1
|
Loffredo L, Pignatelli P, Pirro M, Ceccarelli G, Oliva A, Maggio E, Cancelli F, D'Ardes D, Amitrano M, Zicari AM, Cinicola BL, Taliani G, Cangemi R, Lichtner M, Falcone M, Orlando F, Pugliese F, Venditti M, Mastroianni CM, Violi F. Association between PaO 2/FiO 2 ratio and thrombotic events in COVID-19 patients. Intern Emerg Med 2023; 18:889-895. [PMID: 36650311 PMCID: PMC9845099 DOI: 10.1007/s11739-023-03196-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023]
Abstract
PaO2/FiO2 (P/F ratio) is considered a marker of hypoxia/hypoxemia and mortality. Several prothrombotic changes are associated with the decrease of P/F ratio. The role of P/F ratio in patients with arterial and venous thrombosis remains unclear. The aim of this study was to assess in patients with coronavirus disease 2019 (COVID-19), the association between P/F ratio and arterial/venous thrombosis. One thousand and four hundred and six COVID-19 patients were recruited; 289 (21%) patients had P/F ratio < 200 and 1117 (79%) ≥ 200. Compared to the patients with P/F ratio ≥ 200, those with P/F ratio < 200 were older and with higher levels of glycemia, D-dimer and lower levels of albumin. Multiple linear regression analysis showed that albumin (standardized coefficient β: 0.156; SE: 0.001; p = 0.0001) and D-dimer (standardized coefficient β: -0.135; SE: 0.0001; p = 0.0001) were associated with P/F ratio. During the hospitalization 159 patients were transferred in intensive care unit (ICU), 253 patients died, 156 patients had arterial or venous thrombotic events. A bivariate logistic analysis was performed to analyze the predictors of thrombosis in COVID-19 patients; P/F ratio < 200 (Odds Ratio: [OR] 1.718, 95% Confidence Interval [CI] 1.085-2.718, p = 0.021), albumin (OR 1.693, 95% CI 1.055-2.716, p = 0.029), D-dimer (OR 3.469, 95% CI 2.110-5.703, p < 0.0001), coronary artery disease (CAD) (OR 1.800, 95% CI 1.086-2.984, p = 0.023) and heart failure (OR 2.410 95% CI 1.385-4.193, p = 0.002) independently predicted thrombotic events in this population. This study suggests that the P/F ratio is associated with thrombotic events by promoting a hypercoagulation state in patients hospitalized for COVID-19.
Collapse
Affiliation(s)
- Lorenzo Loffredo
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy.
| | - Pasquale Pignatelli
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Matteo Pirro
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Enrico Maggio
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Francesca Cancelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Damiano D'Ardes
- Clinica Medica, Department of Medicine and Aging, "G. D'Annunzio, University of Chieti-Pescara, Chieti, Italy
- Mediterranea Cardiocentro-Napoli, Via Orazio, 2, 80122, Naples, Italy
| | - Maria Amitrano
- Internal Medicine Unit, Moscati Hospital, Avellino, Italy
| | - Anna Maria Zicari
- Department of Maternal Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Bianca Laura Cinicola
- Department of Maternal Sciences, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Gloria Taliani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Roberto Cangemi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Miriam Lichtner
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Federica Orlando
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Francesco Pugliese
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Francesco Violi
- Mediterranea Cardiocentro-Napoli, Via Orazio, 2, 80122, Naples, Italy
| |
Collapse
|
2
|
Ciarambino T, Ilardi A, Giannico OV, Maffettone A, Ciaburri F, Delli Paoli V, Fontanella A, Tirelli P, Bologna C, Gallucci F, Visconti M, Caruso D, Amitrano M, Giordano M, D'Avino M. Gender differences in COVID-19 patients: a regional survey among physicians of Internal Medicine Wards. Ital J Med 2021. [DOI: 10.4081/itjm.2021.1443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) has infected millions of individuals around the World. Hypertension (HT), chronic heart disease (CHD), and diabetes mellitus (DM), particularly in the elderly, increase susceptibility to SARS-CoV-2 infection. However, conflicting results [such as coronavirus 2019 (COVID-19) disease vulnerability, case fatality, etc.] have been reported about the response to infection and COVID-19 outcomes in men and women. Therefore, understanding predictors of Intensive Care Unit (ICU) admission might help future planning and management of the disease. We conducted a multicenter survey about COVID-19 involving internists from Internal Medicine Wards. This survey indirectly allowed us to analyze the information of 2400 patients hospitalized in 35 wards of Internal Medicine of the Campania Region between July and October 2020. Our investigation has detected that the infection is more frequent in males, and the number of male patients hospitalized in ICU is also higher than females, with a large proportion of hypertensive patients. Extensive prospective studies are required to confirm this finding and explore the mechanisms for which hypertensive males are exposed to a higher proportion of admission to ICU and higher case fatality rates.
Collapse
|
3
|
Di Micco P, Tufano A, Cardillo G, Imbalzano E, Amitrano M, Lodigiani C, Bellizzi A, Camporese G, Cavalli A, De Stefano C, Russo V, Voza A, Perrella A, Prandoni P. The Impact of Risk-Adjusted Heparin Regimens on the Outcome of Patients with COVID-19 Infection. A Prospective Cohort Study. Viruses 2021; 13:v13091720. [PMID: 34578301 PMCID: PMC8473366 DOI: 10.3390/v13091720] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 02/05/2023] Open
Abstract
Background. According to recent guidelines, all hospitalized patients with COVID-19 should receive pharmacological prophylaxis for venous thromboembolism (VTE), unless there are specific contraindications. However, the optimal preventive strategy in terms of intensity of anticoagulation for these patients is not well established. Objectives. To investigate the impact of individualized regimens of enoxaparin on the development of VTE and on the risk of major bleeding complications during hospitalization in patients with COVID-19 infection. Methods. All consecutive patients admitted to the medical wards of six Italian hospitals between 15 September and 15 October 2020 with COVID-19 infection of moderate severity were administered enoxaparin in subcutaneous daily doses adjusted to the Padua Prediction Score stratification model: No heparin in patients scoring less than 4, 4000 IU daily in those scoring 4, 6000 IU in those scoring 5, and 8000 in those scoring six or more. Objective tests were performed in patients developing clinical symptoms of deep vein thrombosis and/or pulmonary embolism. Bleeding complications were defined according to the ISTH classification. Results. From the 154 eligible patients, enoxaparin was administered in all: 4000 IU in 73 patients, 6000 IU in 53, and 8000 IU in the remaining 28. During the course of hospitalization, 27 patients (17.5%) died. VTE developed in 14 of the 154 patients (9.1%; 95% CI, 4.6% to 13.6%), and was fatal in 1. Major bleeding complications developed in 35 patients (22.7%; 95% CI, 16.1% to 29.3%), and were fatal in 8. Conclusions. Despite the use of risk-adjusted doses of enoxaparin, the rate of VTE events was consistent with that reported in contemporary studies where fixed-dose low-molecular-weight heparin was used. The unexpectedly high risk of bleeding complications should induce caution in administering enoxaparin in doses higher than the conventional low ones.
Collapse
Affiliation(s)
- Pierpaolo Di Micco
- Department of Medicine, Ospedale Buon Consiglio Fatebenefratelli di Napoli, 80122 Naples, Italy
- Correspondence:
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy;
| | | | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy;
| | - Maria Amitrano
- Department of Medicine, AO Moscati, 83100 Avellino, Italy; (M.A.); (C.D.S.)
| | - Corrado Lodigiani
- Humanitas Clinical and Research Center IRCCS, 20089 Rozzano, Italy; (C.L.); (A.V.)
| | - Annamaria Bellizzi
- Unit of Internal Medicine, Frangipane Hospital, 83031 Ariano Irpino, Italy; (A.B.); (A.C.)
| | - Giuseppe Camporese
- Unit of Angiology, Department of Cardiac, Thoracic and Vascular Sciences, Padua University, 35100 Padua, Italy;
| | - Antonella Cavalli
- Unit of Internal Medicine, Frangipane Hospital, 83031 Ariano Irpino, Italy; (A.B.); (A.C.)
| | - Carmela De Stefano
- Department of Medicine, AO Moscati, 83100 Avellino, Italy; (M.A.); (C.D.S.)
| | - Vincenzo Russo
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Antonio Voza
- Humanitas Clinical and Research Center IRCCS, 20089 Rozzano, Italy; (C.L.); (A.V.)
| | | | - Paolo Prandoni
- Arianna Foundation on Anticoagulation, 40138 Bologna, Italy;
| |
Collapse
|
4
|
Limongelli G, Iucolano S, Monda E, Elefante P, De Stasio C, Lubrano I, Caiazza M, Mazzella M, Fimiani F, Galdo M, De Marchi G, Esposito M, Rubino M, Cirillo A, Fusco A, Esposito A, Trama U, Esposito S, Scarano G, Sepe J, Andria G, Orlando V, Menditto E, Chiodini P, Iolascon A, Franzese A, Sanduzzi Zamparelli A, Tessitore A, Romano A, Venosa A, Nunzia Olivieri A, Bianco A, La Manna A, Cerbone AM, Spasiano A, Agnese Stanziola A, Colao A, De Bellis A, Gambale A, Toriello A, Tufano A, Ciampa A, Maria Risitano A, Pisani A, Russo A, Volpe A, De Martino B, Amato B, De Fusco C, Piscopo C, Selleri C, Tucci C, Pignata C, Cioffi D, Melis D, Pasquali D, De Brasi D, Spitaleri D, De Brasi D, Russo D, Martellotta D, De Michele E, Varricchio E, Miraglia Del Giudice E, Coscioni E, Cimino E, Pane F, Tranfa F, Pollio F, Lonardo F, Nuzzi F, Simonelli F, Trojsi F, Habetswallner F, Valentini G, Cerbone G, Parenti G, Tedeschi G, Capasso G, Battista Rossi G, Gaglione G, Sarnelli G, Argenziano G, Bellastella G, De Michele G, Fiorentino G, Spadaro G, Scala I, Santoro L, Zeppa L, Auricchio L, Elio Adinolfi L, Alessio M, Amitrano M, Savanelli MC, Russo MG, Ferrucci MG, Carbone MT, Pellecchia MT, Salerno M, Melone M, Del Donno M, Vitale M, Triggiani M, Della Monica M, Lo Presti M, Tenuta M, Mignogna MD, Schiavulli M, Zacchia M, Brunetti-Pierri N, Iovino P, Moscato P, Iandoli R, Scarpa R, Russo R, Troisi S, Sbordone S, Perrotta S, Fecarotta S, Sampaolo S, Cicalese V. Diagnostic issues faced by a rare disease healthcare network during Covid-19 outbreak: data from the Campania Rare Disease Registry. J Public Health (Oxf) 2021; 44:586-594. [PMID: 33982102 PMCID: PMC8194710 DOI: 10.1093/pubmed/fdab137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 12/16/2022] Open
Abstract
Background The aims of this study were: to investigate the capacity of the rare disease healthcare network in Campania to diagnose patients with rare diseases during the outbreak of Covid-19; and to shed light on problematic diagnoses during this period. Methods To describe the impact of the Covid-19 pandemic on the diagnosis of patients with rare diseases, a retrospective analysis of the Campania Region Rare Disease Registry was performed. A tailored questionnaire was sent to rare disease experts to investigate major issues during the emergency period. Results Prevalence of new diagnoses of rare disease in March and April 2020 was significantly lower than in 2019 (117 versus 317, P < 0.001 and 37 versus 349, P < 0.001, respectively) and 2018 (117 versus 389, P < 0.001 and 37 versus 282, P < 0.001, respectively). Eighty-two among 98 rare disease experts completed the questionnaire. Diagnostic success (95%), access to diagnosis (80%) and follow-up (72%), lack of Personal Protective Equipment (60%), lack of Covid-19 guidelines (50%) and the need for home therapy (78%) were the most important issues raised during Covid-19 outbreak. Conclusions This study describes the effects of the Covid-19 outbreak on the diagnosis of rare disease in a single Italian region and investigates potential issues of diagnosis and management during this period.
Collapse
Affiliation(s)
| | - Stefano Iucolano
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Emanuele Monda
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Pasquale Elefante
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Chiara De Stasio
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Imma Lubrano
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Martina Caiazza
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | | | - Fabio Fimiani
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Maria Galdo
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Giulia De Marchi
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Martina Esposito
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Marta Rubino
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Annapaola Cirillo
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Adelaide Fusco
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Augusto Esposito
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Ugo Trama
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Salvatore Esposito
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Gioacchino Scarano
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Joseph Sepe
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Generoso Andria
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Valentina Orlando
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Enrica Menditto
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Paolo Chiodini
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Abstract
Post-thrombotic syndrome (PTS) is a chronic venous insufficiency manifestation following an episode of deep-vein thrombosis (DVT). It is an important and frequent long-term adverse event of proximal DVT affecting 20-50% of patients. This position paper integrates data guiding clinicians in deciding PTS diagnosis, treatment and follow-up.
Collapse
Affiliation(s)
- Adriana Visonà
- Angiology Unit, Azienda ULSS 2 Marca Trevigiana, Castelfranco Veneto, Italy
| | - Isabelle Quere
- Médecine Vasculaire, Université de Montpellier, Montpellier, France
| | - Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Maria Amitrano
- Internal Medicine Unit, Moscati Hospital, Avellino, Italy
| | - Marzia Lugli
- Department of Vascular Surgery, International Center of Deep Venous Surgery, Hesperia Hospital, Modena, Italy
| | - Juraj Madaric
- Clinic of Angiology, Comenius University and National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | | | | |
Collapse
|
6
|
Cardillo G, Viggiano GV, Russo V, Mangiacapra S, Cavalli A, Castaldo G, Agrusta F, Bellizzi A, Amitrano M, Iannuzzo M, Sacco C, Lodigiani C, Fontanella A, Di Micco P. Antithrombotic and Anti-Inflammatory Effects of Fondaparinux and Enoxaparin in Hospitalized COVID-19 Patients: The FONDENOXAVID Study. J Blood Med 2021; 12:69-75. [PMID: 33603528 PMCID: PMC7886238 DOI: 10.2147/jbm.s285214] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/26/2021] [Indexed: 12/16/2022] Open
Abstract
Background Since the outbreak of novel coronavirus SARS-CoV2 around the world, great attention has been paid to the effects of such antithrombotic drugs as heparinoids, because they have antiviral action in vitro and antithrombotic actions in vivo. We conducted a retrospective analysis in inpatients with confirmed COVID-19 on the anti-inflammatory and antithrombotic effects of enoxaparin and fondaparinux at prophylactic doses. Methods This retrospective cohort study used patients with confirmed COVID-19 during the first months of the Italian outbreak from February 18 to April 30, 2020. Our aim was to compare clinical characteristics, prophylactic treatment, markers of inflammation, and thrombotic outcomes in inpatients positive for SARS-CoV2 during hospitalization associated with thromboprophylaxis with enoxaparin (40 mg or 60 mg once daily) or fondaparinux (2.5 mg once daily). Statistical analysis was conducted with using MatLab R2016B and ad hoc functions. Results There were no significatant differences in clinical characteristics between patients that used enoxaparin or fondaparinux as thromboprophylaxis for SARS-CoV2. No differences were found in D-dimer and fibrinogen levels either, which were used as markers of inflammation during the infection at testing on admission and after 3 weeks.Significant differences in CRP, IL6, and LDH were found in patients after 21 days’ treatment. Discussion Increased levels of fibrinogen and D-dimer in patients with confirmed COVID-19 have been reported in several studies. Our results showed that anti-inflammatory effects of fondaparinux and enoxaparin after 3 weeks of prophylactic treatment were similar when levels of fibrinogen and D-dimer were considered. Furthermore, levels of CRP showed a decrease in patients treated with enoxaparin and fondaparinux, although the decrease in the fondaparinux group seems to be more relevant.
Collapse
Affiliation(s)
| | - Giuseppe Vito Viggiano
- UO Pronto Soccorso e Medicina D'urgenza, Semintensiva Covid, Ospedale Ramazzini Di Carpi - AUSL Modena, Modena, Italy
| | - Vincenzo Russo
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli Monaldi Hospital, Piazzale Ettore Ruggeri, Naples 80131, Italy
| | | | - Antonella Cavalli
- UOC Medicina-Covid, Presidio Opsedaliero Frangipane Di ArianoIrpino (AV), Naples, Italy
| | - Giampiero Castaldo
- UO Pronto Soccorso e Medicina D'urgenza, Semintensiva Covid, Ospedale Ramazzini Di Carpi - AUSL Modena, Modena, Italy
| | - Federica Agrusta
- UO Pronto Soccorso e Medicina D'urgenza, Semintensiva Covid, Ospedale Ramazzini Di Carpi - AUSL Modena, Modena, Italy
| | - Annamaria Bellizzi
- UOC Medicina-Covid, Presidio Opsedaliero Frangipane Di ArianoIrpino (AV), Naples, Italy
| | | | | | - Clara Sacco
- Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | | | | | | | | |
Collapse
|
7
|
Blondon M, Jimenez D, Robert‐Ebadi H, Del Toro J, Lopez‐Jimenez L, Falga C, Skride A, Font L, Vazquez FJ, Bounameaux H, Monreal M, Prandoni P, Brenner, B, Farge‐Bancel D, Barba R, Di Micco P, Bertoletti L, Schellong S, Tzoran I, Reis A, Bosevski M, Malý R, Verhamme P, Caprini JA, My Bui H, Adarraga MD, Agud M, Aibar J, Aibar MA, Alfonso J, Amado C, Arcelus JI, Baeza C, Ballaz A, Barba R, Barbagelata C, Barrón M, Barrón‐Andrés B, Blanco‐Molina A, Botella E, Camon AM, Castro J, Caudevilla MA, Cerdà P, Chasco L, Criado J, de Ancos C, de Miguel J, Demelo‐Rodríguez P, Díaz‐Peromingo JA, Díez‐Sierra J, Díaz‐Simón R, Domínguez IM, Encabo M, Escribano JC, Falgá C, Farfán AI, Fernández‐Capitán C, Fernández‐Reyes JL, Fidalgo MA, Flores K, Font C, Francisco I, Gabara C, Galeano‐Valle F, García MA, García‐Bragado F, García‐Mullor MM, Gavín‐Blanco O, Gavín‐Sebastián O, Gil‐Díaz A, Gómez‐Cuervo C, González‐Martínez J, Grau E, Guirado L, Gutiérrez J, Hernández‐Blasco L, Jara‐Palomares L, Jaras MJ, Jiménez D, Joya MD, Jou I, Lacruz B, Lecumberri R, Lima J, Lobo JL, López‐Brull H, López‐Jiménez L, López‐Miguel P, López‐Núñez JJ, López‐Reyes R, López‐Sáez JB, Lorente MA, Lorenzo A, Loring M, Madridano O, Maestre A, Marchena PJ, Martín del Pozo M, Martín‐Martos F, Martínez‐Baquerizo C, Mella C, Mellado M, Mercado MI, Moisés J, Morales MV, Muñoz‐Blanco A, Muñoz‐Guglielmetti D, Muñoz‐Rivas N, Nart E, Nieto JA, Núñez MJ, Olivares MC, Ortega‐Michel C, Ortega‐Recio MD, Osorio J, Otalora S, Otero R, Parra P, Parra V, Pedrajas JM, Pellejero G, Pérez‐Jacoiste A, Peris ML, Pesántez D, Porras JA, Portillo J, Reig L, Riera‐Mestre A, Rivas A, Rodríguez‐Cobo A, Rodríguez‐Matute C, Rogado J, Rosa V, Rubio CM, Ruiz‐Artacho P, Ruiz‐Giménez N, Ruiz‐Ruiz J, Ruiz‐Sada P, Sahuquillo JC, Salgueiro G, Sampériz A, Sánchez‐Muñoz‐Torrero JF, Sancho T, Sigüenza P, Sirisi M, Soler S, Suárez S, Suriñach JM, Tiberio G, Torres MI, Tolosa C, Trujillo‐Santos J, Uresandi F, Usandizaga E, Valle R, Vela JR, Vidal G, Vilar C, Villares P, Zamora C, Gutiérrez P, Vázquez FJ, Vanassche T, Vandenbriele C, Verhamme P, Hirmerova J, Malý R, Salgado E, Benzidia I, Bertoletti L, Bura‐Riviere A, Crichi B, Debourdeau P, Espitia O, Farge‐Bancel D, Helfer H, Mahé I, Moustafa F, Poenou G, Schellong S, Braester A, Brenner B, Tzoran I, Amitrano M, Bilora F, Bortoluzzi C, Brandolin B, Ciammaichella M, Colaizzo D, Dentali F, Di Micco P, Giammarino E, Grandone E, Mangiacapra S, Mastroiacovo D, Maida R, Mumoli N, Pace F, Pesavento R, Pomero F, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tufano A, Visonà A, Vo Hong N, Zalunardo B, Kalejs RV, Maķe K, Ferreira M, Fonseca S, Martins F, Meireles J, Bosevski M, Zdraveska M, Mazzolai L, Caprini JA, Tafur AJ, Weinberg I, Wilkins H, Bui HM. Comparative clinical prognosis of massive and non-massive pulmonary embolism: A registry-based cohort study. J Thromb Haemost 2021; 19:408-416. [PMID: 33119949 DOI: 10.1111/jth.15146] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 06/02/2020] [Revised: 09/29/2020] [Accepted: 10/21/2020] [Indexed: 01/16/2023]
Abstract
AIMS Little is known about the prognosis of patients with massive pulmonary embolism (PE) and its risk of recurrent venous thromboembolism (VTE) compared with non-massive PE, which may inform clinical decisions. Our aim was to compare the risk of recurrent VTE, bleeding, and mortality after massive and non-massive PE during anticoagulation and after its discontinuation. METHODS AND RESULTS We included all participants in the RIETE registry who suffered a symptomatic, objectively confirmed segmental or more central PE. Massive PE was defined by a systolic hypotension at clinical presentation (<90 mm Hg). We compared the risks of recurrent VTE, major bleeding, and mortality using time-to-event multivariable competing risk modeling. There were 3.5% of massive PE among 38 996 patients with PE. During the anticoagulation period, massive PE was associated with a greater risk of major bleeding (subhazard ratio [sHR] 1.72, 95% confidence interval [CI] 1.28-2.32), but not of recurrent VTE (sHR 1.15, 95% CI 0.75-1.74) than non-massive PE. An increased risk of mortality was only observed in the first month after PE. After discontinuation of anticoagulation, among 11 579 patients, massive PE and non-massive PE had similar risks of mortality, bleeding, and recurrent VTE (sHR 0.85, 95% CI 0.51-1.40), but with different case fatality of recurrent PE (11.1% versus 2.4%, P = .03) and possibly different risk of recurrent fatal PE (sHR 3.65, 95% CI 0.82-16.24). CONCLUSION In this large prospective registry, the baseline hemodynamic status of the incident PE did not influence the risk of recurrent VTE, during and after the anticoagulation periods, but was possibly associated with recurrent PE of greater severity.
Collapse
Affiliation(s)
- Marc Blondon
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - David Jimenez
- Respiratory Department Hospital Ramón y Cajal and Medicine Department Universidad de Alcalá (IRYCIS) Madrid Spain
| | - Helia Robert‐Ebadi
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Jorge Del Toro
- Department of Internal Medicine Hospital General Universitario Gregorio Marañón Madrid Spain
| | | | - Conxita Falga
- Department of Internal Medicine Hospital de Mataro Barcelona Spain
| | - Andris Skride
- Department of Cardiology Ospedale Pauls Stradins Clinical University Hospital Riga Latvia
| | - Llorenç Font
- Department of Haematology Hospital de Tortosa Verge de la Cinta Tarragona Spain
| | | | - Henri Bounameaux
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Manuel Monreal
- Department of Internal Medicine Hospital Germans Trias i Pujol Badalona Spain
- Universidad Catolica de Murcia Murcia Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Brogna B, Amitrano M, Mangiacapra S, Gravino E, Capasso PMF, Gagliardi G, Musto LA. A floating thrombus detected by CT in the descending aorta in an obese patient: A possible genetic-environmental interaction. Radiol Case Rep 2020; 16:348-352. [PMID: 33312322 PMCID: PMC7721593 DOI: 10.1016/j.radcr.2020.11.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/21/2020] [Accepted: 11/22/2020] [Indexed: 12/03/2022] Open
Abstract
A floating thrombus in a nonaneurysmal, nonatherosclerotic aorta is a rare finding and may represent an unusual source of systemic embolism. Less than 130 cases have been reported in the literature. We describe a rare case of aortic floating thrombus in the descending aorta and the proximal portion of the suprarenal abdominal aorta detected by computed tomography angiography in a 50-year-old woman who was admitted to our emergency room with epigastric abdominal pain. The computed tomography angiography also showed some defects in the subsegmentary pulmonary artery branches along with a splenic infarction with splenic artery and vein thrombi, and a left renal thrombus. On genetic testing the patient resulted heterozygous for the polymorphism for 5,10‐methylentetrahydrofolate reductase C677T polymorphism and also with homozygous deletion alleles of the angiotensin-converting enzyme gene. The aortic floating thrombus resolved during anticoagulant therapy after 4 weeks.
Collapse
Affiliation(s)
- Barbara Brogna
- Department of Radiology "San Giuseppe Moscati Hospital" Avellino, Amoretta Street, 83100 Avellino, Italy
| | - Maria Amitrano
- Department of General Medicine "San Giuseppe Moscati Hospital" Avellino, Amoretta Street, 83100 Avellino, Italy
| | - Sara Mangiacapra
- Department of General Medicine "San Giuseppe Moscati Hospital" Avellino, Amoretta Street, 83100 Avellino, Italy
| | - Enzo Gravino
- Department of Radiology "San Giuseppe Moscati Hospital" Avellino, Amoretta Street, 83100 Avellino, Italy
| | | | - Giuliano Gagliardi
- Department of Radiology "San Giuseppe Moscati Hospital" Avellino, Amoretta Street, 83100 Avellino, Italy
| | - Lanfranco Aquilino Musto
- Department of Radiology "San Giuseppe Moscati Hospital" Avellino, Amoretta Street, 83100 Avellino, Italy
| |
Collapse
|
9
|
Galiero R, Pafundi PC, Simeon V, Rinaldi L, Perrella A, Vetrano E, Caturano A, Alfano M, Beccia D, Nevola R, Marfella R, Sardu C, Coppola C, Scarano F, Maggi P, De Lucia Sposito P, Vocciante L, Rescigno C, Sbreglia C, Fraganza F, Parrella R, Romano A, Calabria G, Polverino B, Pagano A, Bologna C, Amitrano M, Esposito V, Coppola N, Maturo N, Adinolfi LE, Chiodini P, Sasso FC. Impact of chronic liver disease upon admission on COVID-19 in-hospital mortality: Findings from COVOCA study. PLoS One 2020; 15:e0243700. [PMID: 33301529 PMCID: PMC7728173 DOI: 10.1371/journal.pone.0243700] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/27/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Italy has been the first Western country to be heavily affected by the spread of SARS-COV-2 infection and among the pioneers of the clinical management of pandemic. To improve the outcome, identification of patients at the highest risk seems mandatory. OBJECTIVES Aim of this study is to identify comorbidities and clinical conditions upon admission associated with in-hospital mortality in several COVID Centers in Campania Region (Italy). METHODS COVOCA is a multicentre retrospective observational cohort study, which involved 18 COVID Centers throughout Campania Region, Italy. Data were collected from patients who completed their hospitalization between March-June 2020. The endpoint was in-hospital mortality, assessed either from data at discharge or death certificate, whilst all exposure variables were collected at hospital admission. RESULTS Among 618 COVID-19 hospitalized patients included in the study, 143 in-hospital mortality events were recorded, with a cumulative incidence of about 23%. At multivariable logistic analysis, male sex (OR 2.63, 95%CI 1.42-4.90; p = 0.001), Chronic Liver Disease (OR 5.88, 95%CI 2.39-14.46; p<0.001) and malignancies (OR 2.62, 95%CI 1.21-5.68; p = 0.015) disclosed an independent association with a poor prognosis, Glasgow Coma Scale (GCS) and Respiratory Severity Scale allowed to identify at higher mortality risk. Sensitivity analysis further enhanced these findings. CONCLUSION Mortality of patients hospitalized for COVID-19 appears strongly affected by both clinical conditions on admission and comorbidities. Originally, we observed a very poor outcome in subjects with a chronic liver disease, alongside with an increase of hepatic damage.
Collapse
Affiliation(s)
- Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Pia Clara Pafundi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Vittorio Simeon
- Medical Statistics Unit, Department of Physical and Mental Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | | | - Erica Vetrano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Maria Alfano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Domenico Beccia
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Riccardo Nevola
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Internal Medicine, Sant’Ottone Frangipane Hospital, Ariano Irpino, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Carmine Coppola
- COVID Center "S. Anna e SS. Madonna della Neve" Hospital, Boscotrecase, Italy
| | - Ferdinando Scarano
- COVID Center "S. Anna e SS. Madonna della Neve" Hospital, Boscotrecase, Italy
| | - Paolo Maggi
- U.O.C. Infectious and Tropical Diseases, S. Anna e S. Sebastiano Hospital, Caserta, Italy
| | | | | | - Carolina Rescigno
- U.O.C. Infectious Diseases and Neurology, Cotugno Hospital, Naples, Italy
| | - Costanza Sbreglia
- U.O.C. Infectious Diseases of the Elderly, Cotugno Hospital, Naples, Italy
| | | | - Roberto Parrella
- U.O.C. Respiratory Infectious Diseases, Cotugno Hospital, Naples, Italy
| | | | - Giosuele Calabria
- IX Division of Infectious Diseases and Interventional Ultrasound, Cotugno Hospital, Naples, Italy
| | | | - Antonio Pagano
- Emergency and Acceptance Unit, "Santa Maria delle Grazie" Hospital, Pozzuoli, Italy
| | | | - Maria Amitrano
- U.O.C. Internal Medicine—Moscati Hospital, Avellino, Italy
| | - Vincenzo Esposito
- IV Division of Immunodeficiency and Gender Infectious Diseases, Cotugno Hospital, Naples, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Centro COVID A.O.U. Vanvitelli, Naples, Italy
| | - Nicola Maturo
- U.O.S.D. Infectious Diseases Emergency and Acceptance, Cotugno Hospital, Naples, Italy
| | - Luigi Elio Adinolfi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Paolo Chiodini
- Medical Statistics Unit, Department of Physical and Mental Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | | |
Collapse
|
10
|
Russo V, Cardillo G, Viggiano GV, Mangiacapra S, Cavalli A, Fontanella A, Agrusta F, Bellizzi A, Amitrano M, Iannuzzo M, Sacco C, Lodigiani C, Castaldo G, Di Micco P. Thromboprofilaxys With Fondaparinux vs. Enoxaparin in Hospitalized COVID-19 Patients: A Multicenter Italian Observational Study. Front Med (Lausanne) 2020; 7:569567. [PMID: 33330530 PMCID: PMC7729125 DOI: 10.3389/fmed.2020.569567] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/30/2020] [Indexed: 01/01/2023] Open
Abstract
Importance: The use of anticoagulant therapy with heparins decreased mortality in hospitalized patients with severe coronavirus disease 2019 (COVID-19). Even if enoxaparin and fondaparinux have the same clinical indication for venous thromboembolism (VTE) prevention; to date, there are no data about the use of fondaparinux in terms of safety, effectiveness, and impact on clinical prognosis among COVID-19 patients. Objective: To evaluate the safety, effectiveness, and clinical impact of VTE prophylaxis with fondaparinux and enoxaparin among COVID-19 patients hospitalized in internal medicine units. Design, Setting, and Participants: This was a retrospective multicenter observation study, including consecutive symptomatic patients with laboratory-proven COVID-19 admitted to internal medicine units of five Italian hospitals from 15th February to 15th March 2020. Main Outcomes and Measures: The primary safety outcome was the composite of major bleeding and clinically relevant non-major bleeding; the primary effectiveness outcome was the composite of all events classified as pulmonary embolism and deep venous thrombosis. The secondary effectiveness outcome included acute respiratory distress syndrome and all-cause death. Results: Among 120 COVID-19 patients enrolled in the study, 74 were taking enoxaparin (4,000 or 6,000 units/day) and 46 fondaparinux (2.5 units/day). No statistically significant difference in demographic and laboratory and clinical characteristics between the two groups has been shown. During a median follow-up of 32 (interquartile range: 14-51) days, the cumulative incidence rates of VTE and bleeding events on pharmacological thromboprophylaxis with heparins were 19% and 8%, respectively. The incidence of both VTE (6.5 vs. 13.5%; P = 0.36) and bleeding events (6.5 vs. 4.1%; P = 0.68) did not show a significant difference between COVID-19 patients on fondaparinux compared with those on enoxaparin therapy. The regression model for the risk of outcome events according to different VTE prophylaxis drugs did not show significant differences. Conclusions and Relevance: Although these results need confirmation by prospective studies including a larger population, our study provides preliminary evidence of a safe and efficacy use of fondaparinux for VTE prophylaxis in hospitalized COVID-19 patients.
Collapse
Affiliation(s)
- Vincenzo Russo
- Department of Translational Medical Sciences, Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | | | | | | | | | | | | | - Maria Amitrano
- Internal Medicine Unit, Moscati Hospital, Avellino, Italy
| | | | - Clara Sacco
- Thrombosis and Hemorragic Center, Humanitas Research Hospital and University, Rozzano, Italy
| | - Corrado Lodigiani
- Thrombosis and Hemorragic Center, Humanitas Research Hospital and University, Rozzano, Italy
| | | | | |
Collapse
|
11
|
Tufano A, López-Jiménez L, Bikdeli B, García-Bragado F, Mazzolai L, Amitrano M, Gómez-Cuervo C, Marchena PJ, Madridano O, Monreal M, Di Micco P. Inferior vena cava agenesis in patients with lower limb deep vein thrombosis in the RIETE registry. When and why to suspect. Int J Cardiol 2020; 305:115-119. [DOI: 10.1016/j.ijcard.2020.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/12/2019] [Accepted: 01/08/2020] [Indexed: 12/12/2022]
|
12
|
Galanaud JP, Bertoletti L, Amitrano M, Fernández-Capitán C, Pedrajas JM, Rosa V, Barrón M, Lorenzo A, Madridano O, Quéré I, Kahn SR, Prandoni P, Monreal M. Predictors of Post-Thrombotic Ulcer after Acute DVT: The RIETE Registry. Thromb Haemost 2018; 118:320-328. [PMID: 29378357 DOI: 10.1160/th17-08-0598] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In patients with deep-vein thrombosis (DVT) in the lower limbs, venous ulcer is the most debilitating and end-stage clinical expression of the post-thrombotic syndrome (PTS). To date, risk factors for PTS-related ulcer in DVT patients have not been identified.We used the international observational RIETE registry to assess the evolution of PTS signs and symptoms during a 3-year follow-up period and to identify independent predictors of PTS ulcer at 1 year in patients with acute DVT.Among 1,866 eligible patients, cumulative rates of PTS ulcer at 1, 2 and 3 years were 2.7% (n = 50), 4.3% (n = 54) and 7.1% (n = 60), respectively. The proportion of patients with PTS symptoms at 1, 2 or 3 years remained stable (≈40%), while the proportion of patients with PTS signs increased slightly over time (from 49 to 53%). Prior history of venous thromboembolism (VTE) (odds ratio [OR] = 5.5 [2.8-10.9]), diabetes (OR = 2.3 [1.1-4.7]), pre-existing leg varicosities (OR = 3.2 [1.7-6.1]) and male sex (OR = 2.5 [1.3-5.1]) independently increased the risk of PTS ulcer at 1 year. Obesity also increased the risk but failed to reach statistical significance (OR = 1.8 [0.9-3.3]). DVT treatment characteristics (duration or drug) did not influence the risk.Our results evidence that after acute DVT, pre-existing leg varicosities, prior venous thromboembolism, diabetes and male gender independently increased the risk for PTS ulcer. This suggests that clinicians should consider strategies aimed to prevent ulcers in high-risk DVT patients, such as preventing VTE recurrence, use of stockings in those with pre-existing venous insufficiency, careful monitoring of diabetic patients and encouraging weight loss in obese patients.
Collapse
Affiliation(s)
- Jean-Philippe Galanaud
- Department of Internal Medicine and Clinical Investigation Centre, Montpellier University Hospital, Montpellier University, Montpellier, France.,Department of General Internal Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada
| | - Laurent Bertoletti
- Department of Vascular Medicine, Saint Etienne University Hospital, Saint Etienne, France
| | - Maria Amitrano
- Department of General Medicine, Azienda Ospedaliera S. G. Moscatti Hospital, Avellino, Italy
| | | | - José María Pedrajas
- Department of Internal Medicine, San Carlos University Hospital, Madrid, Spain
| | - Vladimir Rosa
- Department of Internal Medicine, Virgen de la Arrixaca University Hospital, El Palmar, Murcia, Spain
| | - Manuel Barrón
- Department of Pneumology, San Pedro Hospital, Logrono, Spain
| | - Alicia Lorenzo
- Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - Olga Madridano
- Department of Internal Medicine, Hospital Infanta Sofía, Madrid, Spain
| | - Isabelle Quéré
- Department of Internal Medicine and Clinical Investigation Centre, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Susan R Kahn
- Department of Medicine, McGill University and Centre for Clinical Epidemiology, Jewish; General Hospital, Montreal, Canada
| | - Paolo Prandoni
- Department of Clinical Medicine, University of Padua, Padua, Italy
| | - Manuel Monreal
- Department of Internal Medicine, Hospital De Badalona Germans Trias I Pujol, Universidad Católica De Murcia, Spain
| | | |
Collapse
|
13
|
Tufano A, Cannavacciuolo F, Gianno A, Cerbone AM, Mangiacapra S, Coppola A, Amitrano M. Inferior Vena Cava Agenesis and Deep Vein Thrombosis in the Young: A Review of the Literature and Local Experience. Semin Thromb Hemost 2017; 43:827-835. [PMID: 28609803 DOI: 10.1055/s-0037-1603363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractCongenital agenesis of the inferior vena cava (AIVC) is a rare vascular abnormality with a prevalence of 0.0005 to 1% in the general population. This condition is found in almost 5% of young patients (younger than 30 years) with proximal, typically bilateral, deep venous thrombosis (DVT) of the lower limbs, often in the absence of apparent risk factors. However, AIVC in young patients with DVT is probably underestimated because AIVC cannot be detected by the standard DVT diagnostic workup. Inherited thrombophilia has been reported in patients with AIVC-associated DVT, as an additional risk factor, but its role is poorly investigated. The best therapeutic strategy and the optimal duration of anticoagulant treatment of DVT in patients with AIVC are still unclear. Here, we describe 14 young patients (2 females and 12 males, mean age at first DVT: 27.8 ± 10.1 years), with color Doppler ultrasound (US) and abdominal computed tomography scan confirmed AIVC-associated DVT and discuss their characteristics in the framework of a literature review on this topic. Our patients were mainly males (10/12) and experienced proximal DVT events, not complicated by pulmonary embolism. DVT-precipitating factors were detected only in five cases, the two female patients (oral contraceptives and puerperium), and three male patients (one after leg fracture and two after abdominal surgery). Thrombophilic abnormalities were found in eight patients (heterozygous factor V Leiden mutation, n = 3; mild/moderate hyperhomocysteinemia, n = 3; reduced protein C activity, n = 1; antiphospholipid syndrome, n = 1). The majority of patients (13/14) were treated with long-term oral anticoagulant therapy and elastic stockings (ES), with a very low rate of DVT recurrence (1/14, mean follow-up 7 years). These clinical characteristics were largely consistent with those of 161 patients identified by review of the literature. On the whole, although many aspects are still poorly known, our case series and literature review suggest that a search should be undertaken for AIVC in young patients with proximal idiopathic, particularly when bilateral, DVT, which should then be treated with prolonged anticoagulation and ES.
Collapse
Affiliation(s)
- Antonella Tufano
- Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, Federico II University Hospital, Napoli, Italy
| | | | - Adriana Gianno
- Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, Federico II University Hospital, Napoli, Italy
| | - Anna Maria Cerbone
- Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, Federico II University Hospital, Napoli, Italy
| | - Sara Mangiacapra
- Unit of Angiology, Department of Internal Medicine. AORN "G. Moscati," Avellino, Italy
| | - Antonio Coppola
- Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, Federico II University Hospital, Napoli, Italy
| | - Maria Amitrano
- Unit of Angiology, Department of Internal Medicine. AORN "G. Moscati," Avellino, Italy
| |
Collapse
|
14
|
Pesavento R, Amitrano M, Trujillo-Santos J, Di Micco P, Mangiacapra S, López-Jiménez L, Falgá C, García-Bragado F, Piovella C, Prandoni P, Monreal M. Fondaparinux in the initial and long-term treatment of venous thromboembolism. Thromb Res 2015; 135:311-7. [DOI: 10.1016/j.thromres.2014.11.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/24/2014] [Accepted: 11/30/2014] [Indexed: 10/24/2022]
|
15
|
Dentali F, Di Micco G, Giorgi Pierfranceschi M, Gussoni G, Barillari G, Amitrano M, Fontanella A, Lodigiani C, Guida A, Visonà A, Monreal M, Di Micco P. Rate and duration of hospitalization for deep vein thrombosis and pulmonary embolism in real-world clinical practice. Ann Med 2015; 47:546-54. [PMID: 26422329 DOI: 10.3109/07853890.2015.1085127] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Current guidelines recommend initial treatment with anticoagulants at home in patients with acute deep vein thrombosis (DVT) and in patients with low-risk pulmonary embolism (PE) with adequate home circumstances. However, most of the patients with acute venous thromboembolism (VTE) are currently hospitalized regardless of their risk of short-term complications. AIM OF THE STUDY To assess the proportion of outpatients with acute VTE initially treated in hospitals, to assess the mean duration of hospitalization, and to identify predictors for in-hospital or home treatment. METHODS Data of Italian patients enrolled in the RIETE registry from January 2006 to December 2013 were included. RESULTS Altogether 766 PE and 1,452 isolated DVT were included. Among PE patients, mean PESI score was 84 points (SD 35), and 56% of patients had a low-risk PESI score (<85). In all, 53.7% of DVT and 17.0% of PE were entirely treated at home, and 38.2% of DVT patients and 19.9% of PE patients were hospitalized for ≤5 days. On multivariate analysis, low PESI score was not independently associated with the hospitalization of PE patients. CONCLUSIONS One in every two patients with DVT and five in every six with PE are still hospitalized.
Collapse
Affiliation(s)
- Francesco Dentali
- a Department of Internal Medicine , Università dell'Insubria , Varese , Italy
| | - Gianluca Di Micco
- b Department of Cardiology , Ospedale Fatebenefratelli , Napoli , Italy
| | | | | | | | - Maria Amitrano
- f Department of Angiology , AO Moscati , Avellino , Italy
| | - Andrea Fontanella
- g Department of Internal Medicine , Ospedale Fatebenefratelli , Napoli , Italy
| | - Corrado Lodigiani
- h Thrombosis Center, IRCCS Istituto Clinico Humanitas , Milano , Italy
| | - Anna Guida
- i Critical Care Department , AOU S. Giovanni e Ruggi , Salerno , Italy
| | | | - Manuel Monreal
- k Department of Internal Medicine , Hospital Universitari Germans Trias i Pujol , Badalona , Spain
| | - Pierpaolo Di Micco
- g Department of Internal Medicine , Ospedale Fatebenefratelli , Napoli , Italy
| |
Collapse
|
16
|
di Micco P, di Micco G, Guida A, Tufano A, Amitrano M, Gussoni G, Frasson S, Dentali F, Monreal M, Visonà A. C0597: Analysis on the Outcome of Italian Patients with Deep Vein Thrombosis Treated with Classic Anticoagulants: Data from the Riete Registry. Thromb Res 2014. [DOI: 10.1016/s0049-3848(14)50231-9] [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: 11/30/2022]
|
17
|
Antignani PL, Benedetti-Valentini F, Aluigi L, Baroncelli TA, Camporese G, Failla G, Martinelli O, Palasciano GC, Pulli R, Rispoli P, Amato A, Amitrano M, Dorigo W, Gossetti B, Irace L, Laurito A, Magnoni F, Minucci S, Pedrini L, Righi D, Verlato F. Diagnosis of vascular diseases. Ultrasound investigations--guidelines. INT ANGIOL 2012; 31:1-77. [PMID: 23470846] [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: 06/01/2023]
|
18
|
Sacco F, Spezzaferro M, Amitrano M, Grossi L, Manzoli L, Marzio L. Efficacy of four different moxifloxacin-based triple therapies for first-line H. pylori treatment. Dig Liver Dis 2010; 42:110-4. [PMID: 19846355 DOI: 10.1016/j.dld.2009.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 05/12/2009] [Accepted: 05/20/2009] [Indexed: 12/11/2022]
Abstract
UNLABELLED Moxifloxacin has been used in the first-line treatment of Helicobacter pylori infection. The optimal dosage and duration have not been assessed. AIM To evaluate the effectiveness of moxifloxacin, amoxicillin and esomeprazole in four regimens, in previously untreated patients infected by H. pylori. METHODS AND PATIENTS Patients were randomly assigned to: esomeprazole 20 mg b.i.d., amoxicillin 1g b.i.d., and one of each of the four following dosages of moxifloxacin: moxifloxacin 400 mg b.i.d. for 10 days (EAM800x10), moxifloxacin 400 mg b.i.d. for 7 days (EAM800x7), moxifloxacin 400 mg b.i.d. for 5 days (EAM800x5), moxifloxacin 400 mg o.i.d. for 10 days (EAM400x10). Eradication was assessed by the Urea Breath Test (UBT) 2 months following the end of therapy. RESULTS Ninety-four, 102, 92 and 105 patients were recruited in EAM800x10, EAM800x7, EAM800x5, and EAM400x10 respectively. The eradication rate was for Intention-To-Treat (ITT) and Per Protocol (PP) analyses: EAM800x10 group ITT: 90.4%, PP: 94.4%; EAM800x7 group ITT: 80.3%, PP: 86.3%; EAM800x5 group ITT: 71.4%, PP: 75.2%; EAM400x10 group ITT: 80.0%, PP 84.8%. A statistically significant difference was reached between EAM800x10 vs. EAM800x7 (ITT and PP: P<0.05), and between EAM800x10 vs. EAM800x5 (ITT and PP: P<0.01) and vs. EAM400x10 (ITT: P<0.05; PP: P<0.04). Thirty patients treated unsuccessfully with EAM800x5 and EAM400x10 were re-treated with EAM800x10 with an eradication rate of 86.7% (ITT) and 92.2% (PP). Nineteen patients with positive UBT after EAM800x10 and EAM800x7 underwent a second-line rifabutin-based therapy with an eradication rate of 84.2% (ITT and PP). CONCLUSION A triple therapy with 800 mg of moxifloxacin a day for 10 days is more effective than the same treatment for 5 or 7 days and a treatment with 400mg of moxifloxacin a day for 10 days for the first-line eradication of H. pylori infection. The high cost of moxifloxacin-based treatment however, may limit its wide use as first-line treatment of H. pylori infection.
Collapse
Affiliation(s)
- F Sacco
- Section of Digestive Sciences, Department of Medicine, G.d'Annunzio University, Chieti-Pescara, Italy
| | | | | | | | | | | |
Collapse
|
19
|
Leone S, Amitrano M, D'Avanzo A, Acone N, Giglio S. Carotid artery intima-media thickness in highly treated HIV-1 patients. Infez Med 2008; 16:15-20. [PMID: 18367878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The authors used ultrasonography to measure carotid artery intima-media thickness in a cohort of antiretroviral-experienced patients. Overall, 52 patients were enrolled in the study. Twenty-two patients (42.3%) showed a IMT > 1 mm and among these 14 (26.9%) showed a atheromatous plaque. Data analysis showed that IMT > 1 mm was associated with the duration of HIV infection (p 0.03), nadir CD4 cell count (p < 0.01), and conventional cardiovascular risk factors. No association was found between IMT and type or duration of antiretroviral therapy. These data confirm the direct role of HIV in the development of endothelial damage.
Collapse
Affiliation(s)
- Sabastiano Leone
- Infectious Diseases Division, AIDS Service, AORN San Giuseppe Moscati, Avellino, Italy
| | | | | | | | | |
Collapse
|
20
|
Di Micco P, Amitrano M, Niglio A, Fontanella A. Molecular and clinical conditions associated with venous thromboembolism in oncological patients. Exp Oncol 2006; 28:194-7. [PMID: 17080011] [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: 05/12/2023]
Abstract
The association between cancer and thrombophilia has been known since 1865 since Trousseau described it. However in the last three decades an increased interest has been raised on this issue related to several molecular and condition that are involved in the daily management of oncological patients. This brief review has been focused on molecular conditions underlying cancer acquired thrombophilia then to further clinical aspects inducing thrombophilia in oncological patients such as surgery, chemotherapy, concomitant medical illness and inherited thrombophilia.
Collapse
Affiliation(s)
- P Di Micco
- Division of Internal Medicine, Buonconsiglio Fatebenefratelli Hospital of Naples, Naples, Italy.
| | | | | | | |
Collapse
|
21
|
Grassi R, Pinto A, Scaglione M, Ragozzino A, Gagliardi N, Pellegrino G, Amitrano M. [Volvulus of the splenic flexure of the colon. Report of a case]. Radiol Med 1997; 93:783-4. [PMID: 9411530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- R Grassi
- Dipartimento di Emergenza, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, Napoli
| | | | | | | | | | | | | |
Collapse
|
22
|
Brunese L, Amitrano M, Gargano V, Pinto A, Vallone G, Grassi R, Rotondo A, Smaltino F. [Role of anal endosonography in inflammation and trauma of the anal canal]. Radiol Med 1996; 92:742-7. [PMID: 9122465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Anal endosonography (US) is a valuable tool to represent the normal anatomy of the anal canal and also to reliably examine patients with anal conditions. Our series consisted of 40 patients with suspected inflammatory and traumatic conditions of the anal canal submitted to anal US, which showed the presence of abscesses in 18 patients with suspected anal canal inflammation. A fistula was associated in 14 of the 18 patients and US after air injection easily showed a cutaneous orificium in 6 of the 14 patients. Anal US showed the presence and site of all abscessual foci and fistulae, also identifying the inner orificium and the involvement of muscular sphincteral structures, which is useful information to plan the most appropriate medical or surgical treatment. As for traumas, anal US is also a useful tool for identifying sphincteral injuries secondary to blunt trauma and for following-up sphincteral reconstruction with graciloplasty. Twenty-two patients with suspected sphincteric trauma were examined and anal US showed a sphincteral injury in 7 of 13 patients with acute postpartum-related symptoms; the clinical picture was ascribed to postpartum stretching of the pudendal nerve in 6 other patients. Finally, this method can be very useful in the follow-up of anal diseases, both to study surgical drainages and in the postoperative study of anal fistulae.
Collapse
Affiliation(s)
- L Brunese
- Istituto di Scienze Radiologiche, Università Federico II, Napoli
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Amitrano M, Izzo M, Castaldo G, Lombardi R, Tizzano R, Bellizzi AM, Vietri GC, Sorrentino A, D'Avanzo A. [Short- and long-term evaluation of treatment of critical ischemia of the lower lim with PGE1 (alprostadyl alpha-cyclodestrine)]. Minerva Cardioangiol 1996; 44:391-6. [PMID: 8965998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Twenty-five patients affected by chronic lower limb obliterating arteriopathy with critical ischemia in one limb were treated with PGE1 for 4 weeks and then followed-up for one year. On day 14 of treatment three groups of patients were selected on the basis of clinical symptoms and instrumental tests; patients were subdivided into Responders, Partial Responders and Non-Responders. The results obtained were satisfactory in view of the fact that the selection into three groups enabled Partial Responders to be reclassified, in some cases by repeating the treatment cycle.
Collapse
Affiliation(s)
- M Amitrano
- Divisione di Medicina Generale, S. Giuseppe Moscati- Avellino
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Brunese L, Amitrano M, Gargano V, Vallone G, Grassi R, Rotondo A, Smaltino F. [Anal endosonography: the study technic and the correlations between the normal and echographic anatomy]. Radiol Med 1996; 91:253-7. [PMID: 8628939] [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: 02/01/2023]
Abstract
The authors report on 16 healthy volunteers examined with anal endosonography. The US examinations were performed with a dedicated Bruel and Kjaer 1846 unit equipped with a 7-MHz probe (type 1850) with 360 degrees circular mechanic movement. A rigid plastic cone filled of degassed water is mounted on the probe to ensure the symmetrical representation of the anal canal. A condom with gel on both the internal and the external surfaces is put on the cone. The peculiar anatomy of the single layers which form the anal canal determines their different US patterns. Endosonography was performed on three levels, i.e., deep, intermediate and superficial planes. In the deep plane (at the anorectal junction) anal endosonography demonstrates: epithelial-subepithelial complex (intermediate echogenicity); internal sphincter muscle (low echogenicity), made of smooth muscular fibers; longitudinal muscle (intermediate echogenicity), made of smooth and striated muscular fibers; puborectal muscle (high echogenicity), made of striated muscular fibers, and perineal body, which has a longitudinal shape in men and a transverse shape in women. In the intermediate plane anal endosonography demonstrates: epithelial-subepithelial complex, internal sphincter muscle, longitudinal muscle, and external sphincter muscle (high echogenicity), made of striated muscular fibers. In the superficial plane (distal anal canal extremity), anal endosonography demonstrates: epithelial-subepithelial complex and external sphincter muscle. Internal sphincter muscle thickness was measured and the results follow: while the average thickness was 2.1 mm, we had 1.8 mm in 12 patients under 44 and 2.6 mm in 4 patients over 44 years old. This finding is in agreement with literature data. External sphincter muscle thickness did not vary significantly in the two groups.
Collapse
Affiliation(s)
- L Brunese
- Istituto di Scienze Radiologiche, Facoltà di Medicina e Chirurgia, Università degli Studi Federico II, Napoli
| | | | | | | | | | | | | |
Collapse
|
25
|
Grassi R, Rotondo A, Catalano O, Amitrano M, Vallone G, Gargano V, Fanucci A. [Endoanal ultrasonography, defecography, and enema of the colon in the radiologic study of incontinence]. Radiol Med 1995; 89:792-7. [PMID: 7644730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In the last 3 years, the authors examined 564 patients with disturbed anorectal function. Of 41 incontinent subject in this series, 30 were retrospectively analyzed to assess the diagnostic contribution of double contrast barium enema, defecography and endoanal sonography. The authors propose a classification of fecal incontinence based on imaging findings: indeed, rectal incontinence can be distinguished from pelvic and sphincteral incontinence. Large bowel enema and defecography are the examinations of choice if rectal incontinence is suspected on the basis of clinical history and possible endoscopic, manometric and electromyographic findings. Defecography is suggested if pelvic incontinence is suspected, while anal endosonography is the exam of choice in case of suspected sphincteral incontinence. Especially thanks to the recent availability of the latter technique, today radiologists can directly visualize the anal sphincteral apparatus and its lesions, yielding objective evidence of this type of incontinence too. The authors report on both limitations and indications of each diagnostic method and conclude by stressing the fundamental role diagnostic imaging plays today in the study of this disorder.
Collapse
Affiliation(s)
- R Grassi
- Istituto di Scienze Radiologiche, Facoltà di Medicina, Università Federico II, Napoli
| | | | | | | | | | | | | |
Collapse
|
26
|
Grassi R, Catalano O, Salzano A, Amitrano M, Parisi B, Rotondo A. [Functional ano-rectal disorders: associated defecographic findings and related symptoms]. Radiol Med 1994; 88:56-62. [PMID: 8066256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We retrospectively analyzed our latest 564 defecographies to evaluate: the frequency of each single defecographic finding on the total number of patients and in the two sexes; the frequency of the finding as single disorder and in association with other anorectal disorders; the correlation between findings and symptoms. The most common disorders were anterior rectocele (54%), mucosal prolapse (53%), puborectalis muscle syndrome (15%), and intussusception (15%); this order is respected in women (70, 57, 17 and 16% of the study population) but differs in men (mucosal prolapse 42%, puborectalis muscle syndrome 18%, posterior rectocele 14%, and intussusception 14%). Intussusception and puborectalis muscle syndrome were identified as an isolated finding in many cases (55% and 43%, respectively). The most common associations are: posterior rectocele with anterior rectocele (58% of cases), anterior rectocele with mucosal prolapse and vice versa (63% and 64%), intussusception with anterior rectocele (52%), puborectalis muscle syndrome with mucosal prolapse (36%) and with anterior rectocele (49%) and descending perineum syndrome with anterior rectocele (81%) and with mucosal prolapse (70%). The low rate of association among some disorders should be mentioned too for example, mucosal prolapse is associated, with intussusception only in 10% of cases. Clinical-defecographic correlations are less apparent: if some symptoms are found to be more typical of some disorders, this correlation is not pathognomonic and the clinical picture is quite aspecific. We stress the value of a careful correlation between clinical-anamnestic and defecographic findings for the correct evaluation of these disorders.
Collapse
Affiliation(s)
- R Grassi
- II Cattedra di Radiologia, Facoltà di Medicina e Chirurgia, Università Federico II, Napoli
| | | | | | | | | | | |
Collapse
|
27
|
Grassi R, Rotondo A, Catalano O, Salzano A, Parisi B, Amitrano M, Fanucci A. [Videoproctography (VPG) in the study of rectal mucosal prolapse and rectal intussusception]. Ann Ital Chir 1994; 65:167-70. [PMID: 7978757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- R Grassi
- II Cattedra di Radiologia, Università degli Studi di Napoli Federico II
| | | | | | | | | | | | | |
Collapse
|