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Biomedical subjects

A Salvi

Publications and source records attributed to A Salvi.

At least 91 records · Page 5Linked to original sources
PubMed1985

A reappraisal of the factors affecting early patency of aortocoronary saphenous vein bypass grafts. Current experience with extensive revascularization employing sequential grafting techniques.

A number of factors potentially influencing the patency rates of aortocoronary bypass grafts were investigated in a consecutive series of 50 patients by control angiography at 28 +/- 26 days and by univariate and multivariate analysis of a selected set of clinical, surgical and angiographic predictors. There were 234 anastomoses in this series, a mean of 4.7 per patient (range 1 to 9), 215 of which were connected to sequential vein grafts. After surgery, 40 patients were treated with anticoagulants and/or platelet inhibitors. Of the 234 coronary anastomoses studied, 219 were patent (93.6%). Coronary artery diameter, patient's age and previous myocardial infarction were shown to be independent predictors of increased risk of anastomotic occlusion. Arteries less than 1.5 mm in diameter had a patency rate of 84.9%, versus 96.1% for vessels 1.5 mm or larger (p = 0.009). The use of side-to-side anastomoses with sequential grafts seemed to counterbalance the unfavourable effect of small arterial size. Patients aged 65 or older had a lower probability of having all their grafts patent than younger patients did (50 vs 89%, p = 0.01). Patients with previous myocardial infarction similarly had a lower probability of having all their grafts patent compared to patients without previous infarction (68 vs 95%, p less than 0.05); this correlation was explained by a more frequent occlusion rate of grafts directed to fibrotic left ventricular areas. The effect of anticoagulants and of platelet-inhibitors was favourable, but did not reach statistical significance.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

May early exercise testing after myocardial infarction predict the extent of coronary artery disease?

To determine whether exercise testing performed soon after myocardial infarction may predict the degree of coronary artery disease, 78 patients performed stress testing and coronary angiography 15 +/- 5 and 64 +/- 35 days, respectively, after myocardial infarction. Out of 34 patients with a positive test, 22 (65%) demonstrated a multivessel disease, and 37 (84%) out of 44 patients with a negative test had normal coronary angiograms or single vessel disease (p = .0006). In addition to stress testing, no clinical parameter considered (infarct location, heart failure and cardiomegaly) was predictive of the extent of coronary artery disease.

Coronary Angiography↗
PubMed1984

[Retrospective study of coxsackie B virus infections and congestive cardiomyopathy].

Thirty patients with congestive cardiomyopathy (C.C.) have been studied for the prevalence of neutralizing antibodies to coxsackie B viruses in comparison with age and sex matched controls. Seropositivity toward each antigen was similar in cases and controls: an exception was coxsackie B5 virus, where a significantly seropositivity was found in the control group. As a whole, high antibody titers to any antigen were observed more frequently on sera of cardiopathic patients; however the difference between cases and controls of g.m.t. to each antigen tested was not statistically significant, with the exception of coxsackie B1 virus. The absence of a clear relationship between C.C. and viral infections might be explained through biological as well as epidemiological considerations; of particular relevance, the long duration of cardiac disease (average length 71 months, median 54). Final considerations are offered regarding the methodologic approach for a better understanding of the etiology of this elusive disease.

Adolescent↗
PubMed1984

Lymphadenopathic and oropharyngeal Kaposi's sarcoma in a drug addict with acquired immunodeficiency syndrome. Immunological abnormalities in peripheral blood and lymphoid tissue.

Lymphocyte subsets were analyzed in peripheral blood and lymph nodes from a drug-addict with acquired immunodeficiency syndrome (AIDS) presenting with disseminated lymphadenopathic and oropharyngeal Kaposi's sarcoma. At the onset of disease, hypergammaglobulinemia, increase of OKT8+ T cell subset and reversal of OKT4/OKT8 ratio were found in the blood. At the same time, lymph nodes displayed, besides Kaposi's sarcoma, marked follicular hyperplasia, plasmocytosis and increase of OKT8+/Leu 2a+ T cells within follicular centers. These results are interpreted to indicate that at an early stage of disease the major tissue alterations took place within follicular centers and consisted of both B cell activation and T suppressor cell reaction. These changes correlated with immunological abnormalities observed in peripheral blood. Immunohistochemical investigation of lymphoid tissue may be useful to detect AIDS patients at an early stage.

Acquired Immunodeficiency Syndrome↗
PubMed1983

Immune complexes and complement profile in essential mixed cryoglobulinemia before and after plasma exchange.

Five patients affected by essential mixed cryoglobulinemia (EMC) with renal involvement unresponsive to high doses of corticosteroids, have been treated with 16 plasma exchanges (PE). The plasma removed at each apheresis was 1652 +/- 416 ml. The following data were evaluated before and after PE: levels of immune complexes as detected by cryocrit and C1q binding assay; total complement activity (CH50) and alternative pathway complement activity (APCH 50); concentrations of 9 complement components (C1q, C1s, C4, C3, C5, C6, B, I and H) and of the C3 split product C3d. By definition all serum samples had detectable cryoprecipitates and 4 out 5 had C1q binding activity higher than the upper limit of 2 SD. The effect of the PE was the decrease of cryocrit and of C1q binding activity approximately to one half their initial values. The basal complement profile suggested and excessive activation of complement through the classical pathway. Indeed we found low levels of the early complement components (C1q, C1s and C4), reduced CH50, normal levels of C3 and an increase of C3 split product C3d concentrations. APCH50 as well as C5, C6, B, I and H concentrations were found within the normal range. After each PE a significant decrease of the previously normal components was observed. The decrease was independent of the replacement fluid used (5% albumin solution or fresh plasma or cryoglobulin-depleted autologous plasma) and had a short duration. Indeed all these components after the drop following the PE increased rapidly reaching the basal level over a period of 24-48 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Antigen-Antibody Complex↗
PubMed1983

Calcium antagonists in heart failure.

Clinical experience with calcium antagonists in congestive heart failure has, to date, been mainly restricted to the use of nifedipine but there is either no or only a limited extent of information available on diltiazem and verapamil. In patients with acute and chronic congestive heart failure, single-dose administration of nifedipine was seen to lead to a decrease in systemic vascular resistance, left ventricular filling pressure and ventricular volumes as well as to an increase in stroke volume, ejection fraction and mean velocity of circumferential fiber shortening. These favorable effects could not be detected in eight patients during a three-week treatment phase with 80 mg nifedipine daily: resting blood pressure, cardiac volumes, echocardiographically-dimensions and exercise tolerance were unchanged as compared with placebo. In patients with ischemic heart disease and impaired ventricular function, in addition to an improvement in systolic function, single-dose nifedipine administration led to favorable effects on diastolic function with a shift of the diastolic pressure-volume relationship downward and to the diastolic pressure-volume relationship downward and to the left. In patients with severe aortic regurgitation, the observed increase in effective cardiac output affected by nifedipine was primarily attributable to an increase in heart rate. In the presence of an initially-elevated systemic vascular resistance, the regurgitation fraction decreased. In pulmonary hypertension, favorable hemodynamic effects have been reported after acute administration of verapamil as well as diltiazem and nifedipine. In individual cases, promising results in patients with primary pulmonary hypertension have been reported during long-term therapy with nifedipine provided that a favorable initial response could be documented.

Aortic Valve Insufficiency↗
PubMed1983

[Pharmacologic myocardial revascularization in acute infarct. Experience with 52 cases].

Coronary thrombosis is frequently demonstrated in the early hours of acute myocardial infarction. Local infusion of thrombolytic agents has been proposed in order to dissolve intracoronary thrombi and to restore myocardial perfusion. We report our initial experience in 52 patients. Thirty-nine males and 13 females had a coronary angiogram performed within 5 hours from the beginning of persistent ischemic pain (mean 2h 34 min +/- 68 min; range 20 min--5h 30 min). In all an ST segment elevation was documented on an ECG recording. Coronary occlusion was found in 86.5% (45/52) of our cases. Flow restoration was obtained in 39 of 45 of patients (86.6%) within 45 +/- 28 min. The mean dose of streptokinase employed was 272,140 +/- 112,484 IU (range 120,000--400,000 IU). Myocardial reperfusion was accompanied by the reduction of ischemic pain and ST elevation. In 8 cases severe ventricular arrhythmias occurred. Serious haemorrhagic complications were observed only in one patient. Eight patients developed a new myocardial infarction within few days from the procedure and two died 2 hours and 6 days respectively after myocardial revascularization. Thirty-two of thirty-nine patients underwent a angiographic control study within 11-128 days and coronary patency was shown in 75% (24/32). Seven patients underwent a coronary artery bypass procedure. At surgical inspection no clear evidence of myocardial necrosis was observed. Coronary flow restoration is rapidly and safely obtained i acute myocardial infarction by means of intracoronary streptokinase infusion but the efficacy of the procedure in salvaging myocardium has not been demonstrated yet.

Adult↗
PubMed1983

[Problems appearing after pharmacologic thrombolysis in acute myocardial infarct].

Pharmacologic myocardial reperfusion is a new strategy in the treatment of acute myocardial infarction, but its widespread use has raised several problems which are still unsolved. The time limit from the onset of ischemic pain until the beginning of thrombolysis is undefined yet. Experimental and clinical observations set this time within three hours. A reopened vessel is still at risk for reocclusion and anticoagulants are not always effective in the prevention of this. It is likely therefore that pharmacologic thrombolysis is only one step in the process of myocardial salvage and that other techniques like transluminal coronary angioplasty and/or coronary bypass surgery, should follow shortly. Intracoronary thrombolysis does not carry an increased risk for acute myocardial infarction patients. However haemorrhagic complications are expected to occur in less than 6% of cases during their hospital stay. To evaluate the extent of myocardial salvage quantitative ventriculography and intracoronary thallium 201 scintigraphy represent the most reliable techniques. Only the results of the continuing randomized trials will clarify the efficacy of this new way of therapy for morbidity, mortality and myocardial salvage.

Fibrinolytic Agents↗
PubMed1982

Hemodynamic effects of nifedipine in pulmonary hypertension.

Nifedipine is a calcium antagonistic drug which reduces elevated vascular resistances. The hemodynamic effects of 20 mg of sublingual nifedipine were studied in 10 patients with chronic pulmonary hypertension. The etiology of pulmonary hypertension was chronic lung disease in 4, congenital heart disease in 2, mitral stenosis in 1, recurrent pulmonary embolism in 2 and primary pulmonary hypertension in one case. 30' after the drug administration there was a fall both of total pulmonary vascular resistance (from 992 +/- 586 to 648 +/- 428 d s cm-5, p less than 0.02) and of systemic vascular resistance (from 1416 +/- 868 to 896 +/- 440 d s cm-5 p less than 0.02) with an increase of systemic cardiac index from 3.2 +/- 1 to 4.5 +/- 2 l/min/m'2 (p less than 0.02). No significant change in systemic arterial oxygen saturation was noted, while pulmonary arterial oxygen saturation increased from 56 +/- 16 to 62 +/- 13% (p less than 0.01). These hemodynamic changes persisted for 120' when a significant fall of mean pulmonary arterial pressure was also noted (from 59 +/- 11 to 52 +/- 9 mm Hg, p less than 0.02). These data indicate that nifedipine may be useful to reduce pulmonary resistance in pulmonary hypertension. However this effect was less pronounced in patients with chronic lung disease compared to the other cases. It is suggested that the type of pulmonary arterial changes may determine the hemodynamic response. Nifedipine may be particularly indicated when vasoconstriction (as in primary pulmonary hypertension) is the main determinant of pulmonary hypertension.

Adult↗