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Objective: To evaluate 31 patients suffering from drug resistant neuropathic pain due to only one peripheral nerve damage and treated by new dedicated device for peripheral nerve stimulation (PNS). Materials and Methods: The evaluation was on pain using the Numeric Rating Scale (NRS) and on mental status component (MSC) using the SF-36 at baseline and at median follow-up (18 months) after implant. Results: The NRS baseline score was 8.9 ± 1.1 and at last follow-up 3.6 ± 2.2 with an improvement of the 59.7% (p < 0.001); the MSC of the SF-36 started fron a baseline score of 36.4 ± 11.5 to a follow-up score of 45 ± 9.6 (p < 0.05) with improvement of the 23.8%. Conclusions: This new device has been able to improve statistically the NRS and the MCS of the SF-36 scores with a clinical reduction of the pain and an increase of the mental status. [ABSTRACT FROM AUTHOR]

Background and Aim: Individuals with ischemia during cardiac stress-test (cST) have a high risk of developing myocardial infarction (MI), but the pathophysiologic mechanism has never been clarified. It is thought that non flow-limiting coronary plaques (FLP) cause more often MI than FLP, but this is in contradiction with the predictive value of cST. We investigated the correspondence between reversible ischemia and location of subsequent MI, since functional assessment shortly before MI could clarify whether the culprit plaque is a FLP or not., Methods: From 4505 MI and 4959 cST -2017 contrast perfusion stress-echo (cDipSE) and 2942 scintigraphy (SPECT)- performed from 2007 to 2011- 25 patients fulfilling criteria (<3 months between cST and subsequent MI, angiography within 72 hours of symptoms onset and no revascularization between cST and MI) were extracted and data matched. Reversible perfusion defects were considered the endpoint to define a positive cST., Results: Reversible perfusion defects on cST were found in 84% of patients (21/25) and 80% (20/25) had matched defects; 95% (20/21) of patients demonstrating a reversible defect had a subsequent MI in the same territory., Conclusion: Our data suggest that when cST-MI time is shortened, and plaque progression bias consequently minimized, most MI (80%) develop in the coronary territory where reversible perfusion defects were detected shortly before. These data encourage reconsidering FLP as main determinant of MI.

Background and Aim: According to the published data and guidelines the diagnosis of pericarditis is mainly clinical; if we exclude patients with pericardial effusion, no single study has been able to relate specific echocardiographic findings to acute pericarditis. We hypothesized that pericardial hyperechogenicity and a defined finding that we named "pericardial comets", in analogy to lung comets, may be associated with acute pericarditis., Methods: We retrospectively analysed the echocardiograms of patients aged <50 y/o with a confirmed pericarditis diagnosis and compared them with 2 prospectively healthy controls groups (either < or > 50 y/o) to detect a potential association of pericardial hyperechogenicity and/or pericardial comets with acute pericarditis., Results: Comparison between the pericarditis and the control groups did not evidence significant differences regarding the prevalence of hyperechogenicity and pericardial comets when comparing patients with pericarditis and age-matched controls (younger than 50 years); the group of elderly healthy controls (>50 y/o) showed significantly lower prevalence of pericardial hyperechogenicity (p<0.001) and comets (p<0.001), compared with the other 2 groups. A significantly higher number of patients with pericarditis demonstrated ≥2 pericardial comets compared with age-matched controls (68% vs 48%, p=0.042)., Conclusion: The echocardiographic prevalence of both pericardial hyperechogenicity and comets per patient is heavily influenced by age (inversely proportional), but the presence of at least 2 pericardial comets is significantly more frequent in patients with pericarditis than in healthy aged-matched controls. Nonetheless, this echocardiographic finding may have limited clinical usefulness, due to the frequent detection of ≥2 comets in healthy young subjects also.

Aim: To assess the predictive value of CT coronary angiography (CT-CA) in the stratification of patients with acute chest pain., Materials and Methods: We enrolled 48 patients (31 males and 17 females, mean age 61.0 +/- 14yrs) with acute chest pain of suspected coronary origin, without diagnostic alterations of the ECG and/or increase of the myocardial biomarkers. Sixty-four slice CT-CA was performed within 48-72 hours. Depending on the clinical judgment, the patients were dismissed or underwent conventional coronary angiography (CAG). Patients underwent clinical follow-up at 6 months, recording the prevalence of major cardiovascular events., Results: One patient was excluded from the analysis because of poor image quality. CT-CA showed no coronary artery disease in 38.3% (18/47) of the patients, no significant coronary artery disease (<50% lumen reduction) in 31.9% (15/47) of the patients, significant coronary artery disease (> or = 50% lumen reduction) in 29.8% (14/47) of the patients. In 87.2% (41/47) of the patients no indication for CAG was present. In 6 (12,8%) patients with significant stenosis at CT-CA indication for CAG was present. In 50% (3/6) of these patients, CAG showed no significant coronary artery disease and in the remaining 50%(3/6) CAG was followed by percutaneous coronary angioplasty. At follow-up no major cardiovascular events were observed., Conclusions: CT-CA showed high sensitivity for the detection of significant coronary artery disease and a negative predictive value at 6-month follow-up.

Objective: To evaluate the diagnostic accuracy of 64-slice computed tomography (CT) coronary angiography (CA) for the detection of significant coronary artery stenosis (> or = 50% lumen reduction) as compared to invasive coronary angiography (ICA) in a population of patients with chest pain and high risk., Materials and Methods: 44 patients (30 male; mean age 60.2+/- 12.1 yrs) with chest pain were prospectively enrolled. In patients with heart rate > or = 70 bpm an oral dose of 100 mg of beta-blocker was administered. For CT-CA (Sensation 64, Siemens, Germany) an intravenous bolus of 100 ml of iodinated contrast material (Iomeron 400, Bracco, Italy) was injected. The average scan time was 13.3 +/- 0.9s. Two observers evaluated CT-CA vs. ICA as a reference standard for the detection of significant (> or = 50% lumen reduction) coronary artery stenosis., Results: ICA demonstrated the absence of coronary artery disease (CAD) in 13.6% of the patients (6/44), the presence of non significant CAD 4.6% (2/44), single vessel disease in 27.2% (12/44) and multi-vessel disease in 54.6% (24/44) of the patients. None of the patients was excluded from the study population. Ninety-three significant obstructive coronary lesions were observed. Sensitivity, specificity, positive and negative predictive value of CT-CA were 98.6% (70/71), 92.4% (97/105), 89.7% (70/78) and 99% (97/98), respectively. All patients with at least one significant coronary lesion were correctly identified by CT-CA., Conclusions: CT-CA is a reliable alternative to ICA in a selected population of patients with chest pain and high risk.

The introduction of the multislice computed tomography (MSCT) scanners and their application to coronary imaging has created a new clinical imaging field. Even though MSCT coronary angiography has been reported to be able to detect significant stenoses with very high diagnostic accuracy, the clinical implementation is still difficult and the users are having difficulties in reproducing the results in literature, partly due to the limited experience in the field of coronary MSCT. Several details can be overlooked so that diagnostic mistakes are possible. In this paper we tried to collect a series of technical "tips and tricks" that might improve the quality of coronary imaging in the clinical practice.

Non-invasive coronary artery imaging challenges any diagnostic modality, because of the complex and tortuous anatomy and cardiac contraction and respiration. Therefore, non-invasive coronary imaging requires high spatial and temporal resolution. Our purpose is to discuss the feasible applications in coronary imaging of Magnetic Resonance Imaging and Multi-slice Computed Tomography (MSCT). Focus will be devoted to potential indications and clinical impact of MSCT because of the fast development and the important results recently reported, in particular with the recent introduction of 64-slice equipments. MSCT of the coronary arteries is a promising imaging modality for the assessment of coronary lumen and wall.

Background and Aims of the Study: The study aim was to evaluate the operative risks of reoperation on heart valve prostheses., Methods: Between January 1985 and December 2000, 154 patients (79 males, 75 females, mean age 61.2+/-9.5 years) underwent cardiac valve reoperation for which indications were prosthetic failure (n = 133; prosthetic mitro-aortic dysfunction occurred in 16 cases), native valve disease in patients with a previous prosthetic valve implantation (n = 12), and both situations concomitantly (n = 9). Total valve replacements numbered 161 (64 in the aortic position, 96 in the mitral position, and one in the tricuspid position). There were 18 valve repairs (eight in the mitral position, 10 in the aortic position). One patient underwent prosthesis thrombectomy (mechanical valve)., Results: Overall operative mortality was 8.4% (n = 13); emergency operation (p <0.002), advanced NYHA class (p <0.026), indication for reoperation (p <0.026), gender (p <0.016) and number of previous reoperations (p = 0.05) were independent determinants for reoperation. Non-significant determinants were age and position of replacement., Conclusion: Correct planning of reoperation timing reduces operative risks due to NYHA class (3.8% mortality rate for class II-III versus 21.7% for class IV), and to urgent-emergency procedures (35.7% mortality versus 6.5% for elective operations). The high operative risk of prosthesis thrombosis is a deterrent to implanting mechanical prostheses in patients with disorders of hemostasis.