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Tagliamonte E, Sperlongano S, Montuori C, Riegler L, Scarafile R, Carbone A, Iodice F, Gioia R, Di Vilio A, Serio A, Radmilovic J, Ricciardi S, D"andrea A. Microvascular coronary dysfunction affects global longitudinal strain after stress echocardiography. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND. Coronary microvascular dysfunction (CMD) is a potential cause of myocardial ischemia and may affect myocardial function at rest and during stress. CMD can be identified, in patients with non-obstructive coronary artery disease (CAD), by a reduced transthoracic Doppler-derived coronary flow reserve (CFR), which is an index of coronary arterial reactivity, and can be impaired in both obstructive CAD and CMD.
The aim of this study was to investigate the dipyridamole-induced changes of left ventricular (LV) global longitudinal strain (GLS) in patients with CMD.
METHODS. 59 patients (39% women, mean age 65.6 ± 6.1 years) with history of chest pain and without obstructive coronary artery disease (CAD) underwent dipyridamole stress echocardiography. Coronary flow was assessed in the left anterior descending coronary artery. Coronary flow reserve (CFR) was determined as the ratio of hyperaemic to baseline diastolic coronary flow velocity. CMD was defined as CFR < 2. GLS was measured at rest and at peak dose, using automated function imaging, through the positioning of three endocardial markers (two markers at the mitral annulus and one at the apex) in each apical view. Subsequently, the obtained segmental values of GLS were visualized as a bull’s-eye map in a quick and feasible manner. We had optimal left ventricular endocardial tracking in the overall population.
In each patient, we used a frame rate of 70 frames/sec for adequate 2D strain analysis. We analyzed GLS at each step of stress test and compared peak-dose values with baseline.
RESULTS. Nineteen patients (32%) among the overall population showed CMD. Baseline GLS was significantly lower in patients with CMD (-16.8 ± 2.7 vs. -19.1 ± 3.1, p < 0.01). A different contractile response to dipyridamole infusion was observed between the two groups: GLS significantly increased up to peak dose in patients without CMD (from -19.1 ± 3.1 to -20.2 ± 3.1, p < 0.01), and significantly decreased in patients with CMD (from -16.8 ± 2.7 to -15.8 ± 2.7, p < 0.01). There was a significant inverse correlation between CFR and DGLS (r = -0.82, p < 0.01).
CONCLUSIONS. GLS analysis, particularly performed by comparing dipyridamole peak-dose with baseline values, shows that in patients with CMD there is a different response of LV myocardium to stress test. It could be assumed that the inverse correlation between CFR and delta GLS reflects a progressive subclinical worsening of LV myocardial function and lack of LV contractile reserve due to underlying myocardial ischemia. Larger studies could confirm our data. Abstract Figure. Abstract Figure.
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Affiliation(s)
- E Tagliamonte
- Umberto I Hospital, Department of Cardiology, Nocera Inferiore, Italy
| | - S Sperlongano
- university of Campania Luigi Vanvitelli, Department of Cardiology, Naples, Italy
| | - C Montuori
- San Giuliano Hospital, Division of Cardiology, Giugliano (Naples), Italy
| | - L Riegler
- "Umberto I" Hospital, Operative Unit of Cardiology, Nocera Inferiore, Italy
| | - R Scarafile
- "Umberto I" Hospital, Operative Unit of Cardiology, Nocera Inferiore, Italy
| | - A Carbone
- university of Campania Luigi Vanvitelli, Department of Cardiology, Naples, Italy
| | - F Iodice
- "Umberto I" Hospital, Operative Unit of Cardiology, Nocera Inferiore, Italy
| | - R Gioia
- "Umberto I" Hospital, Operative Unit of Cardiology, Nocera Inferiore, Italy
| | - A Di Vilio
- "Umberto I" Hospital, Operative Unit of Cardiology, Nocera Inferiore, Italy
| | - A Serio
- "Umberto I" Hospital, Operative Unit of Cardiology, Nocera Inferiore, Italy
| | - J Radmilovic
- "Umberto I" Hospital, Operative Unit of Cardiology, Nocera Inferiore, Italy
| | - S Ricciardi
- "Umberto I" Hospital, Operative Unit of Cardiology, Nocera Inferiore, Italy
| | - A D"andrea
- "Umberto I" Hospital, Operative Unit of Cardiology, Nocera Inferiore, Italy
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Brancaccio G, Trezzi M, Chinali M, Vignaroli W, D'Anna C, Iodice F, Giorni C, Iacobelli R, Iorio F, Galletti L, Croci I, Carotti A. Predictors of survival in paediatric mitral valve replacement. Eur J Cardiothorac Surg 2021; 60:361-366. [PMID: 33582753 DOI: 10.1093/ejcts/ezab078] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to identify the predictors of death and of reintervention after mitral valve replacement (MVR) in children. METHODS A single-centre retrospective study was performed including 115 patients under the age of 18 undergoing MVR between 1982 and 2019. For all patients, the ratio of prosthetic valve size (diameter in mm) to weight (kg) at surgery was calculated and long-term result was assessed. The primary outcome was freedom from mitral valve (MV) re-replacement. The composite secondary outcome was freedom from death or transplant. RESULTS Fifty-four patients had a previous surgical attempt to MV repair. The median age at surgery was 5.5 years (interquartile range 1.21-9.87). Death/transplant-free survival was 77 ± 4% at 5 years and 72 ± 5% at 10 years. Univariate analysis showed a size/weight ratio higher than 2 and age <2 years as significant risk factors for death or transplant. Freedom from MV re-replacement at 5 and 10 years was 90 ± 3% and 72 ± 6%, respectively. Biological prosthesis implanted at first replacement (P = 0.007) and size/weight ratio higher than 2 (P = 0.048) were predictors of reoperation. Significant upsizing (P < 0.0001) of mitral prosthesis was observed at re-replacement. CONCLUSIONS MVR is a viable strategy in children with unrepairable MV disease. Mortality can be predicted based on size/weight ratio and age <2 years. MV re-replacement can be performed with low morbidity and mortality and a larger-size prosthesis can often be placed at the time of redo.
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Affiliation(s)
- Gianluca Brancaccio
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Matteo Trezzi
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Marcello Chinali
- Department of Pediatric Cardiology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Walter Vignaroli
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Carolina D'Anna
- Department of Pediatric Cardiology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesca Iodice
- Department of Anesthesiology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Chiara Giorni
- Department of Anesthesiology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Roberta Iacobelli
- Department of Pediatric Cardiology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Fiore Iorio
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Lorenzo Galletti
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Ileana Croci
- Predictive and Preventive Medicine Research Unit, Multifactorial and Complex Disease Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Adriano Carotti
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
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Brancaccio G, Perri G, Della Porta M, Iodice F, Trezzi M, Filippelli S, Amodeo A, D'Abramo M, Iorio FS, Galletti L. Use of carotid artery cannulation during redo sternotomy in congenital cardiac surgery: a single-centre experience. Interact Cardiovasc Thorac Surg 2021; 33:119-123. [PMID: 33704457 DOI: 10.1093/icvts/ivab060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/09/2020] [Accepted: 12/20/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Management of resternotomy is often a difficult challenge in patients with congenital diseases who have undergone multiple sternotomies. Our goal was to report our single-centre experience with carotid cannulation using a graft interposed during redo sternotomy in complex cardiac reintervention procedures. METHODS We performed a retrospective review of all patients who had undergone complex redo sternotomies between January 2019 and May 2020 utilizing a cervical cannulation technique with a Gore-Tex graft interposed on the carotid artery. We classified our population study on the basis of the primary diagnosis and the type of surgery. The primary outcomes of our analysis were the evaluation of the safety of the procedure in terms of survival and freedom from neurological events. RESULTS We analysed 22 patients who had undergone previous complex operations. The median age and weight at the time of reintervention were 130.35 (range 0.46-435) months and 31.5 (range 2.2-85) kg, respectively. Composite graft carotid cannulation provided adequate arterial flow in all patients with a median arterial flow of 3.5 l/min/m2 (range 0.6-6). One major cardiac injury occurred during sternotomy when emergency cardiopulmonary bypass (CPB) was initiated. Moreover, during their hospital stays, all patients had an uneventful recovery without neurological or vascular complications and no cervical wound infections. CONCLUSIONS Carotid cannulation using interposition of a side graft on the common carotid artery for arterial inflow is a reliable and safe method for initiation of CPB in complex redo surgeries in patients with congenital disease. Complications directly associated with this type of cannulation are uncommon and allow surgical re-entry with overall low risks.
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Affiliation(s)
- Gianluca Brancaccio
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Gianluigi Perri
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Marco Della Porta
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesca Iodice
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Matteo Trezzi
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Sergio Filippelli
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonio Amodeo
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mizar D'Abramo
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Fiore S Iorio
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Lorenzo Galletti
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
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Schreier DR, Di Lorenzo F, Iodice F, Shribman S. Do you want to perform endovascular therapy? Perspectives from neurology trainees across Europe. Eur J Neurol 2020; 27:2646-2650. [PMID: 32918361 DOI: 10.1111/ene.14519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/31/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular therapy (EVT) has become standard care for acute ischaemic stroke caused by large-vessel occlusion in the anterior circulation. However, access to this treatment in Europe remains poor. The lack of operators is a contributing factor and there is on-going discussion as to whether other specialists, including neurologists, could contribute to the EVT workforce. The question remains whether the next generation of neurologists want to become 'interventional neurologists'. The aim of this study was to address this question. METHODS We conducted a short survey within the National Representatives Network (a division of the Resident and Research Fellow Section, European Academy of Neurology) in order to determine the interest of future neurologists in performing EVT. RESULTS A total of 1218 responses from 27 European countries were received, with some variation in the number of respondents and results among individual countries. In total, 568 neurology trainees (47%) stated that they would want to be an 'interventional neurologist'. CONCLUSION Our findings suggest that neurologists could make a significant contribution to the workforce performing EVT and have important implications for the development and uptake of training programmes in Europe.
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Affiliation(s)
- D R Schreier
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - F Di Lorenzo
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - F Iodice
- Institute of Neurology, Catholic University of the Sacred Heart, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - S Shribman
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, UK
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Granata G, Valle G, Di Iorio R, Iodice F, Petrini FM, Strauss I, D'anna E, Iberite F, Lauretti L, Fernandez E, Romanello R, Stieglitz T, Raspopovic S, Calabresi P, Micera S, Rossini PM. Cortical plasticity after hand prostheses use: Is the hypothesis of deafferented cortex "invasion" always true? Clin Neurophysiol 2020; 131:2341-2348. [PMID: 32828036 DOI: 10.1016/j.clinph.2020.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/14/2020] [Accepted: 06/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study motor cortex plasticity after a period of training with a new prototype of bidirectional hand prosthesis in three left trans-radial amputees, correlating these changes with the modification of Phantom Limb Pain (PLP) in the same period. METHODS Each subject underwent a brain motor mapping with Transcranial Magnetic Stimulation (TMS) and PLP evaluation with questionnaires during a six-month training with a prototype of bidirectional hand prosthesis. RESULTS The baseline motor maps showed in all three amputees a smaller area of muscles representation of the amputated side compared to the intact limb. After training, there was a partial reversal of the baseline asymmetry. The two subjects affected by PLP experienced a statistically significant reduction of pain. CONCLUSIONS Two apparently opposite findings, the invasion of the "deafferented" cortex by neighbouring areas and the "persistence" of neural structures after amputation, could vary according to different target used for measurement. Our results do not support a correlation between PLP and motor cortical changes. SIGNIFICANCE The selection of the target and of the task is essential for studies investigating motor brain plasticity. This study boosts against a direct and unique role of motor cortical changes on PLP genesis.
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Affiliation(s)
- G Granata
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
| | - G Valle
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Bertarelli Foundation Chair in Translational Neural Engineering. Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - R Di Iorio
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - F Iodice
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Department of Neuroscience, San Raffaele Pisana IRCCS, Rome, Italy
| | - F M Petrini
- Bertarelli Foundation Chair in Translational Neural Engineering. Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - I Strauss
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Bertarelli Foundation Chair in Translational Neural Engineering. Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - E D'anna
- Bertarelli Foundation Chair in Translational Neural Engineering. Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - F Iberite
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - L Lauretti
- Institute of Neurosurgery, Catholic University of The Sacred Heart, Roma, Italy
| | - E Fernandez
- Institute of Neurosurgery, Catholic University of The Sacred Heart, Roma, Italy
| | - R Romanello
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - T Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center Freiburg and BrainLinks-BrainTools Center, University of Freiburg, Freiburg, Germany
| | - S Raspopovic
- Bertarelli Foundation Chair in Translational Neural Engineering. Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - P Calabresi
- Area of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - S Micera
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Bertarelli Foundation Chair in Translational Neural Engineering. Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - P M Rossini
- Department of Neuroscience, San Raffaele Pisana IRCCS, Rome, Italy
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Amodeo A, Filippelli S, Perri G, Iacobelli R, Adorisio R, Iodice F, Rizza A, Massicotte MP, Baldwin JT, Almond CS. First human implantation of a miniaturized axial flow ventricular assist device in a child with end-stage heart failure. J Heart Lung Transplant 2020; 39:83-87. [DOI: 10.1016/j.healun.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/09/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022] Open
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Pro S, Iodice F, Alessandri B, Di Chiara L, Di Capua M. Somatosensory Evoked Potentials for prediction of outcome in Pediatric Cardiac Intensive Care Unit. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2018.09.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Filippelli S, Perri G, Di Molfetta A, Iacobelli R, Toscano A, Adorisio R, Iodice F, Di Chiara L, Iorio F, Amodeo A. RF20 EVOLUTION OF SMALLEST INTRACORPOREAL CONTINUOUS FLOW LVAD. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550050.58377.16] [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: 11/05/2022]
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Perri G, Filippelli S, Di Molfetta A, Testa G, Iodice F, Adorisio R, Iacobelli R, Massetti M, Amodeo A. OC54 OUTCOME OF A CONTINOUS FLOW PUMP (JARVIK 2000) AS BRIDGE TO TRANSPLANTATION OR DESTINATION THERAPY IN PEDIATRIC PATIENTS. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549871.57072.9e] [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: 11/05/2022]
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Di Molfetta A, Iacobelli R, Filippelli S, Grutter G, Perri G, Iodice F, Pasquini L, Guccione P, Amodeo A. Evolution of Biventricular Loading Condition in Pediatric LVAD Patient: A Prospective and Observational Study. Artif Organs 2017; 42:386-393. [PMID: 29230826 DOI: 10.1111/aor.13050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of this study was to describe the echocardiographic trend of left ventricular (LV) and right ventricular (RV) function after implantation of a pulsatile flow left ventricular assist device (LVAD) in children. From 2013 to 2016, we prospectively evaluated 13 consecutive pediatric Berlin Heart EXCOR LVAD patients. Clinical and echocardiographic data were collected at baseline, within 24 h after implantation and monthly until LVAD explant. Median age and weight at the implantation was 8 (4-23) months and 5 (4.6-8.3) kg at the time of implantation, respectively. All were affected by dilated cardiomyopathy. Average LVAD support time was 226.2 ± 121.2 days. Nine (70%) were transplanted, 4 (30%) died. LV end-systolic and end-diastolic volumes were reduced until the follow up of two months (P = 0.019 and P = 0.001). A progressive increase in RV dimensions was observed. After 4 months of follow up, RV fractional area change worsening was statistically related with the deterioration of LV unloading (P = 0.0036). Four patients needed prolonged inotropic support for RV failure. Pulsatile LVAD in pediatrics is followed by an early and mid-term LV unloading, as expressed by a decrease in LV volumes and diameters at echocardiogram. The effects of unloading do not remain stable at long term follow up. RV function improved in the acute phase, but a progressive dilatation of RV was noted over time. In some patients, RV failure might lead to the need of an increase of inotropic support at long term follow up.
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Affiliation(s)
- Arianna Di Molfetta
- Department of Pediatric Cardiology and Cardiac Surgery-Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Roberta Iacobelli
- Department of Pediatric Cardiology and Cardiac Surgery-Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery-Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Giorgia Grutter
- Department of Pediatric Cardiology and Cardiac Surgery-Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Gianluigi Perri
- Department of Pediatric Cardiology and Cardiac Surgery-Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Francesca Iodice
- Department of Pediatric Cardiology and Cardiac Surgery-Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Luciano Pasquini
- Department of Pediatric Cardiology and Cardiac Surgery-Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Paolo Guccione
- Department of Pediatric Cardiology and Cardiac Surgery-Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiac Surgery-Pediatric Hospital Bambino Gesù, Rome, Italy
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Perri G, Filippelli S, Testa G, Iodice F, Adorisio R, Iacobelli R, Di Molfetta A, Massetti M, Amodeo A. Outcome of a Continous Flow Pump (Jarvik 2000) as Bridge to Transplantation or Destination Therapy in Pediatric Patients. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.084] [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] Open
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Di Molfetta A, Iacobelli R, Grutter G, Filippelli S, Perri G, Iodice F, Pasquini L, Guccione P, Amodeo A. Prospective Evaluation of Ventricular Loading Trend in Pediatric Patients with Pulsatile Flow LVAD. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.743] [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: 11/24/2022] Open
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Iodice F, Testa G, Morelli S, Gandolfo F, Amodeo A. Jarvik 2000 in Pediatrics as a Bridge to Trasplantation or as Destination Therapy: Perioperative Management. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.1015] [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: 10/21/2022] Open
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Iodice F, Testa G, Averardi M, Brancaccio G, Amodeo A, Cogo P. Implantation of a left ventricular assist device as a destination therapy in Duchenne muscular dystrophy patients with end stage cardiac failure: management and lessons learned. Neuromuscul Disord 2014; 25:19-23. [PMID: 25444433 DOI: 10.1016/j.nmd.2014.08.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 07/15/2014] [Accepted: 08/28/2014] [Indexed: 01/16/2023]
Abstract
Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder, characterized by progressive skeletal muscle weakness, loss of ambulation, and death secondary to cardiac or respiratory failure. End-stage dilated cardiomyopathy (DCM) is a frequent finding in DMD patients, they are rarely candidates for cardiac transplantation. Recently, the use of ventricular assist devices as a destination therapy (DT) as an alternative to cardiac transplantation in DMD patients has been described. Preoperative planning and patient selection play a significant role in the successful postoperative course of these patients. We describe the preoperative, intraoperative and postoperative management of Jarvik 2000 implantation in 4 DMD pediatric (age range 12-17 years) patients. We also describe the complications that may occur. The most frequent were bleeding and difficulty in weaning from mechanical ventilation. Our standard protocol includes: 1) preoperative multidisciplinary evaluation and selection, 2) preoperative and postoperative non-invasive ventilation and cough machine cycles, 3) intraoperative use of near infrared spectroscopy (NIRS) and transesophageal echocardiography, 4) attention on surgical blood loss, use of tranexamic acid and prothrombin complexes, 5) early extubation and 6) avoiding the use of nasogastric feeding tubes and nasal temperature probes. Our case reports describe the use of Jarvik 2000 as a destination therapy in young patients emphasizing the use of ventricular assist devices as a new therapeutic option in DMD.
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Affiliation(s)
- Francesca Iodice
- Department of Pediatric Cardiac Anesthesia and Intensive Care, Ospedale Bambino Gesu', Rome, Italy.
| | - Giuseppina Testa
- Department of Pediatric Cardiac Anesthesia and Intensive Care, Ospedale Bambino Gesu', Rome, Italy
| | - Marco Averardi
- Department of Pediatric Cardiac Anesthesia and Intensive Care, Ospedale Bambino Gesu', Rome, Italy
| | | | - Antonio Amodeo
- Department of Cardiothoracic Surgery, Ospedale Bambino Gesu', Rome, Italy
| | - Paola Cogo
- Department of Pediatric Cardiac Anesthesia and Intensive Care, Ospedale Bambino Gesu', Rome, Italy
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Testa G, Iodice F, Ricci Z, Vitale V, De Razza F, Haiberger R, Iacoella C, Conti G, Cogo P. Comparative evaluation of high-flow nasal cannula and conventional oxygen therapy in paediatric cardiac surgical patients: a randomized controlled trial. Interact Cardiovasc Thorac Surg 2014; 19:456-61. [DOI: 10.1093/icvts/ivu171] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ferilli M, Fasano A, Iodice F, Granata G, Pilato F, Rossini P. P347: Paired associative stimulation-25ms in stroke patients. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50462-2] [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: 11/26/2022]
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Ricci Z, Pezzella C, Romagnoli S, Iodice F, Haiberger R, Carotti A, Cogo P. High levels of free haemoglobin in neonates and infants undergoing surgery on cardiopulmonary bypass. Interact Cardiovasc Thorac Surg 2014; 19:183-7. [PMID: 24812332 DOI: 10.1093/icvts/ivu129] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Haemolysis is known to occur during surgery on cardiopulmonary bypass (CPB) and to be responsible for kidney injury. The aim of this study was to assess, in a cohort of infants, the reference levels of free haemoglobin (fHb) and their change over time postoperatively; the predicting variables of haemolysis in the intraoperative phase; and the association between fHb and renal function. METHODS A retrospective analysis in infants undergoing surgery on CPB was conducted. Children with preoperative renal dysfunction and need for extracorporeal membrane oxygenation support were excluded. fHb was sampled before and after CPB and on the first 2 postoperative days (POD). RESULTS Twenty-two patients with a median (interquartile) age of 111 (63-184) days and Aristotle score of 8 (6.4-9) were enrolled. fHb had a baseline value of 29 (24-41) mg/dl, peaked to 75 (65-109) mg/dl at CPB weaning and returned to 35 (30-55) mg/dl on POD 2 (P <0.0001). The median normalized index of haemolysis was 0.15 (0.09-0.19) g of fHb per 100 l of pumped blood. A multivariable regression model showed that, at CPB weaning, fHb levels were independently associated with left atrial venting flow (P = 0.02), and that CPB time remained the only independent variable (P = 0.034), when left atrial venting was excluded from the analysis. Acute kidney injury (AKI) occurred in 10 patients (45%). fHb levels in the 48 post-CPB hours were not significantly different between AKI and non-AKI patients: However, a significant correlation was present between creatinine on POD1 and CPBw-fHb (r = 0.48; P = 0.045); and between cystatin C on POD1 and CPBw-fHb (r = 0.58; P = 0.02). CONCLUSIONS A high rate of fHb is released during paediatric surgery with CPB in infants. fHb mainly depends on the left atrial venting flow rate and CPB duration. However, such peaks of fHb levels were not associated with renal dysfunction.
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Affiliation(s)
- Zaccaria Ricci
- Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Pezzella
- Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Romagnoli
- Department of Health Sciences, Section of Anesthesiology and Intensive Care, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesca Iodice
- Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Roberta Haiberger
- Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Adriano Carotti
- Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola Cogo
- Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Giorni C, Ricci Z, Iodice F, Garisto C, Favia I, Polito A, Carotti A, Cogo P. Use of Confidex to control perioperative bleeding in pediatric heart surgery: prospective cohort study. Pediatr Cardiol 2014; 35:208-14. [PMID: 23843105 DOI: 10.1007/s00246-013-0760-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
Abstract
Bleeding during and after cardiac surgery is a major issue in pediatric patients. A prospective cohort study was conducted to evaluate the effect of a commercially available prothrombin complex (Confidex) administered in cardiac surgery after weaning from cardiopulmonary bypass of infants with nonsurgical bleeding. In this study, 14 patients younger than 1 year received a Confidex bolus and were matched with 11 patients of a similar age who did not receive the drug. The preoperative coagulation profile was similar in the two groups. No side effects, including anaphylaxis or thrombotic events, were observed. The numbers of units of packed red blood cells and fresh frozen plasma administered both intra- and postoperatively were similar. The postoperative coagulation examination results and thromboelastographic parameters did not differ significantly between the two groups. However, the Confidex patients bled significantly less than the control subjects during the first 24 postoperative hours. The median volume of drained blood was 0.0 ml/kg h (range 0-1.9 ml/kg h) compared with 1.9 ml/kg h (range 1-3 ml/kg h) (p = 0.009). At least one unit of packed red blood cells in the postoperative phase was required by 2 patients (14 %) in the Confidex group and six patients (54 %) in the control group (odds ratio [OR], 0.13; 95 % confidence interval [CI], 0.02-0.9; p = 0.03). The median duration of mechanical ventilation was 3 days (range 2-4 days) in the Confidex group and 4 days (range 0-8 days) in the control group (p = 0.66). The median stay in the intensive care unit was 6 days (range 5-9 days) in the Confidex group and 7 days (range 4-12 days) in the control group (p = 0.88). The use of Confidex for infants undergoing cardiac surgery was safe and effective. It reduced postoperative bleeding and allowed fewer units of packed red blood cells to be infused in the postoperative phase without major side effects.
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Affiliation(s)
- Chiara Giorni
- Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Piazza S.Onofrio 4, 00165, Rome, Italy
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Abstract
Neurally adjusted ventilator assist (NAVA) is a ventilator mode based on providing assistance to the patient in proportion to the electrical activity of the diaphragm. NAVA may improve patient-ventilator interactions. We describe a very complex case of a child with a permanent ventricular assist device where we attempted to use NAVA during the weaning process and then realised that it was impossible to use.
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Affiliation(s)
- Francesca Iodice
- Department of Anesthesia and Intensive Care, Children's Hospital Bambino Gesu, Rome, Italy.
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Rossi L, Zoratto F, Papa A, Iodice F, Minozzi M, Frati L, Tomao S. Current approach in the treatment of hepatocellular carcinoma. World J Gastrointest Oncol 2010; 2:348-59. [PMID: 21160806 PMCID: PMC2999141 DOI: 10.4251/wjgo.v2.i9.348] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 08/24/2010] [Accepted: 08/31/2010] [Indexed: 02/05/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common malignant hepatobiliary disease; it is responsible for about 1 million deaths per year. Risk factors include hepatitis B and C, hepatic cirrhosis, including alcohol related hepatitis, metabolic and nutritional hepatic damage. The main modality of diffusion is intrahepatic in the natural course of the disease. There are two leading types of treatment: local and systemic. Surgical resection and liver transplantation constitute the most appropriate local treatments and are considered the only real possibility for recovery. Other local approaches include: radiofrequency ablation, percutaneous ethanol ablation, hepatic endoarterial chemoembolization and intrahepatic radiotherapy (SIRT: selective internal radiation therapy). These last treatments are used to control the disease when surgery or transplantation is not achievable; in some cases they are able to prolong survival while they constitute mainly a palliative treatment. Systemic treatments include: chemotherapy, immunological and hormonal therapies and, more recently, the introduction of new specific molecular target drugs. At the moment, in this group, the only drug that has given positive results during phase III trials (SHARP study) is Sorafenib. Sorafenib represents the only primary systemic therapy that has demonstrated, unlike the other treatments previously described, an increase in survival rate in patients affected with advanced HCC. Currently, other studies are taking place that are further developing the potential of this drug. These studies, including phase III trials, are directed in order to test the activity and safety of new emerging drugs with targeted activity. Examples of these new agents are: Sunitinib, Gefitinib, Cetuximab, Bevacizumab and Erlotinib.
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Affiliation(s)
- Luigi Rossi
- Luigi Rossi, Federica Zoratto, Anselmo Papa, Marina Minozzi, Luigi Frati, Silverio Tomao, Department of Experimental Medicine, University of Rome "Sapienza", Viale Regina Elena 324, 00161 Rome, Italy
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Drago F, Silvetti MS, De Santis A, Marcora S, Fazio G, Anaclerio S, Versacci P, Iodice F, Di Ciommo V. Paroxysmal reciprocating supraventricular tachycardia in infants: electrophysiologically guided medical treatment and long-term evolution of the re-entry circuit. Europace 2008; 10:629-35. [PMID: 18385122 DOI: 10.1093/europace/eun069] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The aim of this study is to evaluate the long-term prognosis in infants affected by paroxysmal reciprocating supraventricular tachycardia (SVT), to identify predictors of SVT disappearance, and to assess the efficacy of electrophysiologically guided drug therapy in preventing recurrences. METHODS AND RESULTS A six step regimen of oral therapy was used in 55 infants with SVT: (i) propafenone (P); (ii) flecainide (F); (iii) flecainide plus propranolol (FP); (iv) amiodarone (A); (v) amiodarone plus propranolol (AP); (vi) amiodarone plus flecainide plus propranolol (AFP). If one step was not successful, the patient was passed on to the next treatment step and so on. Transesophageal atrial pacing (TAP) was used to evaluate treatment efficacy and the evolution of SVT at the end of the first, second, and third year. Propafenone was successful in 32.7% of the patients, F in 14.5%, FP in 23.6%, A alone in 5.4%, and AP in 18.1%; only 7.2% reached step 6. At month 12, after therapy wash out, SVT recurred spontaneously in 2 patients (3.6%) and remained inducible in 25 (45.5%). Inducibility was significantly higher in patients treated with A. At 24 months, SVT was inducible or spontaneous in 86% of the cases and at 36 months in 87%. There were no recurrences using the treatment confirmed by TAP. No further predictor of SVT inducibility was identified. CONCLUSION Supraventricular tachycardia disappeared in approximately 50% of the patients during the first year of life and in another 20% thereafter. The necessity for A treatment is the only predictor of persistence of the re-entry circuit during the first year of life. Transesophageal atrial pacing is useful in guiding the medical treatment.
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Affiliation(s)
- Fabrizio Drago
- Paediatric Cardiology Department, Bambino Gesù Paediatric Hospital, Piazza Sant' Onofrio 4, 00165 Rome, Italy.
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Marano M, Iodice F, Stoppa F, Tomasello C, Perrotta D, Cecchetti C, Di Nardo M, Ciampalini P, Pirozzi N. Treatment of severe diabetic acidosis with tris-hydroxymethyl aminomethane in a thirteen-year-old child. Minerva Anestesiol 2008; 74:93-95. [PMID: 18288072] [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: 05/25/2023]
Abstract
Diabetic ketoacidosis is a severe complication of type I diabetes. A 13-year-old female (40 kg) patient was admitted to our Intensive Care Unit with severe metabolic acidosis (pH: 6.8), hyperglycemia (835 mg/dL) and coma. Her hemodynamic conditions were unstable and, even though a large amount of plasma expanders, crystalloids, and inotropic support were supplied, the patient went into cardiac arrest in the first hour of treatment. After resuscitation, a better hemodynamic balance was achieved and metabolic acidosis was treated with fluid replacement therapy, continuous insulin infusion, and Tris-hydroxymethyl aminomethane (THAM) as a buffering agent. This therapy rapidly improved her metabolic conditions. The patient was discharged 5 days after Intensive Care Unit admission in good condition and without neurological sequelae.
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Affiliation(s)
- M Marano
- DEA-Area Rossa, Bambino Gesù' Pediatric Hospital , IRCCS, Rome, Italy.
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Iodice F, Brancaccio G, Lauri A, Di Donato R. Preventive ligation of the innominate artery in patients with neuromuscular disorders. Eur J Cardiothorac Surg 2007; 31:747-9. [PMID: 17236784 DOI: 10.1016/j.ejcts.2006.12.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [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] [Received: 09/04/2006] [Revised: 11/27/2006] [Accepted: 12/04/2006] [Indexed: 10/23/2022] Open
Abstract
Tracheostomy, long-term mechanical ventilation, spinal deformaties are factors that contribute in patients with neuromuscular disorders to the development of an erosion of the tracheal wall and subsequent formation of a tracheo-innominate artery fistula. This condition is fatal unless promptly treated by exclusion of the innominate artery, which is often performed under desperate circumstances. We electively adopted a preventive ligation of the innominate artery in patients at risk for trachea-innominate artery fistula (TIF). We present seven patients with neuromuscular disorders who underwent preventive ligation of the innominate artery. All seven patients survived.
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Affiliation(s)
- Francesca Iodice
- Division of Anesthesia and Intensive Care, Ospedale Bambino Gesù-Palidoro, Rome, Italy.
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Pignata S, Pisano C, Di Maio M, Iodice F, Casella G, Laurelli G, Greggi S, Iaffaioli RV. Medical treatment of resistant or recurrent epithelial ovarian cancer. Ann Oncol 2006; 17 Suppl 7:vii49-50. [PMID: 16760292 DOI: 10.1093/annonc/mdl950] [Citation(s) in RCA: 4] [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: 11/13/2022] Open
Abstract
Epidemiologic analysis reveals that mortality rates from ovarian cancer are continuously decreasing due to the improvement of surgery and chemotherapy. However, overall, the prognosis of ovarian cancer patients is still unsatisfactory considering that only 30% of the patients are alive after 5 years. In fact, although surgery and first-line systemic chemotherapy induce complete and partial response in up to 80% of patients, with about a 25% pathological complete remission rate, recurrences occur in the majority of patients. Most of these patients are subject to repetitive treatment cycles that, although palliative in nature, are also able to prolong survival. Important results have been obtained, in particular in platinum sensitive recurrent disease where a platinum base chemotherapy is able to prolong progression-free survival and overall survival. Overall, our armamentarium for the treatment of progressive or recurrent ovarian cancer is significantly richer than in the past, and in many patients it is possible to achieve the objective to reach a chronic history of the disease.
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Affiliation(s)
- S Pignata
- Divisione di Oncologia Medica B, Istituto Nazionale Tumori, Napoli.
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Iodice F, Salzano M, Prosperi M, D' Amico A, Lauri A, Bertini E. Acute quadriplegic myopathy in a 16-month-old child. Paediatr Anaesth 2005; 15:611-5. [PMID: 15960648 DOI: 10.1111/j.1460-9592.2005.01491.x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present a case of a 16-month old previously healthy child who was hospitalized because of an acute respiratory insufficiency most likely caused by a viral infection and who then developed a severe acute quadriplegic myopathy (AQM). Initial clinical symptoms were respiratory acidosis, dypnea, intense wheezing, and deterioration of the level of consciousness, which required orotracheal intubation and mechanical ventilation. We administered neuromuscular blocking agents, corticosteroids, and antibiotics. After 9 days the clinical picture improved. An attempt to wean from the ventilator failed. We diagnosed AQM. This paper discusses AQM and its clinical importance.
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Affiliation(s)
- Francesca Iodice
- Department of Anaesthesia and Intensive Care, Ospedale Pediatrico Bambino, Gesu-Palidoro, Rome, Italy.
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Fontana C, Favaro M, Carletti M, Carducci G, Salzano M, Iodice F, Silvestri A, Iandimarino F, Gallo M, Pelagalli L, Natoli S, Testore G. CLONALITÀ DI STAFILOCOCCHI OXACILLINO RESISTENTI ISOLATI DAL NASO DI PAZIENTI E PERSONALE IN 4 RIANIMAZIONI ROMANE (SEERBIO). Microbiol Med 2004. [DOI: 10.4081/mm.2004.3853] [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: 11/23/2022] Open
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Tambaro R, Greggi S, Iaffaioli RV, Rossi A, Pisano C, Manzione L, Ferrari E, Di Maio M, Iodice F, Casella G, Laurelli G, Pignata S. An escalating dose finding study of liposomal doxorubicin and vinorelbine for the treatment of refractory or resistant epithelial ovarian cancer. Ann Oncol 2003; 14:1406-11. [PMID: 12954580 DOI: 10.1093/annonc/mdg364] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the maximum tolerated dose (MTD) of liposomal doxorubicin (LD)-vinorelbine (V) in patients with refractory or resistant ovarian cancer. PATIENTS AND METHODS Thirty patients were eligible. Seven levels were studied [LD 25-V20 (three patients enrolled); LD 30-V20 (three); LD 35-V20 (three); LD 20-V25 (three); LD 25-V25 (three); LD 30-V25 (10); LD 35-V25 (five)]. LD was given on day 1, while V was given on days 1 and 8 every 21 days. Cohorts of three patients were enrolled at each level, and another three patients were planned, if one dose-limiting toxicity (DLT) was registered. RESULTS DLT was observed in four patients: two febrile neutropenia, one grade 4 thrombocytopenia and one grade 3 palmar-plantar erythrodysesthesia (PPE) at level 7 (LD 35-V25). Thus, liposomal doxorubicin 30 mg/m(2) plus vinorelbine 25 mg/m(2) was the MTD. The most frequent toxicity was neutropenia. Fifteen patients (50%) experienced grade 3 neutropenia and 10 (33.3%) grade 4 neutropenia. Non-hematological toxicity was mild. Mucositis and PPE were the most frequent toxicities, but in most cases were grade 1. Out of 29 assessable patients, six (20.7%; 95% confidence interval 10%-39%) experienced an objective response, with one complete response. CONCLUSIONS In patients with refractory or resistant ovarian cancer, the recommended doses for the combination studied are liposomal doxorubicin 30 mg/m(2) (day 1) plus vinorelbine 25 mg/m(2) (day 1 and 8). Neutropenia is the most frequent toxicity, while non-hematological toxicity is mild. Substantial activity was recorded and a phase II study is justified.
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Affiliation(s)
- R Tambaro
- Divisione di Oncologia Medica B, Istituto Nazionale Tumori, Napoli, Italy
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Pignata S, Varriale E, Casella G, Iodice F, De Placido G, Perrone F, Tramontana F, Ricchi P, De Vivo R, Costanzo R, Vernaglia A, Tramontana S. A phase I study of gemcitabine and epirubicin for the treatment of platinum-resistant or refractory advanced ovarian cancer. Ann Oncol 2000; 11:613-6. [PMID: 10907958 DOI: 10.1023/a:1008344528791] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 11/12/2022] Open
Abstract
BACKGROUND Gemcitabine is active in patients with otherwise resistant or refractory ovarian cancer. As the drug is well tolerated, studies using gemcitabine combined with other antineoplastic agents are needed. The aim of the study was to determine the maximum tolerated dose (MTD) of epirubicin combined with gemcitabine, with and without support of G-CSF. PATIENTS AND METHODS Patients with platinum-resistant or refractory ovarian cancer were eligible. Gemcitabine (G) (starting dose 800 mg/m2 day 1 and 8; 200 mg/m2 escalation per level) and epirubicin (E) (starting dose 60 mg/m2 day 1; 15 mg/m2 escalation per level) were given every 21 days for four to six cycles. G-CSF (filgrastim 5 microg/kg/die) was given in case of grade 4 neutropenia (levels without support) or from day 9 up to leukocyte count > 10.000/mm3 after nadir (levels with support). Cohorts of three patients were enrolled at each level, and another three patients were planned, if one dose-limiting toxicity (DLT) was registered. MTD was determined first without and then with G-CSF. RESULTS Four levels were studied (G 800 + E 60; G 1000 + E 60; G 1000 + E 75; G 1000 + E 75 + G-CSF) with four, four, three and three patients enrolled, respectively. DLT (grade 4 febrile neutropenia) was observed in two patients at level 3. Thus, G1000 + E 60 mg/m2 was the MTD without G-CSF. The addition of prophylactic G-CSF did not allow a further increase of the dose and grade 4 thrombocytopenia was the DLT at level 4. Non-hematological toxicity was mild. Grade 2 mucositis was reported in four patients. Among the 13 patients with measurable or evaluable disease, 3 partial responses were observed for an overall response rate of 23.1%. CONCLUSIONS The combination of gemcitabine 1000 mg/m2 (day 1, 8) and epirubicin at 60 mg/m2 (day 1) is a feasible therapy. Grade 4 neutropenia is frequent and G-CSF support is often required. With prophylactic support of G-CSF, the DLT is thrombocytopenia.
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Affiliation(s)
- S Pignata
- Divisione di Oncologia Medica B, Istituto Nazionale Tumori, Napoli, Italy.
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Pignata S, Frezza P, Tramontana S, Perrone F, Tambaro R, Casella G, Ferrari E, Iodice F, De Vivo R, Ricchi P, Tramontana F, Silvestro G. Phase I study with weekly cisplatin-paclitaxel and concurrent radiotherapy in patients with carcinoma of the cervix uteri. Ann Oncol 2000; 11:455-9. [PMID: 10847466 DOI: 10.1023/a:1008379922120] [Citation(s) in RCA: 29] [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: 11/12/2022] Open
Abstract
BACKGROUND Cisplatin and paclitaxel are active in cervical cancer and both are able to potentiate the effects of radiotherapy. In this study we evaluated the maximum-tolerated dose (MTD) of paclitaxel in combination with a fixed dose of cisplatin when given weekly concurrently with pelvic radiotherapy to patients with carcinoma of the cervix uteri. PATIENTS AND METHODS Eighteen patients with cervical cancer were enrolled in this study. Cisplatin (30 mg/m2) and paclitaxel (starting dose 40 mg/m2; 5 mg/m2 escalation per level) were given on day 1 of radiotherapy and then weekly for six times. Radiotherapy was given to the pelvis with a four-field box technique for five days each week. Patients received 65 Gy in 1.8 Gy fractions. Cohorts of three patients were enrolled at each level and three further patients were included if one or two dose-limiting severe adverse events (SAE) were recorded. SAE was defined as grade 3 or 4 nonhematologic toxicity, excluding nausea or vomiting and alopecia, grade 4 neutropenia or thrombocytopenia, and prolonged (> 1 week) neutropenia or thrombocytopenia. RESULTS Four levels were studied (paclitaxel 40, 45, 50, 55 mg/m2) with three, five, four and six patients enrolled, respectively. The MTD of paclitaxel was found at 50 mg/m2/wk and cisplatin 30 mg/m2/wk. Diarrhea was the dose-limiting toxicity. Thirteen patients were evaluable for response: seven complete and five partial responses were obtained with an overall response rate of 92.3%. CONCLUSIONS The MTD of paclitaxel is 50 mg/m2/wk when associated to cisplatin 30 mg/m2/wk and concurrent pelvic radiotherapy. Diarrhea is the dose limiting side effect. Preliminary data suggest that concurrent chemoradiotherapy with paclitaxel and cisplatin could be a very active treatment for patients with locally advanced carcinoma of the cervix.
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Affiliation(s)
- S Pignata
- Divisione di Oncologia Medica B, Istituto Nazionale Tumori, Napoli, Italy.
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Pallavicini F, Izzi I, Pennisi MA, Morace G, Portaccio GG, Bello G, Iodice F, Godino D, Del Borgo C, Proietti R. Evaluation of the utility of serological tests in the diagnosis of candidemia. Minerva Anestesiol 1999; 65:637-9. [PMID: 10522134] [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: 02/14/2023]
Abstract
BACKGROUND It has been observed that the incidence and prevalence of candida infections in critically ill non-immunocompromised patients has increased. This study aims to evaluate the utility of the use of serological tests (double immunodiffusion and Cand-Tec Test) for the determination of candidemia. METHODS A retrospective evaluation is made of 214 patients admitted to the Intensive Care Unit (ICU) of the Agostino Gemelli University Polyclinic during a period of 42 months. The double immunodiffusion technique was utilized for the determination of Candida antibodies. The Cand-Tec latex agglutination test was performed to evaluate the presence of Candida antigen. Four hundred and fifty-five antigen and antibody tests were performed. RESULTS Thirty-six patients (16.8%) developed an invasive candidiasis. The sensitivity and specificity of antibody detection tests was 29 and 67 respectively; the positive predictive value was 15 and the negative predictive value was 82. The sensitivity and specificity of the antigen detection test ranged between 82 and 3 and between 8 and 98 respectively according to different cut-off titre; the positive predictive value was low (13-17%) and the negative predictive value decreased from 70 to 29. CONCLUSIONS The utility of the use of serological tests in the diagnosis of candidemia is extremely limited. The gold standard for the determination of Candida sepsis remains the demonstration of candida in blood or in tissues.
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Affiliation(s)
- F Pallavicini
- Istituto di Clinica delle Malattie Infettive, Università Cattolica del Sacro Cuore, Roma
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Marfella A, Bilancio A, Polese C, Iodice F, Edmondo C, Cerasuolo D, Esposito G, Zannoni V, Beneduce G. Urinary neopterin and kynurenine in patients submitted to surgical stress with different inhalational anesthetics (halothane or isoflurane). Int J Immunopharmacol 1999; 21:423-33. [PMID: 10454016 DOI: 10.1016/s0192-0561(99)00021-1] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Measurements were taken of urinary levels of neopterin (NPT) and kynurenine (KYN), using an HPLC method for their simultaneous analysis in patients submitted to anesthetical surgical stress with two different inhalational anesthetics (halothane and isoflurane). We studied twenty-one women affected by uterine fibromyomatosis and submitted to total hysterectomy (mean age of 42.7+/-5.4 years). They showed the same pre-operative evaluation (ASA-1), and underwent the same i.v. anesthetic treatment. Our patients were randomized in two groups: Group A: 11 patients had halothane as an inhalational anesthetic drug for the maintenance of the anesthetic induction (mean time= 1 h). Group B: 10 patients had isoflurane. A significant decrease in urinary NPT and KYN, parallel to serum-NPT, was found 4 h after anesthetic induction. Raised NPT levels appeared 24 h after A.I. with significant increased levels after 7 days. A strong correlation between urinary and serum NPT levels was seen (Rs= 0.74; p < 0.001). Significantly low KYN levels were observed both 4 h and 24 h after A.I.. In addition to the delayed increase of the excretory KYN levels, significantly raised KYN levels in Group B (isoflurane) 48 h after A.I. (10.59+/-14.31 vs 5.99+/-7.17 micromol/mol creat.; p < 0.01) were shown, whereas in Group A (halothane) we observed a progressive increase as compared to the pre-surgery values starting from 72 h after surgery. Our data seem to show that: (a) it is possible to have a biochemical and non invasive monitoring of the anesthetical-surgical stress on MM "priming" activity; (b) the activation of the phagocyte compartment is one of the earlier immunological events after surgery (NPT), but the efficiency of this "priming" appears to be delayed (KYN); (c) isoflurane appears to induce an earlier recovery in MM activation.
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Affiliation(s)
- A Marfella
- Servizio di Patologia Clinica, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Sen. G. Pascale, Napoli, Italy.
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Affiliation(s)
- A Caricato
- Department of Anesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy.
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Lauria R, Ferrari E, Tramontana S, Morabito A, Perrone F, Maffeo A, Fiorentino R, Casella G, Iodice F, Ricchi P, Carlomagno C, Varriale E, De Placido G, De Placido S, Bianco AR, Pignata S. A phase I study of paclitaxel and epirubicin, without and with filgrastim, for the treatment of platinum-resistant advanced ovarian cancer. Oncology 1999; 56:267-73. [PMID: 10343189 DOI: 10.1159/000011977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 11/19/2022]
Abstract
The aim of the study was to determine the maximum tolerated dose (MTD) of epirubicin combined with a fixed dose of paclitaxel, without and with support of filgrastim, in patients with platinum resistant or refractory ovarian cancer. Paclitaxel (150 mg/m2) and epirubicin (starting dose 90 mg/m2, 15 mg/m2 escalation per level) were given on day 1, every 28 days for 4-6 cycles. Filgrastim (F) (5 microg/kg/die) was given in case of grade 4 leukopenia (levels without support) or from day 4 up to leukocyte count >10,000/mm3 after nadir (levels with support). Cohorts of 3 patients were enrolled at each level and further 3 patients were planned if 1 or 2 unacceptable toxic events (UTE) were registered. MTD was determined first without and then with filgrastim. Four levels were studied (90, 90+F, 105+F, 120+F) with 4, 6, 5 and 4 patients enrolled, respectively. UTE (grade 4 neutropenia) were observed in 3 patients at level 1. Thus, 90 mg/m2 was the MTD for epirubicin without filgrastim. MTD of epirubicin with filgrastim was not reached at 120 mg/m2. Hematological toxicity was mild. Grade 3 mucositis was reported in 1 patient. Among the 14 patients with measurable or evaluable disease, 3 objective responses were observed (1 complete and 2 partial) for an overall response rate of 21.4%. The combination of paclitaxel 150 mg/m2 and epirubicin at 120 mg/m2 with filgrastim is a feasible therapy. Grade 4 leukopenia is the dose limiting toxicity using epirubicin at 90 mg/m2 without filgrastim.
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Affiliation(s)
- R Lauria
- Dipartimento di Endocrinologia ed Oncologia Molecolare e Clinica, Facoltà di Medicina e Chirurgia, Università Federico II, Napoli, Italia
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Pignata S, Silvestro G, Ferrari E, Selvaggi L, Perrone F, Maffeo A, Frezza P, Di Vagno G, Casella G, Ricchi P, Cormio G, Gallo C, Iodice F, Romeo F, Fiorentino R, Fortuna G, Tramontana S. Phase II study of cisplatin and vinorelbine as first-line chemotherapy in patients with carcinoma of the uterine cervix. J Clin Oncol 1999; 17:756-60. [PMID: 10071263 DOI: 10.1200/jco.1999.17.3.756] [Citation(s) in RCA: 57] [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: 11/20/2022] Open
Abstract
PURPOSE To evaluate the activity and toxicity of the combination of cisplatin (80 mg/m2 day 1) and vinorelbine (25 mg/m2 days 1 and 8) in patients with carcinoma of the uterine cervix that has not been previously treated with chemotherapy. PATIENTS AND METHODS Fifty patients with cervical cancer were enrolled onto this study (27 stage IB-III, 23 stage IVB-recurrent). A two-stage optimal Simon design was applied. Thirteen responders of 29 treated patients were required to proceed beyond the first stage, and 28 responders were needed overall. RESULTS Hematologic toxicity was mild, with neutropenia being the most frequent side effect. Nonhematologic toxicity was frequent but never severe; one patient had grade 3 peripheral neurotoxicity. Objective responses were recorded for 32 patients (64%): 11 patients (22%) achieved a complete response (CR) and 21 patients (42%) achieved a partial response (PR). The response rate was 81.5% in patients with IB-III stage (25.9% CR rate) and 43.5% in patients with IVB-recurrent disease (17.4% CR rate). Responses were seen both in stage IVB patients (one CR and two PRs, for an overall rate of 37.5%) and in patients with recurrent disease (three CRs + four PRs, for an overall rate of 46.7%). CONCLUSION The combination of cisplatin and vinorelbine is an active regimen in the treatment of patients with early-stage and advanced carcinoma of the uterine cervix. The hematologic and nonhematologic toxicity of this combination is mild.
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Affiliation(s)
- S Pignata
- Divisione di Oncologia Medica B, Istituto Nazionale Tumori, Napoli, Italy
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Stellato G, Iodice F, Casella G, Fortuna G, Tramontana R, di Bonito M, Tramontana S. Primary malignant melanoma of the vagina: case report. EUR J GYNAECOL ONCOL 1998; 19:186-8. [PMID: 9611064] [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: 02/07/2023]
Abstract
Primary vaginal melanoma is a very rare gynecological malignant tumor (less than 150 reported cases to-date). Prognosis is poor in spite of treatment. Due to the fact that only small groups of patients have been compared, conservative treatment has usually been recommended. In recent times, radical pelvic surgery has appeared to improve the chances of survival. We present an unusual case of primitive melanoma of the upper-third of the vagina with urethral and urinary bladder infiltration in a 47-year-old woman. Treatment consisted of preliminary pelvic bilateral lymphadenectomy, anterior exenteration, and urinary bladder reconstruction according to the Bricker technique. Four months after surgical treatment, liver metastases were found. Chemotherapy was initiated consisting of 8 cycles every 21 days of fotemustine 100 mg/m2 (day 1) and dacarbazine (DTIC) 250 mg/m2 (days 2-5). Interferon alpha-2-b, 3 MU thrice weekly, for the whole period of chemotherapy, was also administered. The patient is in partial remission one year after surgical treatment.
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Affiliation(s)
- G Stellato
- Division of Gynecologic Oncology, The National Tumor Institute, Napoli, Italy
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Iodice F, Germano A, Casella G, Tramontana R, Fortuna G, Tramontana S. Surgical treatment of invasive carcinoma of the vulva: two different techniques. J Chemother 1997; 9:131-2. [PMID: 9176758 DOI: 10.1179/joc.1997.9.2.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- F Iodice
- Department of Gynecological Oncology, National Cancer Center Fond. Sen. Pascale Napoli, Italy
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Affiliation(s)
- F Iodice
- Gynecological Department, National Cancer Center Fond, Sen. Pascale Naples, Italy
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Paris V, Scoppa G, Iodice F, Guida C. Preoperative radio-chemotherapy response as prognostic factor in colorectal cancer. Tumori 1995; 81:72-3. [PMID: 7571059] [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: 01/26/2023]
Abstract
In order to demonstrate if radiotherapy (RT) is able to reduce the number of local recurrences and to increase the survival rate of patients (pts) with colorectal cancer, the authors are participating in a large randomized international trial with the goal of comparing patients treated with preoperative radiotherapy plus surgery and patients treated only by surgery. The authors noticed that some patients treated with preoperative radiotherapy showed a reduction in tumor size at the time of endorectal ultrasonography. The authors considered the incidence of recurrences in patients responsive to radiotherapy (RT responsive group), in patients non responsive to radiotherapy (RT non responsive group) and in patients not treated with radiotherapy (no RT group) with the aim of establishing if the responsiveness to preoperative radiotherapy could be considered a prognostic factor in colorectal cancer. After a three year follow-up RT responsive group (41 pts) showed no recurrences (0%); RT non responsive group (27 pts) showed 7 (25%) recurrences; no RT group (66 pts) showed 27 (41%) recurrences. Our data indicates that responsiveness to preoperative RT can be considered a prognostic factor. A large number of patients is required to confirm this observation.
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Affiliation(s)
- V Paris
- Surgical Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G. Pascale, Napoli
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Iodice F, De Michele F. [Cardiohemodynamic pulmonary assessment in environmental respiratory disease]. Arch Monaldi Mal Torace 1989; 44:991-9. [PMID: 2577821] [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: 01/01/2023]
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Condorelli M, Rengo F, Trimarco B, Bonaduce D, Iodice F, Piscione F, Vigorito C, Marone G. Mechanisms underlying pulmonary hypertension by hypoxemia. Adv Exp Med Biol 1984; 164:309-23. [PMID: 6421105 DOI: 10.1007/978-1-4684-8616-2_31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Iodice F, Rufolo L, Piscione F, De Michele G. Hemodynamic and ventilatory effects of intravenous salbutamol in patients affected by cold. Respiration 1980; 40:272-7. [PMID: 7232877 DOI: 10.1159/000194294] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Hemodynamic and ventilatory effects of i.v. administration of salbutamol (3 micrograms/kg body weight) have been studied in 6 patients affected by chronic obstructive lung disease. A fall of mean pulmonary arterial pressure (PAP), pulmonary vascular resistances index (PVRI), left ventricular end-diastolic pressure (LVEDP) and systemic vascular resistances index (SVRI) have been found significant. Furthermore, heart rate (HR), cardiac index (CI) and left ventricle dp/dt max (LV dp/dt max) were early and remarkably increased. At 30 min after drug administration such effects disappeared in all patients. Regarding the ventilatory data, the authors assume that a significant and precocious FEV1 and vital capacity increase was still present at 30 min. Hemodynamic effects can be related to either an increased venous return due to peripheral vasodilatation or to a beta 1-cardiac receptor stimulation.
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Iodice F, Piscione F, Giuffrida G, De Michele G. [Effects of antihistaminics on pulmonary hypertension caused by chronic hypoxia in humans]. Bronchopneumologie 1977; 27:120-30. [PMID: 880494] [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: 12/24/2022]
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45
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Cazzola M, Iodice F, Tucci M, Russo A, Malagoli T, Piedimonte V. [Ventilatory and cardiovascular effects of a new beta stimulating agent, terbutaline, administered subcutaneously in patients with bronchial obstruction]. Arch Monaldi 1977; 32:83-96. [PMID: 348148] [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: 12/14/2022]
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46
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Iodice F, Rufolo L, Tucci M, Cazzola M, Scotto d'Abusco R, Russo A. [Evaluation of hemodynamic, ventilatory and blood-gas effects of terbutaline administered intravenously in various doses in patients with spastic bronchial obstruction]. Arch Monaldi 1977; 32:97-114. [PMID: 348149] [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: 12/14/2022]
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Catena E, Del Bono M, Iodice F. [Qualitative aspects of tubercular pathology caused by mycobacteria primarily resistant to chemoantibiotics]. Arch Monaldi 1972; 27:475-86. [PMID: 4680309] [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: 01/11/2023]
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48
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Iodice F. [Long-term results of treatment with rifampicin in early pulmonary tuberculosis]. Arch Monaldi 1972; 27:51-6. [PMID: 4568896] [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: 01/11/2023]
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49
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Catena E, Marsico SA, Iodice F. [On nosological classification of bronchial carcinoid]. Arch Monaldi 1970; 25:32-44. [PMID: 4324394] [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: 01/10/2023]
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50
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Nitti V, Ninni A, Iodice F. [The determination of mycobacterial resistance to Rifampicin with the proportion method. (Technical problems and definition of the critical levels)]. Arch Tisiol Mal Appar Respir 1968; 23:979-1000. [PMID: 4977268] [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: 01/13/2023]
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