Giorgio Morando

Primary leiomyosarcoma of the pulmonary artery: Diagnostic and surgical implications

Primary pulmonary trunk sarcoma is a rare and highly lethal disease. A case of multicentric pulmonary trunk leiomyosarcoma with right and left main pulmonary artery involvement, mimicking massive pulmonary embolism, is described. The importance of a timely diagnosis and of radical surgical excision is discussed.

Quantitative angiographic identification of functional left ventricular aneurysms

Thirty-three 30 degrees RAO left-ventricular angiograms with postinfarction aneurysms were analyzed to determine whether some quantitative variables could describe their morphological characteristics. Seventeen aneurysms were classified as functional (localized without a clear neck), and 16 as true (with a saccular shape). Left-ventricular volumes and global ejection fractions did not differ between the two types. The volume of functional aneurysms as a fraction of global end-diastolic volume was significantly larger (24.4+or-10.6% versus 13.2+or-8.5%, p=0.01). The end-systolic shape of ventricles with a functional aneurysm was more circular (77+or-6 versus 71+or-7, p<0.05) and showed a significantly smoother transition between contractile and noncontractile regions in the anterior site. The anatomic characteristics of resected areas in operated patients were similar in the two types of aneurysms.<<ETX>>

Severe acute left ventricular dysfunction in multiple sclerosis.

Since then, she has presented a relapsing-remitting form and has experienced several relapses involving visual, sensibility and motor systems. Her rheumatic serologic tests [antinuclear antibody (ANA), extractable nuclear antigens (ENAs), antineutrophil cytoplasmic antibody (ANCA)] and C-reactive protein were in the normal range. She was treated with interferon for about 4 years, and then discontinued treatment of her own free will because of side effects. In the previous 10 months a lesion of the left cerebellar peduncle was diagnosed through an MRI examination. She passed to a secondary progressive form and since then she has been treated with azathioprine (2.5 mg/kg orally daily). Over recent months, she has had some autonomic symptoms, common in MS, such as disorders of micturition, sudomotor and gastrointestinal disturbances such as nausea and diarrhea. At the last follow-up evaluation, her neurologic condition was stable, with an Expanded Disability Status Scale (EDSS) score of 3.5.

From in-clinic to fully remote follow-up model for pacemaker patients: A four-year experience

Abstract Background Guidelines on remote monitoring (RM) still suggest at least 1 in-person visit per year for all remotely followed patients, including pacemaker patients. Methods The RM of pacemaker patients was systematically introduced in our clinic since January 2013. Patients without RM were visited 2 months after implantation and afterwards annually. Subjects with RM had in-person visit only at 2-month follow-up and at device replacement. Results At the end of 2016 a total of 2233 patients (mean age 81.4 ± 9.9 years, 55% male) were followed by our centre. The patient population had a mean annual growth of 2.8 ± 2.3% with an incidence of RM increasing from 0% in 2012 to 45% in 2016. The in-clinic visits significantly decreased from the second year (I year: −12, 0%; II year: −324, −17%; III year: −276, −17%, IV year: −127, −10%). The annual incidence of unscheduled ambulatory visit for patients with RM was 15.9 ± 2.9%, mainly triggered by device reprogramming, transmission problems and autocapture deactivation. There was no effect on the incidence of serious adverse events and mortality. Conclusions This fully remote follow-up model for pacemaker patients reduced in-clinic visits since the second year from its implementation in our clinical practice. This strategy may increase the organizational benefits of RM in low-risk patients.

Endothelial dysfunction late after coronary angioplasty: a quantitative coronary angiographic study in patients without restenosis

Endothelial function after coronary angioplasty (PTCA) has been evaluated by quantitative coronary angiography in 18 patients with no evidence of significant restenosis at routine angiographic followup. Increasing doses of acetylcholine (Ach) were infused in the dilated coronary artery, followed by a 250 mu g bolus of nitroglycerin. Total PTCA segments examined were 21. The PTCA treated vessels showed abnormal response to Ach in all their segments. This vasoconstriction was more evident not only at the site of previous maximal stenosis but also in normal vascular sites stretched by the balloon. Vascular response to Ach suggests that endothelial function of neointima is impaired late after PTCA.<<ETX>>