162 research outputs found
General anaesthesia for external electrical cardioversion of atrial fibrillation: experience of an exclusively cardiological procedural management.
No full textAIMS: External electrical cardioversion (EC) usually requires brief general anaesthesia involving anaesthetists. The aim of this study was to evaluate the feasibility and safety of inducing anaesthesia for EC of atrial fibrillation (AF) exclusively by the cardiologic team with anaesthetists on-hand. METHODS AND RESULTS: A retrospective analysis of 624 elective EC, over a 6-year period, was made. No patients were excluded due to the severity of pathology or comorbidities. The protocol of the intravenous anaesthesia was 5 mg bolus of midazolam and subsequent increasing doses of propofol starting from 20 mg to achieve the desired sedation level. After delivering DC shock, a direct observation period followed in order to assess the post-sedation recovery and to detect the procedure-related complications. Electrical cardioversion was effective in 98.9\% of the cases. General anaesthesia was effective in 100\% of cases with a dosage of propofol, ranging between 20 mg to a maximum of 80 mg, after 5 mg of midazolam was administered. All patients generally showed a fast recovery waking up in a few minutes. The anaesthesiology team was never called for assistance. All the procedures were carried out by the cardiologic team as planned. No thrombo-embolic and allergic complications were observed. Arrhythmic complications were uncommon and essentially bradyarrhythmias. CONCLUSION: A general anaesthesia for outpatient EC of AF can be safely handled by a cardiologist having adequate experience with anaesthetical agents. Moreover, the association of midazolam and a very small dosage of propofol, given their synergic action, is effective and safe in inducing anaesthesia. Arrhythmic complications are rare and limited to bradyarrhythmias
Autochthonous Cases of Mycetoma in Europe: Report of Two Cases and Review of Literature
No full textBackground: Mycetoma is a chronic granulomatous infection involving cutaneous and subcutaneous tissues. It is endemic in tropical and subtropical areas, but sporadic cases have been reported also in countries of temperate climate. The purpose of this paper is to review the cases of mycetoma in European subjects (and presumably acquired in Europe), to give an insight in the main factors associated with this condition, and to describe two previously unpublished cases observed at our Centre. Methods and Findings: PubMed was systematically searched for case reports and case series of mycetoma in Europeans reported between 1980 and 2014, using specific search strategies. Two further cases diagnosed by the authors are described. Forty-two cases were collected. Eleven cases were caused by Scedosporium apiospermium, mainly in immunosuppressed patients from Bulgaria, Germany, the Netherlands, Portugal, Slovenia, Spain and the United Kingdom. Excluding all patients with immunosuppression, 29 cases remain. Most of them were reported from Bulgaria and in Albanian patients (all diagnosed outside Albania). In the Bulgarian case series many different micro-organisms, both bacteria and fungi, were isolated, while all the 5 cases from Albania were caused by Actinomadura spp. Other countries reporting cases were Greece, Italy and Turkey. In general, Actinomadura spp is the most frequent causative agent isolated, followed by Nocardia spp and Madurella mycetomatis. The foot was the most reported site involved. Most patients were medically treated, but unfortunately a long-term follow up (at least one year) was available only in a few cases. Conclusions: Our review and our own cases suggest that Europeans without travel history can be affected by Madura foot. The lack of a surveillance system is likely to cause an underreporting of cases. Moreover, the unfamiliarity of Western doctors with this peculiar infection may cause a mismanagement, including unnecessary amputations
Coccidioidomycosis: first imported case in Italy
No full textWe report a case of pulmonary coccidioidomycosis imported from the United States to Italy. This disease should enter in the differential diagnosis of any febrile patient (especially if presenting with pulmonary symptoms, with or without hypereosinophilia) coming from Coccidioides immitis endemic areas
Additional file 2: of Acute histoplasmosis in immunocompetent travelers: a systematic review of literature
No full textCOI disclosure of each Author. (DOCX 90 kb
Outpatients electrical cardioversion of atrial fibrillation: 8 years' experience. Analysis of shock-related arrhythmias.
No full textBackground: Outpatient electrical cardioversion (EC) of atrial fibrillation is currently the standard of care. Shock-related arrhythmias may be particularly deleterious in this setting. Preoperative identification of high-risk patients may be very useful. Methods: A retrospective analysis was made of 543 consecutive elective EC procedures in 457 outpatients over an 8-year period in a university cardiological institute. The protocol included adequate anticoagulation, intravenous anesthesia, direct current shock, and a direct observation after a shock to detect procedure-related complications. No patients were excluded due to severity of pathology or comorbidities. Clinical characteristics, energy delivered, medications, arrhythmic phenomena, and predictors of success and complications were analyzed. Results: Of 543 ECs performed, 88.2% restored sinus rhythm, which persisted at discharge in 83.2%. No anesthesia-related complications were detected. No thromboembolic complications were detected. Use of a biphasic cardioverter was the only predictor of success (P = 0.0001). The bradyarrhythmic complication rate was 1.5%. No ventricular arrhythmic events were detected. Atrial flutter was present in five of eight patients who developed complications versus 44 of 535 patients who had no complications (P < 0.0005), and prosthetic heart valves in four of eight complicated versus 40 of 535 uncomplicated cases (P = 0.0044). The combination of atrial flutter and prosthetic heart valve was found in four of eight complicated versus 11 of 535 uncomplicated cases (P < 0.0005). Conclusion: Shock-related arrhythmias are essentially bradyarrhythmias. Atrial flutter and previous cardiac surgery identify a subgroup of patients at high risk of postshock bradyarrhythmic complications
Coronary sinus and great cardiac vein electroanatomic mapping predicts the activation delay of the coronary sinus branches
No full textBackground: Implantation of left ventricular (LV) lead in segments with delayed electrical activation may improve response to cardiac resynchronization therapy (CRT). The search for the latest LV electrical delay (LVED) site can be time-consuming. Objective: To assess if electrical mapping of coronary sinus (CS) and magna cardiac vein can help to identify the latest activated CS branch. Methods: We retrospectively evaluated 48 consecutive patients who underwent electroanatomic mapping system-guided (EAMS)-CRT device implantation with ≥2 mapped CS branches. The activation mapping of the CS and relative branches were performed using an insulated guide wire. LVED was defined as the interval between the beginning of the QRS complex on the surface electrocardiogram and the local electrogram and expressed in milliseconds (ms). Results: Thirty-two (67%) patients showed left bundle branch block (LBBB) and 16 (33%) non-LBBB electrocardiographic patterns. A total of 116 CS branches (mean, 2.4/patient; range, 2-5) were mapped. In the left oblique view, most patients (N = 39, 81%) showed the latest CS-LVED in lateral segments while nine (19%) showed the latest CS-LVED in anterior or posterior segments. Specifically, 94% of patients with LBBB showed the latest CS-LVED in lateral segments while CS activation among non-LBBB patients was heterogeneous. In all patients, the CS branch that demonstrated the highest LVED originated from the latest activated segment of the CS. Conclusion: Electrical mapping of CS allows identifying the latest activated branches. This finding may contribute to simplify CRT device implantation compared to activation mapping of all the branches
Clinical recrudescence of chronic untreated P. malariae infection after BNT162b2 CoVID-19 vaccine
No full textWe described a case of clinical reactivation of chronic P. malariae infection following CoVID-19 vaccination with BNT162b2 (Pifzer-Biontech CoVID-19 vaccine) in a 48-year old Italian man.The patient came to our attention for fever of unknown origin show a quartan pattern (every third day) associated to splenomegaly, the onset of the fever occurred one month after CoVID-19 vaccination with BNT162b2. P. malariae was diagnosed using CarestartTM malaria rapid test and Polymerase-Chain Reaction. Post-vaccine transient reduction of immune reactivity is described in literature, although the mechanism is unknown.(c) 2022 Published by Elsevier Ltd.CC_BY_NC_ND_4.
Reactivation of Chagas disease after a bone marrow transplant in Italy: first case report
No full textA 9-year old Argentinean girl had been diagnosed with acute lymphoblastic leukaemia in 1999 and was successfully treated with the ALL 96/BFM protocol. In February 2004, following the development of secondary acute myeloid leukaemia, the girl was treated with the AML 97/BFM protocol and obtained a complete remission. In October 2004 she was transferred to Italy in the Unit of Paediatric Haematology/Oncology in Pisa to undergo an allogeneic BMT from a matched, unrelated donor. The pre-transplant evaluation (including electrocardiography and echocardiography) was normal, except for a known cerebral atrophy. A conditioning regimen (fractioned total body irradiation, cyclophosphamide, anti-thymocyte globulin) was administered and 4.34×108/kg of haematopoietic stem cells were infused. Graft-versus-Host Disease (GvHD) prophylaxis was given (cyclosporine A and short course of methotrexate). Polymorphonuclear leucocyte and platelet engraftment occurred on day +20 and +28, respectively. Treatment with prednisolone was started on day +26 because of grade II GvHD of the skin. On day +46 the patient was found to have fever with progressive anaemia (lowest haemoglobin level 7.9 g/dL), neutropenia (180 neutrophils/μL) and thrombocytopenia (12,000 platelets/μL), increased lactate dehydrogenase (1,330 U/L) and alanine transaminase (120 U/L) and mildly increased C-reactive protein (59 mg/L). Clinical examination was non-informative and blood, urine and cerebrospinal fluid cultures were negative. Bone marrow aspiration confirmed the leukaemia remission. Echocardiography and total body computed tomography scans were normal. Broad-spectrum antibiotics were started and antifungal therapy was added 5 days later. Epstein-Barr virus reactivation on day +46 was successfully treated with rituximab, with normalisation of virological markers but no effect on the fever. On day +56 the patient’s general conditions worsened and she developed hepatomegaly and laboratory evidence of abnormal liver function (gamma-glutamyl transferase 425 U/L, alanine transaminase 232 U/L, alkaline phosphatase 830 U/L, lactate dehydrogenase 11,526 U/L). A peripheral blood smear revealed flagellated parasites identified as T. cruzi trypomastigotes. Therapy with benznidazole (10 mg/kg/die) was started but 3 days later the patient died from multi-organ failure (day +70)
Failure of dihydroartemisinin-piperaquine treatment of uncomplicated Plasmodium falciparum malaria in a traveller coming from Ethiopia
No full textBackground: Artemisinin combination therapy (ACT) is used worldwide as the first-line treatment against uncomplicated Plasmodium falciparum malaria. Despite the success of ACT in reducing the global burden of malaria, the emerging of resistance to artemisinin threatens its use. Case report: This report describes the first case of failure of for the treatment of P. falciparum malaria diagnosed in Europe. It occurred in an Italian tourist returned from Ethiopia. She completely recovered after the DHA-PPQ treatment but 32 days after the end of therapy she had a recrudescence. The retrospective analysis indicated a correct DHA-PPQ absorption and genotyping demonstrated that the same P. falciparum strain was responsible for the both episodes. Conclusion: In consideration of the growing number of cases of resistance to ACT, it is important to consider a possible recrudescence, that can manifest also several weeks after treatment
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