The prevalence of resistant arterial hypertension and secondary causes in a cohort of hypertensive patients: a single center experience

The prevalence of resistant hypertension (RHT) still remains unknown. Aim of the study was to investigate in a large cohort of hypertensive patients the prevalence of RHT, and to identify in these patients the secondary forms of arterial hypertension (SH). We enrolled a series of 3685 consecutive hypertensive patients. All patients underwent complete physical examination, laboratory tests, screening for SH. Ambulatory blood pressure monitoring (ABPM) was performed to exclude white-coat hypertension. Further, we investigated for any obstructive sleep apnea syndrome (OSA). Only 232 (5.8%) hypertensive patients fulfilled criteria for RHT. 91 (39%) had a SH; 56 (61%) hypertensive patients had a primary aldosteronism, 22 (24%) had OSA, 7 (7.7%) had a hypercortisolism, and 5 (5.5%) had a renovascular hypertension (RVH). Only one patient had adrenal pheochromocytoma. An accurate definition and investigation into RHT is needed. We recommend ABPM to all patients at diagnosis. Finally, all patients must be screened for SH, such as adrenal hypertension, OSA and RVH, especially those who are apparently resistant to polypharmacological treatment

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

The physician's gender influences the results of the diagnostic workup for erectile dysfunction

Despite the well-known influence of psychological and situational factors on erectile dysfunction (ED), the influence of the physician's gender on the andrological work-up has never been investigated so far

Recent advances and future perspectives of position sensitive PMT

In recent years there has been a growing interest in developing compact gamma cameras to improve gamma ray imaging for application in nuclear medicine as well as in astrophysics, radiation physics and high energy physics. The gamma cameras based on position sensitive photomultipliers could be the best chance to obtain a realistic and low cost compact gamma camera. Since 1985 the development of position sensitive photo multiplier tubes (PSPMT) has shown the highest rate in technological advancement achieving very compact size (25 x 25 x 20 mm(3)) by a novel charge multiplication system. The PSPMT shows the same advantages of a standard gamma camera with the additional possibility to utilize scintillation arrays with pixel dimension less than 1 mm, thus achieving sub-millimeter spatial resolution values. The last technological advance is a PSPMT with Flat Panel structure, named H8500. Its dimension is 50 x 50 mm(2) with a narrow peripheral dead zone to place closely different modules achieving large detection areas. In this paper the technological development of different PSPMT generations is reviewed and some measurements of the first Flat Panel PMT prototype are presented and compared with ones from previous generation. Flat Panel PMT could be the best trade-off between compactness, large detection areas, effective area (packing density) and imaging performance. (C) 2003 Elsevier B.V. All rights reserved

Factors affecting cancer detectability in 99Tc MIBI scintimammography

Scintimammography shows strong potential in detecting and differentiating breast cancer. This scintigraphic technique, using a standard gamma camera, allows high sensitivity and specificity values (>95%) for detected tumors more than 1cm size. However, the sensitivity of scintimammography using conventional gamma cameras is considerably less (40-50%) for tumors with smaller size. Recently, the authors demonstrated how the use of a small FOV dedicated gamma camera (Single Photon Emission Mammography, or SPEM camera), with very high intrinsic spatial resolution (1.7mm FWHM), working with breast moderately compressed and positioned close to the breast tumor (i.e., analogously to X-ray mammography) increased sensitivity up to 80% for tumors sized between 0.5 and 1cm (T1b). The aim of this paper is to demonstrate how the reduced breast thickness can play a primary role in small cancer detection. Five different methods were taken into account: clinical measurements, comparing tumor SNR values obtained from the same patients in prone scintimammography and in SPEM, comparing SNR values between compressed and uncompressed breast in craniocaudal projection, breast phantom measurements, Monte Carlo simulations and simplified theoretical model. Results confirm that the mechanism for the improvement in visualizing sub-centimeter lesions due to compression is a reduction of lesion-detector distance. As a result of this reduced distance there is a less reabsorption of signal by interposed breast tissue, and improved detector intrinsic spatial resolution. © 2002 Elsevier Science B.V. All rights reserved

Design and characterization of a dual modality (SPET-US) tomographic device

In the last few years, integrated dual-imaging systems have emerged as a new modality for cancer staging with the aim to offer both functional and anatomic information. At moment the prevalent dual modality devices are based on Computer Tomography and Positron Emission Tomography. In this sense, the scientific community is debating about the high effective dose to the patient, representing an indicator of the stochastic risk, especially from Computer Tomography examination. So, a new dual modality imager, based on a Ultrasound probe and a Single Photon Emission Tomography was made in order to combine functional information, from gamma camera with structural one, obtained from the Ultrasound equipment. The Ultrasound probe is the most diffuse anatomical examination device at zero-dose, using a cost-effective and reliable method with few restriction in use. The proposed Single Photon Emission Tomography detector is a compact gamma camera (10x10 cm(2) active area), based on LaBr3:Ce scintillation crystal coupled to 4x4 array of Hamamatsu HS500-CMODS Multi Anode Photomultiplier, with high spatial and energy resolution performances, equipped with rotating slanthole collimator. A calibration phantom, made of a Co-57 point source inside a water filled box, was utilized to acquire 3D dual modality images. The detector has shown good performances in terms of spatial resolution and localization along z-axis of object of interest. This project was developed by several Italian Universities under an INFN collaboration

Dual Modality Ultrasound-SPET Detector for Molecular Imaging

We present an innovative compact dual-modality detector, which integrates an ultrasound probe with a scintigrafic γ-camera for molecular imaging in medicine, in order to get both morphological and functional information in a single three-dimensional image. The scintigraphic detector consists of a 2×2 array of a multi-anode PMT Hamamatsu H8500-Mod8 and a 4.0 mm thick continuous LaBr3(Ce) crystal equipped with four segment slant-hole collimators for single photon imaging (SPET). The collimator permits to recover the depth of a lesion by rotating around its vertical axis (z) without the need of rotating the camera around the investigated object. This detector can take advantage from being positioned close to the object and overcome the intrinsic limitations in spatial resolution arising from the geometry of SPET/CT gantry. The aim of this work is to describe preliminary phantom analysis and to provide a 3D US/SPET image. © 2011 Elsevier B.V

Frequency of Left Ventricular Hypertrophy in Non-Valvular Atrial Fibrillation

Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 \ub1 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index 640.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc 652 seen in 93% of LVH and in 73% of patients without LVH (p <0.05). Women with LVH had a higher prevalence of concentric hypertrophy than men (46% vs 29%, p = 0.0003). Logistic regression analysis demonstrated that female gender (odds ratio [OR] 2.80, p <0.0001), age (OR 1.03 per year, p <0.001), hypertension (OR 2.30, p <0.001), diabetes (OR 1.62, p = 0.004), and previous MI (OR 1.96, p = 0.001) were independently associated with LVH. In conclusion, patients with NVAF have a high prevalence of LVH, which is related to female gender, older age, hypertension, and previous MI. These patients are at high thromboembolic risk and deserve a holistic approach to cardiovascular prevention