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Biomedical subjects

A Serradimigni

Publications and source records attributed to A Serradimigni.

At least 55 records · Page 3Linked to original sources
PubMed1987

[Ergometrine test in 1200 consecutive patients presenting with normal coronary vessels].

An ergonovine test (ET) was performed in 1,200 patients-742 men, 458 women aged from 34 to 73 years (mean: 49.5 years)-either during (850 cases) or after (350 cases) coronary arteriography. Another ET made more sensitive by blocking the cardiac autonomous nervous system (CANS) with labetalol 0.04 and 2 mg/kg was performed in 291 of these patients. The ET test was positive in 10.7 p. 100 (127) of all patients and in 11.2 p. 100 (127/1125) of patients presenting with retrosternal pain. In the group where spontaneous angina could be confirmed by ECG recordings during the attack, the percentage of positive responses rose significantly to 53.7 p. 100 patients with ST depression and 56.6 p. 100 of patients with ST elevation. When the anginal nature of the retrosternal pain was not confirmed before the test, the proportion of positive responses was 6.6 p. 100. In patients who had the sensitized test the positive response rate increased in all groups and globally rose significantly from 7.9 p. 100 to 18.6 p. 100 (p less than 0.01). Thus, the usually low frequency of positive ergonovine tests differs according to the population selected and increases after CANS blockade.

Adult↗
PubMed1987

[Detection by echocardiography of a thrombus of the right cavities in acute pulmonary embolism].

Echocardiography evaluates the severity of acute pulmonary embolism from its repercussions on haemodynamics. However, many authors have reported the discovery of thrombosis in the right heart cavities of patients with acute pulmonary embolism. In order to assess the frequency of intracavitary thrombosis and to evaluate the practical problems it raises, we have systematically examined by echocardiography 84 patients hospitalized for severe, acute pulmonary embolism (mean Miller's score: 21). In this series of 39 men and 45 women (mean age 62 years), 9 thrombi were detected, i.e. an incidence of 11%. Depending on the ultrasonographic images they presented, these patients were divided into two groups: 1. Six patients with low mobility thrombi attached to the cardiac wall. All benefited from a medical treatment consisting of heparin in 4 cases and a thrombolytic drug in 2 cases. There was no clinical evidence of recurrent embolism. Echocardiography showed complete disappearance of the thrombi in 5 of these 6 patients and partial regression under heparin therapy in one. 2. Three patients with a large and mobile thrombus threatening to prolapse through the tricuspid valve during atrial systole. It seemed rational to regard such thrombi as carrying a high risk of embolism with recurrences, especially since they had formed in patients already with severe pulmonary embolism. This view was confirmed by a search in the literature which yielded a 40% death rate figure when these thrombi were associated with pulmonary embolism. This high mortality, however, can be reduced by diagnostic and therapeutic measures.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1987

[Pure coronary spasm: autonomic disease or form of onset of atheroma? Contribution of repeat coronarography in 23 patients].

Coronary spasm has often been blamed for facilitating the development of atheroma, but some authors regard it as a separate disease. In order to form an opinion on these two theories, we performed repeat coronary arteriography at an interval of 4 years on average in 23 patients: 19 men and 4 women aged from 38 to 62 years (mean: 49,4 years). At the initial examination the coronary vessels were normal in 11 patients and showed irregular arterial walls without significant stenosis in 12 patients. Coronary spasm was demonstrated directly in 17 cases (6 spontaneous spasms during arteriography and 11 induced spasms) and indirectly in 6 cases (ECG signs of ischaemia during the anginal attack). At the second coronary arteriography we found that the spasms persisted, with positive response to a challenge test in 17 out of the 19 patients tested. The challenge test was not performed in 4 patients who had developed significant lesions. The vessels themselves were altered in 6 patients, with images of occlusion (2 cases), stenosis (2 cases), parietal irregularities (1 case) and aneurysm (1 case) appearing on spastic arteries, and images of stenosis in 2 patients with apparently non-spastic arteries. There was no difference in age, sex, risk factors, initial coronary status and time interval between arteriographies between these 6 patients and the 17 patients whose coronary arteries had remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Has the prognosis of recent myocardial infarction changed?].

In this retrospective study changes in the prognosis of recent myocardial infarction were evaluated by comparing 731 patients hospitalized in the 1970-1974 period (group I) with 755 patients hospitalized in the 1984-1986 period (group II). The possible factors responsible for the changes observed were investigated. A 34 percent decrease in hospital mortality was recorded (19.2% in group I versus 12.6% in group II; P less than 0.001). The decrease was present irrespective of the patients' sexes and ages; it was more pronounced in patients under 65 (-42%) and in elderly women (-43%). Compared with group I patients, group II patients showed a significant decrease in cardiogenic shock (P less than 0.02), atrial fibrillation (P less than 0.05) and, chiefly, atrioventricular block (P less than 0.001). The improvement in prognosis cannot be ascribed to a change of population since both groups were matched in male to female ratio, age distribution and presence of the main risk factors. Three factors may have contributed to a better prognosis: (1) more rapid admission to hospital; the proportion of patients admitted within 6 hours of the initial symptoms rose from 37.5% in group I to 49.8% in group II (P less than 0.001); (2) modification of the conventional treatment, with a reduced prescription of digitalis and a less frequent recourse to temporary electrical pacing; (3) introduction of new treatments aimed at limiting the size of the necrotic area; these include thrombolytic agents which were administered in 19.2% of patients under 65 and may well have played the principal role in the improvement of outcome.

Adult↗
PubMed1987

[Value and place of real-time ultrasonic diagnosis combined with continuous-wave Doppler in the diagnosis and follow-up of thromboembolic disease].

The authors compared the results of real time ultrasound imaging and continuous wave Doppler (Echography-Doppler with bilateral venography and ilio-cavography in the diagnosis and the follow-up of deep venous thrombosis (D.V.T.). Diagnosis of D.V.T. The value of echography-Doppler (ED) compared to venography is studied on 297 patients (590 legs) suspected of D.V.T. (221) or pulmonary emboli (76). The two methods give concording results in 95% (563/590). Discrepancies (27) are more often located in distal veins. If we refer to venography as the gold standard, sensitivity of ED is 98% (236/242) and specificity is 95% (327/344). Other diagnosis are possible: hematoma (9), extrinsic compression (15), Baker's cyst (4), muscular problems (3)... Topographic value Sensitivity in isolated calf vein thrombosis is 90% (54/60 are detected, 22 are bilateral). 4/6 false negatives are located in the presumable healthy legs. Sensitivity in proximal D.V.T. is excellent 100% (182 D.V.T. with 28 bilateral). The upper extremity of the thrombus is located exactly by ED whatever the topography (35 in the inferior vena cava, three of them beyond the renal veins), the degree of obstruction (partially occluded veins: 32), and even if it's extended or not (27). Follow-up of D.V.T. Assessment of the results in 80 patients under treatment is identical with the two methods, whatever the topography, the degree of obstruction and the evolution of thrombosis. E.D. predictive value in therapeutic efficiency is discussed according to the evolution data in 260 patients. Screening of D.V.T. ED is compared to venography (13) and/or Fibrinogen test (15), in 23 patients (46 legs) with high risk of thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Follow-Up Studies↗
PubMed1987

[Acute myocardial infarction. Different treatment, different prognosis?].

Many statistics demonstrate a definite improvement of myocardial infarction during hospitalization, especially a decrease in the mortality. It appears tempting to credit that improvement to the numerous modifications of the treatment of this dangerous disease in the last few decades. The study reported here indicates, however, that other factors must be taken into account. We compared the evolution of two groups of patients hospitalized for acute myocardial infection, 10 years apart: The first group (G1) of 731 patients corresponds to years 1970-1975; the second group (G2) of 729 patients, corresponds to the years 1984-85-86. During these ten years, mortality decreased by 38 p. cent, from 19.2 p. cent (G1) to 11.9 p. cent (G2). This decrease remains significant regardless of age and sex, except in two subgroups with the least number of patients, i.e. women under the age of 65 and men over 65. It should be noted that rhythm disorders occur with the same frequency in both sub-groups while atrio-ventricular blocks seem to have decreased. The difference in the mortality cannot be attributed to the patient's selection. In fact, in both groups, they are comparable regarding the men/women ratio, the age distribution and the presence of main risk factors (tobacco abuse, dyslipidemia, arterial hypertension, diabetes, heredity). The treatment results in many alterations especially concerning diuretics which seem to be used in approximately 30 p. cent of the patients in both groups. On the contrary, steroids, prescribed in 25.3 p. cent of G1 patients are abandoned; electro-systolic stimulation established in 21.2 p. cent of G1 patients, concerned only 4 p. cent of G2 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1986

[Infectious endocarditis, complication of mitral valve prolapse].

Among 77 patients with bacterial endocarditis on native valves explored by echocardiography, 12 (7 male, 5 female, mean age: 50 years) presented with mitral valve prolapse. This condition is relatively common, being found in 15.5% of patients with bacterial endocarditis and in 32% of those with mitral valve endocarditis. Two-dimensional TM echocardiography showed the mitral valve prolapse in every case and, in 11/12 cases, a vegetation associated with a varying degree of thickening of the valve due to myxoid degeneration. Although cardiac signs were sometimes minimal. Ten hemocultures were positive: 7 for streptococci, 2 for staphylococci and 1 for Hemophilus para-aphrophilus. Two patients died of cerebral haemorrhage, and there were 2 cases of hemiplegia, 4 cases of transient left ventricular failure and 2 cases of spleen embolism. These findings suggest that prophylactic treatment of bacterial endocarditis should be undertaken in patients with mitral valve prolapse and signs of myxoid degeneration at echocardiography.

Adult↗
PubMed1986

[Hypertrophic myocardiopathy. Course and prognosis. 60 cases].

The evolution of 60 cases of hypertrophic cardiomyopathy over a mean period of 6.3 years is described. The cases were separated according to echo-cardiographic findings into 4 categories: obstructive cardiomyopathy (29 cases), asymmetrical septal hypertrophy (22 cases), diffuse cardiomyopathy (6 cases) and apical cardiomyopathy (3 cases). A number of complications occurred during the follow-up, consisting of cardiac failure (20 cases), embolic accident (9 cases), aortic endocarditis (1 case) and arrhythmia (32 cases including 12 cases of supraventricular arrhythmia and 20 cases of ventricular arrhythmia). Five patients died suddenly. These data are compared with those obtained from the literature in an attempt to determine the main prognostic factors in hypertrophic cardiomyopathy.

Adolescent↗
PubMed1986

The circumflex coronary artery occlusion canine model of sudden death: methodology and electrocardiographic observations.

This study deals with a left circumflex coronary artery occlusion-reperfusion canine model of sudden death using multiple electrocardiographic leads to define a subgroup of animals at high risk of ventricular fibrillation. Occlusion was followed by ventricular fibrillation in 15 of 30 animals (50%). In the 15 dogs surviving 60 min postocclusion, reperfusion gave rise to ten cases of ventricular fibrillation (66.7%). Thus, the total incidence of occlusion-reperfusion ventricular fibrillation was 25 of 30 (83.3%). Electrocardiographic delta R% changes greater than or equal to 25% in leads 2 and 3 at both 3 and 5 min postocclusion predicted the occurrence of postocclusion ventricular fibrillation with 80% specificity and 56% sensitivity. However, ST segment elevation greater than or equal to 0.5 mV in the same leads at the same times predicted postocclusion ventricular fibrillation with 67% specificity and 100% sensitivity. When only dogs with ST segment elevation greater than or equal to 0.5 mV in leads 2 and 3 at both 3 and 5 min postocclusion were considered, ventricular fibrillation postocclusion was seen in 15 of 20 dogs (75%) and ventricular fibrillation after reperfusion occurred in four of the remaining five animals (80%). Thus, in the subgroup of animals presenting with ST segment elevation greater than or equal to 0.5 mV in leads 2 and 3 at both 3 and 5 min postocclusion, the overall incidence of occlusion-reperfusion ventricular fibrillation was 19 of 20 (95%). These data may be useful in studies aimed at testing the effectiveness of drugs or other interventions in a canine model of sudden death.

Animals↗
PubMed1986

Molsidomine prevents post-ischaemic ventricular fibrillation in dogs.

Forty anaesthetized dogs were subjected to left circumflex coronary artery ligation followed by reperfusion. Molsidomine was randomly administered to 20 dogs (50 micrograms kg-1 as an i.v. bolus - 15 min prior to coronary occlusion - followed by an infusion of 0.05 micrograms kg-1 min-1. Standard electrocardiographic leads 2 and 3 were continuously recorded to measure ST segment and delta R% changes and to document both the number of ventricular premature beats and the onset of ventricular fibrillation; aortic pressure and cardiac output were measured; thromboxane B2 plasma levels, platelet aggregation produced by ADP, and molsidomine plasma levels were determined before and at 10, 30 and 75 min after the start of the drug protocol. Molsidomine protected the treated animals from early (10 min) post-ischaemic ventricular fibrillation (0 of 20 vs 6 of 20, P = 0.0202), reduced the incidence of overall post-occlusion ventricular fibrillation (3 of 20 vs 10 of 20, P = 0.0407) and improved the total survival rate (P = 0.0067). In molsidomine treated dogs: mean aortic pressure and the rate-pressure product were lowered 10 min after the start of the drug; immediate post-occlusion (3 min) ST segment changes (0.82 +/- 0.52 vs 1.52 +/- 0.78 mV, P less than 0.025) and delta R% changes (37 +/- 50 vs 90 +/- 84%, P less than 0.025) were less marked; the number of ventricular premature beats was lowered and finally, a progressive decline of platelet aggregation produced by ADP was achieved after 75 min of drug infusion. These results were obtained in the presence of mean plasma levels of molsidomine ranging from 20 to 28 ng ml-1. The time-action curve of the antifibrillatory effect of molsidomine parallels those at the level of post-ischaemic electrocardiographic changes.

Adenosine Diphosphate↗