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Magrì D, Gallo G, Piepoli M, Salvioni E, Mapelli M, Vignati C, Fiori E, Muthukkattil ML, Corrà U, Metra M, Paolillo S, Maruotti A, Di Loro PA, Senni M, Lagioia R, Scrutinio D, Emdin M, Passino C, Parati G, Sinagra G, Correale M, Badagliacca R, Sciomer S, Di Lenarda A, Agostoni P, Filardi PP. What about chronotropic incompetence in heart failure with mildly reduced ejection fraction? Clinical and prognostic implications from the Metabolic Exercise combined with Cardiac and Kidney Indexes score dataset. Eur J Prev Cardiol 2024; 31:263-271. [PMID: 37890033 DOI: 10.1093/eurjpc/zwad338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/29/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023]
Abstract
AIMS Chronotropic incompetence (CI) is a strong predictor of outcome in heart failure with reduced ejection fraction, however no data on its clinical and prognostic impacts in heart failure with mildly reduced ejection fraction (HFmrEF) are available. Therefore, the study aims to investigate, in a large multicentre HFmrEF cohort, the prevalence of CI as well as its relationship with exercise capacity and its prognostic role over the cardiopulmonary exercise testing (CPET) parameters. METHODS AND RESULTS Within the Metabolic Exercise combined with Cardiac and Kidney Indexes (MECKI) database, we analysed data of 864 HFmrEF out of 1164 stable outpatients who performed a maximal CPET at the cycle ergometer and who had no significant rhythm disorders or comorbidities. The primary study endpoint was cardiovascular (CV) death. All-cause death was also explored. Chronotropic incompetence prevalence differed depending on the method (peak heart rate, pHR% vs. pHR reserve, pHRR%) and the cut-off adopted (pHR% from ≤75% to ≤60% and pHRR% ≤ 65% to ≤50%), ranging from 11% to 62%. A total of 84 (9.7%) CV deaths were collected, with 39 (4.5%) occurring within 5 years. At multivariate analysis, both pHR% [hazard ratio 0.97 (0.95-0.99), P < 0.05] and pHRR% [hazard ratio 0.977 (0.961-0.993), P < 0.01] were associated with the primary endpoint. A pHR% ≤ 75% and a pHRR% ≤ 50% represented the most accurate cut-off values in predicting the outcome. CONCLUSION The study suggests an association between blunted exercise-HR response, functional capacity, and CV death risk among patients with HFmrEF. Whether the CI presence might be adopted in daily HFmrEF management needs to be addressed in larger prospective studies.
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Affiliation(s)
- Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' Università degli Studi di Roma, Via di Grottarossa 1035-1039, 00189 Roma, Italy
| | - Giovanna Gallo
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' Università degli Studi di Roma, Via di Grottarossa 1035-1039, 00189 Roma, Italy
| | - Massimo Piepoli
- Department of Biomedical Science for Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy, and Clinical Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
| | | | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, 20138 Milano, Italy
| | - Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, 20138 Milano, Italy
| | - Emiliano Fiori
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' Università degli Studi di Roma, Via di Grottarossa 1035-1039, 00189 Roma, Italy
| | - Melwyn Luis Muthukkattil
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' Università degli Studi di Roma, Via di Grottarossa 1035-1039, 00189 Roma, Italy
| | - Ugo Corrà
- Cardiology Department, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno Institute, Via Revislate 13, 28010 Veruno, Italy
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazza del Mercato 15, 25121 Brescia, Italy
| | - Stefania Paolillo
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Via Leonardo Bianchi, 80131 Napoli, Italy
| | - Antonello Maruotti
- Dipartimento di Giurisprudenza, Economia, Politica e Lingue Moderne, Libera Università Maria Ss Assunta, Via della Traspontina 21, 00193 Roma, Italy
| | - Pierfrancesco Alaimo Di Loro
- Dipartimento di Giurisprudenza, Economia, Politica e Lingue Moderne, Libera Università Maria Ss Assunta, Via della Traspontina 21, 00193 Roma, Italy
| | - Michele Senni
- Department of Cardiology, Heart Failure and Heart Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Rocco Lagioia
- Division of Cardiology, 'S. Maugeri' Foundation, IRCCS, Institute of Cassano Murge, Via Generale Bellomo 73-75, 70124 Bari, Italy
| | - Domenico Scrutinio
- Division of Cardiology, 'S. Maugeri' Foundation, IRCCS, Institute of Cassano Murge, Via Generale Bellomo 73-75, 70124 Bari, Italy
| | - Michele Emdin
- Life Science Institute, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127 Pisa, Italy
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
| | - Claudio Passino
- Life Science Institute, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127 Pisa, Italy
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Piazzale Brescia 20, 20149 Milano, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Via della Pietà 19, 34129 Trieste, Italy
| | - Michele Correale
- Department of Cardiology, University of Foggia, Via Antonio Gramsci 89, 71122 Foggia, Italy
| | - Roberto Badagliacca
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, 'Sapienza', Rome University, Via del Policlinico 155, 00161 Rome, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, 'Sapienza', Rome University, Via del Policlinico 155, 00161 Rome, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, Health Authority n°1 and University of Trieste, Via Slataper 9, 34134 Trieste, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, 20138 Milano, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Via Festa del Perdono 7, 20122 Milano, Italy
| | - Pasquale Perrone Filardi
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Via Leonardo Bianchi, 80131 Napoli, Italy
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2
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Puddu L, Cortese F, Fantinato E, Pescia S, Fiori E, Pisanu F, Doria C, Santandrea A, Lugani G, Mercurio D, Caggiari G. Maisonneuve fracture treated with suture-button system stabilization combined with plate and arthroscopic assistance (SBPAA): Clinical and radiological evaluation in short-medium period. J Orthop 2023; 46:12-17. [PMID: 37954526 PMCID: PMC10632099 DOI: 10.1016/j.jor.2023.10.007] [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] [Received: 08/12/2023] [Accepted: 10/08/2023] [Indexed: 11/14/2023] Open
Abstract
The aim of this study was to estimate the time needed for patients with Maisonneuve fractures to return to routine activities, after treatment with a suture-button system stabilization combined with plate and arthroscopic assistance (SBPAA). Methods The study included 13 patients treated at our surgical department from January 2018 to June2022. Specific radiographical follow-up and periodic checks were performed in a short -to-medium term period, to evaluate syndesmosis evolution and tibiofibular overlap with medial clear space (MCS). Results Progressive recovery and improvement were observed during follow-up from both radiographic and clinical perspective. Data showed that patients were able to return to full weight-bearing walking around the ninth week and to sport activities in 7.5 months. Long-term complications associated with residual joint stiffness, complex regional pain syndrome, or wound complications were observed in three patients. Conclusions Intraoperative arthroscopy represent a valid diagnostic tool to better recognize and evaluate osteochondral lesions in case of syndesmosys. The study demonstrates the importance of intraoperative arthroscopy for recognizing and treating associated osteochondral lesions with proper syndesmosis evaluation. Plate associated to double TightRope represent valid solution to functionally fix and reduce fractures. Additionally, it imitates the normal syndesmosis's anatomy and provides elasticity and robustness, guaranteeing a rapid return to sporting activity. Data and casuistry support these findings.
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Affiliation(s)
- L. Puddu
- Orthopaedic Department, Rovereto Hospital (Italy), Corso Verona 4, Rovereto, (TN), Italy
| | - F. Cortese
- Orthopaedic Department, Rovereto Hospital (Italy), Corso Verona 4, Rovereto, (TN), Italy
| | - E. Fantinato
- Orthopaedic Department, Sassari University Hospital (Italy), Viale San Pietro 43b, Sassari, (SS), Italy
| | - S. Pescia
- Orthopaedic Department, Sassari University Hospital (Italy), Viale San Pietro 43b, Sassari, (SS), Italy
| | - E. Fiori
- Orthopaedic Department, Sassari University Hospital (Italy), Viale San Pietro 43b, Sassari, (SS), Italy
| | - F. Pisanu
- Orthopaedic Department, Sassari University Hospital (Italy), Viale San Pietro 43b, Sassari, (SS), Italy
| | - C. Doria
- Orthopaedic Department, Sassari University Hospital (Italy), Viale San Pietro 43b, Sassari, (SS), Italy
| | - A. Santandrea
- Orthopaedic Department, Rovereto Hospital (Italy), Corso Verona 4, Rovereto, (TN), Italy
| | - G. Lugani
- Orthopaedic Department, Rovereto Hospital (Italy), Corso Verona 4, Rovereto, (TN), Italy
| | - D. Mercurio
- Orthopaedic Department, Rovereto Hospital (Italy), Corso Verona 4, Rovereto, (TN), Italy
| | - G. Caggiari
- Orthopaedic Department, Sassari University Hospital (Italy), Viale San Pietro 43b, Sassari, (SS), Italy
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Tocci G, Biondi-Zoccai G, Forte M, Gallo G, Nardoianni G, Fiori E, D'Ambrosio L, Di Pietro R, Stefanini G, Cannata F, Rocco E, Simeone B, Sarto G, Schirone L, D'Amico A, Peruzzi M, Nocella C, Volpe M, Rubattu S. Effects of two-month treatment with a mixture of natural activators of autophagy on oxidative stress and arterial stiffness in patients with essential hypertension: A pilot study. Nutr Metab Cardiovasc Dis 2023; 33:2287-2293. [PMID: 37580230 DOI: 10.1016/j.numecd.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/14/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND AND AIMS Trehalose, spermidine, nicotinamide, and polyphenols are natural substances that exert pro-autophagic and antioxidant properties. Their role in blood pressure (BP) regulation and preservation of vascular function in essential hypertension is unknown. The aim of this study was to evaluate the effect of a mixture of these agents on BP level, markers of oxidative stress, autophagy, endothelial function, and vascular stiffness in outpatients with grade 1 uncomplicated essential hypertension. METHODS AND RESULTS A single-centre, open-label, case-control, pilot study was conducted in adult outpatients (aged ≥18 years) receiving or not the mixture for two months along with the standard therapies. Both at baseline and at the end of the treatment the following clinical parameters were evaluated: brachial seated office BP level, central aortic pressure, pulse wave velocity, augmentation index (AI@75). Both at baseline and at the end of the treatment, a blood sample was drawn for the measurement of: H2O2, HBA%, levels of sNOX2-dp, Atg 5, P62, endothelin 1, and NO bioavailability. The mixture of nutraceuticals did not influence BP levels. Patients receiving the mixture showed a significant decrease of oxidative stress, stimulation of autophagy, increased NO bioavailability and no increase of the AI@75, in contrast to what observed in hypertensive patients not receiving the mixture. CONCLUSIONS The supplementation of the trehalose, spermidine, nicotinamide, and polyphenols mixture counteracted hypertension-related arterial stiffness through mechanisms likely dependent on oxidative stress downregulation and autophagy stimulation. These natural activators of autophagy may represent favourable adjuvants for prevention of the hypertensive cardiovascular damage.
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Affiliation(s)
- Giuliano Tocci
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | | | - Giovanna Gallo
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Giulia Nardoianni
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Emiliano Fiori
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Luca D'Ambrosio
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | | | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | | | - Leonardo Schirone
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Alessandra D'Amico
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Mariangela Peruzzi
- Mediterranea Cardiocentro, Napoli, Italy; Department of Clinical Internal, Anestesiological and Cardiovascular Science, Sapienza University of Rome, Italy
| | - Cristina Nocella
- Department of Clinical Internal, Anestesiological and Cardiovascular Science, Sapienza University of Rome, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Italy; IRCCS S. Raffaele, Rome, Italy
| | - Speranza Rubattu
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli, Italy.
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4
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Piccirillo G, Moscucci F, Di Diego I, Mezzadri M, Caltabiano C, Carnovale M, Corrao A, Lospinuso I, Stefano S, Scinicariello C, Giuffrè M, De Santis V, Sciomer S, Rossi P, Fiori E, Magrì D. Effect of Head-Up/-Down Tilt on ECG Segments and Myocardial Temporal Dispersion in Healthy Subjects. Biology (Basel) 2023; 12:960. [PMID: 37508390 PMCID: PMC10376208 DOI: 10.3390/biology12070960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023]
Abstract
The head-up/-down tilt test acutely modifies the autonomic nervous system balance throughout a deactivation of the cardiopulmonary reflexes. The present study examines the influence of head-up/-down tilt on a number of ECG segments. A total of 20 healthy subjects underwent a 5 min ECG and noninvasive hemodynamic bio-impedance recording, during free and controlled breathing, lying at (a) 0°; (b) -45°, tilting up at 45°, and tilting up at 90°. Heart rate variability power spectral analysis was obtained throughout some ECG intervals: P-P (P), P-Q (PQ), PeQ (from the end of P to Q wave), Q-R peak (QR intervals), Q-R-S (QRS), Q-T peak (QTp), Q-T end (QTe), STp, STe, T peak-T end (Te), and, eventually, the TeP segments (from the end of T to the next P waves). Results: In all study conditions, the Low Frequency/High FrequencyPP and LFPP normalized units (nu) were significantly lower than the LF/HFRR and LFRRnu, respectively. Conversely, the HFPP and HFPPnu were significantly higher in all study conditions. STe, QTp, and QTe were significantly related to the PP and RR intervals, whereas the T wave amplitude was inversely related to the standard deviations of all the myocardial repolarization variables and to the left ventricular end-systolic volume (LVEDV). The T wave amplitude diminished during head-up tilt and significantly correlated with the LVEDV.
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Affiliation(s)
- Gianfranco Piccirillo
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Federica Moscucci
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, Viale del Policlinico, 00161 Rome, Italy
| | - Ilaria Di Diego
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Martina Mezzadri
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Cristina Caltabiano
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Myriam Carnovale
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Andrea Corrao
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Ilaria Lospinuso
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Sara Stefano
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Claudia Scinicariello
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Marco Giuffrè
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Valerio De Santis
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Susanna Sciomer
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Pietro Rossi
- Arrhythmology Unit, Fatebenefratelli Hospital Isola Tiberina-Gemelli Isola, 00186 Rome, Italy
| | - Emiliano Fiori
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, "Sapienza" University of Rome, 00198 Rome, Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, "Sapienza" University of Rome, 00198 Rome, Italy
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5
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Magrì D, Palermo P, Salvioni E, Mapelli M, Gallo G, Vignati C, Mattavelli I, Gugliandolo P, Maruotti A, Di Loro PA, Fiori E, Sciomer S, Agostoni P. Influence of exertional oscillatory breathing and its temporal behavior in patients with heart failure and reduced ejection fraction. Int J Cardiol 2023:S0167-5273(23)00659-9. [PMID: 37164295 DOI: 10.1016/j.ijcard.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/12/2023] [Accepted: 05/05/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Exertional oscillatory breathing (EOV) represents an emerging prognostic marker in heart failure (HF) patients, however little is known about EOV meaning with respect to its disappearance/persistence during cardiopulmonary exercise test (CPET). The present single-center study evaluated EOV clinical and prognostic impact in a large cohort of reduced ejection fraction HF patients (HFrEF) and, contextually, if a specific EOV temporal behavior might be an addictive risk predictor. METHODS AND RESULTS Data from 1.866 HFrEF patients on optimized medical therapy were analysed. The primary cardiovascular (CV) study end-point was cardiovascular death, heart transplantation or LV assistance device (LVAD) implantation at 5-years. For completeness a secondary end-point of total mortality at 5- years was also explored. EOV presence was identified in 251 patients (13%): 142 characterized by EOV early cessation (Group A) and 109 by EOV persistence during the whole CPET (Group B). The entire EOV Group showed worse clinical and functional status than NoEOV Group (n = 1.615) and, within the EOV Group, Group B was characterized by a more severe HF. At CV survival analysis, EOV patients showed a poorer outcome than the NoEOV Group (events 27.1% versus 13.1%, p < 0.001) both unpolished and after matching for main confounders. Instead, no significant differences were found between EOV Group A and B with respect to CV outcome. Conversely the analysis for total mortality failed to be significant. CONCLUSIONS Our analysis, albeit retrospective, supports the inclusion of EOV into a CPET-centered clinical and prognostic evaluation of the HFrEF patients. EOV characterizes per se a more advanced HFrEF stage with an unfavorable CV outcome. However, the EOV persistence, albeit suggestive of a more severe HF, does not emerge as a further prognostic marker.
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Affiliation(s)
- Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" University, Rome, Italy
| | | | | | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.; Dept. of Clinical sciences and Community health, Cardiovascular Section, University of Milano, Milan, Italy
| | - Giovanna Gallo
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" University, Rome, Italy
| | | | | | | | - Antonello Maruotti
- Dipartimento di Giurisprudenza, Economia, Politica e Lingue Moderne - Libera Università Maria Ss Assunta; Department of Mathematics, University of Bergen, Norway; School of Computing, University of Portsmouth, United Kingdom
| | | | - Emiliano Fiori
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" University, Rome, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza" University, Rome, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.; Dept. of Clinical sciences and Community health, Cardiovascular Section, University of Milano, Milan, Italy..
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6
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Raffa S, Forte M, Gallo G, Ranieri D, Marchitti S, Magrì D, Testa M, Stanzione R, Bianchi F, Cotugno M, Fiori E, Visco V, Sciarretta S, Volpe M, Rubattu S. Atrial natriuretic peptide stimulates autophagy/mitophagy and improves mitochondrial function in chronic heart failure. Cell Mol Life Sci 2023; 80:134. [PMID: 37099206 PMCID: PMC10133375 DOI: 10.1007/s00018-023-04777-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/04/2023] [Accepted: 04/10/2023] [Indexed: 04/27/2023]
Abstract
Mitochondrial dysfunction, causing increased reactive oxygen species (ROS) production, is a molecular feature of heart failure (HF). A defective antioxidant response and mitophagic flux were reported in circulating leucocytes of patients with chronic HF and reduced ejection fraction (HFrEF). Atrial natriuretic peptide (ANP) exerts many cardiac beneficial effects, including the ability to protect cardiomyocytes by promoting autophagy. We tested the impact of ANP on autophagy/mitophagy, altered mitochondrial structure and function and increased oxidative stress in HFrEF patients by both ex vivo and in vivo approaches. The ex vivo study included thirteen HFrEF patients whose peripheral blood mononuclear cells (PBMCs) were isolated and treated with αANP (10-11 M) for 4 h. The in vivo study included six HFrEF patients who received sacubitril/valsartan for two months. PBMCs were characterized before and after treatment. Both approaches analyzed mitochondrial structure and functionality. We found that levels of αANP increased upon sacubitril/valsartan, whereas levels of NT-proBNP decreased. Both the ex vivo direct exposure to αANP and the higher αANP level upon in vivo treatment with sacubitril/valsartan caused: (i) improvement of mitochondrial membrane potential; (ii) stimulation of the autophagic process; (iii) significant reduction of mitochondrial mass-index of mitophagy stimulation-and upregulation of mitophagy-related genes; (iv) reduction of mitochondrial damage with increased inner mitochondrial membrane (IMM)/outer mitochondrial membrane (OMM) index and reduced ROS generation. Herein we demonstrate that αANP stimulates both autophagy and mitophagy responses, counteracts mitochondrial dysfunction, and damages ultimately reducing mitochondrial oxidative stress generation in PBMCs from chronic HF patients. These properties were confirmed upon sacubitril/valsartan administration, a pivotal drug in HFrEF treatment.
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Affiliation(s)
- Salvatore Raffa
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University, Rome, Italy.
| | | | - Giovanna Gallo
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Danilo Ranieri
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University, Rome, Italy
| | | | - Damiano Magrì
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Marco Testa
- Cardiology Unit, Azienda Ospedaliero-Universitaria Sant'Andrea, Rome, Italy
| | | | | | | | - Emiliano Fiori
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Vincenzo Visco
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Sebastiano Sciarretta
- IRCCS Neuromed, Pozzilli, Isernia, Italy
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University, Rome, Italy
- IRCCS S. Raffaele, Rome, Italy
| | - Speranza Rubattu
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University, Rome, Italy.
- IRCCS Neuromed, Pozzilli, Isernia, Italy.
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Gallo G, Raffa S, Forte M, Ranieri D, Marchitti S, Magrì D, Testa M, Stanzione R, Bianchi F, Cotugno M, Fiori E, Visco V, Sciarretta S, Volpe M, Rubattu S. 755 ATRIAL NATRIURETIC PEPTIDE STIMULATES AUTOPHAGY/MITOPHAGY AND IMPROVES MITOCHONDRIAL DISFUNCTION IN CHRONIC HEART FAILURE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.458] [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: 12/23/2022]
Abstract
Abstract
Background
Mitochondrial dysfunction, causing increased reactive oxygen species production, is a molecular feature of heart failure (HF) and it has been reported in circulating leucocytes of patients with HF with reduced ejection fraction (HFrEF). Atrial natriuretic peptide (ANP) exerts many cardiac beneficial effects, including the ability to protect cardiomyocytes by promoting autophagy.
Objective
To test the impact of ANP on autophagy/mitophagy responses, altered mitochondrial structure and function and increased oxidative stress in chronic HFrEF patients.
Experimental design. The present study used both ex-vivo and in-vivo approaches. We examined sixteen consecutive chronic HFrEF patients referring to the outpatient clinic of the Cardiology unit of Sant’Andrea Hospital in Rome. Out of them, for the ex-vivo study we enrolled 10 patients matching the following inclusion criteria: age under 75 years and left ventricle ejection fraction <40%. For the in-vivo study we recruited six patients and evaluated them before and after 2-month treatment with the Angiotensin Receptor Neprilysin inhibitor (ARNi) sacubitril/valsartan started at the dosage of 49/51 mg twice daily, rapidly uptitrated at the dosage of 97/103 mg twice daily, while maintaining unchanged the remaining therapy. Patients with recent hospitalizations for acute HF or other acute conditions within the last 3 months before the enrollment, with malignancy, inflammatory or infectious diseases, diabetes mellitus, history of cigarette smoking and alcohol abuse were excluded.
Results
The ex-vivo direct exposure to αANP caused an improvement of mitochondrial membrane potential with a restoration of the mitochondrial protonmotive force (p<0.05) and promoted the recovery of the IMM extension with a significant improvement in the IMM/OMM index (p<0.05). The production of ROS was significantly decreased after the exposure to αANP (p<0.05). Analyzing the mitochondrial stress, we observed that the treatment with αANP induced a down-modulation of p66shc mRNA (p<0.01). The αANP treatment induced a rapid and significant autophagic response. The cytofluorimetric analysis showed a significant increase of LysoTracker levels highlighting a rise of intracellular acidic compartments (p<0.05), with the up modulation of the LC3 and Beclin mRNA levels (p<0.01 and p<0.05 respectively). The significant reduction in mitochondrial mass observed in treated PBMCs evoked an increase of the mitophagic process related to αANP (p<0.01). In vivo, the efficacy of the treatment with sacubitril/valsartan was proved by the increase in αANP levels (p<0.01) whereas levels of NT-proBNP decreased (p<0.05). PBMCs collected after treatment were characterized by lower mitochondrial oxidative stress levels and were provided of structurally more intact mitochondria characterized by better functional performances (p<0.05). PBMCs of the treated patients showed an increased level of acid compartments associated with an up-modulation of LC3 and Beclin mRNA levels and a reduction of mitochondrial mass (p<0.05). Also in this experimental context, the activation of autophagy was confirmed by ultrastructural morphometric evaluation (p<0.05).
Conclusions
αANP stimulates both autophagy and mitophagy responses, counteracts mitochondrial dysfunction and damage ultimately reducing mitochondrial oxidative stress generation in PBMCs from chronic HF patients. These properties were confirmed upon sacubitril/valsartan administration, a therapeutic approach indicated for HFrEF treatment.
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Affiliation(s)
- Giovanna Gallo
- Department Of Clinical And Molecular Medicine, Sapienza University Of Rome , Rome , Italy
- Cardiology Unit , Ospedale Sant’andrea, Rome , Italy
| | - Salvatore Raffa
- Department Of Clinical And Molecular Medicine, Sapienza University Of Rome , Rome , Italy
| | | | - Danilo Ranieri
- Department Of Clinical And Molecular Medicine, Sapienza University Of Rome , Rome , Italy
| | | | - Damiano Magrì
- Department Of Clinical And Molecular Medicine, Sapienza University Of Rome , Rome , Italy
- Cardiology Unit , Ospedale Sant’andrea, Rome , Italy
| | - Marco Testa
- Cardiology Unit , Ospedale Sant’andrea, Rome , Italy
| | | | | | | | - Emiliano Fiori
- Department Of Clinical And Molecular Medicine, Sapienza University Of Rome , Rome , Italy
- Cardiology Unit , Ospedale Sant’andrea, Rome , Italy
| | - Vincenzo Visco
- Department Of Clinical And Molecular Medicine, Sapienza University Of Rome , Rome , Italy
| | - Sebastiano Sciarretta
- Department Of Medical-Surgical And Biotechnologies, Sapienza University Of Rome , Latina , Italy
| | - Massimo Volpe
- Department Of Clinical And Molecular Medicine, Sapienza University Of Rome , Rome , Italy
- Cardiology Unit , Ospedale Sant’andrea, Rome , Italy
| | - Speranza Rubattu
- Department Of Clinical And Molecular Medicine, Sapienza University Of Rome , Rome , Italy
- Cardiology Unit , Ospedale Sant’andrea, Rome , Italy
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8
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Gazzanelli S, Miccini M, Sapienza P, Cavallaro G, Biacchi D, Crocetti D, Fiori E, Sammartino P, Guerra C, Ranieri MV. Fracture and migration in right atrium of a permanent venous central access system in a elderly patient: case report and literature review. Clin Ter 2022; 173:207-213. [PMID: 35612331 DOI: 10.7417/ct.2022.2419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Catheter dislocation and fracture with migration of central venous lines have been reported in the International literature. Catheter fracture with consequent migration has been observed in 0.5-3.0% and may either be consequent to catheter removal or it can occur spontane-ously. Our case report concerns the migration of a Hickman catheter connected to a venous port to the right atrium in a 61-year old patient. A literature up-to-date has been performed to assess the risk of port-a-cath positioning. The position of catheter tip is considered critical for the risk of migration, that is greater as higher the tip localization respect to the carina. The aim of our study is to underline the critical role of X-ray to visualize the exact location of the catheter tip, regard-less of the approach used for catheter positioning.
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Affiliation(s)
- S Gazzanelli
- Department of Anesthesiology and Palliative Care, Sapienza University, Rome, Italy
| | - M Miccini
- Department of Surgery P. Valdoni, Sapienza University, Rome, Italy
| | - P Sapienza
- Department of Surgery P. Valdoni, Sapienza University, Rome, Italy
| | - G Cavallaro
- Department of Surgery P. Valdoni, Sapienza University, Rome, Italy
| | - D Biacchi
- Department of Surgery P. Valdoni, Sapienza University, Rome, Italy
| | - D Crocetti
- Department of Surgery P. Valdoni, Sapienza University, Rome, Italy
| | - E Fiori
- Department of Surgery P. Valdoni, Sapienza University, Rome, Italy
| | - P Sammartino
- Department of Surgery P. Valdoni, Sapienza University, Rome, Italy
| | - C Guerra
- Department of Anesthesiology and Palliative Care, Sapienza University, Rome, Italy
| | - M V Ranieri
- Department of Anesthesiology and Palliative Care, Sapienza University, Rome, Italy
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9
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Williams MGL, Liang K, De Garate E, Spagnoli L, Fiori E, Lawton CB, Dastidar A, Johnson TW, Biglino G, Bucciarelli-Ducci C. Diagnostic and prognostic role of peak troponin T in patients with acute coronary syndromes and non-obstructive coronary arteries. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1494] [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
Up to 10% of patients who present with an acute coronary syndrome have a myocardial infarction with non-obstructive coronary arteries (MINOCA). Troponin T predicts infarct size and outcomes in patients with ST-elevation myocardial infarction. The value of peak troponin T in patients with a working diagnosis of MINOCA is not well understood.
Purpose
The aim of this study is to investigate the diagnostic and prognostic role of troponin in patients with MINOCA.
Methods
Consecutive patients with a working diagnosis of MINOCA from a single tertiary centre who underwent comprehensive cardiovascular magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) were followed prospectively. Peak troponin T was identified during the index admission and divided into deciles and quartiles for analysis. The primary endpoint was all-cause mortality.
Results
Among 796 patients undergoing CMR, 719 met the study criteria and had underwent a diagnostic quality scan. The peak Troponin T threshold for optimal diagnostic sensitivity and specificity was 211 ng/L. Peak troponin T ≥211 ng/L and time to CMR of ≤14 days has a sensitivity of 94%, specificity of 35%, PPV 57% and NPV 94% for the CMR making a diagnosis. Each increase in troponin decile increases the mean diagnostic yield of the CMR by 3.65% (p<0.001, 95% CI 3.38 – 3.91; R2 0.84; Figure 1).
If the troponin is in the lowest decile and the CMR is performed at ≤14 days, the diagnostic yield is still 72%. There is no overall difference in median troponin in patients who died and those who survived (229 ng/l v. 424 ng/l; p=0.157), however mortality is significantly lower in the highest two troponin quartiles (6.9% versus 11.9%; p=0.009; Figure 2).
Conclusion
Peak troponin T is readily available during the index admission in patients presenting with MINOCA and provides useful diagnostic and prognostic information for the attending cardiologist.
Funding Acknowledgement
Type of funding sources: None. Figure 1. CMR diagnosis by troponin decileFigure 2. Mortality by troponin quartile
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Affiliation(s)
- M G L Williams
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - K Liang
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - E De Garate
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - L Spagnoli
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - E Fiori
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - C B Lawton
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - A Dastidar
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - T W Johnson
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - G Biglino
- University of Bristol, Bristol, United Kingdom
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10
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Williams MGL, Dastidar A, Liang K, Johnson TW, Baritussio A, Strange JW, Joshi N, Dorman S, De Garate E, Spagnoli L, Fiori E, Lawton CB, Biglino G, Plein S, Bucciarelli-Ducci C. Sex and age differences in patients with acute coronary syndrome and non-obstructive coronary arteries: presentation and outcome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
A substantial number of patients present with acute coronary syndrome (ACS) and non-obstructive coronary arteries. Sex and age differences in these patients are not well understood. This study aims to evaluate the impact of sex and age on clinical presentation and outcome in patients with ACS and non-obstructive coronary arteries, with either an ischaemic or non-ischaemic cause.
Methods and results
Consecutive patients with an ACS and non-obstructive coronary arteries (n=719) from a single tertiary centre underwent comprehensive cardiovascular magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE). The primary endpoint was all-cause mortality. CMR was performed at a median time of 30 days after presentation and identified a diagnosis in 74% of patients. Patients with an ischaemic or non-ischaemic aetiology (n=529) on CMR were followed prospectively. All-cause mortality was 11% over a median follow up of 4.9 years, with no significant difference between sexes (11% versus 11% p=0.732). Women were more likely to have an ischaemic aetiology on CMR (40% v 31%, p=0.037). Age group (HR 1.48, p=0.002), log peak troponin (HR 0.78, p=0.033) and LVEF (HR 0.98, p=0.032) were independent predictors of mortality. Men aged >60 years with a non-ischaemic aetiology on their CMR were at higher risk of death than women >60 years (p=0.003).
Conclusions
There is no difference in all-cause mortality between sexes in patients presenting with ACS and non-obstructive coronary arteries but increasing age is an important predictor of mortality in both sexes.
Funding Acknowledgement
Type of funding sources: None. Sex differences in CMR diagnosisSex, age and mortality
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Affiliation(s)
- M G L Williams
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - A Dastidar
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - K Liang
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - T W Johnson
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - A Baritussio
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - J W Strange
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - N Joshi
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - S Dorman
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - E De Garate
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - L Spagnoli
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - E Fiori
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - C B Lawton
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - G Biglino
- University of Bristol, Bristol, United Kingdom
| | - S Plein
- University of Leeds, Department of Biomedical Imaging Science, Leeds, United Kingdom
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11
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Williams MGL, Liang K, De Garate E, Spagnoli L, Fiori E, Lawton CB, Biglino G, Dastidar A, Johnson TW, Bucciarelli-Ducci C. The role of peak troponin in patients with a working diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA). Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.087] [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
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Rosetrees Trust James Tudor Foundation
Background
6-10% of patients who present with an acute coronary syndrome have a myocardial infarction with non-obstructive coronary arteries (MINOCA). Troponin T predicts infarct size and outcomes in patients with ST-elevation myocardial infarction. The value of peak troponin T in patients with a working diagnosis of MINOCA is not well understood.
Purpose
The aim of this study is to investigate the diagnostic and prognostic role of troponin in patients with MINOCA.
Methods
Consecutive patients with a working diagnosis of MINOCA (n = 719) from a single tertiary centre who underwent comprehensive cardiovascular magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) were followed prospectively. The primary endpoint was all-cause mortality.
Results
Peak troponin T ≥211 ng/L and time to CMR of ≤17 days have a positive predictive value of 94% for being able to make a diagnosis on CMR. If the scan was performed in ≤17 days the diagnostic yield was still 75% even in the lowest troponin decile, but this was 59% if performed after 17 days. Each increase in troponin decile increases the mean diagnostic yield of the CMR by 3.7% (p < 0.001, 95% CI 3.4 – 3.9; R2 0.84; Figure 1). There is no overall difference in median troponin in patients who died and those who survived (229 ng/l v. 424 ng/l; p = 0.157), however mortality is significantly lower in the highest two troponin quartiles (11.9% versus 6.9%; p = 0.009, figure 2).
Conclusions
Peak troponin T and time to CMR can be used by cardiologists to determine the likelihood of making a diagnosis using CMR. A higher troponin quartile is associated with lower mortality.
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Affiliation(s)
- MGL Williams
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - K Liang
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - E De Garate
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - L Spagnoli
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - E Fiori
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - CB Lawton
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - G Biglino
- University of Bristol, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - A Dastidar
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - TW Johnson
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - C Bucciarelli-Ducci
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
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12
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Williams MGL, Dastidar A, Liang K, Johnson TW, Baritussio A, Strange JW, Joshi N, Dorman S, Dr Garate E, Spagnoli L, Fiori E, Lawton CB, Biglino G, Plein S, Bucciarelli-Ducci C. Sex and age differences in patients with a working diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA): presentation and outcome. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.093] [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
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Rosetrees Trust James Tudor Foundation
Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is an increasingly recognised working diagnosis. Sex and age differences in MINOCA are not well understood.
Purpose This study aims to evaluate the impact of sex and age in patients with MINOCA due to ischaemic and non-ischaemic causes on clinical presentation and outcome.
Methods and Results Consecutive patients with a working diagnosis of MINOCA (n = 719) from a single tertiary centre who underwent comprehensive cardiovascular magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) were followed prospectively. The primary endpoint was all-cause mortality. CMR was performed at a median time of 30 days after presentation and identified a diagnosis in 74% of patients. Men were more likely to have a non-ischaemic cause on CMR (55% v. 41%, p < 0.001) and less likely to have a normal/non-specific scan (21% v. 32%, p = 0.001, figure 1). All-cause mortality was 9.5% over a median follow up of 4.9 years, with no significant difference between sexes (8.7% versus 10.1% p = 0.456). Age group (HR 1.61, p < 0.001) and LVEF (HR 0.98, p = 0.020) were independent predictors of mortality. Men aged >60 years with a non-ischaemic aetiology on their CMR were at higher risk of death than women with non-ischaemic causes >60 years (p = 0.003, figure 2).
Conclusions There is no difference in all-cause mortality between sexes in MINOCA but increasing age is the most important predictor of mortality in both sexes.
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Affiliation(s)
- MGL Williams
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - A Dastidar
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - K Liang
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - TW Johnson
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - A Baritussio
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - JW Strange
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - N Joshi
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - S Dorman
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - E Dr Garate
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - L Spagnoli
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - E Fiori
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - CB Lawton
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - G Biglino
- University of Bristol, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Department of Biomedical Imaging Science, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C Bucciarelli-Ducci
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
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13
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Irace L, Martinelli O, Gattuso R, Mingoli A, Fiori E, Alunno A, Di Girolamo A, Crocetti D, Sapienza P. The role of self-expanding vascular stent in superior vena cava syndrome for advanced tumours. Ann R Coll Surg Engl 2021; 103:296-301. [PMID: 33682470 DOI: 10.1308/rcsann.2020.7127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Superior vena cava (SVC) syndrome (SVCS) is a life-threatening occurrence that necessitates prompt treatment. At present, endovascular stenting is proposed as a first-line treatment to relieve symptoms. We assessed the effectiveness, safety and outcome of SVC stent positioning in patients affected with advanced cancer. METHODS Forty-two patients undergoing stent positioning in the SVC for neoplasms from January 2002 to December 2018 form the basis of this retrospective study. Demographic data, risk factors, associated diseases, symptoms at presentation according to the score proposed by Kishi and the type of SVCS according to Sanford and Doty were collected. Minor and major complications were recorded. Suspected stent occlusion was confirmed by means of recurrence of symptoms followed by a confirmatory computed tomography (CT). RESULTS Thirty-four (81%) patients had a nonresectable lung tumour invading or compressing the SVC. Five (12%) patients had a non-Hodgkin's lymphoma, and three (7%) had metastatic lymphadenopathies. Nitinol stents (Memotherm®) were employed in 19 (45%) patients, and steel stents (Wallstent™) in the remaining 23 (55%) patients. Thirty-five (85%) patients died during follow up for disease progression and the overall survival rate at 24 months was 11% (standard error (SE)=0.058). Thirteen patients (32%) had a recurrence of SVCS because of stent thrombosis in three (23%) and extrinsic compression from uncontrolled cancer progression in ten (77%). The overall symptom-free interval at 24 months was 57% (SE=0.095). CONCLUSIONS We recommend the use of the endovascular procedure as a first-line treatment in locally advanced or metastatic tumour in the presence of SVCS.
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Affiliation(s)
- L Irace
- Sapienza University of Rome, Italy
| | | | | | | | - E Fiori
- Sapienza University of Rome, Italy
| | - A Alunno
- Sapienza University of Rome, Italy
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14
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Lamazza A, Fiori E, Carati MV, Guzzo A, Pronio A, Sterpetti AV. Therapeutic options for emergency gastrointestinal malignancy in COVID19 pandemic. The role of operative endoscopy. Br J Surg 2020; 107:e403-e404. [PMID: 33448343 PMCID: PMC7929232 DOI: 10.1002/bjs.11846] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 11/17/2022]
Affiliation(s)
- A Lamazza
- Department of Surgery, University of Rome Sapienza
| | - E Fiori
- Department of Surgery, University of Rome Sapienza
| | - M V Carati
- Department of Surgery, University of Rome Sapienza
| | - A Guzzo
- Department of Surgery, University of Rome Sapienza
| | - A Pronio
- Department of Surgery, University of Rome Sapienza
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15
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Tarallo M, Crocetti D, Fiori E, Sapienza P, Letizia C, De Toma G, Cavallaro G. Criticism of learning curve in laparoscopic adrenalectomy: a systematic review. Clin Ter 2020; 171:e178-e182. [PMID: 32141491 DOI: 10.7417/ct.2020.2209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Laparoscopic adrenalectomy (LA) has become the treatment of choice for benign adrenal lesions. Lateral Transperitoneal Laparoscopic Adrenalectomy (LTLA) is considered the gold standard. The number of LTLAs a surgeon must perform, in order to complete his learning curve, is not well defined in Literature. Moreover, the few papers dealing with the learning curve for LTLAs show controversial results and consider different evaluation parameters. METHODS The systematic review has been carried out according to PRISMA statement. The literature search included PubMed and Scopus database. Hand searching of reference lists of previous review articles and relevant studies was also performed. The search string was "learning curve AND laparoscopic adrenalectomy". RESULTS A total of 9 papers met the inclusion criteria out of 94 non duplicate citations. The aim of this systematic review is to provide a multidimensional evaluation by bringing into focus evaluation parameters of surgical performance, (operative time, intraoperative complications, conversion rate and blood loss), factors related to patient's pathology (side, size, adrenal pathology) and surgeon-specific properties. CONCLUSIONS Operative time, intraoperative bleeding, intraoperative complications and conversion rate are the main parameters that have been considered for the achievement of learning curve, and for each there are discrepancies, mainly due to the relative rarity of adrenal tumors, and so for difficulties in obtaining approper analysis that could establish an effective learning curve. So, further evaluations in larger experience are needed.
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Affiliation(s)
- M Tarallo
- Department of Surgery "P. Valdoni", Sapienza University, Rome
| | - D Crocetti
- Department of Surgery "P. Valdoni", Sapienza University, Rome
| | - E Fiori
- Department of Surgery "P. Valdoni", Sapienza University, Rome
| | - P Sapienza
- Department of Surgery "P. Valdoni", Sapienza University, Rome
| | - C Letizia
- Department of Clinical Sciences, Sapienza University, Rome, Italy
| | - G De Toma
- Department of Surgery "P. Valdoni", Sapienza University, Rome
| | - G Cavallaro
- Department of Surgery "P. Valdoni", Sapienza University, Rome
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16
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Chiappini A, Frattolillo G, Paradiso G, De Gori A, Scarano Catanazaro V, Avantifiori R, Fiori E, De Toma G. Current role of open surgery in adrenal tumors. G Chir 2020; 41:79-83. [PMID: 32038016] [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: 06/10/2023]
Abstract
AIM The aim of this retrospective evaluation is to assess the current role of open adrenalectomy, in particular in cases of adrenocortical carcinoma (ACC). MATERIALS AND METHODS From January 2009 to May 2019, 26 open out of 233 adrenalectomies were performed in our Academic Department. Open adrenalectomy was performed by the anterior approach. A midline abdominal incision or a subcostal surgical incision was used to reach the peritoneal cavity. The resection was defined R0 if the margins of the sample were negative for malignancy. RESULTS Open adrenalectomy was performed in 26 patients: 10 men and 16 women with a mean age of 61±25.3 years and a mean BMI of 28.4±2.9. The right adrenal gland was removed in 15 cases Romaand the left in 11 cases.We reported 18 diagnosis of malignant pathology. The other diagnosis concerned 5 cases of pheochromocytoma, 1 case of Cushing's disease and 2 cases of hyperaldosteronism. Mean tumor size was 7.7±5.5. Mean operative time was 160 min (range=110-205 minutes). Mean postoperative stay was 7±2 days. Only 3 (10%) patient showed postoperative grade II complications, according to Clavien-Dindo classification. Midline abdominal incision was used in 18 patients, subcostalsurgical incision in 5 patients and bilateral subcostal surgical incision in 3 patients. 3 right nephrectomy was necessary to remove the entire tumor mass. An en bloc R0 tumor resection was accomplished in all cases.There was no intra and perioperative mortality. All patients recovered well from surgery. The mean follow-up period was 15 (range=6-48) months. CONCLUSION In conclusion, our retrospective study points out the role of open adrenalectomy as the treatment of choice in selected cases with known or suspected malignant adrenal tumors and with size greater than 12 cm.
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Crocetti D, Cavallaro G, Tarallo MR, Chiappini A, Polistena A, Sapienza P, Fiori E, De Toma G. Preservation of left colic artery with lymph node dissection of IMA root during laparoscopic surgery for rectosigmoid cancer. Results of a retrospective analysis. Clin Ter 2019; 170:e124-e128. [PMID: 30993308 DOI: 10.7417/ct.2019.2121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND During sigmoid or rectal cancer surgery, dissection of lymph-nodes at the origin of inferior mesenteric artery is mandatory. Nevertheless, ligation of the origin of IMA should compromise blood supply to left colon and affect anastomosis. The aim of this retrospective evaluation is to compare high IMA ligation and low IMA ligation with preservation of LCA and skeletonization of the origin of IMA during laparoscopic colorectal resection. METHODS All 120 patients included were affected by clinically M-0 sigmoid or rectal cancer. A laparoscopic colorectal resection with low or high ligature of IMA was performed. Low ligation was carried out with lymphadenectomy of the arterial root. Patients were divided in 2 groups according to type of treatment: Group A, high IMA ligation (N=65), Group B, low ligation with lymphadenectomy of IMA root (N=55). RESULTS Preoperatively 59 patients had stage I, 42 patients had stage II and 19 patients had stage III tumor. A mean of 20.3 +/- 4.5 lymph nodes were removed in group A patients and 18.9 +/- 9.1 in group B patients, and this difference was not statistically significant. Operative time, intraoperative and postoperative complication rates were not different between the two group. CONCLUSIONS Low IMA ligation combined with lymph-node dissection at its origin is safe and effective, not time consuming and not associated to increased risk of complications and nerve damage. This technique can be considered as alternative to standard high IMA ligation in selected patients.
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Affiliation(s)
- D Crocetti
- Department of Surgery "P. Valdoni", Sapienza University, Rome
| | - G Cavallaro
- Department of Surgery "P. Valdoni", Sapienza University, Rome
| | - M R Tarallo
- Department of Surgery "P. Valdoni", Sapienza University, Rome
| | - A Chiappini
- Department of Surgery "P. Valdoni", Sapienza University, Rome
| | - A Polistena
- Department of Surgical and Biomedical Sciences, University of Perugia, Italy
| | - P Sapienza
- Department of Surgery "P. Valdoni", Sapienza University, Rome
| | - E Fiori
- Department of Surgery "P. Valdoni", Sapienza University, Rome
| | - G De Toma
- Department of Surgery "P. Valdoni", Sapienza University, Rome
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Ursi P, Tarallo M, Crocetti D, Cavallaro G, Fiori E, D'Andrea V, De Toma G. Second jejunal loop adenocarcinoma associated with celiac disease: the first case report. G Chir 2019; 40:225-229. [PMID: 31484013] [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: 06/10/2023]
Abstract
INTRODUCTION Jejunal adenocarcinoma is a very rare disease but the frequency of this rare carcinoma is higher in celiac patients. We report the first case report of a second jejunal loop adenocarcinoma associated with celiac disease. PRESENTATION OF CASE A 47-year-old woman, with a history of celiac disease. Computerized tomographic scans of the abdomen and pelvis demonstrated a severe retroperitoneal lymphoadenopathy, para-aortic, inter-aorto-caval, porto-caval, posterior pancreaticoduodenal space, celiac trunk, lesser gastric curvature, lymph node grouping. The patient underwent digiunal resection and regional lymphadenectomy. Diagnosis was poorly differentiated jejunal adenocarcinoma, infiltrating subserosal adipose tissue, metastasing in five out of eight regional lymph nodes. U.I.C.C. 2017 grading = pT3 pN2 G3 R0; Stage IIIB. DISCUSSION The jejunum accounts for 11-25% of small bowel adenocarcinoma, that accounts for less than 5% of gastrointestinal cancer, notwithstanding that 90% of the mucosa surface area of the digestive tract is made by small intestine. To the best of our knowledge, this is the first report on a second loop jejunal adenocarcinoma complicating celiac disease. In our study, the diagnosis of cancer was made by computed tomography (CT) of abdomen and the patient was operated. For the diagnosis of small bowel tumour, CT enteroclysis has a sensitivity of 85-95% and a specificity of 90-96%. Complete resection (RO) of the jejunal adenocarcinoma, with regional lymph nodes resection and jejuno-jejunal anastomosis should be performed. CONCLUSION After curative surgical resections of small bowel adenocarcinoma, adjuvant chemo-therapy has not shown a clear benefit in retrospective studies. Preoperative Chemo-Radio-therapy and careful Imaging Staging are the first steps to planning surgery.
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Crocetti D, Fiori E, Costi U, De Gori A, Miccini M, Valabrega S, Cavallaro G, De Toma G. Right pneumothorax secondary to colonoscopic perforation: a case. G Chir 2018; 39:375-377. [PMID: 30563601] [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: 06/09/2023]
Abstract
AIM The purpose of this study is to determine the anatomical aspects, mechanisms, risk factors and appropriate management of development of pneumothorax during a routine colonoscopy. CLINICAL CASE We report a case of an accidental bowel wall injury during diagnostic colonoscopic with consequent pneumoperitoneum; this was followed by expansion of gas through diaphragmatic fenestration perhaps congenital, in right pleural cavity causing pneumothorax. DISCUSSION Rarely, colonic perforation during colonoscopy can occur into the extraperitoneal space, thus leading to the passage and diffusion of air along the fascial planes and large vessels, possibly causing pneumoretroperitoneum, pneumomediastinum, pneumopericardium, pneumothorax, and subcutaneous emphysema. The combination of intraperitoneal and extraperitoneal perforation has also been reported. Pneumothorax following a colonoscopy sigmoid perforation is an extremely rare but severe and often lifethreatening complication. CONCLUSION If the patient develops dyspnea and pneumoderma during or after this procedure, a chest radiogram or thoracoabdominal CT should be taken for diagnostic purposes. Urgent treatment, starting with chest tube insertion(s) and laparotomy or laparoscopy could be lifesaving.
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Lamazza A, Fiori E, Schillaci A, Sterpetti AV. Proper placement of colorectal self-expandable metal stents with the help of a thin colonoscope - a video vignette. Colorectal Dis 2018; 20:356-357. [PMID: 29352563 DOI: 10.1111/codi.14022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/11/2018] [Indexed: 02/08/2023]
Affiliation(s)
- A Lamazza
- Istituto Pietro Valdoni, University of Rome La Sapienza, Rome, Italy
| | - E Fiori
- Istituto Pietro Valdoni, University of Rome La Sapienza, Rome, Italy
| | - A Schillaci
- Istituto Pietro Valdoni, University of Rome La Sapienza, Rome, Italy
| | - A V Sterpetti
- Istituto Pietro Valdoni, University of Rome La Sapienza, Rome, Italy
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Grodner E, Srebrny J, Droste C, Próchniak L, Rohoziński SG, Kowalczyk M, Ionescu-Bujor M, Ur CA, Starosta K, Ahn T, Kisieliński M, Marchlewski T, Aydin S, Recchia F, Georgiev G, Lozeva R, Fiori E, Zielińska M, Chen QB, Zhang SQ, Yu LF, Zhao PW, Meng J. First Measurement of the g Factor in the Chiral Band: The Case of the ^{128}Cs Isomeric State. Phys Rev Lett 2018; 120:022502. [PMID: 29376727 DOI: 10.1103/physrevlett.120.022502] [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] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 11/05/2017] [Indexed: 06/07/2023]
Abstract
The g factor of the 56 ns half-life isomeric state in ^{128}Cs has been measured using the time-differential perturbed angular distribution method. This state is the bandhead of the positive-parity chiral rotational band, which emerges when an unpaired proton, an unpaired neutron hole, and an even-even core are coupled such that their angular momentum vectors are aplanar (chiral configuration). g-factor measurements can give important information on the relative orientation of the three angular momentum vectors. The measured g factor g=+0.59(1) shows that there is an important contribution of the core rotation in the total angular momentum of the isomeric state. Moreover, a quantitative theoretical analysis supports the conclusion that the three angular momentum vectors lie almost in one plane, which suggests that the chiral configuration in ^{128}Cs demonstrated in previous works by characteristic patterns of electromagnetic transitions appears only above some value of the total nuclear spin.
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Affiliation(s)
- E Grodner
- National Centre for Nuclear Research, 05-540 Świerk, Poland
- Faculty of Physics, University of Warsaw, 02-093 Warsaw, Poland
| | - J Srebrny
- Heavy Ion Laboratory, University of Warsaw, 02-093 Warsaw, Poland
| | - Ch Droste
- Faculty of Physics, University of Warsaw, 02-093 Warsaw, Poland
| | - L Próchniak
- Heavy Ion Laboratory, University of Warsaw, 02-093 Warsaw, Poland
| | - S G Rohoziński
- Faculty of Physics, University of Warsaw, 02-093 Warsaw, Poland
| | - M Kowalczyk
- Heavy Ion Laboratory, University of Warsaw, 02-093 Warsaw, Poland
| | - M Ionescu-Bujor
- Horia Hulubei National Institute for Physics and Nuclear Engineering, 077125 Bucharest, Romania
| | - C A Ur
- Extreme Light Infrastructure, IFIN-HH, 077125 Bucharest, Romania
| | - K Starosta
- Simon Fraser University, V5A 1S6 Vancouver, British Columbia, Canada
| | - T Ahn
- Department of Physics, University of Notre Dame, 46556 Notre Dame, Indiana, USA
| | - M Kisieliński
- Heavy Ion Laboratory, University of Warsaw, 02-093 Warsaw, Poland
| | - T Marchlewski
- Heavy Ion Laboratory, University of Warsaw, 02-093 Warsaw, Poland
| | - S Aydin
- Instituto Nazionale di Fisica Nucleare, 2 35020 Legnaro, Italy
- Department of Physics, Aksaray University, 68100 Aksaray, Turkey
| | - F Recchia
- Dipartimento di Fisica dell'Università di Padova and INFN sez. Padova, I-35131 Padova, Italy
| | - G Georgiev
- CSNSM, Univ. Paris-Sud, CNRS/IN2P3, Université Paris-Saclay, 91405 Orsay, France
| | - R Lozeva
- CSNSM, Univ. Paris-Sud, CNRS/IN2P3, Université Paris-Saclay, 91405 Orsay, France
| | - E Fiori
- CSNSM, Univ. Paris-Sud, CNRS/IN2P3, Université Paris-Saclay, 91405 Orsay, France
| | - M Zielińska
- Heavy Ion Laboratory, University of Warsaw, 02-093 Warsaw, Poland
| | - Q B Chen
- State Key Laboratory of Nuclear Physics and Technology, School of Physics, Peking University, Beijing 100871, China
| | - S Q Zhang
- State Key Laboratory of Nuclear Physics and Technology, School of Physics, Peking University, Beijing 100871, China
| | - L F Yu
- State Key Laboratory of Nuclear Physics and Technology, School of Physics, Peking University, Beijing 100871, China
| | - P W Zhao
- State Key Laboratory of Nuclear Physics and Technology, School of Physics, Peking University, Beijing 100871, China
| | - J Meng
- State Key Laboratory of Nuclear Physics and Technology, School of Physics, Peking University, Beijing 100871, China
- Yukawa Institute for Theoretical Physics, Kyoto University, Kyoto 606-8502, Japan
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Lamazza A, Fiori E, Sterpetti AV. Endoscopic placement of a covered stent to arrest bleeding from obstructing colorectal cancer. Tech Coloproctol 2017; 21:901-903. [PMID: 29098461 DOI: 10.1007/s10151-017-1712-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/19/2017] [Indexed: 12/18/2022]
Affiliation(s)
- A Lamazza
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - E Fiori
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - A V Sterpetti
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy. .,Policlinico Umberto I, Viale del Policlinico, 00167, Rome, Italy.
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Fiori E, Babicola L, Andolina D, Coassin A, Pascucci T, Patella L, Han YC, Ventura A, Ventura R. Neurobehavioral Alterations in a Genetic Murine Model of Feingold Syndrome 2. Behav Genet 2015; 45:547-59. [PMID: 26026879 PMCID: PMC4561592 DOI: 10.1007/s10519-015-9724-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 05/20/2015] [Indexed: 12/13/2022]
Abstract
Feingold syndrome (FS) is an autosomal dominant disorder characterized by microcephaly, short stature, digital anomalies, esophageal/duodenal atresia, facial dysmorphism, and various learning disabilities. Heterozygous deletion of the miR-17-92 cluster is responsible for a subset of FS (Feingold syndrome type 2, FS2), and the developmental abnormalities that characterize this disorder are partially recapitulated in mice that harbor a heterozygous deletion of this cluster (miR-17-92∆/+ mice). Although Feingold patients develop a wide array of learning disabilities, no scientific description of learning/cognitive disabilities, intellectual deficiency, and brain alterations have been described in humans and animal models of FS2. The aim of this study was to draw a behavioral profile, during development and in adulthood, of miR-17-92∆/+ mice, a genetic mouse model of FS2. Moreover, dopamine, norepinephrine and serotonin tissue levels in the medial prefrontal cortex (mpFC), and Hippocampus (Hip) of miR-17-92∆/+ mice were analyzed.Our data showed decreased body growth and reduced vocalization during development. Moreover, selective deficits in spatial ability, social novelty recognition and memory span were evident in adult miR-17-92∆/+ mice compared with healthy controls (WT). Finally, we found altered dopamine as well as serotonin tissue levels, in the mpFC and Hip, respectively, of miR-17-92∆/+ in comparison with WT mice, thus suggesting a possible link between cognitive deficits and altered brain neurotransmission.
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Affiliation(s)
- E. Fiori
- Dipartimento di Psicologia and Centro “Daniel Bovet”, Sapienza - Università di Roma, Rome, Italy
- Santa Lucia Foundation, European Centre for Brain Research (CERC), Via del Fosso di Fiorano, 64, 00143 Rome, Italy
| | - L. Babicola
- Santa Lucia Foundation, European Centre for Brain Research (CERC), Via del Fosso di Fiorano, 64, 00143 Rome, Italy
- Dipartimento di Scienze e Tecnologie Biomediche, Università dell’Aquila, L’Aquila, Italy
| | - D. Andolina
- Santa Lucia Foundation, European Centre for Brain Research (CERC), Via del Fosso di Fiorano, 64, 00143 Rome, Italy
- Dipartimento di Scienze e Tecnologie Biomediche, Università dell’Aquila, L’Aquila, Italy
| | - A. Coassin
- Dipartimento di Psicologia and Centro “Daniel Bovet”, Sapienza - Università di Roma, Rome, Italy
- Santa Lucia Foundation, European Centre for Brain Research (CERC), Via del Fosso di Fiorano, 64, 00143 Rome, Italy
| | - T. Pascucci
- Dipartimento di Psicologia and Centro “Daniel Bovet”, Sapienza - Università di Roma, Rome, Italy
- Santa Lucia Foundation, European Centre for Brain Research (CERC), Via del Fosso di Fiorano, 64, 00143 Rome, Italy
| | - L. Patella
- Santa Lucia Foundation, European Centre for Brain Research (CERC), Via del Fosso di Fiorano, 64, 00143 Rome, Italy
- Dipartimento di Scienze e Tecnologie Biomediche, Università dell’Aquila, L’Aquila, Italy
| | - Y.-C. Han
- Pfizer- Oncology, Pearl River, NY, USA
| | - A. Ventura
- Memorial Sloan-Kettering Cancer Center, Cancer Biology & Genetics Program, New York, NY, USA
| | - R. Ventura
- Santa Lucia Foundation, European Centre for Brain Research (CERC), Via del Fosso di Fiorano, 64, 00143 Rome, Italy
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La Mazza A, Fiori E, Schillaci A, De Cesare A, Sterpetti AV. Endoscopic stenting for colorectal obstruction from unresectable ovarian and colorectal cancer: a bridge to surgery. Colorectal Dis 2015; 17:646-7. [PMID: 25988549 DOI: 10.1111/codi.13005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 03/17/2015] [Indexed: 02/08/2023]
Affiliation(s)
- A La Mazza
- University of Rome Sapienza, Av. Sterpetti-Policlinico Umberto I, Viale Del Policlinico 00167, Rome, Italy
| | - E Fiori
- University of Rome Sapienza, Av. Sterpetti-Policlinico Umberto I, Viale Del Policlinico 00167, Rome, Italy
| | - A Schillaci
- University of Rome Sapienza, Av. Sterpetti-Policlinico Umberto I, Viale Del Policlinico 00167, Rome, Italy
| | - A De Cesare
- University of Rome Sapienza, Av. Sterpetti-Policlinico Umberto I, Viale Del Policlinico 00167, Rome, Italy
| | - A V Sterpetti
- University of Rome Sapienza, Av. Sterpetti-Policlinico Umberto I, Viale Del Policlinico 00167, Rome, Italy.
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Lamazza A, Fiori E, Schillaci A, Sterpetti AV, Lezoche E. Treatment of rectovaginal fistula after colorectal resection with endoscopic stenting: long-term results. Colorectal Dis 2015; 17:356-60. [PMID: 25524247 DOI: 10.1111/codi.12876] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/15/2014] [Indexed: 01/12/2023]
Abstract
AIM To treat patients with rectovaginal fistula after anterior resection for cancer using self-expanding metal stents. METHOD Ten patients of mean age of 56.3 years with rectovaginal fistula after colorectal resection for cancer were treated with endoscopic placement of a self-expanding metal stent. In three patients a diverting proximal stoma had been performed elsewhere. The rectal opening of the fistula was located from 3 to 10 cm from the anal verge (mean 6 cm). All patients had preoperative radiotherapy. In seven patients the stent was placed as the initial treatment while three referred patients had had multiple failed operations. RESULTS There were no complications after the procedure. At a mean follow-up of 24 months the rectovaginal fistula has healed without major faecal incontinence in eight patients. In the remaining two the fistula has reduced significantly in size to allow a successful flap transposition. CONCLUSION Endoscopic placement of a self-expanding metal stent is a valid adjunct to treat patients with rectovaginal fistula after colorectal resection for cancer.
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Affiliation(s)
- A Lamazza
- Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
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Isaak J, Löher B, Savran D, Aumann T, Beller J, Cooper N, Derya V, Duchêne M, Endres J, Fiori E, Kelley J, Knörzer M, Pietralla N, Ponomarev V, Romig C, Scheck M, Scheit H, Silva J, Tonchev A, Tornow W, Weller H, Werner V, Zilges A, Zweidinger M. Decay pattern of the Pygmy Dipole Resonance in 140Ce. EPJ Web of Conferences 2015. [DOI: 10.1051/epjconf/20159301048] [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: 11/14/2022] Open
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Lamazza A, Fiori E, Sterpetti AV, Schillaci A, Scoglio D, Lezoche E. Self-expandable metal stents in the treatment of benign anastomotic stricture after rectal resection for cancer. Colorectal Dis 2014; 16:O150-3. [PMID: 24206040 DOI: 10.1111/codi.12488] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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: 05/10/2013] [Accepted: 07/29/2013] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the use of self-expandable metallic stents to treat patients with symptomatic benign anastomotic stricture after colorectal resection. METHOD Ten patients with a benign symptomatic anastomotic stricture after colorectal resection were treated with endoscopic placement of a self-expandable metal stent. RESULTS The stent was placed successfully in all 10 patients without any major morbidity. At a mean follow-up of 18 months the stenosis was resolved successfully in 7 out 10 patients (70%). The remaining three patients were subsequently treated successfully with balloon dilatation. CONCLUSION Self-expandable metal stents represent a valid alternative to balloon dilatation to treat patients with benign symptomatic anastomotic stricture after colorectal resection for cancer.
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Affiliation(s)
- A Lamazza
- Istituto Pietro Valdoni-Istituto Paride Stefanini, University of Rome La Sapienza, Rome, Italy
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Isaak J, Beller J, Fiori E, Krtička M, Löher B, Pietralla N, Romig C, Rusev G, Savran D, Scheck M, Silva J, Sonnabend K, Tonchev A, Tornow W, Weller H, Zweidinger M. Decay pattern of the Pygmy Dipole Resonance in 130Te. EPJ Web of Conferences 2014. [DOI: 10.1051/epjconf/20146602055] [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: 11/15/2022] Open
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29
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Lamazza A, Fiori E, De Masi E, Scoglio D, Sterpetti AV, Lezoche E. Self-expanding metal stents for treatment of anastomotic complications after colorectal resection. Endoscopy 2013; 45:493-5. [PMID: 23733731 DOI: 10.1055/s-0032-1326488] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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: 12/10/2022]
Abstract
Self-expanding metal stents (SEMS) can be used to treat patients with symptomatic anastomotic complications after colorectal resection. In the present case series, 16 patients with symptomatic anastomotic stricture after colorectal resection were treated with endoscopic placement of SEMS. Seven patients had a "simple" anastomotic stricture and nine patients had a fistula associated with the stricture. The anastomotic fistula healed without evidence of residual stricture or major fecal incontinence in seven of the nine patients. Overall the anastomotic stricture was resolved in 10 of the 16 patients. SEMS placement represents a valid adjunctive to treatment in patients with symptomatic anastomotic complications after colorectal resection for cancer.
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Affiliation(s)
- A Lamazza
- Department of Surgery Pietro Valdoni, University of Rome La Sapienza, Rome, Italy.
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Albers M, Warr N, Nomura K, Blazhev A, Jolie J, Mücher D, Bastin B, Bauer C, Bernards C, Bettermann L, Bildstein V, Butterworth J, Cappellazzo M, Cederkäll J, Cline D, Darby I, Das Gupta S, Daugas JM, Davinson T, De Witte H, Diriken J, Filipescu D, Fiori E, Fransen C, Gaffney LP, Georgiev G, Gernhäuser R, Hackstein M, Heinze S, Hess H, Huyse M, Jenkins D, Konki J, Kowalczyk M, Kröll T, Krücken R, Litzinger J, Lutter R, Marginean N, Mihai C, Moschner K, Napiorkowski P, Singh BSN, Nowak K, Otsuka T, Pakarinen J, Pfeiffer M, Radeck D, Reiter P, Rigby S, Robledo LM, Rodríguez-Guzmán R, Rudigier M, Sarriguren P, Scheck M, Seidlitz M, Siebeck B, Simpson G, Thöle P, Thomas T, Van de Walle J, Van Duppen P, Vermeulen M, Voulot D, Wadsworth R, Wenander F, Wimmer K, Zell KO, Zielinska M. Evidence for a smooth onset of deformation in the neutron-rich Kr isotopes. Phys Rev Lett 2012; 108:062701. [PMID: 22401060 DOI: 10.1103/physrevlett.108.062701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Indexed: 05/31/2023]
Abstract
The neutron-rich nuclei 94,96Kr were studied via projectile Coulomb excitation at the REX-ISOLDE facility at CERN. Level energies of the first excited 2(+) states and their absolute E2 transition strengths to the ground state are determined and discussed in the context of the E(2(1)(+)) and B(E2;2(1)(+)→0(1)(+)) systematics of the krypton chain. Contrary to previously published results no sudden onset of deformation is observed. This experimental result is supported by a new proton-neutron interacting boson model calculation based on the constrained Hartree-Fock-Bogoliubov approach using the microscopic Gogny-D1M energy density functional.
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Affiliation(s)
- M Albers
- Institut für Kernphysik, Universität zu Köln, Köln, Germany.
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31
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Wimmer K, Kröll T, Krücken R, Bildstein V, Gernhäuser R, Bastin B, Bree N, Diriken J, Van Duppen P, Huyse M, Patronis N, Vermaelen P, Voulot D, Van de Walle J, Wenander F, Fraile LM, Chapman R, Hadinia B, Orlandi R, Smith JF, Lutter R, Thirolf PG, Labiche M, Blazhev A, Kalkühler M, Reiter P, Seidlitz M, Warr N, Macchiavelli AO, Jeppesen HB, Fiori E, Georgiev G, Schrieder G, Das Gupta S, Lo Bianco G, Nardelli S, Butterworth J, Johansen J, Riisager K. Discovery of the shape coexisting 0+ state in 32 Mg by a two neutron transfer reaction. Phys Rev Lett 2010; 105:252501. [PMID: 21231582 DOI: 10.1103/physrevlett.105.252501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Indexed: 05/30/2023]
Abstract
The "island of inversion" nucleus 32 Mg has been studied by a (t, p) two neutron transfer reaction in inverse kinematics at REX-ISOLDE. The shape coexistent excited 0+ state in 32 Mg has been identified by the characteristic angular distribution of the protons of the Δ L=0 transfer. The excitation energy of 1058 keV is much lower than predicted by any theoretical model. The low γ-ray intensity observed for the decay of this 0+ state indicates a lifetime of more than 10 ns. Deduced spectroscopic amplitudes are compared with occupation numbers from shell-model calculations.
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Affiliation(s)
- K Wimmer
- Physik Department E12, Technische Universität München, 85748 Garching, Germany
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32
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Gaudefroy L, Daugas JM, Hass M, Grévy S, Stodel C, Thomas JC, Perrot L, Girod M, Rossé B, Angélique JC, Balabanski DL, Fiori E, Force C, Georgiev G, Kameda D, Kumar V, Lozeva RL, Matea I, Méot V, Morel P, Singh BSN, Nowacki F, Simpson G. Shell Erosion and Shape Coexistence in (16)43S27. Phys Rev Lett 2009; 102:092501. [PMID: 19392514 DOI: 10.1103/physrevlett.102.092501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Revised: 12/17/2008] [Indexed: 05/27/2023]
Abstract
We report on the g-factor measurement of the first isomeric state in (16)43S27 [Ex=320.5(5) keV, T1/2=415(5) ns, and g=0.317(4)]. The 7/2- spin-parity of the isomer and the intruder nature of the ground state of the nucleus are experimentally established for the first time, providing direct and unambiguous evidence of the collapse of the N=28 shell closure in neutron-rich nuclei. The shell model, beyond the mean-field and semiempirical calculations, provides a very consistent description of this nucleus showing that a well deformed prolate and quasispherical states coexist at low energy.
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33
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Volpino P, Cangemi R, Fiori E, Cangemi B, De Cesare A, Corsi N, Di Cello T, Cangemi V. Risk of mortality from cardiovascular and respiratory causes in patients with chronic obstructive pulmonary disease submitted to follow-up after lung resection for non-small cell lung cancer. J Cardiovasc Surg (Torino) 2007; 48:375-83. [PMID: 17505444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
AIM Considerable controversy surrounds mortality from non-neoplastic diseases during the postoperative follow-up of patients with non-small cell lung cancer (NSCLC) and chronic obstructive pulmonary disease (COPD). This study investigated the incidence of mortality from cardiovascular and respiratory (CVR) causes in patients with COPD submitted to follow-up after lung resection for NSCLC, and identified preoperative and postoperative risk factors. METHODS A total of 398 patients with mild or moderate COPD were followed up in our department after lung resection for NSCLC (median follow-up 61 months). Statistical analysis of the data was carried out to determine the incidence and the prognostic factors of postoperative death from CVR causes. RESULTS Of the 398 resected patients, 186 survived without tumor recurrence; 24/186 (12.9%) died of CVR causes (acute respiratory failure, pneumonia, pulmonary embolism, acute pulmonary edema, acute myocardial ischemia or stroke). These 24 patients had a higher frequency of pre-existing coronary artery disease or heart failure (P=0.0003), predicted postoperative FEV1 <1000 mL (P=0.0008), exertional dyspnea (P=0.0000), and 30-day operative cardiopulmonary complications (P=0.001). Protective features were young age (<40 years), early stage disease, and minor resection (lobectomy). Independently significant adverse prognostic factors were stage III-IV disease (cumulative CVR death rate 47% at 5-10 years; P=0.028 vs. stage I-II) and completion pneumonectomy or partial resection of the other lung for a second primary tumor (cumulative CVR death rate 50% and 57%, respectively, at 5-10 years; P=0.0016 vs. all other resections). Older age and tumor histology were significant risk factors only in patients with advanced stage disease. CONCLUSION The findings suggest that postoperative CVR death may be expected in patients with COPD and advanced stage NSCLC or in those undergoing completion pneumonectomy or partial resection of the other lung for a second primary tumor. Other risk factors are previous coronary artery disease and/or heart failure, exertional dyspnea and predicted postoperative FEV1 <1000 mL.
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Affiliation(s)
- P Volpino
- Department of Surgery Pietro Valdoni, University La Sapienza, Rome, Italy.
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34
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Henschke C, Sone S, Markowitz S, Tockman M, Shaham D, Zulueta J, Fiori E, Kopel S, Rice K, Klippenstein D. PD-055 CT screening for lung cancer: Staging of multiple lung cancerswithout other evidence of metastases. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80388-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Izzo L, Stasolla A, Basso L, Caputo M, Kharrub Z, Marini M, Mingazzini P, Fiori E, Galati G, D'Aprile MR, Mele LL, Marini M. Characterization of tumoral lesions of the breast: preliminary experience with multislice spiral CT. J Exp Clin Cancer Res 2005; 24:209-15. [PMID: 16110753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The aim of the present study was to validate low dose Multislice Spiral Computed Tomography (MSCT) in the diagnosis of breast lesions. Fourteen patients with mammographic and ultrasound findings suspect of malignant neoplasm underwent dynamic MSCT of the breast under basal conditions and 1, 3, and 6 minutes after intravenous injection of iodinated contrast medium. Both enhancement of the lesion >100% without further increase after 6 minutes, and irregular margins of the lesion were considered signs of malignancy. All lesions were examined cytologically and/or histologically. A correct diagnosis was achieved by MSCT in 7/8 malignant lesions, and in 6/6 benign lesions. The only malignant lesion missed by MSCT was histologically a ductal carcinoma in situ (false negative). In one case the MSCT showed the multifocality of an infiltrating ductal carcinoma, and in another it defined the bilaterality of the malignant lesions. Sensitivity and specificity of MSCT in the diagnosis of malignancy of a lesion were 88% and 100%, respectively. Our results suggest that MSCT is an effective diagnostic method to define suspicious breast lesions, and a valid alternative to Magnetic Resonance Imaging, especially when the latter is not feasible.
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Affiliation(s)
- L Izzo
- Dept. of Surgery "Pietro Valdoni", University of Rome "La Sapienza" Medical School, Rome, Italy.
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36
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Izzo L, Sassayannis PG, Frati R, Stasolla A, Alradhi H, Caputo M, Costi U, Gabriele R, Biacchi D, Guerrisi R, Fiori E, Marini M. The role of Echo Colour/Power Doppler and magnetic resonance in expansive parotid lesions. J Exp Clin Cancer Res 2004; 23:585-92. [PMID: 15743028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The purpose of this research was to evaluate the role of Echo Colour/Power Doppler and Magnetic Resonance Imaging (MRI) in the diagnosis of expansive parotid lesions, and to establish criteria for differential diagnosis between benign and malignant forms. Forty nine patients (23 males and 26 females), aging from 30 to 85 years, with an expansive pathology of parotid gland were enrolled in our study from February 1999 through August 2004. Each patient was carefully assessed employing both ultrasonography integrated with Color/Power Doppler and MRI. Eventually, all patients received echo-guided needle-biopsy and surgical excision of the parotid lesion. Preliminary ultrasound assessed site, size, echoic appearance and margins of the lesion. In order to assess blood supply by means of Colour/Power Doppler, we divided the patients in four groups. Our MRI diagnostic criteria included site, size, intensity of signal, behaviour of the lesion after i.v. contrast, relationship with facial nerve and retromandibular vein, detection of margins and proximity to adjacent structures. On the basis of our results, the Authors concluded that both Echo Colour/Power Doppler and MRI play a very important role in the diagnosis and surgical planning of parotid gland lesions.
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Affiliation(s)
- L Izzo
- Dept. of Surgery, University La Sapienza, Rome, Italy.
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37
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Caporale A, Cosenza UM, Galati G, Fiori E, Benvenuto E, Giuliani A. Oesophagocardioplasty for residual dysphagia following multiple pneumatic dilatations for achalasia. Br J Surg 2004; 91:995-6. [PMID: 15286960 DOI: 10.1002/bjs.4555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A novel approach to a difficult problem
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Affiliation(s)
- A Caporale
- Department of Surgery Pietro Valdoni, University La Sapienza, viale del Policlinico 155, 00161 Rome, Italy.
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38
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Pastore D, Iacoangeli A, Galati G, Izzo L, Fiori E, Giuliani A, Castelli M, Risuleo G. Variations of telomerase activity in cultured mouse fibroblasts upon proliferation of polyomavirus. Anticancer Res 2004; 24:791-4. [PMID: 15161028] [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: 04/29/2023]
Abstract
Telomerase plays a central role in various biological phenomena such as cell differentiation and proliferation, apoptosis, malignant transformation and virus infection, for instance HIV and papillomavirus. In addition, it has recently been shown that, in human fibroblasts transformed by monkey polyomavirus SV40, telomeres became stabilized as a consequence of telomerase activation. However, no information exists on the effects of acute infection by murine polyomavirus on the telomeres maintenance and telomerase activity in the host cell. In this paper we report on a differential activity of telomerase in productively infected cells. The results showed a decreased activity of the enzyme as assessed by the TRAP assay. The decrease had already occurred at a non-lytic time of infection and was observed both after infection and naked DNA transfection. Therefore nuclear decapsidation is not involved in the determination of the phenomenon that is attributed to the proliferation of the virus.
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Affiliation(s)
- D Pastore
- Dipartimento di Medicina Interna, Laboratorio di Medicina Molecolare, Universita' di Roma Tor Vergata, Rome, Italy
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39
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Galati G, Fiori E, Sammartino F, Cosenza M, Teggi A, Tiziano G, Bolognese A. [Unusual localizations of hydatid cyst. Epidemiological aspects and diagnostic problems. Description of a clinical case]. MINERVA CHIR 2003; 58:231-4. [PMID: 12738932] [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: 03/02/2023]
Abstract
A rare case of primary hydatid cyst of the mesentery is described. Though cystic echinococcosis infestation can occur in any part of the body primary peritoneal involvement is rare. The mechanism of primitive peritoneal infection by the parasite is still unclear. The hypotheses which can explain this rare primary localization, the sensitivity and the specificity of the serological and instrumental tests and the therapeutic management of this atypical lesion are discussed.
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Affiliation(s)
- G Galati
- Dipartimento di Chirurgia Generale Pietro Valdoni, Università degli Studi di Roma La Sapienza, Roma, Italy
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40
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Izzo L, Caputo M, Tiziano G, Sammartino F, Galati G, Fiori E, Binda B, Bononi M. [Intrabiliary rupture of hepatic echinococcosis cysts: presentation of a clinical case and review of the literature]. G Chir 2003; 24:92-5. [PMID: 12822215] [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: 03/03/2023]
Abstract
Intrabiliary rupture of hydatid cyst of liver is a complication of hydatid disease. The authors report the case of a patient surgically treated by total pericistectomy and suture communication with biliary system, the best treatment for this condition.
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Affiliation(s)
- L Izzo
- Dipartimento di Chirurgia Pietro Valdoni, Università degli Studi La Sapienza, Roma
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41
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Fiori E, Galati G, Bononi M, De Cesare A, Binda B, Ciardi A, Volpino P, Cangemi V, Izzo L. Subcutaneous metastasis of pancreatic cancer in the site of percutaneous biliary drainage. J Exp Clin Cancer Res 2003; 22:151-4. [PMID: 12725336] [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: 03/02/2023]
Abstract
A subcutaneous metastatic lesion from a carcinoma of the pancreas or common bile-duct along the tract of a percutaneous transhepatic biliary drainage is a rare finding. Prompted by a case that came to our observation by chance, we reviewed the literature and analysed the 29 cases collected. Neoplastic cell seeding along a percutaneous drainage tract, albeit rare, must be kept in mind. The complication can be avoided if patients at risk, whenever possible, undergo endoscopic drainage.
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Affiliation(s)
- E Fiori
- Dept. of General Surgery Pietro Valdoni, University of Rome La Sapienza, Rome, Italy.
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42
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Fiori E, De Cesare A, Galati G, Bononi M, D'Andrea N, Barbarosos A, Izzo L, Bolognese A. Prognostic significance of primary-tumor extension, stage and grade of nuclear differentiation in patients with renal cell carcinoma. J Exp Clin Cancer Res 2002; 21:229-32. [PMID: 12148583] [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: 02/26/2023]
Abstract
Surgery remains the preferred therapy for renal cell carcinoma. The various adjunctive or complementary therapies currently yield disappointing results. Identifying reliable prognostic factors could help in selecting patients most likely to benefit from postoperative adjuvant therapies. We reviewed the surgical records of 78 patients who had undergone radical nephrectomy with lymphadenectomy for renal cell carcinoma, matched for type of operation and histology. According to staging (TNM), 5.1% of the patients were classified as stage I, 51.3% as stage II, 29.5% as stage III and 14.5% as stage IV. Of the 78 patients 40 were T2N0 and 21 T3aN0. Tumor grading showed that 39.7% of the patients had well-differentiated tumors(G1), 41.1% moderately-differentiated (G2), and 19.2% poorly-differentiated tumors (G3). Overall actuarial survival at 5 and 10 years was 100% for stage 1; 91.3% at 5 years and 83.1% at 10 years for stage II; 45.5% and 34.1% for stage III; and 29.1% and nil for stage IV (stage II vs stage III p = 0.0001). Patients with tumors confined to the kidney (pT2N0) had better 5- and 10-year survival rates than patients with tumors infiltrating the perirenal fat (pT3aN0) (p = 0.000006). Survival differed according to nuclear grading (G1 vs G3 ; p = 0.000005; G2 vs G3; p = 0.0009). In conclusion our review identified tumor stage, primary-tumor extension, and the grade of nuclear differentiation as reliable prognostic factors in patients with renal cell carcinomas.
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Affiliation(s)
- E Fiori
- Dept. of General Surgery Pietro Valdoni, University of Rome La Sapienza, Italy.
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43
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Galati G, Sammartino F, Tiziano G, Fiori E, Bononi M, Caputo M, Gazzanelli S. [Non-Hodgkin's lymphoma of the testis. Report of a clinical case and review of the literature]. G Chir 2002; 23:257-9. [PMID: 12422782] [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: 02/27/2023]
Abstract
The Authors report a case of primary non-Hodgkin's lymphoma of the testis. Although lymphoma is a rare neoplasm, it is commonest tumor in the elderly age. Surgical therapy is essential but some times it can be associated to radio-chemotherapy.
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Affiliation(s)
- G Galati
- Dipartimento di Chirurgia Pietro Valdoni, Università degli Studi La Sapienza Roma
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44
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Fiori E, Mazzoni G, Galati G, Lutzu SE, Cesare A, Bononi M, Bolognese A, Tocchi A. Unusual breakage of a plastic biliary endoprosthesis causing an enterocutaneous fistula. Surg Endosc 2002; 16:870. [PMID: 11997843 DOI: 10.1007/s004640042021] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2000] [Accepted: 11/23/2001] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of our study was to illustrate a case of endoscopically placed biliary stent breakage. METHODS A72-year-old woman with a prolonged history of cholangitis following laparoscopic cholecistectomy was referred to our institution 8 years ago. Dilatation of the intra- and extrahepatic biliary tree and a benign stricture at the cystic confluence were observed at US and endoscopic retrograde cholangiopancreatography (ERCP). A 12-F gauge plastic endoprosthesis was placed. In the absence of any symptoms, breakage of the stent was revealed 18 months later at plain radiology. Eight years later an enterocutaneous fistula occurred originating from a jejunal loop containing the indwelled distal part of the stent. Surgery was undertaken and the distal part of the stent removed with the perforated jejunal loop. The proximal part was successively endoscopically removed. CONCLUSIONS Disruption of a biliary endoprosthesis is observed in patients in whom the stent is kept in situ for a long period or consequent to exchange. The removal and exchange is mandatory when the stent disruption is followed by cholangitis. In the current case, because of the absence of any symptoms the removal of the stent was not attempted. Immediate endoscopic removal of the prosthetic fragments seems to be the treatment of choice for replacement of a new stent.
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Affiliation(s)
- E Fiori
- Medical School, I Department of Surgery, University of Rome, "La Sapienza" 00191 Rome, Italy.
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45
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Cangemi V, Borghese M, Fiori E, Bononi M, Ricci F, Cangemi R, Galati G, Montalto R, Volpino P. Giant diverticulum of the sigmoid colon with perforation. Report of a case. MINERVA CHIR 2002; 57:213-6. [PMID: 11941296] [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: 02/24/2023]
Abstract
We present a case of perforated giant diverticulum of the sigmoid colon. This condition is extremely rare and only a few cases have so far been reported in the literature. Our case involved a 55-year old woman. Diagnosis was easy with barium enema and CT scan examination. Laparotomy revealed a giant diverticulum of the sigmoid colon compressing adjacent structures with signs of inflammation. An en bloc resection of the sigmoid colon, ovary and fallopian tube was performed with primary colon-rectal anastomosis. The post-operative course was uneventful.
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Affiliation(s)
- V Cangemi
- Department of Surgery, University of Rome La Sapienza, Rome, Italy
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46
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Galati G, Giuliani A, Fiori E, Tiziano G, Sammartino F, Benvenuto E, Montone G. [Considerations and results of the use of paramomycin in the prevention of infectious complications in colorectal surgery]. G Chir 2002; 23:154-6. [PMID: 12164005] [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: 02/26/2023]
Abstract
The efficacy of short term prophylaxis in the prevention of infection has been tested in 72 patients who underwent surgical treatment for colorectal pathology. General tolerance to the antibiotics was good. The Authors took this remark as a starting point for reviewing the literature and making comments.
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Affiliation(s)
- G Galati
- Dipartimento di Chirurgia Pietro Valdoni, Divisione di i Patologia Chirurgica, Università degli Studi La Sapienza, Roma
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47
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Galati G, Fiori E, Tiziano G, Sammartino F, De Cesare A, Bononi M, Barbarosos A, Bolognese A. [Apudoma of Vater's ampulla: case report and review of the literature]. G Chir 2002; 23:97-100. [PMID: 12109233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The Authors report a case of Vater's ampulla apudoma and after having examined the characteristics of these neoplasms they discuss clinical presentation, diagnostic and treatment problems of islet cell adenomas. They review the literature and make some remarks.
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Affiliation(s)
- G Galati
- Dipartimento di Chirurgia Pietro Valdoni, Università degli Studi La Sapienza, Roma
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48
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Galati G, Fiori E, De Cesare A, Bononi M, Sammartino F, Tiziano G, Cosenza M, Barbarosos A, Bolognese A. [Retroperitoneal leiomyosarcoma: clinical case]. G Chir 2002; 23:85-7. [PMID: 12109230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The Authors have reported a case of retroperitoneal leiomyosarcoma. The retroperitoneal localization is quite unusual and early diagnosis is difficult. Only surgery operation and radio-chemotherapy can improve the prognosis. Tumor size is the major prognostic factor.
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Affiliation(s)
- G Galati
- Dipartimento di Chirurgia Pietro Valdoni, Università degli Studi La Sapienza, Roma
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49
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Galati G, Giuliani A, Fiori E, Tiziano G, Sammartino F, Benvenuto E, Meucci M. [Is blood transfusion a risk factor in colorectal surgery for cancer?]. G Chir 2002; 23:26-8. [PMID: 12043466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Personal experience in the treatment of 93 cases of cancer of the large bowel and rectal localization is reported 32 patients (A group) received blood transfusions, 61 patients (B group) hadn't any transfusions or autotransfusions. Postoperative morbidity was 34.37% in A group and 14.75% in B group. The Authors stress the basic importance of autotransfusions as well in patients surgically treated for colorectal cancer.
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Affiliation(s)
- G Galati
- Dipartimento di Chirurgia Pietro Valdoni, Università degli Studi La Sapienza, Roma
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50
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Gazzanelli S, Fiori E, Di Giulio E, Sammartino F, Galati G, Piat G. [Emergency treatment of bleeding esophageal varices]. MINERVA CHIR 2001; 56:573-81. [PMID: 11721201] [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: 02/22/2023]
Abstract
BACKGROUND The hemorrhage from breakup of the varix esophageal is a dramatic complication of the hypertension of the circle portal, numerous attempts have stayed performed for identify the patients that present taller risk of hemorrhage, to the purpose of to establish the preventive more proper measures to arrive before the first episode of hemorrhage. The treatment of the patient with high pressure portal stays still today extremely controversial, to concern the choice of the more opportune strategies, that for it as concerns the choice of the better moment for effect the single therapies. METHODS We have taken 63 patients treatises in urgency for esophageal variceal bleeding in consideration, we of the initial group of the 63 patients have subjected endoscopic 34 patients, subjected elastic binding of the varix 20 patients, and to derivative interventions in urgency 9 patients. RESULTS The results to distance after surgical treatment for it as concern the rise of encephalopatia it show a percentage of the 60% of patient and the actuarial survival to 5 ages is of the 33.3%. CONCLUSIONS In conclusion seem us of power affirm that the role of the endoscopic of the esophageal varix is prominent in the management of massive acute esophageal bleeding.
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Affiliation(s)
- S Gazzanelli
- I Divisione di Patologia Speciale Chirurgica, Policlinico Umberto I, Università La Sapienza, Rome, Italy
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