Giornale italiano di cardiologia : organo ufficiale della Federazione italiana di cardiologia : organo ufficiale della Società italiana di chirurgia cardiaca
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G Ital Cardiol (Rome) · Apr 2006
Review Comparative Study[Cardiac cell therapy: the puzzle is waiting to be solved].
Cell therapy has been proposed as an innovative hypothesis to treat acute myocardial infarction and heart failure. However, the mechanism by which stem cells could improve cardiac function remains unclear and many controversies have been arisen in interpretation of experimental and clinical data. Answering the five "WH questions" we discuss the process that has led to consider cell therapy as a new treatment option for myocardial tissue regeneration after ischemic damage. 1) Why should we use stem cells? The rationale derives from the disclosure that apoptosis and regeneration occur at the myocardial level and stem cells migrate from bone marrow to repopulate the damaged cardiac tissue. 2) Which are the most appropriate cells, delivery methods and therapeutic purposes? Adult stem cells can be mobilized or directly transplanted in human hearts to accomplish myocardioneogenesis, neoangiogenesis and/or paracrine effects. 3) Where should we transplant these cells? The infarct border zone seems to be the best place to home and differentiate transplanted cells hampering post-ischemic cardiac remodeling. 4) When should we perform cell therapy? Cell therapy should be performed during or after an acute myocardial infarction: best setting and timing still need to be precisely addressed. 5) Who might be the suitable patient? Further multicenter randomized trials with adequate patient selection are needed to answer this crucial question.
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G Ital Cardiol (Rome) · Mar 2006
Review[Management of acute chest pain in the emergency department].
Acute chest pain is one of the most common symptoms in emergency departments. Immediate assessment is mandatory on arrival in order to ensure the appropriate care. Diagnostic work-up should be based on conventional tools, i.e. clinical presentation, physical examination, electrocardiogram, as well as on modern information, i.e. biochemical markers of myocardial damage or provocative tests. ⋯ An agreement on specific protocols is often difficult to achieve between different specialties. Also, no official guidelines on low-risk chest pain patients or patients with non-cardiac chest pain are available. Finally, the minimal data set of diagnostic tools that should be applied in case of acute chest pain in any emergency setting is still lacking.
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G Ital Cardiol (Rome) · Feb 2006
Case Reports[Widespread embolism in tricuspid and mitral endocarditis caused by chronic lymphangitis. Case report].
Infective endocarditis, a serious microbial infection of the cardiac endothelial surface, may involve any heart valve. However, right-sided endocarditis is uncommon in non-intravenous drug abusers without underlying heart disease, and the contextual involvement of the left-sided valve is exceptional. A 63-year-old man with no evidence of intravenous drug abuse or heart disease, presented with persistent fever, worsening of breath, and aphasia. ⋯ Blood cultures identified Staphylococcus aureus. The only risk factor was large skin sepsis. Despite successful antibiotic therapy, the patient died for development of renal and respiratory failure.