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Andreozzi P, de Nucci G, Devani M, Redaelli D, Schettino M, Iuliano D, Zulli C, Maurano A, Bottiglieri ME, Paspatis G, Dinelli M, Manes G. The high rate of spontaneous migration of small size common bile duct stones may allow a significant reduction in unnecessary ERCP and related complications: results of a retrospective, multicenter study. Surg Endosc 2021; 36:3542-3548. [PMID: 34494152 DOI: 10.1007/s00464-021-08676-8] [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] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/07/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Common bile duct stones (CBDS) can spontaneously migrate through the duodenal papilla. In this case, ERCP could be unnecessary and a significant rate of complications could be avoided. In this study, we aim at retrospectively evaluating the rate of spontaneous stone passage in patients with an imaging diagnosis of CBDS and at analysing the factors associated to spontaneous stone migration. METHODS We conducted a retrospective multi-centre analysis of patients undergoing ERCP for CBDS in a 12-month period. 1016 patients with CBDS were analysed. In all patients CBDS was diagnosed with adequate imaging methods performed prior to ERCP. ERCPs with failed biliary cannulation were excluded. Data regarding patients' characteristics, imaging findings and ERCP procedure were analysed. RESULTS 1016 patients with CBDS undergoing ERCP were analysed (male sex 43.3%; mean age 69.9 ± 16.5 years). Diagnosis of CBDS was obtained by EUS in 415 patients (40.8%), MR in 343 (33.8%), CT in 220 (21.7%), and US in 38 (3.7%). No stones were found at ERCP in 179 patients (17.6%), in 14 (6.2%) when ERCP was performed within 6 h from imaging study, in 114 (18.5%) between 7 h and 7 days, in 32 (24.6%) between 8 and 29 days, and in 19 (43.2%) after 30 days. The rate of unnecessary ERCP occurred significantly more frequently in patients in whom imaging methods demonstrated either sludge or ≤ 5 mm CBDS (29.9 vs. 8.3%; p < 0.001). DISCUSSION Spontaneous migration of small CBDS is a frequent event, and ≤ 5 mm size and a delay in ERCP > 7 days represent predictive factors for it. We suggest that CBDS ≤ 5 mm should not undergo immediate removal and this fact would allow reducing the rate of unnecessary ERCP with their related complications. Prospective studies are needed to confirm these results and demonstrate the safety of a conservative management in this setting.
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Affiliation(s)
- Paolo Andreozzi
- Gastroenterology and Endoscopy Unit, ASL Caserta, Marcianise Hospital, Marcianise, Caserta, Italy
| | - Germana de Nucci
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, Viale Forlanini 95, Garbagnate Milanese, Milan, Italy
| | - Massimo Devani
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, Viale Forlanini 95, Garbagnate Milanese, Milan, Italy
| | - Davide Redaelli
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, Viale Forlanini 95, Garbagnate Milanese, Milan, Italy
| | - Mario Schettino
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, Viale Forlanini 95, Garbagnate Milanese, Milan, Italy
| | - Donato Iuliano
- Gastroenterology and Endoscopy Unit, ASL Caserta, Marcianise Hospital, Marcianise, Caserta, Italy
| | - Claudio Zulli
- Endoscopic Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Attilio Maurano
- Endoscopic Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | | | - Gregorios Paspatis
- Gastroenterology Department, Benizelion General Hospital, Heraklion, Crete, Greece
| | - Marco Dinelli
- Gastroenterology and Endoscopy Unit, San Gerardo Hospital, Monza, Italy
| | - Gianpiero Manes
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, Viale Forlanini 95, Garbagnate Milanese, Milan, Italy.
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Borsotti E, Barberio B, D'Incà R, Bonitta G, Cavallaro F, Spina L, Pastorelli L, Rondonotti E, Samperi L, Dinelli M, Vecchi M, Tontini GE. Low prevalence of colorectal neoplasia in microscopic colitis: A large prospective multi-center study. Dig Liver Dis 2021; 53:846-851. [PMID: 33129712 DOI: 10.1016/j.dld.2020.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/02/2020] [Revised: 08/28/2020] [Accepted: 09/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Microscopic colitis (MC) is the most frequent condition in subjects undergoing ileocolonoscopy for chronic non-bloody diarrhea (CNBD) in Western countries. Emerging evidence has shown a negative association between MC and colorectal cancer. Within this prospective multi-center study we have evaluated the risk of colorectal neoplasia in MC and non-MC patients with CNBD receiving ileocolonoscopy with high-definition plus virtual chromoendoscopic imaging and histopathological assessment. METHODS Patients with CNBD of unknown origin were prospectively enrolled in 5 referral centers in Northern Italy for ileocolonoscopy with high-definition and digital/optical chromoendoscopy plus multiple biopsies in each segment. The prevalence of colorectal neoplasia (cancer, adenoma, serrated lesion) in MC was compared to that observed in a control group including CNBD patients negative for MC, inflammatory bowel disease or eosinophilic colitis. RESULTS From 2014 and 2017, 546 consecutive CNBD patients were recruited. Among the 492 patients (mean age 53±18 years) fulfilling the inclusion criteria against the exclusion critieria, MC was the predominant diagnosis at histopathological assessment (8.7%: N=43, 28 CC, 15 LC). The regression model adjusted for age and gender showed a significant negative association between the diagnosis of CM and colorectal neoplasia (OR=0.39; 95% CI 0.22-0.67, p <0.001) with a 60% decreased risk of adenomatous and neoplastic serrated polyps as compared to the control group (n=412). CONCLUSION This multi-center study confirms MC as a low-risk condition for colorectal neoplasia. No surveillance colonoscopy program is to be performed for MC diagnosis.
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Affiliation(s)
- Edoardo Borsotti
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Brigida Barberio
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Renata D'Incà
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Gianluca Bonitta
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Flaminia Cavallaro
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luisa Spina
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luca Pastorelli
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Leonardo Samperi
- Gastroenterology and Digestive Endoscopic Unit, Ospedale Morgagni Pierantoni, Forlì, Italy
| | - Marco Dinelli
- Gastroenterology Division, San Gerardo Hospital, Monza, Italy
| | - Maurizio Vecchi
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy
| | - Gian Eugenio Tontini
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy.
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3
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Donato G, Forti E, Mutignani M, Laterra MA, Arese D, Coppola F, Zaccari P, Mariani A, Arcidiacono PG, Pigò F, Conigliaro R, Costa D, Tringali A, Lavagna A, Rocca R, Gabbiadini R, Fugazza A, Repici A, Fava G, Marini F, Mosca P, Urban F, Monica F, Crinò SF, Gabbrielli A, Blois M, Binda C, Sbrancia M, Fabbri C, Frego R, Dinelli M, Imbesi V, Gambitta P, Balzarini M, Segato S, Grazioli LM, Spada C, Amato A, Venezia G, Aragona G, Rosa C, Alvisi C, Devani M, Manes G, Dell’Amico I, Gemme C, Reati R, Auriemma F, Mangiavillano B, Rodi M, Bertani H, Mazzucco D, Armellini E, Cantù P, Penagini R, Occhipinti P. A multicenter survey on endoscopic retrograde cholangiopancreatography during the COVID-19 pandemic in northern and central Italy. Endosc Int Open 2021; 9:E629-E634. [PMID: 33880397 PMCID: PMC8050562 DOI: 10.1055/a-1380-3419] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/13/2021] [Indexed: 12/12/2022] Open
Abstract
Background and study aims COVID-19 has dramatically impacted endoscopy practice because upper endoscopy procedures can be aerosol-generating. Most elective procedures have been rescheduled. Endoscopic retrograde cholangiopancreatography (ERCP) is frequently performed in emergency or urgent settings in which rescheduling is not possible. We evaluated the impact of the COVID-19 pandemic on ERCP in Italy during the SARS-CoV-2 lockdown, in areas with high incidence of COVID-19. Patients and methods We performed a retrospective survey of centers performing ERCP in high COVID-19 prevalence areas in Italy to collect information regarding clinical data from patients undergoing ERCP, staff, case-volume and organization of endoscopy units from March 8, 2020 to April 30, 2020. Results We collected data from 31 centers and 804 patients. All centers adopted a triage and/or screening protocol for SARS-CoV-2 and performed follow-up of patients 2 weeks after the procedure. ERCP case-volume was reduced by 44.1 % compared to the respective 2019 timeframe. Of the 804 patients undergoing ERCP, 22 (2.7 %) were positive for COVID-19. Adverse events occurred at a similar rate to previously published data. Of the patients, endoscopists, and nurses, 1.6 %, 11.7 %, and 4.9 %, respectively, tested positive for SARS-CoV-2 at follow up. Only 38.7 % of centers had access to a negative-pressure room for ERCP. Conclusion The case-volume reduction for ERCP during lockdown was lower than for other gastrointestinal endoscopy procedures. No definitive conclusions can be drawn about the percentage of SARS-CoV-2-positive patients and healthcare workers observed after ERCP. Appropriate triage and screening of patients and adherence to society recommendations are paramount.
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Affiliation(s)
- Giulio Donato
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Edoardo Forti
- Digestive and Operative Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimiliano Mutignani
- Digestive and Operative Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Daniele Arese
- Gastroenterology Unit, Ospedale San Giovanni Bosco, Torino, Italy
| | - Franco Coppola
- Gastroenterology Unit, Ospedale San Giovanni Bosco, Torino, Italy
| | - Piera Zaccari
- Pancreatobiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Alberto Mariani
- Pancreatobiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Flavia Pigò
- Gastroenterology and Digestive Endoscopy – Azienda Ospedaliero-Universitaria Modena, Ospedale di Baggiovara, Italy
| | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy – Azienda Ospedaliero-Universitaria Modena, Ospedale di Baggiovara, Italy,Digestive Endoscopy Unit, Azienda Ospedaliero-Universitaria Modena, Policlinico di Modena, Italy
| | - Deborah Costa
- Gastroenterology Unit, ULSS 2 Marca Trevigiana, Ospedale Conegliano-Vittorio Veneto, Italy
| | - Alberto Tringali
- Gastroenterology Unit, ULSS 2 Marca Trevigiana, Ospedale Conegliano-Vittorio Veneto, Italy
| | | | - Rodolfo Rocca
- Gastroenterology Unit, AO Ordine Mauriziano, Torino, Italy
| | - Roberto Gabbiadini
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center – IRCCS, Rozzano, Milan, Italy
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center – IRCCS, Rozzano, Milan, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center – IRCCS, Rozzano, Milan, Italy
| | - Giammarco Fava
- SOD Malattie Apparato Digerente, Endoscopia Digestiva, Malattie Infiammatorie Croniche Intestinali, Ospedali Riuniti, Ancona, Italy
| | - Francesco Marini
- SOD Malattie Apparato Digerente, Endoscopia Digestiva, Malattie Infiammatorie Croniche Intestinali, Ospedali Riuniti, Ancona, Italy
| | - Piergiorgio Mosca
- SOD Malattie Apparato Digerente, Endoscopia Digestiva, Malattie Infiammatorie Croniche Intestinali, Ospedali Riuniti, Ancona, Italy
| | - Flavia Urban
- Gastroenterology Unit, ASU GI Ospedale di Cattinara Trieste, Italy
| | - Fabio Monica
- Gastroenterology Unit, ASU GI Ospedale di Cattinara Trieste, Italy
| | | | - Armando Gabbrielli
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, Verona, Italy
| | - Matteo Blois
- Operative Endoscopy Unit, Azienda Usl Toscana Nord-Ovest, Livorno, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy
| | - Monica Sbrancia
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy
| | | | | | - Venerina Imbesi
- Gastroenterology and Digestive Endoscopy Unit, ASST Ovest Milanese, Legnano, Milan, Italy
| | - Pietro Gambitta
- Gastroenterology and Digestive Endoscopy Unit, ASST Ovest Milanese, Legnano, Milan, Italy
| | | | - Sergio Segato
- Gastroenterology Unit, ASST Sette-Laghi, Varese, Italy
| | | | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Arnaldo Amato
- Gastroenterology Unit, Ospedale Valduce, Como, Italy
| | - Giovanna Venezia
- Gastroenterology Unit, Azienda Ospedaliera S.Croce e Carle, Cuneo, Italy
| | - Giovanni Aragona
- Gastroenterology and Hepatology Unit, Ospedale Civile, AUSL Piacenza, Italy
| | - Cesare Rosa
- Digestive Endoscopy Unit, ASST Pavia, Ospedali Voghera-Vigevano, Pavia, Italy
| | - Costanza Alvisi
- Digestive Endoscopy Unit, ASST Pavia, Ospedali Voghera-Vigevano, Pavia, Italy
| | | | | | - Iginio Dell’Amico
- Endoscopy Unit, Azienda Usl Toscana Nord-Ovest, Massa Carrara, Italy
| | - Carlo Gemme
- Gastroenterology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Raffaella Reati
- ASST Rhodense, Presidio di Garbagnate Milanese, Milan, Italy
| | - Francesco Auriemma
- Gastrointestinal Endoscopy Unit, Humanitas – Mater Domini, Castellanza, Varese, Italy
| | | | - Marcello Rodi
- Gastroenterology and Digestive Endoscopy Unit, Ospedale S. Andrea, ASL VC, Vercelli, Italy
| | - Helga Bertani
- Digestive Endoscopy Unit, Azienda Ospedaliero-Universitaria Modena, Policlinico di Modena, Italy
| | | | - Elia Armellini
- Gastroenterology and Digestive Endoscopy Unit, ASST Bergamo Est, Bergamo, Italy
| | - Paolo Cantù
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Roberto Penagini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Pietro Occhipinti
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
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de Nucci G, Reati R, Arena I, Bezzio C, Devani M, Corte CD, Morganti D, Mandelli ED, Omazzi B, Redaelli D, Saibeni S, Dinelli M, Manes G. Efficacy of a novel self-assembling peptide hemostatic gel as rescue therapy for refractory acute gastrointestinal bleeding. Endoscopy 2020; 52:773-779. [PMID: 32316041 DOI: 10.1055/a-1145-3412] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 02/08/2023]
Abstract
BACKGROUND Acute gastrointestinal bleeding (AGIB) results in significant morbidity and mortality. Topical hemostatic products have been developed for endoscopic use to help in the management of difficult bleeding. Our aim was to demonstrate the ease of use, safety, and efficacy of PuraStat, a novel hemostat, to control AGIB. METHODS We describe 77 patients (41 men) who were treated for acute upper and lower AGIB in a 2-year period. In 50 patients, bleeding occurred as a complication of a previous endoscopic procedure, predominantly endoscopic mucosal resection (EMR) and endoscopic retrograde cholangiopancreatography (ERCP); however, in the other 27 patients, it derived from peptic ulcers, angiodysplasia, cancers, and surgical anastomoses. Bleeding was spurting in 13 of the 77 patients and oozing in 64. PuraStat was used after the failure of at least two conventional hemostatic methods. RESULTS A mean of 2.6 conventional hemostatic methods had been attempted prior to the application of PuraStat. PuraStat achieved successful hemostasis in 90.9 % of patients. In 41 patients, once hemostasis was obtained with PuraStat, endoscopists further stabilized hemostasis by using at least one additional method. Recurrence of bleeding was observed in eight patients (10.4 %). In 16 patients with intraprocedural bleeding, it was possible to complete the procedures (14 EMR, 2 ERCP) after PuraStat hemostasis. No adverse events related to PuraStat were recorded. CONCLUSIONS PuraStat is feasible, safe, and effective in controlling different types of gastrointestinal hemorrhage after failure of conventional hemostatic methods. Its application also does not hinder continuing endotherapy.
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Affiliation(s)
- Germana de Nucci
- Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense - Garbagnate Milanese, Milan, Italy
| | - Raffaella Reati
- Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense - Garbagnate Milanese, Milan, Italy
| | - Ilaria Arena
- Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense - Rho Hospital, Milan, Italy
| | - Cristina Bezzio
- Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense - Rho Hospital, Milan, Italy
| | - Massimo Devani
- Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense - Rho Hospital, Milan, Italy
| | - Cristina Della Corte
- Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense - Rho Hospital, Milan, Italy
| | - Daniela Morganti
- Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense - Garbagnate Milanese, Milan, Italy
| | - Enzo Domenico Mandelli
- Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense - Garbagnate Milanese, Milan, Italy
| | - Barbara Omazzi
- Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense - Rho Hospital, Milan, Italy
| | - Davide Redaelli
- Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense - Garbagnate Milanese, Milan, Italy
| | - Simone Saibeni
- Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense - Rho Hospital, Milan, Italy
| | | | - Gianpiero Manes
- Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense - Garbagnate Milanese, Milan, Italy.,Gastroenterology and Endoscopy Unit, Aziende Socio Sanitaria Territoriale Rhodense - Rho Hospital, Milan, Italy
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5
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Armellini E, Repici A, Alvisi C, Dinelli M, Gambitta P, Manes G, Mutignani M, Orlando S, Radaelli F, Salerno R, Venezia G, Verna C, Penagini R, Pace F. Analysis of patients attitude to undergo urgent endoscopic procedures during COVID-19 outbreak in Italy. Dig Liver Dis 2020; 52:695-699. [PMID: 32425732 PMCID: PMC7229951 DOI: 10.1016/j.dld.2020.05.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 12/12/2022]
Abstract
We conducted a survey to investigate to what extent the fear of COVID-19 has influenced the patients decision to undergo or to cancel endoscopic procedures. We collected data from 847 patients from 13 centres. The main indication for endoscopy was anemia, followed by pain and unexplained weight loss. The percentage of not presenters progressively increased throughout the three weeks of study, from 15.1% at the beginning to 48.2% at the end. 37 (34.2%) upper GI endoscopies and 112 (56.3 %) colonoscopies showed an organic cause explaining the symptoms presented by the patients, respectively; 5 cases of gastric cancer (4.6%) and 16 cases of colorectal cancer (CRC) (6.0%), respectively, were detected; during the second week the percentage of organic diseases found at upper endoscopy was 19 (33.3%) with 5 cancer (8.7%), and 61 (49.1% ) at colonoscopy, with 2 CRC (1.6%); finally, during the third week the corresponding figures were 19 (48.7%) for upper GI examinations, with 3 gastric cancers (7.7%), and 43 (60.5%) with 4 (6.5%) CRC cases found.We conclude that patients weighted the fear of having a clinically relevant disease with the fear of becoming infected by coronavirus, and a relevant percentage of them (29.4%) decided not to attend the endoscopy suites at the scheduled date.
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Affiliation(s)
| | - A. Repici
- Division of Gastroenterology, Humanitas Research Hospital, Rozzano
| | - C. Alvisi
- Digestive Endoscopy Unit, ASST Pavia, Vigevano
| | - M. Dinelli
- Interventional Endoscopy Unit, S. Gerardo Hospital, Monza
| | - P. Gambitta
- Division of Gastroenterology, Legnano Hospital, Legnano
| | - G. Manes
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate Milanese Hospitals, Rho
| | - M. Mutignani
- Digestive Endoscopy Unit, Niguarda Hospital, Milano
| | - S. Orlando
- Division of Gastroenterology, Maggiore della Carità Hospital, Novara
| | - F. Radaelli
- Division of Gastroenterology, Valduce Hospital, Como
| | - R. Salerno
- Endoscopy Unit, ASST Fatebenefratelli Sacco, Milan
| | - G. Venezia
- Endoscopy Unit, S. Croce e Carle Hospital, Cuneo
| | - C. Verna
- Division of Gastroenterology, Alessandria Hospital, Alessandria
| | - R. Penagini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano,Department of Pathophysiology and Transpantation, University of Milano
| | - F. Pace
- GI Unit, ASST Bergamo Est, Seriate
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6
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Repici A, Pace F, Gabbiadini R, Colombo M, Hassan C, Dinelli M. Endoscopy Units and the Coronavirus Disease 2019 Outbreak: A Multicenter Experience From Italy. Gastroenterology 2020; 159:363-366.e3. [PMID: 32283102 PMCID: PMC7151374 DOI: 10.1053/j.gastro.2020.04.003] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/27/2020] [Accepted: 04/02/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Alessandro Repici
- Humanitas Clinical and Research Center, Digestive Endoscopy Unit, Rozzano, Milan, Italy; Humanitas University, Department of Biomedical Sciences, Rozzano, Milan, Italy.
| | - Fabio Pace
- Bolognini Hospital, Gastroenterology Unit, Seriate, Bergamo, Italy
| | - Roberto Gabbiadini
- Humanitas Clinical and Research Center, Digestive Endoscopy Unit, Rozzano, Milan, Italy,Humanitas University, Department of Biomedical Sciences, Rozzano, Milan, Italy
| | - Matteo Colombo
- Humanitas Clinical and Research Center, Digestive Endoscopy Unit, Rozzano, Milan, Italy,Humanitas University, Department of Biomedical Sciences, Rozzano, Milan, Italy
| | - Cesare Hassan
- Nuovo Regina Margherita Hospital, Digestive Endoscopy, Rome, Italy
| | - Marco Dinelli
- San Gerardo Hospital Azienda Socio Sanitaria Territoriale Monza, Endoscopy Unit, Monza, Monza-Brianza, Italy
| | - ITALIAN GI-COVID19 Working GroupMaselliRobertaMD, PhD1SpadacciniMarcoMD12MutignaniMassimilianoMD3GabbrielliArmandoMD4SignorelliClementinaMD5SpadaCristianoMD6LeoniPieraMD7FabbriCarloMD8SegatoSergioMD9GaffuriNicolaMD10MangiavillanoBenedettoMD11RadaelliFrancoMD12SalernoRaffaeleMD13BargiggiaStefanoMD14MaroniLucaMD, PhD15BenedettiAntonioMD15OcchipintiPietroMD16De GraziaFedericoMD17FerrarisLucaMD18CengiaGianpaoloMD19GrecoSalvatoreMD20AlvisiCostanzaMD21ScarcelliAntonellaMD22De LucaLucaMD22CereattiFabrizioMD23TestoniPier AlbertoMD24MingottoRobertoMD25AragonaGiovanniMD26ManesGianpieroMD27BerettaPaoloMD28AmvrosiadisGeorgiosMD29CennamoVincenzoMD30LellaFaustoMD31MissaleGuidoMD32LagoussisPavlosMD33TriossiOmeroMD34GiovanardiMauroMD35De RobertoGiuseppeMD36CantùPaoloMD37BuscariniElisabettaMD38AnderloniAndreaMD, PhD1CarraraSilviaMD1FugazzaAlessandroMD1GaltieriPiera AlessiaMD1PellegattaGaiaMD1AntonelliGiulioMD39RöschThomasMD40SharmaPrateekMD41Humanitas Clinical and Research Center, Digestive Endoscopy Unit, Rozzano (Milan). ItalyHumanitas University, Department of Biomedical Sciences, Rozzano (Milan). ItalyNiguarda-Ca' Granda Hospital, Digestive and Operative Endoscopy Unit, Milan. ItalyThe Pancreas Institute, University Hospital of Verona, Gastroenterology and Digestive Endoscopy Unit, Verona. ItalyASST Bergamo Ovest, Gastroenterology and Digestive Endoscopy, Bergamo. ItalyFondazione Poliambulanza, Digestive Endoscopy Unit, Brescia. ItalyAO Lodi, Gastroenterology & Digestive Endoscopy Unit, Lodi. ItalyAUSL Bologna Bellaria-Maggiore Hospital, Gastroenterology and Digestive Endoscopy Unit, Bologna. ItalyASST Dei Sette Laghi, Gastroenterology and Gastrointestinal Endoscopic Unit, Varese. ItalyHumanitas Gavazzeni, Gastrointestinal Endoscopy Unit, Bergamo. ItalyHumanitas Mater Domini, Gastrointestinal Endoscopy Unit, Castellanza (Milan). ItalyValduce Hospital, Gastroenterology Unit, Como. ItalyFatebenefratelli Sacco, Gastroenterology and Digestive Endoscopy Unit, ASST Milan. ItalyClinica San Carlo, Gastroenterology and Digestive Endoscopy Unit, Paderno Dugnano (Milan). ItalyUniversità Politecnica delle Marche, Department of Gastroenterology and Hepatology, Ancona. ItalyDepartment of Gastroenterology, "Maggiore Della Carità" Hospital, Novara. ItalyFondazione IRCCS Policlinico San Matteo, University of Pavia, First Department of Internal Medicine, Pavia. ItalyASST Valleolona PO, Gastroenterology and Digestive Endoscopy, Gallarate (Varese). ItalyOspedale di Manerbio, Endoscopy Unit, Brescia. ItalyPapa Giovanni XXIII Hospital, Gastroenterology and Digestive Endoscopy Units, Bergamo. ItalyASST Pavia, Digestive Endoscopy Unit, Pavia. ItalyAzienda Ospedaliera Ospedali Riuniti Marche Nord, Gastroenterology and Digestive Endoscopy Units, Pesaro (Pesaro-Urbino). ItalyCremona Hospital, Digestive Endoscopy and Gastroenterology Unit, Cremona. ItalyVita Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Division of Gastroenterology and Gastrointestinal Endoscopy, Milan. ItalyASST Melegnano-Martesana, Gastroenterology and Digestive Endoscopy, Melegnano (Milan). Italy"Guglielmo da Saliceto" Hospital, Department of Internal Medicine, Gastroenterology and Hepatology Unit Piacenza. ItalyASST Rhodense, Department of Gastroenterology and Digestive Endoscopy, Garbagnate Milanese (Milan). ItalyCittà Studi, Gastroenterology and Digestive Endoscopy Unit, Milan. ItalyPoliclinico San Marco, Department of Gastroenterology, Zingonia (Bergamo). ItalyBellaria-Maggiore Hospital, Division of Gastroenterology, Bologna. ItalyPoliclinico San Pietro, Gastroenterology and Digestive Endoscopy Unit, Bergamo. ItalyASST Spedali Civili, Brescia University, Digestive Endoscopy Unit, Brescia. ItalyIRCCS Policlinico San Donato, Digestive Endoscopy, San Donato Milanese (Milan). ItalyAUSL Romagna, Gastroenterology Unit, Ravenna. ItalyOspedale di Rimini, Gastroenterology and Digestive Endoscopy, Rimini. ItalyInstitute of Oncology IRCCS, Division of Endoscopy, European Milan. ItalyFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan. ItalyMaggiore Hospital, Gastroenterology and Digestive Endoscopy Unit, Crema (Cremona). ItalyNuovo Regina Margherita Hospital, Digestive Endoscopy, Rome. ItalyUniversity Hospital Hamburg-Eppendorf, Department of Interdisciplinary Endoscopy, Hamburg, GermanyUniversity of Kansas Medical Center, Division of Gastroenterology & Hepatology, Department of Internal Medicine, Kansas, Missouri, USA
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Tamini N, Ceresoli M, Aldè S, Carissimi F, Ripamonti L, Nespoli L, Dinelli M, Braga M, Gianotti L. Quasi-elective left colectomy after endoscopic colon stenting for obstructive cancer yields comparable oncologic outcome to full-elective operation. Int J Colorectal Dis 2020; 35:633-640. [PMID: 32006138 DOI: 10.1007/s00384-020-03519-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Accepted: 01/26/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Whether deferring surgery after endoscopic self-expandable metal stent (SEMS) placement for neoplastic stricture, and operating patients in a quasi-elective situation, may result in similar oncologic outcomes to elective operations is unclear. This study aimed to evaluate the disease-free survival (DFS) rates of patients who underwent an interval colon resection after SEMS placement or an elective operation with comparable cancer stages. METHODS From a prospective dataset, we retrospectively selected patients with the following characteristics: (1) left-sided colon cancer and (2) cancer stage I to III. Exclusion criteria were as follows: (1) palliative surgery and (2) emergency operation. Then we stratified patients into two groups: (A) full-elective left colon resection and (B) quasi-elective left colon resection, defined as surgery performed after SEMS placement for obstructive colon cancer. DFS function was studied by the Kaplan-Meier method. RESULTS After 1:2 matching based on cancer stage, 106 patients of the group A were compared with 53 patients of group B. In each group, there were 9.4% of stage I, 39.4% of stage II, and 50.9% of stage III patients. The rate of technical failure in SEMS placement was 3.8%. After a mean follow-up of 54 months, 16 (15.1%) patients in the full-elective groups and 10 (18.9%) in the quasi-elective group experience cancer recurrence (log rank = 0.588). DFS curve did not reach the median value. CONCLUSIONS SEMS placement with interval colon resection for obstructive neoplastic strictures seems to provide similar long-term oncologic outcomes to operations performed in an elective setting when a low rate of technical failure is achieved.
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Affiliation(s)
- Nicolò Tamini
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
| | - Marco Ceresoli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Simone Aldè
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Lorenzo Ripamonti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Luca Nespoli
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Marco Braga
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Luca Gianotti
- Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy.
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
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8
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Galeazzi M, Mazzola P, Valcarcel B, Bellelli G, Dinelli M, Pasinetti GM, Annoni G. Endoscopic retrograde cholangiopancreatography in the elderly: results of a retrospective study and a geriatricians' point of view. BMC Gastroenterol 2018. [PMID: 29540171 PMCID: PMC5853060 DOI: 10.1186/s12876-018-0764-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background The incidence of biliary tract pathology is growing with an age-related trend, and progresses as the population ages. Endoscopic Retrograde Cholangiopancreatography (ERCP) represents the gold standard for treatment in these cases, but evidence about its safety in the elderly is still debated. Methods We retrospectively analyzed the clinical records of all patients aged ≥65 undergoing ERCP between July 2013 and July 2015. Of 387 ERCP cases, 363 (~ 94%) were completed entirely. The mean age of the study population (n = 363) was 79.9 years old (range 70–95), with 190 subjects aged 70–79 and 173 older than 80. We recorded demographics, Charlson Comorbidity index (CCI), American Society of Anesthesiologists (ASA) physical status classification score, indication for the use of the ERCP procedure, and clinical outcomes. Then, we tested all variables to identify the potential risk factors for complications associated with the procedure. Results The older group (those ≥80 years old) showed significantly more patients with ASA Classes III-IV than the younger one (those ≤79 years old). Interestingly, the CCI was higher in the younger group (p = 0.009). The overall complication rate was 17.3% without inter-group differences. Older age, sex, CCI and intra-ERCP procedures were not related to a higher risk of complications, and the multivariate regression did not identify any of the considered variables to be an independent risk factor for complications. Conclusion ERCP appears as safe in the patients aged 80 years and older, as it is in those aged 70–79 years old in our study, however, a selection bias may affect these findings. A study including a comprehensive geriatric assessment will contribute to shedding light on this issue.
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Affiliation(s)
- Marianna Galeazzi
- University of Milano-Bicocca, School of Medicine and Surgery, U8 Building, Floor 4, Lab 4045, Via Cadore, 48 - 20900, Monza, MB, Italy
| | - Paolo Mazzola
- University of Milano-Bicocca, School of Medicine and Surgery, U8 Building, Floor 4, Lab 4045, Via Cadore, 48 - 20900, Monza, MB, Italy. .,NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences research area, Milan, MI, Italy.
| | | | - Giuseppe Bellelli
- University of Milano-Bicocca, School of Medicine and Surgery, U8 Building, Floor 4, Lab 4045, Via Cadore, 48 - 20900, Monza, MB, Italy.,NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences research area, Milan, MI, Italy.,San Gerardo Hospital ASST Monza, Acute Geriatrics Unit, Monza, MB, Italy
| | - Marco Dinelli
- San Gerardo Hospital ASST Monza, Endoscopy Unit, Monza, MB, Italy
| | - Giulio Maria Pasinetti
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Giorgio Annoni
- University of Milano-Bicocca, School of Medicine and Surgery, U8 Building, Floor 4, Lab 4045, Via Cadore, 48 - 20900, Monza, MB, Italy.,NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences research area, Milan, MI, Italy.,San Gerardo Hospital ASST Monza, Acute Geriatrics Unit, Monza, MB, Italy
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9
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Mazzola P, Carissimi F, Floris P, Pittella F, Galeazzi M, Moretti D, Bellelli G, Dinelli M, Annoni G. Megaesophagus in an elderly man with achalasia: a "not so benign" condition. Aging Clin Exp Res 2017; 29:809-814. [PMID: 27714664 DOI: 10.1007/s40520-016-0633-3] [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: 07/01/2016] [Accepted: 09/16/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Paolo Mazzola
- Acute Geriatrics Unit, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy.
- Clinical Neurosciences Research Area, NeuroMI - Milan Center for Neuroscience, 20126, Milan, MI, Italy.
| | | | - Patrizia Floris
- Acute Geriatrics Unit, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy
| | - Francesca Pittella
- Acute Geriatrics Unit, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy
| | - Marianna Galeazzi
- Acute Geriatrics Unit, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy
| | - Daniela Moretti
- Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
| | - Giuseppe Bellelli
- Acute Geriatrics Unit, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy
- Clinical Neurosciences Research Area, NeuroMI - Milan Center for Neuroscience, 20126, Milan, MI, Italy
- Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
| | - Marco Dinelli
- Endoscopy Unit, San Gerardo Hospital ASST Monza, Monza, Italy
| | - Giorgio Annoni
- Acute Geriatrics Unit, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy
- Clinical Neurosciences Research Area, NeuroMI - Milan Center for Neuroscience, 20126, Milan, MI, Italy
- Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
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Abstract
We describe our experience with a new over-the-scope clip (OTSC) system (Padlock Clip?) in the treatment of 14 patients. Eight of the 14 patients were treated for closure of gastrointestinal fistulas (n?=?4), iatrogenic gastrointestinal perforations (n?=?2), or hemostasis of post-polypectomy bleeding (n?=?2). The site of clipping was the lower gastrointestinal tract in five patients and the upper gastrointestinal tract in three patients. The clip was successfully delivered in seven out of the eight patients and clinical success was achieved in all patients. Endoscopic full thickness resection (EFTR) was performed to treat six patients: four with recurrent adenoma (n?=?4), one with ulcerated nodules at ileorectal anastomosis, and one with a neuro-endocrine tumor of the rectum. A complete intestinal wall resection was achieved in three of the six patients (50?%) and an R0 resection in five of the six patients (83.3?%). No complications related to the procedure and no recurrence at endoscopic follow-up were observed in any patient. The novel Padlock Clip seems to be an effective and safe tool to treat gastrointestinal fistulas, perforations or post-polypectomy bleeding, and to perform EFTR.
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Affiliation(s)
- Marco Dinelli
- Gastroenterology and Endoscopy Unit, San Gerardo Hospital, Monza, Italy,Corresponding author Marco Dinelli Gastroenterology and Endoscopy UnitSan Gerardo HospitalVia Giambattista Pergolesi, 3320900 Monza MBItaly+39-039-2332131
| | - Barbara Omazzi
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate Milanese Hospital, Milan, Italy
| | - Paolo Andreozzi
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate Milanese Hospital, Milan, Italy
| | | | | | - Gianpiero Manes
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate Milanese Hospital, Milan, Italy
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Mariani M, Decimi V, Bettini LR, Maitz S, Gervasini C, Masciadri M, Ajmone P, Kullman G, Dinelli M, Panceri R, Cereda A, Selicorni A. Adolescents and adults affected by Cornelia de Lange syndrome: A report of 73 Italian patients. Am J Med Genet C Semin Med Genet 2016; 172:206-13. [PMID: 27164219 DOI: 10.1002/ajmg.c.31502] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Cornelia de Lange syndrome (CdLS) is a rare genetic condition related to mutation of various cohesion complex related genes. Its natural history is quite well characterized as regard pediatric age. Relatively little information is available regarding the evolution of the disease in young-adult age. In medical literature, only one specific study has been published on this topic. We report on our experience on 73 Italian CdLS patients (40 males and 33 females) with and age range from 15 to 49 years. Our results confirm the previous study indicating that gastroesophageal reflux disease (GERD) is the main medical problem of these patients in childhood and young-adult age. Other medical features that should be considered in the medical follow-up are tendency to overweight/frank obesity, constipation, discrepancy of limbs' length, epilepsy, hearing, and visual problems. Behavioral problems are particularly frequent as well. For this reason, every source of hidden pain should be actively searched for in evaluating a patient showing such a disorder. Finally, recommendations for medical follow-up in adult age are discussed. © 2016 Wiley Periodicals, Inc.
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12
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Amato A, Radaelli F, Dinelli M, Crosta C, Cengia G, Beretta P, Devani M, Lochis D, Manes G, Fini L, Paggi S, Passoni GR, Repici A. Early and delayed complications of polypectomy in a community setting: The SPoC prospective multicentre trial. Dig Liver Dis 2016; 48:43-8. [PMID: 26493629 DOI: 10.1016/j.dld.2015.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 08/12/2015] [Accepted: 09/18/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Colonoscopic polypectomy is effective in reducing the incidence of and mortality from colorectal cancer, but is not complication-free. AIMS To evaluate the incidence of early and delayed polypectomy complications and factors associated with their occurrence in a community setting. METHODS Web-database collection of patients' and polyp's features in consecutive colonic polypectomies during a 3-month period in 18 endoscopy centres. RESULTS Data on 5178 polypectomies in 2692 patients (54.3% males, mean age 59 years) were collected. The majority of the polyps were <10mm (83.5%). Antithrombotic agents were taken by 22.7% of patients, 57.3% of which withheld them before the procedure. Overall, 5 patients experienced perforations (0.2%) and 114 had bleeding (4.2%); the overall complication rate was 4.4%. Early complications were observed in 87 (3.2%); delayed complications (all major bleedings) occurred in 32 (1.2%). At multivariate analysis polyp size (size >10mm: OR 4.35, 95% CI 5.53-7.48) and, inversely, right-sided location (OR 0.58, 95% CI 0.36-0.94) were correlated with bleeding events. The use of antithrombotics was associated with 5-fold increased risk of delayed bleeding. CONCLUSIONS In the community setting, polypectomy was associated with a 1.4% risk of major complications. Polyp size and, inversely, right-sided location were associated with early bleeding; the use of antithrombotics increased the risk of delayed events.
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Affiliation(s)
- Arnaldo Amato
- Department of Gastroenterology, Valduce Hospital, Como, Italy.
| | - Franco Radaelli
- Department of Gastroenterology, Valduce Hospital, Como, Italy
| | - Marco Dinelli
- Gastroenterology and Endoscopy Unit, San Gerardo Hospital, Monza, Italy
| | - Cristiano Crosta
- Division of Endoscopy, European Institute of Oncology, Milano, Italy
| | - Gianpaolo Cengia
- Department of Surgery, University of Brescia, Spedali Civili, Brescia, Italy
| | - Paolo Beretta
- Endoscopy Service, Città Studi Clinical Institute, Milano, Italy
| | - Massimo Devani
- Department of Gastroenterology, AO Salvini, Rho Hospital, Italy
| | | | - Giampiero Manes
- Department of Gastroenterology, AO Salvini, Garbagnate Hospital, Italy
| | - Lucia Fini
- Department of Internal Medicine, AO Circolo, Busto Arsizio, Italy
| | - Silvia Paggi
- Department of Gastroenterology, Valduce Hospital, Como, Italy
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Mangiavillano B, Manes G, Baron TH, Frego R, Dinelli M, Radaelli F, Teruzzi V, Amato A, Pallotta S, Santoro T, Masci E. The use of double lasso, fully covered self-expandable metal stents with new "anchoring flap" system in the treatment of benign biliary diseases. Dig Dis Sci 2014; 59:2308-13. [PMID: 24748231 DOI: 10.1007/s10620-014-3158-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 04/05/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND Many benign biliary diseases (BBD) can be treated with fully covered, self-expandable metal stents (FCSEMS) but stent migration occurs in up to 35.7 %. The aim of this study was to prospectively assess the rate of, safety and effectiveness and stent migration of a new biliary FCSEMS with an anti-migration flap (FCSEMS-AF) in patients with BBD. PATIENTS AND METHODS This was a prospective study from four Italian referral endoscopy centers of 32 consecutive patients (10 females and 22 males; mean age: 60.1 ± 14.8 years; range: 32-84 years) with BBD who were offered endoscopic placement of a FCSEMS-AF as first-line therapy. RESULTS Were 24 strictures and 8 leaks. Stent placement was technically successful in 32/32 patients (100 %). Immediate clinical improvement was seen in all 32 patients (100 %). One late stent migration occurred (3.3 %). FCSEMS-AF were removed from 30 of the 32 patients (93.7 %) at a mean (± SD) of 124.4 ± 84.2 days (range: 10-386 days) after placement. All patients remained clinically and biochemically well at 1- and 3-month follow-up. One patient (3.3 %) with a post-laparoscopic cholecystectomy stricture developed distal stent migration at 125 days. CONCLUSION This new FCSEMS with anti-migration flap seems to be a safe and effective first-line treatment option for patients with BBD.
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Affiliation(s)
- B Mangiavillano
- Gastrointestinal Endoscopy, Azienda Ospedaliera San Paolo, Universitary Hospital, University of Milan, Via A. di Rudinì no. 8, 20142, Milan, Italy,
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14
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Masci E, Viale E, Notaristefano C, Mangiavillano B, Fiori G, Crosta C, Dinelli M, Maino M, Viaggi P, Della Giustina F, Teruzzi V, Grasso G, Manes G, Zambelli S, Testoni PA. Endoscopic mucosal resection in high- and low-volume centers: a prospective multicentric study. Surg Endosc 2013; 27:3799-805. [PMID: 23708711 DOI: 10.1007/s00464-013-2977-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 04/05/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Endoscopic mucosal resection (EMR) is an effective therapeutic technique well-standardized worldwide for the treatment of gastrointestinal neoplasm limited to the mucosal layer. To date, no study has compared technical and clinical differences based on the number of EMRs performed per year. This study aimed to compare EMR technical success, complications, and clinical outcome between low-volume centers (LVCs) and high-volume centers (HVCs). A total of nine endoscopic centers were included in the study. METHODS This prospective study investigated consecutive patients with sessile polyps or flat colorectal lesions 1 cm or larger referred for EMR. RESULTS A total of 427 lesions were resected in 384 patients at nine endoscopic centers. Males accounted for 60.4% and females for 39.6% of the patients. Most of the EMRs (84.8%) were performed in HVCs and only 15.2% in LVCs. All the lesions were resected in only one session. Argon plasma coagulation was performed on the margins of piecemeal resection in 15.7% of the patients in HVCs only. Complete excision was achieved for 98.6% of the lesions in HVCs and 98.8% of the lesions in LVCs. The complication rate was 4.4% in HVCs and 4.6% in LVCs (p = 0.94). Delayed bleeding occurred in 2.5% of the HVC cases and 3.1% of the LVC cases. Perforation occurred in 1.9% of the HVC cases and 1.5% of the LVC cases (p = 1.00). Recurrences were experienced with 15% of the lesions: 15.5% in HVCs and 14% in LVCs (p = 0.79). CONCLUSIONS The study showed that EMR can be performed also in LVC.
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Affiliation(s)
- E Masci
- Gastrointestinal Endoscopy, Azienda Ospedaliera San Paolo, University Hospital, University of Milan, Via A. di Rudinì 8, 20142, Milan, Italy,
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15
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Mitro P, Kirsch P, Gajek J, Zysko D, Mazurek W, Ruiz GA, Chirife R, Tentori C, Nogues M, Grancelli H, Nur-Mammadova G, Mustafaev I, Gajek J, Zysko D, Mazurek W, Sredniawa B, Cebula S, Musialik-Lydka A, Kowalczyk J, Sliwinska A, Sedkowska A, Wozniak A, Kalarus Z, Pietrucha AZ, Wojewodka-Zak E, Bzukala I, Wnuk M, Mroczek-Czernecka D, Konduracka E, Piwowarska W, Peppes V, Kontomerkos D, Parisi T, Dimopoulos M, Antoniou A, Freitas JP, Santos RM, Boomsma F, Maciel MJ, Iacoviello M, Forleo C, Guida P, Ciccone MM, D'andria V, Sorrentino S, Panunzio M, Favale S, Candeias R, Silva J, Santos A, Marques N, Jesus I, Gomes V, Gajek J, Zysko D, Mazurek W, Olendrzynski LUK, Kramarz EK, Kubik LK, Zysko D, Gajek J, Mazurek W, Tahir T, Rose S, Garratt C, Clarke B, Cooper P, Fitzpatrick A, Petkar S, Fuca G, Dinelli M, Gianfranchi L, Corbucci G, Alboni P, Leiria TLL, Kus T, Godin B, Ayala-Paredes F, Lemieux A, Sturmer ML, Stanczyk A, Gatzoulis K, Karystinos G, Gialernios T, Sotiropoulos H, Sideris S, Dilaveris P, Arsenos P, Stefanadis C, Maggi R, Kohno R, Abe H, Otsuji Y. Poster Session 4: Syncope. Europace 2009. [DOI: 10.1093/europace/euq238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Masci E, Minoli G, Rossi M, Terruzzi V, Comin U, Ravelli P, Buffoli F, Lomazzi A, Dinelli M, Prada A, Zambelli A, Fesce E, Lella F, Fasoli R, Perego EM, Colombo E, Bianchi G, Testoni PA. Prospective multicenter quality assessment of endotherapy of biliary stones: does center volume matter? Endoscopy 2007; 39:1076-81. [PMID: 18072060 DOI: 10.1055/s-2007-966934] [Citation(s) in RCA: 11] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS To study the effectiveness of endoscopic treatment for biliary stones in a large case list of patients treated in units with different experience and different workloads in a region of northern Italy. PATIENTS AND METHODS We prospectively studied 700 patients undergoing endoscopic retrograde cholangiopancreatography or sphincterotomy, in 14 units (> or < 200 examinations/year), for their first treatment of biliary stones. The difficulty of the examinations, the results in terms of clearance of the stones, and the late outcomes (24 months) were recorded. A questionnaire (GHAA-9modified) was administered 24 hours and 30 days after the procedure to measure patient satisfaction. RESULTS There were six units with a heavy workload and eight with a light schedule. There were 176 (25.1 %) difficult examinations (Schutz grades 3, 4, and 5). Stones were found in 580 (82.9 %) and were cleared in 504 of these patients (86.9 %). No differences were observed in the clearance of stones for the different groups of difficulty and high- and low-volume centers. Over the 24-month follow-up period, 96 patients (13.7 %) complained of recurrent symptoms and 44 (6.3 %) had proof of stones. In all, 603 questionnaires were evaluable and more than 80 % of patients expressed satisfaction. CONCLUSIONS Our findings confirm the effectiveness of endoscopic treatment of biliary stones. However, the number of patients with symptoms (13.7) after 24 months, with or without persistence of stones, was not insignificant. It is feasible to record patient satisfaction, and in this series patients stated they were satisfied. Criticism mostly concerned pain control and explanations provided before the examination.
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Affiliation(s)
- E Masci
- Gastroenterology and Endoscopic Unit, S. Raffaele Hospital, Milan, Italy.
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Olmi S, Scaini A, Cesana G, Dinelli M, Lomazzi A, Croce E. Acute colonic obstruction: endoscopic stenting and laparoscopic resection. Surg Endosc 2007; 21:2100-4. [PMID: 17479321 DOI: 10.1007/s00464-007-9352-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Revised: 11/23/2006] [Accepted: 12/18/2006] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Acute colonic obstruction is a frequent emergency condition in a general surgical setting. The use of an endoscopic self-expanding stent can relieve obstruction and eventually prepare the patient for elective laparoscopic or open surgery. MATERIALS AND METHODS From September 2001 to March 2006 we treated 25 patients with acute left or transverse colonic obstruction. In 23 patients stents were positioned planning an elective procedure to be performed. In two patients with multiple liver metastases and malignant ascites only a palliation was intended (2 of 25 patients). RESULTS Mean age was 66.6 years. The 23 patients who underwent resection, 14 females and nine males, had a mean age of 65.5 years. Obstructions were located in the rectum (five), in the sigmoid (16) and in the transverse colon (two). In one patient stricture was due to radiotherapy, in twenty four cases it was due to primary cancer. Stents were successfully placed in 24 patients. In one of them two stents had to be placed due to the slippage of the first one beyond the stricture. Excellent resumption of colonic transit was achieved in all the patients. No complications were observed. In 23 patients resection was performed (19 laparoscopy; four open). Complications occurred in one patient in open group (pancreatic fistula after splenectomy) and was treated conservatively. Mean postoperative stay was 18.5 (range 9-35) days for the open group and 12 (range 9-20) for the laparoscopic group. Mean follow-up was 36 months. CONCLUSIONS Use of self expanding endoscopic colonic stents can provide excellent palliation in acute obstruction, aiming both to prepare the colon to elective surgery after adequate preparation or to palliate the stricture in case of unresectable advanced tumors.
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Affiliation(s)
- Stefano Olmi
- Department of General Surgery, Center for Laparoscopic and Minimally Invasive Surgery, Ospedale S. Gerardo, Monza, Italy.
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Radaelli F, Strocchi E, Passaretti S, Strada E, Frego R, Dinelli M, Fossati D, Barzaghi F, Limido E, Bortoli A, Della Casa D, Missale G, Snider L, Noris R, Viviani G, Minoli G. Is esophageal pH monitoring used appropriately in an open-access system? A prospective multicenter study. Am J Gastroenterol 2004; 99:2115-20. [PMID: 15554989 DOI: 10.1111/j.1572-0241.2004.40175.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate the referral patterns and indications for esophageal pH monitoring in an open-access system and to determine whether these indications conform to practice guidelines of the American Gastroenterological Association (AGA). METHODS A total of 851 consecutive patients referred for ambulatory pH monitoring to nine open-access gastrointestinal units over a 12-month period received a structured interview. The indication for the examination was decided by the physician performing the procedure, on the basis of the patient's clinical history and main complaint. RESULTS Three hundred and twenty-three (38%) examinations were for indications in accordance with the guidelines. The proportion of appropriate requests in each center ranged from 34% to 47%. This figure was not significantly different in larger gastrointestinal units (more than 150 examinations per year) and smaller ones (35% and 40%; p= 0.14). The proportion of appropriate requests was 45% for gastroenterologists, 38% for surgeons, 32% for other specialists, and 24% for primary care physicians (PCPs) (p < 0.001). The percentage of appropriateness was significantly different between gastrointestinal specialists and PCPs (p < 0.001 vs gastroenterologists, p= 0.015 vs GI surgeons), and between gastroenterologists and other specialists (p= 0.006). The underuse of an empirical trial of acid-suppression therapy in patients with suspected reflux disease and the overuse of this test to confirm a diagnosis in patients with erosive esophagitis and in endoscopy-negative cases with typical symptoms responding completely to antisecretory therapy accounted for most of the referrals, which was not in accordance with the guidelines. CONCLUSIONS In an open-access system, a high proportion of esophageal pH studies are done for indications not consistent with published guidelines, particularly among the examinations not requested by gastrointestinal specialists. Further education is still needed on the appropriate use of esophageal pH monitoring and management of gastroesophageal reflux disease (GERD).
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Affiliation(s)
- Franco Radaelli
- Department of Gastroenterology, Valduce Hospital, Como, Italy
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Donateo P, Brignole M, Alboni P, Menozzi C, Raviele A, Del Rosso A, Dinelli M, Solano A, Bottoni N, Croci F. A standardized conventional evaluation of the mechanism of syncope in patients with bundle branch block. Europace 2002; 4:357-60. [PMID: 12408253 DOI: 10.1053/eupc.2002.0265] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The finding of bundle branch block in patients with syncope suggests that paroxysmal AV block may be the cause of syncope, even though its prevalence is unknown. METHODS We evaluated 55 consecutive patients with syncope and bundle branch block (mean age 75 +/- 8 years; median of two syncopal episodes per patient) referred to three Syncope Units. The hierarchy and appropriateness of diagnostic tests and the definitions of the final diagnoses followed standardized predefined criteria. RESULTS Cardiac syncope was diagnosed in 25 patients (45%): AV block in 20, sick sinus syndrome in 2, sustained ventricular tachycardia in 1, aortic stenosis in 2. Neurally mediated syncope was diagnosed in 22 (40%): carotid sinus syndrome in 5, tilt-induced syncope in 15, adenosine-sensitive syncope in 2. Syncope remained unexplained in 8 (15%). CONCLUSIONS Less than half of the patients with bundle branch block have a final diagnosis of cardiac syncope; in these patients, paroxysmal AV block is the most frequent but not the only mechanism supposed.
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Affiliation(s)
- P Donateo
- Department of Cardiology, Ospedali Riuniti, Lavagna, Italy.
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20
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Croci F, Brignole M, Alboni P, Menozzi C, Raviele A, Del Rosso A, Dinelli M, Solano A, Bottoni N, Donateo P. The application of a standardized strategy of evaluation in patients with syncope referred to three syncope units. Europace 2002; 4:351-5. [PMID: 12408252 DOI: 10.1053/eupc.2002.0267] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [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: 11/11/2022] Open
Abstract
BACKGROUND The appropriate diagnostic work-up of patients with syncope is not well defined. We applied the guidelines of Italian 'Associazione Nazionale Medici Cardiologi Ospedalieri' to a group of consecutive patients with syncope referred to three Syncope Units. The aim of the study was to evaluate the applicability of those guidelines in the 'real world' and their impact on the use of the tests. METHODS We evaluated 308 consecutive patients with syncope (mean age 61 +/- 20 years; median of three syncopal episodes per patient). The hierarchy and appropriateness of diagnostic tests and the definitions of the final diagnosis followed standardized predefined criteria. In brief, all patients underwent initial evaluation consisting of history, physical examination, supine and upright blood pressure measurement and standard electrocardiogram (ECG) (only in patients > 45 years or with history of heart disease). Any subsequent investigations were based on the findings of the initial evaluation. Priority was given to cardiological tests (prolonged ECG monitoring, exercise test, electrophysiological study), or to neurally mediated tests (carotid sinus massage, tilt test, ATP test), or to neuro-psychiatric tests, as appropriate. FINDINGS The initial evaluation alone was diagnostic in 72 patients (23%). One further test was necessary for diagnosis in 65 patients (21%), > or = 2 tests in 64 (21%) and > or = 3 tests in 50 (16%). The diagnostic yield was 10% for ECG, 3% for echocardiogram, 16% for Holter, 5% for exercise test, 27% for electrophysiological study, 57% for carotid sinus massage, 52% for tilt testing and 15% for ATP test. At the end of the work-up the mechanism of syncope remained unexplained in 57 patients (18%). CONCLUSIONS When standardized criteria based on the appropriateness of indications are used, few simple tests are usually needed for diagnosis of syncope.
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Affiliation(s)
- F Croci
- Department of Cardiology of Ospedali del Tigullio, Lavagna, Italy.
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Alboni P, Dinelli M, Gruppillo P, Bondanelli M, Bettiol K, Marchi P, degli UEC. Haemodynamic changes early in prodromal symptoms of vasovagal syncope. Europace 2002; 4:333-8. [PMID: 12134982 DOI: 10.1053/eupc.2002.0241] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [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: 11/11/2022] Open
Abstract
AIMS Vasovagal syncope (VVS) is often preceded by prodromal symptoms. The haemodynamic changes occurring during the prodrome have not been systematically investigated. The aim of the present study was to investigate the behaviour of blood pressure (BP), heart rate (HR) and sympathetic activity at the beginning of the prodrome in patients with tilt-induced VVS. METHODS AND RESULTS Sixty-three patients with VVS underwent tilt testing. BP and HR were measured and blood samples for plasma catecholamine determination were obtained during the test. Twenty-seven patients developed syncope of whom all had a prodrome. From the last scheduled measurement before prodromal symptoms to the beginning of the prodrome, both systolic and diastolic BP decreased in all patients (from 105 +/- 16 to 74 +/- 20 mmHg, P<0.001, and from 68 +/- 13 to 51 +/- 12 mmHg, P<0 001, respectively) and HR decreased in 18 (67%) (from 89 +/- 22 to 80 +/- 25 beats/ min P<0 02). At the onset of loss of consciousness both BP and HR showed a further decrease (P<0.001). Plasma adrenaline significantly increased from the last sample before prodromal symptoms to the beginning of the prodrome (P<0.01) and showed a further increase during loss of consciousness (P<0.05), whereas plasma noradrenaline did not increase, as an expression of inhibition of sympathetic neural outflow. CONCLUSION These results demonstrate that in patients with tilt-induced VVS, BP is consistently decreased at the beginning of prodromal symptoms because of the withdrawal of sympathetic activity, and HR is often reduced, probably because of increased vagal activity. We may infer that similar haemodynamic features also occur during spontaneous VVS.
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Affiliation(s)
- P Alboni
- Division of Cardiology, Ospedale Civile, Cento Fe, Italy.
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Alboni P, Brignole M, Menozzi C, Raviele A, Del Rosso A, Dinelli M, Solano A, Bottoni N. Diagnostic value of history in patients with syncope with or without heart disease. J Am Coll Cardiol 2001; 37:1921-8. [PMID: 11401133 DOI: 10.1016/s0735-1097(01)01241-4] [Citation(s) in RCA: 312] [Impact Index Per Article: 13.6] [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: 10/18/2022]
Abstract
OBJECTIVES We sought to establish what historical findings are predictive of the cause of syncope. BACKGROUND The clinical features of the various types of syncope have not been systematically investigated. METHODS Three hundred forty-one patients with syncope were prospectively evaluated. Each patient was interviewed using a standard questionnaire. A cause of syncope was assigned using standardized diagnostic criteria. RESULTS A cardiac cause of syncope was established in 23% of the patients, a neurally mediated cause in 58% and a neurologic or psychiatric cause in 1%, and in the remaining 18%, the cause of syncope remained unexplained. In a preliminary analysis including age, gender and the presence of suspected or certain heart disease after the initial evaluation, only heart disease was an independent predictor of a cardiac cause of syncope (odds ratio 16, p = 0.00001), with a sensitivity of 95% and a specificity of 45%. In contrast, the absence of heart disease allowed us to exclude a cardiac cause of syncope in 97% of the patients. In patients with certain or suspected heart disease, the most specific predictors of a cardiac cause were syncope in the supine position or during effort, blurred vision and convulsive syncope. Significant and specific predictors of a neurally mediated cause were time between the first and last syncopal episode >4 years, abdominal discomfort before the loss of consciousness and nausea and diaphoresis during the recovery phase. In the patients without heart disease, palpitation was the only significant predictor of a cardiac cause. CONCLUSIONS The presence of suspected or certain heart disease after the initial evaluation is a strong predictor of a cardiac cause of syncope. A few historical findings are useful to predict cardiac and neurally mediated syncope in patients with and without heart disease.
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Affiliation(s)
- P Alboni
- Division of Cardiology, Ospedale Civile, Cento, Italy.
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Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M, Minoli G, Crosta C, Comin U, Fertitta A, Prada A, Passoni GR, Testoni PA. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 2001; 96:417-23. [PMID: 11232684 DOI: 10.1111/j.1572-0241.2001.03594.x] [Citation(s) in RCA: 584] [Impact Index Per Article: 25.4] [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: 12/11/2022]
Abstract
OBJECTIVES Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP/ES) can be associated with unforeseeable complications, especially when involving postprocedural pancreatitis. The aim of the study was to investigate risk factors for complications of ERCP/ES in a prospective multicentric study. METHODS One hundred fifty variables were prospectively collected at time of ERCP/ES and before hospital discharge over 2 years, in consecutive patients undergoing the procedure in nine endoscopic units in the Lombardy region of Italy. More than 150 ERCPs were performed in each center per year by a single operator or by a team of no more than three endoscopists. RESULTS Two thousand four hundred sixty-two procedures were performed; 18 patients were discharged because the papilla of Vater was not reached (duodenal obstruction, previous gastrectomy, etc.). Two thousand four hundred forty-four procedures were considered in 2103 patients. Overall complications occurred in 121 patients (4.95% of cases): pancreatitis in 44 patients (1.8%), hemorrhage in 30 (1.13%), cholangitis in 14 (0.57%), perforation during ES in 14 (0.57%), and others in 14 (0.57%); deaths occurred in three patients (0.12%). In multivariate analysis, the following were significant risk factors: a) for pancreatitis, age (< or = 60 yr), use of precutting technique, and failed clearing of biliary stones, and b) for hemorrhage, precut sphincterotomy and obstruction of the orifice of the papilla of Vater. CONCLUSIONS The results of our study further contribute to the assessment of risk factors for complications related to ERCP/ES. It is crucial to identify high risk patients to reduce complications of the procedures.
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Affiliation(s)
- E Masci
- Gastroenterology and Endoscopic Unit, S. Raffaele Hospital, Milan, Italy
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Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M, Minoli G, Crosta C, Comin U, Fertitta A, Prada A, Passoni GR, Testoni PA. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 2001. [PMID: 11232684 DOI: 10.111/j.1572-0241] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP/ES) can be associated with unforeseeable complications, especially when involving postprocedural pancreatitis. The aim of the study was to investigate risk factors for complications of ERCP/ES in a prospective multicentric study. METHODS One hundred fifty variables were prospectively collected at time of ERCP/ES and before hospital discharge over 2 years, in consecutive patients undergoing the procedure in nine endoscopic units in the Lombardy region of Italy. More than 150 ERCPs were performed in each center per year by a single operator or by a team of no more than three endoscopists. RESULTS Two thousand four hundred sixty-two procedures were performed; 18 patients were discharged because the papilla of Vater was not reached (duodenal obstruction, previous gastrectomy, etc.). Two thousand four hundred forty-four procedures were considered in 2103 patients. Overall complications occurred in 121 patients (4.95% of cases): pancreatitis in 44 patients (1.8%), hemorrhage in 30 (1.13%), cholangitis in 14 (0.57%), perforation during ES in 14 (0.57%), and others in 14 (0.57%); deaths occurred in three patients (0.12%). In multivariate analysis, the following were significant risk factors: a) for pancreatitis, age (< or = 60 yr), use of precutting technique, and failed clearing of biliary stones, and b) for hemorrhage, precut sphincterotomy and obstruction of the orifice of the papilla of Vater. CONCLUSIONS The results of our study further contribute to the assessment of risk factors for complications related to ERCP/ES. It is crucial to identify high risk patients to reduce complications of the procedures.
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Affiliation(s)
- E Masci
- Gastroenterology and Endoscopic Unit, S. Raffaele Hospital, Milan, Italy
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25
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Croci F, Alboni P, Brignole M, Menozzi C, Raviale A, Dal Rosso A, Dinelli M, Solano A, Bottoni N, Bottoni N, Donateo P. The diagnosis of syncope using a standardized strategy of evaluation. Europace 2001. [DOI: 10.1016/eupace/2.supplement_1.a43-b] [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: 11/16/2022] Open
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26
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Donateo P, Alboni P, Brignole M, Menozzi C, Raviele A, Del Rosso A, Dinelli M, Solano A, Bottoni N, Croci F. The mechanism of syncope in patients with bundle branch block. Europace 2001. [DOI: 10.1016/eupace/2.supplement_1.a43-a] [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: 10/14/2022] Open
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27
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Bianconi L, Castro A, Dinelli M, Alboni P, Pappalardo A, Richiardi E, Santini M. Comparison of intravenously administered dofetilide versus amiodarone in the acute termination of atrial fibrillation and flutter. A multicentre, randomized, double-blind, placebo-controlled study. Eur Heart J 2000; 21:1265-73. [PMID: 10924317 DOI: 10.1053/euhj.1999.2039] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS This study compared the efficacy and safety of intravenous dofetilide with amiodarone and placebo in converting atrial fibrillation or flutter to sinus rhythm. METHODS AND RESULTS One hundred and fifty patients with atrial fibrillation or flutter (duration range 2 h-6 months) were given 15-min intravenous infusions of 8 microg. kg(-1)of dofetilide (n=48), 5 mg. kg(-1)of amiodarone (n=50), or placebo (n=52) and monitored continuously for 3 h. Sinus rhythm was restored in 35%, 4%, and 4% of patients, respectively (P<0.001, dofetilide vs placebo;P=ns, amiodarone versus placebo). Dofetilide was more effective in atrial flutter than in atrial fibrillation (cardioversion rates 75% and 22%, respectively;P=0.004). The mean time to conversion with dofetilide was 55+/-15 min. Dofetilide prolonged the QTc interval (+16% at 20 min). Amiodarone substantially decreased the ventricular rate in non-converters (-18 beats. min(-1)at 30 min). Two patients given dofetilide (4%) had non-sustained ventricular tachycardias, and four (8%) had torsade de pointes, in one case requiring electrical cardioversion. CONCLUSION Intravenous dofetilide is significantly more effective than amiodarone or placebo in restoring sinus rhythm in patients with atrial fibrillation or flutter. However, when infused intravenously at this dose and rate, dofetilide causes a significant incidence of torsade de pointes.
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Affiliation(s)
- L Bianconi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy.
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Annese V, Bassotti G, Coccia G, Dinelli M, D'Onofrio V, Gatto G, Leandro G, Repici A, Testoni PA, Andriulli A. A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. GISMAD Achalasia Study Group. Gut 2000; 46:597-600. [PMID: 10764700 PMCID: PMC1727941 DOI: 10.1136/gut.46.5.597] [Citation(s) in RCA: 176] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intrasphincteric injection of botulinum toxin (Botx) has been proposed as treatment for oesophageal achalasia. However, the predictors of response and optimal dose remain unclear. AIMS To compare the effect of different doses of Botx and to identify predictors of response. PATIENTS/METHODS A total of 118 achalasic patients were randomised to receive one of three doses of Botx in a single injection: 50 U (n=40), 100 U (n=38), and 200 U (n=40). Of those who received 100 U, responsive patients were reinjected with an identical dose after 30 days. Clinical and manometric assessments were performed at baseline, 30 days after the initial injection of botulinum toxin, and at the end of follow up (mean 12 months; range 7-24 months). RESULTS Thirty days after the initial injection, 82% of patients were considered responders without a clear dose related effect. At the end of follow up however, relapse of symptoms was evident in 19% of patients who received two injections of 100 U compared with 47% and 43% in the 50 U and 200 U groups, respectively. Using Kaplan-Meier analysis, patients in the 100x2 U group were more likely to remain in remission at any time (p<0.04), with 68% (95% CI 59-83) still in remission at 24 months. In a multiple adjusted model, response to Botx was independently predicted by the occurrence of vigorous achalasia (odds ratio 3.3) and the 100x2 U regimen (odds ratio 3.2). CONCLUSIONS Two injections of 100 U of Botx 30 days apart appeared to be the most effective therapeutic schedule. The presence of vigorous achalasia was the principal determinant of the response to Botx.
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Affiliation(s)
- V Annese
- Divisione di Gastroenterologia, Ospedale "CSS"-IRCCS, San Giovanni Rotondo, Italy
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Alboni P, Bondanelli M, Dinelli M, Gruppillo P, Franceschetti P, Marchi P, degli Uberti EC. Role of the serotonergic system in the genesis of vasovagal syncope. Europace 2000; 2:172-80. [PMID: 11225944 DOI: 10.1053/eupc.1999.0088] [Citation(s) in RCA: 14] [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: 11/11/2022] Open
Abstract
AIMS The hypotensive reflex responsible for vasovagal syncope appears related to a reduction in sympathetic neural outflow. Several animal studies suggest that serotonin may play a role in the genesis of this reflex, through inhibition of sympathetic activity. However, the role of the serotonergic system is unknown in humans. The purpose of the study was to investigate the role of the serotonergic system in the genesis of vasovagal syncope by means of the level of platelet and plasma serotonin, as well as plasma catecholamines, during tilt-induced syncope. METHODS AND RESULTS Fifteen patients (age 34 +/- 16 years) with vasovagal syncope underwent a head-up tilt test (HUT, 60 degrees , 45 min). If syncope did not develop, 300 microg nitroglycerin was administered sublingually and patients continued to be tilted for a further 20 min. Blood samples were obtained in the supine position, and then after 3, 10, 15, 30, 45, 48 and 65 min of HUT. If syncope developed, blood samples were obtained at the beginning of the prodrome, during syncope and after the recovery of consciousness. Platelet and plasma serotonin and plasma catecholamines were measured using high-pressure liquid chromatography with electrochemical detection. Ten patients developed syncope during the unmedicated HUT and four after nitroglycerin. In these patients plasma adrenaline significantly increased from the last programmed sample before the prodrome to its beginning and showed a further increase during loss of consciousness, whereas plasma noradrenaline did not increase, as an expression of inhibition of sympathetic neural outflow. In the patients experiencing syncope, both platelet and plasma serotonin showed no significant change after tilt-up, at the beginning of prodrome, during syncope and after recovery of consciousness. CONCLUSION These results do not suggest that the serotonergic system plays a role in the pathophysiology of vasovagal syncope.
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Affiliation(s)
- P Alboni
- Division of Cardiology, Ospedale Civile, Cento, Fe, Italy
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Dinelli M, Passaretti S, Di Francia I, Fossati D, Tittobello A. Area under pH 4: a more sensitive parameter for the quantitative analysis of esophageal acid exposure in adults. Am J Gastroenterol 1999; 94:3139-44. [PMID: 10566704 DOI: 10.1111/j.1572-0241.1999.01505.x] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Traditional quantitative analysis of 24-h esophageal pH monitoring data does not include the pH of reflux episodes. Area under pH 4 (AU4) is a recently introduced parameter that describes the acid exposure rate through both duration and depth of pH falls. METHODS In Study A, we enrolled 20 healthy controls and 42 patients (18 without esophagitis, 24 with Savary I-III esophagitis) in a study evaluating reference values for 24-h reflux time at pH <4 (RT) and 24-h AU4 by means of receiver operating characteristic (ROC) discriminant analysis. For Study B, we next prospectively applied the resulting cutoffs to 16 healthy controls and to 110 gastroesophageal reflux (GERD) patients (55 with esophagitis) to adjust sensitivity, specificity, and predictive values of both RT and AU4. RESULTS In Study A, the best cutoff values were 5.1% for RT (Area Index +/- SE, 0.899 +/- 0.038; 95% confidence interval [C.I.], 0.796 +/- 0.961) and 36.1 pH x min for AU4 (Area Index +/- SE, 0.935 +/- 0.03; 95% C.I., 0.842 +/- 0.981); AU4 gave the best performance (p = 0.038 vs RT) in discriminating controls and GERD patients. In Study B, RT was abnormal in three controls and 79 patients; AU4 identified all the controls and patients with abnormal RT and also 10/31 patients (32.3%) with so-called "normal" acid exposure (according to RT). In the whole GERD group of patients, AU4 and RT specificity was 81.2%, whereas sensitivity was 71.8% for RT and 80.9% for AU4 (chi2, 61.831; DF, 1; p < 0.005); PPV/NPV were 96.3%/29.5% for RT, and 96.7%/38.2% for AU4. CONCLUSIONS AU4 appears to be a simple and sensitive quantitative parameter to measure the esophageal acid exposure in adults submitted to 24-h pH monitoring, and it could be an useful clinical aid in evaluating normal RT tests where, from a clinical point of view, a reflux disease is highly likely.
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Affiliation(s)
- M Dinelli
- Gastroenterology Unit, S. Raffaele Hospital, University of Milan, Italy
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Alboni P, Scarfò S, Fucà G, Mele D, Dinelli M, Paparella N. Short-term hemodynamic effects of DDD pacing from ventricular apex, right ventricular outflow tract and proximal septum. G Ital Cardiol 1998; 28:237-41. [PMID: 9561877] [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: 02/07/2023]
Abstract
Recently, short-term hemodynamic benefits of right ventricular outflow tract (RVOT) or proximal septum (His bundle area) pacing have been reported in comparison with traditional apical stimulation in preliminary investigations. The purpose of the present study was to compare the hemodynamics obtained during DDD pacing from ventricular apex, RVOT and proximal septum in patients with normal left ventricular function. A simultaneous hemodynamic and Doppler-echocardiographic study was performed in 21 patients (age 67 +/- 7 years) with sick-sinus syndrome (8 pts) or 2nd-3rd degree atrioventricular (AV) block (13 pts). The three stimulation sites were randomized and pacing was applied at an identical rate (84 +/- 5 beats/min) and at a constant AV delay (150 ms). Electrocardiographic, hemodynamic and Doppler-echocardiographic investigations were performed during stimulation from each site. The QRS duration did not show significant differences during DDD pacing from ventricular apex, RVOT and proximal septum. The hemodynamic measurements (systemic pressures, mean pulmonary wedge pressure, pulmonary pressures, right ventricular end-diastolic pressure, mean right atrial pressure, cardiac index, systemic vascular resistance and arteriovenous O2 difference) did not show significant differences during pacing from the three sites. Moreover, no significant differences were observed for the Doppler-echocardiographic measurements of systolic function (aortic stroke distance, left ventricular ejection fraction) and diastolic function (isovolumetric relaxion time, mitral E/A ratio, deceleration rate of the E wave). The results suggest that in patients with normal left ventricular function DDD pacing from RVOT or proximal septum does not improve cardiac function with regard to apical pacing.
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Affiliation(s)
- P Alboni
- Divisione di Cardiologia, Ospedale Civile, Cento, FE
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Malfertheiner P, McColl K, Baldi F, Dinelli M, Festi D, Parente F, Ricciardiello L, Roda E, Scarpulla G, Stanghellini V, Torre G. Update on Helicobacter pylori research. Dyspepsia. Eur J Gastroenterol Hepatol 1997; 9:624-5. [PMID: 9222740] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Raviele A, Menozzi C, Brignole M, Gasparini G, Alboni P, Musso G, Lolli G, Oddone D, Dinelli M, Mureddu R. Value of head-up tilt testing potentiated with sublingual nitroglycerin to assess the origin of unexplained syncope. Am J Cardiol 1995; 76:267-72. [PMID: 7618622 DOI: 10.1016/s0002-9149(99)80079-4] [Citation(s) in RCA: 167] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This study was undertaken to assess the value of sublingual nitroglycerin administration during upright tilt as a simple practical test for the diagnosis of vasovagal syncope. To this purpose, 235 patients with syncope of unknown origin and no evidence of organic heart disease (110 men, mean age 52 +/- 20 years) and 35 asymptomatic control subjects underwent head-up tilt testing with nitroglycerin challenge. Patients and subjects were tilted at 60 degrees for 45 + 20 minutes; the initial 45 minutes were without medication and the final 20 minutes after 300 micrograms of sublingual nitroglycerin. During the drug-free phase of the test, 59 patients (25%) and no controls had a positive response. After drug administration, a positive response (syncope in association with sudden hypotension and bradycardia) occurred in 60 patients (26%) and in 2 controls (6%), whereas an exaggerated or false-positive response (minor or different symptoms in association with slowly increasing hypotension alone) was observed in 33 patients (14%) and in 5 controls (14%). We conclude that the sublingual nitroglycerin head-up tilt test is a useful tool to unmask the vasovagal origin of unexplained syncope in patients without organic heart disease. The addition of nitroglycerin to upright tilt allows the positive rate of passive tilting to be doubled (51% vs 25%) while maintaining a high specificity (94% vs 100%).
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Affiliation(s)
- A Raviele
- Division of Cardiology, Ospedale Umberto, I Mestre-Venice, Italy
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Raviele A, Gasparini G, Di Pede F, Menozzi C, Brignole M, Dinelli M, Alboni P, Piccolo E. Nitroglycerin infusion during upright tilt: a new test for the diagnosis of vasovagal syncope. Am Heart J 1994; 127:103-11. [PMID: 8273729 DOI: 10.1016/0002-8703(94)90515-0] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The aim of our present study was to assess the value of nitroglycerin infusion during upright posture as a new provocative test for diagnosis of vasovagal syncope. To this purpose 40 patients with unexplained syncope (17 men and 23 women, mean age 47 years) and 25 asymptomatic control subjects with negative baseline head-up tilt underwent two other tilting tests, one during nitroglycerin infusion and one during isoproterenol infusion. The protocol of the nitroglycerin test consisted of a maximum of five successive stages of 5 minutes in the supine position plus 10 minutes 80-degree upright tilt at progressively increasing infusion rates (increments of 0.86 microgram/kg/hr every stage). During the nitroglycerin test a positive response (syncope in association with sudden hypotension and bradycardia) occurred in 21 (53%) patients with unexplained syncope, an exaggerated response (minor symptoms in association with slowly increasing hypotension alone) occurred in 10 (25%), a negative response in 9 (22%), and drug intolerance in 0. During the isoproterenol test these percentages were 25%, 25%, 32%, and 18%, respectively. Only 2 (8%) control subjects had a positive response to nitroglycerin test and 2 (8%) to isoproterenol test. Thus the nitroglycerin test seems to be a useful alternative tool for diagnosis of vasovagal syncope; it is equally specific but more sensitive and feasible than the isoproterenol test.
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Affiliation(s)
- A Raviele
- Division of Cardiology, Umberto I. Hospital, Mestre-Venice, Italy
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Abstract
OBJECTIVES This study investigates the role of an abnormal neural reflex in causing syncope in patients with sinus bradycardia. BACKGROUND Syncope is commonly considered an indication of severity in sinus bradycardia. However, the occurrence of syncope is unpredictable, and the prognosis appears to be similar in patients with and without syncope. METHODS Head-up tilt testing (60 degrees for 60 min), carotid sinus massage in the supine and standing positions, 24-h Holter ambulatory electrocardiographic (ECG) recording and electrophysiologic study before and after pharmacologic autonomic blockade were performed in 25 patients with sinus bradycardia and syncope (group I, sinus rate < 50 beats/min, age 71 +/- 12 years) and 25 patients with sinus bradycardia and no neurologic symptoms (group II, sinus rate < 50 beats/min, age 67 +/- 16 years). RESULTS Clinical characteristics and ambulatory ECG monitoring data were similar in the two study groups. A positive response (induction of syncope or presyncope with hypotension and/or bradycardia) was obtained by head-up tilt testing in 15 group I (60%) and in 3 group II (12%) patients (p < 0.001) and by carotid sinus massage in 11 group I (44%) and 6 group II (24%) patients (p = NS). Results of at least one test (head-up tilt testing or carotid sinus massage, or both) were positive in 19 group I (76%) and 9 group II (36%) patients (p < 0.01). Basal and intrinsic corrected sinus node recovery time did not differ significantly between the two groups. An abnormal intrinsic heart rate was present in 66% of group I and 26% of group II patients (p < 0.01). The different percentage of positive findings on head-up tilt testing and carotid sinus massage in the two groups was independent of the presence of intrinsic sinus node dysfunction. CONCLUSIONS These results indicate that an abnormal neural reflex plays a role in causing syncope in patients with sinus bradycardia. This reflex seems to be unrelated to the severity of sinus node dysfunction, even if the latter could enhance the cardioinhibitory response.
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Affiliation(s)
- P Alboni
- Division of Cardiology, Ospedale Civile, Cento (Fe), Italy
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Passaretti S, Franzoni M, Comin U, Donzelli R, Rocca F, Colombo E, Ferrara A, Dinelli M, Prada A, Curzio M. Action of glucomannans on complaints in patients affected with chronic constipation: a multicentric clinical evaluation. Ital J Gastroenterol 1991; 23:421-5. [PMID: 1742540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Chronic constipation is a very frequent disease in western countries but fibres can often solve the problem. In the present study, authors tested the efficacy and the acceptability of glucomannans, hydrophylic carbohydrates with a high degree of viscosity, in 93 patients affected with chronic constipation. The multicentric, open and non-controlled study was divided into an initial phase (treatment with 1g of glucomannans t.i.d. for 1 month) and a maintenance phase (1g b.i.d. for one month). We evaluated both objective parameters (number of days per week with bowel movements and number of enemas) and abdominal symptoms. After one month all assessed parameters showed a statistically significant improvement lasting through the second month. Glucomannans were well accepted and devoid of relevant side-effects. In conclusion, considering their efficacy and tolerability, they can be proposed as an ideal therapeutic tool in the management of chronic constipation symptoms.
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Affiliation(s)
- S Passaretti
- Istituto di Medicina Interna, Università di Milano, Italy
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Belloi L, Pirani A, Bongiorno G, Melloni M, Dinelli M, Francia R, Gallerani A, Vecchi GP. [Evaluation of pharmacologic treatment associated with motor-activation therapy in the prevention of senile impairment]. Minerva Med 1987; 78:1543-50. [PMID: 3670697] [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: 01/06/2023]
Abstract
The study was designed to assess any changes in certain aspects of aging produced by combined drug (buflomedil) and motor activation therapy (MAT). The study was conducted on 3 selected groups of 10 women aged 60-74 years with initial signs of mental and physical senile impairment as revealed by appropriate psychometric and laboratories tests. The 3 groups (I: control, II: MAT, III: buflomedil + MAT) were given a series of cognitive, behavioural, affective and cardiovascular tests before and after the 6-month study. The results showed a deterioration in the parameters considered among the control group and a significant improvement especially in cardiovascular, affective and behavioural parameters as well as certain cognitive aspects (attention, mental state) in the group treated with MAT only. The combination of MAT and buflomedil had a positive influence on all parameters considered. In particular it acted extensively on the cognitive parameters. It is therefore concluded that the combination of MAT and drug treatment is a valid system for the prevention of senile impairment since it acts on the main biological, psychological and social aspects of the elderly patient.
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Affiliation(s)
- L Belloi
- Università degli Studi di Modena Cattedra di Gerontologia e Geriatria
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Pirani A, Neri M, Belloi L, Dinelli M, Vecchi GP. Do mental and physical performances have different patterns in elderly? J Sports Med Phys Fitness 1984; 24:303-6. [PMID: 6533404] [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: 01/20/2023]
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