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G Belli

Publications and source records attributed to G Belli.

At least 19 recordsLinked to original sources
PubMed2001

Prognostic value of absolute versus relative measures of the procedural result after successful coronary stenting: importance of vessel size in predicting long-term freedom from target vessel revascularization.

BACKGROUND: The procedural result is a major determinant of the incidence of 6-month target vessel revascularization (TVR) after successful coronary stenting. However, the prognostic implications of the different measures of the procedural result or procedural end points have not been directly compared. In this study, we sought to assess and compare the impact of achieving different procedural end points on the long-term (2-year) incidence of TVR. METHODS AND RESULTS: We studied 234 patients in whom 1 or 2 stents were successfully deployed and ultrasound imaging performed after angiographic optimization. End points included a visually estimated angiographic residual stenosis <10% and ultrasound stent-to-mean reference lumen area > or = 80%. After 2 years, TVR was required in 48 (20.5%) patients. Qualitative predictors of TVR were vein graft lesions, 3-vessel disease, and baseline TIMI flow grade < 3. Quantitatively, reference diameter by quantitative coronary angiography (QCA), final minimum lumen diameter (MLD) by QCA, and in-stent minimum lumen area (MLA) by ultrasound were predictive of TVR. Stent-to-reference ratios were not significantly predictive of TVR. By multivariable analysis, vein graft location and MLA by ultrasound were the only significant predictors of TVR (relative risk, 2.9 [1.5, 5.4] and 0.72 [0.6, 0.9], respectively). Receiver operator curves for MLD by QCA and MLA by ultrasound were similar in predicting TVR. Neither was significantly superior to reference vessel diameter. CONCLUSIONS: Commonly used angiographic and ultrasound stent-to-reference ratios do not predict the incidence of TVR. Absolute measures of the lumen size (MLA by ultrasound and MLD by QCA) were the most important quantitative predictors of TVR within 2 years. This emphasizes the role of the vessel size as the limiting factor in determining the long-term outcome of coronary stenting.

Blood Vessel Prosthesis Implantation↗
PubMed2001

[Limitations and usefulness of coronary stents in diverse clinical conditions. Long-term course].

Since the introduction of balloon angioplasty, the acceptance and widespread application of coronary stents is the most important advance in interventional cardiology. The option of bail-out stenting has liberated interventionalists from the restrains of surgical stand-by. It has also allowed more aggressive balloon angioplasty and better short- and long-term results. This progress was enabled by improvements in deployment technique and antiplatelet therapy preventing most of the vexing problems of subacute stent thrombosis. Whereas initial registries and randomized trials focused on specific narrow patient populations, the clinical indications are broadening based on the results of new clinical trials that have focused on expanding populations, such as restenotic lesions, small vessels, total chronic occlusions, saphenous vein grafts stenoses, and acute ischemic syndromes. Despite this progress, a solution to the problem of in-stent restenosis, although less frequent than after balloon angioplasty alone, is still pending. In this review, we will discuss the process of restenosis which is the main indication for the use of stents, then we will analyze the application of stents in some particular clinical and anatomical situations and finally we will focus on in-stent restenosis which is the main limitation for stenting.

Acute Disease↗
PubMed2001

[Prevalence of anemia in oncologic patients treated with chemotherapy. Italian survey at the national level].

UNLABELLED: In Italy the prevalence of anemia in cancer patients has only been indirectly drawn from clinical studies, and a direct estimation has never been made. METHODS: This is the first nation-wide survey on the prevalence of anemia in cancer patients in Italy. In 193 Centres, clinical data were collected on consecutive patients with non-myeloid malignancies entering a new cycle of chemotherapy during a reference week in 1997. RESULTS: A total of 1763 patients has been recruited. At the time of enrollment grade I-II anemia was observed in 56% of patients, although only 1% showed severe anemia. Most of the patients (73%) experienced a decrease of haemoglobin level following treatment completion. Drop of haemoglobin correlated with a more advanced stage of the disease and with a lower performance status at baseline. CONCLUSION: Anemia is an increasingly common complication in cancer patients undergoing chemotherapy. Improving our knowledge on occurrence of anemia and the type of neoplasms and chemotherapies which are more likely to be associated with this complication may allow the adoption of specific measures to prevent the development of anemia and to avoid the need of blood transfusion in these patients.

Anemia↗
PubMed2000

Evidence for a recessive inheritance of Turcot's syndrome caused by compound heterozygous mutations within the PMS2 gene.

Turcot's syndrome is a genetic disease characterized by the concurrence of primary brain tumors and colon cancers and/or multiple colorectal adenomas. We report a Turcot family with no parental consanguinity, in which two affected sisters, with no history of tumors in their parents, died of a brain tumor and of a colorectal tumor, respectively, at a very early age. The proband had a severe microsatellite instability (MIN) phenotype in both tumor and normal colon mucosa, and mutations in the TGFbeta-RII and APC genes in the colorectal tumor. We identified two germline mutations within the PMS2 gene: a G deletion (1221delG) in exon 11 and a four-base-pair deletion (2361delCTTC) in exon 14, both of which were inherited from the patient's unaffected parents. These results represent the first evidence that two germline frameshift mutations in PMS2, an MMR gene which is only rarely involved in HNPCC, are not pathogenic per se, but become so when occurring together in a compound heterozygote. The compound heterozygosity for two mutations in the PMS2 gene has implications for the role of protein PMS2 in the mismatch repair mechanism, as well as for the presymptomatic molecular diagnosis of at-risk family members. Furthermore, our data support and enlarge the notion that high DNA instability in normal tissues might trigger the development of cancer in this syndrome.

Adenoma↗
PubMed2000

Adjunctive thrombus aspiration and mechanical protection from distal embolization in primary percutaneous intervention for acute myocardial infarction.

Primary percutaneous intervention for acute occlusion of a native coronary artery may be complicated by distal embolization of plaque or thrombotic debris, with infarct extension. We tested the clinical application of a new therapeutic strategy combining maximal antiplatelet therapy, with glycoprotein IIb/IIIa inhibition, and adjunctive mechanical protection from distal embolization and direct aspiration of thrombus with a new balloon and catheter system (PercuSurgetrade mark). Successful aspiration of thrombus could be obtained in 7 out of 8 attempted procedures, with inability to negotiate the angulated take-off of the circumflex coronary artery in one patient. The current mechanical characteristics of the device, primarily developed for use in larger saphenous vein grafts, and certain caveats and limitations are discussed. New dedicated systems should be available in the near future for the native coronary circulation. Excellent immediate angiographic results were obtained in all treated patients, without evidence of loss of distal branches and no intraprocedural complications.

Abciximab↗
PubMed1999

Hepatic resection and percutaneous ethanol injection for the treatment of selected patients with more than one hepatocellular carcinoma.

OBJECTIVE: To report our results in a selected series of patients who had two separate hepatocellular carcinomas that were not suitable for treatment by resection alone or percutaneous injection of ethanol alone, whom we treated by a combination of the two. DESIGN: Open study. SETTING: Teaching hospital, Italy. SUBJECTS: 11 patients with Child's grade A or B cirrhosis who had two hepatocellular carcinomas in distant segments of the liver. INTERVENTIONS: Percutaneous injection of ethanol into the smaller of the two nodules before, during, or after resection. MAIN OUTCOME MEASURES: Morbidity, mortality, and recurrence. RESULTS: No patient died and there was one postoperative complication (atelectasis). During a median follow-up period of 24 months (range 8-48) two patients have developed recurrences (at 10 and 18 months). CONCLUSION: Although we have studied only a few patients for a relatively short time this double approach may be an important treatment option for suitable patients with two hepatocellular carcinomas.

Adult↗
PubMed1999

Coronary angioplasty and coronary artery remodeling.

Coronary artery remodeling is an active process of structural changes in vascular wall structures, in response to varied physiologic or pathologic stimuli. In the past few years, the advent of a new imaging modality such as intravascular ultrasound has allowed in vivo studies, increasing our understanding of this phenomenon. This article reviews some fundamental concepts of coronary vascular remodeling in atherosclerosis and after angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1999

A rare case: surviving acute left main coronary artery occlusion in Kawasaki's disease.

We present a case of cardiogenic shock due to acute thrombotic occlusion of the left main coronary artery in Kawasaki's aneurysmal coronary artery disease. The patient was treated with PTCA as a bridge to CABG. Because of a persistent low-output syndrome, orthotopic heart transplantation was successfully performed three days later. The patient is alive and well one year after the event.

Acute Disease↗
PubMed1999

Treatment of a native right coronary artery with the PercuSurge Guardwire protection system during PTCA and stenting.

Cardiac catheterization in a patient with recent-onset unstable angina demonstrated a suboccluded dominant right coronary artery (RCA), with angiographic evidence of a large thrombus load and a severe focal stenosis of the left anterior descending (LAD) coronary artery. After abciximab, uneventful PTCA and stenting of the LAD was performed. The thrombus containing lesion of RCA was treated with balloon predilatation and stent deployment, and the whole procedure was accomplished with protection of the distal vessel by means of PercuSurge. This device was planned to avoid distal debris migration during percutaneous interventions of saphenous bypass grafts. The system is designed to allow the placement of a temporary occlusion device, a low-profile balloon, distal to the lesion to be treated during the procedure. The occlusive balloon is kept inflated during the treatment of the lesion. Before deflating the balloon and allowing blood to reach the distal vessel, whenever it is necessary, the material proximal to the balloon is aspirated through a monorail catheter. This aspiration removes blood and thrombi proximal to the occlusive balloon from the treated coronary artery. The case we present first reports the application of the device in a large native coronary artery, with an optimal distal flow restoring and no evidence of thrombus embolization. This type of protection of distal coronary vessels towards micro- and macroembolization of thrombi is a promising system of performing safer percutaneous interventions, even in acute ischemic syndromes.

Aged↗
PubMed1999

"Hybrid" and combined percutaneous and surgical intervention to treat selected cardiac patients: a new strategy.

The term "hybrid revascularization" describes the combined use of minimally-invasive surgery without cardiopulmonary bypass and percutaneous coronary revascularization in selected cases. The theoretical advantage of a less invasive surgical intervention must be weighted against the need for additional percutaneous procedures, with their own risks and limitations. We describe our initial experience with hybrid revascularization at the Istituto Clinico Humanitas in Milan. From 7/97 to 10/98, twelve patients underwent hybrid revascularization or a combined percutaneous and surgical intervention. A "classic" hybrid approach, consisting of minimally-invasive direct coronary artery bypass to the left anterior descending coronary artery and angioplasty or stenting of arteries in the right coronary artery or circumflex territories, was used in nine patients. In three patients, myocardial revascularization could be completed with percutaneous procedures after bypass surgery without cardiopulmonary bypass (in two patients because of severe aortic calcification) or valve surgery in a patient with two previous bypass operations. In-hospital complications were observed in three patients. Two required urgent median sternotomy (one for impending cardiac tamponade, one for conversion to bypass on extra-corporeal circulation). One patient developed atheroembolism after percutaneous intervention: after hospital discharge, there was a recurrence of symptoms, clinical deterioration with renal failure and eventually death. At a mean follow-up of 152 +/- 91 days (range 17 to 283) after minimally-invasive surgery and 166 +/- 122 days (range 13 to 397) after angioplasty, all surviving patients are well and free of anginal symptoms. Closer collaboration between surgical and interventional operators may offer a novel approach to effective treatment of difficult patient subsets. However, our initial experience suggests that a cautious evaluation of possible risks and benefits must carefully be entertained in each patient who may be considered a candidate for hybrid revascularization or combined percutaneous and surgical intervention.

Aged↗
PubMed1998

Cystic dilation of extrahepatic bile ducts in adulthood: diagnosis, surgical treatment and long-term results.

To evaluate the long-term results of surgery for choledohal cyst in adulthood, a series of 13 patients over the age of 16 operated on for choledochal cyst during a period of six years and followed-up for a minimum of 3 years was analyzed. Patients with type I and IVa cysts underwent extrahepatic cyst resection and Roux-en-Y hepatico-jejunostomy. Choledochoceles (type III) were managed endoscopically. No operative mortality or morbidity occurred. Type I and III cysts showed almost ideal follow-up with no sign of stricture on HIDA scan. One type IVa cyst patients developed recurrent cholangitis due to anastomotic stricture, managed percutaneously. Whenever possible, complete cyst resection and Roux-en-Y reconstruction is the treatment of choice for all extrahepatic biliary cysts. Intra- and extrahepatic dilatations are adequately treated by extrahepatic resection and careful endoscopic or radiologic surveillance. Small choledochoceles can be safely managed by endoscopic sphincterotomy.

Adolescent↗
PubMed1998

[Computerized tomography and magnetic resonance in the study of retroperitoneal sarcomas].

PURPOSE: We investigated the yield of CT and MRI in the diagnosis and staging of 15 patients with retroperitoneal sarcomas; these lesions are often asymptomatic and need radical surgery to avoid local recurrences. MATERIAL AND METHODS: April 1993, to September 1997, fifteen patients with retroperitoneal sarcomas were examined and then operated on. CT and CT-guided FNAB were always performed, while MRI was performed in 8 patients only. Because of the high risk of sampling errors, the bioptic specimens were immediately evaluated by a pathologist: a second sampling was required in 10 cases and a third sampling in 6 cases. MRI was performed with a .5 T system (GE Vectra); T1- and T2-weighted transverse images of the abdomen were acquired in all patients and additional coronal and sagittal images were acquired for each abnormal region. All patients underwent surgery and the pathologic diagnosis was compared with CT and MR findings. RESULTS: CT always allowed accurate location of the lesions and identification of their components, especially fat deposits. The cytologic examination of FNAB samples allowed the diagnosis of sarcoma in 12 of 15 cases. CT results were compared with MR findings in 8 patients and the latter method had better spatial definition of the abdominal masses, particularly of vascular structures, which is important for surgical planning. DISCUSSION: The present-day imaging techniques are very important to plan the surgical treatment of retroperitoneal sarcomas. In particular, CT has the advantage of high spatial resolution and excellent tissue contrast from abundant retroperitoneal fat tissue; it also permits the cytologic sampling of viable tumor tissue. However the bulk of such lesions often prevents CT from determining the tumor origin, in which case MRI provides better spatial resolution and vascular detailing, which helps surgical planning. CONCLUSIONS: Both CT and MRI are major tools in the diagnosis and staging of retroperitoneal sarcomas because they can accurately define the borders of large tumors and their relationships with surrounding organs. MRI has the advantage of characterizing the blood supply to the mass, but CT is better to guide FNAB.

Adult↗
PubMed1997

An analysis of time-dependence for Chernobyl fallout in Italy.

We present here an analysis of the airborne radioactivity measured in Italy after the Chernobyl accident. We provide some quality assurance, isolate suspicious data, and devise a mathematical model to aid in interpreting time-dependent fallout data. The model consists of an interpolating function whose parameters can be related to 1) the arrival time of the radioactive cloud; 2) the time of the maximum radioactive concentration; and 3) the decay-rate of airborne radioactivity as the pollutant cloud passes. Multiple arrivals of the radioactive cloud in a given site can also be considered. The parametrization can be used to estimate concentrations of 137Cs using measurements of (131)I, 103Ru, or 132Te. The interpolating function is fitted to the data collected in several Italian Provinces. We feel this model is an useful tool for interpreting time-dependent fallout data.

Cesium Radioisotopes↗
PubMed1997

Isolated agenesis of the gallbladder. An intraoperative problem.

Agenesis of the gallbladder and cystic duct is a rare congenital malformation. In 40-70% of cases this anomaly is associated with other gastrointestinal, skeletal, cardiovascular and genitourinary malformations. Lithiasis of the common bile duct is present in 25-50% of cases. In the majority of cases patients are asymptomatic or have symptoms compatible with a biliary disorder. A preoperative diagnosis is extremely difficult and the absence of the gallbladder is often an intraoperative finding. The authors report a case of isolated agenesis of the gallbladder. The relative embryology, development, diagnostic pitfalls, intraoperative behaviour and therapeutic strategies are discussed.

Adult↗
PubMed1996

Subacute stent thrombosis: evolving issues and current concepts.

During percutaneous coronary revascularization, intracoronary stents are effective in the treatment of abrupt vessel closure and improvement of suboptimal angioplasty results, and compared to balloon angioplasty, they reduce stenosis recurrence. Opposing these benefits, subacute thrombosis of stents is associated with a substantial increase in periprocedural morbidity and mortality. To review factors associated with stent thrombosis and to study the impact of evolving procedural techniques on the incidence of stent thrombosis, we reviewed all English articles from MEDLINE (1988 to 1995) with key words "stent" and "thrombosis." Stent registry data and recent abstracts from scientific meetings were also reviewed. Factors related to the clinical setting, the lesion, the stent and the procedural technique that affect the risk of stent thrombosis were identified. Sixty clinical studies were reviewed and include 7,914 patients receiving intracoronary stents. Studies were separated into those reporting stents placed emergently or electively without adjunct high-pressure balloon inflations, stents placed in saphenous vein graft conduits, and stents placed with high-pressure balloon inflations but without subsequent oral anticoagulants. Overall, subacute thrombosis was substantially higher in stents placed emergently (10.1%) compared to those placed electively (4.3%). Among contemporary trials employing high-pressure balloon inflations, the rate of stent thrombosis appears markedly lower (1.3%) despite reduced postprocedural anticoagulation. Taken together, these studies suggest factors associated with a heightened risk of stent thrombosis, many of which can be avoided with proper case selection and contemporary techniques.

Coronary Artery Bypass↗
PubMed1996

Modelling the Chernobyl radioactive fallout (I): A fractal approach in northern Italy.

This paper deals with the 137Cs airborne radioactive concentration measured in Northern Italy after the Chernobyl accident. We devised a fractal model to aid in describing the space-time distribution of radioactivity. The model is based on the Fractal Sum of Pulses theory, involving additive stochastic processes. We use, as input source of information, the parametrization of the time trend of radioactive concentration in a few Italian Provinces we calculated in previous work. The results look promising, since realistic scenarios of environmental pollution are produced.

Air Pollutants, Radioactive↗