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Biomedical subjects

A Papa

Publications and source records attributed to A Papa.

At least 109 records · Page 6Linked to original sources
PubMed1994

Phase I trial of outpatient weekly paclitaxel and concurrent radiation therapy for advanced non-small-cell lung cancer.

PURPOSE: To determine the maximum-tolerated dose (MTD) and dose-limiting toxicities of paclitaxel administered weekly on an outpatient basis with concurrent thoracic radiation to patients with advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: In this phase I clinical trial, paclitaxel was administered as a 3-hour intravenous (IV) infusion, repeated every week for 6 weeks. The starting dose of paclitaxel was 10 mg/m2. Doses were escalated at 10-mg/m2 increments in successive cohorts of three new patients if tolerated. Unacceptable toxicity was defined as grade 3 nonhematologic toxicity, excluding nausea and vomiting, and grade 4 hematologic toxicity according to Cancer and Leukemia Group B expanded common toxicity criteria. Radiation was administered to the primary tumor and regional lymph nodes (40 Gy) followed by a boost to the tumor (20 Gy). RESULTS: Twenty-seven patients were entered onto this study through seven dose escalations (from 10 mg/m2/wk to 70 mg/m2/wk for 6 weeks). Severe esophagitis occurred at 70 mg/m2 (two patients with grade 4 disease and one patient with grade 2). One of six patients at 60 mg/m2 developed grade 3 esophagitis and three of seven patients had grade 2 esophagitis. One of 27 patients developed a hypersensitivity reaction. One of 27 patients developed grade 3 neutropenia. CONCLUSION: Esophagitis is the principle dose-limiting toxicity of weekly paclitaxel and thoracic radiation in the outpatient setting. A phase II trial using concurrent radiation and paclitaxel at the MTD of 60 mg/m2/wk is underway.

Adult↗
PubMed1993

[Treatment of ischemic heart disease in the elderly. Comparison of diltiazem, verapamil and gallopamil].

The medical therapy of myocardial ischemia in elderly patients has not been well evaluated. We studied the age-related changes in 127 patients with proved coronary artery disease and stable effort angina the efficacy and the safety of diltiazem 120 mg tid, verapamil 120 mg tid and gallopamil 50 mg tid a medium term parallel, double blind cross-over placebo controlled study. All patients have been clinically and ergometrically evaluated. In middle-age patients diltiazem, verapamil and gallopamil induced a significant increasing of exercise duration and time to onset ST segment depression > or = 1 mm. In the elderly patients both verapamil and diltiazem as increased the exercise duration and ischemic threshold, while the diltiazem did not increased the exercise duration even if the time of onset ST segment depression > or = 1 mm is increased. At peak exercise the ST segment depression have been reduced both in middle-age and elderly patients after active drugs. Weekly angina and DNT consumption have been significantly reduced after diltiazem, verapamil and gallopamil in middle-age and elderly patients. Side effects have not been relevant even if gallopamil as a lower frequency of them in comparison to diltiazem and verapamil. No patients stopped the treatment because major side effects. Our experience suggests that diltiazem, verapamil and gallopamil have a similar efficacy and rare well tolerated. The choice of one instead of another must be suggested on the basis of side effects developing.

Age Factors↗
PubMed1992

[Mid-term clinical study of the effectiveness of and tolerability to simvastatin ++ in dyslipidemic patients].

The HGM-CoA reductase inhibitors, blaking up intracellular synthesis of cholesterol, support the receptorial captation of cholesterol with a reduction in plasma levels. The simvastatin efficacy was evaluated in 12 patients, mean age 59 +/- 10 years with a primary hypercholesterolemia. All the patients were on a pharmacologic wash out for at least 6 weeks and dietetic treatment (according to their weight and daily needs) for a week. Total cholesterol, HDL-cholesterol and triglycerides plasma levels were taken at time 0. Then a treatment with simvastatin 10 mg/die was begin for 4 weeks and than increased to 20 mg in patients with plasma cholesterol > 200 mg/100 ml at the end of fourth week. In some patients the dose was increased up to 40 mg for the elevated levels of plasma cholesterol at the end of the second month. All the parameters above were controlled monthly for three months. A control was performed at the end of sixth month of treatment. After 4 weeks treatment, simvastatin induced reduction in cholesterol plasma levels (p < 0.005), that continued during the whole time treatment (228 mg/dl at 24 week, p < 0.005 vs basal). The mean dosage of the simvastatin at fourth month was of 25 mg/die. During the treatment an increase of HDL plasma levels was noted, but this increment wasn't statistical significant (40 +/- 7 vs 45 +/- 9 mg/100 ml). No significant impairment of principal metabolic and laboratory parameters were observed during the treatment. These data indicate that simvastatin in small dose induce a reduction in cholesterol plasma levels with a significant increase in HDL without side effects.

Adult↗
PubMed1987

Prediction of the extent of coronary artery disease with the evaluation of left ventricular wall motion abnormalities during atrial pacing. A cross-sectional echocardiographic study.

UNLABELLED: In patients with coronary artery disease, left ventricular performance during stress is affected by the degree of coronary stenosis. In order to verify whether there exists a relationship between the extent of wall motion abnormalities detectable during atrial pacing and the degree of coronary obstruction, 76 patients, without previous myocardial infarction, were studied. Each patient underwent cross-sectional echocardiography during transesophageal atrial pacing and exercise electrocardiography before coronary angiography. Of the 76 patients, 46 had significant coronary artery disease (stenosis greater than or equal to 75% of at least one major coronary vessel), while 30 had normal coronaries or a stenosis of less than 75%. Eighteen patients had single-, 14 had two- and 14 had three-vessel disease. For each patient a coronary score was obtained: the score used took into consideration the site, number and severity of the stenosis. This score was then correlated with the wall motion score, obtained from the analysis of 9 segments of the left ventricle. A weak correlation was obtained between wall motion score at rest and coronary score (r = -0.42), while the correlation between coronary score and the difference between wall motion score at rest and during transesophageal atrial pacing was slightly better (r = 0.53); this correlation further improved if wall motion score during pacing was considered (r = -0.63). If the patients with discordant diagnostic tests (echocardiography during transesophageal atrial pacing and exercise electrocardiography) were excluded, the correlation coefficient between coronary score and wall motion score during pacing increased even more (r = -0.77). IN CONCLUSION: (1) analysis of wall motion of the left ventricle during atrial pacing is useful for the non-invasive evaluation of the severity of coronary disease; (2) cross-sectional echocardiography during atrial pacing, apart from being a useful diagnostic tool, is also a help in judging the degree of severity of coronary artery disease.

Adult↗
PubMed1986

Comparison of postexercise and transesophageal atrial pacing two-dimensional echocardiography for detection of coronary artery disease.

Two-dimensional (2-D) echocardiography during transesophageal atrial pacing (TAP) was recently proposed as an alternative to exercise 2-D echocardiography for the diagnosis of coronary artery disease (CAD). To compare these 2 methods, 78 consecutive patients with good-quality echocardiographic (echo) examinations at rest were studied. Two-dimensional echocardiography was performed immediately after supine bicycle exercise and at peak atrial pacing obtained with transesophageal atrial stimulation. Twenty patients were excluded: 16 because of poor quality of 2-D echo images after exercise and 4 because of inadequate TAP studies (atrial capture not achieved in 2 and intolerance in 2). Of the remaining 58 patients, 39 had significant CAD (at least 75% diameter stenosis of at least 1 major coronary artery) and 19 had no significant CAD. The 2 test responses were considered positive if a wall motion abnormality was detected during pacing or after exercise. Sensitivity and specificity were 82% and 95% after exercise and 90% and 84% during TAP. In patients with significant CAD but without wall motion abnormalities at rest, sensitivity was 75% during pacing and 56% after exercise. In patients with significant CAD, the wall motion score index decreased significantly with both types of stress; during pacing wall motion score index was significantly lower than after exercise. Thus, 2-D echo during TAP appears to be a feasible and reliable alternative to postexercise echo for the detection of CAD.

Blood Pressure↗
PubMed1986

Atrial pacing in the detection and evaluation of coronary artery disease.

Atrial pacing has been recently re-evaluated as a stress test for the detection of coronary artery disease. This sort of stress, especially if used in conjunction with cardiac imaging techniques can be considered a reliable alternative to physical exercise. In patients with recent myocardial infarction it can be usefully and safely utilized to obtain prognostic information. In fact, patients with recent myocardial infarction and a positive electrocardiogram (decreases ST greater than or equal to 1 mm) during atrial pacing more frequently than others present subsequent major cardiac events. Limitations of traditional pacing test (invasivity, poor sensitivity of electrocardiography) can be overcome with a new test we have recently proposed: two-dimensional echocardiography during atrial pacing. We have used this new stress test to detect patients with significant coronary artery disease, to identify patients with myocardial infarction and multivessel disease and to evaluate the effect of coronary artery bypass surgery.

Cardiac Pacing, Artificial↗
PubMed1986

Is 3000 S Hospal a suitable dialyzer to shorten dialysis time schedule? A cooperative study on biofiltration.

The Biofilter 3000 S Hospal may combine higher convective clearance rates (Cc) with usual diffusive clearance rates (Cd) (i.e. similar to Cuprophan dialyzers), giving a higher total clearance rate (Ct) of small and middle molecules. Use of the Biofilter has been suggested to shorten dialysis time schedules. This study was carried out in 8 patients on RDT 3 times weekly, by cuprophan filter and acetate dialysis. The patients were shifted to dialysis with 3000 S guided by two principles: to shorten dialysis time by 1 hour per session, and to reinfuse 6 liters of bicarbonate-saline solution (40 mEq/l) per single dialysis. Besides the usual clinical and laboratory controls, in three patients clearance studies were carried out during four different dialysis sessions: Ct, Cc and Cd of urea K+, creatinine, uric acid and phosphate were measured. No change was observed in the main clinical and laboratory parameters after 3-5 months (average 3.9) of treatment with Biofilter 3000 S; in addition, serum alkaline phosphatase concentration decreased progressively. Clearance results, however, indicate that the expected high values of Ct do not occur, because Cd decreases as Cc is increased. A primary goal of research in hemodialysis is to reduce the average time of treatment while ensuring simultaneously "physiological" dialysis. A possible approach to this problem is to use dialyzers with highly permeable and biocompatible membranes such as the "biofilter" 3000 S Hospal.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetates↗
PubMed1985

Detection of coronary artery disease by two-dimensional echocardiography and transesophageal atrial pacing.

Two-dimensional echocardiography was performed at rest and during rapid transesophageal atrial pacing in 85 patients undergoing coronary arteriography for evaluation of chest pain. Transesophageal atrial pacing was performed with 10 ms pulses of 6 to 27 mA intensity; the rate was progressively increased up to 150 beats/min. Four patients were excluded: two because atrial capture was not achieved and two because of chest discomfort induced during transesophageal atrial pacing. Of the remaining 81 patients, 56 had significant coronary artery disease (greater than or equal to 75% stenosis of at least one major coronary vessel) and 25 had no significant coronary artery disease; 25 of the 56 patients with coronary artery disease had no wall motion abnormalities at rest. The test was considered positive if wall motion abnormalities were detected during pacing. Wall motion abnormalities occurred in 3 of 25 patients without coronary artery disease (specificity 88%) and in 51 of 56 patients with coronary artery disease (sensitivity 91%). Wall motion abnormalities developed in 20 of the 25 patients with coronary artery disease and normal regional wall motion at rest (sensitivity 80%); sensitivity for one, two and three vessel disease was 85% (17 of 20 patients), 94% (15 of 16 patients) and 95% (19 of 20 patients), respectively. In patients without coronary artery disease, wall motion score was 18 at rest and 17.7 +/- 0.9 during pacing (p = NS). In patients with coronary artery disease, wall motion score decreased from 15.2 +/- 3.6 at rest to 11.6 +/- 4.1 during pacing (p less than 0.001). In patients with coronary artery disease and normal regional wall motion at rest, wall motion score decreased from 18 at rest to 14.4 +/- 3.1 during pacing (p less than 0.001). Thus, two-dimensional echocardiography during transesophageal atrial pacing appears both sensitive and specific in detecting patients with coronary artery disease. This new procedure is a feasible and reliable alternative to exercise two-dimensional echocardiography.

Adult↗
PubMed1985

[Spontaneous echocontrastography. Analysis of 50 cases, review of the literature and a proposal for its classification].

Spontaneous echocontrastographic effect (SEE) is sometimes detected in cardiac chambers. In order to propose a classification of the phenomenon we reviewed our series of 50 patients with SEE. We detected three type of SEE: type I, II, III. Type I was characterized by the presence of low amplitude echoes with slow and irregular motion in a cardiac chamber, in some cases the cloud of echoes had not defined borders (type IA), in other cases the cloud had well defined borders and was attached to a mural thrombus (type IB). Type II was characterized by the presence of echoes moving quickly across the mitral valve toward the left ventricle apex. Lastly, type III was characterized by the presence of microbubbles slowly and chaotically moving in right cardiac chambers. Type I SEE was detected only in patients with clinical conditions (mitral stenosis, congestive cardiomyopathies) characterized by slow intracardiac flow; type II was detected in 3 patients with mitral prosthesis, in 3 with constrictive pericarditis and 1 with severe aortic insufficiency. Lastly, type III was detected in 5 patients with tricuspid insufficiency.

Adolescent↗
PubMed1985

[Diagnosis of ischemic cardiopathy by 2-dimensional echocardiography carried out after the bicycle ergometry test in the supine position: feasibility, sensibility and specificity].

We performed two dimensional echocardiography (2D ECO) after bicycle exercise obtained in supine position in 80 patients undergoing coronary angiography for the evaluation of chest pain. Adequate 2D images after exercise were recorded in 64/80 (80%) patients (pts). Forty pts had significative coronary artery disease (CAD), 24 had no CAD. Twenty-three CAD pts had left ventricle wall motion abnormalities (WMA) at rest; 17 pts had 1-, 11 2- and 12 3-vessels disease. The test was considered positive if WMA were present after exercise. Thirty-two CAD pts and 1 pt without CAD had WMA after exercise, thus sensitivity and specificity were, respectively, 80% and 96%. In 1-, 2- and 3-vessels disease pts, sensitivity was, respectively, 71%, 91% and 83%. WMA were observed after exercise in 9/17 (53%) pts without WMA at rest. 2D Echo obtained after bicycle exercise performed in the supine position is a feasible, sensitive and specific technique to detect CAD.

Coronary Disease↗