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Esposito G, Montalto C, Crimi G, Grippo R, Morici N, Bruschi G, Testa L, De Marco F, Soriano F, Nava S, Stefanini G, Bedogni F, Oreglia JA. Time course of ischemic and bleeding burden in consecutive patients undergoing transcatheter aortic valve replacement (FOCUS-ONE registry). Int J Cardiol 2023; 381:2-7. [PMID: 36898584 DOI: 10.1016/j.ijcard.2023.03.009] [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: 12/18/2022] [Revised: 02/25/2023] [Accepted: 03/05/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND AND AIMS Ischemic or bleeding events might occur after transcatheter aortic valve replacement (TAVR), with the potential to hamper clinical outcomes. This study aimed to characterize the average daily ischemic risks (ADIRs) and the average daily bleeding risks (ADBRs) over 1-year in all consecutive patients undergoing TAVR. METHODS ADBR included all bleeding events according to VARC-2 definition, and ADIR included cardiovascular deaths, myocardial infarction and ischemic stroke. ADIRs and ADBRs were assessed within different timeframes post TAVR: acute (0-30 days), late (31-180 days), and very late (>181 days). Generalized estimating equations were used to test the least squares mean differences for the pairwise comparison of ADIRs and ADBRs. Our analysis was performed in the overall cohort and according to antithrombotic strategy (LT-OAC vs No LT-OAC). RESULTS Ischemic burden was higher than bleeding burden, independently from the indication to LT-OAC, and in all timeframes examined. In the overall population, ADIRs were three-fold ADBRs (0.0467 [95% CI, 0.0431-0.0506] vs 0.0179 [95% CI, 0.0174-0.0185]; p < 0.001*). While ADIR was significantly higher in the acute phase, ADBR was relatively stable in all timeframes analysed. Of note, in LT-OAC population, OAC + SAPT group showed lower ischemic risk and higher bleeding events compared with OAC alone (ADIR: 0.0447 [95% CI: 0.0417-0.0477] vs 0.0642 [95% CI: 0.0557-0.0728]; p < 0.001*, ADBR 0.0395 [95% CI: 0.0381-0.0409] vs 0.0147 [95% CI: 0.0138-0.0156]; p < 0.001*). CONCLUSIONS In patients undergoing TAVR Average daily risk fluctuates over time. However, ADIRs overcome ADBRs in all timeframes, especially in the acute phase and regardless of antithrombotic strategy adopted.
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Affiliation(s)
- G Esposito
- Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy.
| | - C Montalto
- Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - G Crimi
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV), IRCCS, Ospedale Policlinico San Martino, Genoa, Italy.
| | - R Grippo
- Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - N Morici
- IRCCS S. Maria Nascente - Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - G Bruschi
- Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - L Testa
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - F De Marco
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - F Soriano
- Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - S Nava
- Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Italy- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - F Bedogni
- IRCCS S. Maria Nascente - Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - J A Oreglia
- Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
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Cappellari AM, Lanfranchi C, Bruschi G, Petaccia A. Sydenham's chorea: A diagnosis not to miss. Rev Neurol (Paris) 2022; 178:855-856. [PMID: 36137829 DOI: 10.1016/j.neurol.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/17/2022] [Accepted: 04/02/2022] [Indexed: 10/14/2022]
Affiliation(s)
- A M Cappellari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience, Milano, Italy.
| | | | - G Bruschi
- Università degli studi di MIlano, Milano, Italy
| | - A Petaccia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pediatric Rheumatology, Milano, Italy
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3
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Carrozzini M, Merlanti B, Olivieri G, Bruschi G, Tata G, Barbiero M, Lanfranconi M, Mondino M, Russo C. The Protek-Duo Cannula for Temporary Percutaneous Right Ventricular Support: An Early Single-Centre Experience. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Giannini C, Angelillis M, Fiorina C, Tamburino C, Bedogni F, Bruschi G, Montorfano M, Poli A, De Felice F, Reimers B, Branca L, Barbanti M, Testa L, Merlanti B, Petronio AS. Clinical impact and evolution of mitral regurgitation after TAVI using the new generation self-expandable valves. Int J Cardiol 2021; 335:85-92. [PMID: 33811960 DOI: 10.1016/j.ijcard.2021.03.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/31/2020] [Accepted: 03/29/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Concomitant mitral regurgitation (MR) impaired prognosis in patients undergoing transcatheter aortic valve implantation (TAVI). It has been suggested that the use of first generation self-expandable valve in patients with significant MR is associated with worse outcome as compared with balloon expandable valve. However, the impact of newer generation transcatheter devices on MR has not been investigated so far. We aim to assess the prognostic impact of MR in patients undergoing TAVI with the first-generation vs. the latest generation of self-expandable valves. METHODS We analyzed 2964 consecutive patients who underwent TAVI. Patients were classified into 4 groups according to the degree of baseline MR and the generation of self expandable valve implanted. RESULTS Of 1234 patients with moderate or severe MR, 817 were treated with first generation and 417 patients with second generation valves. Whereas, of 1730 patients with no or mild MR, 1130 were treated with first generation and 600 patients with second generation valves. Although, concomitant moderate-severe MR was found to be an independent predictor of mortality after TAVI, the use of newer generation self expandable valves was associated with higher survival rate at 1 year irrespective of the degree of preprocedural MR. At multivariable analysis the use of newer generation valve was associated with MR improvement throughout 1 year follow-up. CONCLUSION Baseline moderate-severe MR is associated with an increase in mortality after TAVI. However, the degree of preprocedural MR doesn't impact survival when a second generation self expandable valve is used.
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Affiliation(s)
- C Giannini
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - M Angelillis
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - C Tamburino
- Ferrarotto Hospital, University of Catania, Catania, Italy
| | - F Bedogni
- Policlinico San Donato, San Donato, Italy
| | - G Bruschi
- "De Gasperis" Cardio Center ASST Niguarda Metropolitan Hospital, Milan, Italy
| | | | - A Poli
- Ospedale Civile, Legnano, Italy
| | | | - B Reimers
- Clinical Institute Humanitas, Rozzano, Milan, Italy
| | | | - M Barbanti
- Ferrarotto Hospital, University of Catania, Catania, Italy
| | - L Testa
- Policlinico San Donato, San Donato, Italy
| | - B Merlanti
- "De Gasperis" Cardio Center ASST Niguarda Metropolitan Hospital, Milan, Italy
| | - A S Petronio
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Polimeni A, Sorrentino S, Crea P, Spaccarotella C, Mongiardo A, De Rosa S, Zangara S, Bruschi G, Lopera Quijada M, Cenci C, Mercuro G, Indolfi C. Sex-related trends of cardiovascular risk perception and prevention behaviors: results from the italian society of cardiovascular survey. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3178] [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
Recent reports evidenced gender differences in the knowledge, perception and awareness of cardiovascular risk factors and cardiovascular diseases.
Purposes
To evaluate trends in awareness of cardiovascular risk, as well as knowledge of symptoms and preventive behaviors related to cardiovascular disease (CVD).
Methods
As part of Vivi con il Cuore (campaign with the goal of raising awareness about women's heart disease) a nationwide survey was conducted. Standardized questions on awareness of CVD risk, as well as prevention behaviors and barriers, were provided through a computer-assisted web interviewing platform to a large sample of Italians citizens ranging from 40 to 70 years old. The sample was representative of the population by age, sex, and area of geographical residence.
Results
A total of 1,000 subjects were included in this survey, of which 511 (51%) female. About 60% of women indicated cancer as the leading cause of death among female sex, while only 22% indicated cardiovascular disease. Similarly, when the same question was asked to men, 44% indicated cancer and 21% cardiovascular disease, observations that were consistent across age categories. Although a well sizable part of the population (90% of the interviewees) have consulted the general practitioner in the last year, only 45% of women and 56% of men declared to receive information about CVD risk. Almost 84% among men and women, recognized the importance of knowing how to understand the symptoms of a heart attack due to the possibility of survival. An additional survey was conducted among young cardiologists under 40 years old, including a total of 200 young cardiologists, similarly distributed among men and women (47% and 53% respectively). About 24% of young cardiologists indicated breast cancer as the leading cause of death in women, while only 70% reported cardiovascular diseases. Furthermore, 35% of participants reported that they did not have adequate training on the risks of heart disease in women.
Conclusions
In this survey, only 22% of women were aware that cardiovascular disease is the number one killer of women. Likewise, a well sizable part of young cardiologists (30%) does not recognize cardiovascular disease as the leading cause of death in women. These data should inform public health campaigns to focus on evidence-based strategies to prevent CVD and to help target messages that resonate and motivate women to take action.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Abbott
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Affiliation(s)
- A Polimeni
- Magna Graecia University of Catanzaro, Division of Cardiology, Catanzaro, Italy
| | - S Sorrentino
- Magna Graecia University of Catanzaro, Division of Cardiology, Catanzaro, Italy
| | - P Crea
- University of Messina, Messina, Italy
| | - C Spaccarotella
- Magna Graecia University of Catanzaro, Division of Cardiology, Catanzaro, Italy
| | - A Mongiardo
- Magna Graecia University of Catanzaro, Division of Cardiology, Catanzaro, Italy
| | - S De Rosa
- Magna Graecia University of Catanzaro, Division of Cardiology, Catanzaro, Italy
| | | | | | | | - C Cenci
- Senior Partner Eikon Strategic Consulting, Rome, Italy
| | - G Mercuro
- University of Cagliari, Division of Cardiology, Cagliari, Italy
| | - C Indolfi
- Magna Graecia University of Catanzaro, Division of Cardiology, Catanzaro, Italy
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Cannata A, Bruschi G, Merlanti B, Costetti A, Marchetti C, Passini L, Tata G, Russo C. ISOLATED AORTIC VALVE REPLACEMENT. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550035.05013.d5] [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: 11/05/2022]
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Baldo A, Martina P, Lettieri C, Reimers B, Musto C, Fiorina C, Adamo M, Bruschi G, Petronio AS, Giannini C, Barbanti M, Tamburino C, Testa L, Bedogni F, Poli A. P1676Safety and efficacy of trans-subclavian aortic valve implantation in obese patients: a propensity-matched cohort of trans-subclavian versus trans-femoral approach. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Baldo
- University of Pavia, Cardiology, Pavia, Italy
| | - P Martina
- Civil Hospital of Legnano, Cardiology, Legnano, Italy
| | - C Lettieri
- Hospital Carlo Poma, Cardiology, Mantova, Italy
| | - B Reimers
- Istituto Clinico Humanitas, Milan, Italy
| | - C Musto
- San Camillo Forlanini Hospital, Rome, Italy
| | - C Fiorina
- Civil Hospital of Brescia, Brescia, Italy
| | - M Adamo
- Civil Hospital of Brescia, Brescia, Italy
| | - G Bruschi
- Niguarda Ca' Granda Hospital, Milan, Italy
| | | | | | | | | | - L Testa
- IRCCS, Policlinico San Donato, San Donato Milanese, Italy
| | - F Bedogni
- IRCCS, Policlinico San Donato, San Donato Milanese, Italy
| | - A Poli
- Civil Hospital of Legnano, Cardiology, Legnano, Italy
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8
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Stefanini G, Bruschi G, Cao D, Petronio A, Giannini C, Fiorina C, Adamo M, Colombo P, Latib A, Agnifili M, Poli A, Tamburino C, Fabbiocchi F, Giudice P, Reimers B. 1282Impact of antithrombotic strategies on clinical outcomes after self-expandable TAVI. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.1282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bruschi G, Moat N. 337 * DIRECT AORTIC IMPLANTATION OF A SELF-EXPANDING TRANSCATHETER AORTIC VALVE LEADS TO FAVOURABLE OUTCOMES. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.337] [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: 11/13/2022] Open
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Becatti M, Marcucci R, Bruschi G, Taddei N, Bani D, Gori AM, Giusti B, Gensini GF, Abbate R, Fiorillo C. Oxidative Modification of Fibrinogen Is Associated With Altered Function and Structure in the Subacute Phase of Myocardial Infarction. Arterioscler Thromb Vasc Biol 2014; 34:1355-61. [DOI: 10.1161/atvbaha.114.303785] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Botta L, Caruso R, Cannata A, Bruschi G, Milazzo F, Nonini S, Campolo J, Lanfranconi M, Russo C, Marraccini P, Frigerio M, Parodi O, Martinelli L. Systemic Inflammation in End-Stage Heart Failure Patients Undergoing Different Axial-Flow Left Ventricular Assist Devices. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Bruschi G, Botta L, De Marco F, Colombo P, Barosi A, Mondino M, Klugmann S, Martinelli L. 141 * MINI-THORACOTOMY DIRECT AORTIC SELF-EXPANDING TRANSCATHETER AORTIC VALVE IMPLANTATION: A SINGLE-CENTRE EXPERIENCE. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Botta L, Cannata A, Bruschi G, Colombo T, Russo CF, Paino R, Ammirati E, Frigerio M, Martinelli L. 197 * LEFT VENTRICULAR ASSIST DEVICE VERSUS HEART TRANSPLANTATION IN PATIENTS OVER 60 YEARS: A SINGLE-CENTRE EXPERIENCE. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.197] [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: 11/13/2022] Open
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Botta L, Fratto P, Cannata A, Bruschi G, Rampoldi A, Martinelli L. Aortic-arch Reconstruction with Bolton Medical Branched Thoracic Stent Graft. Eur J Vasc Endovasc Surg 2013. [DOI: 10.1016/j.ejvs.2013.01.020] [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: 11/29/2022]
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Ahmadi N, Negrão S, Katsantonis D, Frouin J, Ploux J, Letourmy P, Droc G, Babo P, Trindade H, Bruschi G, Greco R, Oliveira MM, Piffanelli P, Courtois B. Targeted association analysis identified japonica rice varieties achieving Na(+)/K (+) homeostasis without the allelic make-up of the salt tolerant indica variety Nona Bokra. Theor Appl Genet 2011; 123:881-95. [PMID: 21713536 DOI: 10.1007/s00122-011-1634-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 05/31/2011] [Indexed: 05/18/2023]
Abstract
During the last decade, a large number of QTLs and candidate genes for rice tolerance to salinity have been reported. Using 124 SNP and 52 SSR markers, we targeted 14 QTLs and 65 candidate genes for association mapping within the European Rice Core collection (ERCC) comprising 180 japonica accessions. Significant differences in phenotypic response to salinity were observed. Nineteen distinct loci significantly associated with one or more phenotypic response traits were detected. Linkage disequilibrium between these loci was extremely low, indicating a random distribution of favourable alleles in the ERCC. Analysis of the function of these loci indicated that all major tolerance mechanisms were present in the ERCC although the useful level of expression of the different mechanisms was scattered among different accessions. Under moderate salinity stress some accessions achieved the same level of control of Na(+) concentration and Na(+)/K(+) equilibrium as the indica reference variety for salinity tolerance Nona Bokra, although without sharing the same alleles at several loci associated with Na(+) concentration. This suggests (a) differences between indica and japonica subspecies in the effect of QTLs and genes involved in salinity tolerance and (b) further potential for the improvement of tolerance to salinity above the tolerance level of Nona Bokra, provided the underlying mechanisms are complementary at the whole plant level. No accession carried all favourable alleles, or showed the best phenotypic responses for all traits measured. At least nine accessions were needed to assemble the favourable alleles and all the best phenotypic responses. An effective strategy for the accumulation of the favourable alleles would be marker-assisted population improvement.
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Affiliation(s)
- N Ahmadi
- CIRAD, UPR AIVA, 34398 Montpellier, France.
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Bruschi G, Botta L, Colombo T, Busnach G, Pedrazzini G, Cannata A, Trunfio S, Macera F, Turazza F, Oliva F, Sansalone CV, Paino R, Frigerio M, Martinelli L. Combined heart and kidney transplantation: long-term analysis of renal function and major adverse events at 20 years. Transplant Proc 2010; 42:1283-5. [PMID: 20534282 DOI: 10.1016/j.transproceed.2010.03.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Combined heart-kidney transplantation (HKTx) is an accepted therapeutic option for patients with end-stage heart disease associated with severely impaired renal function. We report our long-term follow-up with this combined procedure. PATIENTS AND METHODS Between April 1989 to November 2009, nine patients underwent combined simultaneous (HKTx) at our center. Seven patients were males (mean age 45.2 +/- 10.12 years); seven patients were on dialysis at the time of transplantation. RESULTS Surgical procedures were uneventful in all patients. One patient died in the intensive care unit 41 days after transplantation. During long-term follow-up, three patients died: one due to infection and multiorgan failure 148 months after HKTx, one due to a lung neoplasm after 6 years, and one, a cerebral stroke at 34 months after transplantation. Only one patient experience renal allograft failure secondary to hypertension and cyclosporine nephrotoxicity at 10 years after HKTx with the need for renal replacement therapy. Last estimated glomerular filtration rates of all other patients was 61.3 +/- 17.4 mL/min. CONCLUSIONS In selected patients, with coexisting end-stage cardiac and renal failure, combined HKTx with an allograft from the same donor proved to give satisfactory short- and long-term results, with a low incidence of both cardiac and renal allograft complications.
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Affiliation(s)
- G Bruschi
- Cardiology & Cardiac Surgery Department A De Gasperis, Niguarda Ca' Granda Hospital, Milan, Italy.
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Colombo P, Bruschi G, Sacco A, Oreglia J, De Marco F, Colombo T, Botta L, Macera F, Turazza F, Frigerio M, Martinelli L, Klugmann S. Percutaneous Coronary Interventions in Cardiac Allograft Vasculopathy: A Single-Center Experience. Transplant Proc 2010; 42:1286-90. [DOI: 10.1016/j.transproceed.2010.03.065] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bruschi G, Colombo T, Trunfio S, Ribera E, Russo C, Turazza F, Oliva F, Frigerio M, Martinelli L. 218: It There Still a Role for Undersized Mitral Annuloplasty for Mitral Regurgitation in End-Stage Dilated Cardiomyopathy: Single Centre Long Term Follow-Up. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.848] [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: 11/25/2022] Open
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Ribera E, Bruschi G, Austoni P, Vignati G, Corato A, Marianeschi S, Paino R, Firgerio M, Martinelli L, Santoro F. 372: Heart Transplantation in Adults with Congenital Heart Disease. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.379] [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: 11/25/2022] Open
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Colombo P, Bruschi G, Sacco A, Silva P, Turazza F, Frigerio M, Martinelli L, Klugmann S. 379: Does Drug-Eluting Stents Reduce In-Stent Re-Stenosis in Cardiac Allograft Vasculopathy? A Single Center Experience. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Colombo P, Bruschi G, Silva P, Sacco A, Turazza F, Frigerio M, Klugmann S. 521: Cardiac Allograft Vasculopathy: Is There a Role for Percutaneous Coronary Intervention? A Single Centre Experience. J Heart Lung Transplant 2008. [DOI: 10.1016/j.healun.2007.11.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Bruschi G, Colombo T, Conforti S, Rinaldo A, Fieschi S, Pedrazzini G, Campisi S, Turazza F, Oliva F, Frigerio M, Ravini M, Vitali E. 492: Short and long-term survival after surgery for lung cancer in heart transplant recipients. J Heart Lung Transplant 2007. [DOI: 10.1016/j.healun.2006.11.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Bruschi G, Colombo P, Frigerio M, Garascia A, Silva P, Bossi I, Klugmann S, Vitali E. 261. J Heart Lung Transplant 2006. [DOI: 10.1016/j.healun.2005.11.271] [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] Open
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Farè S, Brunella MF, Bruschi G, Cigada A, Vitali E. Materials characterization of explanted mechanical heart valves and comparison to patients' clinical data. Int J Artif Organs 2005; 28:701-10. [PMID: 16049904 DOI: 10.1177/039139880502800709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the present study, twelve explanted mechanical heart valves (MHVs)with pyrolitic carbon tilting disc and 14 bileaflet MHVs were analyzed to investigate the effects of material properties on valve performance and patients' general health conditions. Optical and scanning electron microscopy was used to investigate material imperfections, wear patterns or damages to housing and occluder components. All analyzed tilting disc valves exhibited wear effects, particularly due to abrasion and impact to both disc and housing. Wear of pyrolitic carbon disc and housing did not influence their in vivo performance. In the bileaflet MHVs, breakaway of the pyrolitic carbon coating sometimes caused malfunctioning and required surgical retrieval of the valve. In all cases, occurrence of clinical symptoms was more likely when wear effects were located in critical areas. The study supports a correlation between the properties of the MHVs material and patients' symptoms.
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Affiliation(s)
- S Farè
- Department of Bioengineering, Politecnico di Milano, Milano, Italy
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Garatti A, Colombo T, Russo C, Lanfranconi M, Bruschi G, Milazzo F, Catena E, Vitali E. Impella recover 100 microaxial left ventricular assist device: the Niguarda experience. Transplant Proc 2004; 36:623-6. [PMID: 15110614 DOI: 10.1016/j.transproceed.2004.02.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Impella Recover 100 (IR100) is an intravascular microaxial blood pump used to support blood circulation for a maximum of 7 days in cases of reduced left ventricular function, for example in postcardiotomy low output syndrome or in cardiogenic shock after acute myocardial infarction. MATERIALS AND METHODS We supported five patients with the IR100. The mean age, cardiac index (CI), and ejection fraction (EF) of our population were 42 years, 1.83 L/min/m(2), and 20%, respectively. Two patients (group A) with ischemic dilated cardiomyopathy were bridged to heart transplant. Two patients (group B) with fulminan myocarditis and septic shock were bridged to recovery. One patient, with severe valvular cardiomyopathy who underwent aortic valve replacement and mitral valve annuloplasty, was supported to weaning from ECC. RESULTS Mean support time was 9.8 +/- 2.3 days. Only one acute myocarditis patient died from a severe vasoplegic syndrome despite maximal inotropic and vasoactive support. Both group A patients were successfully transplanted. Among group B, the second patient resolved the septic status and was slowly weaned from the device and discharged home with moderate improvement of LV function (EF = 40%). Patient C was weaned from the IR100 and electively placed on the heart transplant recipient list. CONCLUSIONS IR100 is a device that in our experience can be utilized for various indications for short-term support. In compromised patients where a traditional LVAD is contraindicated, the IR100 showed good results, for it is minimally invasive and does not need ECC or systemic anticoagulation.
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Affiliation(s)
- A Garatti
- Cardiac Surgery Division, A. De Gasperis Department, Niguarda Ca'Granda Hospital, Milan, Italy
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Vitali E, Lanfranconi M, Bruschi G, Ribera E, Garatti A, Colombo T, Russo CF. Mechanical circulatory support in severe heart failure: single-center experience. Transplant Proc 2004; 36:620-2. [PMID: 15110613 DOI: 10.1016/j.transproceed.2004.02.050] [Citation(s) in RCA: 4] [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: 10/26/2022]
Abstract
Ventricular assist devices (VADs) have become important therapeutic tools to treat patients with end-stage cardiac failure. VADs are an essential component of transplantation programs as they successfully bridge individuals who would otherwise die. Recently left ventricular VAD (LVAD) therapy has been proposed as alternative to heart transplantation (HTx) for patients who are not transplant candidates. Other indications have now expanded into areas such as postcardiotomy failure, acute myocarditis, and acute massive myocardial infarction. From 1988 to May 2003, 80 patients received left or biventricular mechanical circulatory support including 78 as a bridge to and two as an alternative to HT. All patients survived the operation. Mean duration of VAD support was 77 +/- 150 days. Fifty-one points (63.8%) underwent heart transplantation; 3 (3.8%) recovered and were weaned from VADs. Major bleeding episodes occurred in 11 patients (13.8%) and major neurologic events occurred in 8 (10%). Sixteen patients (20%) were discharged home while waiting for HTx. Twenty-two patients (27.5%) died on VAD. In conclusion, VAD therapy proved effective in bridging patients with end-stage heart failure to HTx. While on LVAD support patients who were assisted with implantable wearable devices could be discharged at home, improving their quality of life.
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Affiliation(s)
- E Vitali
- Department of Cardiac Surgery "Angelo De Gasperis," Niguarda Cà Granda Hospital, Milan, Italy.
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Vitali E, Lanfranconi M, Bruschi G, Colombo T, Russo C. Combined surgical approach to coexistent carotid and coronary artery disease: early and late results. Cardiovasc Surg 2003; 11:113-9. [PMID: 12664045 DOI: 10.1016/s0967-2109(03)00014-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The management of patients with simultaneous coronary artery and carotid artery disease is still controversial. METHODS A retrospective review of the records and follow-up data of 139 consecutive patients undergoing simultaneous coronary artery bypass graft and carotid endarterectomy from 1981 to 1999 was carried out. RESULTS Early mortality was 2.1%, perioperative myocardial infarction and stroke rates were 2.8 and 1.4%, respectively. Survival at 7 years was 74.7+/-5.1% and event-free survival at 7 years was 67.9+/-5.6%. CONCLUSIONS The combined surgical approach has proved to be effective and safe allowing the treatment of both diseases in a single operative procedure.
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Affiliation(s)
- E Vitali
- Department of Cardio-Thoracic Surgery A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale, Maggiore 3, Milan 20162, Italy.
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Tumolo S, Toffoli G, Saracchini S, Lo Re G, Bruschi G, Boccieri MG. Topoisomerase I inhibitors combination chemotherapy in non-small cell lung cancer. Lung Cancer 2001; 34 Suppl 4:S37-46. [PMID: 11742701 DOI: 10.1016/s0169-5002(01)00403-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In the last years, the main topoisomerase I inhibitors (TP1-I) (i.e. topotecan and irinotecan) have been used in combination chemotherapy in non-small cell lung cancer. Several drugs (also alternative to cisplatin) have been used in combination with TP1-I, but to date the higher remission rate obtained with combinations is not translated into a more prolonged survival in comparison with TP1-I given alone. On the other hand, the toxicity of TP1-I combinations is greater than those of TP1-I used alone. The superior efficacy of combinations versus TP1-I used alone remains an open question. Furthermore, the best schedule for TP1-I has not been completely elucidated. Randomised studies are few (only two phase III trials) and only controlled studies will be able to clarify the best TP1-I combination regimen.
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Affiliation(s)
- S Tumolo
- U.O. Oncologia and Pneumologia, AOS-S. Maria degli Angeli, via Montereale 24, 33170 Pordenone, Italy
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Abstract
A case of aortic dissection (De Bakey type I) with a fistula to the right atrium through the interatrial septum, diagnosed by transthoracic and transesophageal echocardiography is reported. The patient presented with cardiac failure and a continuous murmur in the right second and third intercostal spaces. The patient underwent successful operative repair.
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Affiliation(s)
- C Russo
- Department of Cardiac Surgery, Ospedale Niguarda Ca' Granda, Milan, Italy.
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Abstract
The growing number of patients waiting for heart transplantation more than tripled between 1989 and 1998. Various non-pulsatile mechanical circulatory support devices have been developed as bridge to heart transplantation in recent years. We report the first successful Italian clinical experience with an axial-flow pump, DeBakey VAD, in a patient supported as bridge to transplantation for 55 days.
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Affiliation(s)
- S Agati
- Cardiac Surgery Department "Angelo De Gasperis," Niguarda Ca' Granda Hospital, Milan, Italy.
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Colombo T, Russo C, Ciliberto GR, Lanfranconi M, Bruschi G, Agati S, Vitali E. Tricuspid regurgitation secondary to mitral valve disease: tricuspid annulus function as guide to tricuspid valve repair. Cardiovasc Surg 2001; 9:369-77. [PMID: 11420162 DOI: 10.1016/s0967-2109(00)00147-2] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
METHODS A prospective analysis was performed on 50 patients (pts) with rheumatic mitral disease and associate secondary tricuspid insufficiency who underwent mitral valve replacement from January 1995 to December 1998. Surgical indication to tricuspid annuloplasty was considered in patients with echocardiographic tricuspid annulus diameter > 21 mm/m2, regardless semiquantitative evaluation of tricuspid insufficiency. De Vega annuloplasty was performed in 33 out of 50 patients. RESULTS Hospital mortality was 2.0% (CL 0.3-3.6). The follow up of the discharged patients ranged from 3 to 48 months (mean 25 +/- 15.9). Three late deaths occurred (6.1% CL 2.8-9.2). Forty-two patients out of the 46 followed up (91.3% CL 84.9-93.8) were in I or II NYHA class. In eight patients (16.3% of discharged patients) the obtained result has been considered as 'negative late results': persisting moderate (three cases) or moderate-severe (five cases) TrI, together with congestive heart failure requiring a furosemide intake of > 25 mg/day. No patients had severe TrI at follow up. The statistics analysis demonstrated the 'preoperative fraction shortening of the tricuspid annulus' (P = 0.038) as factor predictive of late negative result. The incidence of late negative result was 57.1% among patients with fractional shortening lower than 25% and 0% among those patients with fractional shortening greater than 25% (P = 0.0001). CONCLUSIONS The choice to treat the tricuspid insufficiency according to indexed tricuspid annulus dimension (> 21 mm/m2) has been effective in terms of clinical efficacy and of late functional result. Fractional shortening of the tricuspid annulus, expression of right ventricular cardiomyopathy in patients with poorest prognosis, affects the postoperative evolution of tricuspid insufficiency.
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Affiliation(s)
- T Colombo
- Department of Cardio-Thoracic Surgery 'A. De Gasperis', Ospedale Niguarda Ca'Granda, Piazza Ospedale Maggiore 3, 20162, Milano, Italy
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Abstract
Non-penetrating cardiac trauma resulting in mitral valve rupture is uncommon, requiring a high degree of suspicion for diagnosis. Sudden and severe mitral regurgitation, unless surgically corrected rapidly lead to congestive heart failure and death. We report a patient with traumatic rupture of the antero-lateral papillary muscle of the mitral valve and pericardial injury, after a lateral blunt chest trauma, who successfully underwent emergency mitral valve replacement.
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Affiliation(s)
- G Bruschi
- Department of Cardiac Surgery A. De Gasperis Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 320162 Milan, Italy.
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Lanfranconi M, Russo C, Ribera E, Colombo T, Bruschi G, Agati S, Vitali E. [Left monoventricular assistance with DeBakey VAD continuous flow pump: initial clinical Italian experience]. Ital Heart J Suppl 2001; 2:653-8. [PMID: 11460840] [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: 04/16/2023]
Abstract
BACKGROUND The shortage of heart donors causes a rise in mortality among candidates for cardiac transplantation and increases the waiting list. Consequently mechanical circulatory support for bridge to transplant is now a standard clinical procedure utilized in the most representative cardiac surgery centers. Recently, continuous-axial-flow pumps have been introduced in the clinical practice and have led to new perspectives. METHODS Four patients suffering from end-stage heart failure were implanted with a DeBakey ventricular assist device (VAD) continuous-flow pump as a bridge to heart transplant. The DeBakey VAD is smaller than the pulsatile devices commonly employed, the pump is totally implantable and is connected to a small controller and two batteries by a transcutaneous drive line. RESULTS One patient died of multiorgan failure during assistance; 3 patients were fully rehabilitated and were successfully transplanted after 55, 42 and 141 days respectively. In the early postoperative period the mean pump flow was 4.27 +/- 0.55 l/min, after 1 week of assistance the flow rose to 5.32 +/- 0.57 l/min and then progressively increased to 5.83 +/- 0.57 l/min. CONCLUSIONS This experience demonstrated the possibility of continuous-flow left ventricular support with the DeBakey VAD for mid-term mechanical ventricular assistance. This pump presents new interesting aspects and opens new perspectives for the future of left ventricular mechanical assistance. Increasing experience will define the role of this device in the scenario of heart failure.
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Affiliation(s)
- M Lanfranconi
- Divisione di Cardiochirurgia A. De Gasperis, Ospedale Niguarda Ca Granda, Milano.
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Pelà G, Bruschi G, Cavatorta A, Manca C, Cabassi A, Borghetti A. Doppler tissue echocardiography: myocardial wall motion velocities in essential hypertension. Eur J Echocardiogr 2001; 2:108-17. [PMID: 11882437 DOI: 10.1053/euje.2000.0057] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS Doppler tissue echocardiography (DTE) was applied to extract the myocardial wall velocities along different planes and evaluate the left ventricular function in essential hypertension. METHODS AND RESULTS Fifty-four hypertensives (HT) were compared to a control group of 31 normotensive (NT) subjects. The short-axis shortening and lengthening was assessed through the parasternal projections, sampling from interventricular septum and posterior wall. Through the apical projections the mitral annulus excursion was observed at four sites (anterior, posteroseptal, lateral, inferior walls) to assess the longitudinal dynamic of the heart. In each myocardial segment, peak velocity and time-velocity integral for systolic (S) and diastolic waves (E and A) were measured and their means for the long- and short-axis directions were calculated. Significant changes in hypertensives involved mainly the longitudinal motion. In diastole, the E-wave relaxation velocity was significantly decreased and the late A-wave velocity was unchanged. The E/A velocity ratio was significantly reduced. Relaxation velocity was negatively correlated to age, left ventricular mass and diastolic blood pressure. In systole, the peak S-wave shortening velocity was reduced and no association with age, left ventricular mass and blood pressure could be demonstrated. The range of segmental data produced by DTE proved useful to manufacture sensitive indices for recognition of hypertensive damage. Single DTE variables also proved slightly more sensitive than those extracted from the mitral flow pattern for the discrimination of HT patients. CONCLUSION The presence of impaired relaxation was confirmed by DTE in a large portion of patients with hypertension and left ventricular hypertrophy. A peculiar systolic disturbance is evidenced by this technique. DTE-derived information can be used to detect early and quantify target-organ damage and its progression or regression during antihypertensive treatment.
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Affiliation(s)
- G Pelà
- Dipartimento di Clinica Medica, Nefrologia e Scienze della Prevenzione, University of Parma, Parma, Italy
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Abstract
The use of Gore-Tex (W.L. Gore & Assoc, Flagstaff, AZ) sheet for pericardial closure in patients with left ventricular assist device as a bridge to transplant allows easy dissection of epicardial adhesions and safe resternotomy at the moment of heart transplantation, with no complications or significant cost increase related to the Gore-Tex itself.
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Affiliation(s)
- E Vitali
- Department of Cardio-Thoracic Surgery, Niguarda Hospital, Milan, Italy
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Colombo T, Vitali E, Lanfranconi M, Russo C, Bruschi G, Marchetti C, Colucci V, Frigerio M, Oliva F, Grassi M, Gronda E, Merli M, Pellegrini A. Heart transplantation 1985-1998: 13-years experience at Angelo De Gasperis Cardio-Thoracic Department-Milan. Clin Transpl 1999:315-25. [PMID: 10503110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND After 13 years of transplant experience in our center, we analyzed the results in the overall population and in particular subgroups of heart transplant recipients. We tried to identify risk factors for both early (3 months) and late (over 3 months) mortality after heart transplantation. METHODS The data on 461 patients transplanted from November 1985-June 1998 were reviewed. To study risk factors for mortality, the results for 313 patients operated on from June 1985-June 1995 were studied and analyzed with a multivariate logistic regression and Cox's proportional hazard model. Seventy pre-, intra- and postoperative variables were considered including patient demographics, clinical status, hemodynamic parameters, donor characteristics, donor-recipient HLA mismatches, complications, and immunosuppressive protocols. We also compared results for patients transplanted from 1985-1991 (Group 1) and from 1992-1998 (Group II) to assess improvements due to changes in indications and in perioperative treatments. RESULTS Overall mortality in the entire population was 20.2% (93/461). The 30-day, 3-month and late mortality rates were 8.0%, 10.2%, 11.1%, respectively. Group II mortality rates were 6.5%, 8.5% and 6.8%, respectively, despite a significant increase in Status I patients (20.6% in Group I vs 49.0% in Group II, p = 0.0001). The main causes of death were graft failure (24.7%), cardiac allograft vasculopathy (18.3%), and infection (16.1%). The mean follow-up of the 414 recipients who survived more than 3 months was 54.0 +/- 37.3 months. Actuarial survival was 87.4%, 79.2% and 68.9% at one, 5 and 10 years, respectively. The difference in the 5-year actuarial survival rates between Group I and Group II patients was statistically significant (73.5% vs 83.9%, p = 0.0135). The transpulmonary gradient, right atrial pressure and mid-high doses of donor inotropic support were identified as independent risk factors for early mortality. The number of moderate rejections at biopsy and early posttransplant infections were identified as independent risk factors for late mortality. The results of patients transplanted while on ventricular assist devices, urgent and elective patients and combined heart and kidney transplants were also reported. CONCLUSIONS The overall results of our 13-year experience are very satisfying in relation to early and late mortality, with a significant favorable trend between patients transplanted in the early era (1985-1991) and those transplanted in the recent era (1992-1998). Pulmonary hypertension and elevated preoperative right filling pressure appear to indicate a significantly increased risk of early death and only marginally influence late survival, which is principally influenced by severe postoperative complications. Good results were achieved in combined heart and kidney transplantation and among patients who deteriorated during the waiting period and were supported with ventricular assist devices. The early and late outcomes for urgent (status I) and elective (status II) heart transplant patients were comparable.
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Affiliation(s)
- T Colombo
- Angelo De Gasperis Cardio-Thoracic Department, Niguarda, Ca' Granda Hospital, Milan, Italy
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Abstract
Imbalances in central and peripheral sympathetic nervous system (SNS) activity have been observed in essential and experimental hypertension. This study was carried out in order to evaluate SNS activity in two distinct tissue types of spontaneously hypertensive rats (SHR), compared to Wistar-Kyoto normotensive (WKY) rats, in the pre-hypertensive phase (4-5 weeks of age). Interstitial concentrations of norepinephrine (NE) and other catecholamines were measured by microdialysis in striated muscle, whose tone is controlled by baroreflexes, and in the subcutaneous adipose tissue where sympathetic output mainly controls metabolism. Two groups of SHR and WKY male rats were studied, aged 4-5 weeks, with a mean body weight of 92 and 86 g respectively. Systolic blood pressure (SBP, tail-cuff) values were 113 mm Hg (SD +/- 6.2) in SHR and 108 mm Hg (SD +/- 7.3) in WKY rats (p=0.28,t test). Two microdialysis probes were positioned in the subcutaneous fatty tissue and in the striated muscle of the parascapular region and perfused with Ringers' solution. The dialysate was collected every thirty minutes for 3 hours and analyzed in HPLC-ED to determine the content of NE and other catecholamines. Interstitial levels of NE were higher in SH than in WKY rats in both tissues. Mean NE values from subcutaneous adipose tissue in 4-5 week-old SHR were 1162 +/- 193 pg/ml compared to 496 + 188 pg/ml in WKY rats (p<0.001, t test). Muscle tissue NE levels in SHR were 1241 +/- 337 pg/ml vs. 521 +/- 138 pg/ml in WKY rats (p<0.001, t test). Plasma NE concentrations (279 +/- 61 pg/ml in SHR vs 246 + 69 pg/ml in WKY P = 0.65, t test) were not significantly different between the two strains at this young age. These findings suggest SNS hyperactivity in young SHR, though still normotensive, possibly dissociated from regional components of regulation (baroreceptor control in striated muscle and metabolic control in subcutaneous adipose tissue).
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Affiliation(s)
- A Cabassi
- Department of Clinical Medicine, Nephrology and Health Sciences, University of Parma Medical School, Italy.
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Bruschi G, Cabassi A, Orlandini G, Regolisti G, Zambrelli P, Calzolari M, Borghetti A. Use of Fourier shape descriptors to improve the reproducibility of echographic measurements of arterial intima-media thickness. J Hypertens 1997; 15:467-74. [PMID: 9169998 DOI: 10.1097/00004872-199715050-00001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND A major source of error in the longitudinal assessment of the intima-media thickness (IMT) is the difficulty in retrieving the same echographic view of the vessel. OBJECTIVE To present a method for increasing the reproducibility of IMT measurements by ultrasound in large arteries. METHOD The Fourier descriptor is a well-known means of describing an object's shape. By means of the discrete Fourier transform (DFT), the shape was represented in a frequency domain; the computational advantages of the DFT then permitted a measure of unlikeness between different shapes (the 'distance' measure; DM) to be defined and used as a criterion for reproducing the contour. When the sonographer compared successive images of a complex vascular segment, like the carotid bifurcation, the identity of the echographic cut was deduced from the identity of the vessel's contour. The best match of the baseline image was the view that minimized the contour DM. RESULTS Preliminary studies in the carotid artery bifurcations of eight subjects showed that the DM responds to systematic variations in the ultrasound interrogation angle and reveals minimal changes in transducer position. Duplicate scans of 12 subjects were performed by three sonographers with different strategies for acquisition of the same images: a low DM was associated with a low difference in pairs of IMT measurements. Data were classified into two groups (normal or borderline vessels with a pooled mean IMT of 0.62 mm and overtly thickened segments with a pooled mean IMT of 1.31 mm). When minimization of the DM was the criterion for the acquisition of replicate scans, the mean absolute difference of paired data for the mean IMT of the distal common carotid artery was 0.03 +/- 0.02 mm for the first group and 0.06 +/- 0.03 mm for the second group. This is a significant reduction in comparison with non-quantitative alternative criteria for image reproduction. For the maximum IMT of the same segments the mean absolute differences were 0.07 +/- 0.03 and 0.13 +/- 0.06 mm in the first and second groups, respectively. CONCLUSION This method can be applied to the serial assessment of single atherosclerotic segments. The computational time is negligible. By reducing the scatter in sequential IMT data, longitudinal investigations (e.g. of the results of antihypertensive therapy) with shorter durations and smaller sample groups may be rendered feasible.
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Affiliation(s)
- G Bruschi
- Istituto di Clinica Medica e Nefrologia, Università di Parma, Italy
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Cabassi A, Vinci S, Calzolari M, Bruschi G, Cavatorta A, Borghetti A. [The relationship between regional sympathetic activity and the onset of arterial hypertension in spontaneously hypertensive rats]. Cardiologia 1997; 42:393-6. [PMID: 9244643] [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: 02/04/2023]
Abstract
Several studies on spontaneously hypertensive rats (SHR) have demonstrated increased activity of the sympathetic nervous system (SNS). Using microdialysis, we have observed a greater release of norepinephrine (NE) into the interstitia of striated muscle, than that observed in control Wistar-Kyoto (WKY) rats in the prehypertensive phase. We confirmed these results in the subcutaneous adipose tissue where the sympathetic output controls metabolism. This study was carried out in order to evaluate SNS activity in two district tissue types conducted during both the prehypertensive phase (4-5 weeks of age) and the established hypertensive phase (15-16 weeks of age). Interstitial concentrations of NE were measured by microdialysis in striated muscle and subcutaneous adipose tissue. Two groups of rats were studied. Each group was made up of 8 subjects, SHR and WKY, males of 4-5 weeks of age with a mean body weight of 80 and 75 g respectively. Arterial systolic pressure (tail-cuff) values were 106 mmHg (standard deviation +/-8.2) in SHR and 101 mmHg (standard deviation +/-6.9) in WKY rats (NS). Two microdialysis probes were positioned in the subcutaneous fatty tissue and in the striated muscle of the parascapular region and perfused with Ringers' solution. The dialysate was collected every 30 min for 150 min and analyzed in high-performance liquid chromatography-every day. The content of NE and other catecholamines was determined. The same animals in both groups were reevaluated at 15-16 weeks of age. The mean body weight at this time was 246 g for the SHR and 289 g for the WKY rats. Arterial systolic pressure was 161 mmHg (standard deviation +/-13.3) and 108 mmHg (standard deviation +/-15.6) respectively (p < 0.01, Student's t test). Interstitial levels of NE were higher in SHR than in WKY rats in both tissues examined in the prehypertensive phase and in the established hypertensive phase. Mean NE values from subcutaneous adipose tissue in 4-5 week-old SHR were 1362.1 +/- 181.3 pg/ml compared to 479.0 +/- 162.3 pg/ml in WKY rats (p < 0.001, Student's t test). Muscle tissue NE levels in SHR were 1292.7 +/- 319.1 vs 536.3 +/- 146.7 pg/ml in WKY rats (p < 0.001, Student's t test). Values from the same rats at 15-16 weeks of age were 1405.0 +/- 148.3 pg/ml in SHR compared to 501.6 +/- 131.2 pg/ml in fatty tissue from WKY rats and 1893.7 +/- 214.6 vs 502.0 +/- 118.8 pg/ml in muscle tissue from the respective groups (p < 0.001, Student's t test). Significant differences (p < 0.01, Student's t test) were also observed in mean NE values in striated muscle tissue during the developing phase of hypertension. These findings document SNS hyperactivity in SHR when compared to WKY normotensive controls. This increase in SNS activity was observed in both the prehypertensive phase and in the established hypertensive phase indicating a complete disassociation from regional components of regulation (baroreceptor control and metabolic control), at least in the prehypertensive phase. These results may suggest as alteration in primitive sympathetic central outflow. Higher interstitial NE concentrations in the muscle tissue from SHR during the hypertensive phase compared to levels of young animals that are still normotensive, reveal an interesting pathophysiological aspect for the development of arterial hypertension.
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Affiliation(s)
- A Cabassi
- Dipartimento di Clinica Medica, Nefrologia e Scienze della Prevenzione, Università degli Studi, Parma
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Regolisti G, Coghi P, Bruschi G, Orlandini G, Cabassi A, Zoni A, Guariglia A, Vinci S, Vignali L, Borghetti A. Effects of water immersion on forearm vascular resistance in normotensive subjects. J Hypertens Suppl 1993; 11:S178-9. [PMID: 8158331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- G Regolisti
- Istituto di Clinica Medica e Nefrologia, Università degli Studi, Parma, Italy
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42
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Bruschi G, Regolisti G, Borghetti A. [Cellular calcium, vasoconstriction, hypertension]. Ann Ital Med Int 1992; 7:119S-123S. [PMID: 1338420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The control of vasomotion is a central issue in blood pressure regulation and is a primary goal of antihypertensive therapy. Calcium is the final messenger in the contractile mechanism of vascular smooth and cardiac muscle. Vasoconstrictor agents enhance the entry of Ca++ into vascular myocytes; vasodilators usually depress it. The most recent findings, based on direct measures of intracellular Ca++, have also highlighted the importance of calcium-sensitization mechanisms: vasoconstrictors sensitize the contractile apparatus to Ca++; vasodilators have an opposite effect. Cell calcium control alterations have been reported in different forms of hypertension. An increase in vascular myoplasmic Ca++ and a higher rate of calcium influx through specific, dihydropiridine-sensitive calcium channels have been found in genetic or secondary animal models. In hypertensive patients, an elevation of cytoplasmic Ca++ was noted in the platelets. Since Ca++ is a ubiquitous intracellular messenger, these changes may have profound implications for the pathophysiology of hypertension.
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Affiliation(s)
- G Bruschi
- Istituto di Clinica Medica e Nefrologia, Università degli Studi di Parma
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43
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Bruschi G, Bruschi ME, Capelli P, Regolisti G, Borghetti A. Increased sensitivity to protein kinase C activation in aortas of spontaneously hypertensive rats. J Hypertens Suppl 1988; 6:S248-51. [PMID: 3241211 DOI: 10.1097/00004872-198812040-00075] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The aortic muscle of spontaneously hypertensive (SHR) and normotensive control (WKY) rats was stimulated with phorbol esters and the contractile response was measured as isometric tension. Phorbol esters are known activators of protein kinase C. The aortas of SHR were characterized by the following distinct alterations in the response to phorbol myristate acetate: (1) increased sensitivity: half-maximal force was achieved at 62 +/- 6 nmol/l phorbol myristate acetate in SHR and 105 +/- 8 nmol/l in WKY; (2) increased contractility: the maximal force developed by phorbol myristate acetate was greater in SHR aortas (1.9 +/- 0.3 versus 1.6 +/- 0.2 g in WKY) compared with the decreased contractility generated with noradrenaline and high levels of potassium; (3) decreased dependency on extracellular calcium for half-maximal tension: in the presence of 3 mumol/l phorbol myristate acetate 50% of maximal force was attained at 21 +/- 8 mumol/l extracellular calcium compared with 49 +/- 9 mumol/l in WKY; (4) diminished relaxation in response to excess extracellular calcium: phorbol myristate acetate-precontracted WKY aortas began to relax when calcium was raised above 4 mmol/l in the bath and relaxation reached 51% at 8-10 mmol/l. Relaxation was almost absent in SHR (3-7%). Hence, there is an abnormality in the response to protein kinase C activation by phorbol esters in SHR vascular smooth muscle. Intracellular calcium appears to be involved. Studies of protein kinase C will prove important in understanding vascular smooth muscle function in normal and abnormal states.
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Affiliation(s)
- G Bruschi
- Istituto di Clinica Medica e Nefrologia, Università di Parma, Italy
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44
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Pedrinelli R, Bruschi G, Graziadei L, Taddei S, Panarace G, Orlandini G, Natali A, Borghetti A, Salvetti A. Dietary sodium change in primary aldosteronism. Atrial natriuretic factor, hormonal, and vascular responses. Hypertension 1988; 12:192-8. [PMID: 2970434 DOI: 10.1161/01.hyp.12.2.192] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Atrial natriuretic factor (ANF) may be physiopathologically involved in several clinical conditions including human hypertension. However, few data are available regarding this putative hormone and its relationship to aldosterone, blood pressure, and vascular responsiveness to alpha-adrenergic receptor stimulation in primary aldosteronism, a volume-expanded, low-renin model of human hypertension. For this reason, the behavior of supine and upright plasma ANF as related to aldosterone, blood pressure, and forearm alpha-adrenergic sensitivity (plethysmographic technique) to intra-arterial norepinephrine infusion was studied in eight patients with primary aldosteronism (five with adenomas, three with hyperplasia) before and at the end of two sequential 1-week low (20 mmol/day) and high sodium (200 mmol/day) diet periods. Basal, predict ANF concentrations decreased and increased after low and high sodium intakes, respectively. Furthermore, highly significant postural ANF decrements after 1 hour of standing occurred with each diet, although they were lower after the low than after the high sodium diet. Plasma aldosterone, either supine or upright, was insensitive to dietary sodium manipulations, suggesting the absence of ANF-mediated control of aldosterone secretion in our patients. In spite of about twofold higher ANF concentrations during the high than during the low sodium diet, forearm vascular sensitivity to intra-arterial norepinephrine infusion did not change during the study. Furthermore, systemic arterial blood pressure rose to a highly significant extent after dietary sodium content was increased, thus casting doubt on a role for ANF as an endogenous long-term modulator of systemic blood pressure and peripheral alpha-adrenergic sensitivity in patients with primary aldosteronism.
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Affiliation(s)
- R Pedrinelli
- Hypertension I Clinica Medica, University of Pisa, Italy
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45
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Cusmano F, Bruschi G, De Donatis M, Piazza P, Bassi P. [Preoperative embolization of angiomas of the face. Remote angiographic results]. Radiol Med 1988; 75:613-20. [PMID: 3387613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Preoperative embolization was performed on 27 patients with facial angiomas supplied by the external carotid branches. Sixteen were males and 11 females; 13 of these angiomas were high-flow arteriovenous (A-V), 14 were low-flow capillary malformations. Fourteen patients underwent surgical removal after preoperative embolization; in this group embolization was carried out with Spongel in 3 cases and with Lyodura in 11 cases. In 12 of these patients the last angiographic examination was performed 3-6 years later: angiography evidenced no recurrence in 8 cases (67%), while in 3 cases (25%) there was capillary residual angioma of negligible size. Treatment was unsuccessful in one patient only, due to the large recurrent A-V angioma. Thirteen patients underwent embolization only, which was carried out with Lyodura in 10 cases, and with Ivalon in 3 cases. On 12 of these patients the last angiographic study was performed 2-14 months later: there was recurrent A-V angioma in 5 patients (42%), who underwent a subsequent embolization; angiography evidenced no recurrence in the other 7 patients (58%). In both series, the best results were obtained in the patients with low-flow capillary angiomas. Embolization and subsequent surgical removal are the treatment of choice for facial angiomas; embolization alone is useful in the management of surgically inaccessible vascular malformations, and it can be the only treatment in patients with small low-flow angiomas when distal occlusion of the feeding vessels with Lyodura or Ivalon particles is performed.
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Affiliation(s)
- F Cusmano
- Istituto di Radiologia, Università, Parma
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Bruschi G, Bruschi ME, Regolisti G, Borghetti A. Myoplasmic Ca2+-force relationship studied with fura-2 during stimulation of rat aortic smooth muscle. Am J Physiol 1988; 254:H840-54. [PMID: 3364589 DOI: 10.1152/ajpheart.1988.254.5.h840] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The intracellular Ca indicator fura-2 was used for simultaneous measurements of intracellular free Ca (Ca2+i) and force in arterial smooth muscle. Rat aortic medial rings were submitted to fluorometry in a geometrical arrangement resembling that of adherent cell layers. A rigid force-transducing system served to immobilize the tissue and record the developed force quasi-isometrically. Stimulation was performed with norepinephrine (NE), KCl depolarization (high K), and a nonfluorescent Ca ionophore (ionomycin) at varying extracellular Ca concentrations. The following facts were observed. NE, high K, and ionomycin increased tension along with fura-2-reported Ca2+i; under any circumstances tension was Ca2+i dependent and could be varied by manipulating Ca2+i. However, NE and high K determined a parallel increase in the effectiveness of Ca2+i in comparison with the simple ionophore, i.e., they increased the force-to-Ca2+i ratio. NE and high K produced half-maximal tension at fura-2 estimated Ca2+i of 0.10 and 0.13 microM, whereas ionomycin required 0.6 microM to achieve the same amount of force. It is inferred that Ca2+i is a determinant of vascular contraction, but some results suggest the existence of factors that sensitize the contractile machinery to Ca.
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Affiliation(s)
- G Bruschi
- Instituto di Clinica Medica e Nefrologia, Università di Parma, Italy
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Figoli F, Veronesi A, Ardizzoni A, Canobbio L, Bruschi G, Mazza F, Zagonel V, Lo Re G, Rosso R, Monfardini S. Cisplatin and etoposide as second-line chemotherapy in patients with small cell lung cancer. Cancer Invest 1988; 6:1-5. [PMID: 2835127 DOI: 10.3109/07357908809077023] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Twenty-seven evaluable patients with small cell lung cancer (SCLC) resistant to, or relapsed after induction combination chemotherapy (CT) were treated with etoposide (VP16) plus cisplatin (DDP). Previous treatment was: alternating CT with cyclophosphamide (C), adriamycin (A), methotrexate (M), procarbazine (P) (CAMP)/VP16, BCNU (B), hexamethylmelamine (H) (VP16 BH) in 16 patients; C, A, vincristine (CAV) in 6 patients; C, A, and VP16 (CAVP16) in 5 patients. We observed 2 (7%) complete responses (CR) and 9 (33%) partial responses (PR). Duration of CRs was 8 and 14 weeks, respectively. PRs lasted a median of 22 weeks (range 16-44). Seven of 21 (33%) patients previously treated with VP16 responded to DDP plus VP16 (D-V). These results confirm D-V regimen as active in SCLC patients even when heavily pretreated. Our 33% response in patients who had VP16 in their induction treatment regimen provides further evidence of an important potentiating effect of DDP, as reported in animal system.
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Affiliation(s)
- F Figoli
- Division of Medical Oncology, Centro di Riferimento Oncologico, Aviano, Italy
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Cavatorta A, Falzoi M, Romanelli A, Cigala F, Riccò M, Bruschi G, Franchini I, Borghetti A. Adrenal response in the pathogenesis of arterial hypertension in workers exposed to high noise levels. J Hypertens Suppl 1987; 5:S463-6. [PMID: 3481819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Some neuroendocrine parameters known as stress indices were examined in two groups of healthy male workers in a glass factory: the first group (60 subjects) was exposed to high environmental noise levels [greater than 90 dB(A)]; the second group (52 subjects) was exposed to low noise levels [less than 78 dB(A)]. Subjects with histories of cardiovascular diseases or high arterial pressure were excluded from the study. In both groups serum catecholamines and cortisol, and urinary vanilmandelic and homovanillic acids were evaluated at the beginning and middle of morning and afternoon work-shifts, by high performance liquid chromatography with electrochemical detection. Norepinephrine, epinephrine and vanilmandelic acid were significantly increased (P less than 0.01) during work-shifts in the group exposed to 90 dB(A), compared with baseline levels and also with catecholamine levels in the group exposed to 78 dB(A). Serum dopamine, cortisol and homovanillic acid showed no significant differences. The increased stimulation of the sympatho-adrenal system in response to high and prolonged noise exposure might lead to an abnormal response of the cardiovascular system with increasing arterial pressure values.
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Affiliation(s)
- A Cavatorta
- Istituto di Clinica Medica e Nefrologia, Università di Parma, Italy
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Orlandini G, Bruschi G, Cavatorta A, Ceresini MB, Manca C, Pucci F, Borghetti A. Physiological stimuli to atrial natriuretic peptide secretion in normal humans. J Hypertens Suppl 1987; 5:S67-70. [PMID: 2965234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We tested the response of plasma atrial natriuretic peptide (ANP) levels to the following physiological stimuli: postural changes; head-out water immersion; and physical exercise. Plasma ANP (p-ANP) levels were assessed by a specific, sensitive radio-immunoassay. Plasma ANP rose significantly when posture shifted from upright to recumbent for 1 h, but fell again to basal values after 10 min standing. Circadian variations did not affect the posture study. Head-out water immersion produced a prompt and remarkable (sevenfold) increase in p-ANP, with a plateau reached after 1 h and held until the end of the experiment (2 h). Plasma ANP levels were measured in 10 normal subjects performing supine treadmill exercise at 50% of maximum aerobic capacity for 30 min. Plasma ANP rose from baseline supine values after 15 min exercise, and remained elevated during the following 15 min exercise. During the recovery phase ANP showed a trend towards baseline values, with a 38% decrease attained after 30 min. We propose that the above tests could be used as ANP-stimulating manoeuvres in physiological and clinical conditions in man.
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Affiliation(s)
- G Orlandini
- Istituto di Clinica Medica e Nefrologia, Uiversità di Parma, Italy
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Bruschi G, Scipioni A, Persichetti G. [Combined technic for post dies]. Attual Dent 1987; 3:8-9, 11, 13 passim. [PMID: 3331534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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