[The Siro-ISR registry: treatment of intra-stent restenosis with the sirolimus stent in the real world].
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
G Macaluso
Publications and source records attributed to G Macaluso.
[Acute myocardial infarction in myocardial bridge treated by coronary stent].
The authors report the case of a symptomatic myocardial bridge treated in the acute phase of anterior wall myocardial infarction by classical stenting of the mid and distal left anterior descending artery. One and a half months later, intrastent restenosis at the two dilated sites, led to another angioplasty procedure with implantation of sirolimus-eluding stents. The outcome was good with no recurrence of angina at 16 months and control coronary angiography was totally normal at the 8th month.
Coronary Vessel Anomalies↗
[Biochemical markers of myocardial damage after high-energy radiofrequency ablation of atrial flutter. Value of troponin I].
Creatinine phosphokinase and its MB iso-enzyme do not allow assessment of the degree of tissue necrosis after radiofrequency ablation. Cardiac Troponin I and myoglobin, new markers of myocardial lesions, are rarely used in this indication. The aim of this prospective study was to measure and compare serum markers of myocardial damage after high energy radiofrequency ablation of atrial flutter with an 8 mm distal electrode catheter. The authors measured serum cardiac Troponin I, myoglobin, creatinine phosphokinase and its MB iso-enzyme levels before and 4, 12 and 24 hours after radiofrequency ablation of common atrial flutter in 23 consecutive patients. The same markers were also measured in a control group of 9 patients undergoing electrophysiological investigation without radiofrequency ablation. All ablation procedures were simple with an average of 12.6 +/- 6 applications of radiofrequency. Bidirectional isthmic block was obtained in 22 of the 23 patients. The mean Troponin I levels were 0.01 microgram/l before ablation, 0.87 +/- 0.77 at the 4th hour (p < 0.001 versus control), 1.16 +/- 1.2 at the 12th hour (p < 0.001 versus control) and 0.7 +/- 0.63 microgram/l at the 24th hour (p < 001 versus control) after ablation. Only 13% of patients had cardiac troponin levels greater than the threshold of significant myocardial damage (> 2 micrograms/l) with a higher average number of radiofrequency applications than the rest of the group: 15.2 +/- 1 versus 11.5 +/- 5.1 (p < 0.05). An abnormally high level of markers was found in the ablation group for 19 patients (84%) with Troponin I (> 0.4 microgram/l), for 10 patients (43%) with the MB iso-enzyme (> 8 Ul/L), and for 1 patient (4%) with myoglobin (> 90 micrograms/l), and in no patient for creatinine phosphokinase (> 290 IU/L). All values were normal in the control group. The authors conclude that cardiac Troponin I is the most sensitive marker for myocardial cellular damage after high energy radiofrequency ablation of atrial flutter. The level of cardiac Troponin I seems to correlate with the number of applications of radiofrequency.
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On the synthesis and reactivity of the Z-2,4-dinitrophenylhydrazone of 5-amino-3-benzoyl-1,2,4-oxadiazole.
The synthesis of the title compound (4b) has been completed: its rearrangement (in dioxane/water; 1:1, v/v) into N-(2,4-dinitrophenyl)-5-phenyl-2H-1,2,3-triazol-4-ylurea (7) has been quantitatively studied in a wide reactivity (at 293 K, k(A) 10(-8) -4 s(-1)) and pS+ (4.5-14.1) range and compared with that of the Z-2,4-dinitrophenylhydrazone of 3-benzoyl-5-phenyl-1,2,4-oxadiazole (10), of the 3-(p-nitro)phenylureine of 5-phenyl-1,2,4-oxadiazole (13), and of N-(5-phenyl-1,2,4-oxadiazol-3-yl)-N'-p-nitrophenylformamidine (14). The results (reactivity, occurrence of specific or general base-catalysis, evidence for or absence of rate-limiting constants) have been well interpreted considering the structure of the side-chains involved and the stability of the final rings obtained in the rearrangements.
Journal Article↗
[Antithrombotic treatment protocols in interventional cardiology].
The use of coronary stents has become routine in interventional cardiology, for which anti-platelet drugs are part of the daily antithrombotic routine. The association of ticlopidine and aspirin may be replaced definitively by that of clopidogrel and aspirin. A rapid biological test of the efficacy of these thienopyridines would allow identification of possible drug resistance. The anti-GP IIb/IIIa agents with an immediate onset of action are also widely used in the acute phase of MI and in acute coronary syndromes without ST elevation when the troponin levels could enable selection of high risk patients more likely to benefit from an aggressive antithrombotic strategy. Finally, the superiority of enoxaparin over unfractionated heparin must be emphasised in these same acute coronary syndromes.
Aspirin↗
Unprotected left main coronary artery stenting: immediate and medium-term outcomes of 140 elective procedures.
OBJECTIVES: We sought to evaluate immediate and late outcomes after stenting for left main coronary artery (LMCA) stenosis. BACKGROUND: Conventional percutaneous transluminal coronary angioplasty (PTCA), for which coronary artery bypass grafting (CABG) has been the gold standard therapy for years, has yielded poor results in unprotected LMCA lesions. The development of coronary stents, together with their dramatic patency improvement provided by new antiplatelet regimens and their validation against restenosis, warrants a reappraisal of angioplasty in LMCA stenosis. METHODS: From January 1993 to September 1998, 140 consecutive unselected patients with unprotected LMCA stenosis underwent elective stenting. Group I included 47 high-CABG-risk patients, and group II included 93 low-CABG-risk patients. Ticlopidine without aspirin was routinely started at least 72 h before the procedure and continued for one month. Patients were reevaluated monthly. A follow-up angiography was requested after six months. RESULTS: The procedure success rate was 100%. One-month mortality was 9% (4/47) in group I and 0% in group II. A follow-up angiography was obtained in 82% of cases, and target lesion revascularization was required in 17.4%. One-year actuarial survival was 89% in the first 29 group I patients and 97.5% in the first 63 group II patients. CONCLUSIONS: Stenting of unprotected LMCA stenosis provided excellent immediate results, particularly in good CABG candidates. Medium-term results were good, with a restenosis rate of 23%, similar to that seen after stenting at other coronary sites. Stenting deserves to be considered a safe and effective alternative to CABG in institutions performing large numbers of PTCAs.
Adult↗
Long-term pacemaker dependency after radiofrequency ablation of the atrioventricular junction.
This prospective study was conducted to determine the percentage of patients with long-term pacemaker dependency after successful radiofrequency ablation of the atrioventricular junction. Abrupt inhibition of the pacemaker was performed 13.5 +/- 8.1 months after ablation in 59 patients. A > or =5-second asystole was considered to indicate pacemaker dependency. Pacemaker dependency was present in 18 patients. Absence of escape rhythm immediately after ablation was strongly associated with a higher incidence of long-term pacemaker dependency. The following variables were not associated with pacemaker dependency: age, presence of cardiac disease, presence of preablation bundle branch block, number of radiofrequency applications, a bilateral approach for ablation, and continuation of antiarrhythmic therapy after ablation. We concluded that (1) long-term pacemaker dependency is present in 30.5% of the patients after successful atrioventricular junction radiofrequency ablation and (2) absence of escape rhythm immediately after ablation predicts long-term pacemaker dependency.
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Clinical electrophysiologic effects of a single high oral dose of amiodarone.
Several recent reports have described the antiarrhythmic effects of a single high oral dose of amiodarone but clinical electrophysiologic effects have not been reported. The present study was performed to assess electrophysiologic effects in 12 patients. After baseline electrophysiologic studies (EPS) patients were administered a single oral dose of 30 mg/kg of amiodarone. EPS was repeated 7.5 +/- 0.5 hours later. Plasma levels of amiodarone and its metabolite desethylamiodarone were determined at the time of the second EPS, Holter monitoring was performed for 24 hours after amiodarone administration. Amiodarone significantly increased the following parameters: corrected QT interval (+4.5%), functional refractory period of the right atrium (+7%); AH interval (+12.3%), effective refractory period of the atrioventricular node (+18.5%), and cycle length of Wenckebach block (+8.4%). These effects were not correlated with plasma levels of amiodarone and desethylamiodarone. Holter monitoring detected no significant bradycardia or arrhythmia. These findings indicate that the effects of a single high oral dose of amiodarone are the same as those known to be induced by acute intravenous administration.
Administration, Oral↗
[Mid-term outcome of escape rhythm after radiofrequency ablation of the atrioventricular junction].
UNLABELLED: Mid-term outcome of the underlying escape rhythm developed after radiofrequency ablation of the atrio-ventricular junction was studied in 50 consecutive patients (28 women and 22 men with a mean age of 66.2 +/- 9.6 years). The escape rhythm was assessed immediately after ablation and after 13.7 +/- 8 months. At the end of ablation: an escape rhythm was present in 38 patients (76%), with a mean rate of 40.7 +/- 9.7 beats/min and a QRS morphology identical to the preablation QRS morphology in 22 patients (58%). At follow-up: an escape rhythm was present in 37 patients (74%), with a slower mean rate of 36.4 +/- 6.8 beats/min (p < 0.05) and an unchanged QRS morphology in 87.5% of the patients. Patients presenting with an escape rhythm at follow-up were more frequently found to have a postablation escape rhythm (p < 0.01). Escape rhythm presence at follow-up was not influenced by age, presence of a cardiac disease, continuation of an antiarrhythmic treatment after ablation, use of a bilateral approach for ablation or number of radiofrequency applications. CONCLUSION: after abrupt inhibition of the stimulation, an escape rhythm was present only in 74% of the patients 13.7 +/- 8 months after atrio-ventricular junction radiofrequency ablation. QRS morphology was identical to the preablation morphology in 57% of the patients.
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[Protection systems of dual-chamber pacemakers against atrial arrhythmia].
The incidence of atrial arrhythmias may be as high as 10% in patients paced in the DDD mode carrying the risk of tracking of rapid atrial rates leading to non-physiological rapid ventricular paced responses. The unquestioned benefits of DDD pacing in terms of mortality and morbidity has led to the conservation of this mode in such situations, but with various systems of protection. Initially, limitation of the maximum frequency and programming a long atrial refractory period were proposed, but these measures were contrary to the physiological vocation of DDD pacing. Similarly, DDI and DDIR pacing, which do not ensure synchronisation on spontaneous P waves, were suggested, but in some cases there was loss of atrio-ventricular synchronism in sinus rhythm. Therefore, the manufactures developed "fallback systems" allowing programming of physiological pacing in patients with paroxysmal atrial arrhythmias. The aims of these systems are: 1) to detect atrial arrhythmias; 2) to change the pacing mode when the arrhythmias is detected for ventricular pacing not synchronised on the P wave (VVIR or DDIR modes); 3) to revert to the initial mode of pacing when the arrhythmia is over. This paper describes the different specialised algorhythms currently available, with their advantages and draw-backs, their main indications and possible future developments.
Atrial Fibrillation↗
[Use of esophageal investigation in the mid-term outcome after radiofrequency ablation of intranodal reentrant tachycardia].
The aim of this prospective study was to assess the medium term results of radio-frequency ablation of intranodal tachycardias by transoesophageal stimulation and recordings. Transoesophageal stimulation was performed on average 9 months after ablation. The anterograde Wenckebach point, the presence of dual nodal conduction and inducibility of nodal tachycardias were determined under basal conditions and after isoproterenol. The follow-up period after ablation was 16.1 +/- 10.2 months. At the time of the oesophageal investigation 25 patients were asymptomatic and 5 had a recurrence of palpitations. The investigation was carried out without complications in all patients and lasted 34.8 +/- 14 minutes. The anterograde Wenckebach point was 340 +/- 78.2 ms and was unchanged compared with the value recorded by endocavitary left atrial stimulation before ablation (332 +/- 63.2 ms). Dual nodal conduction was observed in 19 patients. Nodal tachycardia was inducible in only 2 of the 5 patients with palpitations. Of the asymptomatic patients, 3 had inducible nodal tachycardias after isoproterenol. The authors conclude that oesophageal electrophysiological studies are a simple means of assessing the medium-term results of radiofrequency ablation of intranodal tachycardias. In those patients with a recurrence of symptoms but without documented arrhythmias, failure of radiofrequency ablation may be identified. In addition, the possibility of inducing nodal tachycardias in asymptomatic patients may be detected.
Adult↗
[The current role of surgery in renal calculi].
We report our experience on 63 patients submitted to kidney stone surgery, between january '88 and june '94, at the Division of Urology, in Parma (Italy). Nowadays percutaneous lithotripsy (PCNL) and extracorporeal shock wave lithotripsy (ESWL) permit the resolution of lithiasic disease in more than 90% of the cases; in fact, the incidence of open surgery in only about 1-12%. At the present, the role of traditional surgery is also directed to resolution of damages of endourological and extracorporeal failures, as post-traumatic events. We want to emphasize, as now, that essential surgical approach to kidney surgery is lacking in the aim of young urologists training.
Contraindications↗
[Bipolar transseptal radiofrequency ablation of posteroseptal bundle of Kent. Apropos of a case].
The posteroseptal localisation of accessory pathways is sometimes responsible for important difficulties for radiofrequency current endocavitary ablation. Some authors have reported the exceptionally rare use of the transseptal bipolar mode for ablation of this type of accessory pathway. The authors report the case of a patient in whom failure of unipolar radiofrequency ablation at the tricuspid and then mitral annulus was followed by immediate success when the bipolar mode was used. The value of recording with the transseptal dipole at the ablation site is emphasised.
Adult↗
[Acute pericarditis in Coxiella burnetti infection. Apropos of a case].
The authors report a case of pleuro-pericarditis during an acute Coxiella burnetii infection. They point out the rarity of this mode of presentation of acute Q fever and the diagnostic difficulties in the absence of focal pulmonary or hepatic signs. The diagnosis was confirmed by serological changes, essentially indirect immunofluorescence. They underline the importance of early diagnosis before the disease become chronic, exposing the patient to more serious cardiac disease which may be difficult to treat.
Acute Disease↗
[Calyceal diverticula: notes on endourological technique].
Percutaneous approach to complicated small caliceal diverticula is the first choice therapy. Generally, the open surgery is used large diverticula with renal parenchymal damage but, in selected cases, a percutaneous (PCN) treatment may be an effective alternative. The Authors report a case of inferior caliceal diverticulum associated to a parenchymal damage successfully treated using directed PCN management (electrical fulguration) and consequent injection of human fibrin glue.
Diverticulum↗
[Neoadjuvant chemotherapy in advanced-stage bladder carcinoma. A randomized prospective study comparing MVAC and MVEEC].
The Authors report the results with combination of cisplatin, methotrexate, vinblastine with adriamycin or epidoxorubicin (MVAC v MVEEC), in the neoadjuvant treatment of muscle-infiltrating bladder cancer (T2-4NO-1MO), before cystectomy. MVAC has been used in 29 patients and MVEEC in 25, who met eligibility criteria. Results from this prospective randomised trial show that MVAC and MVEEC can produce clinical and pathologic down-staging in 40-50% of cases: cCR+cPR are 15/28 (54%), pCR+pPR are 11/25 (44%). The survival duration of "pathologic" responders has been significantly longer than that of no responders (median no achieved at 200 weeks v 124 weeks for "pathologic" no responders). We conclude that neoadjuvant chemotherapy with MVAC or MVEEC select the more responsive patients, who have a longer survival.
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[Radiofrequency treatment of permanent tachycardia caused by reciprocating rhythm].
Permanent tachycardia by reciprocal rhythm is an arrhythmia due to macro-reentry using the normal conduction pathways in anterograde direction and an accessory atrioventricular pathway, most often posteroseptal, in retrograde direction. It is sometimes worrying because of its chronicity and the deterioration in left ventricular function with which it may be associated. A case is reported of permanent tachycardia by reciprocating rhythm treated by radiofrequency. The diagnostic value, already shown by other authors, of stimulation of the upper part of the interventricular septum to confirm the participation of an accessory atrioventricular pathway in the tachycardia circuit is mentioned, and the need for extensive mapping, because of the recent description of non-postero-septal accessory pathways, is stressed.
Electrocardiography↗
Actions of two novel prostaglandin analogs, SC-29169 and SC-31391, on guinea pig and human isolated urinary bladder.
1. We examined the effects of two novel PGE1 analogs, SC-29169 and SC-31391, on bladder muscle isolated preparations from guinea pig and man, in comparison with some naturally-occurring prostanoids and misoprostol. 2. In the guinea pig detrusor muscle, both prostaglandin analogs enhanced twitch responses elicited by field stimulation in the following order of potency: SC-31391 greater than SC-29169 greater than PGF2 alpha greater than or equal to PGE2, while a well-defined contractile effect was elicited only by SC-31391. 3. In the human detrusor muscle, nerve-mediated responses were not modified by prostaglandin analogs, as well as by PGF2 alpha or PGE2, while a contractile effect was observed with the same compounds: PGF2 alpha = SC-31391 greater than SC-29169 = PGE2 = PGE1. 4. The selective EP1-agonist, misoprostol did not induce any effect, in both guinea pig and human bladder. 5. These data suggest that the effect of prostaglandins in the bladder muscle differs according to the animal species and that, in the human detrusor muscle, SC-31391 and SC-29169 probably stimulate FP receptors.
Adult↗