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Osorio J, Zei PC, Díaz JC, Varley AL, Morales GX, Silverstein JR, Oza SR, D'Souza B, Singh D, Moretta A, Metzl MD, Hoyos C, Matos CD, Rivera E, Magnano A, Salam T, Nazari J, Thorne C, Costea A, Thosani A, Rajendra A, Romero JE. High-Frequency Low-Tidal Volume Ventilation Improves Long-Term Outcomes in AF Ablation: A Multicenter Prospective Study. JACC Clin Electrophysiol 2023; 9:1543-1554. [PMID: 37294263 DOI: 10.1016/j.jacep.2023.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND High-frequency, low-tidal-volume (HFLTV) ventilation is a safe and simple strategy to improve catheter stability and first-pass isolation during pulmonary vein (PV) isolation. However, the impact of this technique on long-term clinical outcomes has not been determined. OBJECTIVES This study sought to assess acute and long-term outcomes of HFLTV ventilation compared with standard ventilation (SV) during radiofrequency (RF) ablation of paroxysmal atrial fibrillation (PAF). METHODS In this prospective multicenter registry (REAL-AF), patients undergoing PAF ablation using either HFLTV or SV were included. The primary outcome was freedom from all-atrial arrhythmia at 12 months. Secondary outcomes included procedural characteristics, AF-related symptoms, and hospitalizations at 12 months. RESULTS A total of 661 patients were included. Compared with those in the SV group, patients in the HFLTV group had shorter procedural (66 [IQR: 51-88] minutes vs 80 [IQR: 61-110] minutes; P < 0.001), total RF (13.5 [IQR: 10-19] minutes vs 19.9 [IQR: 14.7-26.9] minutes; P < 0.001), and PV RF (11.1 [IQR: 8.8-14] minutes vs 15.3 [IQR: 12.4-20.4] minutes; P < 0.001) times. First-pass PV isolation was higher in the HFLTV group (66.6% vs 63.8%; P = 0.036). At 12 months, 185 of 216 (85.6%) in the HFLTV group were free from all-atrial arrhythmia, compared with 353 of 445 (79.3%) patients in the SV group (P = 0.041). HLTV was associated with a 6.3% absolute reduction in all-atrial arrhythmia recurrence, lower rate of AF-related symptoms (12.5% vs 18.9%; P = 0.046), and hospitalizations (1.4% vs 4.7%; P = 0.043). There was no significant difference in the rate of complications. CONCLUSIONS HFLTV ventilation during catheter ablation of PAF improved freedom from all-atrial arrhythmia recurrence, AF-related symptoms, and AF-related hospitalizations with shorter procedural times.
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Affiliation(s)
- Jose Osorio
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Juan C Díaz
- Cardiac Arrhythmia Center, Division of Cardiology, Clinica Las Vegas, Universidad CES, Medellín, Colombia
| | - Allyson L Varley
- Heart Rhythm Clinical and Research Solutions, Birmingham, Alabama, USA
| | | | | | - Saumil R Oza
- Ascension Medical Group, St Vincent's Cardiology, Jacksonville, Florida, USA
| | - Benjamin D'Souza
- Penn Heart and Vascular Center Cherry Hill, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - David Singh
- The Queens Medical Center, Honolulu, Hawaii, USA
| | | | - Mark D Metzl
- Cardiovascular Institute, NorthShore University Health System, Northbrook, Illinois, USA
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Estefania Rivera
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Tariq Salam
- MultiCare Pulse Heart Institute, Tacoma, Washington, USA
| | - Jose Nazari
- Cardiovascular Institute, NorthShore University Health System, Northbrook, Illinois, USA
| | | | - Alexandru Costea
- Center for Electrophysiology, Rhythm Disorders and Electro-Mechanical Interventions, UC Heart, Lung, and Vascular Institute, Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, Ohio, USA
| | - Amit Thosani
- Cardiovascular Institute, Allegheny Health Network, Baden, Pennsylvania, USA
| | - Anil Rajendra
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Rajendra A, Osorio J, Diaz JC, Hoyos C, Rivera E, Matos CD, Costea A, Varley AL, Thorne C, Hoskins M, Goyal S, Oza S, Magnano A, D'Souza B, Silverstein J, Metzl M, Zei PC, Romero JE. Performance of the REAL-AF Same-Day Discharge Protocol in Patients Undergoing Catheter Ablation of Atrial Fibrillation. JACC Clin Electrophysiol 2023; 9:1515-1526. [PMID: 37204358 DOI: 10.1016/j.jacep.2023.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Same-day discharge (SDD) after catheter ablation of atrial fibrillation (AF) has been widely adopted. Nevertheless, planned SDD has been performed by using subjective criteria rather than standardized protocols. OBJECTIVES The goal of this study was to determine the efficacy and safety of the previously described SDD protocol in a prospective multicenter study. METHODS Using the REAL-AF (Real-world Experience of Catheter Ablation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation) SDD protocol eligibility criteria (stable anticoagulation, no bleeding history, left ventricular ejection fraction >40%, no pulmonary disease, no procedures within 60 days, and body mass index <35 kg/m2), operators prospectively determined whether patients undergoing ablation of AF were candidates for SDD (SDD vs non-SDD groups). Successful SDD was achieved if the patient met the protocol discharge criteria. The primary efficacy endpoint was the success rate of SDD. The primary safety endpoints were readmission rates as well as acute and subacute complications. The secondary endpoints included procedural characteristics and freedom from all-atrial arrhythmias. RESULTS A total of 2,332 patients were included. The REAL-AF SDD protocol identified 1,982 (85%) patients as potential candidates for SDD. The primary efficacy endpoint was achieved in 1,707 (86.1%) patients. The readmission rate for SDD vs non-SDD group was similar (0.8% vs 0.9%; P = 0.924). The SDD group had a lower acute complication rate than the non-SDD group (0.8% vs 2.9%; P < 0.001), and there was no difference in the subacute complication rate between groups (P = 0.513). Freedom from all-atrial arrhythmias was comparable between groups (P = 0.212). CONCLUSIONS In this large, multicenter prospective registry, the use of a standardized protocol showed the safety of SDD after catheter ablation of paroxysmal and persistent AF. (Real-world Experience of Catheter Ablation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation [REAL-AF]; NCT04088071).
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Affiliation(s)
- Anil Rajendra
- Arrhythmia Institute at Grandview, Grandview Medical Center, Birmingham, Alabama, USA
| | - Jose Osorio
- Arrhythmia Institute at Grandview, Grandview Medical Center, Birmingham, Alabama, USA
| | - Juan C Diaz
- Cardiac Arrhythmia and Electrophysiology Service, Clinica Las Vegas, Medellin, Colombia
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Estefanía Rivera
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandru Costea
- Heart & Vascular Institute, The Christ Hospital Medical Center, Liberty Township, Ohio, USA
| | - Allyson L Varley
- Heart Rhythm Clinical and Research Solutions, Birmingham, Alabama, USA
| | | | | | - Sandeep Goyal
- Piedmont Heart Institute Buckhead, Atlanta, Georgia, USA
| | - Saumil Oza
- Ascension Medical Group, St. Vincent's Cardiology, Jacksonville, Florida, USA
| | - Anthony Magnano
- Ascension Medical Group, St. Vincent's Cardiology, Jacksonville, Florida, USA
| | - Benjamin D'Souza
- Penn Heart and Vascular Center Cherry Hill, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Joshua Silverstein
- Electrophysiology Service, AHN Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Mark Metzl
- NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Sharma E, Varley A, Osorio J, Thorne C, Varosy P, Metzl M, Rajendra A, Oza S, Morales G, Magnano A, D'Souza B, Sackett M, Sellers M, Silva J, Silverstein J, Ho J, Hoskins M, Kuk R, Romero J, Zei PC. Procedural Trends in Catheter Ablation of Persistent Atrial Fibrillation: Insights From the Real-AF Registry. Circ Arrhythm Electrophysiol 2023:e011828. [PMID: 37254771 DOI: 10.1161/circep.123.011828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Esseim Sharma
- Brigham and Women's Hospital, Boston, MA (E.S., J.R., P.C.Z.)
| | - Allyson Varley
- Heart Rhythm Clinical and Research Solutions, LLC, Birmingham, AL (A.V., J.O., C.T.)
- Birmingham VA Health System, AL (A.V.)
| | - Jose Osorio
- Heart Rhythm Clinical and Research Solutions, LLC, Birmingham, AL (A.V., J.O., C.T.)
- Arrhythmia Institute at Grandview Medical Center, Birmingham, AL (J.O., A.R., G.M.)
| | - Christopher Thorne
- Heart Rhythm Clinical and Research Solutions, LLC, Birmingham, AL (A.V., J.O., C.T.)
| | - Paul Varosy
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (P.V.)
| | - Mark Metzl
- NorthShore University Health System, Evanston, IL (M.M.)
| | - Anil Rajendra
- Arrhythmia Institute at Grandview Medical Center, Birmingham, AL (J.O., A.R., G.M.)
| | - Saumil Oza
- Department of Cardiology, Ascension St. Vincent's Health System, Jacksonville, FL (S.O., A.M.)
| | - Gustavo Morales
- Arrhythmia Institute at Grandview Medical Center, Birmingham, AL (J.O., A.R., G.M.)
| | - Anthony Magnano
- Department of Cardiology, Ascension St. Vincent's Health System, Jacksonville, FL (S.O., A.M.)
| | - Benjamin D'Souza
- Department of Medicine, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia (B.D.)
| | - Matthew Sackett
- Centra Heart and Vascular Institute, Lynchburg, VA (M. Sackett, J. Silva, R.K.)
| | | | - Jose Silva
- Centra Heart and Vascular Institute, Lynchburg, VA (M. Sackett, J. Silva, R.K.)
| | | | - Jeffrey Ho
- Pulse Heart Institute, Tacoma, WA (J.H.)
| | | | - Richard Kuk
- Centra Heart and Vascular Institute, Lynchburg, VA (M. Sackett, J. Silva, R.K.)
| | - Jorge Romero
- Brigham and Women's Hospital, Boston, MA (E.S., J.R., P.C.Z.)
| | - Paul C Zei
- Brigham and Women's Hospital, Boston, MA (E.S., J.R., P.C.Z.)
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Varley AL, Kreidieh O, Godfrey BE, Whitmire C, Thorington S, D'Souza B, Kang S, Hebsur S, Ravindran BK, Zishiri E, Gidney B, Sellers MB, Singh D, Salam T, Metzl M, Ro A, Nazari J, Fisher WG, Costea A, Magnano A, Oza S, Morales G, Rajendra A, Silverstein J, Zei PC, Osorio J. A prospective multi-site registry of real-world experience of catheter ablation for treatment of symptomatic paroxysmal and persistent atrial fibrillation (Real-AF): design and objectives. J Interv Card Electrophysiol 2021; 62:487-494. [PMID: 34212280 PMCID: PMC8249214 DOI: 10.1007/s10840-021-01031-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022]
Abstract
Purpose Catheter ablation has become a mainstay therapy for atrial fibrillation (AF) with rapid innovation over the past decade. Variability in ablation techniques may impact efficiency, safety, and efficacy; and the ideal strategy is unknown. Real-world evidence assessing the impact of procedural variations across multiple operators may provide insight into these questions. The Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal (PAF) and Persistent (PsAF) Atrial Fibrillation registry (Real-AF) is a multicenter prospective registry that will enroll patients at high volume centers, including academic institutions and private practices, with operators performing ablations primarily with low fluoroscopy when possible. The study will also evaluate the contribution of advent in technologies and workflows to real-world clinical outcomes. Methods Patients presenting at participating centers are screened for enrollment. Data are collected at the time of procedure, 10–12 weeks, and 12 months post procedure and include patient and detailed procedural characteristics, with short and long-term outcomes. Arrhythmia recurrences are monitored through standard of care practice which includes continuous rhythm monitoring at 6 and 12 months, event monitors as needed for routine care or symptoms suggestive of recurrence, EKG performed at every visit, and interrogation of implanted device or ILR when applicable. Results Enrollment began in January 2018 with a single site. Additional sites began enrollment in October 2019. Through May 2021, 1,243 patients underwent 1,269 procedures at 13 institutions. Our goal is to enroll 4000 patients. Discussion Real-AF’s multiple data sources and detailed procedural information, emphasis on high volume operators, inclusion of low fluoroscopy operators, and use of rigorous standardized follow-up methodology allow systematic documentation of clinical outcomes associated with changes in ablation workflow and technologies over time. Timely data sharing may enable real-time quality improvements in patient care and delivery. Trial registration Clinicaltrials.gov: NCT04088071 (registration date: September 12, 2019) Supplementary Information The online version contains supplementary material available at 10.1007/s10840-021-01031-w.
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Affiliation(s)
- Allyson L Varley
- Heart Rhythm Clinical and Research Solutions, LLC, AL, Birmingham, USA.
- Birmingham VA Health System, AL, Birmingham, USA.
| | - Omar Kreidieh
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, MA, Boston, USA
| | - Brigham E Godfrey
- Heart Rhythm Clinical and Research Solutions, LLC, AL, Birmingham, USA
- Arrhythmia Institute at Grandview Medical Center, AL, Birmingham, USA
| | - Carolyn Whitmire
- Grandview Medical Group Research, Grandview Medical Center, AL, Birmingham, USA
| | - Susan Thorington
- Grandview Medical Group Research, Grandview Medical Center, AL, Birmingham, USA
| | - Benjamin D'Souza
- Department of Medicine, Penn Presbyterian Medical Center, University of Pennsylvania, PA, Philadelphia, USA
| | | | | | | | | | - Brett Gidney
- Santa Barbara Cottage Hospital, CA, Santa Barbara, USA
| | | | - David Singh
- Center for Heart Rhythm Disorders, The Queen's Medical Center, HI, Honolulu, USA
| | - Tariq Salam
- PulseHeart Institute, Multicare Health System, WA, Tacoma, USA
| | - Mark Metzl
- NorthShore University HealthSystem, IL, Evanston, USA
| | - Alex Ro
- NorthShore University HealthSystem, IL, Evanston, USA
| | - Jose Nazari
- NorthShore University HealthSystem, IL, Evanston, USA
| | | | - Alexandru Costea
- Division of Cardiovascular Health and Disease, University of Cincinnati, OH, Cincinnati, USA
| | - Anthony Magnano
- Department of Cardiology, Ascension St. Vincent's Health System, FL, Jacksonville, USA
| | - Saumil Oza
- Department of Cardiology, Ascension St. Vincent's Health System, FL, Jacksonville, USA
| | - Gustavo Morales
- Arrhythmia Institute at Grandview Medical Center, AL, Birmingham, USA
| | - Anil Rajendra
- Arrhythmia Institute at Grandview Medical Center, AL, Birmingham, USA
| | | | - Paul C Zei
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, MA, Boston, USA
| | - Jose Osorio
- Heart Rhythm Clinical and Research Solutions, LLC, AL, Birmingham, USA
- Arrhythmia Institute at Grandview Medical Center, AL, Birmingham, USA
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5
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Piccoli GB, Soragna G, Palladini G, Magnano A, Sargiotto A, Picciotto G, Terzolo M. End-stage renal failure due to amyloidosis and recurrent fever on dialysis--is there a link? Nephrol Dial Transplant 2008; 23:2419-21. [DOI: 10.1093/ndt/gfm285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Chinitz L, Pu Y, Ferrick K, Magnano A, Gururaj A, Sirulnick E, Winston S, Stahl L, Smyth-Melsky J, Whelan-Schwartz J, Burkhardt E, Zhang G, Sample R, Rapoport D. Prevalence of Complex Sleep-Disordered Breathing in CHF Patients Undergoing Cardiac Resynchronization Therapy. J Card Fail 2007. [DOI: 10.1016/j.cardfail.2007.06.706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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7
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Chinitz L, Higginbotham M, Pu Y, Ferrick K, Magnano A, Gururaj A, Sirulnick E, Winston S, Stahl L, Smyth-Melsky J, Whelan-Schwartz J, Burkhardt E, Zhang G, Sample R, Rapoport D. Impact of Cardiac Resynchronization Therapy on Complex Sleep Disordered Breathing in Heart Failure Patients. J Card Fail 2007. [DOI: 10.1016/j.cardfail.2007.06.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Piccoli GB, Picciotto G, Rossetti M, Burdese M, Consiglio V, Magnano A, Soragna G, Sargiotto G, Maas J, Guarena C, Veglio V, Messina M. Imaging data suggesting acute pyelonephritis in the kidney graft: report of five cases with atypical clinical presentation. Int J Antimicrob Agents 2006; 28 Suppl 1:S64-71. [PMID: 16854571 DOI: 10.1016/j.ijantimicag.2006.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Acute pyelonephritis is a common complication of kidney transplantation, occurring in up to 1% of grafts. Diagnosis is mainly clinical and atypical presentations have seldom been reported. The diagnostic role of imaging techniques has not been defined. Five cases of acute graft pyelonephritis are reported (three kidney, two pancreas-kidney grafts). The patients (median age 48 years) comprised three females and two males. Median post-transplant follow-up was 3 months, with three patients having predisposing factors for diabetes and one for an enteric bladder. None of the patients presented the 'classic' diagnostic tetrad (i.e. fever, positive urine cultures, low urinary tract symptoms and serum creatinine increase); although, at diagnosis, two of five patients presented with fever, one had increased creatinine levels and one had positive urine cultures. Of note, three patients had leucocyte casts at urinary sediment analysis, thus raising clinical suspicion. Renal ultrasounds were negative in all patients. Renal (99m)Tc-MAG3 (mercaptoacetyltriglycine) scintigraphy, which was used for the definition of kidney function impairment (one patient) or because of the presence of urinary casts (three patients), or after the biopsy diagnosis to locate the parenchymal lesions (one patient), was positive in all patients. The presence and pyelonephritic origin of the parenchymal lesions was confirmed by nuclear magnetic resonance or computed tomography scans. Acute graft pyelonephritis may develop in the absence of a full-blown clinical picture. Smouldering symptoms may occur in the presence of large perfusion deficits. (99m)Tc-MAG3 scintigraphy could be an important diagnostic tool in such cases.
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9
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Piccoli GB, Consiglio V, Colla L, Mesiano P, Magnano A, Burdese M, Marcuccio C, Mezza E, Veglio V, Piccoli G. Antibiotic treatment for acute 'uncomplicated' or 'primary' pyelonephritis: a systematic, 'semantic revision'. Int J Antimicrob Agents 2006; 28 Suppl 1:S49-63. [PMID: 16854569 DOI: 10.1016/j.ijantimicag.2006.05.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The definition of acute pyelonephritis is controversial. There are two contrasting approaches: (1) acute pyelonephritis is a severe infectious disease involving the kidney parenchyma, and specific imaging techniques are required for diagnosis; (2) acute pyelonephritis is a urinary tract infection, and diagnosis and therapy follow simplified clinical and laboratory pathways. In this study, recent randomized controlled trials (RCTs) were systematically reviewed and the diagnostic and therapeutic approaches to acute 'uncomplicated' pyelonephritis were analysed. Medline, Embase, Cochrane Central Register of Controlled Trials (CCTR) and Chinal were searched employing Mesh, Emtree and free terms on 'pyelonephritis'. Limits included human, period (1995-2004), and trials-reviews (where available). In total, 904 references and 175 full-text were retrieved; 29 were pertinent RCTs. Seven RCTs were added from reference lists (indexed on urinary tract infections). Imaging examinations were performed in 11 of 14 studies on children (diagnostic requisite in two) and in two studies on adults; scarring was not analysed in adults. Clinical definitions varied widely (fever >37.8 to >39 degrees C, culture titres 10(4) >10(5)). Studies on adults were limited to short-term end-points (microbiological sterilization, clinical improvement). Duration of therapy was 4-20 days. The trend was towards shorter periods of therapy, mainly on an outpatient basis; intravenous therapy, if performed, was usually limited to the first 1-3 days. For acute uncomplicated pyelonephritis, the tendency is towards 2 weeks of mainly oral antibiotic therapy. However, the recent literature on adults does not discriminate among different upper urinary tract infections nor does it provide data on renal scarring. While cost constraints point towards short-term therapies, further studies are needed to assess the prevalence and long-term effect of kidney scars.
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10
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Piccoli GB, Soragna G, Putaggio S, Consiglio V, Magnano A, Mezza E, Bonetto A, Geuna S. Is male homosexuality still a cultural taboo for kidney donation? Transplant Proc 2006; 38:1224-6. [PMID: 16797269 DOI: 10.1016/j.transproceed.2006.02.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND Among the so-called social risk behaviors, male homosexuality is probably one of the most interesting and difficult taboos. Because of changing attitudes of the general population toward irregular sexual behaviors, often considered as markers of unhealthy life styles, there is a need to reconsider at least the most important one-homosexuality. METHODS A semistructured questionnaire included opinions on homosexuality with respect to kidney donation: Would you consider a male homosexual as a kidney donor? If you were on dialysis, would you accept a kidney from a homosexual donor? This instrument was administered to various groups of the general public and caregivers: high school students (Liceo Classico: 59 students, median age 18 years; Istituto Tecnico: n=108, median age 17); first and fourth year of medical school (n=77, age 19; 46, age 22); continuing medical education (n=44, age 32); third year of nursing school (n=31, age 23); "senior citizen university" (n=51, age 63). RESULTS Male homosexuality was well accepted for kidney donation (71.6% yes, 9.6% no, 18.8% uncertain/blank). However, the opinions were different among the groups with male students of a technical institute showing discrimination against male homosexuals. In the univariate analysis, opinions differed according to age, gender, and belonging to the health care team. In the multivariate analysis, the latter was the strongest predictor (P<.01). The specific threats for the health are not well known, even among the caregiver population. CONCLUSION It is difficult to define the role of homosexuality among the so-called social risk behaviors. Negative attitudes existed in some subsets of the population.
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Affiliation(s)
- G B Piccoli
- Nephrology, University of Torino, Torino, Italy.
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Rosenbaum M, Goldsmith R, Bloomfield D, Magnano A, Weimer L, Heymsfield S, Gallagher D, Mayer L, Murphy E, Leibel RL. Low-dose leptin reverses skeletal muscle, autonomic, and neuroendocrine adaptations to maintenance of reduced weight. J Clin Invest 2006; 115:3579-86. [PMID: 16322796 PMCID: PMC1297250 DOI: 10.1172/jci25977] [Citation(s) in RCA: 395] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Accepted: 10/03/2005] [Indexed: 12/23/2022] Open
Abstract
Maintenance of a reduced body weight is accompanied by decreased energy expenditure that is due largely to increased skeletal muscle work efficiency. In addition, decreased sympathetic nervous system tone and circulating concentrations of leptin, thyroxine, and triiodothyronine act coordinately to favor weight regain. These "weight-reduced" phenotypes are similar to those of leptin-deficient humans and rodents. We examined metabolic, autonomic, and neuroendocrine phenotypes in 10 inpatient subjects (5 males, 5 females [3 never-obese, 7 obese]) under 3 sets of experimental conditions: (a) maintaining usual weight by ingesting a liquid formula diet; (b) maintaining a 10% reduced weight by ingesting a liquid formula diet; and (c) receiving twice-daily subcutaneous doses of leptin sufficient to restore 8 am circulating leptin concentrations to pre-weight-loss levels and remaining on the same liquid formula diet required to maintain a 10% reduced weight. During leptin administration, energy expenditure, skeletal muscle work efficiency, sympathetic nervous system tone, and circulating concentrations of thyroxine and triiodothyronine returned to pre-weight-loss levels. These responses suggest that the weight-reduced state may be regarded as a condition of relative leptin insufficiency. Prevention of weight regain might be achievable by strategies relevant to reversing this leptin-insufficient state.
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Affiliation(s)
- Michael Rosenbaum
- Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
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12
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Piccoli GB, Colla L, Burdese M, Marcuccio C, Mezza E, Maass J, Picciotto G, Sargiotto A, Besso L, Magnano A, Veglio V, Piccoli G. Development of kidney scars after acute uncomplicated pyelonephritis: relationship with clinical, laboratory and imaging data at diagnosis. World J Urol 2006; 24:66-73. [PMID: 16429303 DOI: 10.1007/s00345-005-0044-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Accepted: 11/07/2005] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Acute pyelonephritis is a potential cause of kidney scars. AIM To evaluate the relationship between clinical, laboratory and imaging data and the development of kidney scars in acute pyelonephritis. METHODS All consecutive patients hospitalized for acute uncomplicated pyelonephritis in our nephrology unit from June 1996 to June 2004 were considered: 58 females, median age 25.6 years (16-52). Diagnosis of pyelonephritis required parenchymal lesions shown by CT or NMR scan. RESULTS The lesions were bilateral in 17.2% (10/58) patients, unilateral, but multifocal in 81.0% (47/58); at CT or NMR, 65.5% of the lesions were classified as simple, 19% with tendency to colliquation and 15.5% abscessual. The median interval between first symptoms and diagnosis was 5 days (1-25); at referral, only 20.7% had a positive urine culture and 94.8% (55/58) had undergone previous antibiotic treatment. The therapeutic protocol required intravenous therapy for > or = 2 weeks, followed by 2-4 weeks of oral therapy. At 6-8 months, the prevalence of kidney scars was 29.3%. Their development was highly correlated with the type of lesions at diagnosis (highest risk with abscessual lesions; uni- and multivariate analysis). No other clinical or laboratory marker (age, fever, positive cultures, levels of acute phase reactants, interval between onset and diagnosis) was correlated with the outcome (scars). CONCLUSIONS The type of lesion at diagnosis of acute uncomplicated pyelonephritis is highly correlated with the development of kidney scars. Further studies are needed to test the therapeutic schedules tailored according to the imaging data.
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Affiliation(s)
- G B Piccoli
- Department of Nephrology, University of Turin, S.C.D.U. Nefrologia, Dialisi e Trapianto, Corso Bramante 88, 10126 Torino, Italy.
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13
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Xydas S, Rosen RS, Ng C, Mercando M, Cohen J, DiTullio M, Magnano A, Marboe CC, Mancini DM, Naka Y, Oz MC, Maybaum S. Mechanical unloading leads to echocardiographic, electrocardiographic, neurohormonal, and histologic recovery. J Heart Lung Transplant 2005; 25:7-15. [PMID: 16399524 DOI: 10.1016/j.healun.2005.08.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Revised: 05/09/2005] [Accepted: 08/01/2005] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Mechanical unloading during left ventricular assist device (LVAD) support may lead to cardiac recovery. Predictors of recovery, however, have not been identified. We aimed to evaluate the time course and durability of echocardiographic, electrocardiographic (ECG), histologic, and neurohormonal changes that occur with LVAD support and to screen for non-invasive markers of cardiac recovery. METHODS LVAD patients underwent monthly testing, including echocardiographic, ECG, and serum B-type natriuretic peptide (BNP) measurement. Paired myocardial tissue samples from implant and explant were also analyzed. RESULTS Thirty-six LVAD patients were prospectively followed for an average of 101 +/- 99 days. Left ventricular ejection fraction (LVEF) and end-diastolic diameter (LVEDD) significantly improved at 30 days compared with pre-LVAD (19% +/- 6.6% vs 33% +/- 8.1%, 7.1 +/- 1.2 cm vs 4.9 +/- 1.0 cm, respectively; both p < 0.001), with no improvement thereafter. At 30 days, QRS duration and QTc interval were significantly decreased from pre-LVAD (both p < 0.05). There was a marked reduction in BNP, myocyte size, and collagen deposition with LVAD support (all p < 0.01). In screening for markers of recovery, the decrease in QTc was inversely related to LVEDD at 60 days. Changes in QRS and myocyte diameter also correlated with the improvement in LVEF at 30 days. No patients had sufficient recovery for device explantation. CONCLUSIONS We demonstrate echocardiographic, ECG, histologic, and neurohormonal improvement during LVAD support. Cardiac recovery peaked by 60 days, and there was a trend toward progressive improvement in QRS duration with ongoing support. We report the association of ECG changes with echocardiographic and histologic improvements. Future prospective studies may yield important markers of recovery.
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Affiliation(s)
- Steve Xydas
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York, NY 10032, USA.
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14
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Fossa AA, Wisialowski T, Magnano A, Wolfgang E, Winslow R, Gorczyca W, Crimin K, Raunig DL. Dynamic Beat-to-Beat Modeling of the QT-RR Interval Relationship: Analysis of QT Prolongation during Alterations of Autonomic State versus Human Ether a-go-go-Related Gene Inhibition. J Pharmacol Exp Ther 2004; 312:1-11. [PMID: 15306635 DOI: 10.1124/jpet.104.073288] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Methods to correct the QT interval for heart rate are often in disagreement and may be further confounded by changes in autonomic state. This can be problematic when trying to distinguish the changes in QT interval by either drug-induced delayed repolarization or from autonomic-mediated physiological responses. Assessment of the canine dynamic QT-RR interval relationship was visualized by novel programming of the dynamic beat-to-beat confluence of data or "clouds". To represent the nonuniformity of the clouds, a bootstrap sampling method that computes the mathematical center of the uncorrected beat-to-beat QT value (QTbtb) with upper 95% confidence bounds was adopted and compared with corrected QT (QTc) using standard correction factors. Nitroprusside-induced reflex tachycardia reduced QTbtb by 43 ms, whereas an increase of 55 and 16 ms was obtained using the Bazett (QTcB) and Fridericia (QTcF) formulae, respectively. Phenylephrine-induced reflex bradycardia increased QTbtb by 3 ms but decreased QTcB by 20 ms and QTcF by 12 ms. Delayed repolarization with E-4031 (1-[2-(6-methyl-2-pyridyl)ethyl]-4-methylsulfonylaminobenzoyl)-piperidine), an inhibitor of rectifier potassium current, increased QTbtb by 26 ms but QT prolongation calculations using QTcF and QTcB were between 12 and 52% less, respectively, when small decreases in heart rate (5-8 beats per minute) were apparent. Dynamic assessment of beat-to-beat data, using the bootstrap method, allows quantification of QT interval changes under varying conditions of heart rate, autonomic tone, and direct repolarization that may not be distinguishable with use of standard correction factors.
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Affiliation(s)
- Anthony A Fossa
- Pfizer Global Research and Development, Eastern Point Rd., Bldg. 118, MS 4036, Groton, CT 06340, USA.
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15
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Xydas S, Naka Y, Mancini D, Marboe C, Cohen J, Magnano A, Arnold A, Joyce N, Oz M, Maybaum S. Mechanical unloading leads to echocardiographic, electrophysiological, histological and serological recovery. J Heart Lung Transplant 2004. [DOI: 10.1016/j.healun.2003.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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16
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Antonini I, Polucci P, Magnano A, Martelli S. Synthesis, antitumor cytotoxicity, and DNA-binding of novel N-5,2-di(omega-aminoalkyl)-2,6-dihydropyrazolo[3,4,5-kl]acridine-5-carboxamides. J Med Chem 2001; 44:3329-33. [PMID: 11563932 DOI: 10.1021/jm010917o] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A series of DNA-binding potential antitumor agents bearing a cationic carboxamide side chain attached in position peri to an electron-withdrawing atom, N-5,2-di(omega-aminoalkyl)-2,6-dihydropyrazolo[3,4,5-kl]acridine-5-carboxamides, has been prepared by reaction of the appropriate 1-chloro-9-oxo-9,10-dihydro-4-acridinecarboxamides with the suitable (omega-aminoalkyl)hydrazine. The noncovalent DNA-binding properties of these compounds have been examined using a fluorometric technique. In vitro cytotoxic potency of these derivatives toward the human colon adenocarcinoma cell line (HT29) is described and compared to that of reference drugs. Structure-activity relationships are discussed. Two highly DNA-affinic and potent cytotoxic compounds, 4m,o, have been identified as new leads in the antitumor strategies.
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Affiliation(s)
- I Antonini
- Department of Chemical Sciences, University of Camerino, Via S. Agostino 1, 62032 Camerino, Italy.
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17
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Bloomfield DM, Magnano A, Bigger JT, Rivadeneira H, Parides M, Steinman RC. Comparison of spontaneous vs. metronome-guided breathing on assessment of vagal modulation using RR variability. Am J Physiol Heart Circ Physiol 2001; 280:H1145-50. [PMID: 11179058 DOI: 10.1152/ajpheart.2001.280.3.h1145] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
R-R interval variability (RR variability) is increasingly being used as an index of autonomic activity. High-frequency (HF) power reflects vagal modulation of the sinus node. Since vagal modulation occurs at the respiratory frequency, some investigators have suggested that HF power cannot be interpreted unless the breathing rate is controlled. We hypothesized that HF power during spontaneous breathing would not differ significantly from HF power during metronome-guided breathing. We measured HF power during spontaneous breathing in 20 healthy subjects and 19 patients with heart disease. Each subject's spontaneous breathing rate was determined, and the calculation of HF power was repeated with a metronome set to his or her average spontaneous breathing rate. There was no significant difference between the logarithm of HF power measured during spontaneous and metronome-guided breathing [4.88 +/- 0.29 vs. 5.29 +/- 0.30 ln(ms(2)), P = 0.32] in the group as a whole and when patients and healthy subjects were examined separately. We did observe a small (9.9%) decrease in HF power with increasing metronome-guided breathing rates (from 9 to 20 breaths/min). These data indicate that HF power during spontaneous and metronome-guided breathing differs at most by very small amounts. This variability is several logarithmic units less than the wide discrepancies observed between healthy subjects and cardiac patients with a heterogeneous group of cardiovascular disorders. In addition, HF power is relatively constant across the range of typical breathing rates. These data indicate that there is no need to control breathing rate to interpret HF power when RR variability (and specifically HF power) is used to identify high-risk cardiac patients.
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Affiliation(s)
- D M Bloomfield
- Division of Cardiology, Department of Medicine, School of Public Health, Columbia University, New York, New York 10032, USA
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18
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Schepis F, Cammà C, Niceforo D, Magnano A, Pallio S, Cinquegrani M, D'amico G, Pasta L, Craxì A, Saitta A, Raimondo G. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatology 2001; 33:333-8. [PMID: 11172334 DOI: 10.1053/jhep.2001.21410] [Citation(s) in RCA: 203] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Our aims were to develop a noninvasive predictive tool to identify cirrhotic patients with esophageal varices and to evaluate whether portal Doppler ultrasonographic parameters may improve the value of other predictors. One hundred forty-three consecutive compensated cirrhotic patients underwent upper gastrointestinal endoscopy. Fourteen clinical, biochemical, ultrasonographic, and Doppler ultrasonographic parameters of each patient were also recorded. Esophageal varices were detected in 63 of the 143 patients examined (44%; 95% confidence interval [CI] 36.2-52.6). Medium and large esophageal varices were observed in 28 subjects (44%; 95% CI 31.4-58.4). Using stepwise logistic regression, presence of esophageal varices was independently predicted by prothrombin activity less than 70% (odds ratio [OR]: 5.83; 95% CI: 2.6-12.8), ultrasonographic portal vein diameter greater than 13 mm (OR: 2.92; 95% CI: 1.3-6.4), and platelet count less than 100 x 10(9)/L (OR: 2.83; 95% CI: 1.27-6.28). Variables included in the model were used to generate a simple incremental rule to evaluate each individual patient. The discriminating ability of the prediction rule was relevant (area under the curve: 0.80) and did not change by replacing ultrasonographic portal vein diameter with congestion index of portal vein. We concluded that compensated cirrhotic patients should be screened by upper gastrointestinal endoscopy when prothrombin activity less than 70%, platelet count less than 100 x 10(9)/L, and ultrasonographic portal vein diameter greater than 13 mm are observed, whereas those without any of these predictors should not undergo endoscopy. The contribution provided by portal Doppler ultrasonographic parameters does not appear of practical utility.
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Affiliation(s)
- F Schepis
- Dipartimento di Medicina Interna e Terapia Medica, Policlinico Universitario, Messina, Italy
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19
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Giofré MR, Meduri G, Pallio S, Calandra S, Magnano A, Niceforo D, Cinquegrani M, di Leo V, Mazzon E, Sturniolo GC, Longo G, Fries W. Gastric permeability to sucrose is increased in portal hypertensive gastropathy. Eur J Gastroenterol Hepatol 2000; 12:529-33. [PMID: 10833096 DOI: 10.1097/00042737-200012050-00009] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Portal hypertensive gastropathy (PHG) is frequently found among patients with hepatic cirrhosis and at present the only way to detect and follow PHG is via endoscopy. OBJECTIVE To assess gastric and intestinal permeability and investigate its relationship to endoscopic findings and indices of portal hypertension and hepatic function. DESIGN AND METHODS Thirty-one non-diabetic patients with hepatic cirrhosis and PHG (PHG+) were studied and compared with 17 cirrhotic patients without PHG (PHG-). All patients underwent endoscopy for the assessment of PHG and Helicobacter pylori status, ultrasound determination of the diameters of spleen and portal vein, and, subsequently, an oral load of sucrose, lactulose, and mannitol. Sugar concentrations were determined in 6-h urine specimens and expressed as a percentage of the orally administered dose or as lactulose/mannitol ratio. RESULTS The urinary sucrose excretion was significantly elevated in patients with PHG compared to those without (PHG+, 0.20% +/- 0.03; PHG-, 0.07% +/- 0.01; P< 0.001). No difference was found for the small intestinal probes lactulose and mannitol. Gastric sucrose permeability correlated positively with the endoscopic lesion score (P < 0.001), but not with other parameters of portal hypertension or hepatic function. H. pylori status did not influence gastric permeability. The sensitivity of this test reached 100% for PHG scores > 2. CONCLUSIONS Gastric permeability to sucrose is increased in patients with PHG, independently of the presence of H. pylori. Sucrose permeability may be useful for the follow-up of patients with PHG.
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Affiliation(s)
- M R Giofré
- Gastroenterologia, Università di Messina, Italy
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20
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Abstract
Neurogenic stunned myocardium (NSM), a syndrome of reversible left ventricular dysfunction best described after subarachnoid hemorrhage, has not been associated with peripheral neuropathy. We describe a woman with Guillain-Barre syndrome in whom a syndrome compatible with NSM developed in the setting of a physiologically documented increase in sympathetic cardiovascular tone. This case supports the presumed unifying role of excessive sympathetic nervous system activation in the pathogenesis of NSM.
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Affiliation(s)
- R Bernstein
- Department of Neurology, Neurological Institute, Columbia-Presbyterian Medical Center, New York, NY 10032, USA
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21
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D'Amore F, Buda CA, Magnano A, Bottari A, Consolo P, Romeo L, Giudice A. [Endoscopic treatment of a gastric phytobezoar using electrohydraulic lithotripsy: a case report]. G Chir 1998; 19:475-7. [PMID: 9882953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The Authors report a case of spontaneous large gastric phytobezoar in an unoperated stomach and describe this pathology especially with regards to pathogenesis, diagnosis and endoscopic treatment.
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Affiliation(s)
- F D'Amore
- Cattedra di Diagnostica e Chirurgia Endoscopica, Università degli Studi di Messina
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22
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Bottari M, D'Amore F, Buda CA, Magnano A, Melita G, Dell'Utri P, Crescenti S, Casella G. [Stenosing esophagitis caused by Trichosporon beigelii: presentation of a rare case]. G Chir 1997; 18:344-7. [PMID: 9296595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The Authors describe a rare case of esophageal stenosis complicated by gastroesophageal reflux due to Trichosporon beigelii in the absence of a pathologic predisposition or immunodeficiency. The diagnosis was drawn by embedding membrane fragments obtained endoscopically in Sabouraud and blood-Agar cultures. The patient was treated with antimicotics, immunostimulants, inhibitors of the gastric protonic pump, prokinetics and later underwent endoscopic dilatation combined with Savary-Guillard and pneumatic dilatators of growing diameter, until complete "restitutio ad integrum" of the esophageal lumen.
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Affiliation(s)
- M Bottari
- Cattedra di Diagnostica e Chirurgia Endoscopica, Università degli Studi di Messina
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23
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Molaschi M, Ponzetto M, Magnano A, Castronuovo F, Gangemi D. Risk profile in women with stroke: role of plasma fibrinogen. Arch Gerontol Geriatr 1996; 22 Suppl 1:201-5. [DOI: 10.1016/0167-4943(96)86936-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Russo A, Lanzafame S, Magnano A, Giannone N, Cosentino S. Histologic patterns of omeprazole and nizatidine-healed duodenal ulcers:accuracy of endoscopic diagnosis. Scand J Gastroenterol Suppl 1994; 206:20-4. [PMID: 7863247 DOI: 10.3109/00365529409091416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The mechanisms underlying duodenal ulcer (DU) recurrence after endoscopically confirmed healing are unclear. We sought to examine histologic differences in healing induced by omeprazole and nizatidine. This also entailed assessing interobserver variation in endoscopic diagnosis and the correlation between endoscopic and histomorphologic healing. We treated 31 DU patients for 4 weeks with either omeprazole (20 mg daily a.m.) or nizatidine (300 mg twice daily). The healing rates of both groups showed no significant differences (86.7% versus 81.2%; p = 0.5). Good mucosal repair rates did not differ significantly (38.5% versus 69.2% respectively; p = 0.5). Endoscopists' agreement over scar type was 0.80, with the chance of agreement 0.70 (k = 0.34 +/- -0.08). The correlation between macroscopic and histologic appearance of scars was fair, but fully significant (r = 0.48; p < 0.05). We conclude that the study was too small to detect significant differences in healing patterns between the two drugs. The wide variation in endoscopic diagnosis suggests that mucosal repair is best assessed by histologic examination of biopsy samples.
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Affiliation(s)
- A Russo
- Dept. of Surgery, University of Catania, Italy
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25
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Abstract
Chronic endoscopic esophageal sclerotherapy represents a primary technique for the prevention of recurrent bleeding in cirrhotic patients who have already experienced one variceal bleeding episode. 131 patients with portal hypertension and a history of esophageal variceal bleeding underwent endoscopic sclerotherapy. 74 of these patients constituted a subgroup which was singled out for special analysis. In these patients, treatment had been started after conservative management of an acute bleeding episode had stopped the bleeding and follow-up data for at least 6 months were available. 90.5% of these patients had nonalcoholic etiology for their portal hypertension. 60.8% of patients developed recurrent varices and 11.1% had recurrent bleeding from esophageal varices. The bleeding risk index, calculated as the number of hemorrhages/patient/months of follow-up, correlated strongly with the number of previous hemorrhages and inversely with hepatic reserve (Child's class). The bleeding risk index decreased tenfold after sclerotherapeutic obliteration of varices. These data suggest that chronic elective endoscopic sclerotherapy may play a primary role in the management of patients who have bled from esophageal varices.
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Affiliation(s)
- A Russo
- University of Catania, Italy
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26
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Russo A, Giannone G, Magnano A, Passanisi G, Longo C. Prophylactic sclerotherapy in nonalcoholic liver cirrhosis: preliminary results of a prospective controlled randomized trial. World J Surg 1989; 13:149-53. [PMID: 2658361 DOI: 10.1007/bf01658391] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Between June, 1984 and December, 1985, a total of 41 patients were enrolled in a prospective controlled randomized trial comparing prophylactic sclerotherapy and medical treatment for the prevention of the first esophageal variceal bleeding. All patients had nonalcoholic liver cirrhosis, fourth degree varices, and no past history of gastrointestinal bleeding. The patients were randomly assigned to the control group (20 patients) or to the sclerotherapy group (21 patients); most of the patients belonged to Child's classes A and B. After a mean follow-up of 16.8 months, there were 3 variceal bleeding episodes and a 10% mortality rate in the control group whereas neither hemorrhage nor death was observed in the sclerotherapy group. In the latter group, severe complications occurred in 9.5% of the patients; the rate of recurrence after eradication of esophageal varices was 40%. Although there were no statistically significant results, the favorable trend toward a lower bleeding risk and better survival observed in the treated patients suggests that a longer trial in a larger population of cirrhotic patients with a longer follow-up should be considered.
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27
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Abstract
We report the complications of perendoscopic sclerotherapy observed during treatment of oesophageal varices in 104 patients and 409 sclerotherapy sessions. Complications were related to each individual session and to the aim of the treatment (therapeutic or prophylactic). Major complications occurred in 17.3% of the patients treated: 13 cases of severe bleeding and 5 of oesophageal stricture. Conservative therapy stopped haemorrhage in all but 4 patients, who died of uncontrolled bleeding (3.8%). Three oesophageal strictures recovered spontaneously, while the remaining two required endoscopic dilations. Minor complications occurred after 102/409 sessions (24.9%). Epigastric and/or retrosternal pain developed after 17.6% of the sessions, oesophageal ulcerations after 12.5%, fever after 11.7% and transient dysphagia after 3.7%. Bleeding was observed only in Child's category C patients who underwent therapeutic treatment. The risk of bleeding remained unchanged until complete eradication of varices was achieved. The incidence of minor complications did not correlate with the progression or the aim of the treatment.
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Affiliation(s)
- A Magnano
- Department of Surgical Endoscopy, University of Catania, Italy
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28
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Musso R, Longo A, Triolo A, Giustolisi R, Cacciola RR, Cacciola E, Vecchio R, Russo A, Magnano A. Polidocanol may directly activate the contact phase of blood coagulation during sclerotherapy. Gastrointest Endosc 1987; 33:400-2. [PMID: 3678776 DOI: 10.1016/s0016-5107(87)71661-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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29
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Aprile G, Manusia M, Magnano A, Virgilio C, Sanfilippo G, Russo A. [26 cases of early gastric cancer surgically treated]. MINERVA CHIR 1984; 39:1063-8. [PMID: 6493556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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30
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Virgilio C, Magnano A, Sanfilippo G, Pecorella S, Russo A, Ingegneros L. [Diagnostic validity of the traditional enema and of colonoscopy in the study of diverticular disease of the colon. Apropos of 121 cases]. Minerva Dietol Gastroenterol 1983; 29:113-6. [PMID: 6877645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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31
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Sanfilippo G, Aprile G, Magnano A, Pecorella S, Virgilio C, La Malfa M. [Endoscopic and bioptic diagnosis of primary gastric lymphomas: 33 personal cases]. Minerva Med 1983; 74:595-9. [PMID: 6835550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The Authors have diagnosed by endoscopy and biopsy 33 primitive gastric lymphomas (6,7% of all malignant gastric tumors diagnosed over 6 years). Endoscopic observation alone diagnosed lymphoma in 63,6% of the cases. Exact diagnosis was made in all cases of polymorphic or multi-ulcerated lesions. The observation of a single ulcerated or ulcero-vegetative lesion (30,3%) suggested diagnosis of carcinoma. A false negative diagnosis of inflammatory pathology was made in 6,1% of the cases. Biopsy gave correct diagnosis in 69,7%. Highest percentage of positive biopsies was obtained in both single and multiple ulcerated lesions (88,2%), while infiltrating lesions provided positive biopsies in 50% of the cases. Endoscopy together with biopsy gave correct diagnosis in 90,9%. In fact, endoscopic diagnosis of lymphoma was confirmed after resection in 7 cases even if the individual biopsies showed superficial gastritis. The Authors believe that correct endoscopic study of primitive gastric lymphomas is based on knowledge of the various morphologies of the tumor and on a systematic performance of a large number of biopsies of both the lesions and surrounding mucosa.
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32
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Magnano A, Virgilio C, Sanfilippo G, Patanè R, Russo A. [Colonoscopy in children: personal experience]. Pediatr Med Chir 1982; 4:253-6. [PMID: 6984899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Since 1974, 162 colonoscopies have been performed on patients ranging in age from six months to 15 years. All examinations were done using adult endoscopes. Most of the exams were conducted either without any pharmacological preparation or after administration of benzodiazepine; in only 16 cases was general anesthesia without intubation (Ketamine) necessary. The most frequent indications for performing the exam were various types of anal bleeding, isolated, or associated with diarrhoea. The diagnosis made most frequently was of an isolated polyp (43 cases out of 162), localized almost exclusively in the rectum or sigmoid colon. The second most frequent diagnosis was of an inflammatory process (12 cases out of 162). It was noted that a large number of cases were found to be negative (73 cases out of 162), which may be explained by the fact that many cases of that age group involve acute processes healed when were examined.
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