary endpoint was the 30-day rate of net adverse clinical events (NACEs), defined as a composite of cardiac death, stroke, myocardial infarction, target lesion revascularization, and bleeding). Individual components of NACEs and length of hospital stay were secondary endpoints. Results: The primary endpoint of 30-day NACEs occurred in 68 patients (13.6%) in the radial arm and 105 patients (21.0%) in the femoral arm (p = 0.003). In particular, compared with femoral, radial access was associated with significantly lower rates of cardiac mortality (5.2% vs. 9.2%, p = 0.020), bleeding (7.8% vs. 12.2%, p = 0.026), and shorter hospital stay (5 days first to third quartile range, 4 to 7 days] vs. 6 [range, 5 to 8 days]; p = 0.03). Conclusions: Radial access in patients with ST-segment elevation acute coronary syndrome is associated with significant clinical benefits, in terms of both lower morbidity and cardiac mortality. Thus, it should become the recommended approach in these patients, provided adequate operator and center expertise is present. (Radial Versus Femoral Investigation in ST Elevation Acute Coronary Syndrome [RIFLE-STEACS]; NCT01420614) © 2012 American College of Cardiology Foundation.


Mazza M.,Catholic University | Lotrionte M.,Catholic University | Biondi-Zoccai G.,University of Turin | Abbate A.,Virginia Commonwealth University | And 2 more authors.
Journal of Psychopharmacology | Year: 2010

Depression is an independent negative prognostic factor in patients with acute coronary syndromes (ACS), yet it is unclear if its treatment is beneficial after ACS. We sought to compare, through a meta-analytic process, antidepressant therapy with selective serotonin reuptake inhibitors (SSRIs) versus control treatment in patients with recent ACS. BioMedCentral, CENTRAL, ISI Web of Science, PsycInfo, and PubMed were searched for pertinent studies (November 2008). We selected studies with randomized allocation to antidepressant drug versus control in patients with acute or recent ACS reported as intention-to-treat. Exclusion criteria were: duplicate publication, regimen of antidepressant drug <4 weeks, follow-up <6 weeks or incomplete follow up, or a lack of clear/reproducible results. Changes from the baseline to the follow-up in depression score, major adverse cardiac events (MACE - including death, myocardial infarction, and repeat revascularization), and hospitalizations were pooled with random or fixed-effect methods. Five randomized trials (801 patients) were included. Fifteen studies were excluded because they were unpublished, ongoing, or duplicates. Subjects treated with antidepressant medications did not show, after a median of six months, a significant improvement in depression symptoms, although there was a trend for a reduction in depression scores. Besides, subjects treated with antidepressant medications showed a significantly lower rate of re-hospitalizations from all causes (risk difference (RD) = 14% (95% confidence interval: 5-23%), p = 0.001). Therapy with antidepressants was notably safe, with similar rates of adverse events, including MACE, death, myocardial infarction, or repeat revascularization (all p > 0.05). Treatment with SSRIs in patients recovering from ACS is associated with significant lower re-hospitalization rates. These data suggest that antidepressant therapy with SSRIs, given its efficacy and safety, should be routinely considered in patients with a recent ACS and depression symptoms. © The Author(s) 2010.


Biondi-Zoccai G.,University of Rome La Sapienza | Lotrionte M.,Heart Failure and Cardiac Rehabilitation Unit | Thomsen H.S.,Copenhagen University | Romagnoli E.,Policlinico Casilino | And 3 more authors.
International Journal of Cardiology | Year: 2014

Background/objectives Contrast-induced nephropathy (CIN) may be a severe complication to the administration of iodine-based contrast media for diagnostic or interventional procedure using radiation exposure. Whether there is a difference in nephrotoxic potential between the various agents is uncertain. We aimed to perform a systematic review and network meta-analysis of randomized trials on iodine-based contrast agents. Methods Randomized trials of low-osmolar or iso-osmolar contrast media were searched in CENTRAL, Google Scholar, MEDLINE/PubMed, and Scopus. Risk of CIN was appraised within a hierarchical Bayesian model computing absolute rates (AR) and odds ratios (OR) with 95% credibility intervals, and probability of being best (Pbest) for each agent. Results A total of 42 trials (10048 patients) were included focusing on 7 different iodine-based contrast media. Risk of CIN was similarly low with iodixanol (AR = 5.7% [2.2%-13.9%], Pbest = 18.8%), iomeprol (AR = 6.0% [2.2%-15.4%], Pbest = 24.8%), iopamidol (AR = 6.1% [2.2%-15.5%], Pbest = 21.5%), and ioversol (AR = 6.0% [2.1%-16.4%], Pbest = 31.3%). Conversely, CIN was twice as common with iohexol (AR = 11.2% [4.1%-29.5%], Pbest = 0.1%) and ioxaglate (AR = 11.0% [4.0%-26.9%], Pbest < 0.1%), with both proving less safe than iodixanol (respectively OR = 2.18 [1.22-3.92] and 2.05 [1.26-3.29]), iomeprol (OR = 2.08 [1.04-4.17] and 1.96 [1.06-3.48]) and iopamidol (OR = 2.04 [1.15-3.85] and 1.92 [1.06-3.45]). Data on iopromide were less conclusive (AR = 6.9% [2.6%-17.1%], Pbest = 3.6%). Conclusions Iodixanol, iomeprol, iopamidol and ioversol are iodine-based contrast media with a similar renal safety profile. Iohexol and ioxaglate have a poorer renal safety profile, whereas further data may be required on iopromide. © 2014 Elsevier Ireland Ltd.


Dragoni M.,University of Iowa | Heiner A.D.,University of Iowa | Costa S.,Ospedale San Giovanni Calibita Fatebenefratelli | Gabrielli A.,Policlinico Casilino | Weinstein S.L.,University of Iowa
Journal of Pediatric Orthopaedics | Year: 2012

Background: The initial goals of the treatment of slipped capital femoral epiphysis (SCFE) are to stabilize the epiphysis, prevent slip progression, and avoid complications. In situ fixation with a single screw is the most accepted procedure to provide an optimal fixation, but fixation failure and slip progression suggest that the procedure might be improved. The aim of the present study was to biomechanically compare partially threaded screws (16 mm and 32 mm) and fully threaded screws in an in vitro porcine model. Methods: An unstable/acute SCFE was created in 18 skeletally immature porcine femurs through a type 1 Salter-Harris fracture. Each femur was fixed using a 6.5-mm stainless-steel cannulated screw inserted through the physis under fluoroscopic guidance. The screw was either 16 mm threaded, 32 mm threaded, or fully threaded (n=6 each group). Each specimen was cyclically tested to failure fixation by anterior-to-posterior loading through the femoral head. Results: No significant difference was detected between the Newton cycles to failure of the 3 screw-thread groups. The 16-mm threaded group had the highest frequency of femoral neck failure. Conclusions: The 16-mm threaded screws had the highest rate of neck failure and did not demonstrate additional fixation stability over the 32-mm threaded and fully threaded screws. As femoral neck fracture is a rare but devastating complication in pediatric patients, clinical use of the 32-mm threaded and fully threaded screws may be indicated in SCFE fixation. CLINICAL RELEVANCE: The use of 32-mm or fully threaded screws is a valid SCFE treatment option. The increased number of threads in the metaphysis with these screws may confer additional biomechanical strength to the femoral neck. © 2012 by Lippincott Williams & Wilkins.


Calo L.,Policlinico Casilino | Rebecchi M.,Policlinico Casilino | Sciarra L.,Policlinico Casilino | De Luca L.,Policlinico Casilino | And 7 more authors.
Circulation: Arrhythmia and Electrophysiology | Year: 2012

Background-Catheter ablation of ganglionated plexi (GP) in the left atrium has been proposed in different subgroup of patients with atrial fibrillation (AF). Anatomic studies found a high prevalence of GP in the posterior surface of the right atrium (RA). Experimental data suggested the potential role of right atrial GP in the AF initiation and maintenance. The aim of our study was to assess the efficacy of GP ablation in RA in patients with vagal AF. Methods and Results-Thirty-four patients without structural heart diseases were randomly assigned for a selective ablation procedure targeted on the elimination of vagal reflex evoked by high frequency stimulation or an extensive approach at anatomic sites of GP. All patients underwent Holter ECG and heart rate variability evaluation at baseline and at 3, 6, 12, and 18 months of follow-up. At a mean follow-up of 19.7±5.2 months, AF recurred in 5 of 17 patients with anatomic ablation and in 13 of 17 patients with a selective approach (P=0.01). No patient had major complications. After ablation, heart rate variability parameters showed a significant parasympathetic (and sympathetic) denervation in the first 6 months, which was more prominent in patients with anatomic GP ablation and in those without AF recurrence. Conclusions-This study demonstrates that in a selected population of vagal paroxysmal AF, the anatomic ablation of GPs in the RA is effective in about 70% of patients. These results confirm that atrial vagal denervation can abolish AF, as suggested by experimental and clinical data. © 2012 American Heart Association, Inc.


Sette A.,Policlinico Casilino | Martino A.,Policlinico Casilino | Lioy E.,Policlinico Casilino | Calo L.,Policlinico Casilino
Journal of Cardiovascular Electrophysiology | Year: 2010

Ivabradine in IST. We present a case of a 49-year-old man with inappropriate sinus tachycardia and ventricular dysfunction. The conventional treatment (ace-inhibitor and beta-blockers) was not well tolerated by the patient, so Ivabradine, a specific inhibitor of If current in the sinus node, was started. After 3 months of using this medication, we observed an improvement of ejection fraction and quality of life. © 2010 Wiley Periodicals, Inc.


Summaria F.,Interventional Cardiology | Romagnoli E.,Interventional Cardiology | Preziosi P.,Policlinico Casilino
Journal of Cardiovascular Medicine | Year: 2012

Site of access vascular complications is infrequent after transradial interventions. We report the case of a 66-year-old man referred to our hospital because of right forearm swelling, oedema and pain with functional forearm disability, 1 year after a transradial primary percutaneous coronary intervention (PCI). The diagnostic and procedural issues are discussed. This is the first description of a successful and well-tolerated radial arteriovenous fistula (AVF) treatment by means of percutaneous antegrade approach with the use of a short introducer and a biocompatible covered stent. © 2011 Italian Federation of Cardiology.


Coronary artery ectasia (CAE) is frequently considered an incidental finding during coronary angiography, however, several reports have shown an association with myocardial ischemia and infarction. When acute myocardial infarction (AMI) occurs in cases of CAE, current reperfusion therapies, due to the large arterial size and the massive intracoronary thrombus, when used alone are limited in preventing the development of distal embolization and 'no reflow phenomenon.' In this article, we described the case of a multiple sclerosis (MS) patient with diffuse CAE and ST elevation AMI, treated by coronary dethrombosis multistrategy (mechanical and pharmacologic) during a transradial primary angioplasty. The higher thrombotic burden in MS with CAE was analyzed and possible common pathophysiologic pathways were discovered in the imbalance between proteolytic activities of metalloproteinases and endogenous tissue inhibitor, with subsequent increased proteolysis leading to a risk for coronary plaque rupture. The one-year clinical and angiographic follow-up with coronary computed tomography (CT) angiography, together with long-term antiplatelet therapy, was also evaluated.


Cesaroni A.,Policlinico Casilino | Nardi P.V.,Policlinico Casilino
European Spine Journal | Year: 2010

Prospective case series studies have shown that plasma disc decompression (PDD) using the COBLATION SpineWand device (ArthroCare Corporation, Austin, TX) is effective for decompressing the disc nucleus in symptomatic contained cervical disc herniations. This prospective, randomized controlled clinical trial was conducted to evaluate the clinical outcomes of percutaneous PDD as compared to conservative care (CC) through 1 year. Patients (n = 115) had neck/arm pain >50 on the visual analog scale (VAS) pain scale and had failed at least 30 days of failed CC. Patients were randomly assigned to receive either PDD (n = 62) or CC (n = 58). Clinical outcome was determined by VAS pain score, neck disability index (NDI) score, and SF-36 health survey, collected at 6 weeks, 3 months, 6 months, and 1 year. The PDD group had significantly lower VAS pain scores at all follow-up time points (PDD vs. CC: 6 weeks, -46.87 ± 2.71 vs. -15.26 ± 1.97; 3 months, -53.16 ± 2.74 vs. -30.45 ± 2.59; 6 months, -56.22 ± 2.63 vs. -40.26 ± 2.56; 1 year, -65.73 ± 2.24 vs. -36.45 ± 2.86; GEE, P < 0.0001). PDD patients also had significant NDI score improvement over baseline when compared to CC patients at the 6 weeks (PDD vs. CC: -9.15 ± 1.06 vs. -4.61 ± 0.53, P < 0.0001) and 1 year (PDD vs. CC: -16.70 ± 0.29 vs. -12.40 ± 1.26, P = 0.005) follow-ups. PDD patients showed statistically significant improvement over baseline in SF-36 physical component summary scores when compared to CC patients at 6 weeks and 1 year (PDD vs. CC: 8.86 + 8.04 vs. 4.24 ± 3.79, P = 0.0004; 17.64 ± 10.37 vs. 10.50 ± 10.6, P = 0.0003, respectively). In patients who had neck/arm pain due to a contained cervical disc herniation, PDD was associated with significantly better clinical outcomes than a CC regimen. At 1 year, CC patients appeared to suffer a "relapse, showing signs of decline in most measurements, whereas PDD patients showed continued stable improvement. © 2009 Springer-Verlag.

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