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Ferrero P, Piazza I, Poggioli G, Chessa M, Lorenzelli F. Long-term effects of physical training on cardiopulmonary exercise parameters in young patients with congenital heart diseases. Cardiol Young 2024; 34:831-837. [PMID: 37869879 DOI: 10.1017/s1047951123003621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Physical activity is recognised as an important intervention in patients with CHD. However, more data on the actual magnitude of physical training impact on functional capacity in this group of patients are still warranted. We aim to assess effort tolerance in a contemporary cohort of patients with congenital heart disease, regularly following a training programme, in comparison with a matched control group. METHODS Patients with CHD followed at the sports medicine department, who had undergone cardiopulmonary exercise test between 2011 and 2019, were included. Variables recorded were maximum workload, absolute and indexed maximum oxygen consumption, maximum heart rate, absolute and indexed maximum O2 pulse, ventilatory equivalent of CO2 and oxygen consumption/Work. Trend of cardiopulmonary parameters was analysed over time. Maximal workload, maximum oxygen consumption and ventilatory equivalent of CO2 were compared with a control group of patients with a more sedentary lifestyle, matched for diagnosis, gender, age, and body mass index. RESULTS Among one hundred and eleven patients, 73 males (66%) were analysed. Median age was 14 (12-17) years. Twenty-nine patients (27%) were practising sports at competitive level. Maximum oxygen consumption and oxygen consumption % of maximum predicted were not significantly different at follow-up as compared with baseline. Follow-up of maximum oxygen consumption was 38.2 ± 9 ml/kg/min versus 38.6 ± 9.2 ml/kg/min (p = NS) and follow-up of %oxygen consumption was 88 ± 20 versus 87 ± 15 (p = NS). Ventilatory equivalent of CO2 significantly improved in the last test as compared with the baseline: 30 ± 4 versus 33 ± 5 (p = 0.002). As compared with the control group, trained patients displayed a significantly higher maximum workload and oxygen consumption, while ventilatory equivalent of CO2 was not significantly different. CONCLUSIONS In our cohort, patients following a regular training programme displayed a significantly higher functional capacity as compared with not trained control group, irrespective of NYHA class. Objective functional capacity was stable over a median follow-up of 3 years.
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Affiliation(s)
- Paolo Ferrero
- ACHD Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, San Donato Milanese, Italy
- University of Milano-Bicocca, Milano, Italy
| | - Isabelle Piazza
- Emergency Medicine Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Massimo Chessa
- ACHD Unit, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, San Donato Milanese, Italy
- Vita-Salute San Raffaele University, Milano, Italy
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Ramponi G, Gianni F, Karlafti E, Piazza I, Albertoni F, Colombo G, Casazza G, Garegnani A, Casella R, Costantino G. The diagnostic accuracy of carbon monoxide pulse oximetry in adults with suspected acute carbon monoxide poisoning: a systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1250845. [PMID: 38223786 PMCID: PMC10786445 DOI: 10.3389/fmed.2023.1250845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/09/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Acute carbon monoxide poisoning (COP) is one of the leading causes of intoxication among patients presenting to the emergency department (ED). COP symptoms are not always specific and may vary from mild to critical. In the last few years, COHb pulse oximeters have been developed and applied to the setting of suspected COP. The aim of this systematic review is to assess the diagnostic accuracy of CO pulse oximetry (SpCO) with carboxyhemoglobin (COHb) levels measured by blood gas analysis, used as a reference standard, in patients with suspected COP. Methods We developed our search strategy according to the PICOS framework, population, index/intervention, comparison, outcome, and study, considering the diagnostic accuracy of SpCO compared to COHb levels measured by blood gas analysis, used as a reference standard, in patients with suspected COP enrolled in cross-sectional studies in English. The search was performed on MEDLINE/PubMed and EMBASE in February 2022. Quality assessment was performed using the QUADAS-2 methodology. A COHb cutoff of 10% was chosen to test the sensitivity and specificity of the index test. A bivariate model was used to perform the meta-analysis. The protocol was registered on PROSPERO (CRD42022359144). Results A total of six studies (1734 patients) were included. The pooled sensitivity of the test was 0.65 (95% CI 0.44-0.81), and the pooled specificity was 0.93 (95% CI 0.83-0.98). The pooled LR+ was 9.4 (95% CI 4.4 to 20.1), and the pooled LR- was 0.38 (95% CI 0.24 to 0.62). Conclusion Our results show that SpCO cannot be used as a screening tool for COP in the ED due to its low sensitivity. Because of its high LR+, it would be interesting to evaluate, if SpCO could have a role in the prehospital setting as a tool to quickly identify COP patients and prioritize their transport to specialized hospitals on larger samples with a prospective design.
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Affiliation(s)
- Giacomo Ramponi
- Dipartimento di Scienze Cliniche e Comunità, Università degli Studi di Milano, Milan, Italy
| | - Francesca Gianni
- Dipartimento di Scienze Cliniche e Comunità, Università degli Studi di Milano, Milan, Italy
- Pronto Soccorso, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eleni Karlafti
- Emergency Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Isabelle Piazza
- Dipartimento di Scienze Cliniche e Comunità, Università degli Studi di Milano, Milan, Italy
- Pronto Soccorso, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Giorgio Colombo
- Pronto Soccorso, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Cliniche e Comunità, Università degli Studi di Milano, Milan, Italy
- Pronto Soccorso, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Garegnani
- Pronto Soccorso, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosa Casella
- Pronto Soccorso, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Costantino
- Dipartimento di Scienze Cliniche e Comunità, Università degli Studi di Milano, Milan, Italy
- Pronto Soccorso, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Piazza I, Esquinas A, Cosentini R. Hospital mortality and failure of non-invasive ventilation in COVID-19: looking inside the predictive scores. Intern Emerg Med 2023; 18:681-682. [PMID: 36542303 PMCID: PMC9769552 DOI: 10.1007/s11739-022-03133-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/11/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Isabelle Piazza
- Emergency Medicine Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Roberto Cosentini
- Emergency Medicine Department, ASST Papa Giovanni XXIII, Bergamo, Italy.
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Fiocca L, Rossini R, Carioli G, Carobbio A, Piazza I, Collaku E, Giubilato S, Amico F, Molfese M, De Benedictis M, Calabria P, Limbruno U, Valente S, Ferlini M, Spezzano T, Senni M, Gavazzi A. Adherence of ticagrelOr in real world patients with aCute coronary syndrome: The AD-HOC study. IJC Heart & Vasculature 2022; 42:101092. [PMID: 35873861 PMCID: PMC9301572 DOI: 10.1016/j.ijcha.2022.101092] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/19/2022] [Accepted: 07/13/2022] [Indexed: 10/24/2022]
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Piazza I, Passarella M, Fornelli V, Memaj I. YEARS rule combined with the age-adjusted D-dimer threshold in patients with suspected pulmonary embolism. Intern Emerg Med 2022; 17:2141-2142. [PMID: 35939204 DOI: 10.1007/s11739-022-03070-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/27/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Isabelle Piazza
- Università Degli Studi Di Milano, Milan, Italy.
- Emergency Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy.
| | - Mariele Passarella
- Università Degli Studi Di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Vincenzo Fornelli
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Irdi Memaj
- Università Degli Studi Di Milano, Milan, Italy
- Emergency Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
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Abstract
Dear Editor,
As part of the board of CoSMEU – the Italian association of Emergency Medicine (EM) residents – we are looking with great concern at the current situation of the Emergency Departments (ED) and EM in our country,1 and we would like to share our point of view and experience. [...]
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Ferrero P, Piazza I, Giamberti A, Chessa M. Oncogenesis in patients with congenital heart disease: A possible role of the neural crest. Ann Pediatr Cardiol 2022; 15:273-275. [PMID: 36589641 PMCID: PMC9802619 DOI: 10.4103/apc.apc_213_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/07/2021] [Revised: 01/31/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Abstract
Patients with congenital heart disease (CHD) seem to have a higher risk for specific malignancies. We hypothesize a pathogenetic link between particular congenital heart defects and cancer originating from specific cellular lineages. We report a series of patients, followed in two high-volume referral centers, with CHD involving neural crest-derived structures who developed cancer later in life. Fourteen patients (five female) developed neoplasia with a cellular origin embryologically linked to the neural crest between 2010 and 2020. If confirmed on larger datasets, this observation might support the hypothesis of common embryogenetic pathway suggesting tailored surveillance of a specific subset of patients.
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Affiliation(s)
- Paolo Ferrero
- ACHD UNIT, Pediatric and Adult Congenital Heart Centre, IRCCS – Policlinico San Donato, San Donato Milanese, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, ERN GUARD-Heart, Milan, Italy
| | - Isabelle Piazza
- EAS, Emergency department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alessandro Giamberti
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, ERN GUARD-Heart, Milan, Italy
- Congenital Cardiac Surgery Unit, IRCCS - Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Massimo Chessa
- ACHD UNIT, Pediatric and Adult Congenital Heart Centre, IRCCS – Policlinico San Donato, San Donato Milanese, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, ERN GUARD-Heart, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
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Abstract
CoSMEU group (Italian Society of Emergency Medicine Residents): Cascio Michela, Ceschi Ludovica, Di Cristoforo Monica, La Spina Letizia, Malacarne Cecilia, Pons Sofia, Silvestri Giulia.
Emergency Medicine (EM) is a novel specialty in Italy. It exists only since 2009, and CoSMEU (Coordinamento Specializzandi Medicina d’Emergenza-Urgenza) is the national association of EM residents. On behalf of CoSMEU, we conducted an electronic survey open to all the Italian EM residents, with the aim to assess their awareness about the acquisition of technical skills and clinical knowledge during the academic year 2019-2020. Out of 1666 EM residents, 434 (26%) responded to the survey, in representation of all the 33 medical school programs. For 63.6% of them EM was their first-choice program. A high percentage of EM residents have denounced a lack of education and hands-on opportunities to fully complete their training as planned, in the absence of simulation and certifications, and with not-standardized educational programs across the EM schools. Although the Italian EM and specialty are currently facing a crisis, all the EM residents are working hard to support EM system optimization.
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Piazza I, Ferrero P. First case reported of COVID-19 infection in an adult patient with Ellis-van Creveld syndrome. Progress in Pediatric Cardiology 2022; 67:101508. [PMID: 35250252 PMCID: PMC8885086 DOI: 10.1016/j.ppedcard.2022.101508] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022]
Abstract
Ellis-van Creveld syndrome (EVC) is a rare autosomal recessive disorder, the features of the syndrome are: chondral and ectodermal dysplasia characterized by short ribs, polydactyly, growth retardation resulting in dwarfism, teeth and craniofacial abnormalities and heart defects (mostly endocardial cushions and atrial septal defects). We describe the first case reported of COVID-19 infection in a 24-years-old girl, diagnosed with EVC syndrome. The patient suffered only from a mild illness, she remained stable with normal saturation without need of neither respiratory support nor specific therapy and she was rapidly discharged. This case appraises the pathophysiological interplay between different specific prognostic variable in a syndromic patient with congenital heart disease and COVID-19. In patients with congenital heart disease, comorbidities related to syndromic picture may affect the clinical course of COVID-19 infection regardless of the anatomic complexity.
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Affiliation(s)
- Isabelle Piazza
- Emergency Medicine Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Ferrero
- ACHD Unit - Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, San Donato Milanese, Milan, Italy
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Piazza I, Burti C, Assolari A, Greco S, Benetti A, Cosentini R, Ferrero P. Acute myocarditis as first presentation of severe ulcerative colitis in a young man. Multidisciplinary management and long-term follow-up. J Cardiol Cases 2022; 26:46-50. [DOI: 10.1016/j.jccase.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/26/2022] [Accepted: 02/19/2022] [Indexed: 12/12/2022] Open
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Piazza I, Ferrero P, Marra A, Cosentini R. Early Diagnosis of Acute Myocarditis in the ED: Proposal of a New ECG-Based Protocol. Diagnostics (Basel) 2022; 12:diagnostics12020481. [PMID: 35204572 PMCID: PMC8870824 DOI: 10.3390/diagnostics12020481] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/29/2022] [Accepted: 02/11/2022] [Indexed: 01/27/2023] Open
Abstract
The diagnosis of acute myocarditis (AM) is based on a multi-parametric assessment including clinical presentation, ECG, imaging and biomarkers. Fragmented QRS (fQRS) might be an additional diagnostic sign in patients with proven AM. The main objective of this study was to assess the diagnostic yield of fQRS in patients with suspected AM presenting to the emergency department (ED). Patients admitted between January 2016 and March 2021 with a proven diagnosis of AM, according to clinical, cardiac magnetic resonance (CMR) and/or histologic criteria, were included in the analysis. In total, 51 patients were analyzed (41 men, 78%), with a median age of 36 (29–45) years. Thirty-three (65%) patients had prodromal flu-like symptoms. Patients presented to the ED mostly complaining of chest pain (68%) and palpitations (21%). Seven (14%) patients experienced cardiac arrest, one of whom died. At presentation, 40 patients (78%) displayed fQRS, and 10 (20%) presented ventricular arrhythmias. All the surviving patients underwent CMR and displayed late gadolinium enhancement (LGE). ECG leads showed that fQRS matched the LGE distribution in 38 patients (95%). The presence of fQRS is a simple clinical bedside tool to support the initial suspect of AM in the emergency department and to guide the most appropriate clinical workup.
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Affiliation(s)
- Isabelle Piazza
- Emergency Department, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (I.P.); (A.M.)
- Scuola di Specializzazione in Medicina d’Emergenza e Urgenza, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Paolo Ferrero
- Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20097 San Donato Milanese, Italy;
| | - Alessio Marra
- Emergency Department, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (I.P.); (A.M.)
| | - Roberto Cosentini
- Emergency Department, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (I.P.); (A.M.)
- Correspondence: ; Tel.: +39-035-267111; Fax: +39-035-267-4936
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Ferrero P, Piazza I. Cardio-thoracic imaging and COVID-19 in the pediatric population: A narrative review. World J Radiol 2021; 13:94-101. [PMID: 33968312 PMCID: PMC8069348 DOI: 10.4329/wjr.v13.i4.94] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/19/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023] Open
Abstract
Worldwide experience about coronavirus disease 2019 (COVID-19) pandemics suggests that symptomatic disease is significantly less frequent in the pediatric age range. Nevertheless, multi-system inflammatory syndrome has been consistently reported in children and has been associated with severe acute respiratory syndrome coronavirus 2 exposure. In this paper we give an overview of the multimodality chest imaging of pediatric patients with suspected COVID-19, focusing on relevant differences with adults.
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Affiliation(s)
- Paolo Ferrero
- ACHD Unit–Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, San Donato Milanese 20097, Milan, Italy
| | - Isabelle Piazza
- Department of Emergency Medicine, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
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Ferrero P, Piazza I, Sadou Y, Ciuffreda M. Reversible acute Fontan circulation failure secondary to retrogradely conducted junctional rhythm: clinical echocardiographic correlation. J Congenit Heart Dis 2021. [DOI: 10.1186/s40949-021-00063-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Sequential atrioventricular activation plays a critical role in the physiology of Fontan circulation. Although bradycardia is usually well tolerated, retrogradely conducted junctional rhythm may acutely increase atrial pressure impairing cardiac output. Echocardiographic evaluation can reveal clues of this hemodynamic condition. The clinical impact of arrhythmic disturbance on the follow up of patients who had undergone total cavo-pulmonary connection is well recognized but the role of, transient periods of retrogradely conducted junctional rhythm on the immediate post-operative course is less defined.
Case presentation
We describe two cases of acute Fontan circulatory failure due to postoperative retrogradely conducted junctional escape rhythm despite an adequate heart rate and circadian variation. The patients rapidly improved after atrial pacing, allowing discharge with a minimal dose of diuretic.
Conclusion
In the absence of any hemodynamic target, hearth rhythm should be systematically checked after TCPC irrespective of adequacy of heart rate. Likewise, efficiency of temporary atrial pacing should be granted and surgeons should have a low threshold for epicardial lead implantation.
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Ferrero P, Chessa M, Piazza I, Bonino C, Ferrari I, Giamberti A, Ciuffreda M, Dimopoulos K. COVID-19 in adults with congenital heart disease: early morbidity and mortality in two northern Italian specialist centers. Ital J Med 2021. [DOI: 10.4081/itjm.2021.1397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
There is no information on coronavirus disease 2019 (COVID-19)-related outcomes for adult patients with congenital heart disease (ACHD). We aim to assess the clinical burden of COVID-19 on ACHD patients during the initial stages of the pandemic in Europe. ACHD patients followed in 2 tertiary centers in the Lombardy region were screened for COVID-19-related symptoms and complications. 661 patients (52.3% male, mean age 34.9±11.7 years) with CHD of moderate (58.5%) or high (32.8%) complexity were contacted. Of these, 145 (21.9%) reported typical COVID-19 symptoms, but only 4.8% required hospitalization. We did not record confirmed COVID-19-related deaths. Patients hospitalized were elderly (P=0.03), more likely to be receiving diuretics (P=0.03) or beta-blockers (P=0.02), and have been admitted over the previous year (P=0.003). Of the 7 patients hospitalized, 2 had a systemic RV and 2 a Fontan circulation. COVID-19-related morbidity and mortality have been low in ACHD patients 6 weeks from the start of the outbreak, in one of the worse hit European regions.
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Piazza I, Brambilla P, Boni R, Ferrero P. B-cell primitive extranodal cardiac lymphoma: multimodal image diagnosis and long-term follow-up. Eur Heart J Case Rep 2021; 4:1-2. [PMID: 33442634 PMCID: PMC7793173 DOI: 10.1093/ehjcr/ytaa461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/02/2020] [Accepted: 11/05/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Isabelle Piazza
- Internal Medicine Department, ASST Papa Giovanni XXIII Bergamo, Italy
| | - Paolo Brambilla
- Diagnostic Radiology, ASST Papa Giovanni XXIII Bergamo, Italy
| | - Roberto Boni
- Nuclear Medicine Unit, ASST Papa Giovanni XXIII Bergamo, Italy
| | - Paolo Ferrero
- Cardiovascular Department, ASST Papa Giovanni XXIII Bergamo, Italy
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Ferrero P, Piazza I, Koneti NR, Ciuffreda M. Catheter closure of a patent vertical vein after repair of an unusual total anomalous variant of pulmonary venous drainage. Ann Pediatr Cardiol 2020; 14:82-84. [PMID: 33679067 PMCID: PMC7918028 DOI: 10.4103/apc.apc_139_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/24/2020] [Accepted: 09/17/2020] [Indexed: 12/04/2022] Open
Abstract
Total anomalous pulmonary venous drainage (TAPVD) encompasses a wide spectrum of anatomical variants. The infradiaphragmatic type is almost always obstructive owing to the interposition of intrahepatic resistances; since almost invariable, the vertical vein inserts on the portal venous system. On correction of this variant, the vertical vein might not be ligated to avoid postoperative pulmonary hypertension. We hereby describe an unusual case of infradiaphragmatic TAPVD, with a vertical vein connected to ductus venosus. Since vertical vein was not ligated, it realized an unrestrictive pathway between the left atrium and the suprahepatic veins which resulted in persistent chylous peritoneal drainage. The patient successfully underwent catheter occlusion of the vertical vein which led to complete resolution of the clinical picture.
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Affiliation(s)
- Paolo Ferrero
- Cardiovascular Department, Division of Cardiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Isabelle Piazza
- Cardiovascular Department, Division of Cardiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Nageswara Rao Koneti
- Department of Pediatric Cardiology, Rainbow Children Heart Hospitals, Hyderabad, Telangana, India
| | - Matteo Ciuffreda
- Cardiovascular Department, Division of Cardiology, ASST Papa Giovanni XXIII, Bergamo, Italy
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Ferrero P, Piazza I, Bonino C, Ciuffreda M. Patterns of myocardial involvement in children during COVID-19 pandemic: Early experience from northern Italy. Ann Pediatr Cardiol 2020; 13:230-233. [PMID: 32863659 PMCID: PMC7437629 DOI: 10.4103/apc.apc_77_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/15/2020] [Accepted: 05/30/2020] [Indexed: 12/19/2022] Open
Abstract
There is limited information about coronavirus disease 2019 (COVID-19) in the pediatric population. Preliminary data suggest a not insignificant prevalence of cardiac involvement. Here, we report our early experience with COVID-19 in the pediatric population. These patients display exceptionally high levels of acute-phase reactants. The clinical syndrome in these patients is somewhat similar to Kawasaki disease with or without myocardial involvement. In some cases, the presentation mimics typical myocarditis. Severe myocardial involvement is associated with transient electrocardiographic and echocardiographic abnormalities. These findings may be due to the cardiotropic nature of the virus or may be the result of an immunologic response to the infection.
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Affiliation(s)
- Paolo Ferrero
- Department of Cardiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Isabelle Piazza
- Department of Cardiology, ASST Papa Giovanni XXIII, Bergamo, Italy.,University of studies of Milan, Italy
| | - Caterina Bonino
- Department of Cardiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Matteo Ciuffreda
- Department of Cardiology, ASST Papa Giovanni XXIII, Bergamo, Italy
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Ferrero P, Piazza I, Kühl U, Grosu A, Tschöpe C, Senni M. QRS fragmentation as a possible electrocardiographic diagnostic marker in patients with acute myocarditis: preliminary histopathological validation. ESC Heart Fail 2020; 7:2527-2533. [PMID: 32562382 PMCID: PMC7524046 DOI: 10.1002/ehf2.12821] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 03/10/2020] [Revised: 05/17/2020] [Accepted: 05/20/2020] [Indexed: 12/17/2022] Open
Abstract
Aims We aim to assess the reproducibility of QRS fragmentation (fQRS) on a multi‐centre dataset of patients with acute myocarditis (AM), including a histopathological validation in a subgroup with biopsy‐proven disease. Electrocardiogram (ECG) in patients with myocarditis is usually considered aspecific. ST changes and conduction anomalies have been commonly reported so far. We have previously described fQRS in patients with AM. Methods and results Patients admitted between 2008 and 2019 in two centres with a diagnosis of AM were included. Standard ECG, echocardiography, and cardiac magnetic resonance (CMR) findings were recorded at baseline and at follow‐up (FU). Eighty patients were analysed, 66 men (82%), with median age of 34 (26–43) years. Twenty‐two patients had biopsy‐proven AM. At presentation, 61 patients (76%) displayed fQRS. Median ejection fraction (EF) was 55% (43–60). Seventy‐two patients (90%) underwent CMR and displayed late gadolinium enhancement (LGE). ECG leads showed that fQRS correlated with distribution of LGE. In patients with positive biopsy, fQRS was present in 18 (81%). Median FU was 419 days (224–956). Complete FU was available for 64 patients (80%), and 33 patients (52%) displayed persistence of fQRS. Median EF was 60% (57–64). Eleven patients underwent a repeated biopsy at FU, eight of whom had persistent inflammation and fQRS. Fifteen patients (23%) had ventricular tachycardia, 14 of whom still showed fQRS. Conclusions In this cohort fQRS was confirmed as an additional useful ECG sign. Persistence of fQRS was associated with ongoing inflammation and with a poorer outcome in terms of ventricular function and occurrence of arrhythmias.
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Affiliation(s)
- Paolo Ferrero
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Isabelle Piazza
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Uwe Kühl
- Department of Cardiology, University of Medicine Berlin, Charité, Campus Virchow Klinikum, Berlin, Germany
| | - Aurelia Grosu
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Carsten Tschöpe
- Department of Cardiology, University of Medicine Berlin, Charité, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Berlin Institute of Health/Center for Regenerative Therapy (BCRT), Berlin, Germany
| | - Michele Senni
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
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19
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Ferrero P, Piazza I, Lorini LF, Senni M. Epidemiologic and clinical profiles of bacterial myocarditis. Report of two cases and data from a pooled analysis. Indian Heart J 2020; 72:82-92. [PMID: 32534694 PMCID: PMC7296240 DOI: 10.1016/j.ihj.2020.04.005] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/29/2020] [Accepted: 04/19/2020] [Indexed: 12/13/2022] Open
Abstract
We aimed to characterize the epidemiology, diagnostic peculiarities and outcome determinants of bacterial myocarditis. Two cases from our institution and literature reports were collected ending up with a total of 66 cases. In 37 (56%) patients, the diagnosis was confirmed by magnetic resonance and histopathological criteria. The other patients were classified as having possible myocarditis. Only occurrence of rhythm disturbances was associated with the specific diagnosis of myocarditis (p = 0.04). Thirty-two (48%) patients presented with severe sepsis that was associated with a worse prognosis. At multivariate analysis, left ventricular ejection fraction (LVEF) at admission and heart rhythm disturbances were associated with incomplete recovery (odds ratio (OR) 1.1, 95% (CI) 1.03–1.2, p = 0.004 and OR 6.6, 95% CI 1.35–32.5, p = 0.02, respectively). In summary, bacterial myocarditis is uncommon. Most commonly, it is secondary to septic dissemination of bacteria or to transient secondary myocardial toxicity.
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Affiliation(s)
- P Ferrero
- Cardiovascular Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy.
| | - I Piazza
- Cardiovascular Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | - L F Lorini
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | - M Senni
- Cardiovascular Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
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20
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Iorio A, Rossini R, Collaku E, Piazza I, Ferrari A, Carobbio A, De Filippo P, Senni M, Gavazzi A. SAFETY AND EFFICACY OF ELECTIVE ELECTRIC CARDIOVERSION IN ATRIAL FIBRILLATION WITHOUT THE USE OF TRANSESOPHAGEAL ECHOCARDIOGRAM THE ECARTE STUDY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31152-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Ferrero P, Piazza I, Tschöpe C, Grosu A, Senni M. QRS FRAGMENTATION: VALIDATION OF A NEW EKG DIAGNOSTIC AND PROGNOSTIC MARKER IN ACUTE MYOCARDITIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31486-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Natali F, Dolce C, Peters J, Stelletta C, Demé B, Ollivier J, Boehm M, Leduc G, Piazza I, Cupane A, Barbier EL. Anomalous water dynamics in brain: a combined diffusion magnetic resonance imaging and neutron scattering investigation. J R Soc Interface 2019; 16:20190186. [PMID: 31409238 DOI: 10.1098/rsif.2019.0186] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 12/31/2022] Open
Abstract
Water diffusion is an optimal tool for investigating the architecture of brain tissue on which modern medical diagnostic imaging techniques rely. However, intrinsic tissue heterogeneity causes systematic deviations from pure free-water diffusion behaviour. To date, numerous theoretical and empirical approaches have been proposed to explain the non-Gaussian profile of this process. The aim of this work is to shed light on the physics piloting water diffusion in brain tissue at the micrometre-to-atomic scale. Combined diffusion magnetic resonance imaging and first pioneering neutron scattering experiments on bovine brain tissue have been performed in order to probe diffusion distances up to macromolecular separation. The coexistence of free-like and confined water populations in brain tissue extracted from a bovine right hemisphere has been revealed at the micrometre and atomic scale. The results are relevant for improving the modelling of the physics driving intra- and extracellular water diffusion in brain, with evident benefit for the diffusion magnetic resonance imaging technique, nowadays widely used to diagnose, at the micrometre scale, brain diseases such as ischemia and tumours.
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Affiliation(s)
- F Natali
- Institut Laue-Langevin, Grenoble Cedex 9, France.,CNR-IOM, OGG, Grenoble Cedex 9, France
| | - C Dolce
- Institut Laue-Langevin, Grenoble Cedex 9, France.,CNRS, Univ. Grenoble Alpes, LIPhy, 38000 Grenoble, France.,Department of Physics and Chemistry, University of Palermo, Palermo, Italy
| | - J Peters
- Institut Laue-Langevin, Grenoble Cedex 9, France.,CNRS, Univ. Grenoble Alpes, LIPhy, 38000 Grenoble, France
| | - C Stelletta
- Department of Animal Medicine, Production and Health, University of Padova, Padova, Italy
| | - B Demé
- Institut Laue-Langevin, Grenoble Cedex 9, France
| | - J Ollivier
- Institut Laue-Langevin, Grenoble Cedex 9, France
| | - M Boehm
- Institut Laue-Langevin, Grenoble Cedex 9, France
| | - G Leduc
- Biomedical Facility, ESRF, Grenoble, France
| | - I Piazza
- Institut Laue-Langevin, Grenoble Cedex 9, France.,Department of Physics and Chemistry, University of Palermo, Palermo, Italy
| | - A Cupane
- Department of Physics and Chemistry, University of Palermo, Palermo, Italy
| | - E L Barbier
- Grenoble Institut Neurosciences, University of Grenoble Alpes, Inserm, U1216, 38000 Grenoble, France
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23
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Ferrero P, Piazza I, Grosu A, Brambilla P, Senni M. QRS FRAGMENTATION: A POSSIBLE NEW MARKER OF EDEMA AND FIBROSIS IN MYOCARDITIS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31413-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Ferrero P, Piazza I, Grosu A, Brambilla P, Sironi S, Senni M. QRS fragmentation as possible new marker of fibrosis in patients with myocarditis. Preliminary validation with cardiac magnetic resonance. Eur J Heart Fail 2019; 21:1160-1161. [PMID: 30714659 DOI: 10.1002/ejhf.1413] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/24/2018] [Accepted: 12/16/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Paolo Ferrero
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Isabelle Piazza
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Aurelia Grosu
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paolo Brambilla
- Radiology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Sandro Sironi
- Radiology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.,School of Medicine, Bicocca University Milano, Italy
| | - Michele Senni
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
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25
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Rossini M, Viapiana O, Vitiello M, Malavolta N, La Montagna G, Maddali Bongi S, Di Munno O, Nuti R, Manzini C, Ferri C, Bogliolo L, Mathieu A, Cantatore F, Del Puente A, Muratore M, Grassi W, Frediani B, Saviola G, Delvino P, Mirone L, Ferraccioli G, Tripi G, Piazza I, Gatti D. Prevalence and incidence of osteoporotic fractures in patients on long-term glucocorticoid treatment for rheumatic diseases: the Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) study. Reumatismo 2017; 69:30-39. [DOI: 10.4081/reumatismo.2017.922] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 04/02/2017] [Accepted: 04/05/2017] [Indexed: 11/22/2022] Open
Abstract
Osteoporosis and fractures are common and invalidating consequences of chronic glucorticoid (GC) treatment. Reliable information regarding the epidemiology of GC induced osteoporosis (GIOP) comes exclusively from the placebo group of randomized clinical trials while observational studies are generally lacking data on the real prevalence of vertebral fractures, GC dosage and primary diagnosis. The objective of this study was to evaluate the prevalence and incidence of osteoporotic fractures and to identify their major determinants (primary disease, GC dosage, bone mineral density, risk factors, specific treatment for GIOP) in a large cohort of consecutive patients aged >21 years, on chronic treatment with GC (≥5 mg prednisone - PN - equivalent) and attending rheumatology centers located all over Italy. Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) is a national multicenter cross-sectional and longitudinal observational study. 553 patients suffering from Rheumatoid Arthritis (RA), Polymyalgia Rheumatica (PMR) and Connective Tissue Diseases (CTDs) and in chronic treatment with GCs were enrolled. Osteoporotic BMD values (T score <-2.5) were observed in 28%, 38% and 35% of patients with CTDs, PMR or RA at the lumbar spine, and in 18%, 29% and 26% at the femoral neck, respectively. Before GC treatment, prevalent clinical fractures were reported by 12%, 37% and 17% of patients with CTDs, PMR, or RA, respectively. New clinical fragility fractures during GC treatment were reported by 12%, 10% and 23% of CTDs, PMR and RA patients, respectively. Vertebral fractures were the prevailing type of fragility fracture. More than 30% of patients had recurrence of fracture. An average of 80% of patients were in supplementation with calcium and/or vitamin D during treatment with GCs. Respectively, 64%, 80%, and 72% of the CTDs, PMR and RA patients were on pharmacological treatment for GIOP, almost exclusively with bisphosphonates. The GIOTTO study might provide relevant contributions to clinical practice, in particular by highlighting and quantifying in real life the prevalence of GIOP and relative fractures, the frequency of the main risk factors, and the currently sub-optimal prevention. Moreover, these results emphasize the importance of the underlying rheumatic disease on the risk of GIOP associated fractures.
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26
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Sfriso P, Priori R, Colafrancesco S, Valesini G, Rossi S, Montecucco C, D'Ascanio A, Carli L, Bombardieri S, La Selva G, Iannone F, Lapadula G, Alivernini S, Ferraccioli G, Caso F, Colaci M, Ferri C, Iacono D, La Montagna G, Costa L, Scarpa R, Lo Monaco A, Bagnari V, Govoni M, Piazza I, Adami S, Schinocca C, Ciccia F, Triolo G, Alessandri E, Cutolo M, Cantarini L, Galeazzi M, Punzi L. THU0395 Adult Onset Still's Disease: A Multicenter Retrospective Cohort Study of 233 Italian Patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5300] [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: 11/04/2022]
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27
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Abstract
A 51-year-old man with chronic alcoholic liver disease developed a severe haemolytic anaemia characterized by the presence of circulating burr-shaped cells (echinocytes). Several transfusions of packed red cells were ineffective in raising the haemoglobin concentration, showing that the abnormality was acquired by the transfused cells. Liver biopsies revealed haemochromatosis. Haematological parameters normalized four months after the patient stopped drinking alcohol, but burr cells were still present and erythrocyte life-span was still markedly shortened at one year follow-up. Since serum cholesterol, HDL-cholesterol, and Apo-AI and Apo-B lipoproteins were considerably decreased, the lipid composition of the red cell membrane was studied. Findings showed that echinocytosis occurred with no change in membrane cholesterol content, nor in cholesterol:phospholipid ratio, but with an alteration in the phosphatidylserine and phosphatidylinositol concentrations. While haemochromatosis was most likely the cause of the erythrocyte anomaly, alcohol intake was probably responsible for the acute onset of haemolytic anaemia with effects directly on the erythrocyte membrane as well as mediated by the progressive hepatic injury, with alterations in the plasma and successively in the intramembrane lipid composition.
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Affiliation(s)
- N Bizzaro
- Laboratorio di Patologia Clinica, Ospedale Civile, Venice, Italy
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28
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Pirovano F, Piazza I, Brambilla F, Sozzi T. Impedimetric method for selective enumeration of specific yoghurt bacteria with milk-based culture media. ACTA ACUST UNITED AC 1995. [DOI: 10.1051/lait:1995320] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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29
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Piazza I, Bizzaro N. Humoral response to subcutaneous, oral, and nasal immunotherapy for allergic rhinitis due to Dermatophagoides pteronyssinus. Ann Allergy 1993; 71:461-9. [PMID: 7755664] [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: 01/27/2023]
Abstract
We investigated variations in total IgE, and specific IgE, IgG, and IgG4 for Dermatophagoides pteronyssinus in 57 patients with perennial rhinitis due to house dust mite allergy in an open controlled study: 43 subjects received immunotherapy (17 subcutaneous, 14 sublingual, and 12 local immunotherapy) and 14 were controls. The results were compared with the clinical course to determine possible associations between serum and clinical changes. Subcutaneous, but not sublingual and nasal, immunotherapy induced a significant clinical benefit (P < .001). Specific antibody behavior in patients receiving subcutaneous immunotherapy was similar to literature reports. Specific IgE levels fell starting from the 6th month of therapy, and specific IgG and IgG4 levels rose significantly, but there was no correlation with the clinical course. The other two forms of immunotherapy did not induce significant specific antibody modifications. We conclude that the specific IgG4 rise induced by subcutaneous immunotherapy was the most important variation observed. This change, however, was not correlated with the clinical outcome.
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Affiliation(s)
- I Piazza
- Department of Internal Medicine, Hospital of San Doná di Piave (Venice), Italy
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30
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Giunta G, Piazza I. Fatal septicaemia due to Listeria monocytogenes in a patient with systemic lupus erythematosus receiving cyclosporin and high prednisone doses. Neth J Med 1992; 40:197-9. [PMID: 1603211] [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: 12/27/2022]
Abstract
Cyclosporin A is widely used in organ transplantation, preventing the rejection of multiple types of organ allografts. It is also being increasingly used as an immunosuppressive agent to treat various autoimmune diseases in patients refractory to more commonly used immunosuppressive therapy. Several trials are currently evaluating the utility of this drug associated with corticosteroids in the treatment of systemic lupus erythematosus. This case, describing a lethal septicaemia caused by Listeria monocytogenes in a patient receiving this treatment, seems to indicate that the use of these "cocktails" of immunosuppressive drugs should be particularly cautious to prevent fatal infectious complications.
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Affiliation(s)
- G Giunta
- Department of Internal Medicine, Hospital of San Donà di Piave, Venice, Italy
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31
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Abstract
Pulmonary toxicity is an important adverse effect of amiodarone therapy that usually manifests as an acute or chronic diffuse lung disease; in rare cases localized lesions have also been described. We observed a solitary mass localized in the left lung base and involving the adjacent pleura in a 69-year-old man who had been treated for 1 year with amiodarone (cumulative dose 52 g). Cytological and histological examination showed that the lesion consisted of fibrotic tissue and a massive macrophagic infiltration. Following suspension of amiodarone and surgical excision, there was a complete recovery and the mass did not relapse. We confirm that respiratory complaints can occur in patients treated by long-term amiodarone therapy and that lung involvement can manifest with a solitary localized (fibrotic) lesion.
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Affiliation(s)
- I Piazza
- Department of Internal Medicine, Hospital of San Donà di Piave, Venice, Italy
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32
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Abstract
We describe a case of a male teenager, affected by acne fulminans. He had lytic bone lesions in both clavicles and arthritis of the right sacroiliac joint and spine. A bone scan showed increased uptake in these areas. Infection or a neoplastic disease was suspected but the cytological examination and the bacterial cultures of the material collected with a fine needle biopsy from the clavicular lesion were negative. The patient was treated with diclofenac and promptly recovered. Our report emphasizes that, although unusual, acne fulminans can be complicated by an erosive systemic arthritis and bone lesions. An immunological mechanism seems to be involved in this association.
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Affiliation(s)
- I Piazza
- Department of Internal Medicine, Hospital of San Donà di Piave, Venice, Italy
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33
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Giunta G, Piazza I. Recurrent bacterial meningitis occurring five years after closed head injury and caused by an intranasal post-traumatic meningo-encephalocele. Postgrad Med J 1991; 67:377-9. [PMID: 2068033 PMCID: PMC2398824 DOI: 10.1136/pgmj.67.786.377] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [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: 12/30/2022]
Abstract
A case of atypical presentation of a post-traumatic intranasal meningo-encephalocele is described in a patient with a history of recurrent bacterial meningitis occurring 5 years after closed head injury. The usefulness of the CT and MRI findings in diagnostic evaluation of this lesion is emphasized.
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Affiliation(s)
- G Giunta
- Department of Internal Medicine, Hospital of San Donà di Piave, Venice, Italy
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34
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Abstract
A case of chronic lymphocytic leukemia is described in which peripheral blood and bone marrow films showed lymphocytes arranged in aggregates resembling epithelial cell clusters. Due to this morphological conformation, automatic hemogram screening was not able to detect the presence of chronic lymphocytic leukemia. Correct interpretation of a typical histogram pattern led to the final diagnosis.
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Affiliation(s)
- N Bizzaro
- Laboratorio di Patologia Clinica, Ospedale Civile di San Doná di Piave, Venezia, Italia
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35
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Giunta G, Pappagallo G, Piazza I, Girardi A. [A rare case of recurrent meningitis: intranasal encephalocele]. Minerva Med 1990; 81:577-81. [PMID: 2381556] [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: 12/31/2022]
Abstract
Intranasal meningoencephalocele is a rare malformation characterized by a protrusion of brain tissue and meninges out of the cranial cavity into the nose, through a discontinuity of the ethmoidal cribriform plate. It is a congenital anomaly but it may be also due to trauma or to chronic intracranial hypertension. It is clinically apparent as a small mass that may be confused with nasal polyp. A cerebrospinal fluid leakage may be present. In a few cases it gives no symptoms until adulthood, but usually recurrent meningitis may occur. A case of young woman with intranasal encephalomeningocele who suffered from 18 episodes of meningitis is reported. Nevertheless she is at present without neurological consequences.
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Affiliation(s)
- G Giunta
- II Divisione Medica, Ospedale Civile di S. Donà di Piave
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36
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Piazza I, Girardi A, Giunta G, Pappagallo G. Femoral nerve palsy secondary to anticoagulant induced iliacus hematoma. A case report. INT ANGIOL 1990; 9:125-6. [PMID: 2174952] [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: 12/30/2022]
Abstract
A case of femoral neuropathy from iliac muscle hematoma occurring in a patient treated with urokinase, subcutaneous heparin and aspirin for myocardial infarction is reported. Diagnosis of this complication was suspected on the basis of clinical signs and on the fact that the patient had received anticoagulants. Computed tomography allowed direct and clear visualization of the hematoma. Anticoagulant suspension followed by an early surgical decompression seems to be the ideal treatment for this neuropathy; however, our patient died for a reinfarction after stopping heparinic administration. This may indicate that, in some patients "at risk", it is better to reduce rather than stop anticoagulant therapy.
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Affiliation(s)
- I Piazza
- Department of Internal Medicine, General Hospital, San Donà di Piave, Venice, Italy
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37
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Abstract
Diagnostic endoscopy of the upper gastrointestinal tract is a safe procedure, which, however, is not without complications. We report the rare occurrence of retroperitoneal, mediastinal and subcutaneous emphysema following routine endoscopy, with no obvious evidence of a site of perforation. Possible etiological aspects are discussed. This complication appeared to be a benign clinical condition that was resolved with conservative, nonsurgical treatment.
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Affiliation(s)
- A Girardi
- Divisione Medica, Ospedale di San Donà (Venice), Italy
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38
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Piazza I, Girardi A. [Acute rhabdomyolysis, myoglobinuria and renal insufficiency caused by ethanol: review of the literature and description of a clinical case with fatal outcome]. G Clin Med 1989; 70:661-9. [PMID: 2599288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Several studies demonstrated that alcohol can induce both chronic and acute myopathy with myoglobinuria. Acute rhabdomyolysis is commonly followed by a renal failure (R.F.) of variable degree. The Authors report a case of rhabdomyolysis induced acute R.F. in a chronic alcoholic young man. The patient died in irreversible shock. Early diagnosis of the disease seems to be important, because early treatment can prevent acute myoglobinuric R.F.
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39
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Abstract
We describe an atypical case of subacute thyroiditis affecting a 50 year old patient with long lasting fever, weight loss, malaise and a high erythrocyte sedimentation rate. Cytological examination of the thyroid gland showed the classic granulomas with giant cells. However, the patient had neither painful enlargement of the gland nor thyrotoxicosis. This case, as well as others previously described, probably represents a new subtype of subacute thyroiditis, painless giant cell thyroiditis. The presence of painless giant cell thyroiditis should be considered in any patient with undiagnosed pyrexia, weight loss and elevated ESR.
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Affiliation(s)
- I Piazza
- Department of Internal Medicine, Hospital of San Donà di Piave (Ve), Italy
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40
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Girardi A, Piazza I. [Infection and digestive bleeding: late complications of aortofemoral bypass surgery]. Minerva Med 1988; 79:1095-9. [PMID: 3264892] [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: 01/05/2023]
Abstract
Graft-enteric fistulas and (the most uncommon) graft-enteric erosions are feared complications of aortic reconstructive surgery and infection and hemorrhage are their major clinical manifestations. A case considered unusual due to the simultaneous presence of two graft-enteric erosions: duodenal and sigmoid is reported. The first erosion was revealed by endoscopy performed for gastrointestinal bleeding. The role played by infection and mechanical factors in the pathogenesis of these complications is then discussed.
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Affiliation(s)
- A Girardi
- U.S.L. n. 15, Ospedale Civile, San Donà di Piave, Venezia, Medicina 2
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41
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Girardi A, Giunta G, Piazza I. [Acute gastric volvulus]. Chir Ital 1988; 40:400-5. [PMID: 3267478] [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: 01/05/2023]
Abstract
Gastric volvulus is an uncommon condition in which a torsion of the stomach results in acute or chronic gastrointestinal symptoms. We report a case of an intrathoracic organo-axial gastric volvulus secondary to a hiatal hernia. The patient died after surgery. Even though it was a surgical emergency, the patient was admitted to a Medical Department because she was regularly examined by the Digestive Endoscopy Unit for a hiatal hernia. The Authors emphasize the contribution of endoscopy to the preoperative recognition of this condition.
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Affiliation(s)
- A Girardi
- ULS N. 15 Basso Piave Servizio di Endoscopia Digestiva
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Piazza I, Girardi A. [Amiodarone-induced thyroiditis: description of a case]. Medicina (Firenze) 1988; 8:297-8. [PMID: 3231040] [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: 01/04/2023]
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Piazza I, Giunta G, Girardi A. [Bronchial asthma complicated by mediastinal emphysema. Description of 2 cases]. Recenti Prog Med 1988; 79:125-8. [PMID: 3393718] [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: 01/05/2023]
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Girardi A, Piazza I. [Liver cirrhosis associated with hereditary hemorrhagic telangiectasia: presentation of a case]. G Clin Med 1988; 69:37-41. [PMID: 3384230] [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: 01/05/2023]
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Benvenuti L, Gagliardi R, Giombini SM, Andreoli A, Limoni P, Piazza I, Benericetti E, Reale F. Long-term follow-up in 257 ICA occlusion: comparison between EIAB-treated and untreated patients. Neurol Res 1984; 6:181-3. [PMID: 6152311 DOI: 10.1080/01616412.1984.11739686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The purpose of this paper is to estimate the real value of the Extra-Intracranial Arterial Bypass (EIAB) in preventing or reducing further and more catastrophic ischaemic events in patients suffering from an Internal Carotid Artery (ICA) occlusion. 257 patients, suffering from ICA occlusion, are considered retrospectively: 122 of them submitted to EIAB and 135 medically treated or untreated. In both groups, homogeneous by sex, age, neurological grading distribution and length of follow-up, the following parameters were considered: the incidence of ischaemic recurrences during the follow-up period; the characters of the recurrences with particular reference to the fatal stroke; the rate of ischaemic events per year. The comparison between the outcome in surgically treated patients and in "untreated" ones indicates that the EIAB can be effective in preventing or reducing the ischaemic recurrences and the frequency of fatal stroke in TIA-, RIND, or stroke-patients suffering from ICA occlusion.
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Reale F, Benericetti E, Benvenuti L, Gagliardi R, Andreoli A, Limoni P, Giombini S, Piazza I, Parenti G, Lenzi B. Extra-intracranial arterial bypass in typical carotid reversible ischaemic deficits: long-term follow-up in 100 patients. Neurol Res 1984; 6:113-4. [PMID: 6151132 DOI: 10.1080/01616412.1984.11739673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The long-term follow-up of 100 consecutive patients who suffered from a reversible ischaemic attack (RIA) in the carotid territory and were submitted to extra-intracranial arterial bypass (EIAB) surgery in seven Italian Neurosurgical Centres is reported. The preoperative angiographic and clinical features, and the surgical complications are reported. The follow-up ranged from two to seven years with a mean of thirty-five months. In this period in the territory served by the bypass only two completed strokes and six RIAs occurred. Four patients died, only one for cerebral ischaemic problems. The results of the present series have been compared with those of the literature: they appeared consistent with other surgical series and clearly better than those of medical treated patients. The EIAB can then be considered a good therapeutic choice for the treatment of RIAs in carotid territory.
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Nicola GC, Piazza I, Tonnarelli GP. [Cerebral microsurgery and revascularization]. Riv Neurobiol 1979; 25:429-34. [PMID: 262055] [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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Semenzato G, Amadori G, Piazza I, Pezzutto A, Colombatti M, Gasparotto G. Stimulation induced by autologous lymphocyte subpopulations from healthy subjects in mixed lymphocyte reaction (MLR). Transplant Proc 1979; 11:1373-4. [PMID: 157574] [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: 12/13/2022]
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Piazza I, Alibrandi F, Semenzato G, Battistella L, Amadori G, Gasparotto G. T mediated immunity in patients undergoing periodic hemodialysis. Boll Ist Sieroter Milan 1978; 57:631-6. [PMID: 314813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Seventeen patients with well compensated chronic renal failure undergoing periodic hemodialysis were studied with regard to absolute number of T and B lymphocytes, spontaneous and PHA induced lymphocyte blastogenesis both with autologous and homologous compatible plasma. A normal lymphocyte count as well as a normal relative and absolute number of T and B lymphocytes was found in most cases. Spontaneous blastogenesis was normal. Lymphocyte response to PHA was reduced both with autologous and homologous plasma, but the depression was more relevant when autologous plasma was used in culture. The authors discuss these findings with respect to available data, particularly concerning inhibitory factors in uraemic plasma.
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