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Biomedical subjects

A Colombo

Publications and source records attributed to A Colombo.

At least 37 records · Page 2Linked to original sources
PubMed2003

A multicentre European registry of intraluminal coronary beta brachytherapy.

AIMS: To assess the feasibility, safety and effectiveness of intravascular brachytherapy (VBT) in routine clinical practice. METHODS AND RESULTS: Between April 1999 and September 2000, 1098 consecutive patients treated in 46 European centres by intraluminal irradiation using a Sr/Y(90)source train (BetaCath, Novoste, GA) were included in a registry, and follow-up data were obtained for 98.8% of them after 6.3+/-2.4 months. Eight hundred and forty (76.5%) patients were males, and mean age was 62.0+/-10.2 years. Two hundred and seventy-one (26.9%) had unstable angina, and 256 (23.5%) were diabetics. Nine hundred and thirteen lesions (77.7%) were the result of in-stent restenosis, 208 (17.7%) were de novo lesions and 48 (4.1%) non-stented restenotic lesions. Mean estimated reference diameter was 3.2+/-0.5mm and mean estimated lesion length was 19.0+/-11.8mm. The prescribed radiation dose was 18.8+/-3.2Gy. Multivessel irradiation was done in 6.2% of cases, and a new stent was implanted in 29.6% of cases. Most patients received 6 or 12 months of combined aspirin and thienopyridin treatment after the procedure. Technical success was obtained in 95.9% of treated lesions, and the in-hospital major adverse cardiac event (MACE) rate was 1.8%. At follow-up, the MACE rate was 18.7% (1.9% deaths from any cause, 2.6% AMI, 13.3% TVR by PCI and 3.3% TVR by CABG). CONCLUSION: The major current application of VBT is the treatment of in-stent restenosis. The good results of VBT observed in recent randomized controlled trials can be reproduced in clinical practice.

Aged↗
PubMed2003

Evaluating the influence of implicit models of mental disorder on processes of shared decision making within community-based multi-disciplinary teams.

This paper reports findings from a qualitative study concerning the influence of implicit models of mental disorder on shared decision making within community-based mental health teams. One-hundred participants representing five distinct multi-agency groups: psychiatrists, community psychiatric nurses, approved social workers, patients and informal carers operating within Leicestershire, England were interviewed using a standard case vignette describing a person whose behaviour suggests he may have schizophrenia. The results showed that each of the study's multi-agency groups implicitly supports a complex range of model dimensions regarding the nature of schizophrenia, the appropriateness of specific forms of treatment and care, and their respective rights and obligations towards each other. The influence of these implicit model patterns on processes of shared decision making are discussed through evaluating their contribution to our understanding of the power relationships existing between various practitioner groups (including informal carers), and between practitioners and patients during clinical encounters.

Attitude of Health Personnel↗
PubMed2003

Clinical and angiographic acute and follow up results of intracoronary beta brachytherapy in saphenous vein bypass grafts: a subgroup analysis of the multicentre European registry of intraluminal coronary beta brachytherapy (RENO).

OBJECTIVE: To assess clinically and angiographically the feasibility, safety, and effectiveness of vascular brachytherapy (VBT) in saphenous vein bypass grafts (SVG). PATIENTS AND METHODS: 67 of 1098 (6.1%) consecutive patients of the European registry of intraluminal coronary beta brachytherapy underwent treatment for 68 SVG lesions by VBT using a Sr/Y(90) source train (BetaCath). Clinical follow up data were obtained for all of them after a mean (SD) of 6.3 (2.4) months and angiographic follow up was performed in 61 patients (91.0%) after 6.9 (2.0) months. RESULTS: 58 (86.6%) patients were men, their mean (SD) age was 66 (10) years, 28 (41.8%) had unstable angina, and 21 (31.3%) had diabetes. Fifty three (77.9%) lesions were in-stent restenosis, 13 (19.1%) de novo lesions, and 2 (3.0%) non-stented restenotic lesions. Mean (SD) reference diameter before the intervention was 4.19 (0.52) mm, mean (SD) lesion length was 23.56 (20.38) mm, and mean (SD) minimum lumen diameter measured 0.73 (0.62) mm. Mean (SD) acute gain was 3.02 (0.88) mm. The prescribed radiation dose was 20.1 (3.2) Gy. Pullback manoeuvres were performed in 17 (25.0%) of cases. Most patients received combined aspirin and thienopyridin treatment for 6 or 12 months after the procedure. Technical success was obtained in 62 (91.2%) treated lesions and in-hospital major adverse cardiac events occurred in 4.5%. At follow up, mean (SD) reference diameter was 4.20 (0.53) mm, minimum lumen diameter 2.94 (1.50) mm, and late loss 0.86 (1.25) mm. The overall major adverse cardiac events rate was 26.7%. CONCLUSION: VBT of SVG is feasible and safe. At follow up the reintervention rate and cardiac morbidity and mortality seem to be favourable, considering that interventions in SVG usually are associated with the highest risks.

Aged↗
PubMed2003

Clinical and angiographic outcome of directional atherectomy followed by stent implantation in de novo lesions located at the ostium of the left anterior descending coronary artery.

BACKGROUND: Lesions located at the ostium of the left anterior descending coronary artery (LAD) are considered an ideal target for directional atherectomy (DCA), but few data are available about the value of using this strategy before stenting in comparison with stenting alone. OBJECTIVES: To investigate the immediate and mid term clinical and angiographic results of DCA followed by stent implantation for ostial LAD lesions. DESIGN: Retrospective comparison of the immediate and mid term angiographic and clinical results of a series of 117 consecutive patients with de novo lesions located at the ostium of the LAD. Of these, 46 underwent DCA before stenting and 71 were treated with stenting alone. RESULTS: Technical success in the two groups was similar at around 98%. DCA plus stenting provided a larger minimum lumen diameter at the end of the procedure than stenting alone (3.57 (0.59) mm v 3.33 (0.49) mm, p = 0.022). There were no differences for in-hospital major adverse events (MACE) (7.5% for atherectomy plus stenting, and 5.3% for stenting alone; p = 0.41). All patients had clinical follow up at a mean of 7.9 (2.7) months. Angiographic follow up was done in 89 patients (76%) at a mean of 5.9 (2.2) months. The atherectomy plus stenting group had a larger minimum lumen diameter than the stenting group (2.79 (0.64) mm v 2.26 (0.85) mm, p = 0.004) and a lower binary restenosis rate (13.8% v 33.3%, p = 0.031). Six month MACE were reduced in the atherectomy plus stenting group (8.7% v 23.9%, p = 0.048). CONCLUSIONS: Debulking before stenting in de novo lesions located at the ostium of the LAD is safe and is associated with a high rate of technical success. Follow up data show that DCA plus stenting results in a significantly larger minimum lumen diameter and a lower incidence of restenosis than stenting alone.

Angioplasty, Balloon, Coronary↗
PubMed2003

[How to quantify the severity of brain injury during intensive care after adult head trauma].

Adequate early assessment of brain damage is essential. Location, extension and severity of structural damage affect brain function and ultimately determine the outcome. The extent of functional impairment, and the morphology of intracranial lesions, require specific treatment, often a combination of medical and surgical interventions. Brain damage usually evolves over time, and repeated assessments are necessary. Clinical evaluation is often biased by concomitant sedation and/or anesthesia, but remains necessary. A revision of the literature is presented. Brain damage is assessed combining clinical and instrumental data. Clinical examination is performed assessing the 3 components of the Glasgow Coma Scale. Spontaneous or stimulated (pain stimulus) eye opening, verbal and motor responses are observed after hemodynamic and respiratory stabilisation. Unfortunately a significant proportion of patients can not be properly examined for several reasons: eye opening can be altered by palpebral and facial injuries, verbal response can be impaired by maxillo-facial injuries or by endotracheal intubation, and motor response remains the most consistent parameter. Sedation, analgesia and myorelaxants, however, can profoundly diminish or abolish the motor response to maximal stimulation, so that examination should be performed after clearance of drugs. Often alcohol or other substances can further impair the neurological performances. Pupils diameter and reactivity to light should be observed, excluding pharmacologic effects (as dilation due to catecholamines) and direct ocular or orbital damage. The CT scan is necessary for disclosing surgical masses and for identifying the extent of diffuse damage and the location of focal lesions. These data should be combined with additional functional exploration, as provided by cerebral extraction of oxygen and electrophysiologic data. Early estimation of cerebral damage is complex and prone to mistakes. Accurate, repeated evaluations, based on the combination of clinical observation and imaging, are necessary.

Brain Injuries↗
PubMed2003

Using intravascular ultrasound with drug-eluting stents. What have we learned so far?

Drug-eluting stents (DES) promise to change the landscape of interventional cardiology, overcoming restenosis that is the major limitation of percutaneous coronary interventions. Intravascular ultrasound (IVUS) examination has been at the centre of our efforts to understand the mechanisms and define different treatment strategies during coronary interventions. IVUS interrogation and 3-dimensional IVUS measurements have been used to better define the mechanisms of benefit and potential drawbacks of DES. The findings of these studies are summarized in this article and the potential importance of IVUS in the era of DES is discussed. Evidence of neointimal hyperplasia (IH) suppression and assessment of any edge effect or vessel remodeling after implantation of DES has been evaluated by IVUS. The overall clinical importance of IVUS in the new era will depend on the amount and the clinical significance of any unsolved questions we will face and on its ability to provide answers to the evolving questions.

Clinical Trials as Topic↗
PubMed2002

Angiographical follow-up after radioactive "Cold Ends" stent implantation: a multicenter trial.

BACKGROUND: Radioactive stents with an activity of 0.75 to 12 microCi have shown >40% edge restenosis due to neointimal hyperplasia and negative remodeling. This trial evaluated whether radioactive Cold Ends stents might resolve edge restenosis by preventing remodeling at the injured extremities. METHODS AND RESULTS: The 25-mm long (15-mm radioactive center and 5-mm nonradioactive ends) Cold Ends stents had an activity of 3 to 12 microCi at implantation. Forty-three stents were implanted in 43 patients with de novo native coronary artery disease. Two procedural, 1 subacute, and 1 late stent thrombosis occurred. A restenosis rate of 22% was observed with a shift of the restenosis, usually occurring at the stent edges of radioactive stents, into the Cold Ends stents. The most severe restenosis occurred at the transition zone from radioactive to nonradioactive segments, a region located in dose fall-off. CONCLUSION: Cold Ends stents did not resolve edge restenosis.

Adult↗
PubMed2002

Cerebral veno-arterial pCO2 difference as an estimator of uncompensated cerebral hypoperfusion.

The aim of the present study was to assess the veno-arterial difference in pCO2 (delta pCO2) as an indicator of ischemia compared to the arteriovenous O2 difference (AVDO2). Staircase cerebral blood flow (CBF) reductions were obtained in seven domestic pigs by inducing intracranial hypertension: CBF 100%, 50-60% of baseline, 20-30% of baseline. ICP, MAP, CPP and CBF (Laser-Doppler method) were continuously recorded. The superior sagittal sinus was punctured to determine AVDO2 and delta pCO2. AVDO2 was 5.9 (+/- 1.78, range 3.3-7.4), 7.01 (+/- 1.31, range 5-8.9) and 8.17 (+/- 1.51, range 6.0-11.3) ml/100 ml in the three CBF steps (p = 0.001). CBF impairment was accompanied by the following increases in delta pCO2: from 10 (+/- 4, range 4-15) mmHg to 14.5 (+/- 4.11, range 10-27) mmHg, and to 31.2 (+/- 9.0, range 17-39) mmHg (p < 0.001). When CBF declines AVDO2 increases, indicating greater extraction of O2 to satisfy the aerobic metabolism. However, this mechanism can no longer compensate once a critical CBF threshold is reached. delta pCO2 rises slowly during moderate CBF reduction because of defective washout; the rise is impressive during marked CBF impairment when anaerobic metabolism takes place with proton buffering in CO2 and H2O. Therefore, when the brain's ability to compensate for low blood flow is exceeded, CO2 production outweighs O2 extraction.

Animals↗
PubMed2002

Discrepancy between angiography and intravascular ultrasound when analysing small coronary arteries.

AIMS: A small reference diameter may be the consequence of high plaque burden and diffuse disease. The reference vessel diameter in small coronary arteries may vary according to the method of measurement used. We endeavoured to confirm the difference between data from examinations conducted using angiography with that revealed by intravascular ultrasound. METHODS AND RESULTS: Between March 1993 and October 1999, 344 consecutive patients with 419 lesions in small vessels (< or =2.75 mm, Small group) and 953 patients with 1161 lesions in large vessels (Large group) underwent intravascular ultrasound-guided percutaneous transluminal angioplasty in our Institution. The mean difference between the intravascular ultrasound and the angiographic reference diameter (Delta(IVUS-Angio)) was 1.3+/-0.5 mm in the Small group and 1.0+/-0.6 mm in the Large group (P<0.001). There was a stronger correlation between plaque burden and Delta(IVUS-Angio)in the Small group (r=0.80, P<0.001) than in the Large group (r=0.59, P<0.001). An Delta(IVUS-Angio)> or =0.30 mm occurred in 99.5% of cases in the Small group and in 90% in the Large group (P<0.001). An Delta(IVUS-Angio)> or =0.50 mm occurred in 96% of case in the Small group and 80% in the Large group (P<0.001). Predictors of Delta(IVUS-Angio)> or =0.50 in the Small group were: proximal or middle lesion site, vessel type (left anterior descending artery, diagonal and obtuse marginal branches) and female sex. An Delta(IVUS-Angio)> or =1.0 mm occurred in 71% of cases in the Small group and in 49% in the Large group (P<0.001). Predictors of Delta(IVUS-Angio)> or =1.0 mm in the Small group were: proximal or middle lesion site, female sex, and lesion length. CONCLUSIONS: A high percentage of vessels measuring < or =2.75 mm are large vessels with a high plaque burden. This condition is particularly prevalent in females, with lesions in the proximal or middle left anterior descending artery, and in obtuse marginal and diagonal branches.

Aged↗
PubMed2002

Impact of final coronary flow velocity reserve on late outcome following stent implantation.

Aims To assess whether coronary flow velocity reserve following stent implantation is predictive of the subsequent need of target lesion revascularization. Methods and Results The outcome was examined of 417 patients enrolled in a multicentre prospective randomized study (DESTINI), who received a successful single vessel stent implantation in native coronary arteries and in whom coronary flow velocity reserve was measured. Logistic regression analysis and the receiver operator characteristic curve were used. When compared with 358 patients not requiring target lesion revascularization, 59 patients (14%) who underwent target lesion revascularization had a lower final coronary flow velocity reserve (2.33 +/- 0.87 vs 2.48+/- 0.80, P= 0.20) and smaller final minimal lumen diameter (2.62 +/- 0.66 mm vs 2.73+/- 0.60, P= 0.19); however, those differences were not statistically significant. Patients with a coronary flow velocity reserve of < 2.0 (n=109, 26%) exhibited a significantly higher target lesion revascularization rate than patients with a coronary flow velocity reserve of > or = 2.0 (22% vs 11%, P= 0.010). This difference remained significant (odds ratio=2.01, 95% CI=1.11 to 3.66) after adjustment for other variables that were also correlated with the incidence of target lesion revascularization. Conclusion The presence of a final coronary flow velocity reserve of < 2.0 is an independent predictor of the need for target lesion revascularization after stent implantation in native coronary artery lesions.

Blood Flow Velocity↗
PubMed2002

Production of anti-endomysial antibodies in cultured duodenal mucosa: usefulness in coeliac disease diagnosis.

BACKGROUND: Although anti-endomysial antibodies (EmA) have been found in the supernatants of cultured intestinal mucosa from patients with coeliac disease (CD), in no study has the clinical reliability of this new diagnostic tool been investigated. Our aims were to evaluate the clinical usefulness of the in vitro production of EmA in CD diagnosis in consecutive patients with suspected CD, and to evaluate the reliability of the in vitro challenge in CD patients on a gluten-free diet (GFD). METHODS: For the former aim, consecutive patients who were due to undergo intestinal biopsy for suspected diagnosis of CD were enrolled: according to the final diagnosis, these patients were divided into two groups: Group 1 comprised 91 newly diagnosed CD patients (40 males; age range 7 months to 84 years), Group 2 included 100 subjects with diseases other than CD (44 males; age range 9 months to 76 years). For the latter aim, we also studied 21 CD patients on a gluten-free diet after 16-123 months (8 males; age range 3-51 years), with normal intestinal architecture (Group 3) and 22 patients who served as controls (12 males; age range 4-60 years) with gastroesophageal reflux disease-like symptoms (Group 4). All patients underwent determination of serum anti-gliadin (AGA) and EmA antibodies, histology evaluation of the intestinal biopsies and EmA assay in the supernatants of in vitro gliadin-challenged duodenal mucosa. RESULTS: EmA assay in the supernatants showed a sensitivity and specificity of 96% and 100%, respectively; these were not significantly different from those observed for serum EmA (88% and 99%, respectively). However, EmA assay in the supernatants was useful in CD patients with mild intestinal histology lesions (infiltrative/hyperplastic type): in this subgroup it was positive in 9/12 of cases, but serum EmA was positive in only 2/12. As regards the reliability of the in vitro gliadin challenge, EmA production in supernatants was recorded only in 10/21 CD patients on a gluten-free diet. The patients with a positive in vitro challenge had a higher number of intra-epithelial lymphocytes than patients with a negative challenge. CONCLUSIONS: 1) EmA assay in the medium of cultured intestinal biopsy can detect gluten-sensitive enteropathy, characterized by an infiltrative/hyperplastic histological pattern, which is often associated with negative serum EmA. 2) The in vitro challenge in CD patients on a gluten-free diet detects EmA production in the culture medium only in half of the cases and other studies must be performed to evaluate whether EmA production after in vitro challenge can be considered a reliable test for confirming CD diagnosis.

Adolescent↗
PubMed2002

Carotid artery stenting in the first 100 consecutive patients: results and follow up.

BACKGROUND: Carotid artery stenting is now used as an alternative to surgical endarterectomy. The availability of cerebral protection systems has expanded the area of application of this procedure. OBJECTIVE: To assess the feasibility, safety, and immediate and late clinical outcome in patients undergoing percutaneous carotid interventions. METHODS: Between January 1999 and December 2000, 100 consecutive patients with 102 carotid artery stenoses were treated (71 men, 29 women, mean (SD) age 67 (8) years): 49 had coronary artery disease, 28 had previous stroke or transient ischaemic attack (TIA). On the basis of the Mayo Clinic carotid endarterectomy risk scale, 73 patients were grade III-IV and 13 grade VI. RESULTS: Baseline diameter stenosis was 78.8 (10)%, with a mean lesion length of 12.6 (5.8) mm. Angiographic success was obtained in 99 lesions (97.0%) with a final diameter stenosis of 2.4 (3.5)%. Procedural success was obtained in 96 patients (96%). Selective cannulation of three carotid arteries was impossible owing to severe vessel tortuosity. Carotid stenting was performed in 97 of the treated lesions, and protection devices were used in 67 lesions. In-hospital complications occurred in seven patients (six TIA, one (category 1) minor stroke). No major stroke or death occurred. All patients were discharged from the hospital after an average of 2.5 days. At 12 (6.2) months of follow up restenosis occurred in three patients (3.4%) (one patient with carotid occlusion had TIA). Six patients had died: two from cerebrovascular events (5 and 11 months after the procedure) and four from cardiovascular causes. CONCLUSIONS: Carotid stenting appears feasible and safe, with few major complications. Long term follow up is affected by a high incidence of cardiovascular mortality.

Adult↗
PubMed2002

Drug-eluting stents.

Drug-eluting stents represent the third revolution in the field of Interventional Cardiology following balloon angioplasty (PTCA) and the implantation of metal stents. The main limitation of percutaneous coronary intervention (PCI) is restenosis. The introduction of drug eluting stents able to release antiproliferative compounds led to the evaluation of several antiproliferative drugs in order to reduce restenosis. Rapamycin (Sirolimus) has been demonstrated to inhibit smooth muscle cell (SMC) proliferation and migration in vitro and to reduce in vivo neointima formation with blockage of the cell cycle progression at the G1-S transition. In a pilot study, recently confirmed by a randomized trial, rapamycin drug-eluting stents have been reported to eliminate restenosis after stent implantation. Promising data also come from the use of paclitaxel drug-eluting stents. Paclitaxel (Taxol) is a microtubule-stabilizing agent with potent antiproliferative activity. Even if drug-eluting stents represent one of the most promising fields in Interventional Cardiology today before being sure of their real potential it is necessary to wait for results from several ongoing clinical studies, their usage in real-world lesions and extended follow-up to 5 years.

Angioplasty, Balloon, Coronary↗
PubMed2001

Immediate and long-term clinical and angiographic results from Wiktor stent treatment for true bifurcation narrowings.

From January 1996 to December 1998, 90 consecutive patients with true bifurcation lesions underwent percutaneous coronary angioplasty with Wiktor stent implantation in our centers. In 1 group (group I, n = 45), a simple approach (main vessel stenting and balloon angioplasty of the side branch) was pursued. In the other group (group II, n = 45), both the main vessel and the side branch were stented ("T" technique). There was no significant difference in clinical and angiographic characteristics between the 2 groups. Angiographic and procedural successes were 100% and 95.6%, respectively, in both groups. Angiographic results for the side branch were better in group II than in group I. In-hospital and long-term (12 month) major cardiac events were similar in the 2 groups. Target lesion revascularization was 15.5% in group I and 35.5% in group II (p = 0.12). In the main vessel, restenosis rate was 12.5% in group I and 25% in group II (p = 0.15). In the side branch, restenosis rate was 37.5% in group II and 12.5% in group I (p = <0.05; odds ratio 2.42; 95% confidence interval 1.05 to 6.26). Event-free probability at 12 months was 61% in group II and 80% in group I (p = 0.10). When dealing with true bifurcation lesions, a simple strategy is associated with a lower risk of restenosis in the side branch. In contrast, a complex approach does not appear to give any benefit in terms of early or long-term outcome or restenosis rate.

Angioplasty, Balloon, Coronary↗