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1.
Acta Chir Belg ; 110(6): 575-83, 2010.
Article in English | MEDLINE | ID: mdl-21337836

ABSTRACT

Endovascular renal artery stent therapy for atherosclerotic renal artery stenosis (RAS) is associated with excellent acute technical success, low complication rates and acceptable long-term patency. However, the clinical benefits to patients of renal artery stenting remain uncertain. To facilitate debate regarding the treatment of RAS, we need to understand the epidemiology, basic physiology and clinical consequences of renal artery stenosis. We must attempt to determine which patients are likely to benefit from renal artery stenting, assess the nuances of the percutaneous procedure and review the current literature pertaining to renal artery stenting.


Subject(s)
Renal Artery Obstruction/surgery , Abciximab , Angioplasty, Balloon , Antibodies, Monoclonal/therapeutic use , Atherosclerosis/complications , Clinical Trials as Topic , Disease Progression , Humans , Hypertension/epidemiology , Immunoglobulin Fab Fragments/therapeutic use , Patient Selection , Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors , Practice Guidelines as Topic , Recurrence , Renal Artery Obstruction/epidemiology , Renal Artery Obstruction/etiology , Renal Artery Obstruction/physiopathology , Severity of Illness Index , Stents , Treatment Outcome , Vascular Patency
2.
J Interv Cardiol ; 22(4): 350-3, 2009 Aug.
Article in English | MEDLINE | ID: mdl-19453819

ABSTRACT

BACKGROUND: Coronary perforations represent a serious complication of percutaneous coronary intervention (PCI). METHODS: We performed a retrospective analysis of documented coronary perforations at Massachusetts General Hospital from 2000 to 2008. Medical records review and detailed angiographic analysis were performed in all patients. RESULTS: Sixty-eight cases of coronary perforation were identified from a total of 14,281 PCIs from March 2000 to March 2008 representing an overall incidence of 0.48%. The study cohort was predominantly male (61.8%), mean age 71+/-11 years with 78% representing acute cases (unstable angina: 36.8%, NSTEMI: 30.9%, STEMI: 10.3%). Coronary artery perforation occurred as a complication of wire manipulation in 45 patients (66.2%) with 88.9% of this group being hydrophilic wires, of coronary stenting in 11 (16.2%), of angioplasty alone in 6 (8.8%), and of rotational atherectomy in 8 (11.8%). The perforation was sealed with an angioplasty balloon alone in 16 patients (23.5%), and with stents in 14 patients (20.6%) (covered stents: 11.8% and noncovered stents: 8.8%). Emergency CABG was performed in 2 patients (2.9%). Five patients (7.4%) developed periprocedural MI. The in-hospital mortality rate was 5.9% in the study cohort. CONCLUSION: Coronary artery perforation as a complication of PCI is still rare as demonstrated in our series with an incidence of 0.48%. The predominant cause of coronary perforations in the current era of PCI is wire injury.


Subject(s)
Angioplasty, Balloon, Coronary/adverse effects , Coronary Artery Disease , Coronary Vessels/injuries , Adult , Aged , Aged, 80 and over , Female , Humans , Iatrogenic Disease , Male , Middle Aged , Myocardial Infarction/etiology , Retrospective Studies , Time Factors
4.
Med Lav ; 82(1): 30-7, 1991.
Article in Italian | MEDLINE | ID: mdl-1865845

ABSTRACT

The paper reports a case of asbestosis in a truck driver whose anamnesis, at first, revealed no evidence of previous exposure to asbestos, whether occupational or extra occupational. A pleuro-pulmonary fibrosis was discovered in 1987, following an episode of exudative pleurisy on the right side. The thickened pleura was then surgically removed. In the samples of pleuro-pulmonary fibroid tissue taken during the operation, typical asbestos bodies were demonstrated in optical microscopy. The analysis of possible exposure to asbestos that might not have been referred in the anamnesis revealed that in at least six widely used truck models (of which three were driven by the worker from 1958 to 1984), the presence of an asbestos winding around a manifold found on the bottom or on the side of the engine. In such trucks, the engine is inside the driver's cab, covered by a cowling set on the floor. Asbestos fibers could enter the driver's cab through a little window in the cowling or through outlets in the dashboard, carried by the airflow generated by the big fan at the back of the radiator and by the truck motion itself. The window or the outlets remained open during cold periods of the year to allow the air, warmed by the motor, to enter the driver's cab.


Subject(s)
Asbestosis/diagnosis , Automobile Driving , Occupational Exposure/adverse effects , Asbestosis/etiology , Asbestosis/pathology , Chronic Disease , Humans , Male , Middle Aged , Pleura/pathology , Pulmonary Fibrosis/chemically induced , Pulmonary Fibrosis/diagnosis , Pulmonary Fibrosis/pathology
6.
Int J Epidemiol ; 14(1): 113-7, 1985 Mar.
Article in English | MEDLINE | ID: mdl-3988425

ABSTRACT

The effects on health of the 1980 earthquake in southern Italy were surveyed retrospectively. The sample population includes 3619 people living in seven villages situated near the epicentre. Deaths were one hundred times and injury rates more than five times higher in trapped than in non-trapped victims. The possibility for escape was crucial for survival and depended on the type of building. Most of the rescue and relief work was carried out within a few days by unprepared local people who concentrated assistance on people sharing the same dwelling. The results suggest that the emergency phase for medical care was limited to the three to four days after impact. During the 18 months following the quake, mortality rates in injured (13.7%) and non-injured victims (15.8%) were similar. These results point to the need to establish, in each disaster prone area, a health evaluation system on which effective disaster relief and especially the preparedness of the community can be based.


Subject(s)
Disasters , Morbidity , Mortality , Disaster Planning , Female , Humans , Italy , Male , Relief Work , Retrospective Studies , Wounds and Injuries/epidemiology , Wounds and Injuries/mortality
7.
J Hyg (Lond) ; 93(1): 67-78, 1984 Aug.
Article in English | MEDLINE | ID: mdl-6379044

ABSTRACT

An epidemic caused by Serratia marcescens that involved 26 infants admitted to the Neonatal Intensive Care Unit (NICU) and 82 infants admitted to the Nursery of the 2nd Medical School of Naples is reported. Two different biotypes of S. marcescens with two completely different epidemiological patterns were identified. The prevalent biotype (A8b trigonelline-) was isolated in the delivery room, in the operating room, in the Nursery and in the NICU from items, healthy infant excreters and affected infants; the second biotype (A3a) was isolated only in the NICU from staff, two healthy infant excreters and two affected infants. Colonization of the throat and the gastrointestinal tract was frequent. Infected and colonized infants were the most important reservoir for serratia in the Nursery and in the NICU particularly for the type strain A3a. A mucus aspiration apparatus contaminated in the delivery room and the contamination of several instruments and items probably had a major role in the initiation and maintenance of the spread of the A8b strain. Mass contamination of the nursery has been related to overcrowding and a lack of the control measures; the transfer of high-risk colonized infants caused spread in the NICU. In the NICU the attack rate 26%; 69% of infants became ill; the case fatality ratio was 19%. Epidemiological investigation of the infants at risk showed some factors predisposing to infection with serratia. The hygienic measures failed to control the spread of serratia and it was necessary to refuse new admissions to pregnant women in order to decontaminate and re-organize the wards.


Subject(s)
Cross Infection/epidemiology , Disease Outbreaks/epidemiology , Enterobacteriaceae Infections/epidemiology , Intensive Care Units, Neonatal , Nurseries, Hospital , Serratia marcescens/isolation & purification , Anti-Bacterial Agents/pharmacology , Cross Infection/microbiology , Cross Infection/transmission , Enterobacteriaceae Infections/microbiology , Enterobacteriaceae Infections/transmission , Feces/microbiology , Humans , Infant, Newborn , Infant, Premature , Italy , Microbial Sensitivity Tests , Personnel, Hospital , Pharynx/microbiology , Serratia marcescens/classification , Serratia marcescens/drug effects , Skin/microbiology
8.
Bull World Health Organ ; 61(6): 1021-5, 1983.
Article in English | MEDLINE | ID: mdl-6609007

ABSTRACT

A retrospective survey was undertaken on the health effects of the 1980 earthquake in southern Italy. The study population included 3619 people living in 7 villages situated near the epicentre of the disaster. The overall casualty rate (dead and injured) was 19.7%. Nearly all the deaths (192/202) occurred among trapped people who died before they could be rescued. Eighty per cent of all the trapped people were extricated within 2 days, mostly without the use of sophisticated means. The probability of survival decreased sharply, the longer the time before extrication. The crude mortality during the 18 months following the earthquake was 19.0 per thousand among the injured people who received treatment, and 14.1 per thousand among non-injured people. After age standardization, there was no significant difference between these two figures and the expected mortality figures for the Italian population in normal times (14.4 per thousand). These results stress the importance of providing rescue activities in the first 48 hours after the impact. Strengthening the self-reliance of the community in disaster preparedness is suggested as the best way to improve the effectiveness of relief operations. In disaster-prone areas, training and education in methods of rescue should be an integral part of any primary health care programme.


Subject(s)
Disasters , Humans , Italy , Mortality , Retrospective Studies , Wounds and Injuries/epidemiology , Wounds and Injuries/etiology
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