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Gritti V, Pierini S, Ferlini M, Mauri S, Barbieri L, Castiglioni B, Lettieri C, Mircoli L, Mortara A, Nassiacos D, Oltrona Visconti L, Paggi A, Soriano F, Sponzilli C, Corsini A. Atrial fibrillation and ischemic heart disease: (un)solved therapeutic dilemma? Minerva Cardiol Angiol 2023:S2724-5683.23.06275-0. [PMID: 37870421 DOI: 10.23736/s2724-5683.23.06275-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Concomitant presence of atrial fibrillation and coronary artery disease requiring percutaneous coronary intervention is a frequent occurrence. The choice of optimal antithrombotic therapy, in this context, is still challenging. To offer the best protection both in terms of stroke and stent thrombosis, triple therapy with oral anticoagulation and dual antiplatelet therapy would be required. Several drug combinations have been tested in recent years, including direct oral anticoagulants, with the aim of balancing ischemic and bleeding risk. Both pharmacokinetic aspects of the molecules and patient's characteristics should be analyzed in choosing oral anticoagulation. Then, as suggested by guidelines, triple therapy should start with a seven-day duration and the aim to prolong to thirty days in high thrombotic risk patients. Dual therapy should follow to reach twelve months after coronary intervention. Even not fully discussed by the guidelines, in order to balance ischemic and bleeding risk it should also be considered: 1) integrated assessment of coronary artery disease and procedural complexity of coronary intervention; 2) appropriateness to maintain the anticoagulant drug dosage indicated in technical data sheet; the lack of data on the suspension of antiplatelet drugs one year after percutaneous intervention; 3) the possibility of combination therapy with ticagrelor; and 4) the need to treat the occurrence of paroxysmal atrial fibrillation during acute coronary syndrome. With data provided clinician should pursue a therapy as personalized as possible, both in terms of drug choice and treatment duration, in order to balance ischemic and bleeding risk.
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Affiliation(s)
- Valeria Gritti
- Division of Cardiology, Foundation IRCCS Polyclinic San Matteo, Pavia, Italy -
| | - Simona Pierini
- Unit of Cardiology and Cardiac Intensive Care, ASST Nord Milano, Sesto San Giovanni, Milan, Italy
| | - Marco Ferlini
- Division of Cardiology, Foundation IRCCS Polyclinic San Matteo, Pavia, Italy
| | - Silvia Mauri
- Cardiology and Coronary Unit, ASST Ovest Milanese, Milan, Italy
| | - Lucia Barbieri
- Unit of Cardiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Luca Mircoli
- Unit of Cardiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Mortara
- Department of Clinical Cardiology, Polyclinic of Monza, Monza, Monza-Brianza, Italy
| | - Daniele Nassiacos
- Unit of Cardiology and Cardiac Intensive Care, ASST Valle Olona, Saronno, Varese, Italy
| | | | - Anita Paggi
- Unit of Cardiology and Cardiac Intensive Care, ASST Nord Milano, Sesto San Giovanni, Milan, Italy
| | - Francesco Soriano
- Cardiothoracovascular Department, ASST Niguarda Hospital, Milan, Italy
| | | | - Alberto Corsini
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
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Sardella G, Stefanini G, Leone PP, Boccuzzi G, Fovero NT, Van Mieghem N, Giacchi G, Escaned J, Fineschi M, Testa L, Valenti R, Di Mario C, Briguori C, Cortese B, Ribichini F, Oreglia JA, Colombo A, Sangiorgi G, Barbato E, Sonck J, Ugo F, Trani C, Castriota F, Paggi A, Porto I, Tomai F, Mancone M. Coronary Lithotripsy as Elective or Bail-Out Strategy After Rotational Atherectomy in the Rota-Shock Registry. Am J Cardiol 2023; 198:1-8. [PMID: 37182254 DOI: 10.1016/j.amjcard.2023.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/04/2023] [Accepted: 04/15/2023] [Indexed: 05/16/2023]
Abstract
Debulking lesions with severe coronary artery calcification (CAC) is highly recommended to obtain good procedural and long-term success. Utilization and performance of coronary intravascular lithotripsy (IVL) after rotational atherectomy (RA) has not been thoroughly studied. This study aimed to evaluate the efficacy and safety of IVL with the Shockwave Coronary Rx Lithotripsy System in lesions with severe CAC as elective or bail-out strategy after RA. This observational, prospective, single-arm, multicenter, international, open-label Rota-Shock registry included patients with symptomatic coronary artery disease and lesions with severe CAC treated by percutaneous coronary intervention, including lesion preparation with RA and IVL, at 23 high-volume centers. Primary efficacy end point was procedural success, defined as final diameter stenosis <30% by quantitative coronary angiography. Primary safety end point was freedom from serious angiographic complications, which included >National Heart, Lung and Blood Institute type B dissection, perforation, abrupt closure, slow or no flow, final thrombolysis in myocardial infarction flow <3, and acute thrombosis. A total of 160 patients were enrolled between June 2020 and June 2022. The primary efficacy end point was observed in 155 patients (96.9%). The primary safety end point occurred in 145 cases (90.6%). Dissections >National Heart, Lung and Blood Institute type B occurred in 3 patients (1.9%), whereas slow or no flow occurred in 8 (5.0%), final thrombolysis in myocardial infarction flow <3 in 3 (1.9%), and perforation in 4 patients (2.5%). Free from inhospital major adverse cardiac and cerebrovascular events, including cardiac death, target vessel myocardial infarction, target lesion revascularization, cerebrovascular accident, definite/probable stent thrombosis, and major bleeding, occurred in 158 patients (98.7%). In conclusion, IVL after RA in lesions with severe CAC was effective and safe, with a very low incidence of complications as either elective or bail-out strategy.
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Affiliation(s)
- Gennaro Sardella
- Department of Clinical, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy; Division of Cardiology, Montefiore Medical Center, Bronx, New York
| | - Giacomo Boccuzzi
- Division of Cardiology, Department of Medicine, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Natalia Tovar Fovero
- Department of Cardiology, Erasmus Medical University Center, Rotterdam, The Netherlands
| | - Nicolas Van Mieghem
- Department of Cardiology, Erasmus Medical University Center, Rotterdam, The Netherlands
| | | | - Javier Escaned
- Interventional Cardiology Unit, Hospital Clinico San Carlos IdISSC, Universidad Complutense de Madrid, C/ Profesor Martín Lagos, Madrid, Spain
| | - Massimo Fineschi
- Interventional Cardiology, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Luca Testa
- IRCCS Policlinico S. Donato, Milan, Italy
| | - Renato Valenti
- Division of Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Carlo Briguori
- Division of Interventional Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - Bernardo Cortese
- Foundation for Cardiovascular Research and Innovation, Milan, Italy
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Jacopo Andrea Oreglia
- Department of Cardiology and de Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy; Interventional Cardiology Unit, EMO-GVM, Centro Cuore Columbus, Milan, Italy
| | | | - Emanuele Barbato
- Cardiology Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fausto Castriota
- Interventional Cardiology Unit, Maria Cecilia Hospital GVM Care and Research, Cotignola, Italy
| | - Anita Paggi
- Laboratory of Interventional Cardiology; Department of Cardiology, S. Anna Hospital, Catanzaro, Italy
| | - Italo Porto
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa, Italy
| | - Fabrizio Tomai
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
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Chiarito M, Sturla M, Briguori C, Mancone M, Tamburino C, Fabbiocchi F, Trabattoni D, Tomai F, Paggi A, Gioffrè G, Sclafani R, Giordano A, Stefanini GG, Sardella G. Polymer-free biolimus-A9-eluting stent performance according to renal impairment: insights from the RUDI-FREE registry. J Cardiovasc Med (Hagerstown) 2022; 23:127-134. [PMID: 34632982 DOI: 10.2459/jcm.0000000000001269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular disease and have a worse prognosis after percutaneous coronary interventions (PCI). The BioFreedom polymer-free biolimus-A9-eluting stent (PF-BES) has shown promising results in patients at high bleeding risk; however, its performance in CKD patients has yet to be analyzed. METHODS The all-comers RUDI-FREE registry documented patients undergoing PCI with PF-BES in routine clinical practice. Patients were stratified into three groups according to their estimated glomerular filtration rate (eGFR): preserved renal function, mild renal insufficiency (RI), and with moderate to severe RI (eGFR ≥ 90, between 90 and 45, and <45 ml/min/1.73 m2, respectively). The primary safety end point was a patient-oriented composite end point of cardiovascular death, myocardial infarction (MI), and definite or probable stent thrombosis (ST). The primary efficacy end point was target lesion revascularization (TLR). RESULTS The registry documented 1,104 consecutive patients treated with PF-BES: 258 (23.4%) with preserved renal function, whereas 712 (64.7%) and 131 (11.9%) had mild and moderate to severe RI, respectively. At 1 year, the primary safety end point was significantly higher in patients with moderate to severe RI (3.5% vs. 2.8% vs. 11.5%; P < 0.001). Conversely, TLR proved similar among groups (0.4% vs. 1.8% vs. 0.8%; P = 0.235). CONCLUSIONS Patients with worse renal function had increased risk of the composite of cardiovascular deaths, MI, and definite or probable ST. However, the PF-BES showed similar efficacy despite differences in renal function. These findings need to be confirmed in large-scale randomized trials.
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Affiliation(s)
- Mauro Chiarito
- Humanitas Clinical and Research Hospital IRCCS
- Department of Biomedical Sciences, Humanitas University, Milan
| | - Matteo Sturla
- Humanitas Clinical and Research Hospital IRCCS
- Department of Biomedical Sciences, Humanitas University, Milan
| | - Carlo Briguori
- Clinica Mediterranea, Laboratory of Interventional Cardiology and Department of Cardiology, Naples, Italy
| | - Massimo Mancone
- Policlinico Umberto I, Department of Cardiovascular Sciences, Rome
| | | | | | | | - Fabrizio Tomai
- European Hospital, Laboratory of Interventional Cardiology and Department of Cardiology, Rome
| | - Anita Paggi
- S. Anna Hospital, Laboratory of Interventional Cardiology and Department of Cardiology, Como
| | - Gaetano Gioffrè
- S. Eugenio Hospital, Laboratory of Interventional Cardiology and Department of Cardiology, Rome
| | | | - Arturo Giordano
- Clinica Pineta Grande, Laboratory of Interventional Cardiology and Department of Cardiology, Castel Volturno, Italy
| | - Giulio G Stefanini
- Humanitas Clinical and Research Hospital IRCCS
- Department of Biomedical Sciences, Humanitas University, Milan
| | - Gennaro Sardella
- Policlinico Umberto I, Department of Cardiovascular Sciences, Rome
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Ruocco G, McCullough PA, Tecson KM, Mancone M, De Ferrari GM, D'Ascenzo F, De Rosa FG, Paggi A, Forleo G, Secco GG, Pistis G, Monticone S, Vicenzi M, Rota I, Blasi F, Pugliese F, Fedele F, Palazzuoli A. Mortality Risk Assessment Using CHA(2)DS(2)-VASc Scores in Patients Hospitalized With Coronavirus Disease 2019 Infection. Am J Cardiol 2020; 137:111-117. [PMID: 32991860 PMCID: PMC7521434 DOI: 10.1016/j.amjcard.2020.09.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 12/18/2022]
Abstract
Early risk stratification for complications and death related to Coronavirus disease 2019 (COVID-19) infection is needed. Because many patients with COVID-19 who developed acute respiratory distress syndrome have diffuse alveolar inflammatory damage associated with microvessel thrombosis, we aimed to investigate a common clinical tool, the CHA(2)DS(2)-VASc, to aid in the prognostication of outcomes for COVID-19 patients. We analyzed consecutive patients from the multicenter observational CORACLE registry, which contains data of patients hospitalized for COVID-19 infection in 4 regions of Italy, according to data-driven tertiles of CHA(2)DS(2)-VASc score. The primary outcomes were inpatient death and a composite of inpatient death or invasive ventilation. Of 1045 patients in the registry, 864 (82.7%) had data available to calculate CHA(2)DS(2)-VASc score and were included in the analysis. Of these, 167 (19.3%) died, 123 (14.2%) received invasive ventilation, and 249 (28.8%) had the composite outcome. Stratification by CHA(2)DS(2)-VASc tertiles (T1: ≤1; T2: 2 to 3; T3: ≥4) revealed increases in both death (8.1%, 24.3%, 33.3%, respectively; p <0.001) and the composite end point (18.6%, 31.9%, 43.5%, respectively; p <0.001). The odds ratios for mortality and the composite end point for T2 patients versus T1 CHA(2)DS(2)-VASc score were 3.62 (95% CI:2.29 to 5.73,p <0.001) and 2.04 (95% CI:1.42 to 2.93, p <0.001), respectively. Similarly, the odds ratios for mortality and the composite end point for T3 patients versus T1 were 5.65 (95% CI:3.54 to 9.01, p <0.001) and 3.36 (95% CI:2.30 to 4.90,p <0.001), respectively. In conclusion, among Italian patients hospitalized for COVID-19 infection, the CHA(2)DS(2)-VASc risk score for thromboembolic events enhanced the ability to achieve risk stratification for complications and death.
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Affiliation(s)
- Gaetano Ruocco
- Cardiology Division, Regina Montis Regalis Hospital, Mondovì, Cuneo, Italy
| | - Peter A McCullough
- Baylor Heart and Vascular Institute, Dallas, Texas; Baylor University Medical Center, Dallas, Texas; Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas
| | - Kristen M Tecson
- Baylor Heart and Vascular Institute, Dallas, Texas; Baylor University Medical Center, Dallas, Texas; Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas
| | - Massimo Mancone
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza, University of Rome, Rome, Italy
| | - Gaetano M De Ferrari
- Cardiology, Department of Medical Science University of Turin, Città della Salute e Della Scienza Le Molinette Hospital Torino, Torino, Italy
| | - Fabrizio D'Ascenzo
- Cardiology, Department of Medical Science University of Turin, Città della Salute e Della Scienza Le Molinette Hospital Torino, Torino, Italy
| | - Francesco G De Rosa
- Infectious Disease, Department of Medical Sciences, University of Torino, AOU Città della salute e della Scienza, Torino, Italy
| | - Anita Paggi
- Interventional Cardiology Department of Internal Medicine, ASSST Nord Milano E Bassini Hospital Cisanello Balsamo, Milan, Italy
| | - Giovanni Forleo
- Section Head Electrophysiology and Cardiac Pacing Azienda Ospedaliera, Polo Universitario -"Luigi Sacco," Milano, Italy
| | - Gioel G Secco
- Interventional Cardiology and Cardiac Surgery Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Gianfranco Pistis
- Interventional Cardiology and Cardiac Surgery Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Silvia Monticone
- Division of Internal Medicine, Department of Medical Sciences University of Turin, Turin, Italy
| | - Marco Vicenzi
- Cardiovascular Disease Unit, Department of Internal Medicine, University of Milano, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Irene Rota
- Cardiovascular Disease Unit, Department of Internal Medicine, University of Milano, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Francesco Blasi
- Respiratory Unit and Adult Cystic Fibrosis Center, Department of Internal Medicine, University of Milano, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Francesco Pugliese
- Department of General Surgery, Surgical Specialities "Paride Stefanini," Rome Italy
| | - Francesco Fedele
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza, University of Rome, Rome, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Medical Sciences, Le Scotte Hospital, University of Siena, Siena, Italy.
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Gritti V, Pierini S, Ornaghi M, Paggi A, Baragetti I, Buzzi L, Gentile F. Contrast induced acute kidney injury prevention during angiographic procedure with early renal replacement therapy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and purpose
Post-angiography renal replacement therapy (RRT) has shown protective effects from Ci-AKI (contrast induced acute kidney injury) in patients with pre-existing advanced renal disfunction. We analysed a series of 1095 continuative patients who undergone coronary or peripheral angiography in our center. In non-haemodialyzed patients with eGFR <20ml/min/1.73m2 or with poor renal reserve we performed an “early” RRT, starting during angiography procedure and applied for at least 6 h after procedure, thus diverging from previous literature data based only on post-procedure hours delayed RRT application. The RRT modality chosen was CVVHDF (continous veno-venous hemodiafiltration).
Methods
We considered following subjects variability: age, sex, weight, presence of hypertension, dyslipidaemia, diabetes, smoking habitude, left ventricular ejection fraction, amount of contrast media given and shock or infection occurrence during hospital stay. We evaluate statistic significative of serum creatine (SCr) variation in patients receiving RRT from pre-procedure time (T0), at 24h (T1), 48h (T2), 72h (T3) after procedure and at 3–8 weeks follow-up (T4). Quantitative data were compared with Student T test, qualitative data with Chi Square test, considering statistically significant p value <0.05 with two tails. Ci-AKI was defined as serum creatinine rise ≥0.3 mg/dL at 48h from contrast media administration, following KDIGO (kidney disease improving global outcomes) guidelines definition.
Results
26 patients received RRT. Medium SCr at T0 was 3.37 mg/dl and showed a significative reduction (see figure) at T1 (−0.88mg/dl = −20.6%, p=0.003) and T2 (−0.96mg/dl = −18.33%, p=0.029) and a trend towards reduction at T3 (−0.78mg/dl, p=0.174) and at T4 (−0.28mg/dl, p=0.568).
Between 26 pts, 6 pts (23%) developed Ci-AKI. Only contrast media amount significatively diverge between two groups (183 ml in the group with Ci-AKI vs 162 ml in pts with no Ci-AKI, p=0.03), showing also a trend towards significance for infection occurrence (83.3% pts Ci-AKI vs 40% pts no Ci-AKI, p=0.06) and shock onset (33.3%pts Ci-AKI vs 5% pts no Ci-AKI, p=0.06).
Average SCr diverge at T2 (3.18mg/dl Ci-AKI vs 2.04mg/dl no Ci-AKI, p=0.01) and at T3 (3.33mg/dl CI-AKI vs 2.31mg/dl no CI-AKI, p=0.06); we also found a trend towards progressive increase of SCr for Ci-AKI pts (T0-T1: +0.17mg/dl, p=ns; T0-T2: +0.41mg/dl, p=ns; T0-T3: +0.57mg/dl, p=ns; T0-T4: +1.35mg/dl, p=ns) and a significative reduction in SCr for no Ci-AKI pts (T0-T1: −1.23mg/dl = −29.32% p=0.001; T0-T2: −1.46mg/dl = −30.78%, p=0.01; T0-T4: −0.41mg/dl = −15.5%, p=0.05).
Conclusions
Early RRT with CVVHDF modality results effective in 77% of patients in avoiding Ci-AKI, with a significative SCr reduction at 24 and 48h. An increased amount of contrast media is significatively related to Ci-AKI incidence. Ci-AKI development could also possibly be related to shock and infection occurrence.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- V Gritti
- Bassini Hospital, Cinisello Balsamo, Italy
| | - S Pierini
- Bassini Hospital, Cinisello Balsamo, Italy
| | - M Ornaghi
- Bassini Hospital, Cinisello Balsamo, Italy
| | - A Paggi
- Bassini Hospital, Cinisello Balsamo, Italy
| | | | - L Buzzi
- Bassini Hospital, Cinisello Balsamo, Italy
| | - F Gentile
- Bassini Hospital, Cinisello Balsamo, Italy
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Palazzuoli A, Mancone M, De Ferrari GM, Forleo G, Secco GG, Ruocco GM, D'Ascenzo F, Monticone S, Paggi A, Vicenzi M, Palazzo AG, Landolina M, Taravelli E, Tavazzi G, Blasi F, Infusino F, Fedele F, De Rosa FG, Emmett M, Schussler JM, Tecson KM, McCullough PA. Antecedent Administration of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Antagonists and Survival After Hospitalization for COVID-19 Syndrome. J Am Heart Assoc 2020; 9:e017364. [PMID: 33023356 PMCID: PMC7763715 DOI: 10.1161/jaha.120.017364] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) utilizes the angiotensin-converting enzyme-2 (ACE-2) receptor to enter human cells. Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ARB) are associated with ACE-2 upregulation. We hypothesized that antecedent use of ACEI/ARB may be associated with mortality in coronavirus disease 2019 (COVID-19). Methods and Results We used the Coracle registry, which contains data of patients hospitalized with COVID-19 in 4 regions of Italy, and restricted analyses to those ≥50 years of age. The primary outcome was in-hospital mortality. Among these 781 patients, 133 (17.0%) used an ARB and 171 (21.9%) used an ACEI. While neither sex nor smoking status differed by user groups, patients on ACEI/ARB were older and more likely to have hypertension, diabetes mellitus, and congestive heart failure. The overall mortality rate was 15.1% (118/781) and increased with age (PTrend<0.0001). The crude odds ratios (ORs) for death for ACEI users and ARB users were 0.98, 95% CI, 0.60-1.60, P=0.9333, and 1.13, 95% CI, 0.67-1.91, P=0.6385, respectively. After adjusting for age, hypertension, diabetes mellitus, and congestive heart failure, antecedent ACEI administration was associated with reduced mortality (OR, 0.55; 95% CI, 0.31-0.98, P=0.0436); a similar, but weaker trend was observed for ARB administration (OR, 0.58; 95% CI, 0.32-1.07, P=0.0796). Conclusions In those aged ≥50 years hospitalized with COVID-19, antecedent use of ACEI was independently associated with reduced risk of inpatient death. Our findings suggest a protective role of renin-angiotensin-aldosterone system inhibition in patients with high cardiovascular risk affected by COVID-19.
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Affiliation(s)
- Alberto Palazzuoli
- Cardiovascular Diseases UnitDepartment of Medical SciencesAOUS Le Scotte Hospital University of SienaItaly
| | - Massimo Mancone
- Department of Clinical Internal, Anesthesiological and Cardiovascular SciencesSapienza, University of RomeItaly
| | - Gaetano M. De Ferrari
- CardiologyDepartment of Medical Science,University of TurinCittà della Salute e Della Scienza Le Molinette Hospital TorinoTorinoItaly
| | - Giovanni Forleo
- Section Head Electrophysiology and Cardiac Pacing Azienda Ospedaliera ‐ Polo Universitario ‐ "Luigi Sacco"MilanoItaly
| | - Gioel G. Secco
- Interventional Cardiology and Cardiac Surgery UnitAzienda Ospedaliera SS Antonio e Biagio e Cesare ArrigoAlessandriaItaly
| | | | - Fabrizio D'Ascenzo
- CardiologyDepartment of Medical Science,University of TurinCittà della Salute e Della Scienza Le Molinette Hospital TorinoTorinoItaly
| | - Silvia Monticone
- Division of Internal MedicineDepartment of Medical SciencesUniversity of TurinItaly
| | - Anita Paggi
- Interventional CardiologyDepartment of Internal MedicineASSST Nord Milano E Bassini Hospital Cisanello BalsamoMilanItaly
| | - Marco Vicenzi
- Cardiovascular Disease UnitDepartment of Internal MedicineFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoUniversity of MilanoItaly
| | - Anna G. Palazzo
- Infectious DiseaseDepartment of Medical SciencesAOU Città Della Salute e Della ScienzaUniversity of TorinoItaly
| | | | | | - Guido Tavazzi
- Intensive CareFondation IRCCS Policlinico San MatteoUniversity of PaviaItaly
| | - Francesco Blasi
- Respiratory Unit and Adult Cystic Fibrosis CenterDepartment of Internal MedicineFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoUniversity of MilanoItaly
| | - Fabio Infusino
- Department of Clinical Internal, Anesthesiological and Cardiovascular SciencesSapienza, University of RomeItaly
| | - Francesco Fedele
- Department of Clinical Internal, Anesthesiological and Cardiovascular SciencesSapienza, University of RomeItaly
| | - Francesco G. De Rosa
- Infectious DiseaseDepartment of Medical SciencesAOU Città Della Salute e Della ScienzaUniversity of TorinoItaly
| | | | - Jeffrey M. Schussler
- Baylor University Medical CenterDallasTX
- Baylor Scott and White Heart and Vascular HospitalDallasTX
- Baylor Heart and Vascular InstituteDallasTX
| | - Kristen M. Tecson
- Baylor University Medical CenterDallasTX
- Baylor Scott and White Heart and Vascular HospitalDallasTX
- Baylor Heart and Vascular InstituteDallasTX
| | - Peter A. McCullough
- Baylor University Medical CenterDallasTX
- Baylor Scott and White Heart and Vascular HospitalDallasTX
- Baylor Heart and Vascular InstituteDallasTX
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Piffaretti G, Antonello M, Pratesi G, Gelpi G, Galli M, Tadiello M, Xodo A, Barbante M, Paggi A, Romagnoni C, Ippoliti A, Grego F, Castelli P. Comparison of Two Different Techniques for Isolated Left Subclavian Artery Revascularization During Thoracic Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.600] [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: 11/17/2022]
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Chiarito M, Sardella G, Colombo A, Briguori C, Testa L, Bedogni F, Fabbiocchi F, Paggi A, Palloshi A, Tamburino C, Margonato A, Pivato CA, Baber U, Calcagno S, Giordano A, Godino C, Stefanini GG. Safety and Efficacy of Polymer-Free Drug-Eluting Stents. Circ Cardiovasc Interv 2019; 12:e007311. [DOI: 10.1161/circinterventions.118.007311] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 12/21/2022]
Affiliation(s)
- Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (M.C., C.A.P., G.G.S.)
- Humanitas Clinical and Research Center IRCCS - Rozzano, Milan, Italy (M.C., C.A.P., G.G.S.)
| | - Gennaro Sardella
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy (G.S., S.C.)
| | | | | | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese-Milan, Italy (L.T., F.B.)
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese-Milan, Italy (L.T., F.B.)
| | | | - Anita Paggi
- Department of Interventional Cardiology, Sant’Anna Hospital Como (A. Paggi.)
| | - Altin Palloshi
- Interventional Cardiovascular Unit, Cardiology Department, Istituto Clinico Città Studi, Milan, Italy (A. Palloshi)
| | - Corrado Tamburino
- U.O.C. Cardiologia, C.A.S.T. Centro Alte Specialità e Trapianti, P.O. G. Rodolico, A.O.U. Policlinico-V. Emanuele, Università di Catania, Italy (C.T.)
| | | | - Carlo Andrea Pivato
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (M.C., C.A.P., G.G.S.)
- Humanitas Clinical and Research Center IRCCS - Rozzano, Milan, Italy (M.C., C.A.P., G.G.S.)
- San Raffaele Hospital, Milan, Italy (A.M., C.A.P., C.G.)
| | - Usman Baber
- Zena and Michael Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B.)
| | - Simone Calcagno
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy (G.S., S.C.)
| | | | - Cosmo Godino
- San Raffaele Hospital, Milan, Italy (A.M., C.A.P., C.G.)
| | - Giulio G. Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (M.C., C.A.P., G.G.S.)
- Humanitas Clinical and Research Center IRCCS - Rozzano, Milan, Italy (M.C., C.A.P., G.G.S.)
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Piffaretti G, Pratesi G, Gelpi G, Galli M, Criado FJ, Antonello M, Fontana F, Piacentino F, Macchi E, Tozzi M, Castelli P, Barbante M, Ippoliti A, Romagnoni C, Antona C, Paggi A, Xodo A, Grego F. Comparison of Two Different Techniques for Isolated Left Subclavian Artery Revascularization During Thoracic Endovascular Aortic Repair in Zone 2. J Endovasc Ther 2018; 25:740-749. [DOI: 10.1177/1526602818802581] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose: To analyze the results of isolated left subclavian artery (LSA) revascularization during thoracic endovascular aortic repair (TEVAR) using carotid-subclavian bypass (CSbp) or chimney grafts (CGs). Methods: A retrospective multicenter, observational study identified 73 patients (mean age 68±13 years, range 22–87; 56 men) with acute or chronic thoracic aortic lesions who underwent TEVAR with isolated LSA revascularization using either CSbp (n=42) or CGs (n=31) from January 2010 and February 2017. Primary endpoints were TEVAR-related mortality, postoperative stroke, freedom from type Ia endoleak, and LSA patency. Results: Primary technical success was achieved in all cases. Early TEVAR-related mortality was 4.2% (CSbp 2% vs CG 6%, p=0.571). Two (3%) patients had major ischemic strokes (one in each group). Mean follow-up was 24±21 months (range 1–72; median 15). Estimated freedom from TEVAR-related mortality was 93%±3% (95% CI 84.3% to 97.0%) at 12 and 36 months, with no significant difference between CSbp and CG (p=0.258). Aortic reintervention did not differ between the groups (CSbp 5% vs CG 6%, p=0.356); nor did freedom from type Ia endoleak (CSbp 98% vs CG 87%, p=0.134). Gutter-related endoleaks occurred in 4 (13%) CG patients, but none of the patients experienced sac enlargement or the need for reintervention and none died. Primary patency of the LSA was 100% for the entire group during the observation period. Conclusion: In our experience, LSA revascularization proved most satisfactory and equally effective with both the CSbp and CG techniques, without discernible differences at midterm follow-up.
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Affiliation(s)
- Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Circolo University Hospital, Varese, Italy
| | - Giovanni Pratesi
- Vascular Surgery, Department of Surgery, Policlinico Tor Vergata, Rome, Italy
| | - Guido Gelpi
- Cardiac Surgery, Department of Cardiovascular Surgery, Sacco Hospital, Milan, Italy
| | - Mario Galli
- Interventional Cardiology, Department of Medicine, Sant’Anna Hospital, Como, Italy
| | - Frank J. Criado
- Division of Vascular Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Michele Antonello
- Vascular Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua School of Medicine, Padua University Hospital, Padua, Italy
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10
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Sardella G, Stefanini GG, Briguori C, Tamburino C, Fabbiocchi F, Rotolo F, Tomai F, Paggi A, Lombardi M, Gioffrè G, Sclafani R, Rolandi A, Sciahbasi A, Scardaci F, Signore N, Calcagno S, Mancone M, Chiarito M, Giordano A. Safety and efficacy of polymer-free biolimus-eluting stents in all-comer patients: the RUDI-FREE study. EUROINTERVENTION 2018; 14:772-779. [DOI: 10.4244/eij-d-18-00148] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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11
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Stefanini G, Chiarito M, Godino C, Testa L, Palloshi A, Giordano A, Fabbiocchi F, Paggi A, Bedogni F, Tamburino C, Briguori C, Colombo A, Sardella G. TCT-548 Predictors of clinical outcomes after polymer free amphilimus- and biolimus-eluting stents: the FREE-FUTURE study. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1734] [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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12
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Russo F, Paggi A, De Nittis G, Galli M. [Percutaneous treatment of coronary artery fistula: a tailored strategy is needed]. G Ital Cardiol (Rome) 2018; 19:187-190. [PMID: 29873646 DOI: 10.1714/2883.29077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Coronary artery fistula (CAF) is a rare, abnormal connection between one or more coronary arteries and a cardiac chamber, or great vessel.We describe the case of a male patient with worsening effort angina referred for coronary angiography. The examination revealed the presence of a CAF between the proximal left anterior descending (LAD) and pulmonary arteries, with mid LAD subocclusive stenosis. Ad hoc PCI with stenting was performed in the mid LAD, followed by CAF embolization with coils and plugs. Angiography and computed tomography scan at follow-up showed complete CAF occlusion, stent patency, and normal flow reserve of the LAD. CAF treatment is indicated only for large or clinically significant symptomatic fistulas. Treatment strategy, technique and device choice should be tailored on CAF anatomical characteristics. In this case, our strategy was feasible, safe and successful with favorable long-term results.
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Affiliation(s)
- Filippo Russo
- U.O.S.D. Cardiologia - Laboratorio di Emodinamica, Dipartimento di Emergenza, Rianimazione e Anestesia, ASST Lariana, Ospedale S. Anna, Como
| | - Anita Paggi
- U.O.S.D. Cardiologia - Laboratorio di Emodinamica, Dipartimento di Emergenza, Rianimazione e Anestesia, ASST Lariana, Ospedale S. Anna, Como
| | - Giuseppe De Nittis
- U.O.S.D. Cardiologia - Laboratorio di Emodinamica, Dipartimento di Emergenza, Rianimazione e Anestesia, ASST Lariana, Ospedale S. Anna, Como
| | - Mario Galli
- U.O.S.D. Cardiologia - Laboratorio di Emodinamica, Dipartimento di Emergenza, Rianimazione e Anestesia, ASST Lariana, Ospedale S. Anna, Como
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13
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Prat N, Paggi A, Ribera C, Acosta R, Ríos-Touma B, Villamarín C, Rivera F, Ossa P, Rieradevall M. The Cricotopus (Oliveiriella) (Diptera: Chironomidae) of the High Altitude Andean Streams, with Description of a New Species, C. (O.) rieradevallae. Neotrop Entomol 2018; 47:256-270. [PMID: 28905263 DOI: 10.1007/s13744-017-0548-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 07/18/2017] [Indexed: 06/07/2023]
Abstract
The genus Oliveiriella (Chironomidae, Orthocladiinae) was erected by Wiedenbrug & Fittkau (1997). The adults have characteristic black spots on their wings and other characteristics similar to the genus Cricotopus. Pupal skins are very characteristic with strong short spines in the anal lobe instead of setae, while larvae are distinguishable by the long anal papillae and the intense blue color of their body. However, Andersen et al (2013) consider Oliveiriella as a subgenera of Cricotopus. In this paper, using the sequences of the cox1 gene, we conclude that Oliveiriella should be considered a subgenus within Cricotopus, confirming its status in Andersen et al (2013). Furthermore, we describe Cricotopus (Oliveiriella) rieradevallae Prat & Paggi sp. n. from the Saltana river (Ecuador). The adult males, females, and preimaginal stages of the two species of subgenus Oliveiriella known from South America Cricotopus (O.) almeidai n. comb. from Peru, Brazil, and Argentina and Cricotopus (O.) sanjavieri n. comb. from Argentina are compared with those of Cricotopus (O.) rieradevallae sp. n. from Ecuador. The differences allow the distinction of the three species. The cox1 gene reveals that at least three different undescribed species of the same subgenus are present in the high-altitude tropical Andes. The morphology of the available pupae and pupal exuviae reveals the presence of several morphotypes that are candidates to be described as new species. A key used to distinguish these pupal morphotypes is provided, including the three described species. Additionally, the distribution of the subgenus is discussed.
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Affiliation(s)
- N Prat
- Freshwater Ecology and Management Research Group, Dept de Biologia Evolutiva, Ecologia i Ciències Ambientals, Univ de Barcelona, Barcelona, Spain.
| | - A Paggi
- Instituto de Limnología "Dr. R. A. Ringuelet" (ILPLA, CONICET, UNLP), La Plata, Argentina
| | - C Ribera
- Institut de Recerca de la Biodiversitat (IRbio), Dept de Biologia Evolutiva, Ecologia i Ciències Ambientals, Univ de Barcelona, Barcelona, Spain
| | - R Acosta
- Freshwater Ecology and Management Research Group, Dept de Biologia Evolutiva, Ecologia i Ciències Ambientals, Univ de Barcelona, Barcelona, Spain
| | - B Ríos-Touma
- Unidad de Biotecnología y Medio Ambiente (BIOMA), Facultad de Ingenierías y Ciencias Agropecuarias (FICA), Ingeniería Ambiental, Univ de las Américas, Quito, Ecuador
| | - C Villamarín
- Unidad de Biotecnología y Medio Ambiente (BIOMA), Facultad de Ingenierías y Ciencias Agropecuarias (FICA), Ingeniería Ambiental, Univ de las Américas, Quito, Ecuador
| | - F Rivera
- Research Group GEBIOME, Depto de Ciencias Biológicas, Facultad de Ciencias Exactas y Naturales, Univ de Caldas, Manizales, Colombia
| | - P Ossa
- Research Group GEBIOME, Depto de Ciencias Biológicas, Facultad de Ciencias Exactas y Naturales, Univ de Caldas, Manizales, Colombia
| | - M Rieradevall
- Freshwater Ecology and Management Research Group, Dept de Biologia Evolutiva, Ecologia i Ciències Ambientals, Univ de Barcelona, Barcelona, Spain
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Vranckx P, Frigoli E, Rothenbühler M, Tomassini F, Garducci S, Andò G, Picchi A, Sganzerla P, Paggi A, Ugo F, Ausiello A, Sardella G, Franco N, Nazzaro M, de Cesare N, Tosi P, Falcone C, Vigna C, Mazzarotto P, Di Lorenzo E, Moretti C, Campo G, Penzo C, Pasquetto G, Heg D, Jüni P, Windecker S, Valgimigli M. Radial versus femoral access in patients with acute coronary syndromes with or without ST-segment elevation. Eur Heart J 2017; 38:1069-1080. [PMID: 28329389 DOI: 10.1093/eurheartj/ehx048] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 11/06/2016] [Accepted: 01/25/2017] [Indexed: 11/13/2022] Open
Abstract
Aims To assess whether radial compared with femoral access is associated with consistent outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods and results In the Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX (MATRIX) programme patients were randomized to radial or femoral access, stratified by STEMI (2001 radial, 2009 femoral) and NSTE-ACS (2196 radial, 2198 femoral). The 30-day co-primary outcomes were major adverse cardiovascular events (MACE), defined as death, myocardial infarction, or stroke, and net adverse clinical events (NACE), defined as MACE or major bleeding In the overall study population, radial access reduced the NACE but not MACE endpoint at the prespecified 0.025 alpha. MACE occurred in 121 (6.1%) STEMI patients with radial access vs. 126 (6.3%) patients with femoral access [rate ratio (RR) = 0.96, 95% CI = 0.75-1.24; P = 0.76] and in 248 (11.3%) NSTE-ACS patients with radial access vs. 303 (13.9%) with femoral access (RR = 0.80, 95% CI = 0.67-0.96; P = 0.016) (Pint = 0.25). NACE occurred in 142 (7.2%) STEMI patients with radial access and in 165 (8.3%) patients with femoral access (RR = 0.86, 95% CI = 0.68-1.08; P = 0.18) and in 268 (12.2%) NSTE-ACS patients with radial access compared with 321 (14.7%) with femoral access (RR = 0.82, 95% CI = 0.69-0.97; P = 0.023) (Pint = 0.76). All-cause mortality and access site-actionable bleeding favoured radial access irrespective of ACS type (Pint = 0.11 and Pint = 0.36, respectively). Conclusion Radial as compared with femoral access provided consistent benefit across the whole spectrum of patients with ACS, without evidence that type of presenting syndrome affected the results of the random access allocation.
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Affiliation(s)
- Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Stadsomvaart 11, 3500 Hasselt, Belgium
| | | | - Martina Rothenbühler
- Clinical Trials Unit and Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - Francesco Tomassini
- Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3, Str. del Barocchio, 25, 10095 Turin, Italy
| | - Stefano Garducci
- Ospedale Civile di Vimercate (MB), Via Santi Cosma e Damiano, 10, 20871 Vimercate MB, Italy
| | - Giuseppe Andò
- Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino", University of Messina, Via Consolare Valeria, 1, 98125 Messina ME , Italy
| | - Andrea Picchi
- UO Cardiologia, ASL 9 Grosseto, Via Senese - Grosseto; 58100 Grosseto, Italy
| | - Paolo Sganzerla
- AO Ospedale Treviglio-Caravaggio, Piazzale Ospedale, 1, 24047 Treviglio BG, Italy
| | - Anita Paggi
- Azienda Ospedaliera Sant'Anna, Via Ravona, 20, 22020 San fermo della battaglia Como, Italy
| | - Fabrizio Ugo
- San Giovanni Bosco Hospital, Piazza del Donatore di Sangue, 3, 10154 Turin, Italy
| | - Arturo Ausiello
- Casa di Cura Villa Verde, Via Golfo di Taranto, 22, 74121 Taranto, Italy
| | - Gennaro Sardella
- Policlinico Umberto I, "Sapienza" University of Rome, Piazzale Aldo Moro, 5, 00185 Rome, Italy
| | - Nicoletta Franco
- Cardiovascular Department, Infermi Hospital, Viale Luigi Settembrini, 2, 47900 Rimini, Italy
| | - Marco Nazzaro
- San Camillo-Forlanini, Circonvallazione Gianicolense, 87, 00152 Rome, Italy
| | - Nicoletta de Cesare
- Policlinico San Marco, Corso Europa, 7, 24040 Zingonia, Osio Sotto BG, Italy
| | - Paolo Tosi
- Mater Salutis Hospita, Via Carlo Gianella, 37045 Legnago VR, Italy
| | - Camillo Falcone
- Osepdale Sacra Famiglia Fatebenefratelli, Erba, Fatebenefratelli, 22036 Como CO, Italy
| | - Carlo Vigna
- Casa Sollievo della Sofferenza, San Giovanni Rotodondo Foggia, Viale Cappuccini, 1, 71013 San Giovanni Rotondo FG, Italy
| | - Pietro Mazzarotto
- Ospedale di Lodi, Strada Provinciale 19, 1, 26866 Sant'Angelo Lodigiano LO, Italy
| | - Emilio Di Lorenzo
- Ospedale San Giuseppe Moscati, Contrada Amoretta, 83100 Avellino AV, Italy
| | - Claudio Moretti
- A.O.U. San Giovanni Battista Molinette di Torino, Corso Bramante, 88, 10126 Turin Italy
| | - Gianluca Campo
- Azienda Ospedaliera Universitaria di Ferrara, Via Aldo Moro, 8, 44124 Ferrara FE, Italy
| | - Carlo Penzo
- Ospedale Civile di Mirano, Via Zinelli, 30035 Mirano Venezia VE, Italy
| | | | - Dik Heg
- Clinical Trials Unit and Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and Department of Medicine, University of Toronto, Bond Street 30, ON M5B1W8, Toronto, Canada
| | - Stephan Windecker
- Swiss Cardiovascular Center Bern, Bern University Hospital Freiburgstrasse 8, 3010 Bern, Switzerland (M.V.; S.W.) and Thoraxcenter, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Marco Valgimigli
- Swiss Cardiovascular Center Bern, Bern University Hospital Freiburgstrasse 8, 3010 Bern, Switzerland (M.V.; S.W.) and Thoraxcenter, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
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Ackermann M, Ajello M, Atwood WB, Baldini L, Ballet J, Barbiellini G, Bastieri D, Gonzalez JB, Bellazzini R, Bissaldi E, Blandford RD, Bloom ED, Bonino R, Bottacini E, Brandt TJ, Bregeon J, Britto RJ, Bruel P, Buehler R, Buson S, Caliandro GA, Cameron RA, Caragiulo M, Caraveo PA, Carpenter B, Casandjian JM, Cavazzuti E, Cecchi C, Charles E, Chekhtman A, Cheung CC, Chiang J, Chiaro G, Ciprini S, Claus R, Cohen-Tanugi J, Cominsky LR, Conrad J, Cutini S, D’Abrusco R, D’Ammando F, Angelis AD, Desiante R, Digel SW, Venere LD, Drell PS, Favuzzi C, Fegan SJ, Ferrara EC, Finke J, Focke WB, Franckowiak A, Fuhrmann L, Fukazawa Y, Furniss AK, Fusco P, Gargano F, Gasparrini D, Giglietto N, Giommi P, Giordano F, Giroletti M, Glanzman T, Godfrey G, Grenier IA, Grove JE, Guiriec S, Hewitt JW, Hill AB, Horan D, Itoh R, Jóhannesson G, Johnson AS, Johnson WN, Kataoka J, Kawano T, Krauss F, Kuss M, Mura GL, Larsson S, Latronico L, Leto C, Li J, Li L, Longo F, Loparco F, Lott B, Lovellette MN, Lubrano P, Madejski GM, Mayer M, Mazziotta MN, McEnery JE, Michelson PF, Mizuno T, Moiseev AA, Monzani ME, Morselli A, Moskalenko IV, Murgia S, Nuss E, Ohno M, Ohsugi T, Ojha R, Omodei N, Orienti M, Orlando E, Paggi A, Paneque D, Perkins JS, Pesce-Rollins M, Piron F, Pivato G, Porter TA, Rainò S, Rando R, Razzano M, Razzaque S, Reimer A, Reimer O, Romani RW, Salvetti D, Schaal M, Schinzel FK, Schulz A, Sgrò C, Siskind EJ, Sokolovsky KV, Spada F, Spandre G, Spinelli P, Stawarz L, Suson DJ, Takahashi H, Takahashi T, Tanaka Y, Thayer JG, Thayer JB, Tibaldo L, Torres DF, Torresi E, Tosti G, Troja E, Uchiyama Y, Vianello G, Winer BL, Wood KS, Zimmer S. THE THIRD CATALOG OF ACTIVE GALACTIC NUCLEI DETECTED BY THEFERMILARGE AREA TELESCOPE. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-637x/810/1/14] [Citation(s) in RCA: 424] [Impact Index Per Article: 47.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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D'Abrusco R, Massaro F, Paggi A, Smith HA, Masetti N, Landoni M, Tosti G. THE
WISE
BLAZAR-LIKE RADIO-LOUD SOURCES: AN ALL-SKY CATALOG OF CANDIDATE γ-RAY BLAZARS. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/0067-0049/215/1/14] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Caravita S, Secchi MB, Wu SC, Pierini S, Paggi A. Sildenafil Therapy for Interferon-β-1a-Induced Pulmonary Arterial Hypertension: A Case Report. Cardiology 2011; 120:187-9. [DOI: 10.1159/000335064] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 11/04/2011] [Indexed: 11/19/2022]
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Pizzini FB, Polonara G, Mascioli G, Beltramello A, Foroni R, Paggi A, Salvolini U, Tassinari G, Fabri M. Diffusion tensor tracking of callosal fibers several years after callosotomy. Brain Res 2009; 1312:10-7. [PMID: 19931228 DOI: 10.1016/j.brainres.2009.11.030] [Citation(s) in RCA: 17] [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: 08/24/2009] [Revised: 10/23/2009] [Accepted: 11/11/2009] [Indexed: 02/06/2023]
Abstract
Diffusion tensor imaging (DTI) can provide more detailed in vivo information on the structural preservation of transected white matter tracts than conventional imaging methods. Here we show for the first time tracks of severed callosal fibers up to 17 years from resection. Five patients subjected to complete or partial callosotomy several years before the study were examined with DTI and compared to a normal control. Transected fibers were traced in all patients and were more clearly visible in the anterior and posterior parts than in the middle of the commissure. These findings suggest that microstructural changes persist for many years in the severed fibers, as also reflected by fractional anisotropy and apparent diffusion coefficient values, enabling a reconstruction of the longitudinal organization of severed central tracts that could not be achieved with previous techniques.
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Affiliation(s)
- F B Pizzini
- Department of Neuroradiology, Verona University Hospital, Verona, Italy
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Kramer CK, Leitão CB, Azevedo MJ, Canani LH, Maia AL, Czepielewski M, Paggi A, Rodrigues TC, Silveiro SP, Friedman R, Gross JL. Degree of catecholamine hypersecretion is the most important determinant of intra-operative hemodynamic outcomes in pheochromocytoma. J Endocrinol Invest 2009; 32:234-7. [PMID: 19542740 DOI: 10.1007/bf03346458] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Pheochromocytoma resection is often complicated by intra-operative hypertension and post-resection hypotension. Factors associated with these hemodynamic alterations are not well defined. The aim of this study was to analyse the clinical-laboratory features associated with hemodynamic parameters during pheochromocytoma resection. Twenty-seven patients submitted to tumor resection - either open (no.=18) or video laparoscopic - between 1978-2007 were included. Nineteen received pre-operative alpha-blockers. Intra-operative hemodynamic data analysed were: maximum and minimum mean arterial blood pressure (MABP), no. of severe hypertensive (systolic BP >200 mmHg) and hypotensive episodes (MABP <60 mmHg), maximum and minimum heart rate (HR), no. of episodes of tachycardia and bradycardia, need to receive iv intra-operative treatment for hypertension and hypotension and the volume of fluids administered during surgery. Patients were 39.4+/-14.4-yr-old, 66% women. Intra-operative hemodynamic parameters were not different in patients submitted to open or video laparoscopic resection. Maximum intraoperative HR and the percentage of patients with HR>100 beats/min were higher in patients without pre-operative alpha- blocker treatment (no.=8). Pre-operative urinary vanylmandelic acid was positively associated with intra-operative maximum MABP (r=0.535, p=0.047) and with maximum transoperative systolic BP (r=0.805, p=0.016). Pre-operative urinary catecholamine (Pearson correlation r=0.575, p=0.03) and vanylmandelic acid (Pearson correlation r=0.605, p=0.04) levels were associated with maximum intra- operative MABP, adjusted for the presence of pheochromocytoma symptoms, surgical approach and pre-operative alpha-blockers. In conclusion, the degree of pre-operative catecholamine secretion was the most important aspect of transoperative BP control.
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Affiliation(s)
- C K Kramer
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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20
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Fabri M, Polonara G, Mascioli G, Paggi A, Salvolini U, Manzoni T. Contribution of the corpus callosum to bilateral representation of the trunk midline in the human brain: an fMRI study of callosotomized patients. Eur J Neurosci 2006; 23:3139-48. [PMID: 16820004 DOI: 10.1111/j.1460-9568.2006.04823.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Human brain studies have shown that the cutaneous receptors of trunk regions close to the midline are represented in the first somatosensory cortex (SI) of both hemispheres. The present study aims to establish whether in humans, as in non-human primates, the bilateral representation of the trunk midline in area SI depends on the corpus callosum. Data were obtained from eight callosotomized patients: three with complete callosal resection, one with a partial posterior resection including the splenium and the callosal trunk, and four with partial anterior resections sparing the splenium and in one case also the posterior part of the callosal trunk. The investigation was carried out with functional magnetic resonance imaging. Unilateral tactile stimulation was applied by rubbing ventral trunk regions close to the midline (about 20 x 10 cm in width) with a soft cotton pad (frequency 1 Hz). Cortical activation foci elicited by unilateral stimulation of cutaneous regions adjacent to the midline were detected in the contralateral post-central gyrus (PCG), in a region corresponding to the trunk ventral midline representation zone of area SI, as described in a previous study of intact subjects. In most patients, activation foci were also found in the ipsilateral PCG, again as in subjects with an intact corpus callosum. The data confirm that the skin regions adjacent to the trunk midline are represented bilaterally in SI, and indicate that ipsilateral activation is at least partially independent of the corpus callosum.
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Affiliation(s)
- M Fabri
- Dipartimento di Neuroscienze, Sezione di Fisiologia, Università Politecnica delle Marche, Via Tronto 10/A, 60020 Ancona, Torrette, Italy.
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21
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Abstract
Prolonged ingestion of liquorice is a well-known cause of hypertension due to hypermineralocorticoidism. We describe 2 cases of hypertension encephalopathy (in addition to the classical symptoms of hypertension, hypokalemia and suppression of the renin-aldosterone system) which resulted in pseudohyperaldosteronism syndrome due to the regular daily intake of low doses of liquorice. Glycyrrhizic acid, a component of liquorice, produces both hypermineralocorticism and the onset of encephalopathy through the inhibition of 11beta-hydroxysteroid dehydrogenase. Hypertension encephalopathy due to the daily intake of low doses of liquorice, however, has not been previously documented. It is proposed that some people could be susceptible to low doses of glycyrrhizic acid because of a 11beta-hydroxysteroid dehydrogenase deficiency.
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Affiliation(s)
- S Russo
- Pronto Soccorso, Ospedale Cattinara, Trieste, Italy
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22
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Paventi S, Parafati MA, Pellegrino CA, Bevilacqua U, Paggi A. [Atrial stunning and pharmacologic cardioversion in idiopathic atrial fibrillation of recent onset]. Minerva Cardioangiol 1999; 47:239-44. [PMID: 10582434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Normal atrial mechanic function may not return immediately after the successful cardioversion of atrial fibrillation. It has been suggested that the delayed recovery of atrial contraction (atrial stunning) might be due to: 1. the energy delivered during direct current cardioversion 2. the time from the onset of atrial fibrillation 3. the left atrial size 4. the associated cardiac disease. This study evaluates "atrial stunning" in patients pharmacologically treated, with atrial fibrillation of recent onset, normal atrial size and without heart disease. Doppler echocardiography is well suited for assessment of atrial function due to the ability of recording the peak velocity of atrial contraction (A wave). METHODS Twenty-five patients with no evidence of heart disease and M-mode left atrial dimension less than 40 mm underwent successful pharmacologic cardioversion (pro-paphenon or flecainide 2 mg/kg/10 min) of atrial fibrillation of recent onset (less than 48 hours). After cardioversion an echocardiographic study was performed within 12 hours (ECO 1), on day 3 (ECO 2), on day 12 (ECO 3), and on day 30 (ECO 4). RESULTS No significant difference of both left atrial size (37 +/- 3.9 mm; 38.22 +/- 3.8 mm; 38.02 +/- 4.7 mm; 38.2 +/- 4.14 mm) and peak E velocity (57.97 +/- 18.3 mm/sec; 59.4 +/- 18.3 mm/sec; 59.0 +/- 16 mm/sec; 59.07 +/- 16.7 mm/sec) was demonstrated among serial echocardiographic evaluations. Both peak A velocity (mm/sec) and E/A ratio were significantly different in ECO 1 (60.29 +/- 12.3-1.0 +/- 0.37) than in ECO 2 (73.1 +/- 10.7, p < 0.005-0.82 +/- 0.27, p < 0.05); no statistical difference was found between ECO 2 and ECO 3 (76.31 +/- 12-0.78 +/- 0.24 mm/sec)--ECO 4 (76.91 +/- 14.8-0.78 +/- 0.21 mm/sec). CONCLUSIONS This study suggests that patients with atrial fibrillation of recent onset have a delayed recovery of normal atrial systolic function after pharmacologic cardioversion.
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Affiliation(s)
- S Paventi
- Policlinico Umberto I, II Clinica Medica, Università degli Studi di Roma, La Sapienza
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23
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Paggi A, Persegani-Trimarchi C, Russo P, Mastropasqua M, Mosetti MA, Losi T, Leri O. Solitary nodular disease and multinodular goiter: a retrospective study on suppressive versus replacement levothyroxine therapy. Endocr Res 1999; 25:229-38. [PMID: 10382684 DOI: 10.1080/07435809909066144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of the present study was to ascertain whether patients affected by solitary nodular disease of the thyroid or multinodular goiter had a different clinical outcome when treated with suppressive levo-thyroxine (L-T4) therapy rather than replacement L-T4 therapy. We evaluated, by a retrospective analysis, 36 patients who had received TSH-suppressive L-T4 therapy according to TSH value and 55 who had received replacement L-T4 therapy. Fine needle aspiration cytology and thyroid scan after 131I were evaluated before L-T4 administration, while echographic monitoring of number and dimensions of nodules was recorded prior to and during L-T4 treatment. No difference in duration of L-T4 treatment (about 3 years) was registered between the TSH-suppressive therapy group and replacement therapy group. L-T4 administration in a TSH-suppressive or replacement manner did not induce a numerical or volumetric significant decrease of the main nodule or of the total nodule volume. Our data show that chronic TSH-suppressive therapy does not seem to be better than replacement therapy. Moreover, TSH-suppressive therapy presented a higher risk of adverse events than replacement therapy, thus requiring a more careful check with a higher cost of care.
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Affiliation(s)
- A Paggi
- 2nd Medical Clinic, University La Sapienza-Rome, Italy
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24
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Paggi A. [Endemic goiter in Latium: environmental and genetic factors]. Ann Ist Super Sanita 1999; 34:403-8. [PMID: 10052184] [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: 02/11/2023]
Abstract
Most studies on the pathogenesis of endemic goiter focus above all on iodine deficiency. In some endemic goiter areas (i.e. Nigeria) there is no evidence of iodine deficiency; therefore, we suggest the taking into account of various factors, both environmental and non-environmental. We report the results of two studies carried out in three different areas in Latium: one of them (Cerveteri, RM) could be classified as high prevalence of goiter area, while the two others (Roccasecca dei Volsci, LT and Castel San Pietro Romano, RM) are true endemic goiter areas. The role of environmental factors, radioactivity and electromagnetism, foodstuff, the hydrogeological and chemical composition of natural water and the importance of genetics are here discussed, assuming that the endemic goiter could have a multifactorial pathogenesis.
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Affiliation(s)
- A Paggi
- II Clinica Medica, Università degli Studi La Sapienza, Roma
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25
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Cugini P, Paggi A, Cristina G, Ceccotti P, Pellegrino AM, Fontana S, Di Marzo A, Vacca K, Di Siena G. Hunger sensation in Graves' disease before and after pharmacological therapy. Clin Ter 1999; 150:115-9. [PMID: 10396860] [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: 02/13/2023]
Abstract
PURPOSE Hunger sensation (HS) provides information about the need of eating in order to counterbalance the energy expenditure (EE). HS was, thus, investigated in patients affected by Graves' disease (PAGD), a clinical condition characterized by excessive EE. MATERIALS AND METHODS Ten newly diagnosed PAGD were investigated before and after therapy. Thirty clinically healthy subjects (CHS) were investigated as controls. The investigated subjects were asked to provide the 24-h profile of their HS by subjectively self-rating (from 1 to 10 hunger units) their orectic perception (OP) at regular intervals of 30 minutes (orexigram). The orexigrams were investigated via the conventional descriptive statistics as well as the Single-Cosinor method. RESULTS PAGD were found to show a very consistent increase of their HS (hyperorexia), whose day-night variability was, still, the expression of a circadian rhythm, characterized by an elevation in its oscillatory level and extent. Interestingly, the pre-treatment hyperorexia was seen to show a normalization (eurexia) after pharmacological therapy. CONCLUSIONS According to these results, it can be affirmed that hyperorexia is a clinical sign of Graves' disease, which is obtained via mechanisms of tonic and amplitude modulation of the HS circadian rhythm. Because of the eurexia after remission, it can be argued that the hyperorexia is a theleological response really aimed at increasing food intake in order to counterbalance the excessive EE which characterizes the thyrotoxicosis.
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Affiliation(s)
- P Cugini
- Institute of II Medical Clinic, University of Rome La Sapienza, Policlinico Umberto I, Italy.
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26
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Abstract
To analyse the accuracy of the conversion formulae for estimation of glycohaemoglobin (GHb) measured by different methods, we analysed 210 samples for HbA1c using HPLC. Fifty of these specimens were analysed by micro-column chromatography (MC), 43 by electrophoresis (EP), 50 by IMX system (Abbott Laboratories), 38 by Primus HPLC and 29 by Diamat HPLC. Regression analyses were performed and the equations were used to estimate HbA1c values (HbA1c calc) for the five methods. The 95% limits of agreement between HPLC and the converted results were -1.77 to 1.71%, -1.54 to 1.54%, -0.92 to 0.88%, -0.46 to 0.56%, and -0.39 to 0.41% for MC, EP, IMX, Primus and Diamat equations, respectively. The mean relative errors were 3.4 (-28.2 to 35%), 1.3 (-22.9 to 25.5%), 0.4 (-14.6 to 15.0%), 0.51 (-6.55 to 7.57%), -0.20 (-5.8 to 5.4%), for MC, EP, IMX, Primus and Diamat, respectively. These results show that conversion formulae based on methods that do not measure HbA1c (MC, EP and IMX) are inaccurate and can mask a clinically relevant variation of HbA1c. However, GHb results obtained by HPLC methods could be interchangeably converted with an absolute variation of less than 1%. Converted HbA1c results from non-standardized methods should be interpreted with caution.
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Affiliation(s)
- J L Camargo
- Department of Clinical Pathology, Hospital de Clínicas de Porto Alegre, Brazil
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27
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Bruni L, Basili R, Capolino R, Mastropasqua M, Paggi A. Lipid anomaly in a child with partial duplication 3p. Eur Rev Med Pharmacol Sci 1998; 2:127-9. [PMID: 10546407] [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: 02/14/2023]
Abstract
The authors report a case regarding a 7-year-old girl affected by short height, bone growth delay, lipidic alterations (hypercholesterolemia, hypertriglyceridemia and high apolipoprotein B values) and by a partial duplication of the short arm of the third chromosome: 46,XX, dup(3)(p26-pter). This chromosomal alteration appears "de novo", as the parent's karyotypes are normal and none of the patient's next of kin showed evidence of lipidic anomalies. The patient's short height and slight frontal bossing were the only features that could be described as typical of the dup3p syndrome.
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Affiliation(s)
- L Bruni
- Department of Paediatrics, University La Sapienza of Rome, Italy
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28
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Abstract
Different antibodies against both organ- and non-organ-specific autoantigens have been found in patients with autoimmune thyroid diseases. The aim of our study was to evaluate the presence of antineutrophil cytoplasmic antibodies (ANCA) in sera of patients affected by Graves' disease (GD) and Hashimoto's thyroiditis (HT). These antibodies were investigated by indirect immunofluorescence; the reactivity against myeloperoxidase and lactoferrin was assessed by ELISA. ANCA were detected by immunofluorescence in 28.5% of patients with GD and 9% of patients with HT. Anti-lactoferrin antibodies were found in 3 of 21 (14.2%) patients affected by GD and in 2 of 11 (18.1%) cases of HT. Anti-myeloperoxidase antibodies were detected only in one (4.7%) patient with GD.
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Affiliation(s)
- A Afeltra
- Department of Medicina Clinica, University of Rome La Sapienza, Italy
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Paggi A, Amoroso A, Ferri GM, Mariotti A, Pellegrino C, Afeltra A. Methimazole treatment in Graves' disease: behaviour of CD5+B lymphocytes and regulatory T cell subsets. Eur Rev Med Pharmacol Sci 1998; 2:11-9. [PMID: 9825565] [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: 02/09/2023]
Abstract
In the present study we analyzed some circulating lymphocyte subsets in eleven patients affected by Graves' disease before and after three and six months of methimazole treatment. Peripheral blood mononuclear cells were studied by a panel of monoclonal antibodies with single and double fluorescence cytometric analysis. Our results demonstrated an increased percentage of CD5+B cells and HLADR+T lymphocytes at the beginning of the disease in comparison to the normal controls (p < 0.001), and a significant decrease after six months of treatment (p < 0.01 and p < 0.05, respectively). The CD4+ CD45RA+ subset was significantly reduced in untreated Graves' patients in comparison to the normal group (p < 0.01), and increased towards normalization after six months of treatment. The significant modifications of lymphocyte subsets, as well as the reduction of thyroid autoantibodies, support a direct or mediated effect of methimazole on the immune system.
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Affiliation(s)
- A Paggi
- Dpt. of Medicina Clinica, University La Sapienza, Rome, Italy
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30
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Abstract
Hyperparathyroidism due to an ectopic parathyroid adenoma commonly is revealed by parathyroid hormone (PTH) high serum level and its clinical effects on bone loss. We report a case in which exogenous L-thyroxine side effect on bone in the treatment of thyroid solitary nodule disease produced bone loss in a patient with subclinical hyperparathyroidism due to an ectopic parathyroid adenoma. Our case report suggests the importance of monitoring both clinical symptomatology and calcium and phosphorous serum levels as routine lab investigation in all patients who receive L-thyroxine treatment.
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Affiliation(s)
- A Paggi
- 2nd Medical Clinic, University La Sapienza, Rome, Italy
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Zelmanovitz T, Gross JL, Oliveira JR, Paggi A, Tatsch M, Azevedo MJ. The receiver operating characteristics curve in the evaluation of a random urine specimen as a screening test for diabetic nephropathy. Diabetes Care 1997; 20:516-9. [PMID: 9096972 DOI: 10.2337/diacare.20.4.516] [Citation(s) in RCA: 124] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess the performance of measurements of urinary albumin concentration (UAC) and urinary albumin:creatinine ratio (UACR) in a diurnal random urine specimen (RUS) for the screening of diabetic nephropathy. RESEARCH DESIGN AND METHODS A total of 95 ambulatory NIDDM patients (49 women, ages 40-75 years) collected 123 RUSs during the morning after completing a timed 24-h urine collection. Albumin was measured by immunoturbidimetry. According to timed urinary albumin excretion rate (UAER) measured in the 24-h collection (criterion standard), samples were classified as normoalbuminuric (UAER < 20 micrograms/min; n = 54), microalbuminuric (UAER 20-200 micrograms/min; n = 44), and macroalbuminuric (UAER > 200 micrograms/min; n = 25). The receiver operating characteristics (ROC) curve approach was used. The ROC curves of UAC and UACR in RUS for screening of microalbuminuria (normo- and microalbuminuric samples; n = 98) and macroalbuminuria (micro- and macroalbuminuric samples; n = 69) were plotted. RESULTS Spearman's coefficients of correlation of 24-h UAER vs. UAC and UACR were 0.91 and 0.92, respectively (P < 0.001). The calculated areas (+/- SE) under the ROC curves to screen microalbuminuria for UAC (0.9766 +/- 0.015) and UACR (0.9689 +/- 0.014) were similar (P > 0.05) as were the corresponding areas for macroalbuminuria (0.9868 +/- 0.0094 and 0.9614 +/- 0.0241, respectively; P > 0.05). The first point with 100% sensitivity and the point of intersection with a 100%-to-100% diagonal for microalbuminuria were as follows: 16.9 and 33.6 mg/l for UAC and 15.0 and 26.8 mg/g for UACR; for macroalbuminuria 174.0 and 296.2 mg/l for UAC and 116.0 and 334.3 mg/g for UACR, respectively. CONCLUSIONS Albumin measurements (UAC and UACR) in an RUS presented almost perfect accuracy for the screening of micro- and macroalbuminuria and UAC measured in an RUS is simpler and less expensive than UACR and UAER. It is suggested as a valid test for use in screening for diabetic nephropathy.
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Affiliation(s)
- T Zelmanovitz
- Endocrine Unit, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Papo I, Ortenzi A, Cesarano R, Paggi A, Foschi N, Del Pesce M, Rychlicki F. Modifications in morphology of epileptic seizures after callosotomy. J Neurosurg Sci 1997; 41:81-4. [PMID: 9273863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The callosotomy on drug-resistant epileptic seizures may abolish or reduce their frequency and may modified the morphology of different kind of seizures. Our series is composed of 36 patients. Drop-attacks and complex partial seizures (CP) were present in all patients, generalized tonic-clonic seizures (GTC) in 16 (44.4%) and simple partial seizures (SP) and myoclonic attacks (MY) in 6 patients each. We found two kinds of modifications: a) lateralization of hypotonia which becomes hemisomatic, with lateral bending to the hypotonic side; b) different way of falling, due not only to the lateralization of hypotonia but also to the gradual impairment of muscle tone. Modifications in CP mainly concerned automatisms, which disappeared in 39.1% of patients, while 34.8% of them had a significant reduction in automatisms; this reduction consisted in simplification of automatic movements and in shorter duration of seizures.
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Papo I, Quattrini A, Ortenzi A, Paggi A, Rychlicki F, Provinciali L, Del Pesce M, Cesarano C, Fioravanti P. Predictive factors of callosotomy in drug-resistant epileptic patients with a long follow-up. J Neurosurg Sci 1997; 41:31-6. [PMID: 9273856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Some possible factors to predict outcome after callosotomy were investigated in a personal series composed of 36 patients. Twenty-seven of them were submitted to anterior callosotomy, 1 to posterior callosotomy and the remaining 8 patients to two stage complete division of corpus callosum. All factors, either positive or negative, do not appear completely reliable; they can be envisaged only in relative terms and do not seem to be relevant to make surgical decision or to discard surgery. In author's series, dealing specifically with drop-attacks, it clearly appeared that abrupt falls to the ground unpreceded by other epileptic features did definitely better. This was the only statistically significant datum.
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Affiliation(s)
- I Papo
- Neurosurgical Division, Regional Hospital, Ancona, Italy
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Quattrini A, Papo I, Cesarano R, Fioravanti P, Paggi A, Ortenzi A, Foschi N, Rychlicki F, Del Pesce M, Pistoli E, Marinelli M. EEG Patterns after callosotomy. J Neurosurg Sci 1997; 41:85-92. [PMID: 9273864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In 36 patients with drug-resistant epilepsy submitted to anterior callosotomy (27 cases), to two-stage total callosotomy (8 cases) and to posterior callosotomy (1 case) the EEG variations concerning background activity, focal activity and sharp-waves (SW) bisynchronous activity were evaluated. EEG modifications observed after callosotomy are the following: background rhythm tends to be better organised as spectral analysis demonstrated, this finding usually coincide with reduction of bisynchronous discharges. It appears that improvement in background activity cannot be correlated with outcome, but it seems to be to some extent since at the same time cognitive functions also seem to improve; however, this last aspect need to be checked in much larger series. The number and location of EEG foci do not change, but they appear to be more active; this is likely to depend only on the concomitant reduction of bisynchronous activity. No correlation seems to exist between the number and the location of foci, which are generally multiple. Lateralization of bisynchronous discharges as well as the reduction of their frequency and duration were observed. However, the clinical course is quite different: in some patients we have achieved good clinical responses in others postoperative results were poor. Lateralization of bisynchronous discharges is never absolute, on the grounds that in prolonged recordings bisynchronous discharges are nearly always present. Bisynchronous discharges in some cases are alternatively predominant in both hemispheres even within minutes or seconds. It was observed that after certain time, generally some months, lateralized discharges tend to generalize again, confirming that corpus callosum is replaced in discharge diffusion by other structures (brain-stem, diencephalon).
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Affiliation(s)
- A Quattrini
- Epilepsy Centre, Regional Hospital, Ancona, Italy
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35
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Quattrini A, Del Pesce M, Provinciali L, Cesarano R, Ortenzi A, Paggi A, Rychlicki F, Fioravanti P, Papo I. Mutism in 36 patients who underwent callosotomy for drug-resistant epilepsy. J Neurosurg Sci 1997; 41:93-6. [PMID: 9273865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Thirty-six drug-resistant epileptic patients submitted to callosotomy were studied. Anterior callosotomy was performed in 27 patients, total two-stage callosotomy was performed in 8 patients and 1 patient had only posterior callosotomy. We found mutism in 10 patients (2 after complete callosotomy and 8 after anterior section). The patients did not speak, but the comprehension was present: they were able to carry out orders and to write. Their attitude to the environment was characterized by complete indifference. The mutism was always transient, lasting from 4 to 25 days (mean 7 days). Regression of mutism was always complete. We think that this complication should be chiefly attributed mainly to surgical manipulation, even if it is impossible to completely exclude a multi-factorial etiology.
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Affiliation(s)
- A Quattrini
- Epilepsy Centre, Regional Hospital, Ancona, Italy
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36
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Abstract
In a previous study we demonstrated a significant increase of CD5+ B subset in patients with Graves' disease (GD) compared with normal controls. The aim of this study was to compare the percentage of CD5+ B and CD5- B cells in GD with that in different forms of autoimmune and non immune-mediated thyroid diseases. Seventy-two patients were studied: 28 patients with GD, 20 with silent thyroiditis (ST), 12 with Hashimoto's disease (HD), and 12 subjects affected by hyperthyroidism due to toxic adenoma (TA). Eleven out of 28 patients with GD were also evaluated after six months of methimazole treatment. The study was performed by cytometric analysis. In GD the percentage and the absolute number of CD5+ B cells were significantly increased compared with normal controls (42.5 +/- 18.2% versus 19 +/- 6.3%, p < 0.0001; 142 +/- 153.3/cmm versus 46.9 +/- 22/cmm, p < 0.003, respectively. CD5+ B cells tended to normalise after six months of treatment. In ST the percentage of CD5+ B cells was increased (28.6 +/- 10.2%); conversely the absolute number was in the normal range. Patients affected by HD did not show any significant modification in B cells and their subsets in comparison with controls. In TA, CD5+ B were 7.6 /- 4.4% and 14.3 /- 10.9/cmm. Our results demonstrated a marked increase in both percentage and absolute number of CD5+ cells, only in active GD. The expansion of CD5+ B cells could play a role in the immune imbalance present in this disease.
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Affiliation(s)
- A Afeltra
- Department of Medicina Clinica, University of Rome, La Sapienza, Italy
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Russo S, Ombricolo E, Papadopoulou O, Paggi A. [Dilated myocardiopathy and polymyositis. A clinical case and critical review of the literature]. Clin Ter 1997; 148:57-64. [PMID: 9377839] [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: 02/05/2023]
Abstract
A patient affected by a "limb-girdl syndrome" type of polymyositis shows clinical symptoms and signs of progressively worsening dilatative myocardiopathy. The diagnosis was based on well established criteria, such as the following: EF < 45-55%, left ventricular telediastolic diameter higher than 2.7 cm/mq, and normal wall thickness (L. Mestroni 1994, W.H. Abelmann 1989, et al.). The above-mentioned clinical picture was further complicated by amiodarone induced thyrotoxicosis. After the case presentation, and having exhaustively and critically revised the existing literature on polymyositis associated dilatative myocardiopathy and on eventual joint pathogenetic mechanisms, the essay in question focuses on the discussion of the clinical data brought forth in the first part.
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Affiliation(s)
- S Russo
- Ospedale Civile di Aosta, Università degli Studi La Sapienza di Roma
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39
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Cugini P, Battisti P, Paggi A, Di Stasio ME. Twenty-four-hour pattern of hunger sensation in obesity complicated by type 2 diabetes mellitus: a pattern recognition by spectral analysis. Metabolism 1996; 45:1342-7. [PMID: 8931637 DOI: 10.1016/s0026-0495(96)90113-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hunger sensation (HS) in humans physiologically shows intraday (circadian) and within-day (ultradian) recursivity. This intrinsic periodicity was investigated by applying the cosinor method and spectral analysis to the 24-hour profile of HS (orexigram) derived by a self-rating score (from 1 to 10 hunger units [HU]) recorded every half-hour. The study of circadian and ultradian recursivity on the orexigram was performed in 30 diabetic obese patients ([DOPs], 14 men and 16 women aged 22 to 62 years; body weight, 77 to 130 kg; body mass index, 31-47). The control group consisted of 30 clinically healthy subjects ([CHS], 15 men and 15 women aged 21 to 60 years; body weight, 65 to 72 kg; body mass index, 23 to 25). DOPs showed two types of orexigrams in which hunger was felt with limitation to the diurnal part of the day or with extension to the night, respectively. The type 1 orexigram was characterized by a normal spectrum and circadian rhythm. The type 2 orexigram was characterized by subsidiary ultradian components associated with an abnormal elevation of the circadian mesor and a significant delay of the circadian phase, as the spectral analysis was indicative of a structural difference in the frequencies that sustain the intraday and within-day recursivity of the HS. Accordingly, DOPs can be recognized by their orexigram as "eurectic" or "hyperrectic" to indicate subjects with a normal or an exaggerated HS, respectively, during the 24-hour span.
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Affiliation(s)
- P Cugini
- Institute of II Medical Clinic, University La Sapienza, Rome, Italy
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Abstract
OBJECTIVE Diabetic patients (DP) refer increased hunger sensation (HS) when hyperglycemic but not yet ketogenic. As HS shows a within-day (ultradian cyclicity) and intra-day (circadian cyclicity) repetitivity, its recursive pattern was investigated in patients with type 1 and type 2 diabetes mellitus (DM), in compensated and uncompensated metabolic stage. METHOD HS was approached in its cyclic structure by means of spectral analysis (SA), and in its circadian rhythmicity by means of Single Cosinor analysis (SCA), applied to self-rated scores of HS given every 30 min to their HS (orexigram) by DP. RESULTS Exaggerated periprandial, interprandial, and/or nocturnal peaks of HS were seen in the orexigram of both the type I and type II DP. Specific alterations in HS periodogram were detected, structurally denoting a relative prevalence of the ultradian components along with the deamplification and loss of the circadian harmonics. DISCUSSION The increase of HS (hyperorexia) in nonketotic DM may be formally attributed to a mechanism of frequency multiplication and amplitude demodulation in the multifrequency bioperiodic structure which physiologically regulates the recursive pattern to the daily HS in human beings.
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Affiliation(s)
- P Cugini
- Institute of II Medical Clinic, University of Rome La Sapienza, Italy
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Amoroso A, Pasquarelli C, Di Rosa R, Paggi A, Addessi MA. [Pheochromocytoma-gastric leiomyoblastoma association. A possible expression of Carney's triad. A case report]. Recenti Prog Med 1995; 86:348-52. [PMID: 7569296] [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
The case of a 28 yrs old female patient affected by pheochromocytoma and gastric leiomyoblastoma was described. The simultaneous presence of these neoplasms in a young woman supported the diagnosis of the clinical syndrome known as "Carney's triad".
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Affiliation(s)
- A Amoroso
- Dipartimento di Medicina Clinica, Università La Sapienza, Roma
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Afeltra A, Russo S, Peri C, Paggi A. [CD5 positive b-lymphocytes in autoimmunity: possible role in Graves' disease]. Riv Eur Sci Med Farmacol 1995; 17:167-74. [PMID: 8766784] [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: 02/02/2023]
Abstract
CD5+B cells, recently defined B-1a cells, are the main clonotype in the early B cell repertoire and persist throughout adult life. This subset is committed to the production of antibodies, defined "natural antibodies", that bind a lot of exogenous antigens, isologous and heterologous serum proteins, tissues and/or self antigens, such as hormones, nucleic acids and phospholipids. These antibodies, mostly IgM, but also IgG and IgA, are polyreactive: their role is likely that of first line of defence against invading microorganisms. Natural antibodies produced by CD5+ B cells may be involved in maintenance functions such as removal of dead cells. Because of their ability to bind self antigens, they may be important in the establishment of autoimmune phenomena. An increase of CD5+ B cells has been demonstrated in some autoimmune disorders. The authors examine the functional characteristics and the expansion of this subset in different diseases. In particular they report the increase in active Graves' disease and discuss the role of CD5+ B lymphocytes in the immune imbalance present in this thyropathy.
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Affiliation(s)
- A Afeltra
- Dipartimento di Medicina Clinica, Università degli Studi La Sapienza, Roma
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Paggi A, Di Prima MA, Paparo BS, Pellegrino C, Faralli AR, Sinopoli MT, Leri O. Anti 70 kDa heat shock protein antibodies in sera of patients affected by autoimmune and non-autoimmune thyroid diseases. Endocr Res 1995; 21:555-67. [PMID: 7588426 DOI: 10.3109/07435809509030473] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Twenty eight patients (25F, 3M) affected by autoimmune and non-autoimmune thyroid diseases were studied. HSP 70 antibodies were present in 21.4% of patients. Five of them were affected by Graves' disease and one by De Quervain's thyroiditis. The HSP 70 antibodies mean values of patients were significantly higher than the normals (p < 0.05). This datum was confirmed by Western blotting. The presence of HSP 70 antibodies in the sera of those patients may support the link between the protein and the thyroid autoimmune processes.
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Affiliation(s)
- A Paggi
- Department Infectious and Tropical Diseases, University La Sapienza, Rome, Italy
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Cugini P, Battisti P, Paggi A, Di Stasio ME, Di Palma L, Morelli F, Pisculli M, Lavielle R. Chronobiometric identification of disorders of hunger sensation in essential obesity: therapeutic effects of dexfenfluramine. Metabolism 1995; 44:50-6. [PMID: 7869939 DOI: 10.1016/0026-0495(95)90211-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In human beings, hunger is a proprioceptive signal that shows intraday (circadian components) and within-day (ultradian components) recursivity. Both periodic components can be investigated by chronobiometric procedures by combining the Cosinor method with spectral analysis. A 24-hour profile of hunger sensation (HS) can be plotted on a 1-to-10 scale of intensity using self-rated scores performed every half-hour of the day. Circadian and ultradian components were studied in 60 patients affected by essential obesity (20 men and 40 women; mean age, 38.4 years; mean body weight, 101 kg) before and after treatment with dexfenfluramine (Isomeride; Servier, Orléans, France) 15 mg orally twice daily, for 30 days. The control group consisted of 30 clinically healthy subjects (15 men and 15 women; mean age, 37.5 years; mean body weight, 69 kg). Chronobiometric analysis shows three patterns in obese patients, which suggests that HS may be normal (eurectic obesity), exaggerated (hyperrectic obesity), or diminished (hyporectic obesity). After dexfenfluramine administration, HS was showed a substantial decrease in the daily mean level. The spectrum of resolution in circadian and ultradian components was found to be maintained in eurectic obesity and partially readjusted in hyperrectic and hyporectic obesities. This demonstrates that dexfenfluramine acts not only as an anorectic but also as a chronizer by interfering with the recursive components of HS. The anorectic and chronizing effects suggest that dexfenfluramine is a "chronoanorectic drug" that interacts with the chronobiologic properties of the serotoninergic system.
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Affiliation(s)
- P Cugini
- Institute of Medical Clinic II (Chronobiology Unit), University of Rome La Sapienza, Italy
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Abstract
OBJECTIVE In recent years anti-phospholipid antibodies have gained much attention since they are frequently associated with thrombosis, recurrent abortion, and thrombocytopenia. Besides disease-specific autoantibodies, other autoantibodies reactive with both organ and non-organ specific autoantigens have been found in patients with autoimmune thyroid diseases. Therefore the objective of this study was to evaluate the presence and significance of anti-phospholipid antibodies in untreated patients with different forms of autoimmune thyroid diseases. PATIENTS AND METHODS Thirty-one patients (26 females, five males; mean age 42.5 years) affected by different autoimmune thyroid diseases were studied. Fourteen patients were affected by Graves' disease, eight by silent thyroiditis, five by Hashimoto's thyroiditis. Four patients with Graves' disease in remission were also evaluated. Anti-cardiolipin antibodies were detected by enzyme linked immunosorbent assay. In five Graves' disease patients anti-cardiolipin antibodies were evaluated before and after 3 months of therapy with methimazole. RESULTS Seventeen out of 31 patients were positive for IgG and/or IgM anti-cardiolipin antibodies, the highest levels occurring in three Graves' disease patients with severe thyrotoxicosis. In four of five Graves' patients evaluated before and after methimazole therapy, anticardiolipin antibodies decreased following treatment. None of the patients with increased IgG and/or IgM anticardiolipin antibodies showed clinical manifestations of the anti-phospholipid syndrome during our observation which ranged from 1 to 5 years. CONCLUSIONS Our results showed an increased incidence of anti-cardiolipin antibodies in patients affected by autoimmune thyroid diseases. However, these autoantibodies seem merely to represent a non-specific marker of immune dysregulation.
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Affiliation(s)
- A Paggi
- II Clinica Medica, University La Sapienza, Italy
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Abstract
Fifteen patients affected by new-onset Graves' disease with ophthalmopathy have been examined for lymphocyte subset phenotypes by two-colour cytometric analysis. CD5+ B cells were significantly increased in comparison to the normal population (43.2 +/- 20.6% versus 19.5 +/- 6.9%; p < 0.0009); total T cells showed a normal amount (70.4 +/- 9.6%), but the levels of THLADR+ cells were significantly increased in comparison to the control group (13.7 +/- 10.5% versus 4.7 +/- 3.2%; p < 0.007). The characterization of the subset suppressor-inducer CD4+ CD45RA+, evaluated as percentage of the total CD4+ T cells, showed a significant decrease in comparison with the control group (43.8 +/- 13.5% versus 52.3 +/- 6.5%; p < 0.03). Serum immunoglobulin evaluation showed a statistically significant increase of IgM (p < 0.05) and a significant decrease of IgA (p < 0.02). A statistical correlation between IgM levels and percentage of CD5+ B cells has been found (p < 0.04). The defect of suppressor-inducer T cell subset, along with the increase of CD5+ B cells may contribute to the pathogenetic mechanism of the disease in patients with a genetically-induced aberrant immune response.
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Affiliation(s)
- A Afeltra
- Institute III Clinica Medica, University La Sapienza, Rome
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Paggi A, Borgiani P, Gloria-Bottini F, Russo S, Saponara I, Banci M, Amante A, Lucarini N, Bottini E. Further studies on acid phosphatase in obese subjects. Dis Markers 1991; 9:1-7. [PMID: 1742941] [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: 12/28/2022]
Abstract
Low activity genetic variants of acid phosphatase (ACP1) are positively associated with extreme body mass deviations in obese subjects. The same pattern has been found in non-diabetic children, in diabetic pregnant women, and in non-diabetic adult subjects. Low activity variants of ACP1 also show a positive association with family history of obesity, supporting the hypothesis of an enhancing action of these variants on expressivity of obesity.
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Affiliation(s)
- A Paggi
- Chair of Human Development, 2nd University of Rome School of Medicine, Italy
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Provinciali L, Del Pesce M, Censori B, Quattrini A, Paggi A, Ortenzi A, Mancini S, Papo I, Rychlicki F. Evolution of neuropsychological changes after partial callosotomy in intractable epilepsy. Epilepsy Res 1990; 6:155-65. [PMID: 2117530 DOI: 10.1016/0920-1211(90)90091-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [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
Early neuropsychological changes following partial anterior callosotomy were evaluated in 15 patients with epilepsy (10 secondary generalized and 5 Lennox-Gastaut syndromes) by comparing their performances 1 month before surgery and then 15-20 and 90-100 days postoperatively without modifying the anticonvulsant treatment. The following neuropsychological and motor functions were tested: memory, attention, visuo-motor ability, posture, motor dexterity, language, praxis and gnosis. Social behaviour was also investigated. The main results are as follows: (i) most cognitive functions showed no significant variation; (ii) motor organization was still slightly impaired at the second check-up after the surgery; (iii) improvements in social behaviour and posture were frequently observed at the final evaluation. The analysis of individual cases highlights the influence of the extent of commissurotomy, lesions related to the surgical procedure and preoperative brain damage in determining the post-surgical profile. On this basis, the short-term neuropsychological cost of partial callosotomy appears to be low and seems to depend mostly on surgical parameters and brain conditions before the operation.
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Bigi F, Minisola S, Tabolli S, Carnevale V, Bianchi G, Scarnecchia L, Paggi A, Mazzuoli GF. Acute hypocalcemia enhances prolactin levels: a study before and after oophorectomy. Exp Clin Endocrinol 1990; 95:224-8. [PMID: 2365020 DOI: 10.1055/s-0029-1210956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The effect of acute hypocalcemia on serum prolactin values was investigated in 13 female subjects before and after oophorectomy. An infusion of disodium-EDTA (50 mg/kg b.w., for 120 min) was administered to each patient. Ionized calcium, immunoreactive parathyroid hormone and prolactin serum levels were determined 15 min prior to the infusion, at the beginning of each infusion and thereafter at every 30 min interval. The decrease in serum ionized calcium induced by Na2-EDTA infusion was not influenced by surgery. Serum prolactin and parathyroid hormone values before and after oophorectomy showed a significant (p less than 0.01) increase at 90 and 120 min. The maximum serum prolactin increase was achieved at 120 min and was not influenced by oophorectomy. The results demonstrate that acute hypocalcemia increases serum prolactin levels in female subjects and suggest a possible role for parathyroid hormone and dopaminergic system, even if their interaction remains speculative.
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Affiliation(s)
- F Bigi
- Servizio Aggregato Malattie del Ricambio Minerale, University of Rome La Sapienza, Italy
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