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Pittiruti M.,Policlinico Universitario Agemelli | Bertollo D.,Ospedale Civile di Varese | Buononato M.,Ospedali Riuniti di Cremona | Capozzoli G.,Ospedale Civile di Bolzano | And 4 more authors.
Journal of Vascular Access | Year: 2012

Purpose: The aim of this multicenter study was to assess the feasibility, safety, and accuracy of the intracavitary ECG method for real-time positioning of the tip of different types of central venous catheters. Methods: A total of 1444 catheter insertions in adult patients were studied in eight Italian centers (539 ports, 245 PICCs, 325 tunneled CVCs, 335 non-tunneled CVCs). Patients with no visible P wave at the standard baseline ECG were excluded. Depending on the type of catheter and its purpose, the target was to position the tip either (a) at the cavo-atrial junction, or (b) in the lower third of the superior vena cava, or (c) in the upper part of the atrium. The final position was verified by a post-procedural chest x-ray. Results: The method was feasible in 99.3% of all cases. There were no complications potentially related to the method itself. At the final x-ray control, 83% of all tips were positioned exactly at the target; 12.4% were positioned within 1-2 cm from the target, but still in a correct central position; only 3.8% were malpositioned. The mismatch between intra-procedural ECG method and post-procedural x-ray was significantly lower when the x-ray was taken in supine position. Conclusions: Our multicenter study confirms that the intracavitary ECG method for real time verification of tip position is accurate, safe, feasible in all adult patients and applicable to any type of short-term or long-term central venous access device. © 2012 Wichtig Editore.

Valentini V.,Policlinico Universitario Agemelli | Massaccesi M.,Policlinico Universitario Agemelli | Balducci M.,Policlinico Universitario Agemelli | Mantini G.,Policlinico Universitario Agemelli | And 7 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2010

Background and Purpose: In vitro radiation doses of below 0.5 Gy have been shown to be more effective than higher doses per unit dose in killing clonogenic cells of many epithelial tumor cell lines. This phenomenon is known as low-dose hyperradiosensitivity. Preclinical studies have now suggested that there is synergism between chemotherapy and low-dose fractionated radiotherapy (LD-FRT). To test the clinical efficacy of this approach, we prospectively evaluated concurrent palliative chemotherapy and LD-FRT in patients with various types of epithelial tumors. Methods and Materials: Patients suffering from relapses or metastases of epithelial tumors were scheduled to receive concurrent LD-FRT (two fractions of 0.4 Gy per day) and chemotherapy. Radiologic assessments were performed after three cycles of chemotherapy plus LD-FRT. Results: Between June 2006 and October 2007, 12 patients with lung cancer, 7 patients with head-and-neck tumors, 2 patients with breast cancer, and 1 patient with esophageal carcinoma, for a total patient population of 22, underwent concomitant LD-FRT and chemotherapy. All patients but 3 (86%) had received previous treatments for their cancer. The median total dose of LD-FRT delivered was 800 cGy (range, 320-1280 cGy). The overall response rate was 45% (42% in previously treated patients). Grade 3-4 hematologic toxicities (Radiation Therapy Oncology Group ratings) were observed in 2 patients. At a median follow-up of 6.5 months, however, no local toxicity was observed. Conclusion: In our experience, concurrent LD-FRT and chemotherapy was well tolerated. Because the response rate seems promising, prospective Phase II studies of the strategy are now under way. © 2010 Elsevier Inc. All rights reserved.

PubMed | Policlinico Universitario Agemelli
Type: Comparative Study | Journal: Giornale italiano di cardiologia (2006) | Year: 2012

Ischemic heart disease (IHD) is the leading cause of death in women as in men. Several disease mechanisms, however, differ between genders. Women with IHD more frequently than men have normal or non-obstructive epicardial arteries, plaque erosion, spontaneous coronary dissection, microvascular dysfunction, stress cardiomyopathy, and heart rupture after acute infarction. Compared to men, IHD presents 7-10 years later with a heavier burden of cardiovascular risk factors, even after correction for age. The typical woman with IHD is old and frail, with comorbidities such as renal failure. Another vulnerable group comprises those with acute coronary syndromes before the age of 60 in whom hospital mortality is reported to be almost twice that of age-matched men. Such vulnerabilities in women, in apparent contrast with the delayed onset and lesser extent of epicardial atherosclerosis, may be attributable to biases in prevention, presentation, diagnosis and treatment of female IHD, but also to gender-related differences in disease mechanisms.

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