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Biomedical subjects

D Melina

Publications and source records attributed to D Melina.

At least 19 recordsLinked to original sources
PubMed2001

Acute abdominal symptoms in malignant hypertension: clinical presentation in five cases.

Malignant hypertension causes anatomical and functional damage in several target organs, in particular brain, retina, heart and kidneys. Although vascular lesions in the gastroenteric tract are known to occur in several instances, their clinical relevance is unknown. In this study five cases of malignant hypertension, presenting with acute abdominal symptoms, are reported. A history of essential arterial hypertension was present in three patients; while one patient had a previous diagnosis of renovascular hypertension and one patient had renoparenchymal hypertension. However, in all cases the antihypertensive treatment was discontinued and inadequate before the accelerated malignant phase. The acute abdominal symptoms at presentation were due to intestinal infarction in 3 patients and acute pancreatitis in 2 patients. One patient with intestinal infarction died of postoperative cardiogenic shock. Our data are in agreement with previous reports describing the possible intra-abdominal complications of malignant hypertension. The therapeutic approach in such conditions should always consider an effective antihypertensive treatment in conjunction with surgical options.

Acute Disease↗
PubMed1996

Ambulatory blood pressure and cardiac rhythm disturbances in elderly hypertensives: relation to left ventricular mass and filling pattern.

In order to define cardiac hypertensive involvement a group of 25 consecutive elderly male hypertensive outpatients and 25 age-matched male normotensive controls underwent full non-invasive assessment of cardiac status by resting 12-lead electrocardiography, Doppler-echocardiographic examination and simultaneous ambulatory blood pressure and electrocardiographic monitorings. Elderly hypertensives showed a higher prevalence of electrocardiographic left ventricular hypertrophy, an increased echocardiographic left ventricular mass, an impaired left ventricular filling pattern and more frequent ventricular arrhythmias when compared with normotensive controls. In elderly patients, left ventricular mass was found to be correlated with 24-hour ambulatory blood pressure (r = 0.47, p < 0.01) and 24-hour ambulatory blood pressure variability (r = 0.52, p < 0.01), while ventricular arrhythmias were correlated with left ventricular mass (r = 0.52, p < 0.01), the Doppler synthetic index of diastolic function E/A ratio (r = -0.56, p < 0.01) and both 24-hour systolic (r = 0.54, p < 0.01) and diastolic (r = 0.59, p < 0.01) ambulatory blood-pressure variabilities. These data suggest that hypertension induces in elderly patients an impairment of cardiac structure and function comparable with that already shown in younger hypertensives. Therefore, the assessment of hypertensive target-organ damage currently employed in younger subjects should be also considered in elderly hypertensives, at least when no other relevant medical disease is present.

Aged↗
PubMed1995

Blood pressure variations, hemorheological determinants, and platelet aggregation in hypertensive patients with unstable angina.

Plasma viscosity, fibrinogen, haematocrit and beta-thromboglobulin were assessed on venous blood samples taken within 24 hours of admission from 20 consecutive male hypertensive patients with unstable angina and 20 male hypertensive patients with stable angina, matched for clinical variables. Besides, all patients underwent automated indirect blood pressure monitoring for 24 hours, starting just after hospitalization. Despite similar average 24-hour, day-time and night-time systolic and diastolic blood pressure, hypertensive patients with unstable angina showed an increased variability of 24-hour (p <0.01) and day-time (p < 0.05) systolic and disatolic blood pressure, together with higher values of all haemorhelogical parameters (plasma viscosity, fibrinogen and haematocrit) (p < 0.01) and beta-thrombogobulin (p< 0.05), when compared with hypertensive patients with stable angina. Moreover, significant correlations between plasma viscosity and 24-hour systolic (r = 0.42, p < 0.01) and diastolic (r = 0.39, p < 0.05) blood pressure variability were shown in hypertensive patients with unstable angina. Besides, in the same patients, the haematocrit was positively correlated with 24-hour systolic blood pressure variability (r = 0.37, P < 0.05). Our data further support the relevance of rheological determinants, platelet activation and haemodynamic factors in the genesis of the high risk condition of unstable angina.

Aged↗
PubMed1995

[Ischemic hepatitis: case reports and a review of the literature].

Ischemic hepatitis represents a condition in which an acute circulatory failure determines a striking elevation of both serum transaminases and total bilirubin and a prolongation of prothrombin time. Such impairment of liver function tests is due to a haemodynamic hepatocyte injury, showing focal centrilobular necrosis as the specific pathologic correlate. In this paper the authors describe four different cases of ischemic hepatitis, in which an acute derangement of liver function tests occurred as a consequence either of myocardial failure or of systemic venous congestion. Finally, the authors review all current international literature concerning the various clinical, pathologic and therapeutic features of ischemic hepatitis.

Acute Disease↗
PubMed1995

Use of [123I]MIBG to assess cardiac adrenergic innervation: experience in hypertensive cardiopathy and left ventricular aneurysms.

[123I]MIBG has been proposed as a suitable tracer of the adrenergic system of the heart. The aims of this study was to investigate the adrenergic functional status of the heart in hypertensive patients with left ventricular hypertrophy (LVH), and to evaluate the distribution of neuroadrenergic terminals in patients with left ventricular aneurysms (LVA) presenting complex arrhythmias. We studied 21 patients (4 normals, 11 with LVH and hypertension, and 6 with previous myocardial infarction, LVA and complex arrhythmias) who underwent series of [123I]MIBG planar scans (from 0.5 to 24 hours p.i.) and SPECT scans using both [123I]MIBG and 201Tl. Data quantification was performed by calculating the heart/mediastinum ratio (planar scan) and the percent uptake in 5 myocardial regions (SPECT scan). No significant differences between normals and hypertensive patients were found either in the heart/mediastinum ratio or in the regional distribution of [123I]MIBG and 201Tl. In hypertensive patients the uptake of [123I]MIBG was significantly higher than that of 201Tl in the septal wall while in the lateral and inferior walls it was significantly lower. In patients with anteroapical myocardial infarction (MI), the size of the [123I]MIBG defect was slightly smaller than the 201Tl defect; moreover a constant, severe [123I]MIBG defect was observed in the inferior walls whereas 201Tl uptake was normal. We conclude that while in hypertensive patients adrenergic innervation seems to be slightly impaired as compared to myocardial perfusion, in patients with MI a large area of functional or anatomical denervation may be detected despite the preserved perfusion and viability; this mismatch may be the trigger of complex arrhythmias.

3-Iodobenzylguanidine↗
PubMed1993

Prevalence of silent ST segment depression during long-term ambulatory electrocardiographic monitoring in asymptomatic diabetic patients with essential hypertension.

Thirty-five asymptomatic diabetic patients with non insulin-dependent diabetes and mild moderate essential hypertension (18 males and 17 females, mean age 60 +/- 6 years) underwent echocardiographic examination, followed by simultaneous ambulatory blood pressure and electrocardiographic monitorings. Three hundred and sixteen significant episodes of asymptomatic ST segment depression (at least 1 mm 80 msec after the J point, lasting more than 1 min) were recorded in 21 patients (60%) with a total duration of 5637 minutes. Patients with asymptomatic episodes of ST segment depression had significantly higher values of total cholesterol (p < 0.05), LDL cholesterol (p < 0.05), Glycosylated hemoglobin (p < 0.001), left ventricular mass index (p < 0.02), mean 24-hour systolic and diastolic ambulatory blood pressure (p < 0.001), systolic (p < 0.02) and diastolic (p < 0.01) ambulatory blood pressure variability and hypertensive peaks (p < 0.05), with respect to the rest of the study population. The number of ST segment depression episodes was significantly related to total cholesterol levels (r = 0.40, p < 0.05), LDL cholesterol levels (r = 0.36, p < 0.05) glycosylated hemoglobin levels (r = 0.50, p < 0.01), left ventricular mass index (r = 0.48, p < 0.01), ambulatory systolic (r = 0.43, p < 0.01) and diastolic (r = 0.51, p < 0.01) blood pressure variability and hypertensive peaks (r = 0.50, p < 0.01). Our data suggest that haemodynamic and metabolic factors could have a relevant role in high prevalence of SMI in asymptomatic diabetic patients with EH. The evidence of SMI in these patients warrants further diagnostic work-up and prognostic assessment.

Aged↗
PubMed1992

Prevalence of left ventricular hypertrophy and cardiac arrhythmias in borderline hypertension.

Seventy-eight men with borderline hypertension according to the World Health Organization criteria underwent echocardiographic examination, followed by simultaneous ambulatory blood pressure and electrocardiographic monitorings for 24 h. The prevalence of echocardiographic left ventricular hypertrophy was 16.6% (13/78). Borderline hypertensives with left ventricular hypertrophy had more supraventricular (P less than .001) and ventricular ectopic beats (P less than .001) than normotensive controls and borderline hypertensives without cardiac involvement. Furthermore, ventricular ectopic activity was significantly related to left ventricular mass (r = 0.58, P less than .05) in borderline hypertensives showing echocardiographic evidence of left ventricular hypertrophy. Our findings suggest that noninvasive assessment of target organ status, including echocardiography, should be employed to optimize risk stratification in borderline hypertension.

Adult↗
PubMed1992

Target organ status and cardiovascular risk in borderline hypertension.

In order to assess the prevalence of target organ damage 78 men with borderline hypertension, according to the World Health Organization criteria, and 67 normotensive controls underwent echocardiographic, electrocardiographic and fundoscopic examination, followed by ambulatory blood pressure monitoring for 24 hours. Echocardiographic left ventricular hypertrophy was found in 13 borderline hypertensive subjects (16.6%), while no electrocardiographic or fundoscopic abnormalities could be detected. Our data suggest that noninvasive assessment of cardiovascular status, including echocardiography, allows recognition of a subset of borderline subjects with an increased risk for subsequent cardiac morbid events, thereby improving prognostic stratification.

Adult↗
PubMed1992

[Efficacy of the combination of nicardipine-enalapril and atenolol in severe hypertension secondary to chronic renal disease].

The antihypertensive efficacy of combination therapy with N-E-A was evaluated during 6 months in 15 patients with hypertension associated with mild to moderate kidney failure. After 6 months a significant reduction of SBP and DBP (p < 0.001), with improvement of creatinine clearance and with no adverse effects on ECG, heart rate and routine laboratory tests test, was observed in 3 patients treated with N 20 mg x 2/d + E 10 mg/d + A 50 mg/d and in 8 patients treated with N 20 mg x 3 + E 10 mg x 2, + A 50 mg x 2. Four patients did not respond to this therapy.

Adult↗
PubMed1992

[The efficacy and tolerance of heparin-calcium at low doses in postinfarct ischemic cardiopathy].

The above study was undertaken in order to evaluate the efficacy and tolerability of low dose calcium heparin for postinfarct ischemic heart disease (CIPI). In particular, the incidence was checked of: cardiovascular death, reinfarction, angina pectoris, TIA or RIND, stroke, arterial thromboembolism, venous thromboses, heart failure, complex ventricular arrhythmias, silent myocardial ischemia. Eighty patients with CIPI were divided into two groups similar for age, sex, physical features, cardiovascular risk factors, site of infarction, length of hospitalization, complications during hospitalization, clinical and instrumental findings at discharge, concomitant pathology. Upon discharge, patients were randomized into group 1 for traditional treatment and group 2 which in addition received 12,000 U calcium heparin s.c. every 24 h. After 12 months, during which patients were submitted to periodical laboratory and instrumental (standard and dynamic ECG, echoG) evaluation, group 2 had significantly fewer cardiovascular events than group 1 both as to overall number of events and as to number of events per individual patient. Especially, silent myocardial ischemia and ventricular arrhythmias were less frequent in group 2 patients and these two events, especially if coincident, are known to have severe prognostic implications. The efficacy of low-dose calcium heparin must be attributed to the enhancement of physiological antithrombotic mechanisms with compensation of blood clotting disorders that are fairly frequent in CIPI patients. Long-term s.c. administration was well tolerated.

Aged↗
PubMed1991

Abnormal blood pressure response to exercise in borderline hypertension. A two year follow-up study.

Twenty-eight men with borderline hypertension according to the World Health Organization criteria underwent maximal exercise testing, and then were followed for a two year period. The prevalence of abnormal blood pressure behavior during exercise was 53.58% (n = 15). During follow-up established hypertension developed in 63.33% (n = 10) of subjects with an abnormal blood pressure response to exercise, and only in 15% (n = 2) of subjects with normal blood pressure behavior. In predicting established hypertension development in a two year follow-up, maximal exercise testing has the following statistical values: sensitivity = 83.33%, specificity = 68.75%, accuracy = 75%, positive predictive value = 66.66%, negative predictive value = 84.61%.

Adult↗
PubMed1991

Cardiac biopsy in patients with "primary" atrial fibrillation. Histologic evidence of occult myocardial diseases.

Fourteen patients (ten men and four women; mean age, 37 years) with lone atrial fibrillation (AF) (1 to 18 months' duration) were evaluated by thyroid function tests, two-dimensional echocardiography, hemodynamics, coronary angiography, and left ventricular endomyocardial biopsy, because of unresponsiveness to the usual antiarrhythmic therapy. The results of the T3, T4, TSH, and TRH tests were normal in all patients; cardiac valves and ventricular and atrial sizes (left atrium less than 40 mm) were within the normal limits; also normal were LVEDP (less than or equal to 10 mm Hg) and EF (greater than 0.50). Histologic findings were abnormal in all cases, with three patients showing cardiomyopathic changes, three other patients showing active myocarditis (lymphocytic in two and eosinophilic in one), and eight patients with nonspecific necrosis or fibrosis or both. Steroids (prednisone; 50 mg/m2 of body surface area daily) used in addition to antiarrhythmic therapy in patients with eosinophilic and lymphocytic active myocarditis were able to cause reversion to sinus rhythm, while the other patients continued to have AF. This study documents that occult myocardial diseases (myocarditis, cardiomyopathy, and nonspecific necrosis or fibrosis) can underlie "primary" AF. The addition of steroids to antiarrhythmic therapy in patients with refractory AF and histologic evidence of active myocarditis seems to be useful in controlling the arrhythmia.

Adult↗
PubMed1991

[Electrocardiographic changes in hypertensive emergencies. Their incidence and possible pathogenetic mechanisms].

The aim of the study was to analyse electrocardiographic alterations in 30 patients with slight to moderate essential arterial hypertension during the course of hypertensive attacks (DAP greater than 115 mmHg). Standard hematochemical tests were performed in basal conditions, together with 24-h ECG monitoring and an echocardiogram to measure the left ventricular mass index. Echographic monitoring was carried out during hypertensive attacks and for 2 h after the return to basal pressure values. In basal conditions patients showed slight hypopotassemia (23%), left ventricular echographic involvement (57%), left ventricular hypertrophy with or without systolic strain (43%), and ventricular extrasystole (VE) classified as Lown's 1st and 2nd class (17%). During the course of hypertensive attacks, there was a significant increase in systolic strain, the appearance of anterolateral subendocardial ischemia (10%), left anterior hemiblock (3%), lateral subepicardial ischemia (3%), and a marked increase in VE (67%) which were complex in 40% of cases (Lown's classes 3, 4 and 5). A significant correlation was found between the left ventricular mass index and VE/h. The authors stress the multifactorial pathogenesis of echographic alterations and underline left ventricular involvement, acute hemodynamic strain and consequent alterations of coronary perfusion, hypopotassemia, and increased levels of circulating catecholamines.

Adult↗
PubMed1990

[Evaluation of the predictive stable hypertension validity during the ergometric test in borderline hypertension].

Aim of this study was to assess blood pressure (BP) response to exercise in borderline hypertensive subjects and to evaluate its predictive value for subsequent established hypertension development: 74 male subjects (28 borderline subjects, 26 normotensive subjects and 20 subjects with established hypertension) underwent a maximal exercise testing in the sitting position with a bicycle ergometer at the beginning of the study and then after 1 and 2 years; besides casual BP was controlled every 3 months for 2 years. Systolic BP exceeding 220 and/or diastolic BP exceeding 105 mmHg at maximal exercise and/or diastolic BP exceeding 100 mmHg at th fifth min of recovery were considered as abnormal. On the basis of BP response to exercise we divided our study group in: normotensive subjects with a normal BP response (Group A: 88%); normotensive subjects with an abnormal BP response (Group B: 12%); borderline subjects with a normal BP response (Group C: 46%); borderline subjects with an abnormal BP response (Group D:56%). At the end of a 2-year follow-up established hypertension developed in 1 subject of Group B (33%), in 2 subjects of Group C (15%) and in 10 subjects of Group D (67%); 7 subjects of Group C returned to normotension (54%). The incidence of established hypertension is significantly higher in borderline subjects with an abnormal BP response to exercise. This finding is probably due to both functional and organic factors and stresses the predictive value of exercise testing in borderline hypertension.

Adult↗
PubMed1989

Heart rate variability and ventricular ectopic activity in hypertensive patients.

In order to investigate whether the severity of ventricular ectopic beats in hypertensive patients is influenced by the autonomic drive to the heart, we evaluated the relationship between the degree of dysrhythmias and 24-h spontaneous heart rate variability, an index of sympatho-vagal balance at cardiac level. Ambulatory 24-h ECG monitoring was used to examine 42 untreated essential hypertensives, previously scored for the presence and the extent of hypertensive target organ damage. No significant difference was found in the prevalence of complex ventricular ectopic beats in patients with a heart rate variability that was lower and higher than the arbitrary cut off points selected to divide subjects into groups. Neither heart rate variability nor the degree of arrhythmias was correlated with blood pressure levels, whereas the degree of ectopy was influenced by the presence of target organ damage and left ventricular hypertrophy (by ECG). Our results seem to exclude an association between dysrhythmias in hypertensives and autonomic outflow to the heart as detected by the analysis of heart rate variability.

Adult↗
PubMed1989

[The relationship between high-density lipoproteins, thromboxane B2 and arteriosclerosis in a case of primary hypoalphalipoproteinemia].

Data in the literature suggest that cases of hypoalphalipoproteinemia involve an increase in thromboxane B2 (TXB2) together with an increased risk of atherosclerosis. A recent detailed examination of a 32-year-old man revealed clinical and biochemical features strongly indicative of that pathology. The case presented several unusual features: marked infiltration of the skin and mesenteric lymph nodes by histiocytic lipids with sufficient hyperplasia to induce acute intestinal occlusion combined with an in vivo TXB2 generation curve, subsequently inhibited by aspirin, that was comparable to the curves of the control subjects. Furthermore there were no signs of early atherosclerotic damage so that it was possible to postulate the hypothesis that despite the 50% drop in alpha-lipoprotein levels, they were still sufficient to ensure normal turnover of the other lipoproteins so that, however complex the clinical condition, it was an incomplete expression of a phenotype.

Adult↗
PubMed1989

[Usefulness of sublingual captopril in hypertensive emergencies. Preliminary results].

The aim of this study, whose preliminary findings are reported, is to evaluate the efficacy of captopril, administered by a sublingual route, in the treatment of hypertensive emergencies. Captopril has been given by this route to 20 hypertensive patients while these had an ongoing hypertensive crisis (defined as a systolic arterial pressure above 200 mmHg associated with a diastolic arterial pressure above 115 mmHg). Arterial pressure has been measured after 5, 20, 10, 15, 30, 45, 60 and 120 min. For 8 patients it has been measured until the eighth hour. Results were the following: a satisfactory control of hypertensive crisis in 85% of patients, as stated by a slight but significant drop of arterial pressure after 10 min (15/10 mmHg; p less than 0.05) and by a maximum antihypertensive effect after 30 min (57/39 mmHg; p less than 0.001); an antihypertensive effect was evident until 6 hours after the administration of the drug; a positive correlation between the antihypertensive effect and pretreatment levels of arterial pressure and plasma renin activity; drug was free from relevant side effects; sublingual captopril can be considered an efficacious, easy to use and valuable tool in the treatment of hypertensive emergencies.

Administration, Sublingual↗