ABSTRACT
Chronic total occlusion (CTO) is a common finding on diagnostic coronary angiography and represents one of the most challenging lesion subset in interventional cardiology. The introduction of dedicated guidewires and the development of new techniques have led to improve the success rate in the crossing of CTO lesion while the use of bare metal stent first, and, then, the use of drug eluting stent (DES) have significantly reduced the occurrence of restenosis and the need for target lesion revascularization in short and mid-term follow-up after CTO recanalization. However, new unsolved issues about the use of DES in CTO, that might impact long-term outcome, are emerging. The aim of this article is to review the current stage of knowledge on the application of stents in the treatment of CTO, with a particular attention to DES use and to DES-related challenges.
Subject(s)
Coronary Occlusion/therapy , Drug-Eluting Stents , Angioplasty, Balloon, Coronary , Chronic Disease , Coronary Angiography , Coronary Occlusion/diagnosis , Coronary Restenosis/prevention & control , Evidence-Based Medicine , Humans , Risk Assessment , Severity of Illness Index , Stents , Treatment OutcomeABSTRACT
Casual blood pressure (BP) measurements may sometimes indicate the presence of cardiovascular morbidity and mortality, but the correlations between BP values and the subsequent occurrence of such complications are low. This may depend on the known inability of casual BP measurements to reflect accurately the 24-hour mean and overall profile of the BP. In this study, electrocardiography (ECG) of left ventricular muscle mass was related to various measures of BP during circadian ambulatory BP monitoring in 156 hypertensive and non-hypertensive elderly patients. Multiple regression analysis performed to establish the presence of left ventricular hypertrophy (LVH) revealed that the product of ambulatory systolic BP x diastolic BP (p = 0.027) and ambulatory diastolic BP were significant variables. Clinical pressure variables were not significant. Multiple linear regression analysis to establish the degree of LVH in function of the pressure variables generated a model where the variables included are the product of ambulatory systolic BP x diastolic BP (p = 2.7 x 10(-8)), ambulatory systolic BP (p = 7.8 x 10(-6)) and ambulatory diastolic BP (p = 2.4 x 10(-6)). Results obtained agree with the literature and revealed that LVH evaluated using ECG-Romhilt-Estes score was correlated in terms of presence/absence of organ damage and in terms of score to ambulatory monitoring values.
ABSTRACT
Over the last thirty years white coat hypertension has been the object of numerous studies which suggest that the interactions between doctor and patient and environmental, psychological circumstances suffice to determine a significant increase of arterial pressure in subjects who are generally normotense. The aim of this study was to evaluate the prevalence of white coat hypertension in elderly subjects with hypertension which had been diagnosed recently using the traditional sphygmomanometric method three times in the space of one week. We divided 69 patients (age range 60 to 82 years) into three groups depending on their clinic pressures, i.e. patients with isolated systolic, systo-diastolic or diastolic hypertension. Non invasive 24 h pressure ambulatory monitoring was performed in each subject using a Takeda recorder TM 2420 and adopting a protocol for single measurements at 15 minutes intervals between 08.00 and 20.00 (daytime measurements) and 30 minutes intervals between 20.00 and 08.00 (night-time measurements). Ambulatory monitoring with less than 60 recordings, and those where measurements were not taken for over 60 minutes during the day or 90 minutes during the night were excluded from the study, and the mean daytime and 24 h pressure load was calculated. Monitoring conducted in 60 subjects (39 males and 21 females) was considered valid. Statistical analysis of the mean arterial pressure values of each subject determined by the two methods was performed using a t-test.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Hypertension/epidemiology , Hypertension/psychology , Aged , Aged, 80 and over , Blood Pressure Monitoring, Ambulatory , Female , Humans , Hypertension/diagnosis , Male , Middle AgedABSTRACT
Cystic lymphangioma of the retroperitoneum is a primary mesodermal derived benign neoplasm, arising from retroperitoneal lymphatics. The Authors report a case of cystic lymphangioma of the retroperitoneum recently observed, and a review of the international literature registering 181 cases from 1958 up to nowadays. Retroperitoneal localization, sub-clinic evolution and the impossibility to preoperatively define the histological type of the tumour, in spite of the modern diagnostic techniques, explain the difficulties to reach a correct differential diagnosis. The authors conclude that surgery only allows to exactly localize the tumour, yet the definition of cystic lymphangioma is an histological goal.
Subject(s)
Lymphangioma, Cystic/diagnosis , Retroperitoneal Neoplasms/diagnosis , Female , Humans , Lymphangioma, Cystic/pathology , Lymphangioma, Cystic/surgery , Middle Aged , Retroperitoneal Neoplasms/pathology , Retroperitoneal Neoplasms/surgeryABSTRACT
The authors studied the efficacy and safety of a long half-life dihydropyridine calcium-antagonist--amlodipine--in a single daily dose in the treatment of isolated systolic hypertension in the elderly. Ninety-seven subjects, age range 65-85 years, with isolated systolic hypertension were randomized into two groups, similar for age, weight and height, of 47 subjects submitted to active therapy and 50 subjects to placebo, respectively. The study was divided into two phases: in the first one, of three weeks, the first group was administered amlodipine at the dose of 5 mg/day; in the second period, which lasted 9 weeks also in case of systolic pressure normalization, amlodipine at the dose of 10 mg/day was administered. Forty-one subjects of the active drug group and 41 of the control group completed the study. The results were determined as mean +/- standard deviation; statistical analysis was completed by the Student T test. In the amlodipine group, at the end of the third week, a significant decrease in systolic arterial pressure was reported; at the end of the follow-up a further decrease in systolic arterial pressure was observed in the active treatment group as compared to the control group (p < 0.001). The other parameters considered (E.C.G., routine haematochemical tests) did not show significant changes in the two groups during the whole study period. Furthermore, during the follow-up, neither orthostatic hypotension nor reflex tachycardia, events which require particular attention during antihypertensive therapy in the elderly, were observed.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Amlodipine/therapeutic use , Hypertension/drug therapy , Age Factors , Aged , Amlodipine/adverse effects , Body Weight , Calcium Channel Blockers/therapeutic use , Drug Evaluation , Female , Humans , Hypertension, Malignant/drug therapy , Male , Middle Aged , Systole , Vasodilator Agents/therapeutic useABSTRACT
This paper examines recent epidemiological and molecular genetic studies on the genetic basis of Alzheimer's disease (AD). Recent epidemiological studies have shown the existence of a genetic etiology in some cases of Alzheimer's disease. Several pedigrees with an increased incidence of AD (familial Alzheimer's disease--FAD) have been described in the literature. Some of these contain sufficient numbers of affected individuals in multiple generations to provide a rigorous argument for an autosomal dominant inheritance of the AD phenotype. FAD pedigrees show several evidences of as phenotypic heterogeneity of the disease. Molecular genetic studies have shown a linkage between several polymorphic DNA markers specific for the pericentromeric region of chromosome 21 and early-onset FAD. In late-onset FAD pedigrees preliminary reports showed evidence for a linkage with chromosome 19 markers. Molecular genetic studies have clearly demonstrated the genetic heterogeneity of familial Alzheimer's disease. The analysis of new, multigenerational pedigrees with FAD and the study of patients with Down's syndrome and Alzheimer's disease should provide useful informations for the characterization of the gene(s) responsible for familial Alzheimer's disease.
Subject(s)
Alzheimer Disease/genetics , Alzheimer Disease/epidemiology , Diseases in Twins/genetics , Female , Genetic Markers , Humans , Italy , Male , PedigreeABSTRACT
Se presentan 3 pacientes portadores de NEVIL (nevo epidermico verrugoso inflamatorio lineal), se destaca en ellos fundamentalmente la aparicion tardia en la vida Se recuerdan la clinica e histopatologia de esta afeccion y se detallan los diagnosticos diferenciales que deben considerarse
Subject(s)
Adult , Middle Aged , Humans , Male , Female , NevusABSTRACT
Se presentan 3 pacientes portadores de NEVIL (nevo epidermico verrugoso inflamatorio lineal), se destaca en ellos fundamentalmente la aparicion tardia en la vida Se recuerdan la clinica e histopatologia de esta afeccion y se detallan los diagnosticos diferenciales que deben considerarse
Subject(s)
Adult , Middle Aged , Humans , Male , Female , NevusABSTRACT
Se presentan 3 casos de eritroplasia de Queyrat, siendo el objetivo destacar el aspecto verrugoso, no habitual y quiza pre-invasivo de esta enfermedad descartando el concepto de muchos autores de que todos los casos verrugosos son invasivos.Se establece la diferencia con la enfermedad de Bowen. Finalmente, se contribuye con un nuevo aporte terapeutico, la criocirugia con nitrogeno liquido
Subject(s)
Middle Aged , Humans , Male , Cryosurgery , ErythroplasiaABSTRACT
Se comunican dos casos de sindrome del nevo epidermico-sebaceo lineal, uno con situs inversus totalis y pie talo asociados a nevo sebaceo de Jadassohn lineal, y el otro con nevo sebaceo metamerico y nevo unius lateris hemicorporal coexistiendo con osteocondroma. Se ratifica el criterio de unidad del Sindrome del nevo epidermico o sindrome de Solomon y el sindrome del nevo sebaceo o sindrome de Schimmelpenning, Feuerstein y Mims ("facomatosis del nevo organoide"), constituido fundamentalmente por una tetrada: alteraciones cutaneas, neurologicas, oculares y esqueleticas, pudiendo existir formas completas e incompletas, y otras alteraciones mesenquimaticas de observacion mas rara
Subject(s)
Infant , Child, Preschool , Humans , Female , Nevus, Pigmented , Situs Inversus , TalipesABSTRACT
Se comunican dos casos de sindrome del nevo epidermico-sebaceo lineal, uno con situs inversus totalis y pie talo asociados a nevo sebaceo de Jadassohn lineal, y el otro con nevo sebaceo metamerico y nevo unius lateris hemicorporal coexistiendo con osteocondroma. Se ratifica el criterio de unidad del Sindrome del nevo epidermico o sindrome de Solomon y el sindrome del nevo sebaceo o sindrome de Schimmelpenning, Feuerstein y Mims ("facomatosis del nevo organoide"), constituido fundamentalmente por una tetrada: alteraciones cutaneas, neurologicas, oculares y esqueleticas, pudiendo existir formas completas e incompletas, y otras alteraciones mesenquimaticas de observacion mas rara
Subject(s)
Infant , Child, Preschool , Humans , Female , Nevus, Pigmented , Talipes , Situs InversusABSTRACT
Se presentan 3 casos de eritroplasia de Queyrat, siendo el objetivo destacar el aspecto verrugoso, no habitual y quiza pre-invasivo de esta enfermedad descartando el concepto de muchos autores de que todos los casos verrugosos son invasivos.Se establece la diferencia con la enfermedad de Bowen. Finalmente, se contribuye con un nuevo aporte terapeutico, la criocirugia con nitrogeno liquido
