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Biomedical subjects

G Giuffrida

Publications and source records attributed to G Giuffrida.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Safety, feasibility and efficacy of a new single-wire stent in the treatment of complex coronary lesions: the angiostent].

The angiostent is a single wire, flexible, highly radiopaque, balloon expandable stent. To evaluate the feasibility and safety of the deployment of this new stent, we report the clinical and procedural results of 70 procedures performed in 51 native coronary arteries of 48 patients, with objective evidence of ischemia. The target lesion was located in the left anterior descending artery in 18 (36%) cases, in the circumflex artery in 16 (31%) cases and in the right coronary artery in 17 (33%) cases. Mean reference vessel diameter was 3.2 +/- 0.4 mm and the minimal luminal diameter was 0.4 +/- 0.3 mm, with a mean diameter stenosis of 86 +/- 10%. Type B2 and C lesions were encountered in 56% of the cases. More than one angiostent was implanted in 14 vessels and multiple stenting was accomplished with the use of different stents in 8 coronary arteries. No major complications were reported. The post-procedural minimal luminal diameter was 3.2 +/- 0.4 mm with a mean diameter stenosis of 1.4 +/- 3.7%. In 25 cases (49%) major side branches raised from the stented segment and in all but one remained patent. In conclusion, the implantation of the angiostent is safe, feasible and effective, as it can be easily deployed at the lesion site, used for the treatment of complex lesions and preserves the patency of jailed side-branches.

Anticoagulants↗
PubMed1998

[Endothelin-1 variation in the coronary circulation during angioplasty with a stent implant].

Endothelin-1 (ET-1) is an endothelium-derived mediator with vasoconstrictive and mitogenic activity which stimulates vascular smooth muscle cell proliferation. The aim of this study was to evaluate ET-1 production during percutaneous transluminal coronary angioplasty (PTCA) and elective stent implantation. We hypothesized that the additional vessel wall trauma induced by stent deployment might be associated with a greater production of ET-1. To this end, ET-1 levels were measured in 18 patients undergoing PTCA and stenting (12 with left anterior descending coronary artery stenosis and 6 with circumflex artery lesion). The sampling sites were the coronary ostium and coronary sinus in basal conditions (before the procedure), during first balloon inflation, and 5, 20, 60 min after the end of first balloon inflation. At baseline, ET-1 levels were higher in the coronary sinus than in coronary ostium (1.58 +/- 0.22 vs 1.29 +/- 0.20 pg/ml, p < 0.001). During first balloon inflation, ET-1 coronary sinus levels significantly diminished with respect to the basal levels (1.08 +/- 0.32 vs 1.58 +/- 0.22 pg/ml, p < 0.001). Further significant variations of ET-1 levels were not detected neither following the first balloon inflation nor after stent deployment. In conclusion, the culprit lesion seems to produce most of ET-1 circulating in the coronary tree. This is demonstrated by higher ET-1 levels in the coronary sinus compared to coronary ostium at baseline, and even more by the significant ET-1 reduction in the coronary sinus during first balloon inflation. Despite our expectations, we did not detect any significant ET-1 increase during stent deployment.

Aged↗
PubMed1998

[Dynamic obstruction to left ventricular outflow during dobutamine stress echocardiography: the probable mechanisms and clinical implications].

We observed the development of left ventricular outflow tract dynamic obstruction in some patients during dobutamine stress echocardiography. The purpose of this study was to identify the possible mechanisms and to consider the clinical implications. From 11/04/94 to 01/09/97 we studied 547 patients; 42 patients developed dynamic obstruction, defined as a late peak Doppler velocity profile that exceeded baseline outflow velocity by at least 1 m/s. The encountered mechanisms were: increased myocardial contractility; systolic anterior motion of the mitral valve; decreased venous return to the left ventricle, and peculiar characteristics of the left ventricular geometry. The results of this study show that the dynamic obstruction is mainly due to the first mechanism and secondarily to some characteristics of the left ventricular geometry. The hypotension observed in a few cases is not related to the dynamic obstruction but to beta 2 receptor hypersensibility to dobutamine. The symptoms, like dyspnea and chest pain, experienced by these patients are related to the dynamic obstruction rather than to the presence of coronary artery disease. In conclusion, we think that patients who develop dynamic obstruction, without wall motion abnormalities, during dobutamine stress echocardiography, may behave pathophysiologically as patients with obstructive hypertrophic cardiomyopathy, in whom diastolic dysfunction and outflow tract obstruction are responsible for symptoms. Therefore, these patients require a pharmacological treatment with beta blockers and/or non-dihydropyridine calcium channel blockers.

Aged↗
PubMed1997

An open multicenter study to compare the efficacy of intraperitoneal insemination and intrauterine insemination following multiple follicular development as treatment for unexplained infertility.

PURPOSE: This multicenter study was carried out to compare the efficacy of intrauterine insemination (IUI) and intraperitoneal insemination (IPI) associated with multiple follicular development as treatment for unexplained infertility. METHOD: A total of 205 couples completed the trial. Sixty-seven couples underwent treatment with IPI (group A) and 138 couples underwent treatment with IUI (group B). RESULTS: Clinical pregnancy was obtained in 23 couples in group A (pregnancy rate: 34.3%) and in 36 couples in group B (pregnancy rate: 26.1%). No significant difference was observed between group A and group B. As for the evolution of pregnancies and the incidence of twin pregnancies, no significant difference was observed between the two groups. CONCLUSIONS: Because IUI and IPI allow us to obtain same results and IPI is more invasive than IUI, the latter technique can be considered the method of choice and IPI should be used when IUI is difficult to perform, as in the presence of a tight cervical canal.

Adult↗
PubMed1997

[Significance of hypotension and vasovagal reflex during echo-stress using high doses of dobutamine].

Coronary artery disease (CAD) is one of the main causes of cardiovascular morbility and mortality. Actual research lines are directed towards the discovery of silent CAD before hard events as myocardial infarction and sudden death. Dobutamine stress echocardiography is an useful method to assess patients with suspected CAD who, are not able to stand an effort because of physical reasons. During the test, hypotension and/or bradycardia may occur and may cause interruption of the test. The aim of our study was to consider prevalence, meaning and clinical implications of hypotensive, sometimes associated to bradycardia, during dobutamine stress echocardiography. From April 1994 to June 1996, 363 consecutive patients (267 men and 96 women with an average age of 59.3 +/- 10 year) were examined because of suspected or known ischemic cardiopathy. All patients underwent dobutamine stress echocardiography and coronary arteriography. Neither hypotension nor bradycardia was noted in 285 of our patients (78.51%), while in the remaining 78 patients (21.48%) there was a pressure drop > or = 20 mmHg; bradycardia appeared in 6 patients. The study shows that it does not exist a statistically significant difference between the percentage of the patients with CAD of the control group and those of the hypotensive group (91.9 vs 83.3%, NS). As for the changes in well motion score index, there was not a statistically significant difference between patients improved score index in the control group and in the hypotensive group (80 vs 74.3%, NS). The 6 patients with hypotension and bradycardia had normal coronary arteries. In the light of these results hypotension, alone or associated with bradycardia, should not be considered as a negative prognostic factor and should not induce to the interruption of the dobutamine stress echocardiography.

Aged↗
PubMed1997

[Stress echocardiography with dobutamine in the identification of coronary disease in patients with left bundle branch block].

Left bundle branch block does not permit an easy diagnosis of coronary heart disease (CAD) with provocative non-invasive test such as bicycle or treadmill stress test. Echocardiography allows the identification of segmental wall motion by evaluating the movement as well the thickness of the segment examined. Due to its agonist action on beta 1 receptors, dobutamine causes an increase in myocardial oxygen consumption and, as a consequence, may reveal myocardial ischemia; on this basis, we evaluated the sensibility, specificity and diagnostic accuracy of dobutamine stress-echo in identifying CAD in patients with left bundle branch block, and compared results with those obtained from coronary catheterization. From February 1994 to September 1995 we observed 25 patients with left bundle branch block (17 men, 8 women, mean age 61.8 +/- 8.4 years, range 43.75), affected or suspected for CAD. All patients underwent dobutamine stress-echo test and coronary arteriography. We divided patients into two groups: the first one (11 patients) with acute myocardial infarction, the second one (14 patients) without previous ischemic episodes. Diagnostic accuracy, specificity and sensibility of the stress-echo test were evaluated in order to identify significant stenosis of the left anterior descending (LAD), right coronary (RCA), and/or circumflex artery (CA). Dobutamine stress echocardiography showed in all patients, from basal to peak, an increase in blood pressure (from 121.2 +/- 17.4 to 141.8 +/- 23.6 mmHg), heart rate (from 81.3 +/- 10.9 to 140.7 +/- 8.9 b/min), and double product (from 9861.1 +/- 1898.1 to 19976.6 +/- 3603.6). In 8 (32%) patients who had typical chest pain, 7 had CAD. In 17 (68%) patients without chest pain, 5 had CAD and 12 had normal coronary arteries. Dobutamine stress echocardiography showed segmental wall motion variations only in 13 patients; 12 of them had a significant stenosis of coronary artery relative to the ischemic area, the other 1 was a false positive. Coronary arteriography showed stenosis of LAD in 10 and of RCA and/or CA in 12 patients, in both groups dobutamine stress-echo test had 1 false negative. Dobutamine stress echocardiography showed high diagnostic value as a provocative non-invasive test for CAD in patients with left bundle branch block. In conclusion, or study shows that no statistical difference exists in identifying ischemia in identifying ischemia in the LAD territory compared to RCA and/or CA. Further investigations are need to confirm the higher diagnostic accuracy in patients with left bundle branch block and to establish whether lower specificity in patients with a previous myocardial infarction is due to the smaller number of patients or to methodology.

Adrenergic beta-Agonists↗
PubMed1997

[Three dimensional reconstruction in intracoronary echography: a new system with automatic contour definition of ecg-gated image acquisition].

The use of a new automated contour-detection system (CD) allows rapid quantification of the dimensions of coronary lumen and plaque in an entire three-dimensional set of intracoronary images (ICUS), obtained during an ECG-gated pull-back image acquisition. The aim of the study was to evaluate the reproducibility, feasibility and accuracy of this approach in the clinical setting. We examined 32 coronary stents implanted in 28 patients, mean age 59 +/- 16 years. The ICUS images were acquired during a motorized uniform-speed pull-back (0.5 mm/s) of the ultrasound catheter after angiographically guided stent optimization, recorded on videotape, and analyzed during a conventional two-dimensional ICUS examination. An ECG-gated pull-back was then performed and analyzed by a second operator using CD. The minimal lumen area and diameter of the stent and the lumen area of the reference segments were measured. Comparing the analysis on- and off-line, correlation coefficients (r) not less than 0.96, with a mean difference not higher than 0.3 +/- 1.5 were found. On the other side, the comparison between the two-dimensional analysis and the analysis performed on-line showed a good correlation between the two methods. The two-dimensional method revealed a systematic overestimation (delta = -1.3 +/- 2.3) of the area and diameter. The time required for the on-line three-dimensional analysis was 9 +/- 3 min, whereas the off-line analysis was performed within 35 +/- 10 min. Focal segments of stent underexpansion were seen in 4 cases by two-dimensional ICUS and in 3 more cases by three-dimensional ICUS, analyzed on- and off-line. In order to evaluate the reproducibility of the system, we examined ICUS images after an ECG-gated pull-back of 23 segments of coronary arteries in 20 patients. The intra and interobserver variability was evaluated. The mean relative difference between the area and volume measurements of intra and interobserver variability ranged from 0.14 to 1.51%, with a standard deviation not higher than +/- 7.17, a standard error of estimate not higher than +/- 4.85 and a correlation coefficient (r) not less than 0.98. Thus, the "contour detection" in ECG-gated three-dimensional ICUS is highly reproducible, suggesting the use of the system in studies of progression-regression of atherosclerosis. It is feasible for the on-line application as it can be performed rapidly and shows good agreement with measurements obtained by off-line CD.

Aged↗
PubMed1996

Clinical and hormonal effects of gonadotropin-releasing hormone agonist plus an oral contraceptive in severely hirsute patients with polycystic ovary disease.

OBJECTIVE: To evaluate the therapeutic effects of a GnRH agonist (GnRH-a), leuprolide acetate (LA) plus a pill containing ethinyl E2 plus cyproterone acetate (CPA) in a group of women with severe hirsutism who were unresponsive to oral contraceptive (OC) therapy. DESIGN: Twenty-four patients suffering from severe hirsutism secondary to polycystic ovary disease (PCOD) were treated for 12 months with 3.75 mg IM LA every 28 days in association with 0.035 mg/d ethinyl E2 plus 2 mg/d CPA (Diane; Schering, Berlin, Germany) for 21 d/mo. SETTING: Patients were recruited in the Institute of Obstetrics and Gynecology, St. Bambino Hospital, University of Catania, Catania, Italy. Hormonal assays were performed in the Hormone Laboratories of St. Bambino Hospital, University of Catania, Catania, Italy. MAIN OUTCOME MEASURES: Every 3 months the hirsutism score was evaluated. Mean serum concentrations of LH, FSH, E2, total and free T, androstenedione (A), sex hormone-binding globulin (SHBG), and DHEAS were determined. Every 6 months a vaginal ultrasound examination was performed. RESULTS: In all patients after 6 and 12 months of treatment with LA plus OC, the hirsutism score improved significantly. Serum levels of LH, FSH, E2, total and free T, A, and DHEAS decreased significantly, whereas SHBG showed a marked increase. A significant reduction in the ovarian size was observed. CONCLUSION: Gonadotropin-releasing hormone agonist, associated with a pill containing CPA, reduced the hirsutism in severely affected women with PCOD who are unresponsive to OC treatment alone.

Adult↗
PubMed1996

[Percutaneous mitral valvuloplasty in patients who have undergone surgical commissurotomy].

Percutaneous mitral valvuloplasty (PMV) was performed with Inoue's catheter, by anterograde approach, in 19 patients (2 males and 17 females, mean age of 56 +/- 13 years) with restenosis after surgical commissurotomy. Mean valvular area increased from 1.2 +/- 0.2 to 1.9 +/- 0.2 cm2 while mean transvalvular gradient decreased from 13 +/- 6 to 7 +/- 4 mmHg. All but 2 patients reached optimal results; one had a suboptimal result (final valvular area > 1.5 cm2, percentage of increase less than 25%), and 1 was sent to the surgeon for a significant increase in mitral regurgitation ( ). At 1 year follow-up, (available for 11 patients), mean valvular area was 1.7 +/- 0.3 cm2 and transmitral gradient was of 5.4 +/- 2 mmHg. Four patients showed a restenosis; 1 of them underwent surgical mitral valve replacement after a second unsuccessful PMV; 2 showed good clinical conditions, while the fourth patient was sent to the surgeon for the high echocardiographic score. At 2-year follow-up, available for 4 patients, the mean gradient was of 5.5 +/- 2.5 mmHg and the mitral valve area was 1.8 +/- 0.2 cm2. NYHA functional class progressively improved after the procedure in all patients but those undergoing mitral valve replacement. In conclusion, despite the occurrence of restenosis, PMV seems to be feasible in patients who already underwent surgical commissurotomy; this procedure can avoid the risks of a second surgery, and should be considered the first choice treatment in these patients.

Adult↗
PubMed1996

[The immediate and midterm results of percutaneous mitral valvuloplasty in subjects over 60].

We have analyzed the immediate and mid-term (1 and 2 years) results of percutaneous mitral valvuloplasty (PMV) by Inoue's catheter in 97 patients < 60 years (Group A) compared with 34 patients > 60 years (Group B). In 61% Group A the patients were in NYHA functional class II, 36% in III, and 3% in I; in Group B, 56% of the patients were in NYHA functional class III, 38% in II, and 6% in IV. Mean mitral valve area was 1.1 cm2 before dilatation in both groups, and a significant (p < 0.0001) increase was obtained in both Group A (0.9 +/- 0.3 cm2) and Group B (0.8 +/- 0.3 cm2). No significant differences were observed between the two groups. Mean transvalvular gradient decreased significantly (p < 0.0001) from 13.6 +/- 5.7 to 7.2 +/- 3.1 mmHg in Group A, and from 9.9 +/- 4 to 6.5 +/- 2.3 mmHg in Group B (A vs B: p < 0.02). Optimal result was obtained in 94% and 88% of Group A and Group B patients, respectively. Suboptimal result was obtained in 2% and 6% of Group A and Group B patients, respectively. These differences were not significant. Failure of PMV occurred in 4% and 6%, respectively. At 1-year follow-up Group A 7 patients and 5 Group B patients showed restenosis; at 2-year follow-up one more restenosis was present in Group A (A vs B at 1 and 2 years: NS). We conclude that PMV is a safe and effective technique in young patients and in patients > 60 years.

Adult↗
PubMed1996

[Single-center experience with the Palmaz-Schatz intracoronary stent: the immediate results and medium- and long-term follow-up].

The recent implantation of intravascular devices (stents), during percutaneous transluminal coronary angioplasty (PTCA), has shown favourable results, decreasing acute occlusion and restenosis during follow-up as compared to PTCA alone. The aim of the study was to assess in a single center the efficacy of the implantation of a Palmaz-Schatz stent in a homogeneous group of patients and to assess the incidence of angiographic restenosis. Fifty-four consecutive patients (mean age 57 +/- 12 years) with single vessel coronary disease at angiography and with objective evidence of myocardial ischemia were studied. According to the duration of angiographic follow-up, patients were divided into two groups: Group I (mean 6 +/- 3 months) and Group II (mean 29 +/- 5 months). Stent implantation was performed electively in 43 patients (80%) while in the remaining 11 (20%) as "bail out" in a failed PTCA. Sixty-five stents were implanted in 54 patients of whom 1 stent in 47 patients (87%), 2 stents in 3 patients (6%) and 3 stents in the remaining 4 patients (7%). The stents were placed in the anterior descending of the left coronary artery in 32 patients (59%), left circumflex coronary artery in 8 patients (15%) and right coronary artery in 14 patients (26%). Mean diameter stenosis before stent implantation was 88 +/- 6% and decreased significantly to 4 +/- 7% after stent implantation (p < 0.0001). No major complications such as death, Q wave myocardial infarction, emergency coronary artery bypass graft or stroke occurred during the procedure. Minor complications such as wrong positioning of the stent, non occlusive acute thrombosis, non Q wave myocardial infarction and transient vessel occlusion occurred in 9% of treated patients. At follow-up, in Group I, 8 patient of 43 (18%) showed a > or = 50% restenosis and 10 patients < 50% restenosis; in the remaining 25 patients no variations in the caliber of the vessel were observed. In Group II, 2 patients of 11 (18%) showed a > or = 50% restenosis and 1 patient < 50% restenosis; in the remaining 8 patients no variations in the caliber of the vessel were observed. Complications during medium and long-term follow-up included total vessel occlusion in 1 patient. In conclusion, these data confirm that the Palmaz-Schatz stent may be implanted with high success and low complication rate. The percentage of restenosis, occurring in near 20% of the cases, remains an unresolved problem, despite the implantation of such intravascular devices.

Adult↗
PubMed1995

[Diagnostic accuracy of transesophageal echocardiography in the diagnosis of aortic dissection: comparison with computerized axial tomography].

This study was designed to assess the sensibility, specificity and diagnostic accuracy of transesophageal echocardiography (TEE) and X-ray contrast enhanced computed tomography (CT) in the diagnosis of aortic dissection and its complications. Fifty patients with clinically suspected aortic dissection were examined. Imaging results were validated in each case by intraoperative and/or autopsy findings and/or the results of cineangiography. The Stanford and DeBakey classifications were used to differentiate the dissection type; the patients were also subdivided by TEE according to a modified DeBakey classification. The sensibility of TEE to detect aortic dissection was 100%, significantly higher (p < 0.05) than that of CT for type A dissections (77.2%). The two imaging procedures did not statistically differ (NS) in the detection of type B dissection (CT sensibility 87.5%). The specificity of TEE for the detection of type A aortic dissection was 94%; it was not significantly higher (NS) than that of CT (CT specificity 86.6%). Both TEE and CT had no false negative findings in the diagnosis of type B aortic dissection (100%; TEE vs CT, NS). TEE was reliable in the correct identification of the primary entry site in the ascending aorta (80%), the arch (62.5%) and descending aorta (71.4%), and also in the involvement of coronary arteries (62.5%), and aortic arch branch vessels (71.4%); CT scanning was not effective in detecting any of these complications. Aortic regurgitation was accurately identified by TEE in each case. Both TEE and CT scanning correctly identified thrombosis of the false lumen and pericardial effusion. Intraoperative TEE documented in all patients postrepair persistence of the intimal flap in aortic segments that were not operated; flow in the false lumen was detected in 46.6% of the patients; in 26.6% of them secondary tears, not seen before surgical treatment, were detected. In conclusion, TEE allows a bedside, safe and accurate diagnosis and classification of aortic dissection. It also provides the diagnostic information necessary for the therapeutical decision making. Intraoperative TEE allows improvement in preoperatory diagnosis and gives important information for the management of the patient immediately after cardiopulmonary bypass and in the follow-up.

Adult↗
PubMed1995

[Value of intraoperative transesophageal echocardiography during repair of thoracic aorta dissection].

The study was designed to assess the diagnostic accuracy and usefulness of intraoperative transesophageal echocardiography (TEE) during repair of aortic dissection. To this end, 32 patients with ascending aortic dissection, undergoing replacement of the ascending aorta, were examined. The diagnosis was validated in each case by intraoperative and/or autopsy findings. The accuracy of TEE was studied in three different periods of surgical operation: before cardiopulmonary bypass (TEE pre-CPB), during CPB (TEE-CPB) and after CPB (TEE post-CPB). In comparison with TEE performed in the intensive care unit 70 +/- 40 min before surgery, TEE pre-CPB showed a higher diagnostic accuracy (100 vs 96%) in classification of the dissection type, a higher sensibility in the identification of intimal tears (83 vs 75%), involvement of the coronary arteries (71 vs 62%) and of aortic arch branches (81 vs 71%); there was no statistically significant difference in the detection of the aortic valve involvement (100 vs 100%). TEE-CPB showed normal perfusion of the true lumen in all but one patient, in whom TEE-CPB showed retrograde perfusion of the false lumen, promptly resolved by fenestration of the false lumen. TEE post-CPB showed persistence of the intimal flap in non repaired segments in all the patients with type I aortic dissection: in 60% of them there was no communication between the true and false lumen; in 40% of them there was a communication between the two lumina, which was proximal in 25% and distal in 15%; all patients did not show thrombosis of the false lumen. TEE post-CPB allowed also the evaluation of flow in left aortic arch branch vessels in 77% of the patients and in the coronary arteries in 70%, and showed well functioning prosthesis in all patients. In each case aortic regurgitation was mild; however, one case had severe insufficiency which was corrected at the time of surgery with annuloplasty. Ejection fraction was normal in 45% of the patients, whereas it was decreased in the remaining patients. Intraoperative TEE during repair of aortic dissection is accurate and useful: it allows improvement in preoperative diagnosis just before CPB, optimizing surgical technique; it gives also important information for the management of patients immediately after CPB and for the follow-up.

Adult↗