SummaryThis study aimed to verify the impact of heart magnetic resonance imaging on chelation choices and patient compliance in a single-institution cohort as well as its predictive value for heart failure and arrhythmias. Abnormal cardiac T2* values determined changes in treatment in most subjects. Heart T2* was confirmed to be highly predictive over 1 year for heart failure and arrhythmias. The choice of chelation regimens known to remove heart iron efficiently was not sufficient by itself to influence the risk. Compliance with treatment had a more remarkable role.Keywords: beta thalassaemia major, heart magnetic resonance imaging, compliance, heart failure, arrhythmia.The introduction of magnetic resonance imaging (MRI) technology to measure iron overload and the availability of the oral chelators have had a profound impact on the care and prognosis of patients with beta thalassaemia major (Modell et al, 2008;Chouliaras et al, 2011). Identifying those patients at risk of a fall in left ventricular ejection fraction, cardiac T2* also identifies those whose chelation treatment should be intensified. Kirk et al (2009) determined the predictive value of cardiac T2* magnetic resonance for heart failure and arrhythmia in thalassaemia major. The present study aimed to verify the impact of heart MRI on chelation choices and patient compliance as well as its predictive value for heart failure and arrhythmias in patients attending our Centre. MethodsA total of 313 patients (900 consecutive scans) with beta thalassaemia major followed at DH talassemia Et a EvolutivaOspedale Regionale per le Microcitemie-Cagliari, Italy were included in this study. MRI scans were performed with a 1Á5 T General Electric CVi scanner or with a 1Á5 T Magneton Siemens Avanto, using previously reported techniques (Westwood et al, 2003), between 2002 and 2012. Of these patients, 157 were male and 156 female, with a mean age at time of their first scan of 26Á7 AE 6Á2 years. Twenty-two had experienced one or more episodes of heart failure and 13 a history of arrhythmia. At the time of the first scan, 168 patients were receiving deferoxamine (20-50 mg/kg 5-6 d per week), 24 were on deferiprone (75-100 mg/kg per d), 76 were taking deferoxamine (20-50 mg/kg 2-7 d per week) combined with deferiprone (75 mg/kg per d) because of high serum ferritin values and 45 were receiving deferasirox at a dose of 20-35 mg/kg per d. Adherence to and acceptance of chelation therapy (compliance) was evaluated according to pharmacy records of the dispensed drug. It was classified as good, if the mean number of the doses taken was ≥80% of those prescribed, average if it was >50 < 80% and poor if it was <50%. The predictive value of T2* for cardiac events in the year after scan was evaluated including the MRI before heart failure and/or arrhythmias for patients with cardiac events, and a random MRI otherwise. To obtain the most similar control group we randomly sampled one MRI within 'time to first MRI' stratas, to respect case group distribution.Accuracy of T2* predict...

Temozolomide (TMZ) is the first line drug in the care of high grade gliomas. The combined treatment of TMZ plus radiotherapy is more effective in the care of brain gliomas then radiotherapy alone. Aim of this report is a survival comparison, on a long time (>10 years) span, of glioma patients treated with radiotherapy alone and with radiotherapy + TMZ. Materials and Methods. In this report we retrospectively reviewed the outcome of 128 consecutive pts with diagnosis of high grade gliomas referred to our institutions from April 1994 to November 2001. The first 64 pts were treated with RT alone and the other 64 with a combination of RT and adjuvant or concomitant TMZ. Results. Grade 3 (G3) haematological toxicity was recorded in 6 (9%) of 64 pts treated with RT and TMZ. No G4 haematological toxicity was observed. Age, histology, and administration of TMZ were statistically significant prognostic factors associated with 2 years overall survival (OS). PFS was for GBM 9 months, for AA 11. Conclusions. The combination of RT and TMZ improves long term survival in glioma patients. Our results confirm the superiority of the combination on a long time basis.

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We present the case of a 67-year-old woman affected by hypertension and hypercholesterolemia. She had a history of alcoholism, anxiety disorder with panic attacks, and paroxysmal atrial fibrillation. Despite a previous transient ischemic attack and her thromboembolic risk (CHA 2 DS 2 -VASc score: 5), she had not been taking anticoagulants at home without a reasonable motivation. Moreover, around eighteen years prior, she had breast cancer and underwent surgical intervention, radiotherapy and several years of hormone-therapy. However, in the following years, she had pelvic bone metastasis needing multiple orthopaedic procedures.The patient was admitted to the Emergency Department with complaints of diarrhoea lasting one week and palpitations associated with dyspnoea in the last 24-hours.Laboratory tests showed severe hypokalaemia (2.8 meq/l), hypomagnesemia (0.4 mg/dl) and elevation, although not significant, of troponin I (0.09 ng/ml -NV ≤ 0.07).ECG showed atrial fibrillation with fast ventricular rate (140/min) and diffuse inverted T-wave, while echocardiography revealed a normal left ventricular function (EF ≈ 60%).A few hours after intravenous replacement of K + and Mg 2+ , the patient showed spontaneous restoration of sinus rhythm. However, suddenly, she became confused and developed generalized motor and non-motor seizures, causing aggravation of diarrhoea and electrolyte disorders. An urgent cerebral CT scan was performed, which excluded acute cerebral events.Contextually, the patient had severe hypotension (systolic blood pressure < 90 mmHg). A significant elevation of troponin I (34.9 ng/ ml) and lactates with low bicarbonates were detected. ECG was normal; however, the echocardiography revealed a severe left ventricular dysfunction (EF: ≈ 20%) due to akinesia of all basal segment and hyperkinesia of apex. Considering the clinical scenario and that regional wall motion abnormalities extended beyond a single epicardial vascular distribution, a basal Takotsubo syndrome (TTS) was hypothesized.After adequate refilling with bolus fluids and intravenous replacement of bicarbonates and electrolytes, the hemodynamic status improved.Simultaneously, in the following 48-hours neurologists tried multiplies oral and intravenous antiepileptics drugs (oxcarbazepine, levetiracetam, sodium valproate and phenytoin) without success, suggesting a non-convulsive status epilepticus, which was confirmed by electroencephalogram ( Fig. 1A). Finally, a deep sedation with propofol was induced and the patient was assisted by mechanical ventilation. In the following days, we assisted in the resolution of the cardiological and neurological states, and the patient was then extubated.