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Biomedical subjects

C Benvenuti

Publications and source records attributed to C Benvenuti.

At least 91 records · Page 5Linked to original sources
PubMed1990

Enoximone improves selection of candidates for urgent cardiac transplantation.

Immediate cardiac transplantation, or urgent implantation of devices for mechanical support of the failing heart, has been shown to be effective as life-saving procedures in patients with cardiogenic shock unresponsive to maximal sympathomimetic treatment. The intravenous administration of enoximone in these patients, in addition to previous inotropic support, should permit a 'buying of time' strategy, leading to a reduction in the need for complex, invasive and costly techniques, such as artificial hearts. In addition, it should permit improved selection of candidates for cardiac transplantation. A prospective study was started in 1985 to obtain data on the haemodynamic and clinical efficacy of intravenous enoximone in these critically ill patients, and to determine the time gained for evaluation of the need for urgent transplantation. Cardiac index rose from 1.82 +/- 0.26 litres/minute/m2 to 2.67 +/- 0.56 litres/minute/m2 after 30 minutes, while pulmonary capillary wedge pressure decreased from 29.9 +/- 7 mm Hg to 18.0 +/- 7 mm Hg (n = 30). This early beneficial effect waned progressively after 6 hours. Prior to the next intravenous infusion at 8 hours, cardiac index was 2.07 +/- 0.53 litres/minute/m2 and pulmonary capillary wedge pressure was 25 +/- 8.5 mm Hg. Only four patients could not wait for a biological graft and had to be implanted with a complete artificial heart (3 patients), or a ventricular assist device (1 patient). In all, 30 patients improved and their increased survival allowed a re-evaluation for cardiac transplantation itself; 13 were rapidly (1.7 days; range 0.5-5) confirmed as good candidates. As a whole, this strategy compares favourably with the results of a strategy based on mechanical bridging alone.

Adult↗
PubMed1990

Recovery of a normal coronary vascular reserve after rejection therapy in acute human cardiac allograft rejection.

During acute rejection, coronary vascular reserve is severely impaired in human orthotopic heart transplants. To evaluate the effects of rejection therapy on coronary vascular reserve, the ratio of peak-to-resting coronary flow velocity was assessed with a coronary Doppler catheter and a maximally vasodilating dose of intracoronary papaverine (12 mg) in nine allograft recipients without rejection (group 1) and in six recipients before and after treatment of an acute episode of rejection (group 2). All the patients had normal epicardial coronary arteries and were free of left ventricular hypertrophy. In group 2 during rejection, the coronary vascular reserve was significantly lower than in group 1, in which all the patients had a peak-to-resting coronary flow velocity ratio greater than 4 (2.3 +/- 0.5 vs. 5.4 +/- 0.8, respectively, p less than 0.001). In group 2 after treatment of rejection, the peak-to-resting coronary flow velocity ratio was similar to that of group 1 (4.7 +/- 0.8). Heart rate, left ventricular volumes and pressures, hemoglobin concentration, and arterial oxygen pressure were similar in the two groups. This study provides evidence that alterations of coronary vascular reserve because of acute rejection were reversible after treatment of the rejection episode.

Angiography↗
PubMed1990

[Myocardial mass index in the diagnosis of acute rejection of allogeneic heart transplants].

Changes in an index of left ventricular mass were evaluated in the diagnosis of acute cardiac transplant rejection in a prospective study involving 28 transplant patients by comparison with the histology of endomyocardial biopsy. The surface of a ring of left ventricular myocardium obtained from a 2D echocardiographic examination was used as an index of mass. Eighty-three pairs of results--biopsy and index of mass--recorded within a 12 hour interval were obtained between the first day and 10th month of transplantation over a period of 12 consecutive months. Echocardiographic diagnosis of acute rejection was made when the index of myocardial mass increased by over 7 per cent compared with baseline values recorded during the first 3 days of transplantation or during a new period of equilibrium after an episode of rejection. Two groups of patients were identified from the results of biopsy, taken as the reference: in 16 patients with mild or moderate histological signs of rejection the variation of the index of mass was 18.3 +/- 9.1%; endomyocardial biopsy was negative in the 12 other patients and the change in index of mass was -1.5 +/- 5.2% (p less than 0.001). The overall concordance in the 83 successive results was good with a Kappa coefficient of 0.71. The other parameters which have been reported to be useful in diagnosing rejection (relaxation, antegrade diastolic mitral flow, acoustic density of myocardium) present a number of problems in routine practice related either to difficulties with the recording of the data or to its interpretation.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1990

[Cardiac transplantation. Indications, delays, surveillance].

The number cardiac transplantation has been dramatically increasing for the last year and the results are satisfactory regarding survival or functional capacity. The observed increase of cardiac transplantation may tend to vulgarize it. However, this intervention should be only considered in a selected group of patients who have no other option. Many reports concerned various technical approach for a clearcut determination of high and low risk population of patients with congestive heart failure. But, considering individual patients, the value of each prognostic parameter remains unresolved. Nevertheless the more discriminant parameters for the prognosis assessment are: the left ventricular ejection fraction, the NYHA class, right heart catheterization data, the functional capacity, the cardiothoracic ratio on chest X ray, the ischemic etiology of the disease. The role of neuro-hormonal determinant such as norepinephrine circulating concentration or cardiac uptake on MIBG imaging should be further investigated, especially for patients treated by ACE inhibitors or beta blockers. Contraindications for cardiac transplantation are less restrictive, nowadays. Concerning patients selected, and waiting for heart transplantation or patients non primary selected survival can be improved by adjusting medical therapy on objective efficacy criteria.

Contraindications↗
PubMed1990

[Medical strategy in patients awaiting emergency heart transplantation].

Cardiac transplantation is theoretically the optimal final treatment of terminal cardiac failure but the indications, especially in the emergency situation, should be carefully considered. Sympathomimetic agents are of limited use in patients with severe cardiac failure partly because of the down regulation of the myocardial beta-receptors. The phosphodiesterase inhibitors, represented by enoximone, are valuable because of their action on the cardiac muscle (inotropic and lusitropic) and their direct systemic vasodilator effect. Enoximone can be administered by intravenous bolus resulting in a rapid onset of action (peak at 30 minutes) with a prolonged effect due to its hepatic metabolites. The authors' experience in this indication dates over 5 years and over 50 patients were included. A preliminary study in 34 patients with cardiac failure resistant to betamimetic drugs, referred to the intensive care unit for urgent cardiac transplantation, or, in the absence of a donor, circulatory assistance is reported. A Swan Ganz catheter and radial artery canula were inserted for haemodynamic monitoring and enoximone was administered in an intravenous bolus over 15 minutes every 8 hours in addition to sympathomimetic agents. A haemodynamic improvement was observed after the 30th minute in 30 patients. The cardiac index increased from 1.82 to 2.67 l/mn/m2 and the pulmonary capillary pressures decreased from 30.8 to 18.9 mmHg. Systemic arterial resistances fell from 2,170 to 1,520 dynes.s.cm-5. No haemodynamic improvement was observed in 4 patients who were treated by mechanical ventricular assistance. After investigations to detect contra-indications to cardiac transplantation, 12 of the 30 patients remained candidates for cardiac transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

The pharmacokinetics of clotiazepam after oral and sublingual administration to volunteers.

We have studied the single dose pharmacokinetics of 5 mg clotiazepam drops, oral tablets, and sublingual tablets in a cross-over study in 6 healthy volunteers (median age 28 years). The formulations had similar systemic availability. Compared with oral tablets the sublingual route gave a lower peak concentration and a delayed peak time, while drops gave a greater maximum concentration with a similar peak time. The use of drops is suggested for a more marked initial effect and the sublingual route for easier administration, especially in the elderly.

Administration, Oral↗
PubMed1989

Single-dose pharmacokinetics of flurbiprofen granules and tablets in healthy volunteers.

The bioavailability of granules and tablet flurbiprofen in 100 mg single dose was crossover compared in 6 healthy volunteers (mean aged 26.8 years). The granules showed an earlier peaktime and a lower maximum concentration than the tablet. Area under the curve and half-time in terminal phase were similar, with the granule relative bioavailability of 0.98.

Adult↗
PubMed1986

Flurbiprofen versus ASA in influenza symptomatology: a double-blind study.

The effectiveness and safety of flurbiprofen 100 mg b.i.d. vs acetylsalicylic acid (ASA) 500 mg b.i.d. were evaluated in a 4-day double-blind study in 30 patients suffering from influenza. The antipyretic effect of flurbiprofen was similar to that of ASA. Upper and lower respiratory symptoms, gastrointestinal symptoms, articular and muscular pain and asthenia were improved by both drugs. Only one patient on ASA discontinued the treatment.

Adult↗
PubMed1986

Pharmacokinetics of two new oral formulations of ibuprofen.

Two new formulations of ibuprofen were studied in 600 mg coated tablets and granules, to allow an easier adjustment of its daily dosage now higher than in the past. Six healthy volunteers (3M and 3F, mean age 32.6 years took part in a 6 X 6 Latin Square single dose pharmacokinetic study comparing six oral formulations of ibuprofen: 600 mg coated tablets, 300, 400 and 600 mg resinated granules, 300 and 400 mg sugar-coated tablets available on the market as Brufen. The results show that there is a correlation between dose and the area under the blood concentration-time curve. The availability of ibuprofen was similar irrespective of whether it is given in the form of granules or in tablets. The short half-life and the widespread use of ibuprofen give an acceptable range of safety to these new formulations.

Administration, Oral↗
PubMed1985

Peripheral neuropathy in patients treated with almitrine dimesylate.

Sensory peripheral neuropathy developed in 5 patients treated with almitrine dimesylate, 60-100 mg/day. Onset was insidious, beginning symmetrically in the legs with stocking sensory loss and loss of ankle-jerks. Cerebrospinal fluid protein levels were slightly increased and there was electrophysiological and histological evidence of distal axonopathy. The interval between the first dose of almitrine dimesylate and onset of symptoms ranged from 2 to 4 months in 4 patients. All patients had noted a recent weight loss of 4-15 kg which may have resulted in release of previously bound drug.

Aged↗
PubMed1984

[Protocol of combined surgical and polychemico-immunoradiologic therapy of stage T2N2MO lung cancer].

Preliminary data on the use of a combined surgical-polychemical-immunoradiotherapy protocol in the treatment of 13 T2N2M0 lung cancer patients are reported. The results are compared with those obtained in a 13 patient control group, homogenous by histotype, stage and surgical treatment who were given no other therapy. At 24 months the average survival rate in the first group was 61.5% compared to 15.3% in the second. It was significant that survival at 24 months after pneumonectomy rose from 16.6% to 50% and even more significantly survival after lobectomy rose from 14.2% to 71.4%.

Antineoplastic Combined Chemotherapy Protocols↗