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1. Retrospective multicenter study of post-operative stenosis after stapled colorectal anastomosis

Author

Sartori A, De Luca M, Fiscon V, Frego M, Vigna S, Mazzeo A, Coco D, Agresta F, Finotti E, Antoniutti M, Carnio S, Elio A, Brunelli M, Ruffo G, Bertocchi E, Parini D, Losacco L, Poli F, Santoro G, Massani M, Ruffolo C, Cian E, Zanatta L, Genna M, Ballarin A, Rebonato M, Fontana M, Moretto G, Impellizzeri H, Merenda R, Margani G, Merigliano S, Baldan N, Ubiali P, Braini A, Balani A, Kosuta M, Infantino A, Giacomel G, Armatura G, Patauner S, de Manzini N, Palmisano S, Sorrentino M, Brizzolari M, Belluco C, Olivieri M, Lauro E, Scudo G, Valduga P, Brolese A, Pignata G, Andreucetti J, Caruso A, Zappalà F, Portale G ., Sartori, A, De Luca, M, Fiscon, V, Frego, M, Vigna, S, Mazzeo, A, Coco, D, Agresta, F, Finotti, E, Antoniutti, M, Carnio, S, Elio, A, Brunelli, M, Ruffo, G, Bertocchi, E, Parini, D, Losacco, L, Poli, F, Santoro, G, Massani, M, Ruffolo, C, Cian, E, Zanatta, L, Genna, M, Ballarin, A, Rebonato, M, Fontana, M, Moretto, G, Impellizzeri, H, Merenda, R, Margani, G, Merigliano, S, Baldan, N, Ubiali, P, Braini, A, Balani, A, Kosuta, M, Infantino, A, Giacomel, G, Armatura, G, Patauner, S, de Manzini, N, Palmisano, S, Sorrentino, M, Brizzolari, M, Belluco, C, Olivieri, M, Lauro, E, Scudo, G, Valduga, P, Brolese, A, Pignata, G, Andreucetti, J, Caruso, A, Zappalà, F, and Portale G, .

Subjects
Male, medicine.medical_specialty, Colorectal anastomosis, Constriction, Pathologic, Anastomosis, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, Surgical Stapling, Prevalence, medicine, Humans, Colorectal anastomosi, Retrospective Studies, Stenosis, business.industry, Stapled anastomosis, Anastomosis, Surgical, Retrospective cohort study, Endoscopic dilatation, medicine.disease, Colorectal surgery, Surgery, Italy, Multicenter study, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Colorectal Neoplasms, business, Complication, Stapled anastomosi
Abstract

Anastomotic stenosis after colorectal surgery is usually considered low-rate complication and often is under-reported in most studies. Few data are available on management strategies. The aim of the study was to assess the prevalence of stenosis after stapled colorectal anastomosis, performed either in elective or emergent setting, for benign or malignant disease, and to evaluate treatment profiles. This retrospective study was a survey conducted in a large Italian North-Eastern area including three regions (Triveneto), over a 12-month period (January–December 2015). Patients’ characteristics and surgical technique details were recorded, along with data on the prevalence of stenosis and its treatment. Patients with mid or low rectal resection and/or neoadjuvant chemo-radio therapy and/or diverting stoma were excluded. The study was promoted by the Italian Association of Hospital Surgeons (ACOI) and the Society of Surgeons of the Triveneto Region. Twenty-eight surgical units were enrolled in the survey, accounting for over 1400 patients studied. Fifty percent of the units performed laparoscopically > 70% of the colorectal resections and 7.5% of the procedures were emergent. Less than 60% of the units planned regular endoscopic follow-up after colorectal resection. Anastomotic stricture was recorded in 2% of the patients; 88% of the stenoses were diagnosed within 6 months from surgery. Only one anastomotic stricture required re-do surgery. The CANSAS study confirms that colorectal anastomotic stenosis is low-rate—but still present—complication. Treatment strategies vary according to surgeons’ and endoscopists’ preferences. Commonly endoscopic dilatation is preferred, but re-do surgery is required in some cases.

Published
2019

2. Contemporary antithrombotic strategies in patients with acute coronary syndromes managed without revascularization: insights from the EYESHOT study

Author

De Luca, Leonardo, Leonardi, Sergio, Smecca, Ignazio Maria, Formigli, Dario, Lucci, Donata, Gonzini, Lucio, Tuccillo, Bernardino, Olivari, Zoran, Gulizia, Michele Massimo, Bovenzi, Francesco Maria, De Servi, Stefano, Caporale, R., Cavallini, C., Ceravolo, R., Lupi, A., Musumeci, G., Rakar, S., Maggioni, A. P., Lorimer, A., Orsini, G., Fabbri, Giorgio, Bianchini, E., Abrignani, M. G., Bonura, F., Trimarco, B., Galasso, Giorgia, Misuraca, G., Manes, M. T., Irace, Lorenzo, Totis, O., Ledda, A., Mauro, C., Boccalatte, M., Iliceto, S., Cacciavillani, L., Savonitto, S., Tortorella, G., Esposito, L., DE ROSA, Paolo, Calabrò, P., Bianchi, R., Napoletano, C., Lalla Piccioni, L., Pavesi, P. C., Boni, Allegra, Merenda, R., Wolff, S., De Ferrari, G. M., Camporotondo, R., Gambino, Paolo, Cutaia, A., Picariello, C., Cemin, R., Chiarella, F., Grazioli Gauthier, L., Mircoli, L., Del Pinto, M., Finocchiaro, M. L., Scioli, R., Farina, R., Naddeo, C., Scherillo, M., Santopietro, S., Metra, M., Costa, F., Calculli, G., Troito, G., Pennisi, V., Adornato, E. M. F., Pirelli, S., Fadin, B. M., Di Biase, M., Ieva, R., Zuin, G., Sanfilippo, N., Mancuso, LAURA CATERINA, Pani, Luisa Anna, Serra, Eleonora, Marenzi, G., Assanelli, E. M., Ansalone, G., Cacciotti, L., Morocutti, G., Fresco, C., Berti, S., Paradossi, U., Bozzano, A., Mauro, A., Noussan, P., Zanini, P., Bolognese, L., Falsini, G., Costa, P., Manca, G., Caldarola, P., Locuratolo, N., Cipolla, T., Becchina, M., Cocco, Gabriele, Scalera, G., Stefanelli, S., Giunta, N., Sinagra, G., Meloni, L., Lai, O., Chiaranda, G., Luca, G., Sleiman Helou, J., Biscottini, E., Magliari, F., Callerame, M., Uguccioni, M., Pugliese, M., Sanchez, F., Tartaglione, S., Ignone, G., Mavilio, G., Mantovan, R., Bini, R., Caico, S. I., Demolli, V., Proietti, F., Michisanti, M., Musmeci, G., Cantamessa, P., Sicuso, G., Micalef, S. S., Accogli, M., Zaccaria, MICHELA MARIA, Caputo, M., Di Paolo, G., Piatti, L., Farina, A., Vicinelli, P., Paloscia, L., Di Clemente, D., Felis, S., Castini, D., Rota, C., Casu, Gabriella, Bonano, S., Margheri, M., Ricci Lucchi, G., Serdoz, R., Proietti, P., Autore, C., Conti, E., Russo, V., Orlando, P., Ramondo, A. B., Bontorin, M., Marcolongo, M., Marrara, F., Maestroni, A., Vitti, P., Rodella, P., Bonetti, P., Elia, M., Lumare, R., Politi, A., Gritti, S., Poletti, F., Mafrici, A., Fusco, R., Bongo, A. S., Bacchini, S., Gasparetto, V., Ferraiuolo, G., Campana, C., Bonatti, R., Gaita, F., Bergerone, S., Bonmassari, R., Zeni, P., Langialonga, T., Scarcia, A., Caravita, L., Musacchio, E., Augello, G., Usmiani, T., Stomaci, B., Cirino, D., Pierini, S., Bottiglieri, G., Liso, A., Mussardo, M., Tosi, P., Sala, R., Belloni, A., Blengino, S., Lisi, E., Delfino, P., Auguadro, C., Brunazzi, M. C., Pacchioni, E., Fattore, L., Bosco, B., Blandizzi, S., Pajes, G., Patruno, N., Perna, G. P., Francioni, M., Favale, S., Vestito, D., Lombardi, A., Capecchi, A., Ferrero, P., De Vincenzo, C., Magri, G., Indolfi, C., De Rosa, S., Rossi, M., Collarini, L., Agnelli, D., Conti, G., Tonelli, C., Spadaro, C., Negroni, S., Di Noto, G., Lanari, A., Casolo, G., Del Meglio, J., Negrini, M., Celentano, A., Sifola, C., Rellini, G., Della Mattia, A., Molero, U., Piovaccari, G., Grosseto, D., Callegarin, L., Fiasconaro, G., Crivello, R., Thiebat, B., Leone, G., Tamburino, C., Caruso, G., Cassadonte, F., Sassone, B., Fuca, G., Sormani, L., Percoco, G. F., Mazzucco, R., Cazzani, E., Gianni, M., Limido, A., Luvini, M., Guglielmi, R., Mannarini, A., Moruzzi, P., Pastori, P., Golia, B., Marzano, A., Orazi, S., Marchese, I., Anselmi, M., Girardi, P., Nassiacos, D., Meloni, S., Busacca, P., Generali, C. A., Corda, S., Costanza, G., Montalto, S., Argenziano, L., Tommasini, P., Emdin, M., Pasanisi, E. M., Colivicchi, F., Tubaro, M., Azzolini, P., Luciani, C., Doronzo, B., Coppolino, A., Dellavesa, P., Zenone, F., Di Marco, A., De Conti, F., Piccinni, G. C., Gualtieri, M. R., Bisignani, G., Leone, A., Arcuri, G. M., Marinacci, L., Rossi, P., Perotti, S., Cotti Cometti, V., Arcidiacono, S., Tramontana, M., Bazzucchi, M., Mezzetti, P., Romano, M., Villani, R., Di Giovambattista, R., Volpe, B., Tedesco, L., Carini, M., Vinci, S., Paolini, E. A., Busoni, F., Piergentili, C., Navazio, A., Manca, F., Cocco, F., Pennetta, C. A., Maggiolini, S., Galbiati, R., Bruna, C., Ferrero, L., Brigido, S., Barducci, E., Musacchio, D., Manduca, B., Marchese, D., Patrassi, L. A., Pattarino, F. A., Rocchi, M., Briglia, S., Fanelli, R., Villella, M., Gronda, E., Massa, D., Lenti, V., Di Gregorio, L., Bottero, M., Bazzanini, F., Braggion, G., Antoniceli, R., Caraceni, D., Guzzo, V., Di Giovanni, P., Scarpini, S., Severgnini, B., Musolino, M. F., Della Casa, S., Gobbi, M., Arena, G., Bonizzato, S., Agnoletto, V., Sansoni, S., Pes, R. A. M., Denti, S., Polizzi, G. M., Pino, R., Commisso, B., Merlino, A., Di Lorenzo, L., Porchetta, I., Del Furia, F., Colombi, E., Covini, D., Cavalieri, F., Antonaci, S., Rubino, G., Ciulla, A., Bui, F., Casorelli, E., Caliendo, L., Laezza, A., Americo, L., Schillaci, A. M., Cordoni, M., Barsotti, L., Gaudio, C., Barilla, F., Cannone, M., Memeo, R., Truncellito, L., Andriani, A., Salituri, S., Verrina, F., Pafi, M., Sebastiani, M. L., Amico, A. F., Scolozzi, D., D'Alea, A., Catanzariti, D., Angheben, C., Ottaviano, A., and Levantesi, G.

Subjects
Male, Ticagrelor, medicine.medical_specialty, Acute coronary syndrome, medicine.medical_treatment, Conservative strategy, Population, Acute coronary syndromes, Revascularization, acute coronary syndromes, anticoagulant, antithrombotic therapy, conservative strategy, prasugrel, ticagrelor, aged, coronary care units, female, fibrinolytic agents, follow-up studies, hospital mortality, humans, iItaly, length of stay, male, myocardial revascularization, retrospective studies, survival rate, thrombolytic therapy, practice guidelines as topic, Fibrinolytic Agents, Anticoagulant, Antithrombotic therapy, Prasugrel, Acute Coronary Syndrome, Aged, Coronary Care Units, Female, Follow-Up Studies, Hospital Mortality, Humans, Italy, Length of Stay, Myocardial Revascularization, Retrospective Studies, Survival Rate, Thrombolytic Therapy, Practice Guidelines as Topic, Cardiology and Cardiovascular Medicine, Pharmacology (medical), Internal medicine, Antithrombotic, medicine, education, Survival rate, education.field_of_study, business.industry, Clopidogrel, medicine.disease, Cardiology, business, Fibrinolytic agent, medicine.drug
Abstract

Aims Patients with acute coronary syndromes (ACSs) who are managed without coronary revascularization represent a mixed and understudied population that seems to receive suboptimal pharmacological treatment. Methods and results We assessed patterns of antithrombotic therapies employed during the hospitalization and in-hospital clinical events of medically managed patients with ACS enrolled in the prospective, multicentre, nationwide EYESHOT (EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units) registry. Among the 2585 consecutive ACS patients enrolled in EYESHOT, 783 (30.3%) did not receive any revascularization during hospital admission. Of these, 478 (61.0%) underwent coronary angiography (CA), whereas 305 (39.0%) did not. The median GRACE and CRUSADE risk scores were significantly higher among patients who did not undergo CA compared with those who did (180 vs. 145, P < 0.0001 and 50 vs. 33, P < 0.0001, respectively). Antithrombotic therapies employed during hospitalization significantly differ between patients who received CA and those who did not with unfractioned heparin and novel P2Y12 inhibitors more frequently used in the first group, and low-molecular-weight heparins and clopidogrel in the latter group. During the index hospitalization, patients who did not receive CA presented a higher incidence of ischaemic cerebrovascular events and of mortality compared with those who underwent CA (1.6 vs. 0.2%, P = 0.04 and 7.9 vs. 2.7%, P = 0.0009, respectively). Conclusion Almost one-third of ACS patients are managed without revascularization during the index hospitalization. In this population, a lower use of recommended antiplatelet therapy and worse clinical outcome were observed in those who did not undergo CA when compared with those who did. Clinical Trial Registration Unique identifier: [NCT02015624][1], . [10.1093/ehjcvp/pvv017][2] [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02015624&atom=%2Fehjcardpharm%2F1%2F3%2F168.atom [2]: /lookup/doi/10.1093/ehjcvp/pvv017

Published
2015
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3. Antithrombotic strategies in the catheterization laboratory for patients with acute coronary syndromes undergoing percutaneous coronary interventions: insights from the EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units Registry

Author

De Luca, L., Musumeci, G., Leonardi, S., Gonzini, L., Cavallini, C., Calabro, P., Mauro, C., Cacciavillani, L., Savonitto, S., De Servi, S., Caporale, R., Ceravolo, R., Formigli, D., Lupi, A., Rakar, S., Smecca, I. M., Maggioni, A. P., Lucci, D., Lorimer, A., Orsini, G., Fabbri, G., Bianchini, E., Abrignani, M. G., Bonura, F., Trimarco, B., Galasso, G., Misuraca, G., Manes, M. T., Tuccillo, B., Irace, L., Olivari, Z., Totis, O., Ledda, A., Boccalatte, M., Iliceto, S., Tortorella, G., Esposito, L., De Rosa, P., Bianchi, R., Napoletano, C., Piccioni, L. L., Pavesi, P. C., Bovenzi, F. M., Boni, A., Merenda, R., Wolff, S., De Ferrari, G. M., Camporotondo, R., Gambino, P., Cutaia, A., Picariello, C., Cemin, R., Chiarella, F., Gauthier, L. G., Mircoli, L., Del Pinto, M., Finocchiaro, M. L., Scioli, R., Farina, R., Naddeo, C., Scherillo, M., Santopietro, S., Metra, M., Costa, F., Calculli, G., Troito, G., Pennisi, V., Adornato, E. M. F., Pirelli, S., Fadin, B. M., DI Biase, M., Ieva, R., Zuin, G., Sanfilippo, N., Mancuso, L., Pani, A., Serra, E., Marenzi, G., Assanelli, E. M., Ansalone, G., Cacciotti, L., Morocutti, G., Fresco, C., Berti, S., Paradossi, U., Bozzano, A., Mauro, A., Noussan, P., Zanini, P., Bolognese, L., Falsini, G., Costa, P., Manca, G., Caldarola, P., Locuratolo, N., Cipolla, T., Becchina, M., Cocco, G., Scalera, G., Stefanelli, S., Giunta, N., Sinagra, G., Meloni, L., Lai, O., Chiaranda, G., Luca, G., Helou, J. S., Biscottini, E., Magliari, F., Callerame, M., Uguccioni, M., Pugliese, M., Sanchez, F., Tartaglione, S., Ignone, G., Mavilio, G., Mantovan, R., Bini, R., Caico, S. I., Demolli, V., Proietti, F., Michisanti, M., Musmeci, G., Cantamessa, P., Sicuso, G., Micalef, S. S., Accogli, M., Zaccaria, M., Caputo, M., DI Paolo, G., Piatti, L., Farina, A., Vicinelli, P., Paloscia, L., DI Clemente, D., Felis, S., Castini, D., Rota, C., Casu, G., Bonano, S., Margheri, M., Lucchi, G. R., Serdoz, R., Proietti, P., Autore, C., Conti, E., Russo, V., Orlando, P., Ramondo, A. B., Bontorin, M., Marcolongo, M., Santagostino, M., Maestroni, A., Vitti, P., Rodella, P., Bonetti, P., Elia, M., Lumare, R., Politi, A., Gritti, S., Poletti, F., Mafrici, A., Fusco, R., Bongo, A. S., Bacchini, S., Gasparetto, V., Ferraiuolo, G., De Luca, M., Campana, C., Bonatti, R., Gaita, F., Bergerone, S., Bonmassari, R., Zeni, P., Langialonga, T., Scarcia, A., Caravita, L., Musacchio, E., Augello, G., Usmiani, T., Stomaci, B., Cirino, D., Pierini, S., Bottiglieri, G., Liso, A., Mussardo, M., Tosi, P., Sala, R., Belloni, A., Blengino, S., Lisi, E., Delfino, P., Auguadro, C., Brunazzi, M. C., Pacchioni, E., Fattore, L., Bosco, B., Blandizzi, S., Pajes, G., Patruno, N., Perna, G. P., Francioni, M., Favale, S., Vestito, D., Lombardi, A., Capecchi, A., Ferrero, P., De Vincenzo, C., Magri, G., Indolfi, C., De Rosa, S., Rossi, M., Collarini, L., Agnelli, D., Conti, G., Tonelli, C., Spadaro, C., Negroni, S., DI Noto, G., Lanari, A., Casolo, G., Del Meglio, J., Negrini, M., Celentano, A., Sifola, C., Rellini, G., Mattia, A. D., Molero, U., Piovaccari, G., Grosseto, D., Callegarin, L., Fiasconaro, G., Crivello, R., Thiebat, B., Leone, G., Tamburino, C., Caruso, G., Cassadonte, F., Sassone, B., Fuca, G., Sormani, L., Percoco, G. F., Mazzucco, R., Cazzani, E., Gianni, M., Limido, A., Luvini, M., Guglielmi, R., Mannarini, A., Moruzzi, P., Pastori, P., Golia, B., Marzano, A., Orazi, S., Marchese, I., Anselmi, M., Girardi, P., Nassiacos, D., Meloni, S., Busacca, P., Generali, C. A., Corda, S., Costanza, G., Montalto, S., Argenziano, L., Tommasini, P., Emdin, M., Pasanisi, E. M., Colivicchi, F., Tubaro, M., Azzolini, P., Luciani, C., Doronzo, B., Coppolino, A., Dellavesa, P., Zenone, F., DI Marco, A., De Conti, F., Piccinni, G. C., Gualtieri, M. R., Bisignani, G., Leone, A., Arcuri, G. M., Marinacci, L., Rossi, P., Perotti, S., Cometti, V. C., Arcidiacono, S., Tramontana, M., Bazzucchi, M., Mezzetti, P., Romano, M., Villani, R., DI Giovambattista, R., Volpe, B., Tedesco, L., Carini, M., Vinci, S., Paolini, E. A., Busoni, F., Piergentili, C., Navazio, A., Manca, F., Cocco, F., Pennetta, C. A., Maggiolini, S., Galbiati, R., Bruna, C., Ferrero, L., Brigido, S., Barducci, E., Musacchio, D., Manduca, B., Marchese, D., Patrassi, L. A., Pattarino, F. A., Rocchi, M., Briglia, S., Fanelli, R., Villella, M., Gronda, E., Massa, D., Lenti, V., DI Gregorio, L., Bottero, M., Bazzanini, F., Braggion, G., Antoniceli, R., Caraceni, D., Guzzo, V., DI Giovanni, P., Scarpini, S., Severgnini, B., Musolino, M. F., Casa, S. D., Gobbi, M., Arena, G., Bonizzato, S., Agnoletto, V., Sansoni, S., Pes, R. A. M., Denti, S., Polizzi, G. M., Pino, R., Commisso, B., Merlino, A., DI Lorenzo, L., Porchetta, I., Del Furia, F., Colombi, E., Covini, D., Cavalieri, F., Antonaci, S., Rubino, G., Ciulla, A., Bui, F., Casorelli, E., Caliendo, L., Laezza, A., Americo, L., Schillaci, A. M., Cordoni, M., Barsotti, L., Gaudio, C., Barilla, F., Cannone, M., Memeo, R., Truncellito, L., Andriani, A., Salituri, S., Verrina, F., Pafi, M., Sebastiani, M. L., Amico, A. F., Scolozzi, D., Lupi, G., D'Alea, A., Catanzariti, D., Angheben, C., Ottaviano, A., Levantesi, G., de Luca, Leonardo, Musumeci, Giuseppe, Leonardi, Sergio, Gonzini, Lucio, Cavallini, Claudio, Calabrò, Paolo, Mauro, Ciro, Cacciavillani, Luisa, Savonitto, Stefano, de Servi, Stefano, Caporale, Roberto, Ceravolo, Roberto, Formigli, Dario, Lupi, Alessandro, Rakar, Sadir, Smecca, Ivan, Maggioni, Aldo Pietro, Lucci, Donata, Lorimer, Andrea, Orsini, Giampietro, Fabbri, Gianna, Bianchini, Elisa, Abrignani, Maurizio Giuseppe, Bonura, Francesc, Trimarco, Bruno, Galasso, Gennaro, Misuraca, Gianfranco, Manes, Maria Teresa, Tuccillo, Bernardino, and Irace, Luigi.

Subjects
Male, Prasugrel, medicine.medical_treatment, Myocardial Infarction, antithrombotic therapy, 030204 cardiovascular system & hematology, acute coronary syndromes, bivalirudin, heparins, percutaneous coronary intervention, prasugrel, ticagrelor, 0302 clinical medicine, Antithrombotic, 80 and over, Bivalirudin, 030212 general & internal medicine, Myocardial infarction, Prospective Studies, Registries, Aged, 80 and over, General Medicine, Hirudins, Middle Aged, Recombinant Proteins, Italy, Female, Cardiology and Cardiovascular Medicine, Ticagrelor, medicine.drug, medicine.medical_specialty, Platelet Glycoprotein GPIIb-IIIa Complex, NO, 03 medical and health sciences, Percutaneous Coronary Intervention, Internal medicine, medicine, Humans, Acute Coronary Syndrome, Aged, Aspirin, business.industry, Heparin, Percutaneous coronary intervention, Anticoagulants, medicine.disease, Peptide Fragments, Clinical trial, Cross-Sectional Studies, Logistic Models, Conventional PCI, Multivariate Analysis, business
Abstract

Aims In the last decades, several new therapies have emerged for the treatment of acute coronary syndromes (ACS). We sought to describe real-world patterns of use of antithrombotic treatments in the catheterization laboratory for ACS patients undergoing percutaneous coronary interventions (PCI). Methods EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units was a nationwide, prospective registry aimed to evaluate antithrombotic strategies employed in ACS patients in Italy. Results Over a 3-week period, a total of 2585 consecutive ACS patients have been enrolled in 203 cardiac care units across Italy. Among these patients, 1755 underwent PCI (923 with ST-elevation myocardial infarction and 832 with non-ST-elevation ACS). In the catheterization laboratory, unfractioned heparin was the most used antithrombotic drug in both ST-elevation myocardial infarction (64.7%) and non-ST-elevation ACS (77.5%) undergoing PCI and, as aspirin, bivalirudin and glycoprotein IIb/IIIa inhibitors (GPIs) more frequently employed before or during PCI compared with the postprocedural period. Any crossover of heparin therapy occurred in 36.0% of cases, whereas switching from one P2Y12 inhibitor to another occurred in 3.7% of patients. Multivariable analysis yielded several independent predictors of GPIs and of bivalirudin use in the catheterization laboratory, mainly related to clinical presentation, PCI complexity and presence of complications during the procedure. Conclusion In our contemporary, nationwide, all-comers cohort of ACS patients undergoing PCI, antithrombotic therapies were commonly initiated before the catheterization laboratory. In the periprocedural period, the most frequently employed drugs were unfractioned heparin, leading to a high rate of crossover, followed by GPIs and bivalirudin, mainly used during complex PCI. Clinical trial registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02015624.

Published
2017

4. Varespladib and cardiovascular events in patients with an acute coronary syndrome: the VISTA-16 randomized clinical trial

Author

Nicholls, Stephen J., Kastelein, John J. P., Schwartz, Gregory G., Bash, Dianna, Rosenson, Robert S., Cavender, Matthew A., Brennan, Danielle M., Koenig, Wolfgang, Jukema, J. Wouter, Nambi, Vijay, Wright, R. Scott, Menon, Venu, Lincoff, A. Michael, Nissen, Hennekens C, Steven E., Brown, Wv, Demets, D, Pfeffer, M, Roleau, J, Abraham, J, Gebel, J, Huff, C, Katzan, I, Shishehbor, M, Rassi, A, Uchino, K, Vest, A, Zishiri, E, Heckman, Mj, Balog, C, Dart, A, Amerena, J, Prasad, C, Farshid, A, Gunalingam, B, Thompson, P, Collins, N, Arstall, M, van Gaal, W, Aroney, C, Mahar, L, Youssef, G, Horowitz, J, Anand, D, Rodes-Cabau, J, Polasek, P, Lai, C, Huynh, T, Hubacek, J, Kokis, A, Paradis, Jm, Mukherjee, A, Senaratne, M, Constance, C, Gosselin, G, Lavi, S, Parker, J, Zadra, R, Abramson, B, Della-Siega, A, Spinar, J, Pudil, R, Motovska, Z, Maly, M, Hutyra, M, Pleva, L, Mayer, O, Semenka, J, Klimovic, T, Horak, D, Cervinka, P, Klimsa, Z, Hulinsky, V, Reichert, P, Monhart, Z, Rotterova, H, Kobulia, B, Shaburishvili, T, Mamatsashvili, M, Chapidze, G, Chumburidze, V, Megreladze, I, Khintibidze, I, Leithäuser, B, Voehringer, Hf, Wachter, R, Nogai, K, Lapp, H, Haltern, G, Gielen, S, Dorsel, T, Möllmann, H, Stellbrink, C, Hengstenberg, C, Dengler, T, Heuer, H, Kreuzer, J, Leschke, M, Mudra, H, Werner, N, Braun-Dullaeus, R, Rosenberg, M, Frey, N, Koenig, W, Strasser, R, Genth-Zotz, S, Kiss, R, Nagy, A, Kovacs, Z, Csapo, K, Edes, I, Sereg, M, Vertes, A, Ronaszeki, A, Kancz, S, Benczur, B, Polgar, P, Muller, G, Simonyi, G, Dezsi, C, Merkely, B, Dinnyes, J, Lupkovics, G, Kahali, D, Banker, D, Trivedi, S, Rajput, R, Premchand, R, Dani, S, Vadaganelli, P, Gupta, S, Chandra, S, Fulwani, M, Chawla, K, Parikh, K, Prati, F, Speciale, G, Valgimigli, M, Suriano, P, Sangiorgi, G, Fineschi, M, Merenda, R, Marenzi, G, Berti, S, Corrada, E, Cuccia, C, Testa, R, Moretti, L, Mennuni, M, Biasucci, Lm, Lioy, E, Auguadro, C, Magagnini, E, Fedele, F, Piscione, F, Azar, R, Trip, Md, Liem, A, den Hartoog, M, Lenderink, T, van de Wetering ML, Lok, D, Oei, F, Tans, Jg, Ilmer, B, Keijzers, M, Monraats, P, Kedhi, E, Breedveld, Rw, Herrman, J, van Wijk, L, Ronner, E, Nierop, P, Bosschaert, M, Hermans, W, Doevendans, P, Troquay, R, van der Heijden, R, Veen, G, Bokern, Mj, Bronzwaer, Pn, Kie, Sh, Den Hartog, F, Elliott, J, Wilkins, G, Hart, H, Devlin, G, Harding, S, Ponikowski, P, Madej, A, Kochmanski, M, Witkowski, A, Pluta, W, Bronisz, M, Kornacewicz-Jach, Z, Wysokinski, A, Ujda, M, Drozdz, J, Derlaga, B, Gessek, J, Dabrowski, M, Miekus, P, Kozlowski, A, Gniot, J, Musial, W, Dobrzycki, S, Rynkiewicz, A, Psuja, P, Rekosz, J, Drzewiecki, A, Kuznetsov, V, Gordeev, I, Goloshchekin, B, Markov, V, Barbarich, V, Belenky, D, Mikhin, V, Volkova, E, Timofeev, A, Ermoshkina, L, Barbarash, O, Klein, G, Libis, R, Vishnevsky, A, Linev, K, Khaisheva, L, Ruda, M, Dovgalevskiy, Y, Shvarts, Y, Zateyshchikov, D, Kostenko, V, Shalnev, V, Simanenkov, V, Arkhipov, M, Ovcharenko, E, Guseva, G, Akhunova, S, Ortiz, Ai, Navarro, Mj, Romero, Aj, Goya, Il, Peñaranda, As, Cendon, Aa, Rubio, Am, Zubiri, Jj, Soriano, Fr, Sanz, Rr, Genís, Ab, Lago, Vn, Fernández, Jd, Romo, Ai, Franco, Sn, Martin, Ih, Montero, Js, Martin Mde, M, González, Mj, Antolin, Jm, Areses, El, Miranda, Jm, Alonso-Pulpón, L, Esquivias, Gb, Jarne, Ef, Cortés, Jm, Pérez, Mb, Gormaz, Cl, Alegret, Jm, Nava, Js, Ingelmo, Jm, Urbano, Rh, Sanmartín, M, Katerenchuk, O, Vakaliuk, I, Karpenko, O, Prokhorov, O, Koval, O, Faynyk, A, Kopytsya, M, Karpenko, Y, Kraiz, I, Feskov, O, Rudenko, L, Kozhukhov, S, Goloborodko, B, Rivera, E, Broadwater, S, Crowley, S, Vijay, N, Goswami, R, Ferrier, L, Blanchard, A, Mccullum, K, Chernick, R, Bertolet, B, Battaglia, J, Richardson, J, Lochridge, S, Lieberman, S, Amkieh, A, Cavender, Jb, Denning, S, Treasure, C, Kmetzo, J, Stillabower, M, Brilakis, E, Schwartz, G, Acheatel, R, Kukuy, E, Ashchi, M, Skelding, K, Martin, L, Gillespie, E, French, W, Pollock, S, Polk, D, Black, R, Drenning, D, Anderson, J, Sanz, M, Korban, E, Wiley, M, Rezkalla, S, Minisi, A, Shah, A, Silverman, P, Amlani, M, Eaton, G, Brown, A, Jay, D, Loussararian, A, Lamas, G, Lauer, M, Williams, J, Asfour, A, Runquist, L, Robertson, R, Blonder, R, Davies, C, Downes, T, Chronos, N, Marso, S, Haldis, T, Eich, D, Ahmed, M, East, C, Macdonald, L, Seigel, P, White, M, Camp, A, Kleiman, N, Burtt, D, Strain, J, Go, B, Henry, P, Sultan, P, Delafontaine, P, Kashou, H, Lambert, C, Movahed, M, Saucedo, J, Thadani, U, Chandrashekhar, Y, Lu, D, Chandna, H, Mann, J, Ramaswamy, G, Browne, K, Janik, M, Cannon, K, Tolerico, P., Berni, Andrea, ACS - Amsterdam Cardiovascular Sciences, Vascular Medicine, and Cardiology

Subjects
Male, Indoles, Acetates, Acute Coronary Syndrome, Aged, Angina, Unstable, Atherosclerosis, Double-Blind Method, Early Termination of Clinical Trials, Female, Heptanoic Acids, Humans, Middle Aged, Phospholipases A, Phospholipases A2, Secretory, Pyrroles, Risk, Stroke, Survival Analysis, Treatment Outcome, Myocardial Infarction, law.invention, chemistry.chemical_compound, Randomized controlled trial, law, Atorvastatin, Clinical endpoint, Medicine (all), General Medicine, Angina, Keto Acids, medicine.medical_specialty, Acute coronary syndrome, Placebo, Unstable, Internal medicine, Multicenter trial, medicine, Atorvastatin Calcium, Unstable angina, business.industry, Secretory, medicine.disease, Interim analysis, Surgery, Phospholipases A2, chemistry, Varespladib, business
Abstract

Importance Secretory phospholipase A 2 (sPLA 2 ) generates bioactive phospholipid products implicated in atherosclerosis. The sPLA 2 inhibitor varespladib has favorable effects on lipid and inflammatory markers; however, its effect on cardiovascular outcomes is unknown. Objective To determine the effects of sPLA 2 inhibition with varespladib on cardiovascular outcomes. Design, Setting, and Participants A double-blind, randomized, multicenter trial at 362 academic and community hospitals in Europe, Australia, New Zealand, India, and North America of 5145 patients randomized within 96 hours of presentation of an acute coronary syndrome (ACS) to either varespladib (n = 2572) or placebo (n = 2573) with enrollment between June 1, 2010, and March 7, 2012 (study termination on March 9, 2012). Interventions Participants were randomized to receive varespladib (500 mg) or placebo daily for 16 weeks, in addition to atorvastatin and other established therapies. Main Outcomes and Measures The primary efficacy measure was a composite of cardiovascular mortality, nonfatal myocardial infarction (MI), nonfatal stroke, or unstable angina with evidence of ischemia requiring hospitalization at 16 weeks. Six-month survival status was also evaluated. Results At a prespecified interim analysis, including 212 primary end point events, the independent data and safety monitoring board recommended termination of the trial for futility and possible harm. The primary end point occurred in 136 patients (6.1%) treated with varespladib compared with 109 patients (5.1%) treated with placebo (hazard ratio [HR], 1.25; 95% CI, 0.97-1.61; log-rank P = .08). Varespladib was associated with a greater risk of MI (78 [3.4%] vs 47 [2.2%]; HR, 1.66; 95% CI, 1.16-2.39; log-rank P = .005). The composite secondary end point of cardiovascular mortality, MI, and stroke was observed in 107 patients (4.6%) in the varespladib group and 79 patients (3.8%) in the placebo group (HR, 1.36; 95% CI, 1.02-1.82; P = .04). Conclusions and Relevance In patients with recent ACS, varespladib did not reduce the risk of recurrent cardiovascular events and significantly increased the risk of MI. The sPLA 2 inhibition with varespladib may be harmful and is not a useful strategy to reduce adverse cardiovascular outcomes after ACS. Trial Registration clinicaltrials.gov Identifier:NCT01130246

Published
2014

5. Change in portal flow after liver transplantation: effect on hepatic arterial resistance indices and role of spleen size

Author

Bolognesi, Massimo, Sacerdoti, David, Bombonato, G, Merkel, Carlo, Sartori, G, Merenda, R, Nava, V, Angeli, Paolo, Feltracco, P, and Gatta, Angelo

Subjects
Adult, Liver Cirrhosis, Male, Liver Failure, Acute, Middle Aged, Liver Transplantation, Portal System, Hepatic Artery, Regional Blood Flow, Humans, Female, Ultrasonics, Vascular Resistance, Cardiac Output, Blood Flow Velocity, Spleen
Abstract

Information on changes in splanchnic hemodynamics after liver transplantation is incomplete. In particular, data on long-term changes are lacking, and the relationship between changes in arterial and portal parameters is still under debate. The effect of liver transplantation on splanchnic hemodynamics was analyzed with echo-Doppler in 41 patients with cirrhosis who were followed for up to 4 years. Doppler parameters were also evaluated in 7 patients transplanted for acute liver failure and in 35 controls. In cirrhotics, portal blood velocity and flow increased immediately after transplantation (from 9.1 plus minus 3.7 cm/sec to 38.3 plus minus 14.6 and from 808 plus minus 479 mL/min to 2,817 plus minus 1,153, respectively, P.001). Hepatic arterial resistance index (pulsatility index) also augmented (from 1.36 plus minus 0.32 to 2.34 plus minus 1.29, P.001) and was correlated with portal blood velocity and flow. The early changes in these parameters were related, in agreement with the hepatic buffer response theory. Portal flow returned to normal values after 2 years. Superior mesenteric artery flow normalized after 3 to 6 months. Splenomegaly persisted after 4 years, when spleen size was related to portal blood flow. In 7 patients transplanted for acute liver failure, portal flow, and hepatic arterial resistance index were normal after transplantation. In conclusion, a high portal flow was present in cirrhotics until 2 years after transplantation, probably because of maintenance of elevated splenic flow. An early increase in hepatic arterial resistance indices is a common finding, but it is transient and is related to the increase in portal blood flow. A normal time course of portal-hepatic hemodynamics was detected in patients transplanted for acute liver failure.

Published
2002

7. Preoperative selective portal vein embolization (PSPVE) before major hepatic resection. Effectivenes of Doppler estimation of hepatic blood flow to predict the hypertrophy rate of non-embolized liver segments

Author

Gerunda, G. E., Bolognesi, M., Neri, D., Merenda, R., Miotto, D., Barbazza, F., Zangrandi, F., Bisello, M., Michele Valmasoni, Gangemi, A., Gagliesi, A., and Maffei Faccioli, A.

Subjects
Male, Ultrasonography, Doppler, Duplex, Carcinoma, Hepatocellular, Portal Vein, Liver Neoplasms, Hypertrophy, Embolization, Therapeutic, Hepatic Artery, Liver, Regional Blood Flow, Preoperative Care, Humans, Vascular Resistance, Aged
Abstract

Hepatocellular carcinoma may be unresectable for volumetric reasons. The future remaining liver after hepatectomy might be too small to ensure survival. Preoperative selective portal vein embolization of the tumorous lobe can induce hypertrophy of the future remaining liver and enable safer surgery. A 76-year-old patient with hepatocellular carcinoma needed right lobectomy however, the future remaining liver was judged insufficient to ensure an uneventful postoperative course. The left lobe to whole liver volumetric ratio was to small (29.7%) and a preoperative selective portal vein embolization of the right portal branch via a percutaneous, transhepatic, contralateral approach was performed without side effects. A Doppler estimation of left branch portal blood flow and velocity was carried out before and after preoperative selective portal vein embolization. After 21 days the left lobe volume increased by about 44.2% with a safe left lobe/whole liver ratio of 40.8%. The portal blood flow and portal blood flow velocity showed an increase of 253% and 122%, respectively. A right lobectomy was performed without complications. Three months later, computed tomography scan showed no hepatocellular carcinoma recurrence. Preoperative selective portal vein embolization is a safe technique which can enable major hepatectomy to be performed in situations otherwise judged unresectable for a life-threatening volumetric insufficiency. The portal blood flow and portal blood flow velocity evaluations can easily predict the hypertrophy rate of non-embolized liver segments.

8. Comparison between two high-dose methylprednisolone schedules in the treatment of acute hepatic cellular rejection in liver transplant recipients: a controlled clinical trial

Author

Roberto Merenda, Angelo Gatta, Mario Strazzabosco, Antonietta Sticca, Carlo Merkel, Daniele Neri, Paolo Feltracco, Roberta Volpin, Silvano Fasolato, F. Casagrande, Franco Del Piccolo, Giorgio Enrico Gerunda, Alessandra Galioto, Paolo Angeli, Franco Barbazza, Volpin, R, Angeli, P, Galioto, A, Fasolato, S, Neri, D, Barbazza, F, Merenda, R, Del Piccolo, F, Strazzabosco, M, Casagrande, F, Feltracco, P, Sticca, A, Merkel, C, Gerunda, G, and Gatta, A

Subjects
Graft Rejection, Male, methylprednisone, hacute rejection, liver transplantation, medicine.medical_specialty, medicine.medical_treatment, Liver transplantation, Gastroenterology, Methylprednisolone, Group B, law.invention, Randomized controlled trial, MED/12 - GASTROENTEROLOGIA, law, Internal medicine, medicine, Humans, Transplantation, Homologous, Glucocorticoids, Aged, Transplantation, Analysis of Variance, Hepatology, medicine.diagnostic_test, business.industry, Alanine Transaminase, Bilirubin, Middle Aged, Surgery, Liver Transplantation, Clinical trial, Regimen, Liver biopsy, Female, business, medicine.drug
Abstract

Intravenous methylprednisolone is used in most liver transplant centers as first-line therapy of acute hepatic cellular rejection in patients who undergo liver transplant. However, no controlled study has been performed to date to define the optimal dose and duration of the steroid regimen. The schedules that actually are used in most transplant centers are drawn from those that were developed empirically for the treatment of acute renal graft rejection. Thus, the aim of the study was to compare two schedules of steroid treatment of acute hepatic cellular rejection among those most widely used. Thirty-eight eligible patients with grade II or III acute hepatic cellular rejection were randomized to receive two different high-dose methylprednisolone schedules. Eighteen patients were randomized in group A (intravenous dose of 1,000 mg of methylprednisolone followed by a 6-day taper from 200 to 20 mg/d). Twenty patients were randomized in group B (intravenous dose of 1,000 mg of methylprednisolone for three consecutive days). The response to treatment was evaluated by means of a second liver biopsy. The treatment of group A proved to be more effective than treatment of group B. The resolution of acute hepatic cellular rejection was observed in 83.3% of cases in group A and 50.0% of cases in group B (P

Published
2002

9. Cerebral aspergillosis in a liver transplant recipient: a case report of long-term survival after combined treatment with liposomal amphotericin B and surgery

Author

Mario Strazzabosco, Gioacchino Mattisi, Andrea Rossanese, Rosa Maria Iemmolo, Roberto Merenda, Daniele Neri, Gaetano Crepaldi, Andrea Rotilio, Giorgio Enrico Gerunda, Iemmolo, R, Rossanese, A, Rotilio, A, Mattisi, G, Gerunda, G, Merenda, R, Neri, D, Crepaldi, G, and Strazzabosco, M

Subjects
Male, medicine.medical_specialty, Antifungal Agents, Time Factors, medicine.medical_treatment, Liver transplantation, Aspergillosis, Aspergillus fumigatus, Cerebrospinal fluid, Postoperative Complications, MED/12 - GASTROENTEROLOGIA, Amphotericin B, Medicine, Humans, liposomal amphotericin B, Mycosis, Brain Diseases, Drug Carriers, Hepatology, biology, business.industry, Brain, Middle Aged, medicine.disease, biology.organism_classification, Magnetic Resonance Imaging, Surgery, Liver Transplantation, Transplantation, cerebral aspergillosi, Liposomes, business, Complication, Tomography, X-Ray Computed, medicine.drug
Abstract

Cerebral aspergillosis is a life-threatening complication in liver transplant recipients, with mortality rates approaching 100%; treatment with amphotericin B is of limited efficacy because of its poor distribution in the cerebrospinal fluid and its systemic side effects. We report the case of a liver transplant recipient who developed recurrent cerebral Aspergillus fumigatus infection, and was successfully treated by combined surgical excision of the lesion and administration of liposomal amphotericin B. This first report of long-term complication-free survival in a liver transplant recipient suggests that therapy with liposomal amphotericin B may reduce the risk of recurrence of cerebral aspergillosis in these immunocompromised patients.

Published
1998

10. Epstein-Barr virus-associated post-transplant lympho-proliferative disease of donor origin in liver transplant recipients

Author

Chiara Menin, Rosa Maria Iemmolo, Emma D'Andrea, Alvise Maffei Faccioli, Mario Strazzabosco, Alessandro Poletti, Roberto Merenda, Annarosa Del Mistro, Laura Bonaldi, Daniele Neri, M. Montagna, Giorgio Enrico Gerunda, Barbara Corneo, Strazzabosco, M, Corneo, B, Iemmolo, R, Menin, C, Gerunda, G, Bonaldi, L, Merenda, R, Neri, D, Poletti, A, Montagna, M, Del Mistro, A, Faccioli, A, and D'Andrea, E

Subjects
Male, Herpesvirus 4, Human, Pathology, medicine.medical_specialty, medicine.medical_treatment, In situ hybridization, Liver transplantation, medicine.disease_cause, Herpesviridae, Virus, Cell Line, MED/12 - GASTROENTEROLOGIA, medicine, liver transpantation, epstein-barr virus, Humans, Gammaherpesvirinae, Southern blot, B-Lymphocytes, Hepatology, biology, business.industry, Herpesviridae Infections, Middle Aged, biology.organism_classification, Epstein–Barr virus, Lymphoproliferative Disorders, Tissue Donors, Liver Transplantation, Transplantation, Tumor Virus Infections, Immunology, Tomography, X-Ray Computed, business, Microsatellite Repeats
Abstract

Background/Aims: Post-transplant lymphoproliferative disease, a potential complication of solid organ transplantation, occurs in about 3% of orthotopic liver transplant recipients. We report the genetic and virological characterization of two cases of post-transplant lymphoproliferative disease that occurred early (4 and 6 months) after orthotopic liver transplant as large-cell non-Hodgkin's lymphomas located at the hepatic hilum. Methods: Lymphomatous tissues were analyzed for clonality and presence of Epstein-Barr virus (EBV) sequences by Southern blot, polymerase chain reaction, and in situ hybridization techniques. Results: The tumors in both cases were sustained by a clonal proliferation of B lymphocytes containing type A EBV DNA. Moreover, in situ hybridization with a digoxigenin-labeled EBV-specific probe evidenced a strong nuclear signal in most of the neoplastic cells. DNA microsatellite analysis at three different loci detected alleles of donor origin in both tumor samples, suggesting that the neoplastic B cells were of donor origin. Conclusions: EBV-infected donor B lymphocytes might be responsible for intragraft post-transplant lymphoproliferative disease in orthotopic liver transplant recipients. As 20 to 30% of post-transplant lymphomas involve the graft itself, donor-derived post-transplant lymphoproliferative disease might be more frequent than present appreciated. Prospective studies are needed to assess its real incidence and identify possible risk factors.

Published
1997

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