A case of acute renal failure with multiple origins of the renal injury.

Acute kidney injury (AKI) is an abrupt and usually reversible decline in the glomerular filtration rate (GFR). Patients with AKI must be evaluated promptly to determine cause. Different disorders can BE associated with AKI, and biopsy is the most accurate instrument for diagnosis of different types of diseases.

Tailored versus standard dose prophylaxis in children with hemophilia A.

Prophylaxis is universally recognized as the treatment of choice in people with hemophilia, and tailored prophylaxis is the consistent modification of the standard weight-based dosing regimen. A large number of factors guide the choice of a specific tailored regimen, and different regimens are under evaluation. Tailored low-dose frequent regimens are likely to be cost-effective, but they are less accepted by patients.

Effectiveness of cast immobilization in comparison to the gold-standard self-removal orthotic intervention for closed mallet fingers: a randomized clinical trial.

Study Design: Randomized clinical trial.

Introduction: Although orthotic immobilization has become the preferable treatment choice for closed mallet injuries, it is unclear whether orthosis self-removal has an impact on the final outcome.

Purpose: To evaluate the treatment efficacy of cast immobilization of closed mallet fingers using Quickcast(®) (QC) compared to a removable, lever-type thermoplastic orthosis (LTTP).

The immune reconstitution after an allogeneic stem cell transplant correlates with the risk of graft-versus-host disease and cytomegalovirus infection.

Aim of the study was to correlate the clinical outcome of eighteen patients who have undergone an allogeneic stem cell transplant (SCT) with the concentration in the peripheral blood (PB) of lymphocyte subpopulations evaluated at 1 year from transplant. The occurrence of acute GVHD and CMV infection correlated with the concentration of Tregs in the PB; CMV infection also correlated with the content of NK cells. The obtained results document that the concentration of Tregs in the PB after an allogeneic SCT may protect from GVHD and from CMV infection; the potential anti-viral role of NK cells is confirmed.

Management of the 2009 A/H1N1 influenza pandemic in patients with hematologic diseases: a prospective experience at an Italian center.

Data derived from epidemiologic surveillance adopted at our center in hematologic and stem cell transplant patients during the 2009 influenza A (H1N1)v pandemic are reported. Of the 52 patients with influenza-like disease we observed, 37 underwent a real-time PCR evaluation and 21 had a confirmed diagnosis. Of the RT-PCR-confirmed cases, 23.

Evaluation of comorbidities at diagnosis predicts outcome in myelodysplastic syndrome patients.

Recent data suggest that proper assessment of comorbidities is useful to predict the outcome of MDS patients receiving allogeneic stem cell transplantation. However, the results obtained in this highly selected subset of patients cannot be applied to the whole MDS population. We evaluated the impact of comorbidities in 418 consecutive MDS patients diagnosed at our institute from 1992 to 2005.

Papillary muscle perfusion pattern. A hypothesis for ischemic papillary muscle dysfunction.

Background: The pathogenesis of posterior papillary muscle dysfunction is poorly understood. We hypothesized that papillary muscle perfusion pattern may explain the higher prevalence of posterior papillary muscle dysfunction after myocardial infarction.

Methods And Results: Twenty patients were monitored by transesophageal echocardiography during coronary surgery.

Risk factors of incomplete distribution of cardioplegic solution during coronary artery grafting.

Myocardial distribution of cardioplegic solution infused by combined antegrade/retrograde routes was assessed with myocardial contrast echocardiography in 18 patients with chronic stable angina and three-vessel disease undergoing elective coronary artery bypass grafting. Overall myocardial opacification was significantly greater in retrograde than in antegrade cardioplegia (77.7% +/- 13.

Low-dose dobutamine echocardiography predicts the early response of dysfunctioning myocardial segments to coronary artery bypass grafting.

Dobutamine echocardiography has recently been introduced for use in identification of viable myocardium in patients with acute myocardial infarction and prediction of the response of dysfunctioning myocardial segments to coronary angioplasty. The aim of this study was to evaluate whether this test may be used to predict the early response of dysfunctioning myocardial segments to surgical revascularization. We studied 30 patients with three-vessel disease and chronic, stable angina pectoris during coronary artery bypass grafting (CABG).

Mechanisms of incomplete cardioplegia distribution during coronary artery surgery. An intraoperative transesophageal contrast echocardiography study.

Background: Cardioplegia is used to protect the myocardium from ischemic injury during open-heart surgery. However, the delivery of cardioplegic solutions may be impaired by anatomic and/or functional conditions, such as the development of transient aortic regurgitation during antegrade administration of cardioplegia or shunting through a foramen ovale during retrograde administration. In this study, the authors used a new method of cardioplegia administration, based on intraoperative contrast echocardiography, to detect on-line causes of inadequate cardioplegia delivery.

[Anterograde and retrograde cardioplegia in myocardial revascularization. An intraoperative contrast echographic study].

The aim of this study was to assess the distribution of antegrade and retrograde cardioplegia with intraoperative contrast echocardiography in patients undergoing coronary artery bypass grafting. Fifteen patients with chronic stable angina pectoris and severe coronary artery disease were studied. The severity of coronary artery disease was assessed at coronary angiography, using the Jeopardy Score System.

[The identification of vital myocardium with the dopamine stimulation test: an intraoperative echocardiographic study].

The aim of this study was to detect by dopamine echocardiography dysfunctioning but viable myocardial segments. We have studied 19 patients with 3-vessel disease and chronic, stable angina pectoris. Patients were studied by intraoperative transesophageal echocardiography during coronary artery bypass surgery.

Intraoperative contrast echocardiography for assessment of the surgical repair of coronary artery fistula.

We report two cases of acquired coronary fistula in whom fistula flow and surgical repair were evaluated intraoperatively by contrast echocardiography. Surgical repair was carried out through the left atrium because of the associated surgical procedure on the mitral valve. Contrast echocardiography allowed easy identification of the fistula openings in the left atrium and intraoperative control of the efficacy of the surgical closure.

Echocardiographic analysis of dysfunctional and normal myocardial segments before and immediately after coronary artery bypass graft surgery.

Echocardiography has revealed evidence of "subnormal" regional contraction patterns that result from myocardial ischemia and are often accompanied by nonadjacent "hyperkinetic" regions. Whether these regions of hyperkinetic wall motion persist unchanged or revert to normal after coronary artery bypass graft (CABG) surgery has not been studied in humans. Using echocardiography, we evaluated both dysfunctional and normal myocardial regions for changes in segmental wall motion and percent of systolic wall thickening that occurred immediately after CABG surgery in 32 patients.

Reversal of left ventricular dysfunction early after coronary artery bypass grafting.

This study evaluated the early effect of coronary artery bypass grafting (CABG) on left ventricular systolic function. Intraoperative echocardiography was performed in 32 patients with coronary artery disease and chronic, stable angina pectoris. Left ventricular short-axis images at mid-papillary muscle level were videotaped at similar loading conditions shortly after pericardiotomy and 28 +/- 5 min after weaning from cardiopulmonary bypass.

Spontaneous left atrial echocardiographic contrast in mitral stenosis: early disappearance after valve replacement.

We describe a patient with mitral stenosis and severely enlarged left atrium. Transthoracic echocardiography showed a false image of intraatrial thrombus, whereas transesophageal echocardiography showed massive spontaneous left atrial contrast. Intraoperative transesophageal echocardiography was performed.

Ventricular conduction defects and atrial fibrillation after coronary artery bypass grafting. Multivariate analysis of preoperative, intraoperative and postoperative variables.

Preoperative, intraoperative and postoperative variables, which might play a role in the development of ventricular conduction defects (VCD) and atrial fibrillation (AF) following coronary artery bypass grafting (CABG), were evaluated in 236 consecutive patients. VCD and AF developed postoperatively in 15.5% of patients: 4.

Effects of uncomplicated coronary artery bypass graft surgery on global and regional left ventricular function at rest. Study by equilibrium radionuclide angiocardiography.

To evaluate the effects of uncomplicated revascularization surgery on resting global and regional left ventricular function we studied 34 patients, enrolled consecutively, by radionuclide angiocardiography. After surgery, we found no significant change in global left ventricular ejection fraction; this was true even in the subgroup of 14 patients who developed paradoxical septal motion. This finding indicates that the development of paradoxical septal motion after uncomplicated cardiac surgery does not compromise global left ventricular function.