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Spadotto V, Zuin G, Mosconi E, Cutolo A, Grolla E, Ossena G, Cutaia V, Silvano M, Ronco F, Caprioglio F, Rigo F. P589A not so simple pericarditis. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez108.024] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V Spadotto
- Hospital dellAngelo, Mestre-Venice, Italy
| | - G Zuin
- Hospital dellAngelo, Mestre-Venice, Italy
| | - E Mosconi
- Hospital dellAngelo, Mestre-Venice, Italy
| | - A Cutolo
- Hospital dellAngelo, Mestre-Venice, Italy
| | - E Grolla
- Hospital dellAngelo, Mestre-Venice, Italy
| | - G Ossena
- Hospital dellAngelo, Mestre-Venice, Italy
| | - V Cutaia
- Hospital dellAngelo, Mestre-Venice, Italy
| | - M Silvano
- Hospital dellAngelo, Mestre-Venice, Italy
| | - F Ronco
- Hospital dellAngelo, Mestre-Venice, Italy
| | | | - F Rigo
- Hospital dellAngelo, Mestre-Venice, Italy
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Migliore F, Testolina M, Zorzi A, Bertaglia E, Silvano M, Leoni L, Bellin A, Basso C, Thiene G, Allocca G, Delise P, Iliceto S, Corrado D. First-degree atrioventricular block on basal electrocardiogram predicts future arrhythmic events in patients with Brugada syndrome: a long-term follow-up study from the Veneto region of Northeastern Italy. Europace 2018; 21:322-331. [DOI: 10.1093/europace/euy144] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/25/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Via Giustiniani, 2 – Padova, Italy
| | - Martina Testolina
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Via Giustiniani, 2 – Padova, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Via Giustiniani, 2 – Padova, Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Via Giustiniani, 2 – Padova, Italy
| | - Maria Silvano
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Via Giustiniani, 2 – Padova, Italy
| | - Loira Leoni
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Via Giustiniani, 2 – Padova, Italy
| | - Anna Bellin
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Via Giustiniani, 2 – Padova, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Via Giustiniani, 2 – Padova, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Via Giustiniani, 2 – Padova, Italy
| | - Giuseppe Allocca
- Department of Cardiology, Hosptital of Conegliano (TV), Via Brigata Bisagno, 4, Italy
| | - Pietro Delise
- Division of Cardiology, Hospital “P. Pederzoli”, Via Monte Baldo 24 – 37019 Peschiera Del Garda (VR), Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Via Giustiniani, 2 – Padova, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Medical School, Via Giustiniani, 2 – Padova, Italy
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Testolina M, Migliore F, Zorzi A, Bertaglia E, Silvano M, Bellin A, Basso C, Thiene G, Allocca G, Delise P, Iliceto S, Corrado D. 55First degree atrioventricular block on basal electrocardiogram predicts future arrhythmic events in patients with brugada syndrome. Europace 2018. [DOI: 10.1093/europace/euy015.017] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Testolina
- University of Padova, Department of Cardiac Thoracic and Vascular Sciences, Padua, Italy
| | - F Migliore
- University of Padova, Department of Cardiac Thoracic and Vascular Sciences, Padua, Italy
| | - A Zorzi
- University of Padova, Department of Cardiac Thoracic and Vascular Sciences, Padua, Italy
| | - E Bertaglia
- University of Padova, Department of Cardiac Thoracic and Vascular Sciences, Padua, Italy
| | - M Silvano
- University of Padova, Department of Cardiac Thoracic and Vascular Sciences, Padua, Italy
| | - A Bellin
- University of Padova, Department of Cardiac Thoracic and Vascular Sciences, Padua, Italy
| | - C Basso
- University of Padova, Department of Cardiac Thoracic and Vascular Sciences, Padua, Italy
| | - G Thiene
- University of Padova, Department of Cardiac Thoracic and Vascular Sciences, Padua, Italy
| | - G Allocca
- Conegliano General Hospital, Department of Cardiology, Conegliano, Italy
| | - P Delise
- Conegliano General Hospital, Department of Cardiology, Conegliano, Italy
| | - S Iliceto
- University of Padova, Department of Cardiac Thoracic and Vascular Sciences, Padua, Italy
| | - D Corrado
- University of Padova, Department of Cardiac Thoracic and Vascular Sciences, Padua, Italy
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Querin G, Bertolin C, Da Re E, Volpe M, Zara G, Pegoraro E, Caretta N, Foresta C, Silvano M, Corrado D, Iafrate M, Angelini L, Sartori L, Pennuto M, Gaiani A, Bello L, Semplicini C, Pareyson D, Silani V, Ermani M, Ferlin A, Sorarù G. Non-neural phenotype of spinal and bulbar muscular atrophy: results from a large cohort of Italian patients. J Neurol Neurosurg Psychiatry 2016; 87:810-6. [PMID: 26503015 PMCID: PMC4975824 DOI: 10.1136/jnnp-2015-311305] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [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: 05/18/2015] [Accepted: 09/02/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To carry out a deep characterisation of the main androgen-responsive tissues involved in spinal and bulbar muscular atrophy (SBMA). METHODS 73 consecutive Italian patients underwent a full clinical protocol including biochemical and hormonal analyses, genitourinary examination, bone metabolism and densitometry, cardiological evaluation and muscle pathology. RESULTS Creatine kinase levels were slightly to markedly elevated in almost all cases (68 of the 73; 94%). 30 (41%) patients had fasting glucose above the reference limit, and many patients had total cholesterol (40; 54.7%), low-density lipoproteins cholesterol (29; 39.7%) and triglyceride (35; 48%) levels above the recommended values. Although testosterone, luteinising hormone and follicle-stimulating hormone values were generally normal, in one-third of cases we calculated an increased Androgen Sensitivity Index reflecting the presence of androgen resistance in these patients. According to the International Prostate Symptom Score (IPSS), 7/70 (10%) patients reported severe lower urinal tract symptoms (IPSS score >19), and 21/73 (30%) patients were moderately symptomatic (IPSS score from 8 to 19). In addition, 3 patients were carriers of an indwelling bladder catheter. Videourodynamic evaluation indicated that 4 of the 7 patients reporting severe urinary symptoms had an overt prostate-unrelated bladder outlet obstruction. Dual-energy X-ray absorptiometry scan data were consistent with low bone mass in 25/61 (41%) patients. Low bone mass was more frequent at the femoral than at the lumbar level. Skeletal muscle biopsy was carried out in 20 patients and myogenic changes in addition to the neurogenic atrophy were mostly observed. CONCLUSIONS Our study provides evidence of a wide non-neural clinical phenotype in SBMA, suggesting the need for comprehensive multidisciplinary protocols for these patients.
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Affiliation(s)
- Giorgia Querin
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Cinzia Bertolin
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Elisa Da Re
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Marco Volpe
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Gabriella Zara
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Elena Pegoraro
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Nicola Caretta
- Department of Medicine, Centre for Human Reproduction Pathology, University of Padova, Padova, Italy
| | - Carlo Foresta
- Department of Medicine, Centre for Human Reproduction Pathology, University of Padova, Padova, Italy
| | - Maria Silvano
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Massimo Iafrate
- Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Padova, Italy
| | - Lorenzo Angelini
- Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Padova, Italy
| | - Leonardo Sartori
- Department of Medical and Surgical Sciences, University of Padova, Padova, Italy
| | - Maria Pennuto
- Dulbecco Telethon Institute Lab of Neurodegenerative Diseases, Centre for Integrative Biology (CIBIO), University of Trento, Trento, Italy
| | - Alessandra Gaiani
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Luca Bello
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Claudio Semplicini
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Davide Pareyson
- Clinic of Central and Peripheral Degenerative Neuropathies Unit, Department of Clinical Neurosciences-IRCCS Foundation, "C. Besta" Neurological Institute, Milan, Italy
| | - Vincenzo Silani
- Departments of Neurology and Laboratory of Neuroscience, and Pathophysiology and Transplantation, IRCCS Istituto Auxologico Italiano, "Dino Ferrari" Centre, Universita' degli Studi di Milano, Milan, Italy
| | - Mario Ermani
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
| | - Alberto Ferlin
- Department of Medicine, Centre for Human Reproduction Pathology, University of Padova, Padova, Italy
| | - Gianni Sorarù
- Department of Neurosciences, Neuromuscular Center, University of Padova, Padova, Italy
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Silvano M, Mastella G, Zorzi A, Migliore F, Pilichou K, Bauce B, Rigato I, Perazzolo Marra M, Iliceto S, Thiene G, Basso C, Corrado D. Management of arrhythmogenic right ventricular cardiomyopathy. Minerva Med 2016; 107:194-216. [PMID: 27186923] [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: 06/05/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetically determined heart muscle disorder, predisposing to sudden cardiac death (SCD), particularly in young patients and athletes. Pathological features include loss of myocytes and fibrofatty replacement of right ventricular myocardium; a biventricular involvement is often observed. The diagnosis of ARVC (prevalence 1:5.000 in the general population) does not rely on a single gold standard test but is achieved using a scoring system, proposed in 2010 by an International Task Force, which encompasses familial and genetic factors, ECG abnormalities, arrhythmias, and structural/functional ventricular alterations. The main goal of treatment is the prevention of SCD. Implantable cardioverter defibrillator (ICD) is the only proven "lifesaving" therapy; however, it is associated with a significant morbidity due to device-related complications and inappropriate ICD interventions. Other treatment options such as life style changes, antiarrhythmic drugs, beta-blockers and catheter ablation may reduce the arrhythmic burden and alleviate symptoms, without evident impact on prevention of SCD. Selection of patient candidates to ICD implantation is the most challenging issue in the clinical management of ARVC. This article reviews the current perspective on management of ARVC, focusing on clinical manifestations, diagnostic criteria, risk stratification and therapeutic strategies of affected patients.
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Affiliation(s)
- Maria Silvano
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, Medical School, University of Padua, Padua, Italy -
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Migliore F, Silvano M, Zorzi A, Bertaglia E, Siciliano M, Leoni L, De Franceschi P, Iliceto S, Corrado D. Implantable cardioverter defibrillator therapy in young patients with cardiomyopathies and channelopathies. J Cardiovasc Med (Hagerstown) 2016; 17:485-93. [DOI: 10.2459/jcm.0000000000000395] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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7
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Wegner FK, Silvano M, Bögeholz N, Leitz PR, Frommeyer G, Dechering DG, Zellerhoff S, Kochhäuser S, Lange PS, Köbe J, Wasmer K, Mönnig G, Eckardt L, Pott C. Slow pathway modification in patients presenting with only two consecutive AV nodal echo beats. J Cardiol 2016; 69:471-475. [PMID: 27021469 DOI: 10.1016/j.jjcc.2016.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/30/2016] [Accepted: 02/07/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Slow pathway modification (SPM) is the therapy of choice for AV-nodal reentry tachycardia (AVNRT). When AVNRT is not inducible, empirical ablation can be considered, however, the outcome in patients with two AV nodal echo beats (AVNEBs) is unknown. METHODS Out of a population of 3003 patients who underwent slow pathway modification at our institution between 1993 and 2013, we retrospectively included 32 patients with a history of symptomatic tachycardia, lack of paroxysmal supraventricular tachycardia (pSVT) inducibility but occurrence of two AVNEBs. RESULTS pSVT documentation by electrocardiography (ECG) was present in 20 patients. The procedural endpoint was inducibility of less than two AVNEBs. This was reached in 31 (97%) patients. Long-term success was assessed by a telephone questionnaire (follow-up time 63±9 months). A total 94% of the patients benefited from the procedure (59% freedom from symptoms; 34% improvement in symptoms). Among those patients in whom ECG documentation was not present, 100% benefited (58% freedom from symptoms, 42% improvement). CONCLUSION This is the first collective analysis of a group of patients presenting with symptoms of pSVT and inducibility of only two AVNEBs. Procedural success and clinical long-term follow-up were in the range of the reported success rates of slow pathway modification of inducible AVNRT, independent of whether ECG documentation was present. Thus, SPM is a safe and effective therapy in patients with two AVNEBs.
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Affiliation(s)
- Felix K Wegner
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Maria Silvano
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Nils Bögeholz
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Patrick R Leitz
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Dirk G Dechering
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Stephan Zellerhoff
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Simon Kochhäuser
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Philipp S Lange
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Julia Köbe
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Kristina Wasmer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Gerold Mönnig
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Christian Pott
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
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Silvano M, Corrado D, Köbe J, Mönnig G, Basso C, Thiene G, Eckardt L. Risk stratification in arrhythmogenic right ventricular cardiomyopathy. Herzschrittmacherther Elektrophysiol 2013; 24:202-8. [PMID: 24113835 DOI: 10.1007/s00399-013-0291-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 09/16/2013] [Indexed: 12/20/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic cardiomyopathy characterized by myocyte death and fibrofatty replacement mostly in the right ventricle. It is a leading cause of sudden cardiac death (SCD) in individuals under the age of 35 years. The main goal in the treatment of the disease is the prevention of SCD. An implantable cardioverter-defibrillator (ICD) is the only proven life-saving therapeutic option able to improve survival in ARVC patients. This therapy is not free from side effects and it accounts for a relatively high rate of morbidity because of the occurrence of inappropriate ICD interventions and of complications, both at implantation and during the follow-up. In recent years, the approach to ICD implantation has been changing on the basis of new emerging data on risk stratification. The usefulness of ICD implantation for secondary prevention has been definitively proven; the most challenging question is how to treat patients with no history of previous cardiac arrest or hemodynamically unstable ventricular tachycardia (VT). The value of ECG abnormalities, syncope, VT, and right/left ventricular involvement as predictors of SCD has been assessed in different studies with the purpose of better defining risk stratification in ARVC. Nevertheless, in spite of the growing amount of data, primary prevention in ARVC patients remains mostly an individual decision.
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Affiliation(s)
- M Silvano
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova Medical School, Padova, Italy
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Zorzi A, Migliore F, Elmaghawry M, Silvano M, Marra MP, Niero A, Nguyen K, Rigato I, Bauce B, Basso C, Thiene G, Iliceto S, Corrado D. Electrocardiographic predictors of electroanatomic scar size in arrhythmogenic right ventricular cardiomyopathy: implications for arrhythmic risk stratification. J Cardiovasc Electrophysiol 2013; 24:1321-7. [PMID: 24016194 DOI: 10.1111/jce.12246] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/09/2013] [Accepted: 07/12/2013] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The extent of right ventricular (RV) electroanatomic scar (EAS) detected by endocardial voltage mapping (EVM) is a powerful invasive predictor of arrhythmic outcome in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Electrocardiogram (ECG) and signal-averaged ECG are noninvasive tools of established clinical value for the diagnosis of electrical abnormalities in ARVC. This study was designed to assess the role of ECG and SAECG abnormalities for noninvasive estimation of the extent and regional distribution of RV-EAS and prediction of scar-related arrhythmic risk. METHODS AND RESULTS The study population included 49 consecutive patients (38 males, median age 35 years) with a definite diagnosis of ARVC and an abnormal EVM by CARTO system. At univariate analysis, the presence of epsilon waves, the degree of RV dilation, the severity of RV dysfunction, and the extent of negative T waves correlated with RV-EAS% area. Normal T-waves were associated with a median RV-EAS% area of 4.9% (4.5-6.4), negative T waves in V1-V3 of 22.0% (8.5-30.6), negative T waves in V1-V3 extending to lateral precordial leads (V4-V6) of 26.8% (11.5-35.2), and negative T waves in both precordial (V2-V6) and inferior leads of 30.2% (24.8-33.0) (P < 0.001). At multivariate analysis, the extent of negative T waves remained the only independent predictor of RV-EAS% area (B = 4.4, 95%CI 1.3-7.4, P = 0.006) and correlated with the arrhythmic event-rate during follow-up (P = 0.03). CONCLUSIONS In patients with ARVC, the extent of negative T-waves across 12-lead ECG allows noninvasive estimation of the amount of RV-EAS and prediction of EAS-related arrhythmic risk.
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Affiliation(s)
- Alessandro Zorzi
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
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Migliore F, Zorzi A, Silvano M, Bevilacqua M, Leoni L, Marra MP, Elmaghawry M, Brugnaro L, Dal Lin C, Bauce B, Rigato I, Tarantini G, Basso C, Buja G, Thiene G, Iliceto S, Corrado D. Prognostic value of endocardial voltage mapping in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circ Arrhythm Electrophysiol 2013; 6:167-76. [PMID: 23392584 DOI: 10.1161/circep.111.974881] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Endocardial voltage mapping (EVM) identifies low-voltage right ventricular (RV) areas, which may represent the electroanatomic scar substrate of life-threatening tachyarrhythmias. We prospectively assessed the prognostic value of EVM in a consecutive series of patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). METHODS AND RESULTS We studied 69 consecutive ARVC/D patients (47 males; median age 35 years [28-45]) who underwent electrophysiological study and both bipolar and unipolar EVM. The extent of confluent bipolar (<1.5 mV) and unipolar (<6.0 mV) low-voltage electrograms was estimated using the CARTO-incorporated area calculation software. Fifty-three patients (77%) showed ≥1 RV electroanatomic scars with an estimated burden of bipolar versus unipolar low-voltage areas of 24.8% (7.2-31.5) and 64.8% (39.8-95.3), respectively (P=0.009). In the remaining patients with normal bipolar EVM (n=16; 23%), the use of unipolar EVM unmasked ≥1 region of low-voltage electrogram affecting 26.2% (11.6-38.2) of RV wall. During a median follow-up of 41 (28-56) months, 19 (27.5%) patients experienced arrhythmic events, such as sudden death (n=1), appropriate implantable cardioverter defibrillator interventions (n=7), or sustained ventricular tachycardia (n=11). Univariate predictors of arrhythmic outcome included previous cardiac arrest or syncope (hazard ratio=3.4; 95% confidence interval, 1.4-8.8; P=0.03) and extent of bipolar low-voltage areas (hazard ratio=1.7 per 5%; 95% confidence interval, 1.5-2; P<0.001), whereas the only independent predictor was the bipolar low-voltage electrogram burden (hazard ratio=1.6 per 5%; 95% confidence interval, 1.2-1.9; P<0.001). Patients with normal bipolar EVM had an uneventful clinical course. CONCLUSIONS The extent of bipolar RV endocardial low-voltage area was a powerful predictor of arrhythmic outcome in ARVC/D, independently of history and RV dilatation/dysfunction. A normal bipolar EVM characterized a low-risk subgroup of ARVC/D patients.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Medical School, Padova, Italy
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11
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Marra MP, Leoni L, Bauce B, Corbetti F, Zorzi A, Migliore F, Silvano M, Rigato I, Tona F, Tarantini G, Cacciavillani L, Basso C, Buja G, Thiene G, Iliceto S, Corrado D. Imaging study of ventricular scar in arrhythmogenic right ventricular cardiomyopathy: comparison of 3D standard electroanatomical voltage mapping and contrast-enhanced cardiac magnetic resonance. Circ Arrhythm Electrophysiol 2011; 5:91-100. [PMID: 22139887 DOI: 10.1161/circep.111.964635] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The hallmark lesion of arrhythmogenic right ventricular cardiomyopathy (ARVC) is fibrofatty scar replacement. We compared endocardial voltage mapping (EVM) and contrast-enhanced cardiac magnetic resonance (CE-CMR) for imaging scar lesions in ARVC patients. METHODS AND RESULTS We studied 23 consecutive ARVC patients (16 males; mean age, 38±12 years) who underwent RV EVM and CE-CMR and 37 control subjects. In 21 (91%) of 23 ARVC patients, RV EVM was abnormal, with a total of 45 electroanatomical scars (EAS): 17 (38%) in the inferobasal region, 12 (26.6%) in the anterolateral region, 8 (17.7%) in the RV outflow tract (RVOT), and 8 (17.7%) in the apex. RV delayed contrast enhancement (DCE) was found in 9 (39%) of 23 patients, with a total of 23 RV DCE scars: 4 (17.4%) in the inferobasal region, 9 (39.1%) in the anterolateral region, 4 (17.4%) in the RVOT, and 6 (26.1%) in the apex. There was a mismatch in 24 RV scars, with 22 EAS not confirmed by DCE and 2 DCE scars (both in the RVOT) undetected by EVM. In 9 (75%) of 12 patients with abnormal RV EVM/normal RV DCE, ≥1 DCEs were identified in the left ventricle (LV). Overall, ventricular DCE was detected in 78% of patients. No control subjects showed either EAS or DCE. CONCLUSIONS EVM and CE-CMR allow identification of RV scar lesions in most ARVC patients. CE-CMR is less sensitive than EVM in identifying RV scar lesions. The high prevalence of LV DCE confirms the frequent biventricular involvement and indicates the diagnostic relevance of LV scar detection by CE-CMR.
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Affiliation(s)
- Martina Perazzolo Marra
- Departments of Cardiac, Thoracic, and Vascular Sciences, Radiology, and Medical-Diagnostic Sciences and Special Therapies, University of Padua Medical School, Padua, Italy
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Marra MP, Leoni L, Bauce B, Zorzi A, De Lazzari M, Corbetti F, Cacciavillani L, Rigato I, Migliore F, Silvano M, Basso C, Tona F, Buja G, Thiene G, Iliceto S, Corrado D. Imaging study of ventricular scar in arrhythmogenic right ventricular cardiomyopathy/dysplasia: comparison of three-dimensional electroanatomic voltage mapping and contrast-enhanced cardiac magnetic resonance. J Cardiovasc Magn Reson 2011. [PMCID: PMC3106768 DOI: 10.1186/1532-429x-13-s1-p249] [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: 11/10/2022] Open
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13
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Migliore F, Zorzi A, Silvano M, Rigato I, Basso C, Thiene G, Corrado D. Clinical management of arrhythmogenic right ventricular cardiomyopathy: an update. Curr Pharm Des 2011; 16:2918-28. [PMID: 20632952 DOI: 10.2174/138161210793176491] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 07/01/2010] [Indexed: 11/22/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic heart muscle disease characterized by the peculiar right ventricular (RV) involvement. Distinctive pathologic features are myocardial atrophy and fibro-fatty replacement of the RV free wall, and clinical presentation is usually related to ventricular tachycardias with a left bundle branch block pattern or ventricular fibrillation leading to cardiac arrest, mostly in young people and athletes. Later in the disease evolution, progression and extension of RV muscle disease and left ventricular involvement may result in right or biventricular heart failure. In the 1994 an International Task Force proposed standardized diagnostic criteria designed to guarantee an adequate specificity and based on the presence of major and minor criteria encompassing electrocardiographic, arrhythmic, morphofunctional, histopathologic, and genetic factors; more recently, Task Force criteria have been modified to increase their diagnostic sensitivity. Retrospective analysis of clinical and pathologic series including fatal cases identified a series of risk factors such as malignant familial background, youthful age, previous syncope or cardiac arrest, competitive sport activity, severe RV disease with left ventricular involvement, and episodes of complex ventricular arrhythmias or VT. The therapeutic options include beta blockers, antiarrhythmic drugs, catheter ablation, and implantable cardioverter defibrillator (ICD). The ICD is the most effective safe-guard against arrhythmic sudden death. In patients in whom ARVC has progressed to severe RV or biventricular systolic dysfunction with risk of thromboembolic complications, treatment consists of current therapy for heart failure including anticoagulant therapy. In case of refractory congestive heart failure, patients may become candidates for heart transplantation.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac Thoracic and Vascular Sciences University of Padua, Italy
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Silvano M, Zambon CF, De Rosa G, Plebani M, Pengo V, Napodano M, Padrini R. A case of resistance to clopidogrel and prasugrel after percutaneous coronary angioplasty. J Thromb Thrombolysis 2011; 31:233-4. [PMID: 21088983 DOI: 10.1007/s11239-010-0533-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- M Silvano
- Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova, Italy
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Frezza G, Bunkheila F, Caliceti U, Gabbani M, Galuppi A, Guidetti A, Silvano M, Sorrenti G, Babini L. [Radiotherapy of stage T1 carcinoma of the glottis. Analysis of prognostic factors in 154 patients]. Radiol Med 1995; 89:850-4. [PMID: 7644741] [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: 01/26/2023]
Abstract
A retrospective study was carried out on a series of 154 patients affected with vocal cord cancer in stage T1 treated with definitive radiotherapy April, 1979, to November, 1991. According to the 1992 TNM classification (UICC), 121 patients were classified as stage T1a and 33 patients as stage T1b. All patients were treated using parallel opposed fields of a 60 cobalt unit. Field size ranged from 16 to 30 square centimeters and the dose from 4400 to 7000 cGy, but only 15 patients received less than 6400 cGy. All patients were treated with once-daily fractionation (200 cGy/day). Follow-up ranges from 25 to 123 months; the median is 63 months. We observed 14 local recurrences (9.0%), all but one within 36 months from the end of treatment. Ten of 14 patients (71.4%) were rescued by surgery (8 patients underwent total laryngectomy and 2 conservative surgery); 13 patients were lost for intercurrent deaths. The incidence of recurrences is 7.4% for T1a patients (9/121) and 15.1% for T1b patients (5/33). The total dose does not seem to be related to relapse rate since recurrences were found in 6.6% of patients after a dose < 6400 cGy and in 9.3% of patients who had received higher doses. In our experience, field size did not affect, treatment results (< 25 cm2: 7.5% recurrences, > 25 cm2: 10.7%). Besides lesion volume, the main prognostic factor was overall treatment time. The incidence of failure was 3 times lower (5.8%) in the patients who completed the treatment within 7 weeks than in the patients whose treatment lasted more than 8 weeks (16.6%).
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Affiliation(s)
- G Frezza
- Istituto di Radioterapia L. Galvani, Università di Bologna
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16
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Baldissera A, Perini F, Barbioeri E, Frezza G, Silvano M, Neri S, Teodorani N, Palmieri T, Gherlinzoni F, Babini L. [Combined treatment of stage I and II gastric lymphoma]. Radiol Med 1995; 89:702-6. [PMID: 7617915] [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: 01/26/2023]
Abstract
From 1981 to 1991, fifty-three patients with primary gastric lymphoma were referred to our Institute and submitted to a complete pathologic staging followed by gastric resection, i.e., total or partial gastrectomy. According to the Working Formulation criteria, 14 patients (26.4%) were affected with high grade lymphomas, 22 (41.5%) with intermediate lymphomas and 17 (32.1%) with low grade lymphomas. MALT (mucosa associated lymphoid tissue) lymphomas were observed in > 50% of cases. At the pathologic examination of the surgical specimens, infiltration depth was assessed, according to TNM criteria, in the patients whose disease was limited to the muscular gastric wall (T1-T2) and in those whose disease spread to the serosa or beyond it (T3-T4). Twenty-five patients were classified as stage I and 28 as stage II (9 of them in stage II E1 and 19 in stage II E2 according to Musshoff's classification). The treatment protocol of these patients was as follows: stage I patients (T1-T2) with normal surgical resection margins underwent no adjuvant treatment (10 patients); stage I patients (T1-T2) with resection margins infiltrated by the disease were submitted to local irradiation; stage I (T3-T4) and stage II E1 patients underwent large-field postoperative irradiation (14 patients); stage II E2 patients (n = 19) received conventional chemotherapy (CHOP, F-CVP, N-CVP): the ones who failed to reach complete remission or presented with bulky disease at diagnosis completed the treatment with large-field irradiation (10 patients). The disease-free survival (86.5%) and the overall survival (96%) rates of stage I patients exhibited no significant difference relative to stage II patients (DFS: 87% and OS: 90%). The analysis of relapses relative to disease extent demonstrated that this parameter is more significant to prognosis than nodal involvement (T1-T2: 2/39 relapses, 5.1%; T3-T4: 4/14 relapses, 28.6%).
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Affiliation(s)
- A Baldissera
- Istituto di Radioterapia L. Galvani, Università di Bologna
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Zini G, Alberti G, Armaroli L, Barbieri E, Di Marzio G, Frezza G, Neri S, Silvano M, Babini L. [Analysis of prognostic factors in 106 cases of carcinoma of the rhinopharynx treated with cobalt teletherapy]. Radiol Med 1989; 78:430-4. [PMID: 2608930] [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: 01/01/2023]
Abstract
A series of 106 patients affected with nasopharyngeal carcinomas and treated by definitive external irradiation from January 1975 to December 1986 was retrospectively reviewed. The median follow-up, from the end of the treatment, was 43 months (range 24-90). The nasopharynx received not less than 60 Gy to the midplane: the clinically negative neck (N0) was treated with a total dose of 50 Gy and the patients who had N1-3 disease received not less than 60 Gy. Thirty-eight patients had a recurrence in the irradiated areas (31 in the nasopharynx, and 7 in the neck); 17 patients developed distant metastases. Disease-free survival at 60 months was 42%. The most significant prognostic factor (p less than 0.05) was the presence of advanced neck involvement (N2-3), since most of the lymphatic and distant recurrences were observed in this group of patients. The overall results did not reveal but slight differences in the survival according to histology, even though patients with undifferentiated carcinomas had a local recurrence rate significantly lower than those with squamous cell carcinomas. Our findings suggest that patients with N2-3 neck diseases or with locally advanced involvement (T3-4) be treated by adjuvant chemotherapy in order to decrease the risk of local and distant relapses.
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Affiliation(s)
- G Zini
- Sezione di Radioterapia del Servizio di Radiologia I, Ospedale S. Maria Nuova, Reggio Emilia
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Zini G, Barbieri E, Campobassi A, Dallera P, Emiliani E, Frezza G, Marchetti C, Neri S, Romagnoli D, Silvano M. [Pre- and postoperative radiotherapy of oral carcinoma of a locally advanced stage. An analysis of the results and complications]. Radiol Med 1989; 77:99-103. [PMID: 2928571] [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: 01/03/2023]
Abstract
The combination of radiotherapy and surgery in the treatment of advanced oral carcinoma (T3 and T4 lesions) yields good possibilities of recovery; whether radiotherapy should be given before or after surgery is still debated. Fifty patients with advanced oral carcinomas were analyzed: 24 of them were irradiated before and 26 after surgery; doses ranged from 40 to 56 Gy for the first group of patients, and from 50 to 68 Gy for the second one. The disease-free survival 48 months after the diagnosis was 36% in patients who received preoperative irradiation, and 53.6% in patients who received postoperative radiotherapy; the latter allowed local control of the disease to be significantly improved (chi 2 3.99, 0.01 less than p less than 0.05). The quality of survival was worse in the group receiving preoperative irradiation, because of radiation-induced surgical complications, which were especially observed in patients with diffuse disease. Our findings suggest that postoperative radiotherapy may be advisable if the tumor is resectable, since tolerance and local control rate were acceptable. On the contrary, nearly inoperable masses and massive neck diseases often require preoperative irradiation.
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Affiliation(s)
- G Zini
- Istituto di Radioterapia L. Galvani, Università, Bologna
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Neri S, Belli A, Caliceti U, Emiliani E, Frezza G, Palazzi Trivelli A, Silvano M, Zini G, Babini L, Barbieri E. [Radiotherapy of carcinoma of the glottis in the initial stage]. Radiol Med 1987; 74:338-40. [PMID: 3671804] [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: 01/06/2023]
Abstract
The control of early glottic cancer is equally satisfactory with either surgical resection or radiation therapy; this last method gives the patient good functional results. During the period from 1/1978 to 12/1985, 73 patients with early glottic carcinoma (T1 N0 M0) were treated in the Institute of Radiotherapy L. Galvani, University of Bologna; 45 were stage T1a (tumour limited to one vocal cord) and 28 were stage T1b (tumour of both vocal cords or involving anterior commissure); radiation treatment utilised a 60Co machine and 5 x 5 cm fields; the median dose was 67.2 Gy (range 50-76) with conventional fractionation. Ten patients had local recurrence; the median time of recurrence was 13.4 months; 9/10 were treated by surgery and 2/10 died, so the overall control by radiotherapy with surgery in reserve was 100% in T1a tumours and 90.6% in T1b ones. The 5-years disease free survival rate was 93.1% in T1a tumours and 69% in T1b; lesions involving anterior commissure had the worst prognosis, independent of the dose and time-dose factor (3/10 recurrences in the group treated with TDF less than 110 and 4/18 recurrences in the group with TDF more than 110).
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Affiliation(s)
- S Neri
- Istituto di Radioterapia L. Galvani, Bologna
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Abstract
From 1976 to 1982, 78 patients with nasopharyngeal cancer (NPC) were treated with definitive megavoltage irradiation in accordance with a uniform protocol. The results of treatment were analyzed and prognostic factors reviewed. The incidence of primary failures was directly related to the extent of nasopharyngeal disease, since the relapse rate was 11% in T1T2 patients compared with 37.5% in T3T4 patients. Similarly, failure in the neck correlated with the N stage, being negligible for N0 and N1, while 35.7% for N3. The presence of bulky cervical nodes was associated with a higher risk for metastases: hematogenous dissemination occurred in 50% of N3B patients. The histology pattern seemed to significantly affect the ultimate outcome of patients with NPC, since disease-free survival was 65.5% in patients with a diagnosis of undifferentiated carcinoma (UC) and 23.8% in patients with squamous cell carcinoma (SC). The major cause of poor survival in this latter patient group was not only a higher recurrence rate of both primary and nodal disease but a greater incidence of distant metastases as well.
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Barbieri E, Emiliani E, Frezza G, Neri S, Silvano M. [Topical dose-control relationship in high-energy radiation therapy of epithelial tumors of the nasopharynx]. Radiol Med 1983; 69:17-20. [PMID: 6402808] [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: 01/20/2023]
Abstract
The results of megavoltage irradiation at different doses in 188 patients with carcinoma of the nasopharynx treated at the Institute of Radiotherapy "L. Galvani", University of Bologna, from 1960 to 1978, are analyzed. Dose-control relationship is investigated. The incidence of failures at the primary site and in the neck is a function of dose and neoplastic volume: 5,000 rad/5 weeks for sub-clinical disease and 7,000 rad/7 weeks for massive disease appears to eradicate the tumor in a high number of cases. Prognosis of patients with extensive disease in the neck is nevertheless unfavourable, since a great number of them dies for distant metastases. It seems therefore necessary to institute clinical trials testing adjuvant chemotherapy in patients with neck stages N2-N3.
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Bacchini P, Barbieri E, Bertoni F, Brandoli V, Dallera P, Emiliani E, Frezza G, Marchetti C, Neri S, Romagnoli D, Silvano M, Stea G, Babini L. [Incidence of lymph node metastases in epithelial neoplasms of the oral cavity: risk factors]. Radiol Med 1982; 68:759-62. [PMID: 7156427] [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: 01/23/2023]
Abstract
The incidence of pathological neck nodes metastases in a group of 60 patients with a diagnosis of oral squamous carcinoma is reviewed. Risk factors are a size of primary more than 4 cm and tumors of the anterior two-third of the tongue. Carcinomas of oral tongue, also of a size less than 4 cm (T1,T2), have a high incidence of subclinical metastases.
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Silvano M. [In favor of premarital examination]. Rev Enferm (Lisboa) 1969; 8:164-5. [PMID: 5204480] [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: 01/14/2023]
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