Biomedical subjects

Paolo Rossi

Publications and source records attributed to Paolo Rossi.

67 records · Page 4Linked to original sources

PubMed2002

Local electrogram assessment of unidirectional isthmus block is sufficient to predict the acute and long-term success of cavo-tricuspid isthmus ablation.

BACKGROUND: This study investigated whether a minimal approach to typical atrial flutter ablation using an 8 mm tip catheter with a 150 W generator with only the documentation of clockwise block by means of local criteria predicts a good long-term outcome. METHODS: Seventy patients underwent typical atrial flutter ablation. A multipolar catheter was inserted into the coronary sinus (CS) and an 8 mm tip ablation catheter was used to ablate and map the isthmus. The ablation line was performed in the posteroseptal region. The clockwise block was confirmed by recording a corridor of double potentials along the line and by counterclockwise activation of the portion of the isthmus just beyond the lesion line as demonstrated by measuring the conduction times during CS pacing. RESULTS: In case of block, the mean distance between the two split atrial electrograms was 129 +/- 31 ms. Acute isthmus block was achieved in all 70 patients. The median of the radiofrequency pulses was 10 (range 1-36). No immediate or late complications were noted. The long-term follow-up (19.5 +/- 4 months) revealed recurrence of typical atrial flutter in 2 cases (2.8%). CONCLUSIONS: Our results demonstrate that the acute success rate following typical atrial flutter isthmus ablation using an 8 mm tip catheter with a 150 W generator is high. No complications occurred. Moreover, the documentation of just the clockwise isthmus block using a minimal approach according to local electrogram criteria is a good predictor of the long-term success.

Atrial Flutter↗

PubMedDate not supplied

Subcutaneous sumatriptan induces changes in frequency pattern in cluster headache patients.

OBJECTIVES: To document the relationship between the use of subcutaneous (SQ) sumatriptan (sum) and a change in frequency pattern of cluster headache (CH) in six patients. To discuss the clinical and pathophysiological implications of this observation in the context of available literature. BACKGROUND: Treatment with SQ sum may cause an increase in attack frequency of CH but data from literature are scant and controversial. METHODS: Six CH sum-naïve patients (three episodic and three chronic according to the International Headache Society (IHS) criteria) are described. RESULTS: All six patients had very fast relief from pain and accompanying symptoms from the drug but they developed an increase in attack frequency soon after using SQ sum. In all patients, the CH returned to its usual frequency within a few days after SQ sum was withdrawn or replaced with other drugs. Five patients were not taking any prophylactic treatment and SQ sum was the only drug prescribed to treat their headache. CONCLUSIONS: Physicians should recognize the possibility that treatment of CH with SQ sum may be associated with an increased frequency of headache attacks.

Adult↗

PubMedDate not supplied

Are coronary artery anomalies an accelerating factor for coronary atherosclerosis development?

The relevance of benign congenital coronary anomalies (CAAs) in the atherosclerotic process is still confused despite the number of single reports of coronary artery disease in CAAs. The present study is aimed at assessing the role of CAAs on the progression of coronary artery disease (CAD). A review of the last 15,000 coronary angiographies was performed to select patients with CAAs, and they were divided into 2 groups on the basis of the presence (group I) or the absence (group II) of CAD. Clinical and instrumental records of the selected patients were reviewed and the numbers of cardiovascular events for each group (acute myocardial infarct, unstable angina, silent ischemia, bypass or percutaneous transluminal coronary angioplasty (PTCA) interventions, and cardiovascular death) were recorded from the date of diagnosis to July 2002. Group I (22 patients, mean age 64.1 +/- 9.1 years, F/M = 10/12) and group II (17 patients, mean age 66.5 +/- 10.6 years, F/M = 7/10) were similar for age and ejection fraction values. The presence of risk factors was statistically higher in group I. The number of patients with cardiovascular events was significantly higher in group I: 50% (11 patients) in group I vs 12% (2 patients) in group II, p<0.05). Repeated coronary angiography in 8/11 patients of group I and in the 2 patients of group II confirmed that the causes of the events were precedent atherosclerotic lesions in 7 patients and newly developed lesions in 3. At a mean follow-up of 60.4 +/- 12.3 months, mean actuarial survival was lower in group I than in group II (74.8% vs 100%, p=0.045), whereas mean event-free survival was 41.7% in group I and 88.7% in group II (p=0.02). Benign CAAs do not seem per se to be an accelerating factor for coronary atherosclerosis development in patients with no or few classical risk factors.

Aged↗

PubMedDate not supplied

Validation of a clinical-significance-based classification of coronary artery anomalies.

The clinical significance and subsequent management of the various types of coronary artery anomalies (CAAs) are different, as is the relationship to sudden death, coronary artery disease, and myocardial ischemia. A practical global classification based on clinical significance has not yet been proposed. This retrospective study was aimed at evaluating the current clinical significance of CAAs and the effectiveness of a clinical-significance-based classification. In a single-center retrospective study at a public hospital, a review of the last 5,100 coronary angiographies was performed in order to select patients with CAAs. The CAAs were classified into 4 categories on the basis of a literature review according to angiographic appearance and clinical significance: benign (class I); relevant-associated with fixed myocardial ischemia (class II); severe-related to sudden death (class III); and critical-associated with superimposed coronary artery disease (CAD) (class IV). Clinical and instrumental records of the selected patients were reviewed as well as the occurrence of cardiovascular events from the date of diagnosis to July 2002. Sixty-two patients (1.2%, women/men 20/42, mean age 65.3 +/-10.6 years) had CAA on coronary angiography. From the above-described classification, 40 patients were categorized in class I (64.5%), 9 in class II (14.5%), 7 in class III (11.3%), and 6 in class IV (9.7%). During the follow-up (mean duration 60.4 +/-12.3 months) most cardiovascular events and death occurred in class III and IV patients (71.3% and 100% respectively). A high correlation was found between significance level and percentage of patients with cardiovascular events (r = 0.99). Actuarial survival at 5 years was 82.9%. CAAs can be practically classified on the basis of clinical presentation and significance. This clinical classification may be useful in managing patients with CAA and personalizing their follow-up and therapeutic options according to their class and case histories.

Actuarial Analysis↗

PubMedDate not supplied

Bile leak from the hepatic bed after laparoscopic cholecystectomy.

The aim of our study was to identify the best treatment for bile leakage from the gallbladder or hepatic bed as a result of laparoscopic cholecystectomy. Two hundred and fifty laparoscopic cholecystectomies were performed in our department from January 1997 to January 1999 and bile leak was identified in 5 cases (2%). In one case, a right subphrenic collection was detected and resolved with a percutaneous drainage. At ERCP all cases showed a small leak from an accessory hepatic duct (2 pts.) or from the hepatic bed (3 pts.), successfully managed with an immediate endoscopic sphincterotomy, with placement of a nasobiliary tube or a biliary endoprosthesis. The incidence of leakage from an accessory hepatic or from Luschka's duct is not well known. This complication can be successfully managed with endoscopic treatment.

Adolescent↗

PubMedDate not supplied

Sympathetic skin response evoked by laser skin stimulation.

The objective of this study was to evoke sympathetic skin responses (SSRs) in healthy subjects using laser stimulation and to compare these responses with those induced by conventional electrical stimuli. Twenty healthy subjects were investigated. SSRs were obtained using electrical and laser stimuli delivered to the wrist controlateral to the recording site. The sympathetic sudomotor conduction velocity (SSFCV) was measured in 8 subjects by simultaneously recording the SSR from the hand and the axilla. The latency (L) of the laser-induced SSR (ISSR) was significantly longer than that of the electrically-evoked SSR (eSSR) (mean ISSRL= 1.7 +/- 0.145 ms, mean eSSRL= 1.56 +/- 0.14 ms, p<0.05). The amplitude (A) of the ISSR was lower than the eSSR amplitude (mean ISSRA = 1.31 +/- 0.26 mV, mean eSSRA = 2.59 +/- 0.49 mV, p<0.05). No significant difference between the ISSR and eSSR was observed in either the SSFCV or the variability and reproducibility parameters. Our findings show that SSRs can easily be induced by laser stimuli and that this method shares the technical limitations of conventional eSSRs.

Adult↗

PubMedDate not supplied

[Perinatal infections of B19 Parvoviruses]

This study is aimed at detecting perinatal infections of Parvovirus B19 (PV B19). The authors have analyzed specific antibodies (IgM and IgG) in the cord serum of 647 babies, born consecutively at the St. Eugenio Hospital in Rome. 156 of them (24%) were positive to IgG. The analysis of viral genome by PCR methods showed three positive subjects (2%). The three newborn babies did not develop any pathologies during a two-year follow-up and PCR became negative within the first 6 months. Data show that a mass pregnancy test is not useful for PV B19 detection, and that specific antibody analysis should be limited to pregnancies at risk. However healthy the infected patients may appear at birth, though, it is advisable to have them monitored for at least one year so as to avoid the risk of chronic infections.

Journal Article↗

PubMedDate not supplied

Cinnarizine in migraine prophylaxis: efficacy, tolerability and predictive factors for therapeutic responsiveness. An open-label pilot trial.

The efficacy and tolerability of cinnarizine (75 mg, at bedtime) in migraine prophylaxis and the presence of possible predictive factors for therapeutic responsiveness were evaluated in an open-label pilot trial. Eighty consecutive outpatients suffering from migraine with or without aura participated in the study. After 12 weeks of therapy, 55 patients experienced a greater than 66% reduction in headache frequency and were considered responders. A significant reduction in the number of migraine days (mean reduction 58 +/- 8%) and in intake of medication to treat acute attacks (mean reduction 55 +/- 11%) was also observed. Cinnarizine was well tolerated, as documented by the low number of adverse effects. Failure to respond to previous prophylactic treatments was a negative predictive factor correlated with a poor prognosis. This study, even bearing in mind its limitations as an open-label trial, suggests that cinnarizine might be an effective prophylactic anti-migraine agent. The clinical characteristics of migraine patients do not help to predict response to treatment.

Adult↗

PubMedDate not supplied

Spinal myoclonus with giant somatosensory evoked potentials and enhanced long-loop reflex: a case report.

We describe a patient with an ischaemic lesion of the cervical spinal cord who presented with clinical evidence of stimulus-sensitive, multisegmental myoclonic jerks restricted to the truncal and proximal limb muscles and accompanied by electrophysiological features (giant somatosensory evoked potentials and enhanced long-loop reflex) of cortical myoclonus. We hypothesize that these features might result from a loss of inhibitory influences on the sensory input to cortical structures: a concomitant contribution of spinal and cortical hyperexcitability seems to have played a crucial role in inducing myoclonus in our patient.

Aged↗

PubMedDate not supplied

Prodromes and the early phase of the migraine attack: therapeutic relevance.

A migraine attack is a multiphasic event. In some patients the initial phase of the attack is characterized by the presence of "prodromes" or "premonitory symptoms" which are not recognized by the patient as part of the attack. Premonitory symptoms are defined as "symptoms preceding and forewarning of a migraine attack by 2-48 hours, occurring before the aura in migraine with aura and before the onset of pain in migraine without aura". Migraine premonitory symptoms should be differentiated from aura and symptoms of premenstrual syndrome. This differentiation, which is crucial to correct diagnosis, is based on two principal aspects, namely, the timing of these premonitory symptoms prior to the headache pain and their clinical characteristics. The neurotransmitters dopamine and serotonin are possibly involved in the development of premonitory symptoms, as demonstrated by experimental models and by the efficacy of migraine aborting and preventive treatments. Accurate recording of premonitory symptoms may contribute to efforts to design the best therapeutic approach in migraine patients.

Female↗

PubMedDate not supplied

Prodromes and predictors of migraine attack.

Premonitory symptoms of migraine include a wide and heterogeneous collection of cognitive, psychic and physical changes preceding and forewarning of an attack by a few hours to 2-3 days. To date, premonitory symptoms have received little attention in the literature, being treated more as a curiosity than as a primary feature of migraine. This paper provides an extensive critical review of this neglected area of migraine research in the light of the recent advances in our understanding of the pathogenetic mechanisms of migraine. Epidemiological and clinical studies that have investigated the premonitory symptoms of migraine lack scientific rigour, producing conflicting results, whilst genetic and pathophysiological investigations are still in their very early stages. There is evidence supporting the idea that premonitory symptoms could be used as a phenotypical marker to identify subgroups of migraineurs which could show correlations with specific clinical expressions of the disease, genotypes, or responses to treatments. Future studies are needed to clarify the clinical, pathophysiological and therapeutic significance of premonitory symptoms.

Humans↗

PubMedDate not supplied

Hepatic artery ligation for arterio-duodenal fistula secondary to fistulisation of a hepato-hepatic by-pass into the duodenum.

We describe a case of severe acute bleeding from an arterio-duodenal fistula between the duodenum and a hepato-hepatic by-pass. Emergency ligation of the common hepatic artery was successfully achieved. After hepatic artery ligation, revascularization of the liver in human subjects occurs through inferior phrenic, pancreatico-duodenal and intercalary de novo arteries.

Duodenal Diseases↗

PubMedDate not supplied

Medicine in the Internet age. The rise of the network society.

When social scientists began analyzing the socio-cultural impact of the Internet, health emerged as one of the areas in which the Internet has become a key means of communication and cultural expression. It is no exaggeration to say that the Internet is bringing about a structural transformation of the cultural practices and organization of health systems. This is the so-called online revolution of health systems. The Internet has both the usership and the technical prerequisites to be an ideal medium for promoting health-related education and support, but what makes the Internet the health medium par excellence is the fact that it is the mode of cultural expression and output most compatible with the transformations that have taken place and are taking place in our society: that is, with the rise of the network society. In this paper, I discuss the opportunities and challenges arising from the transformation of health systems into patient-centred networks.

Health Education↗