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Villa M, Malighetti F, Sala E, Sharma GG, Arosio G, Gemelli M, Manfroni C, Fontana D, Cordani N, Meneveri R, Zambon A, Piazza R, Pagni F, Cortinovis D, Mologni L. New pan-ALK inhibitor-resistant EML4::ALK mutations detected by liquid biopsy in lung cancer patients. NPJ Precis Oncol 2024; 8:29. [PMID: 38448512 PMCID: PMC10918084 DOI: 10.1038/s41698-024-00498-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/21/2023] [Indexed: 03/08/2024] Open
Abstract
ALK and ROS1 fusions are effectively targeted by tyrosine kinase inhibitors (TKIs), however patients inevitably relapse after an initial response, often due to kinase domain mutations. We investigated circulating DNA from TKI-relapsed NSCLC patients by deep-sequencing. New EML4::ALK substitutions, L1198R, C1237Y and L1196P, were identified in the plasma of NSCLC ALK patients and characterized in a Ba/F3 cell model. Variants C1237Y and L1196P demonstrated pan-inhibitor resistance across 5 clinical and 2 investigational TKIs.
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Affiliation(s)
- Matteo Villa
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Federica Malighetti
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Elisa Sala
- SC Medical Oncology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Geeta G Sharma
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giulia Arosio
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maria Gemelli
- SC Medical Oncology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Medical Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Chiara Manfroni
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Diletta Fontana
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Nicoletta Cordani
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Raffaella Meneveri
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Alfonso Zambon
- Department of Chemistry and Geological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Rocco Piazza
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Pathology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Diego Cortinovis
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- SC Medical Oncology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Luca Mologni
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
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Arosio G, Sharma GG, Villa M, Mauri M, Crespiatico I, Fontana D, Manfroni C, Mastini C, Zappa M, Magistroni V, Ceccon M, Redaelli S, Massimino L, Garbin A, Lovisa F, Mussolin L, Piazza R, Gambacorti-Passerini C, Mologni L. Synergistic Drug Combinations Prevent Resistance in ALK+ Anaplastic Large Cell Lymphoma. Cancers (Basel) 2021; 13:cancers13174422. [PMID: 34503232 PMCID: PMC8431561 DOI: 10.3390/cancers13174422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Despite success of targeted therapy, cancer cells very often find a way to survive treatment; this eventually causes a tumor to relapse. In a particular type of lymphoma carrying a specific chromosomal rearrangement named anaplastic large-cell lymphoma (ALCL), selective drugs targeting the cause of the disease can induce spectacular remission of chemotherapy-resistant cancer. However, the lymphoma relapses again in about half of the cases, leaving no therapeutic options. We studied the possibility to combine two simultaneous treatments in order to prevent the relapse, starting from the hypothesis that acquiring resistance to two drugs at the same time is statistically very unlikely. We demonstrate that treating lymphoma cells with drug combinations has superior efficacy in comparison with single drug treatments, both in cell cultures and in mice. Abstract Anaplastic lymphoma kinase-positive (ALK+) anaplastic large-cell lymphoma (ALCL) is a subtype of non-Hodgkin lymphoma characterized by expression of the oncogenic NPM/ALK fusion protein. When resistant or relapsed to front-line chemotherapy, ALK+ ALCL prognosis is very poor. In these patients, the ALK inhibitor crizotinib achieves high response rates, however 30–40% of them develop further resistance to crizotinib monotherapy, indicating that new therapeutic approaches are needed in this population. We here investigated the efficacy of upfront rational drug combinations to prevent the rise of resistant ALCL, in vitro and in vivo. Different combinations of crizotinib with CHOP chemotherapy, decitabine and trametinib, or with second-generation ALK inhibitors, were investigated. We found that in most cases combined treatments completely suppressed the emergence of resistant cells and were more effective than single drugs in the long-term control of lymphoma cells expansion, by inducing deeper inhibition of oncogenic signaling and higher rates of apoptosis. Combinations showed strong synergism in different ALK-dependent cell lines and better tumor growth inhibition in mice. We propose that drug combinations that include an ALK inhibitor should be considered for first-line treatments in ALK+ ALCL.
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Affiliation(s)
- Giulia Arosio
- Department Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.A.); (G.G.S.); (M.V.); (M.M.); (I.C.); (D.F.); (C.M.); (C.M.); (M.Z.); (V.M.); (M.C.); (S.R.); (L.M.); (R.P.); (C.G.-P.)
| | - Geeta G. Sharma
- Department Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.A.); (G.G.S.); (M.V.); (M.M.); (I.C.); (D.F.); (C.M.); (C.M.); (M.Z.); (V.M.); (M.C.); (S.R.); (L.M.); (R.P.); (C.G.-P.)
- Department Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, 1500 E Duarte Rd, Duarte, CA 91010, USA
| | - Matteo Villa
- Department Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.A.); (G.G.S.); (M.V.); (M.M.); (I.C.); (D.F.); (C.M.); (C.M.); (M.Z.); (V.M.); (M.C.); (S.R.); (L.M.); (R.P.); (C.G.-P.)
| | - Mario Mauri
- Department Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.A.); (G.G.S.); (M.V.); (M.M.); (I.C.); (D.F.); (C.M.); (C.M.); (M.Z.); (V.M.); (M.C.); (S.R.); (L.M.); (R.P.); (C.G.-P.)
| | - Ilaria Crespiatico
- Department Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.A.); (G.G.S.); (M.V.); (M.M.); (I.C.); (D.F.); (C.M.); (C.M.); (M.Z.); (V.M.); (M.C.); (S.R.); (L.M.); (R.P.); (C.G.-P.)
| | - Diletta Fontana
- Department Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.A.); (G.G.S.); (M.V.); (M.M.); (I.C.); (D.F.); (C.M.); (C.M.); (M.Z.); (V.M.); (M.C.); (S.R.); (L.M.); (R.P.); (C.G.-P.)
| | - Chiara Manfroni
- Department Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.A.); (G.G.S.); (M.V.); (M.M.); (I.C.); (D.F.); (C.M.); (C.M.); (M.Z.); (V.M.); (M.C.); (S.R.); (L.M.); (R.P.); (C.G.-P.)
| | - Cristina Mastini
- Department Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.A.); (G.G.S.); (M.V.); (M.M.); (I.C.); (D.F.); (C.M.); (C.M.); (M.Z.); (V.M.); (M.C.); (S.R.); (L.M.); (R.P.); (C.G.-P.)
| | - Marina Zappa
- Department Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.A.); (G.G.S.); (M.V.); (M.M.); (I.C.); (D.F.); (C.M.); (C.M.); (M.Z.); (V.M.); (M.C.); (S.R.); (L.M.); (R.P.); (C.G.-P.)
| | - Vera Magistroni
- Department Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.A.); (G.G.S.); (M.V.); (M.M.); (I.C.); (D.F.); (C.M.); (C.M.); (M.Z.); (V.M.); (M.C.); (S.R.); (L.M.); (R.P.); (C.G.-P.)
| | - Monica Ceccon
- Department Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.A.); (G.G.S.); (M.V.); (M.M.); (I.C.); (D.F.); (C.M.); (C.M.); (M.Z.); (V.M.); (M.C.); (S.R.); (L.M.); (R.P.); (C.G.-P.)
| | - Sara Redaelli
- Department Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.A.); (G.G.S.); (M.V.); (M.M.); (I.C.); (D.F.); (C.M.); (C.M.); (M.Z.); (V.M.); (M.C.); (S.R.); (L.M.); (R.P.); (C.G.-P.)
| | - Luca Massimino
- Department Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.A.); (G.G.S.); (M.V.); (M.M.); (I.C.); (D.F.); (C.M.); (C.M.); (M.Z.); (V.M.); (M.C.); (S.R.); (L.M.); (R.P.); (C.G.-P.)
- Department Gastroenterology, Humanitas University, Pieve Emanuele, 20090 Milano, Italy
| | - Anna Garbin
- Department Women’s and Children’s Health, Clinic of Pediatric Hemato-Oncology, University of Padua, 35122 Padova, Italy; (A.G.); (F.L.); (L.M.)
- Non-Hodgkin Lymphoma Unit, Istituto di Ricerca Pediatrica Fondazione Città della Speranza, 35122 Padova, Italy
| | - Federica Lovisa
- Department Women’s and Children’s Health, Clinic of Pediatric Hemato-Oncology, University of Padua, 35122 Padova, Italy; (A.G.); (F.L.); (L.M.)
- Non-Hodgkin Lymphoma Unit, Istituto di Ricerca Pediatrica Fondazione Città della Speranza, 35122 Padova, Italy
| | - Lara Mussolin
- Department Women’s and Children’s Health, Clinic of Pediatric Hemato-Oncology, University of Padua, 35122 Padova, Italy; (A.G.); (F.L.); (L.M.)
- Non-Hodgkin Lymphoma Unit, Istituto di Ricerca Pediatrica Fondazione Città della Speranza, 35122 Padova, Italy
| | - Rocco Piazza
- Department Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.A.); (G.G.S.); (M.V.); (M.M.); (I.C.); (D.F.); (C.M.); (C.M.); (M.Z.); (V.M.); (M.C.); (S.R.); (L.M.); (R.P.); (C.G.-P.)
| | - Carlo Gambacorti-Passerini
- Department Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.A.); (G.G.S.); (M.V.); (M.M.); (I.C.); (D.F.); (C.M.); (C.M.); (M.Z.); (V.M.); (M.C.); (S.R.); (L.M.); (R.P.); (C.G.-P.)
| | - Luca Mologni
- Department Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.A.); (G.G.S.); (M.V.); (M.M.); (I.C.); (D.F.); (C.M.); (C.M.); (M.Z.); (V.M.); (M.C.); (S.R.); (L.M.); (R.P.); (C.G.-P.)
- Correspondence:
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Sharma GG, Arosio G, Villa M, Mauri M, Zappa M, Magistroni V, Ceccon M, Redaelli S, Crespiatico I, Fontana D, Mastini C, Garbin A, Lovisa F, Mussolin L, Piazza R, Gambacorrti-Passerini C, Mologni L. Abstract 1113: Synergistic drug combinations prevent drug resistance in anaplastic large cell lymphoma preclinical models. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-1113] [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: 11/16/2022]
Abstract
Abstract
Neoplastic cells are characterized by genetic instability, leading to the random accumulation of mutations in different tumor subpopulations, which therefore respond differently to treatments. Given the average mutational rate of tumors, the probability to acquire resistance to a single drug usually exceeds the number of cells present at diagnosis, making drug resistance a fact in most cases. Statistically, the chance of a cell being resistant to two simultaneous treatments is much lower, suggesting that drug combinations may help prevent resistance.
Anaplastic large cell lymphoma (ALCL) is an aggressive type of Non-Hodgkin Lymphoma, characterized by expression of the NPM/ALK oncogenic fusion tyrosine kinase. ALK+ ALCL patients resistant or relapsed (R/R) to front-line chemotherapy have a very poor prognosis. The therapeutic activity of the ALK inhibitor crizotinib has been shown in patients with R/R ALK+ ALCL. However, 30-40% of patients develop resistance to crizotinib monotherapy and relapse within short time, leaving no further therapeutic option than bone marrow transplant, when feasible. This highlights the need to identify new first-line therapies for high-risk patients.We explored the potential of upfront drug combinations to prevent the rise of resistant disease, in vitro and in vivo. Crizotinib was combined with CHOP chemotherapy, an epigenetic drug (decitabine), another targeted inhibitor (trametinib- MEK inhibitor), or a second-generation ALK inhibitor. ALK+ ALCL cells were kept in culture for ~100 days in the presence of different single or combined drugs. We found that in most cases, combined treatments were more effective than single agents in the long-term control of cells expansion. Upon further functional characterization using quantitative PCR and western blot, we found that combination treatments upregulated cell cycle inhibitors and pro-apoptotic genes as well as modulated survival factors to induce deeper inhibition of oncogenic signalling and higher rates of apoptosis. Crizotinib+decitabine combination treatment promoted downregulation of DNMT1 and increase of TGFB1, both of which indirectly affect cell cycle progression. In murine model, crizotinib+decitabine significantly delayed tumour growth, compared to single treatments. Our results indicate that combining a selective drug with a less specific anticancer agent, which allows unspecific killing of resistant clones that might potentially arise, would be beneficial.In conclusion, our data suggest that a polypharmacology approach combining ALK inhibition with other agents could be a valuable therapeutic option for ALK+ ALCL patients, to prevent relapses and improve outcomes.
Citation Format: Geeta G. Sharma, Giulia Arosio, Matteo Villa, Mario Mauri, Marina Zappa, Vera Magistroni, Monica Ceccon, Sara Redaelli, Ilaria Crespiatico, Diletta Fontana, Cristina Mastini, Anna Garbin, Federica Lovisa, Lara Mussolin, Rocco Piazza, Carlo Gambacorrti-Passerini, Luca Mologni. Synergistic drug combinations prevent drug resistance in anaplastic large cell lymphoma preclinical models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1113.
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Mologni L, Sharma GG, Villa M, Mauri M, Arosio G, Lobello C, Larose H, Pirola A, Bombelli S, Cordani N, Massimino L, Pospíšilová Š, Turner SD, Inghirami G, Pagni F, Piazza R, Perego R, Chiarle R, Gambacorti-Passerini C. Abstract 4715: Characterization of potential co-drivers of pathogenesis in ALK positive ALCL. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-4715] [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: 11/16/2022]
Abstract
Abstract
ALK positive Anaplastic large cell lymphoma (ALCL) is an aggressive non-Hodgkin lymphoma characterized by expression of the NPM/ALK fusion tyrosine kinase essential for neoplastic cells growth. When resistant or relapsed to front-line chemotherapy, ALK+ ALCL prognosis is very poor. Although ALK+ ALCL cells are mainly driven by the constitutively active NPM/ALK kinase, presence of additional mutations might affect the disease course and response to treatment, leading to different outcomes in different patients. We employed whole exome sequencing to characterize the co-mutational burden in ALK+ ALCL samples at diagnosis. Diagnosis biopsy and matched healthy control DNA samples from 24 ALK+ ALCL patients were sequenced. Somatic variants present at high frequency within the tumor (at least 25% variant allele frequency), which can be viewed as potential co-drivers, were annotated; the identified mutations were weighed using in silico tools to predict their oncogenic potential and their effects on protein function. All identified variants were confirmed by Sanger sequencing. Gene ontology and pathway analyses identified cell adhesion and actin cytoskeleton among the most enriched biological functions. Using the above-mentioned criteria, we found recurrent somatic variants in 7 genes including PPP1R9A, RUNX1T1, FAT4 and RBBP8. Here we report the initial characterization of the role of FAT4 in ALCL cells. FAT4 is a member of the cadherin superfamily with tumor suppressor functions. In our cohort, 3/24 patients (13%) were found to carry FAT4 mutations, including nonsense mutations and missense changes predicted to be deleterious, suggesting a loss of function effect. To characterize the biological consequences of these mutations, we generated FAT4 knockdown ALCL cell lines. FAT4-silenced cells grew faster and showed increased migratory properties compared to parental cells. They also differed from parental cells in terms of morphology, having bigger size and modulated F-actin rearrangement. Tumor suppressing activity of FAT4 has been linked to Wnt/β-catenin pathway; we found that FAT4-silenced cells had decreased levels of serine/threonine phosphorylated β-catenin and higher nuclear localization, which insinuates activation of Wnt/β-catenin signalling and henceforth, increased cellular proliferation. To explore therapeutic implications of FAT4 mutations, we analyzed the sensitivity of FAT4 silenced cells to chemotherapeutic agents. FAT4 knockdown cells were less sensitive to a CHOP combination treatment as compared to parental cells. No difference was seen in terms of sensitivity to crizotinib. Finally, we investigated the effects of RUNX1T1 somatic variants found in our study. Preliminary luciferase assay results showed that the variants significantly increase the transcriptional repression ability of RUNX1T1. Altogether, our data provides information about genes other than NPM-ALK that might play a role in the pathogenesis of ALCL.
Citation Format: Luca Mologni, Geeta G. Sharma, Matteo Villa, Mario Mauri, Giulia Arosio, Cosimo Lobello, Hugo Larose, Alessandra Pirola, Silvia Bombelli, Nicoletta Cordani, Luca Massimino, Šárka Pospíšilová, Suzanne D. Turner, Giorgio Inghirami, Fabio Pagni, Rocco Piazza, Roberto Perego, Roberto Chiarle, Carlo Gambacorti-Passerini. Characterization of potential co-drivers of pathogenesis in ALK positive ALCL [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4715.
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Affiliation(s)
| | | | | | | | | | | | - Hugo Larose
- 3University of Cambridge, Cambridge, United Kingdom
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Sharma GG, Cortinovis D, Agustoni F, Arosio G, Villa M, Cordani N, Bidoli P, Bisson WH, Pagni F, Piazza R, Gambacorti-Passerini C, Mologni L. A Compound L1196M/G1202R ALK Mutation in a Patient with ALK-Positive Lung Cancer with Acquired Resistance to Brigatinib Also Confers Primary Resistance to Lorlatinib. J Thorac Oncol 2019; 14:e257-e259. [DOI: 10.1016/j.jtho.2019.06.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 11/26/2022]
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Ciceri G, Arosio G, Brunatti M, Fontana G, Riedo R, Vesconi S. [Anesthesia in Apert syndrome]. Minerva Anestesiol 1997; 63:167-9. [PMID: 9380290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The anaesthetic technique chosen for a laparohysterectomy in a woman affected by Apert's acrocephalosyndactilia is described. Difficulties in performing tracheal intubation were overcome by mean of loco-regional anesthesia (LRA). In order to minimize the anaesthetic risk, a standardised preoperative evaluation and assessment integrating the usual investigations and the possibility of employing intubation techniques as alternative to direct laryngoscopy are suggested.
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Affiliation(s)
- G Ciceri
- Ospedale di Desio (Milano), Servizio di Anestesia e Rianimazione, Azienda USSL, Ambito Territoriale N. 30, Lombardia
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La Canna G, Giubbini R, Metra M, Arosio G, Curnis A, Cicogna R, Visioli O. Assessment of myocardial perfusion with thallium-201 scintigraphy in exercise-induced left bundle branch block: diagnostic value and clinical significance. Eur Heart J 1992; 13:942-6. [PMID: 1644085 DOI: 10.1093/oxfordjournals.eurheartj.a060297] [Citation(s) in RCA: 20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Myocardial perfusion scintigraphy with thallium-201 was performed in 33 subjects (mean age 45 years, range 28-61) with exercise-induced, rate-dependent left bundle branch block (LBBB) in order to assess both the value of Thallium-201 myocardial imaging for the diagnosis of coronary artery disease (CAD) and the pathogenesis (ischaemic or not) of the conduction defect. Of the 33 patients evaluated, 16 had chest pain suggestive of CAD and 17 were asymptomatic. None had a history of prior myocardial infarction or clinical and echocardiographic signs of heart disease. LBBB appeared at a heart rate ranging from 70 to 160 b.min-1. Eighteen patients showed repolarization abnormalities (ST segment depression with deep inverted T waves) compatible with ischaemia, after QRS normalization. Thallium-201 myocardial uptake was normal in 12 subjects; in the remaining 21, reversible Thallium-201 defects were demonstrated in the septum (18 patients), septum and apex (2), and septum and infero-apical wall (1). No patient had irreversible defects and all had normal coronary angiography, with negative ergonovine tests for coronary artery spasm. The patients were followed up for a mean of 43 months (range 16-80). One patient died from sudden death, but no cardiac event occurred in the other patients. In conclusion, exercise Thallium-201 myocardial scintigraphy showed a high prevalence (64%) of reversible perfusion defects in a group of patients with exercise-induced LBBB without any evidence of CAD at angiography or coronary spasm at ergonovine test. Moreover, follow-up showed a relatively low rate of major cardiac events.
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Affiliation(s)
- G La Canna
- Università degli Studi di Brescia, Divisione di Cardiologia, Italy
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Abstract
From 1969 to 1973, 68 patients were admitted to the 4th Division of Medicine of the Brescia Civil Hospital with the diagnosis of viral myocarditis. The patients were divided into two groups according to the results of the Coxsackie virus complement fixing antibodies test: Group 1 (42 patients) with a fourfold or greater rising antibody titre; Group 2 (26 patients) with a negative serum test. Both groups were examined after a follow-up period of 15 years. Ten patients from Group 1 died. The diagnoses were chronic myocarditis (three cases); chronic cardiomyopathy-pulmonary embolism (one case); chronic cardiomyopathy-liver cirrhosis (one case); dilated cardiomyopathy-sudden death (two cases); congestive cardiomyopathy (three cases). No Group 2 patients died. The 15-year mortality rate of Group 1 was significantly higher than that of Group 2 (Fisher Test: p less than 0.005). In conclusion, the natural history of Coxsackie virus heart disease is characterized by two possibilities: a complete recovery from a clinical point of view, in some cases with only minor T wave abnormalities, or evolution into a chronic disease (dilated cardiomyopathy) having a high mortality rate within 10 years of the onset of the acute disease.
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Affiliation(s)
- G Levi
- Fondazione clinica del lavoro, Rehabilitation Medical Center, Gussago, Italy
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La Canna G, Giubbini R, Metra M, Guerra UP, Dei Cas L, Manca C, Arosio G, Visioli O. [Value of first-pass radionuclide angiocardiography in the diagnosis of obstructive coronary disease in women with chest pains and repolarization abnormalities of the ischemic type (at rest or during exercise)]. Cardiologia 1988; 33:151-9. [PMID: 3359461] [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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La Canna G, Giubbini R, Caobelli A, Pizzocaro C, Soccisi MC, Guerra UP, Arosio G. [Acute and chronic effects of verapamil on indices of systolic and diastolic function of the left ventricle in patients with hypertrophic cardiomyopathy]. G Ital Cardiol 1987; 17:744-53. [PMID: 3692075] [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: 01/07/2023]
Abstract
The aim of this study has been the analysis of acute and chronic effects of Verapamil on resting left ventricular (LV) systolic and diastolic function indices derived from ECG gated radionuclide Angiocardiography (GRA) in patients (pts) affected by Hypertrophic Cardiomyopathy (HCM). 18 pts with HCM were imaged in basal conditions (twice in two different days) and after i.v. infusion of Verapamil 0.1 mg/kg (1st acute test); than chronic oral treatment of Verapamil (240 mg/die) was started. Three months later 14 pts were studied again, during oral chronic therapy and after a second administration of Verapamil i.v. 0.1 mg/kg (2nd acute test). After acute infusion we observed a significant increase of the peak filling rate (PFR) (from 3.3 +/- 0.9 to 3.51 +/- 0.71 EDV/sec, P less than 0.01) and a shortening of the time to PFR (from 188.1 +/- 24.9 to 165 +/- 30 msec, P less than 0.005). No significant variations of the contribution of atrial systole to the ventricular filling (AS) (from 17.03 +/- 5.96 to 18.15 +/- 6.91%), of the heart rate (from 70 +/- 12 to 69 +/- 12 bat/min), and of systolic function indices, ejection fraction (EF) (from 74.4 +/- 9.7 to 74.30 +/- 10.02), peak ejection rate (ER) (from 4.17 +/- 0.92 to 4.10 +/- 0.9), ejection time (ET) (from 307.4 +/- 46.4 to 322.22 +/- 48.6) were noticed. After chronic oral therapy we observed a significant shortening of the time to PFR (from 197.5 +/- 16.7 to 182.8 +/- 13.7 msec, P 0.01), while the remaining indices of diastolic function we analyzed (PFR from 3.2 +/- 0.6 to 3.3 +/- 0.8 EDV/sec; AS from 17.1 +/- 4.9 to 17.1 +/- 6.6%), the systolic function indices (EF from 74.4 +/- 10.5 to 75.4 +/- 9.4%; ER from 4.2 +/- 0.8 to 4.2 +/- 0.6 EDV/sec; ET from 309.6 +/- 48.5 to 308.9 +/- 40.5 msec) and the heart rate (from 67.7 +/- 8 to 66 +/- 8) were not modified. If a 30 msec time to PFR variation was considered significative (confidence limit of 95% between absolute changes measured on two basal studies) the 1st acute test was predictive of chronic efficacy in 10/14 (71%) pts. Four of five pts in which a shortening of TTPFR was observed during the 2nd acute test, showed the same effect with a higher chronic dose of Verapamil (360 mg/die). Our results suggest that Verapamil after acute or chronic treatment improves diastolic filling of LV, without worsening systolic indices.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- G La Canna
- Servizio di Policardiografia, Spedali Civili, Brescia
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11
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Giubbini R, Metra M, Guerra P, La Canna G, Bissoli G, Arosio G, Niccoli L, Visioli O, Bestagno M. Diagnostic accuracy of rest-exercise first pass ventriculography with a fast single crystal gamma camera in detecting coronary artery disease. Study of a group of male subjects without previous myocardial infarction. Eur J Nucl Med 1987; 13:213-20. [PMID: 3311765 DOI: 10.1007/bf00252595] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Rest and exercise radionuclide ventriculograms were performed in 61 non infarcted, male, patients who underwent cardiac catheterization for chest pain and in 16 normal control subjects. Studies were performed using the first pass method with a fast single crystal gamma camera, which allowed a count rate of 140 +/- 19 Kcounts/sec to be reached during left ventricular filling; the count integral on left ventricular area was 10.8 +/- 1.6 Kcounts and the maximum count/pixel 155 +/- 16. We analyzed sensitivity, specificity, positive and negative predictive value of global ejection fraction (EF) and of the regional wall motion in identifying ventricular function abnormalities due to obstructive coronary artery disease. The regional wall motion was evaluated with four functional images: regional ejection fraction (REF), amplitude (A) and phase (PH) from Fourier analysis and systolic transit times (TT). Sensitivity was near 90% for EF, REF, A and TT, while PH was less sensitive (80%); all functional images were more specific (nearly 90%) than EF (80%). Both sensitivity and specificity were lower for the exercise EKG (59% and 63%, respectively) in this patient group. Significant differences between single vessel and multiple vessel disease were also observed either for the EF increase/decrease (-1.34 +/- 7.4 and -7.82 +/- 9.96; P less than 0.05) or for the number of segments which developed wall motion abnormalities during exercise (1.22 +/- 0.73 and 2.15 +/- 1.04; P less than 0.02). In conclusion, with our method, a fast single crystal gamma camera is suitable for obtaining optimal first pass radionuclide ventriculograms with a count density sufficient either for global or regional left ventricular function evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R Giubbini
- Servizio di Medicina Nucleare, Università di Brescia, Italy
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12
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La Canna G, Giubbini R, Cicogna R, Curnis A, Guerra UP, Arosio G, Visioli O. [Study of myocardial perfusion by means of scintigraphy with thallium-210 in left bundle branch block induced by exertion]. G Ital Cardiol 1987; 17:498-504. [PMID: 3666378] [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
Myocardial perfusion scintigraphy with 201-TL was performed in a group of subjects affected by exercise-induced, rate-dependent left bundle branch block (LBBB). The aim of the study was: to define the significance of the exercise-induced conduction abnormality: "primitive" or "ischemic". 14 patients, aging 28-58 years (x = 42), 8 with chest pain (4 typical angina, 4 atypical angina) and 6 without any symptoms were studied. None had history of prior myocardial infarction or clinical and echocardiographic signs of heart disease. LBBB appeared at a heart rate ranging from 70 to 160 beats/min. 6 patients showed repolarization abnormalities (ST changes, deep and negative T wave) suggestive for ischemia, during successive QRS normalization. 201-TL-uptake was normal in 5 subjects; in the remaining 9 ones reversible TL defects were demonstrated in the septum (6), in the septum and apex (2), in the septum and inferior-apical wall (1). No patients had irreversible impaired perfusion. All the patients had normal coronary angiography, with negative ergonovine test for coronary artery spasm. In conclusion, in the majority of our subjects (64%) with exercise-induced LBBB, a reversible TL-uptake defect, usually located in the septum without diagnostic value of obstructive CAD, has been observed. Further studies will establish if the TL-defect is only an "apparent phenomenon" due to contraction abnormality secondary to LBBB, or, on the contrary, an expression of myocardial ischemia with normal coronary vessels as a consequence of the LBBB.
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Affiliation(s)
- G La Canna
- Cattedra di Cardiologia, Università degli Studi di Brescia
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13
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Zanini R, Giunti G, Bissoli G, La Canna G, Cicogna R, Arosio G. [Systolic time intervals in thyroid pathology]. Minerva Cardioangiol 1985; 33:431-6. [PMID: 4080178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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14
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Bissoli GS, La Canna G, Zanini R, Caobelli A, Berra P, Ettori F, Arosio G. [M-mode echocardiographic evaluation of antihypertensive efficacy and the mechanism of action of pindolol]. Minerva Cardioangiol 1985; 33:337-43. [PMID: 4047421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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15
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La Canna G, Giubbini R, Bissoli G, Guerra UP, Caobelli A, Zanini R, Niccoli L, Arosio G. [Evaluation of the interventricular septum in left bundle branch block using basal echocardiography (M-mode) and myocardial stress scintigraphy (thallium-201)]. G Ital Cardiol 1985; 15:135-41. [PMID: 4007361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In thirty-six consecutive subjects, with left bundle branch block (LBBB) of the interventricular septum (IS), septal perfusion and/or viability was verified by M-mode echocardiography and by stress redistribution 201 TI-scintigraphy. After the early systolic "dip", a characteristic pattern of interventricular septum in left bundle branch block, we observed: a) an anterior paradoxical movement (A-type) during the ejection phase in 5 subjects; b) hypokinetic posterior movement (B-type) in 10 subjects and c) a normal motion (C-type) in 21 subjects. All the subjects with an A-type paradoxical anterior motion of the interventricular septum, showed a persistent defect of T1 uptake both during exercise and after redistribution. Of 31 patients with posterior interventricular septum motion (B and C types), 21 showed normal septal TI uptake and 10 reversible, exercise-induced perfusion defect, with complete redistribution on scintigrams at rest. In conclusion the analysis of our data demonstrates that in patients with left bundle branch block 1) the motion of the interventricular septum is not merely due to the anomalous electrical activation, but to other different factors, such as the anatomical and functional changes underlying the conduction pathology, 2) an A-type motion by M-mode echocardiography is highly predictive of interventricular septum damage.
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16
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Cicogna R, Benedini G, Arosio G, Cuccia C, Riva S. [Implantation of a permanent endocardial pacemaker. Experience of 10 years (519 cases)]. Minerva Cardioangiol 1982; 30:119-27. [PMID: 7088292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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17
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Arosio G, Bartoccioni A, Brambilla L, Donati L, Pandolfo G. [Comparative study of the use of crystalloids and colloids in the therapy of burn shock]. Minerva Anestesiol 1981; 47:499-510. [PMID: 6171756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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18
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Arosio G, Vigasio F, Vegna AM, Lanza G, Corsini M, Rastrelli GF. [Particles in infusion fluids. Preventive effectiveness of terminal filters. Comparative study]. Minerva Anestesiol 1981; 47:155-68. [PMID: 7242964] [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: 01/24/2023]
Abstract
The main particles present in solutions for parenteral use are potentially harmful. Current industrial technologies are not yet capable of supplying products that are entirely free of corpusculated substances. In addition, the latter increase in direct proportion to the number of handlings that are carried out by hospital staff in the preparation of infusion treatments. Filters capable of cutting down the number of infused particles are suggested for application to defluxion devices. Three such filters currently available on the Italian market are examined. The filter with 0.45 mu diameter holes proved capable of minimising the amount for particles without provoking an appreciable interference with the defluxion times of the solutions used in the experiments.
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19
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Arosio G, Lanza G, Vegna AM. [Tube feeding: an old technique with a new method]. Minerva Anestesiol 1980; 46:1277-82. [PMID: 6784034] [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: 01/21/2023]
Abstract
The total parenteral nutrition (T.P.N.) in now largely adopted, often in no strictly cogent indications. The Authors outline the wellknown advantages of enteral nutrition. To overcome the frequent episodes of intolerance in tube feeding, they list the rules followed in preparing diets, strictly balanced from the caloric point of view, using lyophilized natural elements of wellknown composition. Their results seem to confirm the value of the technique.
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20
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Arosio G, Betti A, Di Fabio D, Mondini M, Petroboni V. [Congenital coronary fistula: angiographic diagnosis and surgical therapy]. Radiol Med 1980; 66:165-7. [PMID: 7455230] [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: 01/25/2023]
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21
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Arosio G. [Emergency reanimation in the dental office]. Dent Cadmos 1980; 48:43-50. [PMID: 6932300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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22
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Gola E, Arosio G, Di Girolamo A, Ciampalini G, Oneglia C. [Ergometric evaluation of the long-term treatment with nifedipine and a nitro derivative in subjects with angina of effort]. Minerva Cardioangiol 1979; 27:719-26. [PMID: 545179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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23
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Arosio G, Petroboni V, Cicogna R, Benedini G. [Abnormal passage of the permanent catheter electrode through the chordae tendinae of the tricuspid valve]. Cardiol Prat 1978; 29:141-5. [PMID: 753525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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24
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Arosio G, Mazzardi E, Bellini L, Rastrelli GF. [The problem of physico-chemical and pharmacological incompatibility of the products used in phleboclysis in resuscitation]. Minerva Anestesiol 1976; 42:245-60. [PMID: 1018767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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25
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Rusconi C, Arosio G, Orlando G, Petroboni V, Riva S, Gola E, Benedini G, Cicogna R, Frau G, Prandini BD, Spandrio L, Feroldi P. [Coronary risk factors and ischemic heart disease in bus drivers and conductors]. Minerva Cardioangiol 1975; 23:718-27. [PMID: 1223675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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26
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Frau G, Arosio G. [Permanent electric therapy of atrio-ventricular blocks]. Cardiol Prat 1974; 25:219-24. [PMID: 4434375] [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: 01/10/2023]
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27
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Rusconi C, Gola E, Arosio G, Riva S, Frau G, Albertini A, Prandini BD, Spandrio L. [Plasma lipids in normal subjects, and in patients with coronary disease and peripheral arteriopathy]. Minerva Med 1973; 64:4209-16. [PMID: 4765428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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28
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Frigerio G, Arosio G. [Controlled evaluation of a new analgesic (Z.867) in postoperative pain]. Minerva Anestesiol 1972; 38:297-304. [PMID: 4671655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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29
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Gastaldi A, Samaja BA, Falsetti L, Arosio G. [Childbirth in heart disease. Clinical contribution]. Ann Ostet Ginecol Med Perinat 1971; 92:749-70. [PMID: 5148960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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30
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Arosio G, Mocavero G. [Problems of anesthesia and resuscitation on board merchant ships during navigation]. Ann Med Nav (Roma) 1971; 76:9-70. [PMID: 5582052] [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: 01/15/2023]
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31
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Arosio G, Albertini A, Bordoni L, Fiaccavento S. [Morphological and functional changes of the liver in coma dépassé]. Epatologia 1970; 16:333-6. [PMID: 5525576] [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: 01/15/2023]
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32
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Arosio G, Albertini A, Bordoni L, Fiaccavento S. [Morphological and functional changes of the liver of coma dépassé]. Minerva Anestesiol 1969; 35:1122-9. [PMID: 5374066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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33
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Arosio G, Pandolfo M, Pitzus E. [Air pollution with pathogenic germs and the incidence of cross transmissions in Resuscitation Centers]. Minerva Anestesiol 1969; 35:958-66. [PMID: 5364462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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34
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Arosio G. [The organization of the unit for radiotherapy with hyperoxygenation in the Istituto del Radio "O. Alberti" of the city hospitals of Brescia]. Nunt Radiol 1968; 34:155-66. [PMID: 5717028] [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: 01/16/2023]
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35
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Arosio G, Bertolizio G, Premoli S. [Acid-base equilibrium as a control of the clinical awakening after surgery]. Minerva Anestesiol 1967; 33:816-9. [PMID: 5617730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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36
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Arosio G. [The management of the autonomous Recovery Centers. Criterion for a functional selection]. Minerva Anestesiol 1967; 33:597-8. [PMID: 5605024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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37
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Arosio G. [Nosology of Recovery and Intensive Therapy Centers. Criteria of admission. Statistical data]. Minerva Anestesiol 1967; 33:600-1. [PMID: 5605026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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38
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Arosio G. [Inclusion of the autonomous Recovery Centers in the Italian hospital life]. Minerva Anestesiol 1967; 33:584-5. [PMID: 5605020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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39
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Arosio G. [The Recovery Centers and the problem of septic contagion]. Minerva Anestesiol 1967; 33:598-600. [PMID: 5605025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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40
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Arosio G, Flocchini PA, Premoli S. [The control of acid-base equilibrium as an index of safety during and after pure neuroleptoanalgesia. Its comparison with the spirometric study and electrolyte pattern]. Minerva Anestesiol 1966; 32:565-70. [PMID: 5995741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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41
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Gastaldi A, Pezzoli C, Frangipani GC, Arosio G, Flocchini PA, Premoli S. [Maternal-fetal gas exchange. Findings in the course of cesarean section]. Ann Ostet Ginecol Med Perinat 1966; 88:247-300. [PMID: 5942420] [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: 05/21/2023]
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42
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Bertolizio G, Arosio G, Frangipani GC, D'Aquino P. [The study of pO2 and of acid-base equilibrium in the amniotic fluid during maternal hyperoxygenation]. Ann Ostet Ginecol Med Perinat 1966; 88:301-6. [PMID: 5942421] [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: 01/17/2023]
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43
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Arosio G. [The value of the monitoring system in resuscitation]. Minerva Anestesiol 1966; 32:137-40. [PMID: 5933684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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44
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Arosio G. [The artificial control of cardiac rhythm]. Minerva Anestesiol 1966; 32:144-8. [PMID: 5933687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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45
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Arosio G, Bertolizio G, Frangipani GC. [Study of acid-base equilibrium of the amniotic fluid in the course of normal and pathological pregnancies]. Ann Ostet Ginecol 1965; 87:924-34. [PMID: 5880329] [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: 01/17/2023]
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46
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Arosio G. [Importance of telecommunications in the area of the of Anesthesia and Reanimation]. Minerva Anestesiol 1965; 31:467-9. [PMID: 5854644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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47
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Arosio G. [The use of modern electronic apparatus in resuscitation]. Boll Soc Med Chir Cremona 1964; 18:559-69. [PMID: 5881391] [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: 01/17/2023]
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