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Cinelli F, Sciatti E, Rondi M, Sanvito R, Capoferri A, Innocente F, Fino C, Terzi A. P55 A CHALLENGING RIGHT ATRIAL MASS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.053] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
A 64–year–old woman presented at the Emergency Department with worsening dyspnoea and fever. Blood tests revealed normal white blood count, elevated C–reactive protein (244 mg/L) and D–dimer (2618 ng/mL). At arterial blood gases test hypoxaemia and hypocapnia was found (pH 7.48, pO2 83 mmHg, pCO2 30 mmHg, base excess –1.2 mmol/L, lactates 1.0 mmol/L). She underwent thoracic computed tomography (CT), which showed right inferior pulmonary embolism with infarction. A transthoracic echocardiography (TTE) revealed the presence of a mobile heterogeneous iso–hyperechoic neoformation completely occupying the right atrial cavity and moving partially across the tricuspid valve (Figure 1). A right atrial thrombotic formation was hypothesized and, due to its dimension, despite a valid hemodynamic, the patient underwent thrombolysis with rtPA 100 mg iv infusion over 2 hours. However, the next day at CT and TTE the mass was still there and unmodified. The screening for thrombophilia and for cancer markers were negative. Cardiac magnetic resonance imaging was waived because the clinical conditions were rapidly deteriorating. Indeed, the patient was transferred for urgent cardiac surgery. The excised mass was 5 cm x 3.5 cm large and adherent to the right atrial roof, 1 cm close to the atrioventricular node. It was completely removed by the cardiac surgeon (Figure 2). The subsequent journey was regular, without complications. The histologic exam revealed that the mass was a giant myxoma (Figure 3). At follow–up the patient persisted asymptomatic. Figure 1. Transthoracic echocardiography. Figure 2. The excised right atrial mass. Figure 3. Histologic examination of the right atrial mass.
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Affiliation(s)
- F Cinelli
- ASST BERGAMO OVEST – OSPEDALE DI TREVIGLIO–CARAVAGGIO, TREVIGLIO; ASST PAPA GIOVANNI XXIII, BERGAMO
| | - E Sciatti
- ASST BERGAMO OVEST – OSPEDALE DI TREVIGLIO–CARAVAGGIO, TREVIGLIO; ASST PAPA GIOVANNI XXIII, BERGAMO
| | - M Rondi
- ASST BERGAMO OVEST – OSPEDALE DI TREVIGLIO–CARAVAGGIO, TREVIGLIO; ASST PAPA GIOVANNI XXIII, BERGAMO
| | - R Sanvito
- ASST BERGAMO OVEST – OSPEDALE DI TREVIGLIO–CARAVAGGIO, TREVIGLIO; ASST PAPA GIOVANNI XXIII, BERGAMO
| | - A Capoferri
- ASST BERGAMO OVEST – OSPEDALE DI TREVIGLIO–CARAVAGGIO, TREVIGLIO; ASST PAPA GIOVANNI XXIII, BERGAMO
| | - F Innocente
- ASST BERGAMO OVEST – OSPEDALE DI TREVIGLIO–CARAVAGGIO, TREVIGLIO; ASST PAPA GIOVANNI XXIII, BERGAMO
| | - C Fino
- ASST BERGAMO OVEST – OSPEDALE DI TREVIGLIO–CARAVAGGIO, TREVIGLIO; ASST PAPA GIOVANNI XXIII, BERGAMO
| | - A Terzi
- ASST BERGAMO OVEST – OSPEDALE DI TREVIGLIO–CARAVAGGIO, TREVIGLIO; ASST PAPA GIOVANNI XXIII, BERGAMO
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Buoro S, Tombetti E, Ceriotti F, Simon C, Cugola D, Seghezzi M, Innocente F, Maestroni S, del Carmen Baigorria Vaca M, Moioli V, Previtali G, Manenti B, Adler Y, Imazio M, Brucato A. What is the normal composition of pericardial fluid? Heart 2020; 107:1584-1590. [DOI: 10.1136/heartjnl-2020-317966] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/04/2020] [Accepted: 10/07/2020] [Indexed: 12/21/2022] Open
Abstract
ObjectiveBiochemical and cytological pericardial fluid (PF) analysis is essentially based on the knowledge of pleural fluid composition. The aim of the present study is to identify reference intervals (RIs) for PF according to state-of-art methodological standards.MethodsWe prospectively collected and analysed the PF and venous blood of consecutive subjects undergoing elective open-heart surgery from July 2017 to October 2018. Exclusion criteria for study enrolment were evidence of pericardial diseases at preoperatory workup or at intraoperatory assessment, or any other condition that could affect PF analysis.ResultsThe final study sample included 120 patients (median age 69 years, 83 men, 69.1%). The main findings were (1) High levels of proteins, albumin and lactate dehydrogenase (LDH), but not of glucose and cholesterol (2) High cellularity, mainly represented by mesothelial cells. RIs for pericardial biochemistry were: protein content 1.7–4.6 g/dL PF/serum protein ratio 0.29–0.83, albumin 1.19–3.06 g/dL, pericardium-to-serum albumin gradient 0.18–2.37 g/dL, LDH 141–2613 U/L, PF/serum LDH ratio 0.40–2.99, glucose 80–134 mg/dL, total cholesterol 12–69 mg/dL, PF/serum cholesterol ratio 0.07–0.51. RIs for pericardial cells by optic microscopy were: 278–5608 × 106 nucleated cells/L, 40–3790 × 106 mesothelial cells/L, 35–2210 × 106 leucocytes/L, 19–1634 × 106 lymphocytes/L.ConclusionsPF is rich in nucleated cells, protein, albumin, LDH, at levels consistent with inflammatory exudates in other biological fluids. Physicians should stop to interpret PF as exudate or transudate according to tools not validated for this setting.
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Tille JC, de Valence S, Mandracchia D, Nottelet B, Innocente F, Gurny R, Möller M, Walpoth BH. Histologic Assessment of Drug-Eluting Grafts Related to Implantation Site. J Dev Biol 2016; 4:jdb4010011. [PMID: 29615579 PMCID: PMC5831816 DOI: 10.3390/jdb4010011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/10/2016] [Accepted: 02/16/2016] [Indexed: 11/16/2022] Open
Abstract
Drug-eluting vascular prostheses represent a new direction in vascular surgery to reduce early thrombosis and late intimal hyperplasia for small calibre grafts. Subcutaneous implantation in rats is a rapid and cost-effective screening model to assess the drug-elution effect and could, to some extent, be useful to forecast results for vascular prostheses. We compared biological and histological responses to scaffolds in different implantation sites. Polycaprolactone (PCL), paclitaxel-loaded PCL (PCL-PTX) and dexamethasone-loaded PCL (PCL-DXM) electrospun scaffolds were implanted subcutaneously and in an infrarenal abdominal aortic model in rats for up to 12 weeks. At the conclusion of the study, a histological analysis was performed. Cellular graft invasion revealed differences in the progression of cellular infiltration between PCL-PTX and PCL/PCL-DXM groups in both models. Cell infiltration increased over time in the aortic model compared to the subcutaneous model for all groups. Cell counting revealed major differences in fibroblast, macrophage and giant cell graft colonisation in all groups and models over time. Macrophages and giant cells increased in the PCL aortic model; whereas in the subcutaneous model these cell types increased only after three weeks or even decreased in the drug-eluting PCL groups. Other major findings were observed only in the aortic replacement such as extracellular matrix deposition and neo-angiogenesis. The subcutaneous implant model can be used for screening, especially when drug-eluting effects are studied. However, major histological differences were observed in cell type reaction and depth of cell penetration compared to the aortic model. Our results demonstrate that the implantation site is a critical determinant of the biological response.
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Affiliation(s)
- Jean-Christophe Tille
- Division of Clinical Pathology, University Hospital of Geneva, Geneva 1211, Switzerland.
| | - Sarra de Valence
- School of Pharmaceutical Sciences, University of Geneva, Geneva 1211, Switzerland.
| | - Delia Mandracchia
- Department of Pharmacy-Drug Sciences, University of Bari "Aldo Moro", Bari 70125, Italy.
| | - Benjamin Nottelet
- School of Pharmaceutical Sciences, University of Geneva, Geneva 1211, Switzerland.
| | - Francesco Innocente
- Department of Cardiovascular Surgery, Faculty of Medicine, University Hospital, Geneva 1211, Switzerland.
| | - Robert Gurny
- School of Pharmaceutical Sciences, University of Geneva, Geneva 1211, Switzerland.
| | - Michael Möller
- School of Pharmaceutical Sciences, University of Geneva, Geneva 1211, Switzerland.
| | - Beat H Walpoth
- Department of Cardiovascular Surgery, Faculty of Medicine, University Hospital, Geneva 1211, Switzerland.
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Simon C, Grazioli L, Cugola D, Macchitelli V, Innocente F, Terzi A, Merlo M, Brucato AM, Lorini LM, Galletti L. Use of "LIMON Test" in Constrictive Pericarditis: a case series. J Cardiothorac Surg 2015. [PMCID: PMC4693943 DOI: 10.1186/1749-8090-10-s1-a37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Imazio M, Brucato A, Ferrazzi P, Pullara A, Adler Y, Barosi A, Caforio AL, Cemin R, Chirillo F, Comoglio C, Cugola D, Cumetti D, Dyrda O, Ferrua S, Finkelstein Y, Flocco R, Gandino A, Hoit B, Innocente F, Maestroni S, Musumeci F, Oh J, Pergolini A, Polizzi V, Ristic A, Simon C, Spodick DH, Tarzia V, Trimboli S, Valenti A, Belli R, Gaita F. Colchicine for prevention of postpericardiotomy syndrome and postoperative atrial fibrillation: the COPPS-2 randomized clinical trial. JAMA 2014; 312:1016-23. [PMID: 25172965 DOI: 10.1001/jama.2014.11026] [Citation(s) in RCA: 222] [Impact Index Per Article: 22.2] [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: 11/14/2022]
Abstract
IMPORTANCE Postpericardiotomy syndrome, postoperative atrial fibrillation (AF), and postoperative effusions may be responsible for increased morbidity and health care costs after cardiac surgery. Postoperative use of colchicine prevented these complications in a single trial. OBJECTIVE To determine the efficacy and safety of perioperative use of oral colchicine in reducing postpericardiotomy syndrome, postoperative AF, and postoperative pericardial or pleural effusions. DESIGN, SETTING, AND PARTICIPANTS Investigator-initiated, double-blind, placebo-controlled, randomized clinical trial among 360 consecutive candidates for cardiac surgery enrolled in 11 Italian centers between March 2012 and March 2014. At enrollment, mean age of the trial participants was 67.5 years (SD, 10.6 years), 69% were men, and 36% had planned valvular surgery. Main exclusion criteria were absence of sinus rhythm at enrollment, cardiac transplantation, and contraindications to colchicine. INTERVENTIONS Patients were randomized to receive placebo (n=180) or colchicine (0.5 mg twice daily in patients ≥70 kg or 0.5 mg once daily in patients <70 kg; n=180) starting between 48 and 72 hours before surgery and continued for 1 month after surgery. MAIN OUTCOMES AND MEASURES Occurrence of postpericardiotomy syndrome within 3 months; main secondary study end points were postoperative AF and pericardial or pleural effusion. RESULTS The primary end point of postpericardiotomy syndrome occurred in 35 patients (19.4%) assigned to colchicine and in 53 (29.4%) assigned to placebo (absolute difference, 10.0%; 95% CI, 1.1%-18.7%; number needed to treat = 10). There were no significant differences between the colchicine and placebo groups for the secondary end points of postoperative AF (colchicine, 61 patients [33.9%]; placebo, 75 patients [41.7%]; absolute difference, 7.8%; 95% CI, -2.2% to 17.6%) or postoperative pericardial/pleural effusion (colchicine, 103 patients [57.2%]; placebo, 106 patients [58.9%]; absolute difference, 1.7%; 95% CI, -8.5% to 11.7%), although there was a reduction in postoperative AF in the prespecified on-treatment analysis (placebo, 61/148 patients [41.2%]; colchicine, 38/141 patients [27.0%]; absolute difference, 14.2%; 95% CI, 3.3%-24.7%). Adverse events occurred in 21 patients (11.7%) in the placebo group vs 36 (20.0%) in the colchicine group (absolute difference, 8.3%; 95% CI; 0.76%-15.9%; number needed to harm = 12), but discontinuation rates were similar. No serious adverse events were observed. CONCLUSIONS AND RELEVANCE Among patients undergoing cardiac surgery, perioperative use of colchicine compared with placebo reduced the incidence of postpericardiotomy syndrome but not of postoperative AF or postoperative pericardial/pleural effusion. The increased risk of gastrointestinal adverse effects reduced the potential benefits of colchicine in this setting. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01552187.
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Affiliation(s)
- Massimo Imazio
- Cardiology Department, Maria Vittoria Hospital, Torino, Italy2University of Torino, Torino, Italy
| | | | | | - Alberto Pullara
- University of Torino, Torino, Italy4AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Yehuda Adler
- Chaim Sheba Medical Center, Tel Hashomer and Sacker University, Tel Aviv, Israel
| | - Alberto Barosi
- Department of Internal Medicine and Cardiac Surgery, Ospedale Niguarda, Milano, Italy
| | - Alida L Caforio
- Department of Cardiological Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Roberto Cemin
- Cardiology Department, Ospedale Regionale San Maurizio, Bolzano, Italy
| | - Fabio Chirillo
- Department of Cardiology and Cardiac Surgery, Ca Foncello Hospital, Treviso, Italy
| | - Chiara Comoglio
- Department of Cardiac Surgery and Rehabilitation, Villa Maria Pia Hospital, Torino, Italy
| | | | | | - Oleksandr Dyrda
- Department of Cardiac Surgery and Rehabilitation, Villa Maria Pia Hospital, Torino, Italy
| | - Stefania Ferrua
- Department of Cardiology, Ospedale degli Infermi, Rivoli, Italy
| | - Yaron Finkelstein
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Anna Gandino
- Department of Internal Medicine and Cardiac Surgery, Ospedale Niguarda, Milano, Italy
| | - Brian Hoit
- Case Western Reserve University, Cleveland, Ohio15University Hospitals Case Medical Center, Cleveland, Ohio
| | | | | | | | - Jae Oh
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Amedeo Pergolini
- Department of Cardiac Surgery, Ospedale San Camillo, Roma, Italy
| | - Vincenzo Polizzi
- Department of Cardiac Surgery, Ospedale San Camillo, Roma, Italy
| | - Arsen Ristic
- Department of Cardiology, Belgrade University School of Medicine and Clinical Centre of Serbia, Belgrade, Serbia
| | | | | | - Vincenzo Tarzia
- Department of Cardiological Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Stefania Trimboli
- Department of Cardiac Surgery and Rehabilitation, Villa Maria Pia Hospital, Torino, Italy
| | | | - Riccardo Belli
- Cardiology Department, Maria Vittoria Hospital, Torino, Italy
| | - Fiorenzo Gaita
- University of Torino, Torino, Italy4AOU Città della Salute e della Scienza di Torino, Torino, Italy
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Uriarte DS, Lucreziotti S, Sponzilli C, Innocente F, Menicanti L, Lombardi F. Acute myocardial infarction as first manifestation of left atrial myxoma in a young woman: role of echocardiography. J Cardiovasc Med (Hagerstown) 2014; 16 Suppl 2:S69-70. [PMID: 25050532 DOI: 10.2459/jcm.0000000000000027] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the case of a young woman with an acute myocardial infarction secondary to coronary embolization from a left atrial myxoma, as unusual presentation of a cardiac tumor.We also describe the role of transthoracic echocardiograpy in the multidisciplinary approach to diagnosis and treatment of this life-threatening condition.
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Affiliation(s)
- Diego Salerno Uriarte
- aDivision of Cardiology, Department of Medicine, Surgery and Dentistry, San Paolo Hospital bDivision of Cardiac Surgery IRCCS, Policlinico San Donato Hospital, San Donato Milanese, and Faculty of Medicine, University of Milan, Milan, Italy
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7
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Garatti A, Canziani A, Mossuto E, Gagliardotto P, Innocente F, Corain L, Frigiola A, Menicanti L. Tricuspid valve replacement with mechanical prostheses: long-term results. J Heart Valve Dis 2010; 19:194-200. [PMID: 20369503] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Historically, tricuspid valve replacement (TVR) has been associated with high mortality and morbidity, and current knowledge in the long-term outcome of TVR is limited. The study aim was to review the authors' experience from a consecutive series of patients. METHODS Between January 1990 and December 2005, a total of 43 patients (seven males, 36 females; mean age 52 +/- 14 years) underwent TVR. The etiology was rheumatic in 33 patients (77%) and degenerative disease in 10 (22%). Thirty-six patients (84%) were in NYHA class III or IV. Thirty-four patients (79%) underwent redo procedures; all patients underwent TVR with a mechanical prosthesis. RESULTS The overall operative mortality was 16% (n = 7). Of the 36 survivors, nine (25%) died during follow up. The Kaplan-Meier survival at 2.5, 5, and 10 years was 78%, 70%, and 58%, respectively. Five patients (14%) underwent reoperation during follow up (three for tricuspid valve thrombosis) and all five survived the reoperation. Freedom from reoperation at five and 10 years was 90% and 74%, respectively. On permutation test analysis, older age, liver congestion and redo surgery were found to be the major determinants of long-term mortality. CONCLUSION TVR carries a higher short- and long-term mortality when compared to left-heart valve surgery. A timely referral before the development of end-stage cardiac impairment might determine a further improvement in outcome.
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Affiliation(s)
- Andrea Garatti
- Department of Cardiovascular Disease, 'E. Malan', Cardiac Surgery Unit, Policlinico S. Donato Hospital, San Donato Milanese, Milan, Italy.
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Dalsasso M, Grandis M, Innocente F, Veronese S, Ori C. A survey of 1000 consecutive epidural catheter placements performed by inexperienced anesthesia trainees. Minerva Anestesiol 2009; 75:13-19. [PMID: 19037191] [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: 05/27/2023]
Abstract
BACKGROUND Education is the core activity of academic anaesthesia departments. One of the main difficulties appears to be the development of realistic high-quality 'training' practices that are safe for patients. The aim of this study was to determine the incidence of complications occurring after epidural catheter placement by inexperienced anaesthesia trainees and their possible relationship with the experience of the operator. METHODS In a period covering 16 months, we performed a survey of 1,000 consecutive epidural placements performed by inexperienced anaesthesia residents under the direction of staff members in Padoa University Hospital, Italy. Neurological and cardiovascular complications as well as side effects were assessed and analyzed in terms of the experience levels of the trainees. RESULTS Complications during epidural catheter placement included dural puncture (2.2%), epidural vascular damage (1.7%), and paresthesias (0.9%). Postoperative complications and side effects comprised local bleeding at the catheter insertion point (0.7%), catheter malfunction (0.4%), cardiovascular side effects (2.0%) and persistent postoperative paresthesias not caused by local anaesthetic infusion (1.7%). One patient suffered a transient radiculopathy. The overall incidence of complications was similar for each experience level examined. CONCLUSION Epidural catheterization performed under supervision by inexperienced anaesthesia residents is not associated with a significantly greater number of complications than reported in the literature. Moreover, at the early stage of training, we could not demonstrate any correlation between the experience of the operator and the incidence of complications incidence.
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Affiliation(s)
- M Dalsasso
- Department of Anesthesiology and Intensive Care, University of Padoa, Padoa, Italy
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Santini F, Innocente F, Gilioli E, Rossi A, Ferrara A, Brunelli M, Faggian G, Mazzucco A. Primary bi-atrial Burkitt lymphoma with severe inflow impairment in an immunocompetent patient. Cardiovasc Pathol 2008; 18:123-5. [PMID: 18402831 DOI: 10.1016/j.carpath.2007.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 07/13/2007] [Revised: 11/07/2007] [Accepted: 12/11/2007] [Indexed: 11/16/2022] Open
Abstract
We report herein a case of sporadic primary cardiac bi-atrial Burkitt lymphoma (BL) occurred in a 67-year-old white immunocompetent patient and presenting with signs and symptoms of severe bilateral atrioventricular inflow impairment. Extranodal BL involving the heart is rare and seldom recognized clinically. Delayed discovery contributes to significant mortality. In the case presented extended surgical excision and intensive combination chemotherapy regiments resulted in complete remission at 1 year.
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Walpoth B, Cresce GD, Innocente F, Mugnai D, Tessari M, Mazzucco A, Kalangos A, Faggian G. Cardiopulmonary bypass (CPB) in the rat with a new miniaturized hollow fiber oxygenator. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037822] [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]
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Abstract
UNLABELLED Over the last few years significant changes have occurred in both donor and recipient profiles for heart transplantation (HTX). New therapeutic approaches to chronic heart failure have created a novel class of patients aged between 61 and 70 years. Although they are older than the conventional upper limit, they may undergo HTX using marginal donors. We retrospectively reviewed the outcomes of suboptimal donor implants in older recipients to examine negative prognostic factor. METHODS Among 272 patients who underwent HTX at our institution from May 1994 to December 2005, 75 (26.5%) were 61 to 72 years (group 1). The remaining 197 (73.5%) denoted as group 2 ranged in age from 18 to 60 years. The Sex distribution, cause of end-stage heart failure, preoperative pulmonary hypertension, pre-HTX clinical status and mean follow-up did not show any significant difference between the two groups. However, group 1 patients had their organs retrieved from marginal donors (89%) vs group 2 (29%; P < .005). They were deceased mainly due to cerebrovascular events, (namely, 82% vs 27%, respectively, P < .005). RESULTS All analyzed variables-actuarial survival, perioperative mortality, 12-month acute rejection freedom, 100-month chronic rejection freedom, infection freedom, neoplasia freedom, chronic renal failure freedom-did not show any significant difference. CONCLUSION Advances in chronic heart failure medical therapy have generated a new class of HTX candidates aged between 61 and 70 years who benefitted from transplantation of organs retrieved from suboptimal donors.
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Affiliation(s)
- A Forni
- Division of Cardiac Surgery University Hospital of Verona, Verona, Italy.
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Carron M, Innocente F, Veronese S, Miotto D, Pilati P, Rossi CR, Ori C. Subarachnoid anesthesia for loco-regional antiblastic perfusion with circulatory block (stop-flow perfusion). Minerva Anestesiol 2006; 72:37-45. [PMID: 16407805] [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: 05/06/2023]
Abstract
AIM Loco-regional antiblastic perfusion with circulatory block (stop-flow perfusion, SFP) is a procedure designed to treat solid tumors of the limb and pelvis in an advanced stage, like melanoma, sarcoma of the soft tissues and colon-rectal cancer. The aim of this study was to evaluate if subarachnoid anesthesia could represent a safe and suitable anesthetic technique for this procedure. METHODS Thirty SFP procedures were performed in the angiographic room, 15 for the treatment of lower-limb neoplasias and 15 for pelvic neoplasias. The patients (ASA I-III) had a mean age of 59.1 years (range: 19-81 years). The patients were given different dosages of bupivacaine (range: 10-20 mg) in hyperbaric solution at the concentration of 0.5% and 1% by lumbar subarachnoid injection at different levels (from T12-L1 to L3-L4). Standard monitoring was set up (ECG, pulse-oximetry, and non-invasive artery pressure). The use of any anesthetic and analgesic drug, eventually used in the intra- or postoperative period, was recorded. RESULTS The lumbar puncture was approached at L1-L2 and L2-L3 levels in 80% of the cases. Doses of bupivacaine between 12 mg and 14 mg were administered in 2/3 of the cases. Bupivacaine was formulated in hyperbaric solution and administered at a concentration of 0.5% (8 patients) or 1% (22 patients). Complica-tions related to the anesthetic technique were absent. Intraoperative pain control was almost complete with one exception, when the procedure lasted unusually long. Pain control was satisfying immediately after the procedure as well: only in 3 cases were non-opiod analgesics administered within the first 6 h. CONCLUSIONS Spinal subarachnoid anesthesia has proven to be an effective, safe, and easy-to-manage technique for carrying out SFP procedure in a non-conventional environment such as an angiographic room. It was free of serious side effects and well tolerated even in patients in poor general conditions.
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Affiliation(s)
- M Carron
- Department of Pharmacology and Anesthesiology, University of Padua, Padua, Italy
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Dalsasso M, Tresin P, Innocente F, Veronese S, Ori C. Low-dose ketamine with clonidine and midazolam for adult day care surgery. Eur J Anaesthesiol 2005; 22:67-8. [PMID: 15816577 DOI: 10.1017/s0265021505210141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Veronese S, Cutrone C, Innocente F, Ori C. [Endotracheal tube and trachebronchial obstruction due to a large blood clot. Case report]. Minerva Anestesiol 2002; 68:561-5. [PMID: 12105413] [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: 02/25/2023]
Abstract
A case of endotracheal tube and tracheobronchial acute obstruction caused by a large blood clot reproducing in part the trachea and the right bronchial tree is reported. The event has been anticipated by recurring hemoptyses whose source remained unknown despite any examination. Having established by simple manoeuvres that the obstruction was located at the endotracheal tube level, the tube was removed together with the blood clot without more invasive techniques like rigid or flexible bronchoscopy, embolectomy catheter of fibrinolytic agents. On the other side, those techniques should be used in case of obstruction located under the endotracheal tube. Albeit obstruction of endotracheal tubes due to blood clots is a frequent complication in critical care setting, this case is reported for the peculiar dimension and morphology of the clot, underlying that a precise diagnosis of the obstruction level allows the use of the most suitable technique for its removal.
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Affiliation(s)
- S Veronese
- Dipartimento di Farmacologia ed Anestesiologia, Università degli Studi, Padova, Italy
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Veronese S, Innocente F, Cogo P, Ori C. [General anesthesia and undiagnosed cerebral metastasis. Clinical case]. Minerva Anestesiol 2000; 66:163-6. [PMID: 10817007] [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: 02/16/2023]
Abstract
A case of late recovery from anesthesia in a patient undergoing bronchoscopy for surgical removal of metastatic bronchial mass is presented. The patient was comatose and a CT scan revealed the presence of bleeding inside a tumor, probably a metastasis, located in the right cerebellum. This report demonstrates that undetected cerebral metastases might lead to late recovery from anesthesia and underlines that accurate neurologic examination is mandatory in patients affected by tumors potentially spreading to the brain.
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Affiliation(s)
- S Veronese
- Istituto di Anestesiologia e Rianimazione, Università degli Studi, Padova
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16
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Luzzana F, Gaspari A, Rademacher J, Adams G, Passalia L, Matteotti C, Innocente F, Polese M, Dionigi P, Zonta A, Maestri M. [Whole pancreatic transplantation and islet transplantation. Experiment notes]. MINERVA CHIR 1999; 54:375-88. [PMID: 10479856] [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: 02/13/2023]
Abstract
BACKGROUND The results of pancreas transplantation have greatly improved in recent years. The path to further improvements goes through extensive experimental researches. METHODS This study describes the effects of different procedures as hemodynamic asset and postoperative outcome. Twenty-nine swine underwent a total pancreatectomy, and were stratified into five groups. Group one (n = 5) served as control. Group two (n = 7) was autotransplanted. Group three (n = 6) and group four (n = 6) underwent allotransplantation; the first without immunosuppression and the second treated with cyclosporine and steroids. In group five (n = 5) Langerhans Islets transplantation was performed. RESULTS Survival was different depending on which methodology was applied. The postoperative survival was 7 +/- 2 days in group one, 24 +/- 16 days in group two, 17 +/- 7 days in group three, 27 +/- 8 days in group four and 12 +/- 6 days in group five. CONCLUSIONS The postoperative glucose control was normal in group two and group four while a severe diabetes appeared in group one (group 1 vs group 2: p < 0.05) and in group three during acute graft rejection after the 12th postoperative day (group 3 vs group 4: p < 0.05). Glycemia was slightly controlled in group five. The intraoperative hemodynamic status was evaluated at the time of pancreatectomy, harvesting, revascularization, and when surgery was over. Among the different parameters studied (mean arterial and pulmonary pressure, pulmonary wedge pressure, central venous pressure, cardiac output, oxygen extraction ratio, systemic vascular resistance, oxygen delivery and oxygen consumption), a statistically significant difference between group one and group five (p < 0.05) was observed.
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Affiliation(s)
- F Luzzana
- Dipartimento di Chirurgia, Università degli Studi, Pavia
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17
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Gaspari A, Luzzana F, Rademacher J, Adams G, Innocente F, Passalia L, Bellinzona G, Noli S, Dionigi P, Zonta F, Barbieri A, Zonta A, Maestri M. [The hemodynamic effects of the in-vivo administration of insulin-like growth-factor I]. MINERVA CHIR 1998; 53:691-9. [PMID: 9866934] [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
BACKGROUND Recent studies have demonstrated that IGF-I has several biological activities that correlate with the GH axis, by acting as a cell protecting factor and a promoting compound in different tissues and organs. Our latest findings have demonstrated a potential application of IGF-I in the treatment of postischemic renal injury, which frequently appears after a kidney transplant. The beneficial effect of the renal postoperative recovery probably correlates with the regulation of the vascular tone, in which IGF-I plays a role with other cytokines. However, this rises the question whether IGF-I has any effect on the general hemodynamic status. This study was designed to underline the intraoperative hemodynamic effect of exogenous IGF-I in an experimental setting of renal transplantation in swine. METHODS Twelve female swine underwent a left renal autotransplantation. At the reperfusion the animals were separated in two groups. Group one served as control. Group two received 400 micrograms of IGF-I (added to the flushing solution). The animals were kept under complete hemodynamic monitoring over the operation. RESULTS Among the different parameters studied (mean arterial pressure, mean pulmonary arterial pressure, pulmonary wedge pressure, central venous pressure, cardiac output, oxygen extraction ratio, systemic vascular resistance, oxygen delivery and oxygen consumption), any statistically significant difference between group one and two were observed. CONCLUSIONS While the clinical administration of IGF-I requires further studies, the in vivo administration of this peptide is apparently well tolerated, and does not cause any hemodynamic instability to the operation.
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Affiliation(s)
- A Gaspari
- Chirurgia Generale A, Dipartimento di Chirurgia, Università degli Studi, Pavia
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18
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Maestri M, Adams G, Gaspari A, Passalia L, Innocente F, Rademacher J, Luzzana F, Polese M, Bolla E, Noli S, Scotti-Foglieni A, Scotti-Foglieni C, Dafoe D, Dionigi P, Zonta A, Rabkin R. Role of insulinlike growth factor I in renal transplantation: evaluation of intra- and postoperative effects. Transplant Proc 1998; 30:2019-23. [PMID: 9723374 DOI: 10.1016/s0041-1345(98)00517-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Maestri
- Department of Experimental Surgery, University of Pavia, Italy.
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19
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Maestri M, Dionigi P, Pettenazza P, Visconti F, Rademacher J, Gaspari A, Innocente F, Matteotti C, Luzzana F, Zonta A. [Treatment of the nephrotoxicity of immunosuppressive drugs with insulin-like growth factor-I]. MINERVA CHIR 1998; 53:391-6. [PMID: 9780630] [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
BACKGROUND Delayed graft function is a common and severe complication after cadaveric kidney transplantation. Besides a more complicated postoperative course, DGF can worsen the overall graft survival. In particular, DGF enhances the nephrotoxicity of mainstream immunosuppressants cyclosporine and FK506. This study evaluates a new therapeutical approach to the treatment of DGF related nephrotoxicity, based on the administration of IGF-I. METHODS Sixty inbred Lewis rats underwent a bilateral clamping of the renal pedicles (20') as standard damage. The animals were stratified in six groups, according to the postoperative treatment. Group 1 served as control and received only the standard ischemic injury. Cyclosporine and FK506 were added in groups 3 and 5. Groups 2, 4 and 6 had the same treatment of groups 1, 3, 5 respectively, plus the administration of IGF-I. Blood samples were drawn daily to evaluate creatinine and BUN for 7 days. RESULTS The rats treated with IGF-I had significantly better values compared to the respective controls (2-way ANOVA, p < 0.05). CONCLUSIONS In conclusion, IGF-I improves the nephrotoxicity of mainstream immunosuppressants in this model. Its use is potentially beneficial for transplantation.
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Affiliation(s)
- M Maestri
- Dipartimento di Chirurgia, Università degli Studi, Pavia
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20
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Maestri M, Dafoe DC, Adams GA, Gaspari A, Luzzana F, Innocente F, Rademacher J, Dionigi P, Barbieri A, Zonta F, Zonta A, Rabkin R. Insulin-like growth factor-I ameliorates delayed kidney graft function and the acute nephrotoxic effects of cyclosporine. Transplantation 1997; 64:185-90. [PMID: 9256171 DOI: 10.1097/00007890-199707270-00001] [Citation(s) in RCA: 13] [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: 02/05/2023]
Abstract
BACKGROUND Delayed graft function (DGF) is a relatively common complication after cadaveric renal transplantation. The adverse effect of DGF on long-term graft survival has lead to intensive efforts to reduce ischemic graft injury. In this study we examined the effects of a new protective treatment based on insulin growth factor (IGF)-I. We evaluated the impact of the treatment on renal recovery and on the nephrotoxicity that is a common side effect of mainstream immunosuppressants. Because therapy with IGF-I or the analog des(1-3)IGF-I is effective in treating experimental ischemic renal failure, these peptides may be useful as perspective clinical treatments. METHODS We have addressed three areas relating to the potential use of IGF-I and its analog des(1-3)IGF-I. First, because of the immunogenic properties of IGF-I, we assessed the effect of des(1-3)IGF-I on the rejection of skin allografts in Lewis rats. Next we determined whether treatment with des(1-3)IGF-I influences the early function of transplanted kidneys in a model of DGF induced by a combination of warm and cold ischemia. Finally we tested whether IGF-I protects against acute cyclosporine nephrotoxicity. RESULTS Des(1-3)IGF-I did not accelerate the rejection of the skin grafts (P=0.57). The administration of this peptide in a model of syngenic renal transplant improved the early function of the graft. Postoperative values of creatinine and blood urea nitrogen were significantly better (P<0.05) in treated animals. IGF-I also ameliorated the nephrotoxicity of cyclosporine, with better values of creatinine and blood urea nitrogen (P<0.05). CONCLUSIONS In evaluating this study it should be recognized that the animal models studied, although widely used, differ from the human condition. However, IGF-I and des(1-3)IGF-I exhibit properties that strongly suggest their value in preventing clinical DGF, and they deserve further studies.
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Affiliation(s)
- M Maestri
- Department of Surgery, Experimental Surgery, and Institute of Pharmacology, University of Pavia, Italy
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21
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Michielan F, Barbieri S, Feltracco P, Innocente F, Brezzi ML, Veronese S, Marian F, Giron GP. Postoperative pulmonary complications in orthotopic liver transplantation (OLT). How could they be prevented? Intensive Care Med 1996. [DOI: 10.1007/bf01921316] [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: 10/25/2022]
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22
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Tiberio I, Innocente F, Manfio A, Habicher K, Ori C. [Apneic oxygenation in difficult intubation]. Minerva Anestesiol 1993; 59:693-5. [PMID: 8170619] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- I Tiberio
- Istituto di Anestesiologia e Rianimazione, Università degli Studi di Padova
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23
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Innocente F, Tiberio I, Manfio A, Padoan A, Ori C. [Prognosis of subarachnoid hemorrhage from a ruptured cerebral aneurysm in relation to the timing of the intervention]. Minerva Anestesiol 1993; 59:689-91. [PMID: 8170618] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- F Innocente
- Istituto di Anestesiologia e Rianimazione, Università degli Studi di Padova
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24
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Innocente F, Tiberio I, Fiore D, Ori C. [Peri-operative complications of intravascular treatment of cerebral aneurysms and extra- and intracranial vascular malformations]. Minerva Anestesiol 1992; 58:101. [PMID: 1620424] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- F Innocente
- Istituto di Anestesiologia e Rianimazione, Università degli Studi di Padova
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25
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Innocente F, Ori C, Giron GP. Tracheal intubation under fluoroscopic control. X ray-guided orotracheal intubation in three cases of impossible direct laryngoscopy. Anaesthesia 1990; 45:675-7. [PMID: 2400081 DOI: 10.1111/j.1365-2044.1990.tb14397.x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Three patients are described in whom it was impossible to visualise the larynx at direct laryngoscopy. Tracheal intubation was successfully and rapidly achieved with the aid of continuous fluoroscopy.
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Affiliation(s)
- F Innocente
- Istituto di Anestesiologia e Rianimazione, University of Padua, Italy
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26
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Innocente F, Farnia A, Manuali A, Iob I, Salar G, Ori C. [Postoperative complications in surgery of the posterior cranial fossa]. Minerva Anestesiol 1987; 53:329-34. [PMID: 3438023] [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: 01/05/2023]
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