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Biomedical subjects

E Barbieri

Publications and source records attributed to E Barbieri.

149 records · Page 9Linked to original sources
PubMedDate not supplied

Combined hemodynamic echocardiographic Doppler evaluation of prostaglandin E1 effects in patients with severe dilated cardiomyopathy undergoing evaluation for heart transplantation.

BACKGROUND: Prostaglandin E1 has been used in patients undergoing evaluation for heart transplantation. Because of high lung metabolism, the drug has been used to test pulmonary vasoreactivity, although a systemic effect is also present. The purpose of this study is a more thorough assessment of the drug. METHODS: Prostaglandin E1 was infused with progressive steps in 14 patients in New York Heart Association class III to IV with severe dilated cardiomyopathy. The patients were studied through a combined hemodynamic and Doppler echocardiographic evaluation. RESULTS: With prostaglandin E1, mean aortic and pulmonary arterial pressure decreased by 7% (p < 0.01) and 24% (p < 0.001), respectively with a 23% (p < 0.001) increase in stroke volume index. Systemic vascular resistance decreased by 22% (p < 0.001), and pulmonary vascular resistance decreased by 33% (p < 0.001), with a 15% decrease in the pulmonary/systemic vascular resistance ratio. Heart rate was unaffected. Minimum and end-diastolic left ventricular pressure decreased by 35% (p < 0.001) and 21% (p < 0.001), respectively. The logarithmic time constant of left ventricular isovolumetric relaxation and maximum rate of isovolumic pressure decline were not modified. Early and late left ventricle diastolic filling were not significantly modified if considered separately, but there was a 27% (p < 0.01) decrease in the early/late filling ratio, suggesting a redistribution of diastolic filling to later in diastole. The 34% (p < 0.01) decrease in right atrial pressure suggests a reduction in intrapericardial pressure which mirrors the significant change in the early/late ratio toward a less restrictive filling pattern. CONCLUSIONS: It is possible that the end-stage ventricles of these patients respond to the reduction in pulmonary and systemic resistances secondary to prostaglandin E1 infusion by increasing stroke volume, with a redistribution of diastolic filling to later in diastole.

Alprostadil↗
PubMedDate not supplied

Cardiac injury as late toxicity of mediastinal radiation therapy for Hodgkin's disease patients.

BACKGROUND: During the last 20 years Hodgkin's disease (HD) has become one of the most curable neoplasms; in fact, more than 75-80% of patients are expected to achieve long-term relapse-free survival with appropriate therapy. However, overall survival has been affected by intercurrent or treatment-induced diseases such as the increased risk of cardiac toxicity in patients who received mediastinal irradiation. METHODS: The incidence of cardiac abnormalities after mediastinal radiotherapy was assessed in 102 consecutive HD patients who underwent this treatment from January 1970 to December 1980. Basal investigation procedures included electrocardiogram and echocardiography; myocardial perfusion scintigraphy with 201-thallium and coronary arteriography were performed in selected patients. RESULTS: Eleven patients (10.8%) presented cardiac abnormalities, which were asymptomatic in three cases. Eight cases of myocardial ischemia and 3 of constrictive pericarditis were observed. The incidence of late cardiotoxic effects was related to total mediastinal dose and to the irradiation technique. CONCLUSIONS: The increasing duration of follow-up shows that as mediastinal irradiation increases so does the risk of late cardiotoxic side effects. For this reason, a proper treatment strategy should reduce these risk factors through new combined modality protocols and routine evaluation of cardiologic follow-up.

Adolescent↗
PubMedDate not supplied

Supradiaphragmatic early stage Hodgkin's disease: does mantle radiation therapy still have a role?

Extended field radiation therapy represents the main therapeutic option in early stage Hodgkin's disease with favorable prognostic features. Its role however has recently been criticized, mainly due to the high incidence of late complications in irradiated tissues. Furthermore, surgical staging, which in the opinion of many is mandatory for proper selection of patients for radiotherapy alone, has a well-known morbidity, and splenectomy has been associated with a high risk of secondary leukemias. Lastly, the failure rate after radiotherapy only is not negligible and second-line treatment is not always successful. A review of our experience and of the recent literature has allowed us to refute these objections. The results of radiotherapy, when properly performed, are highly reliable and have been reproducible in many Institutions. Chemotherapy alone cannot yet be regarded as an alternative to radiotherapy in these patients since data reported on this issue are conflicting. Present knowledge regarding the relationship between clinical features and the risk of occult subdiaphragmatic spread allows patients with localized disease to be selected without surgical staging; the results of radiotherapy in clinically staged patients confirm this statement. Concern for the late effects in irradiated tissues is justified, and future efforts should be directed at reducing the toxicity of this treatment. Associating a short chemotherapy course with low-dose radiotherapy to involved sites could help to achieve this goal.

Diaphragm↗
PubMedDate not supplied

Radiotherapy in vertebral tumors. Indications and limits: a report on 28 cases of Ewing's sarcoma of the spine.

After brief notes on techniques used to radiate the spine, its indications and the limits of doses required by its adjacency to the spinal cord, our experience in the treatment of 28 patients with a diagnosis of Ewing's sarcoma localized in the spine, not metastatic at onset, that came to our observation between 1980 and 1994 is reported. All of the patients were treated by chemotherapy. As for local treatment radiotherapy was performed in all of the cases, in 50% of cases it was associated with surgery (6 laminectomies, 6 excisions, and 2 vertebrectomies). Five-year survival rate was 43.5%. The prognosis of this group of patients was intermediate among forms localized in the limbs and those localized in the pelvis. There is a greater frequency of cerebral (20%) and skeletal metastases (55%) as compared to the disease that occurred in other sites where secondary pulmonary localizations generally prevailed. Local control was similar for disease occurring in other sites despite the need to deliver doses that were lower than those typically used for this pathology in regions above the cauda.

Adolescent↗