Multimodality Imaging for Diagnosis and Characterization of a Cardiac Hydatid Cyst.

Here, we report the case of a young patient admitted to the emergency department because of abdominal pain. Computed tomography revealed a mass within her right heart. Through serial multimodality imaging testing, including computed tomography, three-dimensional (2D)- and three-dimensional echocardiography, as well as cardiac magnetic resonance, the diagnosis of cardiac involvement in the course of Echinococcus granulosus infection was hypothesized.

Early 'in-lab' use of levosimendan in patients with cardiogenic shock unsuitable for intra-aortic balloon pump counterpulsation.

Intra-aortic balloon pump counterpulsation is currently the most used mechanical assistance device for patients with cardiogenic shock due to acute myocardial infarction. However, a recently published meta-analysis and trial failed to confirm previous knowledge. We report the results of four patients with ST elevation myocardial infarction, complicated by cardiogenic shock unsuitable for intra-aortic balloon pump counterpulsation treated with early levosimendan infusion during primary percutaneous coronary intervention.

"Primary" percutaneous transluminal renal angioplasty for late stent thrombosis.

Renal artery thrombosis is a rare, but serious and often misdiagnosed, condition, with poor prognosis and renal functional impairment. As for the rarity of the occurrence, data about real incidence of renal stent thrombosis are lacking, ranging from 0 to 1 % depending on the study evaluated. We report the case of a 43-year-old man with nephrovascular hypertension, previously treated with renal stent implantation, with a late stent thrombosis. The diagnostic and subsequent therapeutic management was analyzed and discussed.

Pharmacoeconomic impact evaluation of statin adherence in high-risk unselected post myocardial infarction population: an administrative database-guided analysis.

BACKGROUND: The compliance to statins in secondary prevention is very low, increasing health-care costs principally for rehospitalization. OBJECTIVES: To evaluate the cost of lack of persistence to statin therapy together with identification and cost-estimation of poor compliance. METHODS: Retrospective observational study starting from administrative database analysis of statin prescription after myocardial infarction. RESULTS: Among 463 patients enrolled, 25.1% were never treated, 70.8% received statins regularly; 14.9% received only 1-2 prescriptions (spot prescription), and 12% were occasional users. Among the 288 nonoccasional users, we found a compliance rate of 80% only in the 59.7%. The cost analysis shows that 59.787,72 euros (23.4%) have been spent for patients with compliance of less than 80% (ineffective adherence). CONCLUSIONS: As the lower compliance affects the health-care costs, the identification of occasional users and spot prescriptions of the nonoccasional users, has a potential role in reducing medical expense with limited increase in costs.

Transulnar sheathless percutaneous coronary intervention during bivalirudin infusion in high-risk elderly female with non-ST segment elevation myocardial infarction.

Due to the ageing population and raised life expectancy, elderly patients are increasingly referred for percutaneous coronary intervention (PCI) during acute coronary syndromes (ACS). Bleeding complications are not infrequent during ACS, occurring in 2-5% of patients with prognostic and economic consequences. In particular, periprocedural bleeding and vascular complications are associated with worse clinical outcome, prolonged hospital stay and increased short- and long-term mortality, especially in elderly patients with acute coronary syndromes. We report the case of an 83-year old female referred to our hospital because of non-ST segment elevation myocardial infarction with high bleeding risk and unsuitable radial artery undergoing tran-sulnar sheathless PCI during bivalirudin infusion. The clinical, technical, pharmacological and prognostic implications are discussed.

Simultaneous transradial coronary and renal in stent restenosis treatment in diabetic patient with NSTEMI complicated by hypertensive emergency.

The elderly diabetic patients are increasingly referred for percutaneous coronary interventions during acute coronary syndromes. A nonegligible proportion of this population includes the in stent restenosis as a possible cause of ischemic syndrome. This population accounts an higher risk of ischemic, bleeding and vascular complications affecting the periprocedural management, the length of hospital stay and also the prognosis. The improvement of strategies concerning site of access choice, antithrombotic drug and timing of interventional treatment have significantly reduced the incidence of complications. This paper reports the case of a 76 years-old diabetic female with a high bleeding risk, referred to our hospital because of NSTEMI complicated by pulmonary edema during hypertensive emergency. The patient had a simultaneous in stent restenosis both in left descending coronary artery and left renal artery, undergoing percutaneous transradial treatment during bivalirudin infusion. The clinical, technical, pharmacological and prognostic implications are discussed.

Diffuse coronary ectasia complicated by myocardial infarction in a patient with multiple sclerosis-transradial dethrombosis and one-year coronary computed tomography angiography follow-up.

Coronary artery ectasia (CAE) is frequently considered an incidental finding during coronary angiography, however, several reports have shown an association with myocardial ischemia and infarction. When acute myocardial infarction (AMI) occurs in cases of CAE, current reperfusion therapies, due to the large arterial size and the massive intracoronary thrombus, when used alone are limited in preventing the development of distal embolization and 'no reflow phenomenon.' In this article, we described the case of a multiple sclerosis (MS) patient with diffuse CAE and ST elevation AMI, treated by coronary dethrombosis multistrategy (mechanical and pharmacologic) during a transradial primary angioplasty. The higher thrombotic burden in MS with CAE was analyzed and possible common pathophysiologic pathways were discovered in the imbalance between proteolytic activities of metalloproteinases and endogenous tissue inhibitor, with subsequent increased proteolysis leading to a risk for coronary plaque rupture. The one-year clinical and angiographic follow-up with coronary computed tomography (CT) angiography, together with long-term antiplatelet therapy, was also evaluated.

[Indicators of statin use as a model for qualitative evaluation of chronic disease management in the Local Health Unit Roma B]. / Indicatori di farmacoutilizzazione nel trattamento con Statine come modello per la valutazione qualitativa nella gestione delle patologie croniche nell'Asl Roma B.

In chronic diseases the adherence and persistence to therapeutic treatments are often lower than guidelines said. This leads to a worse therapeutic effect of the treatments and to a misuse in healthcare costs. Our study evaluates the impact of a pharmacoutilization analysis model, derived from the administrative database of the Local Health Unit Roma B. In particularly we calculate some indicators of adherence, persistence, occasional treatment and switch in patients on statins secondary prevention treatment (patients discharged from Hospital with Acute Myocardial Infarction diagnosis). The model that we developed would be successfully used in the cost-effective analysis of other drugs.