COLLEGIO DI DIREZIONE - Azienda Ospedaliera di Parma

18) De Berti, G; Maggi, M; Conigliaro, R; Levrini, G; Salzano, S; Ghadir pour, R; Servadei, F (2012)
Administration of conscious sedation by a neuroradiology team during percutaneous vertebroplasty and
spinal biopsy procedures NEURORADIOLOGY 54(3):231-237 IF=2.87 [Article]
Percutaneous vertebroplasty, i.e. the consolidation of a vertebral body with polymethylmethacrylate, is a safe and
effective image-guided technique increasingly used as a treatment option for different pathologic conditions, mainly
vertebral body fractures secondary to osteoporosis, hemangiomas and metastasis. The procedure, although minimally
invasive, could be painful and is better tolerated if a conscious sedation regimen is added to local anesthesia. An
anesthesiologist usually performs the sedo/analgesia, but frequently, he is not available in our angiography unit, so we
have begun to perform the sedo/analgesia ourselves following an analogous situation that physicians of the Digestive
Endoscopic Unit of our institution experienced some years ago. Using the guidelines developed by Italian Society of
Digestive Endoscopy, Italian Society of Anesthesia, Analgesia, Reanimation and Intensive Therapy and National
Association of Endoscopy Operators and Technicians as a starting point, we then adapted their protocol to our
vertebroplasty requirements, after an adequate training period carried out by our anesthesiologist staff. The results have
been very satisfactory, greatly appreciated by patients for good pain control; we have never registered any adverse
effects nor have we had any particular problems in controlling sedation or monitoring procedures. In our experience, we
have observed that conscious sedation can be safely administered by neuroradiologists during spinal procedures,
provided that some basic rules are respected regarding patient selection and monitoring, personnel training and
angiography equipment.
19) Di Gennaro, C; Saccani-Jotti, G; Pinelli, S; Venturi, N; Palombi, F; Manfredi, G; Pellegrino, A;
Bicchieri, L; Sansoni, P; Montanari, A (2012) Endothelial Dysfunction and High Cardiovascular Risk
Profile in Severe Alcoholics Improve Only Partially Following a Medium-Term Alcohol Withdrawal
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH 36(2):242-250 IF=3.468 [Article]
Background: Little is known about brachial artery flow-mediated vasodilatation (FMD) in active and medium-term
withdrawing heavy alcoholics (HA). Methods: FMD and some parameters of cardiovascular (CV) risk were measured
in 29 HA (average alcohol intake 135, range 86 to 215 g per day) at baseline and after a 9 +/- 7 months withdrawal and
in 35 teetotalers. Results: HA showed baseline impaired maximal % FMD (8.5 +/- 5.4 SD vs. 14.9 +/- 7.4, < 0.001 vs.
teetotalers), higher systolic (SBP) and diastolic (DBP) blood pressure (+ 24 mm Hg, < 0.001; + 15 mm Hg, < 0.01), uric
acid (5.3 +/- 1.1 vs. 4.4 +/- 0.8 mg/dl, < 0.05), high-sensitivity C-reactive protein (hs-CRP; 2.7 +/- 2.0 vs. 1.0 +/- 0.9
mg/l, < 0.02), endothelin-1 (ET-1, 0.88 +/- 0.36 vs. 0.37 +/- 0.10 pg/ml,< 0.001), asymmetric dimethylarginine
(ADMA, 0.50 +/- 0.21 vs. 0.41 +/- 0.12 mu mol/l, p < 0.001), homeostasis model assessment of insulin resistance
(HOMA-IR) (2.3 +/- 1.1 vs. 1.2 +/- 0.4, < 0.001), and urinary 8-isoprostane (U8-iso-PGF2 alpha) (237.2 +/- 172.4 vs.
168.5 +/- 96.6 pg/mg creatinine, < 0.05). After withdrawal, SBP fell by 15 mm Hg, DBP by 11 mm Hg (p < 0.001), and
hs-CRP by 0.94 mg/l (p < 0.02), all remaining still higher than teetotalers (< 0.05, 0.01, 0.05 respectively). ET-1,
HOMA-IR, and U8-iso-PGF2 alpha were unchanged (p = NS vs. baseline, < 0.05 to 0.001 vs. teetotalers). Maximal %
FMD rose (to 10.6 +/- 6.2, p < 0.04), but it still remained impaired (< 0.04 vs. teetotalers). ADMA increased further to
0.64 +/- 0.15 mu mol/l (< 0.05 vs. baseline, < 0.02 vs. teetotalers). Conclusions: HA show marked endothelial
dysfunction (ED) and high BP, impaired insulin sensitivity, inflammation, increased oxidative stress, and elevated ET-1
and ADMA, which are unaffected or only partially reversed by a medium-term alcohol withdrawal. ED and related
abnormalities persist in detoxified alcoholics, thus contributing to a greater CV morbidity and mortality.