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1.
J Headache Pain ; 25(1): 27, 2024 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-38433202

RESUMEN

BACKGROUND: The burden and disability associated with headaches are conceptualized and measured differently at patients' and populations' levels. At the patients' level, through patient-reported outcome measures (PROMs); at population level, through disability weights (DW) and years lived with a disability (YLDs) developed by the Global Burden of Disease Study (GBD). DW are 0-1 coefficients that address health loss and have been defined through lay descriptions. With this literature review, we aimed to provide a comprehensive analysis of disability in headache disorders, and to present a coefficient referring to patients' disability which might inform future GBD definitions of DW for headache disorders. METHODS: We searched SCOPUS and PubMed for papers published between 2015 and 2023 addressing disability in headache disorders. The selected manuscript included a reference to headache frequency and at least one PROM. A meta-analytic approach was carried out to address relevant differences for the most commonly used PROMs (by headache type, tertiles of medication intake, tertiles of females' percentage in the sample, and age). We developed a 0-1 coefficient based on the MIDAS, on the HIT-6, and on MIDAS + HIT-6 which was intended to promote future DW iterations by the GBD consortium. RESULTS: A total of 366 studies, 596 sub-samples, and more than 133,000 single patients were available, mostly referred to cases with migraine. Almost all PROMs showed the ability to differentiate disability severity across conditions and tertiles of medication intake. The indexes we developed can be used to inform future iterations of DW, in particular considering their ability to differentiate across age and tertiles of medication intake. CONCLUSIONS: Our review provides reference values for the most commonly used PROMS and a data-driven coefficient whose main added value is its ability to differentiate across tertiles of age and medication intake which underlie on one side the increased burden due to aging (it is likely connected to the increased impact of common comorbidities), and by the other side the increased burden due to medication consumption, which can be considered as a proxy for headache severity. Both elements should be considered when describing disability of headache disorders at population levels.


Asunto(s)
Trastornos de Cefalalgia , Trastornos Migrañosos , Femenino , Humanos , Carga Global de Enfermedades , Cefalea/diagnóstico , Cefalea/terapia , Trastornos de Cefalalgia/diagnóstico , Trastornos de Cefalalgia/terapia , Envejecimiento
2.
Cephalalgia ; 43(2): 3331024221137091, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-36718044

RESUMEN

BACKGROUND: Calcitonin gene-related peptide-targeted drugs have proven safe and effective for migraine prevention in large randomized-controlled, double-blind trials with an average duration of six months. Open-label studies may provide additional information on the long-term safety and efficacy of these substances. METHODS: We searched PubMed for open-label trials with calcitonin gene-related peptide(-receptor) monoclonal antibodies and calcitonin gene-related peptide-receptor antagonists. We summarized and critically analyzed the literature in a narrative way. RESULTS: Overall, 13 open-label trials were included in this review (n = 4 for erenumab, n = 4 for galcanezumab, n = 3 for fremanezumab, n = 1 for eptinezumab, n = 1 for atogepant). Open-label trial duration ranged between 12 and 264 weeks. No safety concerns emerged, and the adverse events profile was similar to the double-blind study phase. Discontinuation rates were generally low with >75% of patients remaining in the trials after one year. Efficacy data showed a sustained reduction of migraine frequency throughout the trials, along with a lasting improvement in quality of life. CONCLUSIONS: The open-label study program for calcitonin gene-related peptide-targeted migraine preventives confirms the favorable safety and efficacy profile of these drugs over time. Treatment adherence appears higher than with previous unspecific migraine preventives. Real-world data and post-marketing surveillance studies may corroborate and complement open-label results.


Asunto(s)
Antagonistas del Receptor Peptídico Relacionado con el Gen de la Calcitonina , Trastornos Migrañosos , Humanos , Péptido Relacionado con Gen de Calcitonina , Antagonistas del Receptor Peptídico Relacionado con el Gen de la Calcitonina/uso terapéutico , Trastornos Migrañosos/tratamiento farmacológico , Trastornos Migrañosos/prevención & control , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Receptores de Péptido Relacionado con el Gen de Calcitonina
3.
Neurol Sci ; 43(11): 6561-6564, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-35953579

RESUMEN

Vestibular symptoms accompanying headache are quite common in migraine patients. Based on the association of vertigo with migraine, vestibular migraine was included in the appendix of the 3rd edition of the International Classification of Headache Disorders as a possible migraine subtype worthy of further investigation. In this post hoc, exploratory analysis, we investigated the occurrence of oculo-vestibular signs (OVSs) during experimentally induced migraine attacks in 24 episodic migraine patients and 19 healthy controls exposed to sublingual nitroglycerin (NTG - 0.9 mg). A comprehensive clinical examination was performed at baseline, at the onset of the migraine-like attack, and immediately before hospital discharge (180 minutes after NTG administration). Three of the 13 migraine patients who developed a spontaneous-like migraine attack during the hospital observation period (23.1%) also developed OVSs during the induction test. Noteworthy, none of the patients with a negative induction test developed OVSs and no OVSs were reported in healthy subjects at any time point. The exploratory nature of our study does not allow to draw definite conclusions on the possible implications of a vestibular dysfunction in migraine pathophysiology. Our results however suggest that NTG administration may lend itself to investigate vestibular dysfunction in migraine, at least in a subset of patients. The present findings represent a starting point for designing future ad hoc and well-powered studies.


Asunto(s)
Trastornos de Cefalalgia , Trastornos Migrañosos , Vestíbulo del Laberinto , Humanos , Vértigo/diagnóstico , Trastornos Migrañosos/diagnóstico , Cefalea/complicaciones , Trastornos de Cefalalgia/complicaciones
4.
J Headache Pain ; 23(1): 123, 2022 Sep 17.
Artículo en Inglés | MEDLINE | ID: mdl-36115947

RESUMEN

BACKGROUND: In Italy, monoclonal antibodies targeting the CGRP pathway are subsidized for the preventive treatment of high frequency and chronic migraine (CM) in patients with a MIgraine Disability ASsessment (MIDAS) score ≥ 11. Eligibility to treatment continuation requires a ≥ 50% MIDAS score reduction at three months (T3). In this study, we evaluate whether a ≥ 50% MIDAS score reduction at T3 is a reliable predictor of response to one-year erenumab treatment. METHODS: In this prospective, open-label, real-world study, 77 CM patients were treated with erenumab 70-140 mg s.c. every 28 days for one year (T13). We collected the following variables: monthly migraine days (MMDs), monthly headache days (MHDs), days of acute medication intake, MIDAS, HIT-6, anxiety, depression, quality of life and allodynia. Response to erenumab was evaluated as: i) average reduction in MMDs during the 1-year treatment period; and ii) percentage of patients with ≥ 50% reduction in MMDs during the last 4 weeks after the 13th injection (RespondersT13). RESULTS: Erenumab induced a sustained reduction in MMDs, MHDs and intake of acute medications across the 12-month treatment period, with 64.9% of patients qualifying as RespondersT13. At T3, 55.8% of patients reported a ≥ 50% reduction in MIDAS score (MIDASRes) and 55.4% of patients reported a ≥ 50% reduction in MMDs (MMDRes). MIDASRes and MMDRes patients showed a more pronounced reduction in MMDs during the 1-year treatment as compared to NON-MIDASRes (MIDASRes: T0: 23.5 ± 4.9 vs. T13: 7.7 ± 6.2; NON- MIDASRes: T0: 21.6 ± 5.4 vs. T13: 11.3 ± 8.8, p = 0.045) and NON-MMDRes (MMDRes: T0: 23.0 ± 4.5 vs. T13: 6.6 ± 4.8; NON-MMDRes: T0: 22.3 ± 6.0 vs. T13: 12.7 ± 9.2, p < 0.001) groups. The percentage of RespondersT13 did not differ between MIDASRes (74.4%) and NON-MIDASRes (52.9%) patients (p = 0.058), while the percentage of RespondersT13 was higher in the MMDRes group (83.3%) when compared to NON-MMDRes (42.9%) (p = 0.001). MMDRes predicted the long-term outcome according to a multivariate analysis (Exp(B) = 7.128; p = 0.001), while MIDASRes did not. Treatment discontinuation based on MIDASRes would have early excluded 36.0% of RespondersT13. Discontinuation based on "either MIDASRes or MMDRes" would have excluded a lower percentage (16%) of RespondersT13. CONCLUSION: MIDASRes only partly reflects the 12-month outcome of erenumab treatment in CM, as it excludes more than one third of responders. A criterion based on the alternative consideration of ≥ 50% reduction in MIDAS score or MMDs in the first three months of treatment represents a more precise and inclusive option. TRIAL REGISTRATION: The trial was retrospectively registered at www. CLINICALTRIALS: gov (NCT05442008). CGRP: Calcitonin Gene Related Peptide. MIDAS: MIgraine Disability Assessment. MMDs: monthly migraine days. MIDASRes: Patients with a MIDAS score reduction of at least 50% at T3. MMDRes: Patients with a MMDs reduction of at least 50% at T3. ResponderT13: Patients with a MMDs reduction from baseline of at least 50% in the last 4 weeks of observation period (after 13 erenumab administrations). T0: First erenumab administration. T3, T6, T9, T12: Follow-up visits at three, six, nine, and twelve months after first erenumab administration. T13: Last visit of the protocol.


Asunto(s)
Péptido Relacionado con Gen de Calcitonina , Trastornos Migrañosos , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados , Péptido Relacionado con Gen de Calcitonina/uso terapéutico , Evaluación de la Discapacidad , Humanos , Trastornos Migrañosos/prevención & control , Estudios Prospectivos , Calidad de Vida
7.
Artículo en Inglés | MEDLINE | ID: mdl-38880697

RESUMEN

AIMS: The valve-in-valve transcatheter-aortic-valve-implantation (VIV-TAVI) represents an emerging procedure for the treatment of degenerated aortic bio-prostheses, and the occurrence of patient-prosthesis mismatch (PPM) after VIV-TAVI might affect its clinical efficacy. This study aimed to test a multimodal imaging approach to predict PPM risk during the TAVI planning phase and assess its clinical predictivity in VIV-TAVI procedures. METHODS: Consecutive patients undergoing VIV-TAVI procedures at our Institution over 6 years were screened and those treated by self-expandable supra-annular valves were selected. The effective orifice area (EOA) was calculated with a hybrid Gorlin equation combining echocardiographic data with invasive hemodynamic assessment. Severe PPM was defined according to such original multimodality assessment as EOAi≤0.65 cm2/m2 (if BMI < 30 kg/m2) or < 0.55 cm2/m2 (if BMI ≥ 30 kg/m2). The primary endpoint was a composite of all-cause mortality and valve-related re-hospitalization during the clinical follow-up. RESULTS: A total of 40 VIV-TAVI was included in the analysis. According to the pre-specified multimodal imaging modality assessment, 18 patients (45.0 %) had severe PPM. Among all baseline clinical and anatomical characteristics, estimated glomerular filtration rate before VIV-TAVI (OR 0.872, 95%CI[0.765-0.994],p = 0.040), the echocardiographic pre-procedural ≥moderate AR (OR 0.023, 95%CI[0.001-0.964],p = 0.048), the MSCT-derived effective internal area (OR 0.958, 95%CI[0.919-0.999],p = 0.046) and the implantation depth (OR 2.050, 95%CI[1.028-4.086],p = 0.041) resulted as independent predictors of severe PPM at multivariable logistic analysis. At a mean follow-up of 630 days, patients with severe PPM showed a higher incidence of the primary endpoint (9.1%vs.44.4 %;p = 0.023). CONCLUSION: In VIV-TAVI using self-expandable supra-annular valves, a multimodal imaging approach might improve clinical outcome predicting severe PPM occurrence.

8.
J Clin Anesth ; 95: 111418, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38430636

RESUMEN

STUDY OBJECTIVE: Postoperative sore throat (POST) and hoarseness are common complications of tracheal intubation. This study aims to evaluate the efficacy of flurbiprofen administered through the subglottic port of tracheal tubes to prevent POST after cardiac surgery. DESIGN: Single-center, prospective, randomized, double-blind, placebo-controlled trial. SETTING: Tertiary Care Referral University Hospital (Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome). PATIENTS: Included 71 patients undergoing for elective cardiac surgery. Inclusion criteria were (a) age between 50 and 75 years, (b) NYHA class I or II, (c) surgery for myocardial revascularization or valve repair or replacement under cardiopulmonary bypass. INTERVENTION: Patients were double blind randomized to receive flurbiprofen or saline in the subglottic port of the endotracheal tube (groups F and P). The solution was injected ten minutes after tracheal tube placement, ten minutes after ICU admission and ten minutes before tracheal tube removal. MEASUREMENTS: The primary outcome was to assess the effect of topical flurbiprofen administered through the subglottic port of the tracheal tube to prevent post-operative sore throat (POST). The secondary outcomes were the presence of hoarseness safety and patient's subjective satisfaction with their recovery. We did not report any exploratory outcomes. MAIN RESULTS: We analyzed 68 patients, 34 patients in each group. In group F, two patients complained of POST and hoarseness (5.9%), while all controls did. The two groups significantly differed in the severity scores (VAS and TPS for sore throat and HOAR for hoarseness) at all time points. In group P, patients reported mild to moderate symptoms that significantly improved or disappeared 36 h after tracheal tube removal. According to the multivariable model, hoarseness affected women less than men, in the control group (p = 0.002). None of the patients in either group reported any adverse effects. CONCLUSIONS: Repeated administration of flurbiprofen through the subglottic port of tracheal tubes reduced the incidence of sore throat and hoarseness after cardiac surgery without evidence of complications.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Flurbiprofeno , Ronquera , Intubación Intratraqueal , Faringitis , Complicaciones Posoperatorias , Humanos , Flurbiprofeno/administración & dosificación , Flurbiprofeno/efectos adversos , Método Doble Ciego , Faringitis/prevención & control , Faringitis/etiología , Persona de Mediana Edad , Masculino , Femenino , Anciano , Intubación Intratraqueal/efectos adversos , Estudios Prospectivos , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Ronquera/prevención & control , Ronquera/etiología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Antiinflamatorios no Esteroideos/administración & dosificación , Resultado del Tratamiento , Administración Tópica
9.
Sci Rep ; 14(1): 8320, 2024 04 09.
Artículo en Inglés | MEDLINE | ID: mdl-38594322

RESUMEN

Stroke affects the interconnection between the nervous and immune systems, leading to a down-regulation of immunity called stroke-induced immunosuppression (SII). The primary aim of this study is to investigate SII role as a predictor of functional, neurological, and motor outcomes in the neurorehabilitation setting (NRB). We conducted a prospective observational study enrolling post-acute stroke patients hospitalized for neurorehabilitation. At NRB admission (T0) and discharge (T1), we assessed presence of SII (defined by a neutrophil-to-lymphocyte ratio ≥ 5) and we evaluated functional independence (Functional Independence Measure-FIM, Barthel Index-BI), motor performances (Tinetti Score, Hauser Ambulation Index) and neurological impairment (NIHSS). We enrolled 96 patients (45.8% females, 70.6 ± 13.9 years, 88.5% ischemic stroke). At T0, 15.6% of patients (15/96) had SII. When compared to immunocompetent patients (IC), the SII group was characterized by worse baseline functional independence, motor performances and neurological disability. The same was confirmed at T1 (FIM p = 0.012, BI p = 0.007, Tinetti p = 0.034, NIHSS p = 0.001). Neurological disability demonstrated a less pronounced improvement in SII (ΔNIHSS: SII: - 2.1 ± 2.3 vs. IC: - 3.1 ± 2.5, p = 0.035). SII group presented a higher percentage of infectious complications during the neurorehabilitation period (SII 80% vs. IC 25.9%; p = 0.001). SII may represent a negative prognostic factor in the neurorehabilitation setting. SII patients were characterized by poorer functional, motor, neurological performances and higher risk of infectious complications. ClinicaTrial registration: NCT05889169.


Asunto(s)
Rehabilitación Neurológica , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Femenino , Humanos , Masculino , Terapia de Inmunosupresión , Linfocitos , Neutrófilos , Resultado del Tratamiento , Estudios Prospectivos
10.
Gait Posture ; 97: 152-158, 2022 09.
Artículo en Inglés | MEDLINE | ID: mdl-35961132

RESUMEN

BACKGROUND: Harmonic ratios (HRs), recurrence quantification analysis in the antero-posterior direction (RQAdetAP), and stride length coefficient of variation (CV) have recently been shown to characterize gait abnormalities and fall risk in people with Parkinson's disease (pwPD) at moderate disease stages. RESEARCH QUESTION: This study aimed to i) assess the internal and external responsiveness to rehabilitation of HR, RQAdetAP, and CV, ii) identify the baseline predictors of normalization of the gait stability indexes, and iii) investigate the correlations between the gait indexes modifications (∆) and clinical and kinematic ∆s in pwPD at Hoehn and Yahr disease staging classification 3. METHODS: The trunk acceleration patterns of 21 pwPD and 21 age- and speed-matched healthy subjects (HSmatched) were acquired during gait using an inertial measurement unit at baseline (T0). pwPD were also assessed after a 4-week rehabilitation period (T1). Each participant's HR in the antero-posterior (HRAP), medio-lateral (HRML), and vertical directions, RQAdetAP, CV, spatio-temporal, and kinematic variables were calculated. RESULTS: At T1, HRAP and HRML improved to normative values and showed high internal and external responsiveness. Lower HRs and higher pelvic rotation values at baseline were predictors of ∆HRs. A minimal clinically important difference (MCID) ≥ 21.5 % is required to normalize HRAP with 95 % probability. MCID ≥ 36.9 % is required to normalize HRML with 92 % probability. ∆HRAP correlated with ∆HRML and both correlated with ∆stride length and ∆pelvic rotation, regardless of ∆gait speed. RQAdetAP and step length CV were not responsive to rehabilitation. SIGNIFICANCE: When using inertial measurement units, HRAP and HRML can be considered as responsive outcome measures for assessing the effectiveness of rehabilitation on trunk smoothness during walking in pwPD at moderate disease stages.


Asunto(s)
Enfermedad de Parkinson , Aceleración , Marcha , Humanos , Enfermedad de Parkinson/rehabilitación , Caminata , Velocidad al Caminar
11.
Front Neurol ; 12: 723468, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34557151

RESUMEN

Background: The sequence effect (SE), defined as a reduction in amplitude of repetitive movements, is a common clinical feature of Parkinson's disease (PD) and is supposed to be a major contributor to freezing of gait (FOG). During walking, SE manifests as a step-by-step reduction in step length when approaching a turning point or gait destination, resulting in the so-called destination sequence effect (dSE). Previous studies explored the therapeutic effects of several strategies on SE, but none of them evaluated the role of an intensive rehabilitative program. Objectives: Here we aim to study the effects of a 4-week rehabilitative program on dSE in patients with PD with and without FOG. Methods: Forty-three patients (30 males, 70.6 ± 7.5 years old) with idiopathic PD were enrolled. The subjects were divided into two groups: patients with (PD + FOG, n = 23) and without FOG (PD - FOG, n = 20). All patients underwent a standardized 4-week intensive rehabilitation in-hospital program. At hospital admission (T0) and discharge (T1), all subjects were evaluated with an inertial gait analysis for dSE recording. Results: At T0, the dSE was more negative in the PD + FOG group (-0.80 ± 0.6) when compared to the PD - FOG group (-0.39 ± 0.3) (p = 0.007), even when controlling for several clinical and demographic features. At T1, the dSE was reduced in the overall study population (p = 0.001), with a more pronounced improvement in the PD + FOG group (T0: -0.80 ± 0.6; T1: -0.23 ± 0.4) when compared to the PD - FOG group (T0: -0.39 ± 0.3; T1: -0.22 ± 0.5) (p = 0.012). At T1, we described in the overall study population an improvement in speed, cadence, stride duration, and stride length (p = 0.001 for all variables). Conclusions: dSE is a core feature of PD gait dysfunction, specifically in patients with FOG. A 4-week intensive rehabilitative program improved dSE in PD patients, exerting a more notable beneficial effect in the PD + FOG group.

12.
Front Cardiovasc Med ; 6: 22, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30941353

RESUMEN

Tricuspid valve dysfunction adversely affects prognosis and may cause severe symptoms. Among the different opportunity offered by transcatheter techniques, the valve in valve represents an emerging strategy to treat patients with degenerated surgical biological prosthesis. We describe a case report of a percutaneous valve in valve treatment of a very old and fluoroscopy invisible tricuspid degenerated bioprosthesis. In the reported case, pivotal issue for percutaneous valve in valve procedure success was the achievement of perfect alignment between transcatheter valve and degenerated bioprosthesis despite the horizontal right chamber axis and the poor valve visibility. Of note, the combination of jugular vein approach, transapical delivery system rotation, right ventricle guidewire placement, and right atrium angiography made the valve in valve procedure safely.

13.
Acta Biomed ; 90(4): 468-474, 2019 12 23.
Artículo en Inglés | MEDLINE | ID: mdl-31910171

RESUMEN

BACKGROUND: In clinical trials with immunotherapy, histological features such as tumor-infiltrating lymphocytes (TILs) are investigated as potential predictive biomarkers, with the limit of an outdated parameter for a typically dynamic element. METHODS: This explorative study compared, in metastatic renal cell carcinoma (mRCC) patients, basal pathological data about TILs on diagnostic histological specimens with circulating lymphocyte subpopulations measured before and during therapy with nivolumab. RESULTS: Of 11 mRCC patients, 5 had low presence of TILs (L-TILs), 3 moderate amount (M-TILs) and 3 high number (H-TILs). Overall, 8 patients had low intratumoral pathological CD4+/CD8+ ratio (LIPR) ≤1 and 3 cases high intratumoral pathological ratio (HIPR) ≥2. Of 8 patients with LIPR, only 2 matched with low circulating CD4+/CD8+ ratio (LCR) ≤1; 5 had high circulating ratio (HCR) ≥2. All 3 cases with HIPR (≥2) conversely had LCR (≤1). Circulating CD4+/CD8+ ratio remained unchanged during therapy (mean -0.12 in 8 weeks). The respective percentage values of CD4+ and CD8+ circulating T cells also remained stable (variation 0%); the absolute value of CD4+ was more likely to increase (mean +46.3/mm3); the level of CD8+ tended to slightly decrease (mean -6.5/mm3). No correlation of lymphocyte subpopulations with treatment outcome was found. Of note, we did not evidence correspondence between histopathological and circulating findings in terms of T-lymphocyte subpopulations, also suggesting the inconsistency of circulating data in terms of relative variations. CONCLUSIONS: Considering the likely high dynamism of TILs, rebiopsy before therapy might be proposed to assess the utility of TILs characterization for predictive purpose. (www.actabiomedica.it).


Asunto(s)
Antineoplásicos Inmunológicos/uso terapéutico , Carcinoma de Células Renales/sangre , Carcinoma de Células Renales/tratamiento farmacológico , Neoplasias Renales/sangre , Neoplasias Renales/tratamiento farmacológico , Subgrupos Linfocitarios , Linfocitos Infiltrantes de Tumor , Nivolumab/uso terapéutico , Anciano , Anciano de 80 o más Años , Carcinoma de Células Renales/secundario , Correlación de Datos , Femenino , Humanos , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias
14.
Minerva Anestesiol ; 85(12): 1308-1314, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31238640

RESUMEN

BACKGROUND: The partial pressure of carbon dioxide (pCO2) gap is the difference between pCO2 values in the arterial and mixed venous blood; values higher than six mmHg may be predictive of tissue hypoperfusion. It is still doubtful if central venous blood can be used to assess the gap. This study was aimed to compare the values obtained with blood collected from the superior vena cava and the pulmonary artery. METHODS: Data were obtained from a previous study. In 30 patients who underwent on-pump myocardial revascularization, blood samples from a radial artery, the pulmonary artery, and the superior vena cava were collected eight times in the perioperative period. Two-hundred determinations were utilized to calculate the pCO2 gap from central and mixed venous pCO2. RESULTS: The pCO2 gap was 8.7±2.6 mmHg in the superior vena cava, and 6.0±2.7 in the pulmonary artery. The difference between the two values fell within a wide interval between -4.1 mmHg and +9.5 mmHg in 95% of cases. pCO2 values were significantly higher in the superior vena cava than in the pulmonary artery (mean difference 2.7±2.4 mmHg; P<0.0001), causing a systematic bias between the two estimates; such bias increased during spontaneous breathing (P=0.0249). CONCLUSIONS: pCO2 values are higher in the superior vena cava than in the pulmonary artery. As a consequence, the pCO2 gap calculated with the blood taken from the superior vena cava is overestimated, probably because it reflects the pCO2 arteriovenous difference of the upper part of the body, in particular of the brain.


Asunto(s)
Dióxido de Carbono/sangre , Arteria Pulmonar , Vena Cava Superior , Anciano , Análisis de los Gases de la Sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
15.
Immunotherapy ; 10(9): 743-752, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-30008256

RESUMEN

AIM: We studied the possible clinical significance of loss of heterozygosity (LOH) at key tumor suppressor genes loci in advanced renal cancer patients treated with nivolumab. METHODS: LOH study was performed on 3p14.2 (FHIT gene); 3p21.3-21.2; 9p21 (BDMF gene); 9p22 (SH3GL2 gene). RESULTS: Of 12 patients, 8 (67%) had LOH. The most affected gene was FHIT. All five patients with LOH at FHIT locus had good outcome, mean progression free survival of 6.8 months. The patients LOH negative at FHIT locus had mean progression free survival of 4 months, 67% were treatment refractory. Overall, 75% of patients with LOH of at least one gene had benefit; 75% of LOH negative cases were refractory. CONCLUSION: LOH at key tumor suppressor genes should be further investigated as predictive for immunotherapy.


Asunto(s)
Ácido Anhídrido Hidrolasas/genética , Antineoplásicos/uso terapéutico , Carcinoma de Células Renales/dietoterapia , Neoplasias Renales/tratamiento farmacológico , Proteínas de Neoplasias/genética , Nivolumab/uso terapéutico , Proteínas Adaptadoras Transductoras de Señales/genética , Anciano , Anciano de 80 o más Años , Carcinoma de Células Renales/genética , Carcinoma de Células Renales/mortalidad , Reparación del ADN/genética , Femenino , Humanos , Neoplasias Renales/genética , Neoplasias Renales/mortalidad , Pérdida de Heterocigocidad , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Proyectos Piloto , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Proteínas Supresoras de Tumor/genética
16.
Int J Surg Case Rep ; 41: 30-32, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29031174

RESUMEN

INTRODUCTION: Dynamic obstruction of right ventricle outflow tract (RVOTO) is a rare condition that may acutely cause severe heart failure. It has been reported in some hypertrophic cardiomyopathies, after lung transplantation, and in some cases of hemodynamic instability after cardiopulmonary bypass. PRESENTATION OF CASE: We report the case of a 71-year-old man who developed severe hypotension during the induction of general anesthesia for surgical coronary revascularization. Hypotension did not respond to the initial treatment with vasoconstrictors and fluids. RVOTO was suspected during pulmonary artery catheterization because of the difficulty of the catheter tip to move from the right ventricle to the pulmonary artery and, successively, because of the finding of a large gradient between the systolic pressure in the right ventricle and in the pulmonary artery. The diagnosis was confirmed by transesophageal echocardiogram (TEE). Hemodynamics recovered after the infusion of cristalloids, 1L, and the suspension of vasoconstrictors and inotropes. DISCUSSION: This is the first case in which RVOTO was observed during the induction of general anesthesia. Although this is a rare condition, the diagnostic suspect is of outmost importance because treatment is mainly based on fluid administration, and drugs with positive inotropic properties (like most vasoconstrictors) are contraindicated. CONCLUSIONS: RVOTO is an unusual, but possible cause of severe arterial hypotension during general anesthesia induction. TEE is useful for the evaluation of severely hypotensive patients who do not respond to routine treatment with fluids and vasoconstrictors.

17.
Acta Biomed ; 87 Suppl 3: 13-9, 2016 07 28.
Artículo en Inglés | MEDLINE | ID: mdl-27467862

RESUMEN

Ankle sprains are the most common lower limb injuries and affect more frequently young athletes; imaging is needed for an accurate diagnosis of such traumatic injuries. The purpose of this review is to analyse the magnetic resonance (MR) findings of both normal and pathological ankle's ligaments; indeed, MRI is the gold standard for the diagnosis of acute traumatic injuries and is useful for differentiation of the causes of ankle instability as well as for pre-operative planning.


Asunto(s)
Traumatismos del Tobillo/diagnóstico por imagen , Ligamentos Articulares/diagnóstico por imagen , Ligamentos Articulares/lesiones , Imagen por Resonancia Magnética , Esguinces y Distensiones/diagnóstico por imagen , Articulación del Tobillo/anatomía & histología , Articulación del Tobillo/diagnóstico por imagen , Humanos , Ligamentos Articulares/anatomía & histología
18.
Acta Biomed ; 87 Suppl 3: 69-75, 2016 07 28.
Artículo en Inglés | MEDLINE | ID: mdl-27467871

RESUMEN

Intraosseous lipoma is a very rare lesion, accounting for only 0.1% of all primary osseous tumors (1), first described in 1980 (2). This lesion is considered the rarest of benign bone tumors (3); probably it is not the actual incidence because these lesions are frequently asymptomatic and the introduction of cross-sectional imaging, especially MRI, seems to have increased the detection (4). The majority of intraosseus lipomas are in the lower limbs (70%) and the os calcis being the most frequently involved (32%). Most cases reported in literature have an age of 40 years (5). Tumor texture could be measured from medical images that provide a non-invasive method of capturing intratumoral heterogeneity and could potentially enable a prior assessment of a patient. Some Authors recently proposed Texture analysis to characterize musculoskeletal lesions (6). For the first time we measured the tumoral texture from Magnetic Resonance images in tibial intraosseous lipoma in a 29-years-old female.


Asunto(s)
Neoplasias Óseas/diagnóstico por imagen , Aumento de la Imagen , Procesamiento de Imagen Asistido por Computador , Lipoma/diagnóstico por imagen , Imagen por Resonancia Magnética , Tibia/diagnóstico por imagen , Adulto , Femenino , Humanos
19.
Acta Biomed ; 87 Suppl 3: 45-50, 2016 07 28.
Artículo en Inglés | MEDLINE | ID: mdl-27467867

RESUMEN

Congenital pulmonary malformations represent a broad spectrum of anomalies that may result in varied clinical and pathologic pictures, ranging from recurrent pulmonary infections and acute respiratory distress syndrome, which require timely drug therapy, up to large space-occupying lesions needing surgical treatment. This classification includes three distinct anatomical and pathological entities, represented by Congenital Cystic Adenomatoid Malformation, Bronchopulmonary Sequestration and Congenital Lobar Emphysema. The final result in terms of embryological and fetal development of these alterations is a Congenital Lung Hypoplasia. Since even Bronchial Atresia, Pulmonary Bronchogenic Cysts and Congenital Diaphragmatic Hernias are due to Pulmonary Hypoplasia, these diseases will be discussed in this review (1, 2).


Asunto(s)
Quiste Broncogénico/diagnóstico por imagen , Secuestro Broncopulmonar/diagnóstico por imagen , Malformación Adenomatoide Quística Congénita del Pulmón/diagnóstico por imagen , Enfisema Pulmonar/congénito , Bronquios/anomalías , Bronquios/diagnóstico por imagen , Hernias Diafragmáticas Congénitas/diagnóstico por imagen , Humanos , Enfisema Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos X
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