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1. 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial

Author

Halliday, A, Harrison, M, Hayter, E, Kong, X, Mansfield, A, Marro, J, Pan, H, Peto, R, Potter, J, Rahimi, K, Rau, A, Robertson, S, Streifler, J, Thomas, D, Fraedrich G, Asymptomatic Carotid Surgery Trial Collaborative G. r. o. u. p., Schmidauer, C, Hölzenbein, Th, Huk, I, Haumer, M, Kretschmer, G, Metz, V, Polterauer, P, Teufelsbauer, H, Cras, P, Hendriks, J, Lauwers, P, Van Schil, P, de Souza EB, Dourado, Me, Gurgel, G, Rocha, Gm, Petrov, V, Slabakov, G, Cooper, Me, Gubitz, G, Holness, R, Howes, W, Langille, R, Legg, K, Nearing, S, Mackean, G, Mackay, M, Phillips, Sj, Sullivan, J, Wood, J, Erdelez, L, Sosa, T, Angelides, Ns, Christopoulos, G, Malikidou, A, Pesta, A, Ambler, Z, Mracek, J, Polivka, J, Rohan, V, Sevcik, P, Simaná, J, Benes, V, Kramár, F, Kaste, M, Lepäntalo, M, Soinne, L, Cardon, Jm, Legalou, A, Gengenbach, B, Pfadenhauer, K, Wölfl, Kd, Flessenkämper, I, Klumpp, Bf, Marsch, J, Kolvenbach, R, Pfeiff, T, Sandmann, W, Beyersdorf, F, Hetzel, A, Sarai, K, Schöllhorn, J, Spillner, G, Lutz, Hj, Böckler, D, Maeder, N, Busse, O, Grönniger, J, Haukamp, F, Balzer, K, Knoob, Hg, Roedig, G, Virreira, L, Franke, S, Moll, R, Schneider, J, Dayantas, J, Sechas, Mn, Tsiaza, S, Kiskinis, D, Apor, A, Dzinich, C, Entz, L, Hüttl, K, Jàrànyi, Z, Mogan, I, Nagy, Z, Szabo, A, Varga, D, Juhász, G, Mátyás, L, Hutchinson, M, Mehigan, D, Aladjem, Z, Harah, E, Elmakias, S, Gurvich, D, Yoffe, B, Ben Meir, H, Dagan, L, Karmeli, R, Keren, G, Shimony, A, Weller, B, Avrahami, R, Koren, R, Streifler, Jy, Tabachnik, S, Zelikovski, A, Angiletta, D, Federico, F, Impedovo, G, Marotta, V, Pascazio, L, Regina, G, Andreoli, A, Pozzati, E, Bonardelli, S, Giulini, Sm, Guarneri, B, Caiazzo, P, Mascoli, F, Becchi, G, Masini, R, Santoro, E, Simoni, G, Ventura, M, Scarpelli, P, Spartera, C, Arena, O, Collice, M, Puttini, M, Romani, F, Santilli, I, Segramora, V, Sterzi, R, Deriu, G, Verlato, F, Cao, Pg, Cieri, Enrico, De Rango, P, Moggi, L, Ricci, S, Antico, A, Spigonardo, F, Malferrari, G, Tusini, N, Vecchiati, E, Cavallaro, A, Kasemi, H, Marino, M, Sbarigia, E, Speziale, F, Zinicola, N, Alò, Fp, Bartolini, M, Carbonari, L, Caporelli, S, Grili Cicilioni, C, Lagalla, G, Ioannidis, G, Pagliariccio, G, Silvestrini, M, Palombo, D, Peinetti, F, Adovasio, R, Chiodo Grandi, F, Mase, G, Zamolo, F, Fregonese, V, Gonano, N, Mozzon, L, Blair, R, Chuen, J, Ferrar, D, Garbowski, M, Hamilton, Mj, Holdaway, C, Muthu, S, Shakibaie, F, Vasudevan, Tm, Kroese, A, Slagsvold, Ce, Dahl, T, Johnsen, Hj, Lange, C, Myhre, Ho, Gniadek, J, Andziak, P, Elwertowski, M, Leszczynski, J, Malek, Ak, Mieszkowski, J, Noszczyk, W, Szostek, M, Toutounchi, S, Correia, C, Pereira, Mc, Akchurin, Rs, Flis, V, Miksic, K, Stirn, B, Tetickovic, E, Cairols, M, Capdevila, Jm, Iborra Ortega, E, Obach, V, Riambau, V, Vidal Barraquer, F, Vila Coll, R, Diaz Vidal, E, Iglesias Negreia JI, Tovar Pardo, A, Iglesias, Rj, Alfageme, Af, Barba Velez, A, Estallo Laliena, L, Garcia Monco JC, Gonzalez, Lr, Corominas, C, Julia, J, Lozano, P, Marti Masso JF, Porta, Rm, Carrera, Ar, Gomez, J, Blomstrand, C, Gelin, J, Holm, J, Karlström, L, Mattsson, E, Bornhov, S, Dahlstrom, J, De Pedis, G, Jensen, Sm, Pärsson, H, Plate, G, Qvarfordt, P, Arvidsson, B, Brattström, L, Forssell, C, Potemkowski, A, Skiöldebrand, C, Stoor, P, Blomqvist, M, Calander, M, Lundgren, F, Almqvist, H, Norgren, L, Norrving, B, Ribbe, E, Thörne, J, Gottsäter, A, Mätzsch, T, Nilsson, Me, Lonsson, M, Stahre, B, Stenberg, B, Konrad, P, Jarl, L, Lundqvist, L, Olofsson, P, Rosfors, S, Swedenborg, J, Takolander, R, Bergqvist, D, Ljungman, C, Kniemeyer, Hw, Widmer, Mk, Kuster, R, Kaiser, R, Nagel, W, Sege, D, Weder, B, De Nie, J, Doelman, J, Yilmaz, N, Buth, J, Stultiens, G, Boiten, J, Boon, A, van der Linden, F, Busman, Dc, Sinnige, Ha, Yo, Ti, de Borst GJ, Eikelboom, Bc, Kappelle, Lj, Moll, F, Dortland, Rw, Westra, Te, Jaber, H, Manaa, J, Meftah, Rb, Nabil, Br, Sraieb, T, Bateman, D, Budd, J, Horrocks, M, Kivela, M, Shaw, L, Walker, R, D'Sa, Aa, Fullerton, K, Hannon, R, Hood, Jm, Lee, B, Mcguigan, K, Morrow, J, Reid, J, Soong, Cv, Simms, M, Baird, R, Campbell, M, Cole, S, Ferguson, It, Lamont, P, Mitchell, D, Sassano, A, Smith, Fc, Blake, K, Kirkpatrick, Pj, Martin, P, Turner, C, Clegg, Jf, Crosley, M, Hall, J, De Cossart, L, Edwards, P, Fletcher, D, Rosser, S, Mccollum, Pt, Davidson, D, Levison, R, Bradbury, Aw, Chalmers, Rt, Dennis, M, Murie, J, Ruckley, Cv, Sandercock, P, Campbell, Wb, Frankel, T, Gardner Thorpe, C, Gutowski, N, Hardie, R, Honan, W, Niblett, P, Peters, A, Ridler, B, Thompson, Jf, Bone, I, Welch, G, Grocott, Ec, Overstall, P, Aldoori, Mi, Dafalla, Be, Bryce, J, Clarke, C, Ming, A, Wilkinson, Ar, Bamford, J, Berridge, D, Scott, J, Abbott, Rj, Naylor, R, Harris, P, Humphrey, P, Adiseshiah, M, Aukett, M, Baker, D, Bishop, Cc, Boutin, A, Brown, M, Burke, P, Burnand, Kg, Colchester, A, Coward, L, Davies, Ah, Espasandin, M, Giddings, Ae, Hamilton, G, Judge, C, Kakkos, S, Mcguiness, C, Morris Vincent, P, Nicolaides, A, Padayachee, Ts, Riordan, H, Sullivan, E, Taylor, P, Thompson, M, Wolfe, Jh, Mccollum, Cn, O'Neill, Pa, Welsh, S, Barnes, J, Cleland, P, Davis, M, Gholkar, A, Jones, R, Jaykishnam, V, Mendelow, Ad, O'Connell, Je, Siddique, Ms, Stansby, G, Vivar, R, Ashley, S, Cosgrove, C, Gibson, J, Wilkins, Dc, Chant, Ad, Frankel, J, Shearman, Cp, Williams, J, Hall, G, Holdsworth, R, Davies, Jn, Mclean, B, Woodburn, Kr, Brown, G, Curley, P, Loizou, L, Chaturvedi, S, Diaz, F, Radak, D, Todorovic, Pr, Kamugasha, D, Baxter, A, Berry, C, Burrett, J, Collins, R, Crowther, J, Davies, C, Farrell, B, Godwin, J, Gray, R, Harwood, C, Hirt, L, Hope, C, Knight, S, Lay, M, Munday, A, Murawska, A, Peto, Cg, Radley, A, Richards, S., Cras, Patrick, van Schil, Paul, et al., Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group, Halliday, A, Harrison, M, Hayter, E, Kong, X, Mansfield, A, Marro, J, Pan, H, Peto, R, Potter, J, Rahimi, K, Rau, A, Robertson, S, Streifler, J, Thomas, D, Adovasio, Roberto, and Asymptomatic Carotid Surgery Trial Collaborative, Group

Subjects
Male, Time Factors, medicine.medical_treatment, Kaplan-Meier Estimate, Carotid endarterectomy, Aged, 80 and over, Carotid Stenosis, Endarterectomy, Carotid, Female, Humans, Incidence, Middle Aged, Primary Prevention, Stroke, Treatment Outcome, Stroke/epidemiology, law.invention, Randomized controlled trial, law, Aged, 80 and over, Endarterectomy, Carotid, endarterectomy, Carotid Stenosis/mortality, Incidence (epidemiology), Carotid*/mortality, General Medicine, Carotid Stenosis | Internal Carotid Artery | Endarterectomy, medicine.symptom, medicine.medical_specialty, Asymptomatic, Internal medicine, asymptomatic carotid artery stenosi, medicine, asymptomatic carotid artery stenosis, business.industry, Carotid Stenosis/complications, Stroke/prevention & control, Perioperative, medicine.disease, Surgery, Stenosis, Human medicine, business
Abstract

SummaryBackgroundIf carotid artery narrowing remains asymptomatic (ie, has caused no recent stroke or other neurological symptoms), successful carotid endarterectomy (CEA) reduces stroke incidence for some years. We assessed the long-term effects of successful CEA.MethodsBetween 1993 and 2003, 3120 asymptomatic patients from 126 centres in 30 countries were allocated equally, by blinded minimised randomisation, to immediate CEA (median delay 1 month, IQR 0·3–2·5) or to indefinite deferral of any carotid procedure, and were followed up until death or for a median among survivors of 9 years (IQR 6–11). The primary outcomes were perioperative mortality and morbidity (death or stroke within 30 days) and non-perioperative stroke. Kaplan-Meier percentages and logrank p values are from intention-to-treat analyses. This study is registered, number ISRCTN26156392.Findings1560 patients were allocated immediate CEA versus 1560 allocated deferral of any carotid procedure. The proportions operated on while still asymptomatic were 89·7% versus 4·8% at 1 year (and 92·1% vs 16·5% at 5 years). Perioperative risk of stroke or death within 30 days was 3·0% (95% CI 2·4–3·9; 26 non-disabling strokes plus 34 disabling or fatal perioperative events in 1979 CEAs). Excluding perioperative events and non-stroke mortality, stroke risks (immediate vs deferred CEA) were 4·1% versus 10·0% at 5 years (gain 5·9%, 95% CI 4·0–7·8) and 10·8% versus 16·9% at 10 years (gain 6·1%, 2·7–9·4); ratio of stroke incidence rates 0·54, 95% CI 0·43–0·68, p

Published
2010
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2. Long-term mortality and its predictors in patients with critical leg ischemia

Author

Belgrano, Ea, Nardella, L, Ponzio, E, Nessi, E, Guala, A, Mazzucchetti, S, Graziano, L, Urban, I, Palombo, D, Brustia, P, Calzoni, D, Bellone, M, Altieri, M, Agus, Gb, De Angelis, R, Marrocu, R, Grossi, A, Frigerio, D, Biasi, Gm, Piglionica, Mr, Agrifoglio, G, Costantini, A, Della Vedova, Mr, Miglierina, L, Lavorato, E, Emanuelli, G, Rossi, R, Flandoli, C, Ponti, Gb, Berra, S, Losapio, Gm, Ambrosi, R, Inzoli, Mr, Lombardi, G, Tarantola, P, Zocca, N, Sforza, M, Russo, R, Tenchini, P, Bruni, T, Fontanili, M, Guidetti, D, Odero, A, Salvini, M, Pedeferri, G, Bordoni, Mc, Visconti, W, Vedovato, E, Bittolo Bon, G, Maffei, L, Marcon, G, Dell'Olivo, I, Gracco, L, Petralia, G, Cordiano, C, Dorucci, V, Pagnan, A, Visona', A, Tonietto, G, Agresta, E, Burigo, E, Giansante, C, Fiotti, N, Pamich, G, Santirocco, C, Mozzon, L, Gonano, N, Petrilli, Gl, Puzzo, A, Baldino, G, Podestà, A, Guastini, A, Traversaro, A, Zinicola, N, Baglietto, F, Borgatti, E, Filippini, M, Ferrari, E, Tuscano, G, Lonardi, R, Botta, Gc, Banchini, E, Pavarini, E, Delmonte, E, Bucherini, E, Moratti, A, Ieran, M, Bertini, D, Pratesi, C, Corsi, C, Pollastri, M, Marrapodi, E, Vanni, D, Ralli, L, Cecchi, M, Bigalli, A, Del Carratore, G, Mosca, E, Vatteroni, F, Setacci, C, Cao, Piergiorgio, Verzini, Fabio, Mannarino, Elmo, Pasqualini, L, Fedeli, E, Alò, E, Ioannidis, G, Spartera, C, Marino, G, Medori, M, Pola, P, Dal Lago, Aa, Di Giovanani, V, Colli, R, Maniscalco, G, Bartolo, M, Todini, Ar, Benedetti Valentini, E, Irace, L, Fiorani, P, Taurino, M, Marcialis, A, Valitutti, P, Vigliotti, G, Regina, G, Fullone, M, Rizzo, S, Rolli, E, Pascali, M, Lucentini, L, Grilli, M, Correra, H, Florena, M, Cassina, I, Notarbartolo, A, Belvedere, M, Andreozzi, Gm, Di Pino, L, Martini, R, Signorelli, S, Romeo, S, Cormaci, Of, Costanzo, C, Grasso, A, Avanzini, F, Bedoni, P, Bertele', V, Colombo, F, Fellin, G, Pangrazzi, J, Roncaglioni, Mc, Samori, G, Tognoni, G, De Gaetano, G, Garattini, S, and Tognoni, G.

Subjects
Critical leg ischaemia, Peripheral vascular disease, Mortality, Predictive variables
Published
1997

3. A prospective epidemiological survey of the natural history of chronic leg ischaemia. Evidence of the severity of prognosis and need for large-scale clinical trials

Author

Belgrano, Ea, Nardella, L, Ponzio, E, Nessi, E, Guala, A, Mazzucchetti, S, Graziano, L, Urban, I, Palombo, D, Brustia, P, Calzoni, D, Bellone, M, Altieri, M, Agus, Gb, De Angelis, R, Marrocu, R, Grossi, A, Frigerio, D, Biasi, Gm, Piglionica, Mr, Agrifoglio, G, Costantini, A, Della Vedova MR, Miglierina, L, Lavorato, E, Emanuelli, G, Rossi, R, Flandoli, C, Ponti, Gb, Berra, S, Losapio, Gm, Ambrosi, R, Inzoli, Mr, Lombardi, G, Tarantola, P, Zocca, N, Sforza, M, Russo, R, Tenchini, P, Bruni, T, Fontanili, M, Guidetti, D, Odero, A, Salvini, M, Pedeferri, G, Bordoni, Mc, Visconti, W, Vedovato, E, Bittolo Bon, G, Maffei, L, Marcon, G, Dell'Olivo, I, Gracco, L, Petralia, G, Cordiano, C, Dorucci, V, Pagnan, A, Visona', A, Tonietto, G, E Favretti E, Agresta, Burigo, E, Giansante, C, Fiotti, N, Pamich, G, Santirocco, C, Mozzon, L, Gonano, N, Petrilli, Gl, Puzzo, A, Baldino, G, Podestà, A, Guastini, A, Traversaro, A, Zinicola, N, Baglietto, F, Borgatti, E, Filippini, M, E Ridolfi Coppi G, Ferrari, Tuscano, G, Lonardi, R, Botta, Gc, Banchini, E, Pavarini, E, Delmonte, E, Bucherini, E, Moratti, A, Ieran, M, Bertini, D, Pratesi, C, Corsi, C, Pollastri, M, Marrapodi, E, Vanni, D, Ralli, L, Cecchi, M, Bigalli, A, Del Carratore, G, Mosca, E, Vatteroni, F, Setacci, C, Cao, P, Verzini, F, Mannarino, E, Pasqualini, L, Fedeli, E, Alò, E, Ioannidis, G, Spartera, C, Marino, G, Medori, M, Pola, P, Dal Lago AA, Di Giovanani, V, Colli, R, Maniscalco, G, Bartolo, M, Todini, Ar, Benedetti-Valentini, E, Irace, L, Fiorani, P, Taurino, M, Marcialis, A, Valitutti, P, Vigliotti, G, Regina, G, Fullone, M, Rizzo, S, Rolli, E, Pascali, M, Lucentini, L, Grilli, M, Correra, H, Florena, M, Cassina, I, Notarbartolo, A, Belvedere, M, Andreozzi, Gm, Di Pino, L, Martini, R, Signorelli, S, Romeo, S, Cormaci, Of, Costanzo, C, Grasso, A, Avanzini, F, Bedoni, P, Bertele', V, Colombo, F, Fellin, G, Pangrazzi, J, Roncaglioni, Mc, Samori, G, Tognoni, G, De Gaetano, G, and Garattini, S

Subjects
Epidemiology, Critical leg ischaemia, Peripheral vascular disease
Published
1996

4. Rationale and methodology of the ICAI study, a randomised clinical trial of alprostadil in the treatment of chronic critical leg ischemia

Author

Belgrano, Ea, Nardella, L., Guala, A., Mazzucchetti, S., Marinoni, V., Calzoni, D., Bedoni, P., Confalonieri, Ma, Agus, Gb, Mondani, P., Deangelis, R., Biasi, Gm, Piglionica, MR, Abbritti, F., Agrifoglio, G., Costantini, A., DellaVedova, MR, Miglierina, L., Marrocu, R., Bragherio, G., Zanoni, Ce, Borin, F., Alderi, G., Emanuelli, G., Flandoli, C., Colzani, M., Ponti, Gb, Berra, S., Bevilacqua, A., Bocca, M., Invernizzi, C., Deangelis, E., Tacconi, A., Dangelo, F., Vaghi, M., Arzini, A., Boccalon, L., Losapio, Gm, Ambrosi, R., Briolini, F., Inzoli, MR, Lombardi, G., Tarantola, P., Zocca, N., Tenchini, P., Bruni, T., Fontanili, M., Guidetti, D., Pedeferri, G., Bordoni, Mc, Catalano, A., Visconti, W., Vedovato, F., Zucchella, M., Bittolo, Bg, Busetto, Mt, Zambon, C., Carlassara, Gb, Barbato, O., Zambelli, V., Mazzilli, G., Lino, M., Pavan, S., Pagnan, A., Visona, A., Perissinotto, C., Tonietto, G., Michelet, I., Agresta, F., Favretti, F., Burigo, E., Delazzer, L., Giansante, C., Fiotti, N., Grego, S., Mozzon, L., Gonano, N., Pfeiffer, P., Petrilli, Gl, Puzzo, A., Giuseppe Baldino, Podesta, A., Guastini, A., Traversaro, A., Zinicola, N., Baglietto, F., Arnuzzo, L., Defabritiis, A., Filippini, M., Ferrari, F., Martini, L., Testoni, P., Accorsi, F., Maurizi, P., Evangelisti, G., Roffi, A., Marzara, G., Fini, C., Coppi, G., Camparini, S., Tusini, N., Tuscano, G., Lonardi, R., Rozza, A., Botta, Gc, Villani, Lg, Pavarini, E., Campanella, P., Moratti, A., Ieran, M., Bertini, D., Pratesi, C., Narcetti, S., Corsi, C., Pollastri, M., Marrapodi, E., Melillo, E., Iabichella, Ml, Setacci, C., Sozio, G., Cao, P., Verzini, F., Mannarino, E., Pasqualini, L., Vaudo, G., Alo, F., Ioannidis, G., Spartera, C., Marino, G., Bafile, G., Anselmi, E., Maniscalco, G., Longo, P., Digiovanni, V., Colli, R., Fabbri, Mc, Bracale, G., Bernardo, B., Perretti, B., Valitutti, P., Vigliotti, G., Cimino, G., Rolli, F., Pascali, M., Sabella, G., Grilli, M., Correra, M., Palese, E., Florena, M., Cassina, I., Cumbo, P., Comande, C., Notarbartolo, A., Novo, S., Belvedere, M., Caruso, R., Verghi, F., Cavallaro, S., Martello, G., Romeo, S., Cormaci, Of, Binaghi, F., Fronteddu, P., Cannas, F., Degaetano, G., Tognoni, G., Avanzini, F., Bertele, V., Digiulio, P., Pangrazzi, J., Roncaglioni, Mc, Colombo, F., Fellin, G., Terzian, E., Coccheri, S., Delfavero, A., Geraci, E., Janzon, L., Vermylen, J., Beghi, E., Coen, D., and Turazza, F.

5. 'Hot phase' non-dilated left ventricular cardiomyopathy with atypical onset and recurrence: a case report.

Author

Gonano N, Nuzzi V, Pavan D, Piazza R, Pecoraro R, Altinier A, Bussani R, Sinagra G, and Merlo M

Subjects
Humans, Female, Adult, Echocardiography, Electrocardiography, Heart Ventricles diagnostic imaging, Heart Ventricles physiopathology, Myocardium pathology, Recurrence, Magnetic Resonance Imaging, Cine methods
Abstract

Non-dilated left ventricular cardiomyopathy (NDLVC) is a newly categorized cardiomyopathy phenotype includingseveral aetiologies with a linking characteristic represented by the normal left ventricular volume. Inflammatory heart disease (InHD) is a heterogeneous process with variegate clinical manifestations, sometimes in overlap with NDLVC. A 26-year-old woman was admitted forcomplete heart block (CHB) and persistently raised troponin. Echocardiography and coronary angiography were normal. Extensive oedema and late gadolinium enhancement was found at cardiac magnetic resonance. Endomyocardial biopsy showed no signs of active myocarditis. Steroid therapy was started with restoration of atrioventricular conduction but subsequently the patient experienced a mild recurrence with a new troponin relapse. Genetic test was negative for mutations related with the clinical scenario. In this case of NDLVC with InHD the precise diagnostic work-up, including genetic test, was crucial for diagnostic, prognostic andtherapeutic purposes. Multimodality approach is crucial to detect and treat possible recurrences., (© 2024 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Published
2024
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6. Prognostic power of pre- and postoperative B-type natriuretic peptide levels in patients undergoing abdominal aortic surgery.

Author

Vetrugno L, Costa MG, Pompei L, Chiarandini P, Drigo D, Bassi F, Gonano N, Muzzi R, and Della Rocca G

Subjects
Aged, Aortic Aneurysm, Abdominal blood, Female, Humans, Length of Stay, Male, Middle Aged, Peptide Fragments blood, Postoperative Period, Predictive Value of Tests, Preoperative Period, Prognosis, Prospective Studies, Troponin I blood, Aorta, Abdominal surgery, Aortic Aneurysm, Abdominal surgery, Natriuretic Peptide, Brain blood
Abstract

Objectives: The first aim of the present study was to evaluate the pre- and postoperative B-type natriuretic peptide (BNP) levels in patients undergoing surgery for repair of an infrarenal abdominal aortic aneurysm (AAA) and analyze their power as a predictor of in-hospital cardiac events. The second aim was to evaluate the association among pre- and postoperative BNP levels, postoperative patient complications, and length of hospital stay., Design: Prospective observational study., Setting: A university hospital., Participants: Forty-five patients undergoing elective surgery for an abdominal aortic aneurysm., Interventions: The plasma BNP level was assessed just before surgery and then on postoperative day 1. Cardiac troponin I levels were measured postoperatively on arrival to the intensive care unit (time 0) and then 12, 48, and 72 hours later., Measurements and Main Results: The preoperative BNP concentration in patients who developed an acute myocardial infarction was 209 (IQR 84-346) pg/mL compared with 74 (IQR 28-142) pg/mL in those who did not. The difference between groups was statistically significant (p = 0.04). The Spearman correlation showed that postoperative BNP levels correlated significantly with preoperative BNP levels (r = 0.73, p = 0.0001), length of hospital stay (r = 0.35, p = 0.04), and troponin I concentration at 0 hour (r = 0.42, p = 0.02), 12 hours (r = 0.51, p = 0.0052), and 48 hours (r = 0.40, p = 0.033). In contrast, preoperative BNP levels correlated with troponin I at only 12 hours (r = 0.34, p = 0.02). Postoperative BNP levels were influenced significantly by transfusions (p = 0.035) and cross-clamping times (p = 0.038)., Conclusions: The present results confirm the high negative predictive value of preoperative BNP levels; and postoperative BNP levels showed a better correlation with postoperative troponin levels, blood transfusion, and postoperative cardiac events., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Published
2012
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7. Prothrombin complex concentrate such as therapy and prophylaxis in factor X-deficient patient (Friuli variant).

Author

Barillari G, Pasca S, Gonano N, and Daminato R

Subjects
Aged, Humans, Male, Treatment Outcome, Factor X Deficiency drug therapy, Prothrombin therapeutic use
Abstract

Background: Factor X (FX) deficiency is a serious, rare bleeding disorder, with 1 in 500 000 affected people. Hemorrhages, hematuria, epistaxis, and other bleeding complications are frequent., Case Report: Now, we report a case of a well-known 77-year-old FX-deficient patient (Friuli variant, level <1%, mutation Pro(343)→Ser, exon VIII) with hypertension, chronic obstructive pulmonary disease (COPD), and chronic gastritis, admitted many times to hospital due to surgical complications after aortic abdominal aneurysm (AAA) repair. Use of prothrombin complex concentrate (PCC) such as hemostatic therapy during surgeries and prophylaxis after discharge is shown in this article. Three consecutive surgeries were considered. First, endoleak postendoprosthesis; second, AAA breakage; and third, planned surgery, a new endovascular prosthesis positioning and femur-femoral bypass. No adverse events due to PCC were found by local physicians., Discussion: We discuss the methods commonly used in the treatment and prophylaxis of patients with FX deficiency to reduce hemorrhagic risk and to improve their quality of life., Conclusion: Waiting for specific therapeutic options for FX deficiency, currently, the best treatment is represented by PCC. Its correct use permits an improvement in life quality and a reduction in bleeding frequency in FX-deficient patients.

Published
2011
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8. Wake-up test decrease shunts insertion during carotid endarterectomy under general anesthesia.

Author

Vetrugno L, Di Luca E, Drigo D, Fregonese V, Gonano N, and Giordano F

Subjects
Aged, Aged, 80 and over, Anesthetics, Intravenous administration & dosage, Blood Pressure, Blood Pressure Determination, Carotid Stenosis physiopathology, Cerebrovascular Circulation, Cerebrovascular Disorders etiology, Cerebrovascular Disorders physiopathology, Cerebrovascular Disorders prevention & control, Female, Humans, Logistic Models, Male, Middle Aged, Piperidines administration & dosage, Predictive Value of Tests, Propofol administration & dosage, Remifentanil, Reproducibility of Results, Respiration, Artificial, Retrospective Studies, Risk Assessment, Anesthesia, General adverse effects, Anesthesia, General methods, Carotid Stenosis surgery, Cerebrovascular Disorders diagnosis, Endarterectomy, Carotid adverse effects, Monitoring, Intraoperative methods, Neurologic Examination, Wakefulness
Abstract

Objective: The use of locoregional anesthesia versus general anesthesia (GE) in carotid endarterectomy (CEA) has been a debatable issue in clinical studies for the past several years. In our study, GE with wake-up tests (WUTs) during carotid cross-clamping was used instead of stump pressure (SP) to directly assess the neurological status of the patient to determine whether shunting was needed. Our study assessed the percentage of patients under light sedation and mechanically ventilated needing shunting based on WUT compared to a systolic stump pressure (SPs) cutoff value of

Published
2010
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9. American College of Cardiology/American Heart Association perioperative assessment guidelines for noncardiac surgery reduces cardiologic resource utilization preserving a favourable clinical outcome.

Author

Cinello M, Nucifora G, Bertolissi M, Badano LP, Fresco C, Gonano N, and Fioretti PM

Subjects
Algorithms, Elective Surgical Procedures, Humans, Outcome Assessment, Health Care, Risk Assessment, Societies, Medical, Heart Diseases prevention & control, Practice Guidelines as Topic, Vascular Surgical Procedures
Abstract

Objectives: The American College of Cardiology (ACC) and the American Heart Association (AHA) provided perioperative evaluation and management guidelines for assessing cardiac risk in noncardiac surgery. Even if previously validated as safe and effective in risk stratification, there is often a gap between clinical practice and the recommendations of the ACC/AHA guidelines. We evaluated the impact of strict application of ACC/AHA guidelines for cardiac risk assessment of patients undergoing elective noncardiac vascular surgery in a consultant anaesthesiologist-led preoperative clinic., Methods: One hundred and sixty-four consecutive patients who underwent elective vascular surgery after ACC/AHA guidelines implementation (from September 2004 to May 2005) were enrolled in the study and compared with a historical group of 166 patients operated from April 2002 to September 2002. Preoperative resources utilization (cardiologic consultations, non-invasive diagnostic tests, coronary angiograms, coronary revascularizations) and clinical events [all-cause death, acute myocardial infarction (AMI) and acute myocardial ischaemia] occurring within 30 days after surgical procedure were compared., Results: Guidelines implementation reduced preoperative cardiologic consultations by 21% (P < 0.001) and preoperative non-invasive diagnostic testing by 11% (P = 0.01), and increased utilization of preoperative beta-blockers by 13% (P = 0.01). Preoperative coronary angiograms (2% versus 4%) and coronary revascularizations (3% versus 2%) and all-cause death (1% versus 2%), AMI (2% versus 1%) and acute myocardial ischaemia (4% versus 2%) during follow-up were similar in both groups., Conclusions: Implementation of the ACC/AHA guidelines for cardiac risk assessment prior to noncardiac surgery in a consultant anaesthesiologist-led preoperative clinic reduced preoperative resources utilization, improved medical treatment and preserved a low rate of perioperative cardiac complications.

Published
2007
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10. Stent-grafting of the thoracic aorta: feasibility and early results in acute and chronic lesions.

Author

Livi U, Piccoli G, Ciccarese G, Vendramin I, Frassani R, Vit A, Sponza M, Marzio A, Gonano N, and Gasparini D

Subjects
Acute Disease, Adult, Aged, Aortic Dissection pathology, Aortic Dissection surgery, Aorta, Thoracic injuries, Aorta, Thoracic pathology, Aortic Diseases mortality, Aortic Diseases pathology, Blood Vessel Prosthesis Implantation adverse effects, Chronic Disease, Coronary Artery Disease complications, Feasibility Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Radiography, Interventional, Treatment Outcome, Ulcer etiology, Ulcer pathology, Ulcer surgery, Ultrasonography, Interventional, Aorta, Thoracic surgery, Aortic Diseases surgery, Blood Vessel Prosthesis, Stents
Abstract

Background and Aims: Conventional surgery of the thoracic aorta is frequently associated with significant mortality and morbidity. Here we present treatment of surgical pathologies of the thoracic aorta using a less invasive endovascular approach., Methods: From January 2000 to May 2004, 51 patients (mean age 62.7 +/- 12.8 years, 36 men) underwent endovascular repair of thoracic aortic lesions in our institution. All patients underwent computed tomography scan at discharge, 6 and 12 months and annually thereafter. Clinical follow-up was carried out by outpatient clinic visit or by telephone contact with the patients or their referring physicians. Mean follow-up was 15.8 months., Results: The 30-day mortality rate was 3.8%, one death in the group of chronic (1.9%) and one in the group of acute lesion (1.9%). The survival rate in the follow-up period was 92.4% at 6 months. Computed tomography angiography confirmed exclusion of the lesion in 25 out of 27 chronic patients, whereas type I and II endoleaks were detected in two patients treated with a secondary procedure. In addition, two patients with an acute type B aortic dissection presented with early endoleaks. The overall rate of complications was 10%. No other endoleaks or deaths were observed at later follow-up., Conclusions: The early and mid-term results of endovascular stent-grafting for the treatment of chronic and acute thoracic aortic diseases showed a good outcome and low rate of complications. Stent-grafting of the thoracic aorta is still an investigational procedure that needs further validation.

Published
2007
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11. [Leiomyosarcoma of the great veins: a case involving the left iliac vein extending to the inferior vena cava].

Author

Biasi G, Gonano N, Santarelli R, Fregonese V, Andolfato G, Pfeiffer P, and Nozzon L

Subjects
Aged, Biopsy, Needle, Female, Humans, Magnetic Resonance Imaging, Thrombectomy, Thrombophlebitis diagnosis, Thrombophlebitis surgery, Tomography, X-Ray Computed, Vascular Diseases complications, Vascular Diseases diagnosis, Vascular Diseases surgery, Femoral Vein, Iliac Vein, Leiomyosarcoma complications, Leiomyosarcoma diagnosis, Leiomyosarcoma surgery, Soft Tissue Neoplasms complications, Soft Tissue Neoplasms diagnosis, Soft Tissue Neoplasms surgery, Thrombophlebitis etiology, Vena Cava, Inferior
Abstract

Large veins LMS is a rare slow growing malignant tumor originating from smooth muscle cells of the media. The authors report a case of LMS of the left common iliac vein propagating to the Inferior Vena Cava that presented with a left femoral-iliac deep thrombophlebitis. CT scan showed an uneven solid mass approximately 5 cm large within the left side of the pelvis. The mass displaced the left iliac artery and compressed the left iliac vein without a significant cleavage surface between the mass itself and the vascular structures. Location was next to the spine, medially and anteriorily to the psoas muscle. A thrombosis could be noticed within the distal segment of the inferior Vena Cava and within the proximal segment of the left iliac vein. US scan with fine needle biopsy of the mass didn't yield significant information. At surgical exploration a neoplastic mass involving and blocking the left iliac vein was found. Veinotomy performed on the iliac vein and on the distal segment of the Inferior Vena Cava but without infiltration of the vein walls. Surgical treatment consisted of asportation of the neoplastic mass, resection of the left iliac vein and thrombectomy of the Inferior Vena Cava. Histologic examination of the operated specimen revealed a mixoid LMS with vascular origin without involvement of the surrounding lymph nodes. Absence of clinical and radiological signs of relapse eight months after surgery makes further surgical and complementary (drug- and radiotherapy) treatments currently unnecessary.

Published
1993

12. Surgical management of intraluminal carotid thrombi.

Author

Fregonese V, Gonano N, Santarelli R, Biasi G, Andolfato G, Pfeiffer P, and Mozzon L

Subjects
Aged, Carotid Arteries diagnostic imaging, Carotid Artery Thrombosis diagnostic imaging, Humans, Male, Middle Aged, Radiography, Carotid Artery Thrombosis surgery, Cerebral Revascularization
Abstract

The most suitable treatment for intraluminal carotid thrombi remains still a much debated question. Some authors have reported a lower morbidity in patients treated with anticoagulant or antiplatelet therapy; on the other side, urgent or delayed surgery is burdened with a high risk of perioperative stroke. Over 11 years (october 1981-november 1992) 602 surgical revascularizations on epi-aortic vessels have been performed at Vascular Surgery Unit of Udine Regional Hospital. Only 2 cases of intraluminal carotid thrombi were observed: both fulfilled the angiographic requirements for endovasal filling defect, surrounded by contrast medium, adherent to posterior wall and extending to distal internal carotid artery. First patient suffered a TIA 20 days before surgery, the second one a previous major stroke contralateral to the thrombus. The former was given preoperatively a medical anticoagulant treatment (warfarin). At operation we discovered a nearly complete resolution of the thrombus: only its adherent base was still present. Therefore we performed a routine endarterectomy and a PTFE patch angioplasty. The latter case reported had no preliminary medical treatment; a thrombus extending from carotid bulbus to external and internal carotid was detected and then removed without any distal embolization. Arteriotomy was closed by Dacron Velour patch angioplasty. No perioperative stroke occurred in both cases: our second patient showed a partial resolution of his motility deficit. According to our limited experience, delayed surgical treatment of intraluminal carotid thrombi seems not to be affected with higher risk of perioperative stroke than prophylactic carotid endarterectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Published
1993

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