Biomedical subjects

F Di Pede

Publications and source records attributed to F Di Pede.

At least 37 records · Page 2Linked to original sources

PubMed1998

[Effects of spinal cord stimulation on regional myocardial blood flow in patients with refractory angina. A positron emission tomography study].

BACKGROUND: Spinal cord stimulation (SCS) is an alternative therapy in patients with refractory angina pectoris when coronary revascularization cannot be performed. Several hypotheses have been given to explain the effects of SCS in reducing the number and the intensity of anginal crises. These hypotheses include possible variations in myocardial blood flow (MBF). The aim of our study was to assess regional MBF in a group of patients with spinal cord stimulator, using positron emission tomography (PET). METHODS: We studied 15 patients (9 male and 6 female), mean age 74 +/- 7 years, who were carriers of a spinal cord stimulator implanted 17 +/- 14 (range 1-48) months before. All patients had been affected with angina pectoris that was refractory to maximal tolerated pharmacological therapy. Eight patients had had a previous myocardial infarction and four patients had undergone a revascularization procedure. Every patient underwent two PETs with nitrogen-13-ammonia as the perfusion tracer. The first one was performed with the stimulator switched off for at least 20 hours, and the second one with the stimulator switched on for at least 4 hours. The quantitative evaluation of regional MBF (anterior, inferior, lateral, septal walls and apex) was performed with Patlak graphic analysis. The normal value of basal MBF in our laboratory is 0.6-1 ml/min/g. RESULTS: The mean value of MBF increased from 0.72 +/- 0.33 ml/min/g with the stimulator off, to 0.80 +/- 0.33 ml/min/g with it on (p = 0.004). An increase in regional myocardial perfusion, with the stimulator on as opposed to off, was observed in 47 (62%) of the 75 regions studied. With the stimulator on, in comparison with off, the value of MBF increased from 0.45 +/- 0.11 ml/min/g to 0.56 +/- 0.19 (p = 0.0001) in the 35 regions with low basal MBF (< 0.6 ml/min/g), and from 0.77 +/- 0.14 ml/min/g to 0.92 +/- 0.29 ml/min/g (p = 0.013) in the 23 regions with basal MBF between 0.6 and 1 ml/min/g. Instead, in the 17 regions with high basal MBF (> 1 ml/min/g) it decreased with the stimulator on instead of off, going from 1.22 +/- 0.20 to 1.13 +/- 0.22 ml/min/g (p = 0.112). CONCLUSIONS: Our study suggests that the beneficial effects of SCS in refractory angina may also be related to an increase in mean MBF and to a redistribution of MBF between the regions with low or normal basal flow and the regions with high basal flow.

Aged↗

PubMed1997

Effects of transdermal nitroglycerin on left ventricular function after acute myocardial infarction.

Progressive left ventricular dysfunction in acute myocardial infarction patients is associated with a poor prognosis. It has been shown that some therapeutic measures which have the potential for limiting the infarct size and preserving ventricular function, are also able to reduce the incidence of congestive heart and improve survival. The aim of this protocol was to assess the effects of transdermal nitroglycerin administered within 72 hours after the onset of acute myocardial infarction and for the following 6 months, on left ventricular function. A total of 98 consecutive acute myocardial infarction patients were randomly allocated, within 72 hours of onset of symptoms, to a double-blind 6-month-therapy with either 10 mg/24 hour transdermal nitroglycerin or placebo. Patients underwent two-dimensional echocardiography at entry, after 2 weeks, 3 months and 6 months. In the nitroglycerin group, end-diastolic volume increased during the follow-up (+6.7%, p < 0.05) while end-systolic volume remained nearly unchanged; ejection fraction and stroke volume increased progressively (+6.3%, p < 0.05, +14.2%, p < 0.05, respectively) and a important reduction of percent of dyssynergic segments was present (-19.2%, p < 0.005). In the placebo group end-diastolic volume and end-systolic volume slightly increased during the follow-up (+2% and +4.9% respectively); ejection fraction and stroke volume remained nearly unchanged during the study; percent of dyssynergic segments showed an important decrease after 2 weeks and 6 months (-21.3%, p < 0.005). A clinically relevant increase (> 20%) in ejection fraction was present more frequently in the nitroglycerin than in the placebo group (p < 0.001). In conclusion, the early (within 72 hours) and prolonged (6 months) administration of transdermal nitroglycerin in acute myocardial infarction improves ejection fraction and stroke volume but does not modify ventricular remodeling.

Acute Disease↗

PubMed1995

Distribution of bronchial responsiveness in a general population: effect of sex, age, smoking, and level of pulmonary function.

Bronchial responsiveness (BR) was assessed by the methacholine challenge test in 1,694 subjects from a sample of the general population (aged 8 to 73 yr) enrolled in a prospective epidemiologic study on the natural history of chronic obstructive pulmonary disease (COPD). Information on respiratory symptoms and risk factors for COPD were obtained with a standardized questionnaire. The provocative dose causing a 10%, 15%, and 20% decrease in FEV1 was reached in 939 (55%), 658 (39%), and 447 (26%) subjects, respectively, after the last cumulative dose of methacholine (i.e., 4.8 mg). The slope of the dose-response curve was also computed in order to attribute a parameter to subjects who did not reach the provocative dose. After natural log transformation, the slope (Ln Slope) of the curve showed a significant association with the degree of airway obstruction, as assessed by FEV1% predicted, FEV1/VC%, and FEV1/FVC%. Therefore, relationships between BR, sex, age, and smoking were evaluated after adjustments for the initial airway caliber (FEV1, FEV1 adjusted for height, and FEV1/VC%). Females showed significantly higher values of Ln Slope than did males after adjustments were made for baseline lung function. In males, higher BR was observed in childhood-adolescence age groups and at older ages, while in females a higher level of BR was observed during childhood. Significantly higher Ln Slope values were found for females who currently smoked than for non- and ex-smokers. No difference was observed in males in relation to smoking habit. (ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1994

Risk factors for chronic obstructive pulmonary disease in a north Italian rural area.

To assess the role of risk factors for chronic obstructive lung disease (COPD) by multiple logistic models, the data of the first cross-sectional epidemiological survey in the unpolluted rural area of the Po River Delta were analyzed (n = 2382; 20-64 years). Each subject filled out a standardized questionnaire; 94% of the subjects were also able to perform forced expirograms. Dependent variables were chronic respiratory symptoms, asthma, abnormal parameters of flow-volume curve (ABNFVC), and a complex characterized by chronic phlegm, and/or any wheeze and/or dyspnea grade 2+ and/or diagnosis of asthma and/or an FEV1/FVC ratio less than 60% (ANYABN). Independent variables were: age, ever cigarette smoking (SMK) and lifetime cigarette consumption expressed as pack-years, childhood respiratory infections (CRI), adolescence-adulthood respiratory infections (ARI), familial history for COPD (FCOPD) or for asthma/allergies (FASTHMA), work exposure to dusts/chemicals (EXPO), low socio-economic conditions (SES). A significant relationship with almost all dependent variables was shown by pack-years, ARI and age in both sexes. In males, FCOPD was related to chronic mucus hypersecretion and to ABNFVC, FASTHMA was associated with wheeze and ANYABN. EXPO was related to dyspnea and asthmatic symptoms in both sexes and also to bronchitic symptoms in males. CRI was a significant contributor for asthma symptoms in males, for ANYABN in females. SES had no significant association. In conclusion, our findings show that, beside lifetime cigarette smoking, other host--or environment--related conditions are important risk factors for COPD, suggesting the need for a more thorough strategy for prevention.

Adolescent↗

PubMed1994

Nitroglycerin infusion during upright tilt: a new test for the diagnosis of vasovagal syncope.

The aim of our present study was to assess the value of nitroglycerin infusion during upright posture as a new provocative test for diagnosis of vasovagal syncope. To this purpose 40 patients with unexplained syncope (17 men and 23 women, mean age 47 years) and 25 asymptomatic control subjects with negative baseline head-up tilt underwent two other tilting tests, one during nitroglycerin infusion and one during isoproterenol infusion. The protocol of the nitroglycerin test consisted of a maximum of five successive stages of 5 minutes in the supine position plus 10 minutes 80-degree upright tilt at progressively increasing infusion rates (increments of 0.86 microgram/kg/hr every stage). During the nitroglycerin test a positive response (syncope in association with sudden hypotension and bradycardia) occurred in 21 (53%) patients with unexplained syncope, an exaggerated response (minor symptoms in association with slowly increasing hypotension alone) occurred in 10 (25%), a negative response in 9 (22%), and drug intolerance in 0. During the isoproterenol test these percentages were 25%, 25%, 32%, and 18%, respectively. Only 2 (8%) control subjects had a positive response to nitroglycerin test and 2 (8%) to isoproterenol test. Thus the nitroglycerin test seems to be a useful alternative tool for diagnosis of vasovagal syncope; it is equally specific but more sensitive and feasible than the isoproterenol test.

Adult↗

PubMed1994

Peak expiratory flow monitoring in diagnosis and management of occupational asthma.

The role of peak expiratory flow (PEF) monitoring in the diagnosis of occupational asthma has recently been assessed by several studies, which agree that this procedure should always be used to confirm the relationship between symptoms and occupational exposure. Some specific issues should be satisfied: a minimum number of four PEF measurements in a day; several weeks of monitoring in and out of work; and the presence of specific patterns of PEF changes. The sensitivity and specificity of PEF monitoring to detect occupational asthma, in comparison with the specific challenge test in the laboratory (the "gold standard") have been shown to be fairly high, although many authors believe that PEF monitoring cannot substitute for the specific challenge test. Limitations include: the low sensitivity of PEF to detect mild changes in airway calibre with respect to forced expiratory volume in one second (FEV1); the blunting effect of pharmacological treatment; the episodic and irregular exposure to the sensitizer in the workplace; and the compliance and honesty of the subject. Further studies are required to select the best indices of daily and day-to-day variability to be used in the evaluation of PEF changes between work and out-of-work periods.

Asthma↗

PubMed1994

Prevalence rates of diagnosis of asthma in general population samples of northern and central Italy.

In order to assess the distribution of asthma in Italy in the 1980s, we have compared the findings of three general population surveys carried out in the North and the Centre of the country. Two cross-sectional investigations were performed in the Po Delta area (North Italy), 6 yrs apart: 1) 3,285 subjects, aged 8-64 yrs, in 1980-1982 (PD1); and 2) 2,841 subjects, aged 8-73 yrs, in 1988-1991 (PD2). One cross-sectional survey was carried out in Pisa (Central Italy): 3,866 subjects, aged 5-90 yrs, in 1985-1988 (PI1). For this analysis we have used data from the standardized questionnaires of those subjects between 18-64 yrs, who were currently employed. The prevalence rate of ever asthma was 3.3-5.5%, that of current asthma 1.3-2.9%; almost all of the diagnoses were confirmed by a doctor. Taking into account only doctor-confirmed asthma, the age of onset of manifestations was most frequently over 18 yrs (41-79%). It also occurred more frequently after the onset of employment. As regards smoking, whilst most asthmatic males were current or former smokers (70-86%), most asthmatic females were nonsmokers. However, the situation changed in PD2, where females showed the same pattern as males. Considering asthmatic subjects with skin-prick test reactivity (data available only in PD2), the vast majority (67% in males, 75% in females) had an age of disease onset under 18 yrs. In conclusion, the prevalence of asthma in Italy in the 1980s was similar to that in other European countries and was affected by atopy and smoking differently in the two sexes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1994

Bronchial reactivity in a general population of north Italy: relationships with occupational exposure.

Two thousand eight hundred and forty one subjects, aged 8-73 yrs, took part in the second cross-sectional survey in the Po River Delta area: among them, a subsample of currently employed people, aged 14-71 yrs, was chosen to establish the relationship between occupational exposure to dusts, chemicals or gases and respiratory symptoms, lung function and bronchial reactivity. Each subject filled out the Italian National Research Council (CNR) standardized questionnaire concerning respiratory symptoms, diseases and risk factors. A variable proportion of subjects performed acceptable forced and slow vital capacity manoeuvres, diffusing capacity of carbon monoxide and bronchial challenge test to methacholine. Occupational exposure appeared to be related to prevalence rate of respiratory symptoms (wheeze, dyspnoea, presence of at least one respiratory symptom) and bronchial asthma. Consistent effects on lung function were not evident. With respect to the bronchial challenge test, using the measurement of the provocative dose producing a 20% fall in forced expiratory volume in one second (PD20) a significantly higher percentage of hyperreactive subjects was found among ex-smoker exposed men; a borderline higher percentage of hyperreactive subjects was also found in non-smoker exposed women. The study findings support the suggestion that occupational exposure may play a role in the development of airway obstructive diseases.

Adolescent↗

PubMed1993

CO diffusing capacity in a general population sample: relationships with cigarette smoking and airflow obstruction.

The single-breath carbon monoxide diffusing capacity (DLCOsb) was measured together with ventilatory lung function tests as part of a survey of a general population sample living in Northern Italy (n = 2,481). Based on answers to an interviewer-administered questionnaire, subjects free of respiratory symptoms or diseases were identified. Data from subjects who had never regularly smoked cigarettes were used to derive reference equations for the test indexes, and data from the remaining subjects who had smoked were used to derive regression equations incorporating a term expressing cigarette consumption (cube root of pack-years) and a term indicating current smoking decrement, in order to obtain expected DLCOsb percent predicted. Neither number of cigarettes smoked daily or duration of smoking, in smokers, nor duration of smoking or years since quitting smoking, in ex-smokers, entered significantly the multiple-regression model. The mean values of DLCOsb were only slightly affected by the increasing degree of airway obstruction. When subjects with confirmed asthma were analyzed, after stratifying for different levels of FEV1/FVC ratio, increased mean value of DLCOsb (over 100%) was found in those with an FEV1/FVC ratio between 75 and 65%. This cross-sectional analysis suggests that there is a decrease in DLCOsb with cumulative cigarette consumption even in healthy subjects. Further, it confirms the clinical observations of high DLCOsb values in asthmatic patients, at least in those with an initial degree of chronic airflow obstruction.

Adolescent↗

PubMed1992

Residual volume in a general population. Effects of body size, age, cigarette smoking, and respiratory symptoms.

Residual volume (RV) was obtained by subtracting vital capacity from total lung capacity determined by the single breath helium dilution (TLCsb) to measure CO diffusing capacity in 2,680 subjects (8 to 64 years old) of a general population sample. There were 712 normal subjects (243 male and 469 female subjects) selected to evaluate the pattern of RV by age and to derive reference values for internal comparisons. From 8 to 20 years old, RV showed an increase because of the cross-sectional body size effect; after 20 to 30 years, RV was still increasing, however, at a lower level. Age and height coefficients were significantly related to RV in younger and older ages, both in male and female subjects. The RV percent predicted and RV/TLC percent were higher in smokers when compared to nonsmokers and exsmokers (the difference was significant in male subjects). A dose-response effect was observed between RV percent predicted, RV/TLC percent, and pack-years. The RV percent predicted and RV/TLC percent were significantly higher in smokers and nonsmokers with FEV1 percent predicted below the normal limit (the difference was significant in male subjects). Moreover, higher values of RV percent predicted and RV/TLC percent were observed in subjects with wheezy symptoms in male smokers and nonsmokers. A negative significant correlation was observed between RV/TLC percent and the diffusing capacity adjusted for lung volume (DL/VA) in smokers, exsmokers and nonsmokers of both sexes, confirming the hypothesis that the decrease in DL/VA may be ascribed to the enlargement of terminal air spaces. In conclusion, determination of RV by the single breath helium dilution method is suitable in epidemiology, and it allows additional important information for understanding the physiopathologic mechanisms related to the pathogenesis of chronic obstructive lung disease.

Adolescent↗

PubMed1992

Sarcoidosis in Tuscany. A preliminary report.

A retrospective study was carried out by a computerized questionnaire in a sample of 109 sarcoidosis patients (43 men, 66 women) diagnosed between 1977 and 1990 in Pisa. 94% of the patients were resident in Tuscany. The onset of disease was earlier in the men than in the women; in 73% of the patients the symptoms were first noticed between February and July with two incidence peaks; 71% of them had never smoked; 10% of patients were symptom-free and the disease was discovered by chance; the other patients (90%) underwent chest X-ray because of joint symptoms (35%), erythema nodosum (34%), cough (28%), dyspnoea (27%), and fever (24%) which was often associated with other symptoms. Symptoms from the respiratory tract was present in 66 patients (61%); 58% of patients were resident in rural areas; the level of education was limited to primary school in 50% of the patients; as to the prevailing working positions, 27% were clerical workers, 24% manual workers, and 26% housewives.

Adult↗

PubMed1991

Successful catheter ablation by radiofrequency energy of posteroseptal accessory pathway in a patient with drug refractory Wolff-Parkinson-White syndrome.

A 45-year-old patient with the Wolff-Parkinson-White syndrome suffering from recurrent intractable reciprocating atrioventricular tachycardia (RAVT) is reported. He used amiodarone, sotalol, quinidine, propafenone and flecainide unsuccessfully. An electrophysiological study (EPS) performed with four catheters localized the site of the anomalous pathway in the ostium of the coronary sinus. In this region we could also record a Kent potential. In the ostium of the coronary sinus, radiofrequency energy was repeatedly applied until the conduction over the accessory pathway was abolished both in the anterograde and the retrograde direction. The Kent deflection detectable before ablation, could not be detected after it. During follow-up (1 month) the patient remained asymptomatic and the control EPS showed no evidence of pre-excitation, either anterogradely or retrogradely.

Anti-Arrhythmia Agents↗

PubMed1991

Effects of daily cigarette consumption on respiratory symptoms and lung function in a general population sample of north-Italian men.

We assessed the respiratory effects of the number of cigarettes smoked daily (CIGD) in 748 male smokers of a general population sample living in the unpolluted area of the Po Delta (Italy). A standardized questionnaire, flow-volume curves (V/V), the diffusing capacity of carbon monoxide (DLCO) and the slope of the alveolar plateau of nitrogen (DN2%/l) were used. Subjects were divided according to the median value of the observed distribution of CIGD (1-19, 20+) and according to the tertile values of the observed distribution of pack-years (an index representing lifetime cigarette consumption; 1-7, 8-21, 22+). In those with a higher CIGD, the prevalence rate of chronic phlegm was always significantly increased, while the prevalence rate of wheeze was significantly higher if they had smoked 8+ pack-years. Using analysis of variance, adjusted for pack-years, DLCO indexes, FEF75-85 and Vmax75 were significantly reduced in those with higher CIGD. When multiple logistic models, accounting for the independent effects of age and pack-years, were used, significantly increased odds ratios (ORs) for symptoms (e.g. OR = 2.0 for phlegm, OR = 1.8 for cough, OR = 1.6 for wheeze) and abnormal DLCO (OR = 1.9) or DN2%/l (OR = 1.6) were associated with a daily consumption of 10 cigarettes. In conclusion, the amount of cigarettes currently smoked may add a negative effect to that caused by lifetime cigarette consumption on respiratory symptoms and lung function. Moreover, the use of diffusing capacity in general population surveys is advisable.

Adolescent↗

PubMed1991

Respiratory effects of occupational exposure in a general population sample in north Italy.

We assessed the effects of occupational exposure in a general population sample living in an unpolluted rural area of North Italy. In the age range of 18 to 64 yr, there were 417 participants who reported any exposure to dusts, chemicals, or gases and 1,218 who reported no exposure. Each subject completed a standardized interviewer-administered questionnaire (CNR-questionnaire). A variable proportion of participants succeeded in performing flow-volume curves, diffusing capacity of carbon monoxide, and slope of alveolar plateau of nitrogen. There was no significant difference for symptom prevalence rates between exposed and nonexposed in men and women who smoke. In nonsmoking women, those exposed showed significantly higher prevalence rates for exertional dyspnea and asthma. Regarding lung function, in exposed male smokers there was a significantly higher slope of the alveolar plateau. In exposed female nonsmokers, FEV1 and forced expiratory flows were significantly lower. Multiple logistic models in the overall group, accounting for age, smoking, and pack-years, showed that work exposure was associated significantly with higher risks for all symptoms in men (e.g., odds ratio: 2.76 for dyspnea, 2.31 for asthma, 1.69 for cough, and 1.64 for phlegm); in females, the association was significant for dyspnea (OR = 3.74) and asthma (OR = 3.29). Exposed men also had a significantly higher risk for %FEV1 or FEV1/FVC% below 70 (OR = 1.45). Our findings confirm those of the other few epidemiologic surveys in general population samples and contribute to the suggestion of a causal association between occupational exposure and chronic obstructive pulmonary disease.

Adult↗

PubMed1991

[The endocavitary and transesophageal electrophysiological findings in idiopathic atrial fibrillation].

BACKGROUND: We studied 105 patients (pts) in order to help clarify the pathogenetic mechanisms of idiopathic atrial fibrillation (AF). Eighty of these pts (Group I) had experienced paroxysmal AF, and 25 were normal control subjects (Group II). Twenty-two pts out of Group I had idiopathic paroxysmal AF (Group IA), while the remaining 58 (Group IB) presented with a heart disease or a WPW pattern. METHODS: All pts underwent endocavitary (EEPS) (69) or transesophageal (TEPS) (36) electrophysiologic study. In all pts the inducibility of a sustained AF (greater than 1 min) was tested by aggressive stimulation protocols including high frequency atrial bursts. RESULTS: In Group I a sustained AF was induced in 82% of cases vs 4% of Group II cases (p less than 0.001). In Group I there was no difference between pts with or without idiopathic AF (IA 73% vs IB 86%, NS). In two pts with idiopathic AF a concealed Kent bundle was identified and a reciprocating atrioventricular tachycardia was induced, which in one case spontaneously degenerated into AF. Four athletes with idiopathic AF were studied before and after autonomic blockade. AF was induced in all during the basal state, lasting several hours, and after autonomic blockade in 3 pts, lasting again for several hours. In 1 patient (pt) the arrhythmia spontaneously resolved within 50 sec. CONCLUSIONS: 1) The induction of a sustained AF by EEPS or TEPS is a pathologic phenomenon which is frequently observed in pts with clinical episodes of paroxysmal AF, while it is very rare in normal control subjects. 2) Pts with idiopathic AF have an electrophysiologic behaviour similar to pts with non-idiopathic AF. This fact suggests that among the former, most cases probably have a concealed atrial anomaly. In some cases this atrial anomaly can be related to the existence of a Kent bundle. 3) In athletes with paroxysmal AF the inducibility of a sustained AF both in the basal state and after autonomic blockade suggests that the vagal prevalence typical of such subjects probably plays a secondary role.

Atrial Fibrillation↗

PubMed1991

[Treatment of malignant ventricular tachyarrhythmia with amiodarone: comparison of empirical administration and administration guided by Holter or ventricular stimulation. Results of the parallel test].

To assess the most appropriate method of administering amiodarone and predicting its efficacy (empiric vs guided by Holter or by ventricular stimulation), 19 patients with sustained ventricular tachycardia or ventricular fibrillation underwent a "parallel study". Fifteen patients were men and 4 women, with a mean age of 65 years. A coronary artery disease with previous myocardial infarction was present in 15 patients, dilated cardiomyopathy in 3 and arrhythmogenic right ventricular dysplasia in 1 (mean left ventricular ejection fraction = 35%). All 19 patients had, as inclusion criteria, 1) frequent (greater than or equal to 30/hour) and/or repetitive (greater than or equal to 10/24 hours) ventricular premature beats during 24-hour Holter monitoring and 2) inducible sustained (greater than 30/sec) ventricular arrhythmias during programmed ventricular stimulation (1-3 extrastimuli from 2 right ventricular sites). Amiodarone was given at an initial dosage of 15 mg/kg/day for 2 weeks and then at a dosage of 5 mg/kg/day. After 15 days 24-hour Holter monitoring and programmed ventricular stimulation were repeated. The data of these tests, however, were not used to guide the therapy that remained empiric, but served only to assess retrospectively the predictive value of Holter monitoring and ventricular stimulation. The following main results were obtained: The mean duration of follow-up was 25 +/- 13 months. During this period 6 patients (32%) died, 3 from sudden and 3 from non-sudden cardiac death. Two other patients had recurrence of sustained ventricular arrhythmias. After 15 days of therapy amiodarone was effective at Holter monitoring in 15 patients (79%) and not effective in 4 (21%). Two of the 15 patients considered responders died suddenly during the follow-up and 2 had arrhythmic recurrence, vs 1 of the 4 non-responder patients who died suddenly (negative predictive value of Holter monitoring: 73%; positive predictive value: 25%; predictive accuracy: 63%). After 15 days of therapy amiodarone was effective at ventricular stimulation in 10 patients (53%) and not effective in 9 (47%). None of the 10 patients considered responders had arrhythmic events during the follow-up, vs 5 of the 9 non-responders, 3 of whom died suddenly and 2 of whom had arrhythmic recurrences (negative predictive value of ventricular stimulation: 100%; positive predictive value: 56%; predictive accuracy: 79%). Only 1 patient discontinued amiodarone after 25 months of follow-up because of development of an important blue-grey skin discoloration.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1991

Effects of home environment on respiratory symptoms and lung function in a general population sample in north Italy.

Effects of indoor pollution exposure were evaluated in a general population sample (n = 3,289) living in the Po River Delta area. Prevalence rates of chronic cough in men and dyspnoea in women were significantly higher in association with the use of bottled gas (propane) for cooking instead of natural gas (methane). Chronic cough and phlegm in men and dyspnoea in women were significantly associated with the use of a stove for heating. When combining type of heating and fuel used, in men a trend toward higher prevalence rates of chronic cough and phlegm was shown in those with stove or fan heating (regardless of the fuel); in women the trend reached statistical significance for dyspnoea. The relationship between stove (regardless of fuel) and decrease in forced expirograms was statistically significant only in women. In multiple logistic models, accounting for independent effects of age, smoking, pack-years, parents' smoking, socio-economic status, body mass index, significantly increased odds ratios were found in males for the associations of: bottled gas for cooking with cough (1.66) and dyspnoea (1.81); stove for heating with cough (1.44) and phlegm (1.39); stove fuelled by natural gas and fan or stove fuelled other than by natural gas with cough (1.54 and 1.66). In females, significantly increased odds ratios were found only for dyspnoea when associated with bottled gas for cooking (1.45), stove for heating (1.46), stove fuelled by natural gas (1.58), stove or fan fuelled other than by natural gas (1.73).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1990

Usefulness of head-up tilt test in evaluating patients with syncope of unknown origin and negative electrophysiologic study.

The vasovagal nature of syncope, which remained unexplained despite full clinical and electrophysiologic investigation, was evaluated by means of 60 degrees head-up tilt test for 60 minutes. Thirty patients (17 men and 13 women, mean age 65 years, 19 with and 11 without organic heart disease) with 1 to 28 (mean 5) episodes of syncope of unknown origin were studied. Head-up tilt test was considered positive if syncope developed in association with hypotension, bradycardia, or both. During baseline head-up tilt 15 patients (50%) had a positive response. Ten patients had a vasodepressor response (marked hypotension without marked bradycardia) and 5 had a mixed response (marked hypotension with marked bradycardia). None of 8 control subjects became symptomatic during the test. Baseline head-up tilt test was positively reproducible in 10 of 14 patients (71%). Nine of these 10 patients underwent serial head-up tilt tests after drug administration to determine the pathogenesis of vasovagal syncope. Atropine prevented tilt-induced syncope in 3 of 8 patients (37.5%), propranolol in 2 of 8 (25%) and etilephrine in 7 of 7 (100%). Seven patients received long-term drug treatment with drugs selected on the basis of acute drug testing. One responder to atropine received transdermal scopolamine and 6 received etilephrine. None of these 7 patients had syncopal recurrences or death during a mean follow-up of 12 months. Head-up tilt is a very sensitive and highly specific test to unmask susceptibility to vasovagal reaction in patients with syncope of unknown origin. Withdrawal of alpha-sympathetic stimulation is a principal mechanism responsible for vasodilation and syncope during head-up tilt.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Agonists↗