Background-Circumferential radiofrequency ablation around pulmonary vein (PV) ostia has recently ... more Background-Circumferential radiofrequency ablation around pulmonary vein (PV) ostia has recently been described as a new anatomic approach for atrial fibrillation (AF). Methods and Results-We treated 251 consecutive patients with paroxysmal (nϭ179) or permanent (nϭ72) AF. Circular PV lesions were deployed transseptally during sinus rhythm (nϭ124) or AF (nϭ127) using 3D electroanatomic guidance. Procedures lasted 148Ϯ26 minutes. Among 980 lesions surrounding individual PVs (nϭ956) or 2 ipsilateral veins with close openings or common ostium (nϭ24), 75% were defined as complete by a bipolar electrogram amplitude Ͻ0.1 mV inside the lesion and a delay Ͼ30 ms across the line. The amount of low-voltage encircled area was 3594Ϯ449 mm 2 , which accounted for 23Ϯ9% of the total left atrial (LA) map surface. Major complications (cardiac tamponade) occurred in 2 patients (0.8%). No PV stenoses were detected by transesophageal echocardiography. After 10.4Ϯ4.5 months, 152 patients with paroxysmal AF (85%) and 49 with permanent AF (68%) were AF-free. Patients with and without AF recurrence did not differ in age, AF duration, prevalence of heart disease, or ejection fraction, but the LA diameter was significantly higher (PϽ0.001) in permanent AF patients with recurrence. The proportion of PVs with complete lesions was similar between patients with and without recurrence, but the latter had larger low-voltage encircled areas after radiofrequency (expressed as percent of LA surface area; PϽ0.001). Conclusions-Circumferential PV ablation is a safe and effective treatment for AF. Its success is likely due to both PV trigger isolation and electroanatomic remodeling of the area encompassing the PV ostia. (Circulation. 2001;104:2539-2544.)
A large International Restless Legs Syndrome (RLS) Study Group has been formed. As its first task... more A large International Restless Legs Syndrome (RLS) Study Group has been formed. As its first task, the group has taken upon itself the role of definig the clinical features of the RLS. As minimal criteria for diagnosis, the group proposes the following four features: (a) desire to move the extremities, often associated with paresthesias/dysesthesias; (b) motor restlessness; (c) worsening of symptoms at rest with at least temporary relief by activity, and (d) worsening of symptoms in the evening or night. Other features commonly seen in RLS include sleep disturbance, periodic limb movements in sleep and similar involuntary movements while awake, a normal neurological examination in the idiopathic from, a tendency for the symptoms to be worse in middle to older age, and, in some cases, a family history suggestive of an autosomal dominant mode of inheritance.
Results of 33 simultaneous pancreas and kidney transplantations performed at the San Raffaele Hos... more Results of 33 simultaneous pancreas and kidney transplantations performed at the San Raffaele Hospital, Milan, Italy are presented. In 26 cases segmental neoprene duct-injected grafts were transplanted and in seven cases, duodenopancreatic bladder-drained grafts. Five-year patient, kidney and pancreas survival were respectively, 89%,72% and 58%. Five-year survival in patients with technically successful pancreas transplants was 73%. Thrombosis occured in 20% of cases. Mortality was 6% and overall morbidity 76%. Surgical complications were present in 51% of cases.
The role of endoscopic therapy in the management of pancreatic diseases is continuously evolving;... more The role of endoscopic therapy in the management of pancreatic diseases is continuously evolving; at present, most pathological conditions of the pancreas are successfully treated by endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS) or both. Endoscopic placement of stents has played and still plays a major role in the treatment of chronic pancreatitis, pseudocysts, pancreas divisum, main pancreatic duct injuries, pancreatic fistulae, complications of acute pancreatitis, recurrent idiopathic pancreatitis and in the prevention of post-ERCP pancreatitis. These stents are currently routinely placed to reduce intraductal hypertension, bypass obstructing stones, restore lumen patency in cases with dominant, symptomatic strictures, seal main pancreatic duct disruption, drain pseudocysts or fluid collections, treat symptomatic major or minor papilla sphincter stenosis, and prevent procedure-induced acute pancreatitis. The present review aims at updating and discussing techniques, indications and results of endoscopic pancreatic duct stent placement in acute and chronic inflammatory diseases of the pancreas.
Insertional oncogenesis is a possible consequence of the integration of gamma-retroviral (RV) or ... more Insertional oncogenesis is a possible consequence of the integration of gamma-retroviral (RV) or lentiviral (LV) vectors into the human genome. RV common insertion sites (CIS) have been identified in hematopoietic malignancies and in the non-malignant progeny of transduced hematopoietic stem/progenitor cells (HSCs), possibly as a consequence of clonal selection in vivo. We have mapped a large number of RV and LV integrations in human CD34 + HSCs, transduced in vitro and analyzed without selection. Recurrent insertion sites (hot spots) account for >21% of the RV integration events, while they are significantly less frequent in the case of LV vectors. RV but not LV hot spots are highly enriched in proto-oncogenes, cancer-associated CIS, and growthcontrolling genes, indicating that at least part of the biases observed in the HSC progeny in vivo are characteristics of RV integration, already present in non-transplanted cells. Genes involved in hematopoietic and immune system development are targeted at high frequency and enriched in hot spots, suggesting that the CD34 + gene expression program is instrumental in directing RV integration. The lower propensity of LV vectors for integrating in potentially dangerous regions of the human genome may be a factor determining a better safety profile for gene therapy applications.
Background-Circumferential radiofrequency ablation around pulmonary vein (PV) ostia has recently ... more Background-Circumferential radiofrequency ablation around pulmonary vein (PV) ostia has recently been described as a new anatomic approach for atrial fibrillation (AF). Methods and Results-We treated 251 consecutive patients with paroxysmal (nϭ179) or permanent (nϭ72) AF. Circular PV lesions were deployed transseptally during sinus rhythm (nϭ124) or AF (nϭ127) using 3D electroanatomic guidance. Procedures lasted 148Ϯ26 minutes. Among 980 lesions surrounding individual PVs (nϭ956) or 2 ipsilateral veins with close openings or common ostium (nϭ24), 75% were defined as complete by a bipolar electrogram amplitude Ͻ0.1 mV inside the lesion and a delay Ͼ30 ms across the line. The amount of low-voltage encircled area was 3594Ϯ449 mm 2 , which accounted for 23Ϯ9% of the total left atrial (LA) map surface. Major complications (cardiac tamponade) occurred in 2 patients (0.8%). No PV stenoses were detected by transesophageal echocardiography. After 10.4Ϯ4.5 months, 152 patients with paroxysmal AF (85%) and 49 with permanent AF (68%) were AF-free. Patients with and without AF recurrence did not differ in age, AF duration, prevalence of heart disease, or ejection fraction, but the LA diameter was significantly higher (PϽ0.001) in permanent AF patients with recurrence. The proportion of PVs with complete lesions was similar between patients with and without recurrence, but the latter had larger low-voltage encircled areas after radiofrequency (expressed as percent of LA surface area; PϽ0.001). Conclusions-Circumferential PV ablation is a safe and effective treatment for AF. Its success is likely due to both PV trigger isolation and electroanatomic remodeling of the area encompassing the PV ostia. (Circulation. 2001;104:2539-2544.)
A large International Restless Legs Syndrome (RLS) Study Group has been formed. As its first task... more A large International Restless Legs Syndrome (RLS) Study Group has been formed. As its first task, the group has taken upon itself the role of definig the clinical features of the RLS. As minimal criteria for diagnosis, the group proposes the following four features: (a) desire to move the extremities, often associated with paresthesias/dysesthesias; (b) motor restlessness; (c) worsening of symptoms at rest with at least temporary relief by activity, and (d) worsening of symptoms in the evening or night. Other features commonly seen in RLS include sleep disturbance, periodic limb movements in sleep and similar involuntary movements while awake, a normal neurological examination in the idiopathic from, a tendency for the symptoms to be worse in middle to older age, and, in some cases, a family history suggestive of an autosomal dominant mode of inheritance.
Results of 33 simultaneous pancreas and kidney transplantations performed at the San Raffaele Hos... more Results of 33 simultaneous pancreas and kidney transplantations performed at the San Raffaele Hospital, Milan, Italy are presented. In 26 cases segmental neoprene duct-injected grafts were transplanted and in seven cases, duodenopancreatic bladder-drained grafts. Five-year patient, kidney and pancreas survival were respectively, 89%,72% and 58%. Five-year survival in patients with technically successful pancreas transplants was 73%. Thrombosis occured in 20% of cases. Mortality was 6% and overall morbidity 76%. Surgical complications were present in 51% of cases.
The role of endoscopic therapy in the management of pancreatic diseases is continuously evolving;... more The role of endoscopic therapy in the management of pancreatic diseases is continuously evolving; at present, most pathological conditions of the pancreas are successfully treated by endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS) or both. Endoscopic placement of stents has played and still plays a major role in the treatment of chronic pancreatitis, pseudocysts, pancreas divisum, main pancreatic duct injuries, pancreatic fistulae, complications of acute pancreatitis, recurrent idiopathic pancreatitis and in the prevention of post-ERCP pancreatitis. These stents are currently routinely placed to reduce intraductal hypertension, bypass obstructing stones, restore lumen patency in cases with dominant, symptomatic strictures, seal main pancreatic duct disruption, drain pseudocysts or fluid collections, treat symptomatic major or minor papilla sphincter stenosis, and prevent procedure-induced acute pancreatitis. The present review aims at updating and discussing techniques, indications and results of endoscopic pancreatic duct stent placement in acute and chronic inflammatory diseases of the pancreas.
Insertional oncogenesis is a possible consequence of the integration of gamma-retroviral (RV) or ... more Insertional oncogenesis is a possible consequence of the integration of gamma-retroviral (RV) or lentiviral (LV) vectors into the human genome. RV common insertion sites (CIS) have been identified in hematopoietic malignancies and in the non-malignant progeny of transduced hematopoietic stem/progenitor cells (HSCs), possibly as a consequence of clonal selection in vivo. We have mapped a large number of RV and LV integrations in human CD34 + HSCs, transduced in vitro and analyzed without selection. Recurrent insertion sites (hot spots) account for >21% of the RV integration events, while they are significantly less frequent in the case of LV vectors. RV but not LV hot spots are highly enriched in proto-oncogenes, cancer-associated CIS, and growthcontrolling genes, indicating that at least part of the biases observed in the HSC progeny in vivo are characteristics of RV integration, already present in non-transplanted cells. Genes involved in hematopoietic and immune system development are targeted at high frequency and enriched in hot spots, suggesting that the CD34 + gene expression program is instrumental in directing RV integration. The lower propensity of LV vectors for integrating in potentially dangerous regions of the human genome may be a factor determining a better safety profile for gene therapy applications.
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