Feasibility of transradial approach in a hub and spoke cath lab network.

AIM: Radial artery approach for coronary angiography presents advantages in terms of reduction of costs and complications. Opening a diagnostic-only cath lab is controversial in an era of interventional approach. The authors present the data of Carpi diagnostic-only cath lab (Spoke), satellite of the main cath lab situated in Modena (Hub) 20 Kms apart. METHODS: Between January 2004 and December 2007, 1496 coronary angiograms were performed. The indication was ischemic heart disease in 1197 cases (80%), dilated cardiomiopathy in other 165 cases (11%) and valvular heart disease in the remaining 134 patients (9%). The procedure was performed percutaneously via radial artery in 95% (N=1421) of the cases, via brachial artery in 1% (N=15) and via femoral artery in the remaining 4% (N=60) of patients. RESULTS: Among the 1197 patients undergoing coronary angiography for ischemic heart disease, an indication to medical therapy was given in 443 (37%), a surgical indication in 216 (18%) patients and an indication to percutaneous coronary intervention (PCI) in 538 (45%) cases. PCI was performed in the Hub centre the same day and via the same arterial approach of the diagnostic angiography, maintaining the sheath in situ during transport. In 6 patients only it was necessary to shift to a femoral approach. CONCLUSIONS: This model presents many advantages: 1) a cath lab in a peripheral hospital allows a early carrying out of the hemodynamic examination with reduction of hospital stay; 2) transport to the Hub centre cath lab is undertaken only in patients who really need PCI; 3) the PCI is feasible the same day of the diagnostic examination; 4) this model relieves the hub centre congestion, ensuring motivation and professional competence for personnel of peripheral hospital.

Magnetic field exposure and arrythmic risk: evaluation in railway drivers.

Recent studies suggest that professional exposure to Extremely Low Frequency-Electro Magnetic Field (ELF-EMF) can increase the risk of sudden cardiac death. Aim of our work was to find predictive parameters of arrhythmic risk in a population of 28 railways drivers exposed to ELF-EMF. Our findings were that the exposure did not reduce HRV and did not increase the risk of arrhythmias.

Interferon and ribavirin in HIV-negative haemophiliacs with chronic hepatitis C who were nonresponders to a previous interferon treatment.

Between January 1999 and December 2001, 33 HIV-negative haemophiliacs with interferon-nonresponsive chronic hepatitis C were treated with interferon (IFN) alpha2b (5 MU three times weekly) and ribavirin (1-1.2 g daily) for 12 months. Four patients (12.1%) dropped out of the study due to adverse effects. At the end of therapy, normalization of ALT occurred in 14/33 treated patients (42.4%) and HCV-RNA was cleared in 12 (36.4%). Eleven patients (33.3%) became sustained responders. Genotype 1 was the only factor associated with a poor response to therapy (P < 0.001). Our study shows that IFN and ribavirin combination therapy is effective in HIV-negative chronically HCV-infected haemophiliacs who do not respond to a previous IFN treatment.

The natural history of chronic hepatitis C in a cohort of HIV-negative Italian patients with hereditary bleeding disorders.

This study looked at 102 anti-hepatitis C virus (HCV)-positive, hepatitis B virus (HBV)-negative, and HIV-negative patients (median age, 45.1 years; range, 15-71) affected by hereditary bleeding disorders who have been infected with HCV for 15 to 34 years (median, 25.1). All these patients were infected before the mid 1980s because of non-virally inactivated pooled blood products. Fourteen patients (13.7%) were HCV-RNA negative with no signs of liver disease and were considered to have cleared the virus. Eighty-eight patients (86.3%) were HCV-RNA positive. The HCV genotype distribution was 1a in 20.5%, 1b in 36.4%, 2 in 17.0%, 3 in 15.9%, 4 in 3.4%, and mixed in 6.8% of cases. Twenty-four patients (23.5%) had serum cryoglobulins, symptomatic in 4 cases, and associated with liver disease and with genotype 1. Among the 88 HCV-RNA-positive patients, 15 (17.0%) had normal alanine aminotransferase levels and abdominal ultrasound, 61 (69.3%) had nonprogressive chronic hepatitis, and 12 (13.7%) had severe liver disease (6 [6.9%] liver cirrhosis, 4 [4.5%] hepatic decompensation, and 2 [2.3%] hepatocellular carcinoma) after a follow-up period of 25 years. There were 3 (3.4%) liver-related deaths. HCV genotype 1, patient's age at evaluation, duration of infection, and severity of congenital bleeding disorder were associated with more advanced liver disease. The results confirm the slow progression of HCV infection in HIV-negative hemophiliacs.

The Natural History of Hepatitis C Virus Infection in Hemophiliacs.

Hepatitis C virus (HCV) infection is an important cause of morbidity and mortality in patients affected by hereditary bleeding disorders and treated with non-virus inactivated clotting factor concentrates during the 1970s. Since the onset of the infection is known (first treatment with large-pool non-virus inactivated blood products) these patients are a unique model for studying the natural history of HCV infection and associated complications. The course of Hepatitis can be accurately assessed in these patients because they are regularly followed at hemophilia centers with laboratory, clinical and instrumental tests. In this review, we briefly report the present knowledge about the natural course of HCV infection in hemophiliacs, by analyzing the prevalence of HCV infection, the genotype distribution and the risk factors involved in the progression of chronic Hepatitis into severe liver disease as cirrhosis, liver decompensation and hepatocellular carcinoma. Understanding the natural evolution of HCV infection in hemophiliacs helps us to understand better the natural history of HCV infection and to improve the treatment approach to all HCV infected patients.

Serum level of soluble intercellular adhesion molecule 1 in patients with chronic liver disease related to hepatitis C virus: A prognostic marker for responses to interferon treatment.

Intercellular adhesion molecule 1 (ICAM-1) is a marker of inflammation and tissue damage. Levels of soluble ICAM-1 (sICAM-1) were measured in 71 patients with chronic C hepatitis treated with interferon (IFN)-alpha-2a, at baseline and at every 3 months of therapy, and in 42 normal control subjects. The levels of sICAM-1 were significantly higher in the patient than in the control subject group, particularly among cirrhotics. Baseline sICAM-1 levels were similar in responders and nonresponders. By contrast, the concentration of sICAM-1 decreased significantly only in responders during the first 3 months of therapy. The probability of response to treatment, analyzed by Kaplan-Meier analysis, was much higher in the group showing a decrease of sICAM-1 than in the patients who did not show such a decrease. In conclusion, a "longitudinal" evaluation of serum levels of sICAM-1 in the first period of treatment is particularly useful in the identification of patients with high significant probability of response to treatment.

Serum laminin and type III procollagen in chronic hepatitis C. Diagnostic value in the assessment of disease activity and fibrosis.

Laminin P1 (pepsin-resistant fragment of laminin) and aminoterminal peptide of type III procollagen are measurable in serum and are now considered useful serum markers of fibrogenesis and inflammation in chronic liver diseases. However, very few studies thus far have focused on assessing the diagnostic value of these markers in detecting fibrosis and necro-inflammatory activity in chronically diseased liver. The aim of the present study was therefore to investigate the correlations of laminin and type III procollagen with liver histology and to compare their diagnostic value in detecting the degree of liver fibrosis and necro-inflammatory activity in a homogeneous group of 99 patients suffering from chronic hepatitis C, and lacking other factors which can directly affect the serum levels of the two markers. Both these serum markers were measured by radioimmunoassay, employing commercially available kits. The three main aspects of liver pathology, i.e. portal-periportal activity, lobular activity and fibrosis, were histologically evaluated and semiquantitatively expressed by numerical scores. The results of this study show that laminin and type III procollagen were both positively correlated with the histological scores for portal-periportal activity and with those for fibrosis, whereas no significant correlation was observed between each of the two serum markers and the histological scores for lobular activity. The sensitivity and specificity of laminin and type III procollagen in detecting histological aspects of fibrosis and disease activity in liver, computed at various cut-off levels, showed overlapping trends for the two markers; however, the diagnostic value was in general rather low, whatever the cut-off considered. We therefore conclude that the 'static' measurement of both serum laminin and type III procollagen is of limited value for individual diagnosis of liver damage.

Cryoglobulinemia in hepatitis C virus chronic active hepatitis: effects of interferon-alpha therapy.

We investigated the prevalence of mixed cryoglobulinemia (MC) in 100 cases of chronic hepatitis C virus (HCV) infection and the effect of a 6-month treatment with interferon-alpha (IFN-alpha). Cryoglobulins were detected on admission in 36 of 100 patients and appeared during observation in a further 18 cases. Cryocrit ranged from 0.5% to 20%. Patients with MC were older and had a higher incidence of cirrhosis than those without MC. Immunologic characterization of the cryoprecipitate showed the presence of type II in 84% of cases and type III in 16%. The patients received IFN-alpha (6 MU three times per week) for 6 months. Fifty-seven were responders (i.e., reached normal aminotransferase levels), 26 of these relapsed within 2 months after IFN withdrawal, and 30 did not relapse. After IFN-alpha treatment, cryoglobulinemia disappeared in 11 of the 21 evaluable responders, but in none of the 15 nonresponder patients (p < 0.003). The clearance of MC was associated in all cases with clearance of HCV RNA. The delayed appearance of cryoglobulinemia in responders seems to be associated with a higher probability of relapse.

Long-term variations of serum laminin and procollagen III peptide in chronic HCV hepatitis after alpha-interferon therapy.

Twenty-three out of 40 patients affected by chronic HCV hepatitis responded (i.e. aminotransferases returned to normal) after 6-month treatment with 6 MU tiw of recombinant alpha-interferon 2a (IFN); in 11 (Group 1), the remission was maintained for a mean observation time of 33.15 months (range 20-50) after withdrawal of therapy; 12 (Group 2) relapsing after IFN withdrawal, were treated again obtaining in 10 a second response. Seventeen did not respond (Group 3). Serum markers of connective tissue metabolism (laminin and aminoterminal peptide of type III procollagen -NPIIIP-) were assayed in all patients before treatment and every 6th month, to evaluate long-term effects of IFN therapy. In non-responders, NPIIIP after treatment was not different from baseline, while laminin significantly increased at 6 and 12 months; in responders, NPIIIP decreased significantly after therapy, maintaining values lower than baseline on long-term observation. Laminin decreased significantly six months after the end of therapy and remained lower than baseline in all sustained responders. In this group, the drop in laminin was progressive, whereas in Group 2, laminin showed only a slight decrease on long-term control. Our data show that these serum markers persistently decrease in sustained responders to IFN, while in relapsed cases, prolonged therapy is needed to obtain minor effects on laminin; on the contrary, in non-responders, NPIIIP remains unchanged and laminin significantly increases, suggesting a persistence of active fibrogenesis.

Comparación del valor diagnóstico de dos análisis microscopicos de orina: estándar y ampliado, en relación al Urocultivo en muestras de mujeres, Cuajone 1994

Se estudiaron muestras de orina obtenidas a mitad de chorro en mujeres entre 18 y 40 años, para comparar la sensibilidad, especificidad y valores predictivos del análisis de orina estándar comunmente utilizado (leucocitos y bacterias por campo en orina centrifugada) con un análisis ampliado en orina no centrifugada que observó el número de leucocitos/mm cúbicos en un hemocitómetro y la presencia de bacterias en una extensión teñida con Gram. En el análisis de orina estándar la leucocituria definió como al menos 5 leucocitos por campo y la bacteriuria como la presencia de cualquier número de bacterias/campo. Para el análisis de orina ampliado se obtuvieron valores de referencia para leucocituria y bacteriuria calculados en los urocultivos negativos en base a: el promedio +/- 2 desviaciones estándar. Los valores así determinados fueron leucocituria por encima de 23.1 leucocitos/mm cúbico y bacteriuria más de 4.45 bacterias por 10 campos. Los cultivos de orina cuantitativos se consideraron positivos con el crecimiento de un sólo agente patógeno a una concentración de 100000 o mas colonias/ml., a excepción de Estafilococo aureus. El análisis de orina, estándar o ampliado, se consideró positivo cuando se observó la presencia tanto de leucocituria como de bacteriuria. El análisis de orina ampliado presentó una especifidad 98 por ciento y un valor predictivo positivo 95.65 por ciento significativamente mayores en comparación con los del análisis estándar 76 por ciento pero su sensibilidad fue mucho menor 44 por ciento. Finalmente cuando sólo la bacteriuria se tomaba en cuenta para la positividad del análisis ampliado, éste alcanzó los más altos valores (sensibilidad 94 por ciento, especificidad 98 por ciento valor predictivo positivo 97.92 por ciento, valor predictivo negativo 94.23 por ciento), y significativamente mayores que los del análisis estándar (76 por ciento para todos los casos)