Biomedical subjects

Nicola Gandolfo

Publications and source records attributed to Nicola Gandolfo.

5 recordsLinked to original sources

PubMed2002

Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation.

OBJECTIVES: This study evaluated the role of various clinical and echocardiographic parameters, including the left atrial appendage (LAA) anterograde flow velocity, for prediction of the long-term preservation of sinus rhythm (SR) in patients with successful cardioversion (CV) of nonvalvular atrial fibrillation (AF). BACKGROUND: Echocardiographic parameters for assessing long-term SR maintenance after successful CV of nonvalvular AF are not accurately defined. METHODS: Clinical, transthoracic echocardiographic and transesophageal echocardiographic (TEE) data--measured in AF lasting >48 h--of 186 consecutive patients (116 men, mean age: 65 +/- 9 years) with successful CV (electrical or pharmacologic) were analyzed for assessment of one-year maintenance of SR. RESULTS: At one-year follow-up, 91 of 186 (49%) patients who underwent successful CV continued to have SR. Mean LAA peak emptying flow velocity was higher in patients remaining in SR for one year than in those with AF relapse (41.7 +/- 20.2 cm/s vs. 27.7 +/- 17.0 cm/s; p < 0.001). On multivariate logistic regression analysis, only the mean LAA peak emptying velocity >40 cm/s (p = 0.0001; chi(2): 23.9, odds ratio [OR] = 5.2, confidence interval [CI] 95% = 2.7 to 10.1) and the use of preventive antiarrhythmic drug treatment (p = 0.0398; chi(2): 4.2; OR = 2.0, CI 95% = 1.0 to 3.8) predicted the continuous preservation of SR during one year, outperforming other univariate predictors such as absence of left atrial spontaneous echocardiographic contrast during TEE, the left atrial parasternal diameter <44 mm, left ventricular ejection fraction >46% and AF duration <1 week before CV. The negative and positive predictive values of the mean LAA peak emptying velocity >40 cm/s for assessing preservation of SR were 66% (CI 95% = 56.9 to 74.2) and 73% (CI 95% = 62.4 to 83.3), respectively. CONCLUSIONS: In TEE-guided management of nonvalvular AF, high LAA flow velocity identifies patients with greater likelihood to remain in SR for one year after successful CV. Low LAA velocity is of limited value in identifying patients who will relapse into AF.

Aged↗

PubMedDate not supplied

Radiofrequency-assisted liver resection.

Radiofrequency (RF)-assisted thermal ablation has been used with increasing frequency for unresectable hepatic tumors. This new approach employs RF energy to coagulate the liver at the hepatic resection line after which hepatic resection is performed with the use of a common scalpel. This procedure was used in three patients with hepatocellular carcinoma and in five patients with colorectal metastasis to the liver. These eight patients underwent a total of two left bisegmentectomies, three segmentectomies, and seven wedge resections. Mean operative time was 220 minutes. A mean of 78 sessions of RF-assisted ablation were required for these resections. Mean blood loss was 46 ml; no device other than RF ablation was required to obtain hemostasis. None of the patients needed a blood transfusion. Preoperative hemoglobin was 12.8 gm/dl and postoperative hemoglobin was 11.3 gm/dl. There were no perioperative deaths. Postoperative complications occurred in two patients: a liver abscess in one and heart failure in the other. The mean hospital stay was 9.4 days. This new approach, integrated with other techniques, reduces blood loss and coagulates the margins of resection during liver surgery. This new technique has two limitations: (1) it cannot be applied near main portal pedicles, and (2) it requires a long operative time. The best indication for this technique is when segmentectomy is required in patients with cirrhosis. Its role in major hepatic resections has yet to be determined. Further progress in the development of thermal ablation techniques and experience gained during the learning curve should help reduce the operative time, thereby improving the safety and efficacy of this procedure.

Aged↗

PubMedDate not supplied

Use of the sonographic contrast medium in the study of pelvic masses: preliminary remarks.

PURPOSE: To evaluate the role of intravenously injected sonographic contrast medium (CM) in characterising space-occupying pelvic lesions. MATERIALS AND METHODS: Forty-seven women with palpable pelvic mass underwent color Doppler US before and after the intravenous injection of an ultrasound CM. The examination results were divided into three categories: Class I = no additional diagnostic information supplied by the contrast-enhanced examination; Class II = the use of CM facilitated the identification of vascular structures but did not significantly affect the diagnosis or the patient's subsequent diagnostic/therapeutic procedures; Class III = the information obtained significantly affected treatment decisions regarding the single patients. RESULTS: After the CM injection, 9/47 (19.1%) cases were assigned to Class I, 25/47 (53.2%) to Class II, and 13/47 (27.7%) to Class III. At baseline, all 13 lesions later assigned to Class III had shown an avascular appearance or only peripheral vascularisation. This type of vascular distribution was confirmed by the contrast-enhanced study, which helped determine the haemorrhagic nature (with solid appearance) of some lesions, or support the hypothesis put forward during the baseline study, that the lesion was a poorly vascularised benign mass. This lent further support to our choice to undertake a laparoscopic surgical approach in 2 lesions, it altered our decision as to the type of surgery to be performed (laparoscopy vs. laparotomy) in 5 patients, and confirmed our intention to undertake only the follow-up in the 6 remaining cases. CONCLUSIONS: The use of the sonographic CM proved clinically useful in 13/47 patients with space-occupying pelvic lesions. The most important result of this examination was its ability to confirm the nonvascular or poorly vascular component of a lesion, and therefore to suggest its benign nature.

Adult↗

PubMedDate not supplied

[Idiopathic retroperitoneal fibrosis: a case report without increased levels of acute-phase reactants. Noninvasive diagnosis and treatment].

We report a case of benign idiopathic retroperitoneal fibrosis in a 39-year-old male, who was successfully treated with immunosuppressive drugs only. Advances in imaging techniques, especially in magnetic resonance imaging, often permit an accurate diagnosis in retroperitoneal fibrosis, avoiding open biopsy or biopsy by means of image-guided techniques. In addition, the modern medical approach with immunosuppressive drugs is based on evidence of disease regression following the medical therapy and is frequently effective. Hence, it is possible to avoid conventional surgery or laparoscopy. In the present case the response to immunosuppressive treatment was objectively assessed by means of enhanced computed tomography, magnetic resonance and nuclear medicine (Ga-67), showing an important decrease in the extent of the disease at follow-up. Our case shows the important role of the specialist in Internal Medicine in the treatment of this uncommon connective tissue disease.

Acute-Phase Reaction↗

PubMedDate not supplied

Conservative management of a spleen trauma using radiofrequency.

AIM OF THE STUDY: Conservative operative management of a splenic injury has become more and more employed in order to preserve the immune function of the organ. CASE REPORT: A case of a rupture of the spleen successfully treated with the use of a radiofrequency thermal energy generator is eported. The parenchymal tear was coagulated by a one cooled tip needle electrode. There were no postoperative complications and the function of the spleen was preserved. CONCLUSIONS: The technique cannot be applied in case of lesion of the major vessels or in case of avulsion of the hilum. This technique integrates to the others to make the operative conservative management of a splenic injury more and more feasible.

Adult↗