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Biomedical subjects

F Fedele

Publications and source records attributed to F Fedele.

At least 73 records · Page 4Linked to original sources
PubMed1998

Pharmacological characterization and autoradiographic localization of a putative dopamine D4 receptor in the heart.

1. The pharmacological profile and the anatomical localization of a putative dopamine D4 receptor were assessed in sections of rat and human atria and ventricles using combined radioligand binding and autoradiographic techniques with [3H]-spiperone as a ligand. 2. [3H]-Spiperone was bound specifically to sections of human and rat atria and ventricles. The binding was time-, temperature- and concentration-dependent, belonging to a single class of high-affinity sites. In atria, the dissociation constant value (Kd) was 0.45 nM in rats and 0.32 nM in humans, and the maximum density of binding sites (Bmax) was 31.6+/-2.9 fmol mg(-1) tissue in rats and 18.8+/-0.7 fmol mg(-1) tissue in humans. In ventricles, Kd was 0.38 nM in rats and 0.39 nM in humans, and the Bmax was 43.5+/-3.0 fmol mg(-1) tissue in rats and 56.4+/-3.2 fmol mg(-1) tissue in humans. 3. The pharmacological profile of [3H]-spiperone binding to sections of both rat and human atria and ventricles was consistent with the labelling of dopamine D2-like receptors. [3H]-Spiperone binding was more sensitive to displacement by the neuroleptic clozapine in sections of atria than of ventricles, suggesting the expression of a dopamine D4 receptor in atrial tissue. Moreover, preincubation of some sections with a dopamine D4 receptor antibody and subsequent exposure to [3H]-spiperone caused a remarkable decrease of radioligand binding to sections of atria, but only a slight reduction of binding to sections of ventricles. 4. Light microscope autoradiography revealed the accumulation of silver grains over atrial tissue within atrial myocardiocytes. A higher density of silver grains was developed in rat than in human atria. In ventricles, silver grains were accumulated primarily in cluster areas both in rats and in humans. 5. The above findings suggest the expression of a dopamine D4 receptor in rat atria, but not in ventricles. A similar site was identified in human atria. The possible relevance of a dopamine D4 receptor in the heart is discussed.

Adolescent↗
PubMed1998

Degree of residual stenosis of the infarct-related artery. Another variable affecting recovery of regional function after thrombolysis.

AIMS: The aim of this study was to analyse the relationship between infarct-related artery residual stenosis, assessed by quantitative coronary angiography, and left ventricular function changes during the in-hospital period in patients with acute myocardial infarction undergoing thrombolytic treatment. METHODS AND RESULTS: The study population consisted of 90 patients with acute myocardial infarction treated with thrombolysis within 6 h of the onset of symptoms. Left ventricular function was serially assessed by an echocardiographic asynergy score (before thrombolysis and pre-discharge). Left ventricular end-diastolic and end-systolic volumes were also calculated. Coronary stenosis was evaluated by computer-assisted videodensitometric analysis at pre-discharge coronary angiography. Three subgroups were identified on the basis of left ventricular function changes: 25 patients (Group A) with regional myocardial improvement (echo score from 7.5 +/- 3.5 to 4.3 +/- 3.2), 51 (Group B) with no variation in echo score (4.8 +/- 2.7) and 14 (Group C) with myocardial regional worsening (echo score from 4.4 +/- 2.1 to 8.8 +/- 2.4). Group A patients exhibited a very high incidence of infarct-related artery patency (23/25 patients, 92%) vs 71% with unchanged (Group B) and 14% (Group C) with worsening regional left ventricular function (P < 0.001). Subdivision of the study population on the basis of residual stenosis severity showed that a significant improvement in left ventricular function was present only in the subgroup with residual stenosis < 75% (echo score from 5.2 +/- 3.4 to 3.6 +/- 2.9, P < 0.001). CONCLUSION: These results support the important role exerted by complete coronary patency after thrombolysis in inducing left ventricular function recovery, and the poor functional improvement in patients with incomplete coronary patency.

Adult↗
PubMed1998

Three-dimensional echocardiography in ischemic heart disease.

The ability of two-dimensional echocardiography to detect and to evaluate the extent of wall motion abnormalities is limited by the use of few selected, nonparallel, views of the whole left ventricle. This leads to an incomplete appreciation of the spatial relationships between various cardiac structures and inaccuracy in quantitative data as a result of using of geometric assumptions. Dynamic volume-rendered three-dimensional echocardiography has the ability to overcome the above limitations. In this article we review the use of volume-rendered three-dimensional echocardiography in the diagnosis and assessment of ischemic heart disease, including complications related to myocardial infarction.

Echocardiography, Three-Dimensional↗
PubMed1998

[Stress echocardiography in the study of the warm-up phenomenon].

To date, the "warm-up" phenomenon in patients has been evaluated by ECG and symptom analysis. We investigated the warm-up phenomenon with supine bicycle stress echocardiography in patients with coronary artery disease documented by angiography and positive stress echocardiography. Sixteen coronary artery disease patients (54 +/- 9 years), who were off treatment throughout the study, were enrolled. Each of them underwent two consecutive exercise tests (25 W/2 min) with a 10-min recovery to reestablish baseline conditions. At the end of each stage of exercise and at peak exercise, when wall motion abnormalities (WMA), 1 mm ST depression and angina occurred, and at each minute, for the first 6 min of recovery, a 12-lead ECG was recorded and rate-pressure product was calculated. Time of onset and duration of 1 mm ST depression, WMA and angina, were also determined. Peak WMA, peak wall motion score index, duration of exercise and severity of angina were also evaluated. Exercise time duration and peak rate-pressure product were greater during the second than the first test (p = 0.02, p = 0.03 respectively); the second test also showed a longer delay of the onset of 1 mm ST depression and WMA (p = 0.01, p = 0.01 respectively) and higher rate--pressure product values (p = 0.04, p = 0.03 respectively). On the contrary, wall motion score index during the first and the second test was similar. Time to angina onset was longer during the second test (p = 0.03); the recovery period of ST depression and WMA was shorter during the second test (p = 0.02). In conclusion, these preliminary data show that patients tolerated the second period of ischemia better than the first, consistent with the presence of the warm-up phenomenon. However, the similarity of values of wall motion score index and WMA did not support a reduction in the ischemic area during the second test. This is in contrast with a possible modification of myocardial metabolism which typically underlies the ischemic preconditioning.

Angina Pectoris↗
PubMed1997

Role of transthoracic and transesophageal echocardiography in predicting embolic events in patients with active infective endocarditis involving native cardiac valves.

Some studies describe an increased risk for emboli in infective endocarditis patients with large (>10 mm) and mobile vegetations. Other studies fail to demonstrate the above relation. Most studies have been performed using transthoracic echocardiography or with a monoplane transesophageal approach. The present study examines whether distinctive characteristics of vegetative lesions detected by transthoracic and multiplane transesophageal echocardiography are predictive of embolic risk. We reviewed both transthoracic and transesophageal echocardiograms of 57 patients with diagnosis of acute infective endocarditis and no documented or suspected previous embolic events. We evaluated site, length, width, mobility, and echodensity of vegetations. Twenty-five patients (44%) had embolic events. No statistical differences in age, sex distribution, location of endocarditis, or offending pathogens between embolic (n = 25) and nonembolic (n = 32) patients were found. There were no differences in any of the echo characteristics of vegetations detected by transthoracic and transesophageal approach in embolic and nonembolic groups. Thus, transthoracic and transesophageal characteristics of vegetations are not helpful in defining embolic risk in patients with infective endocarditis.

Adult↗
PubMed1997

Clinical and prognostic usefulness of supine bicycle exercise echocardiography in the functional evaluation of patients undergoing elective percutaneous transluminal coronary angioplasty.

BACKGROUND: Supine bicycle exercise echocardiography (SBEE) has never been used before and early after percutaneous transluminal coronary angioplasty (PTCA) for assessing the functional outcome of the procedure and predicting late restenosis. METHODS AND RESULTS: We selected 76 subjects with stable angina, normal wall motion at rest, and exercise-induced wall-motion abnormalities before PTCA. SBEE with peak exercise imaging and the use of a 16-segment, four-grade score model was performed 54 +/- 15 hours after PTCA. No exercise-related adverse events occurred. Patients were grouped according to SBEE results: group 1 (n = 35, 46%) with negative exercise ECG and echo; group 2 (n = 19, 25%) with a positive exercise ECG but normal echo; and group 3 (n = 22, 29%) with a positive exercise echo with either a positive (n = 7, 32%) or negative (n = 15, 68%) ECG. Exercise performance significantly improved in all groups. In group 3, peak wall-motion score index decreased from 1.27 +/- 0.11 before to 1.15 +/- 0.06 after PTCA (P < .05), and duration of wall-motion abnormalities went from 81 +/- 24 to 47 +/- 19 seconds (P < .05). The rate of clinical restenosis (ie, angina recurrence or positive 6-month SBEE in asymptomatic patients, both associated with angiographic restenosis > 50%) was 37%. By multiple logistic regression analysis, clinical restenosis was associated with a positive post-PTCA exercise echo (odds ratio [OR] 3.08, 95% confidence interval [CI] 1.66 to 5.72; P = .0004) and with increasing values of pre-PTCA wall-motion score index (OR 2.86, 95% CI 1.92 to 4.27; P = .005) and duration of wall-motion abnormalities (OR 2.12, 95% CI 1.07 to 4.20; P = .04). CONCLUSIONS: SBEE is a safe and reliable tool to demonstrate changes in exercise-induced wall-motion abnormalities after PTCA and provides prognostic information in the risk assessment of clinical restenosis.

Adult↗
PubMed1997

Valvular perforation in left-sided infective endocarditis: a prospective echocardiographic evaluation and clinical outcome.

We undertook this study to determine the use of transthoracic and transesophageal echocardiography in detecting valvular perforation and the clinical impact of the latter on the outcome of left-sided infective endocarditis. Transthoracic echocardiography was performed in 58 consecutive patients with infective endocarditis. According to the study protocol, a subgroup of 42 patients also underwent transesophageal echocardiogrophy. At referral, 20 (34%) of 58 patients had echocardiographic evidence of valvular perforation (group A). No valvular perforations were found in the remaining 38 patients (group B). During a follow-up period of 27 +/- 16 months, a major complication occurred in 18 of 20 patients in group A and in 11 of 38 patients in group B (p < 0.0001). Univariate analysis indicated previous infective endocarditis, aortic involvement, and New York Heart Association functional class had a predictive value for valvular perforation (p < 0.001). Stepwise regression analysis confirmed aortic valve perforation as the only independent predictive variable for surgery and death. Valvular perforation is a common complication of infective endocarditis and is associated with an adverse outcome. Transthoracic echocardiography can detect or suggest valvular perforation in infective endocarditis, but transesophageal echocardiography better defines this complication and predicts severe heart failure or the need for early surgical management.

Adult↗
PubMed1997

On-line quantitative assessment of left ventricular filling during dobutamine stress echocardiography: a useful addition to conventional wall motion scoring.

In order to determine whether the diastolic rate of ventricular volume change obtained on-line with an automatic border detection (ABD) system during dobutamine stress echocardiography (DSE) would provide an interpretation of the diastolic ventricular response to the drug in quantitative terms in the assessment of coronary artery disease, we studied, with ABD and DSE, 59 patients who underwent coronary arteriography within 2 months of the stress test. Eleven patients had normal coronary findings or non-significant coronary lesions. Significant (> or =70% diameter stenosis) coronary artery disease (CAD) was present in 48 patients (81%). Dobutamine stress echocardiography (DSE) to a maximal dose of 50 microg/kg per min was performed in all patients. ABD images were acquired at rest and at the peak of infusion along with conventional two-dimensional images. The following measurements were evaluated: left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), slope of rapid filling segment (RFS), peak filling rate (PFR), rapid filling phase fractional change (RFFC). Patients with non-significant coronary artery lesions exhibited a hyperdynamic response with an LVEF increment of at least 20% from baseline to peak drug infusion. In these patients the effect of dobutamine produced an increase of RFS from 35.5+/-5.6 to 86.5+/-10.5 ml/s, an increase of PFR from 4.4+/-0.6 to 6.8+/-0.6 EDV/s, and an increase of RFFC from 74+/-8 to 92+/-5% (P<0.001). Of the 48 patients with coronary artery disease, 27 had <20% LVEF increase at peak dobutamine infusion. Four of 22 patients with single vessel disease and 23 of 26 patients with multivessel disease had an abnormal systolic response. After dobutamine infusion single vessel CAD patients showed a decrease of RFS from 33.4+/-5.3 to 26.7+/-5.9 ml/s, a decrease of PFR from 3.8+/-0.7 to 3.0+/-0.7 EDV/s, and a decrease of RFFC from 73+/-6 to 59+/-4% (P<0.001). Multivessel CAD patients showed a decrease of RFS from 32.0+/-5.9 to 23.1+/-4.1 ml/s, a decrease of PFR form 3.8+/-0.6 to 2.8+/-0.6 EDV/s, and a decrease of RFFC from 71+/-5 to 54+/-8% (P<0.001). The overall sensitivity of detecting CAD was 85% for conventional DSE and 90% for ABD-DSE (P=NS). The sensitivities of detecting patients with single vessel and multivessel CAD with conventional DSE were 68 and 92%, respectively, and with ABD-DSE were 91% (P<0.01) and 96% (P=NS), respectively. Our results show that an abnormal diastolic as well as systolic response during on-line quantitative assessment of dobutamine stress echocardiography is a sensitive marker of coronary artery disease and is predictive for the detection of extensive lesions. The described measurements can be utilized to improve the DSE sensitivity in identifying coronary artery disease. On-line quantitation of diastolic indexes with ABD can represent another step toward obtaining uniform results after stress echocardiography.

Adult↗
PubMed1997

Combined use of dobutamine echocardiography and myocardial contrast echocardiography in predicting regional dysfunction recovery after coronary revascularization in patients with recent myocardial infarction.

BACKGROUND: Myocardial contrast echocardiography and dobutamine echocardiography have recently emerged as potentially useful clinical tools to detect reversible myocardial dysfunction. However, the relative accuracy of these two techniques in predicting regional wall motion improvement after coronary interventions is still unclear. The aim of the present study was to compare their diagnostic value in predicting functional recovery after coronary revascularization in patients with recent acute myocardial infarction. METHODS AND RESULTS: Twenty-four patients with acute myocardial infarction underwent myocardial contrast echocardiography and dobutamine echocardiography within 2 weeks of hospital admission. Infarct zone contrast score and wall motion score indexes were derived in each patient. Infarct-related artery revascularization was performed before hospital discharge in all selected patients. Resting echocardiography was repeated 3 months after revascularization, and regional function recovery was analysed. The degree of wall motion score improvement at 3-month follow-up and the percentage of positive responses to dobutamine echo were greater (P < 0.001 and P < 0.002, respectively) in patients with a higher baseline contrast score (> or = 0.50). Conversely, no significant changes were observed either during dobutamine echo or after revascularization in the group of patients without residual perfusion within the infarct area. Diagnostic agreement between both techniques in predicting reversible dysfunction was high (81% of segments). The sensitivity and negative predictive value in predicting functional outcome were 100% (95% confidence interval [CI], 87% to 100%) and 100% (95% CI, 93% to 100%) by contrast echo, and 85% (95% CI, 66% to 96%) and 93% (95% CI, 84% to 98%) by dobutamine echo. The specificity and positive predictive value were 90% (95% CI, 80% to 96%) and 81% (95% CI, 64% to 93%) by contrast echo, and 88% (95% CI, 78% to 95%) and 76% (95% CI, 58% to 90%) by dobutamine echo. The combination of myocardial contrast and dobutamine echocardiography positive responses improved specificity and positive predictive value in detecting functional recovery after revascularization to 100% (95% CI, 94% to 100%) and 100% (95% CI, 85% to 100%), respectively. However, the sensitivity and negative predictive value slightly decreased with the use of both methods (85% [95% CI, 66% to 96%)] and (93%[95% CI, 85% to 98%)], respectively. CONCLUSIONS: In patients with recent myocardial infarction, reversible dysfunction after coronary revascularization and the response to dobutamine infusion are strictly dependent on microvascular integrity. However, microvascular perfusion does not always imply functional recovery after coronary revascularization. The integration with dobutamine echo results seems particularly helpful to further improve myocardial contrast echo specificity and positive predictive values.

Adult↗
PubMed1997

[Therapeutic considerations on a case of mixed teratoma of the testis with seminomatous component].

The Authors present a case of mixed teratoma of the testis with seminomatous cells, occurred in a teenager. Performed the preoperative oncological staging, the patient was submitted to trans-inguinal left orchifunicolectomy. The presence of cells originated by the three embryonal layers, of stroma distributed in a periepithelial fashion and big cells with clear cytoplasm, permitted to formulate the hystological diagnosis of mixed teratoma, mature and immature, associated with seminomatous cells. The observation of this case offer the opportunity for prognostic and therapeutic considerations.

Adolescent↗
PubMed1997

Clinicopathological features of early gastric cancer in younger versus older patients in a high incidence area of northern Italy.

AIMS: The relationship between the clinicopathological features of early gastric cancer and age were analysed in a retrospective study of 168 patients. METHODS: 168 patients, residents of the Region of Cremona, who had undergone surgery in the period 1978 to 1990 for early gastric cancer, were divided into two groups by age and compared. Group I (n = 89) consisted of patients less than 65 years of age and Group II (n = 79) of patients between 66 and 85 years of age. RESULTS: There were no significant differences between the two groups with respect to the sex ratio, tumour size, depth of tumour invasion, and 5-year survival rate. Group I patients showed more lymph node involvement (p < 0.01), cancer of the diffuse histological type (p < 0.01), and cancers located in the gastric body (p < 0.05). Conversely, Group II exhibited more cancers of the protruded (p < 0.05) and intestinal histological type (p < 0.01), and more adenomatous residue (p < 0.01). CONCLUSIONS: Our findings suggest that early gastric cancer may present differently in different age groups; persons 65 years of age and older are more likely to have early gastric cancer of the slow-growing type than middle-aged patients.

Adult↗
PubMed1996

Effects of angiotensin-converting enzyme inhibition on left ventricular geometric patterns in patients with essential hypertension.

Although angiotensin-converting enzyme inhibitors have been shown to affect left ventricular (LV) remodeling favorably in several conditions, it remains unclear whether they can influence LV geometric pattern in hypertension. To address this issue, 122 patients (71 men and 51 women; mean age = 51 +/- 10 years) with mild to moderate hypertension were studied prospectively. All underwent clinical evaluation and Doppler echocardiography at entry and more than 2 years of quinapril therapy (10-40 mg/day). According to either LV mass (normal if < 131 g/m2 for men or < 100 g/m2 for women) or the ratio of LV posterior wall thickness to diastolic diameter (RWT; normal if < 0.45) at baseline, 58 patients had normal mass and RWT, 18 patients had concentric remodelling (i.e., normal mass but increased RWT), 24 patients had eccentric hypertrophy (i.e., increased mass but normal RWT), and 22 patients had concentric hypertrophy (i.e., increase in both mass and RWT). After 6 months of quinapril therapy, all patients with normal left ventricles showed the maintenance of mass and RWT within normal limits. Patients with concentric remodeling showed no increase in mass but had a significant decrease in RWT. Patients with eccentric hypertrophy exhibited a significant reduction in mass with no substantial change in RWT. Patients with concentric hypertrophy had a significant reduction in both mass and RWT. Changes in LV mass and geometry were maintained during the 2-year period of treatment and were paralleled by improvements in Doppler indices of LV diastolic function in each group. It is concluded that quinapril, with its well-known effects on LV hypertrophy, modifies the LV geometric pattern of hypertensive patients favorably, regardless of the presence of an abnormal LV mass or RWT.

Adult↗
PubMed1996

MRI postoperative monitoring in patients surgically treated for aortic dissection.

In most cases, surgery of aortic dissections repairs only the ascending portion of the aorta, leaving a residual dissection in the arch and descending aorta. We studied 17 patients operated upon for type A aortic dissection. A total of 42 magnetic resonance imaging (MRI) examinations were performed, with two to five studies per patient (mean 2.47). The studies were done between 5 weeks and 47 months (mean 17.5 months) after surgery. The patients were evaluated by MRI using gated spin-echo and gradient-echo sequences on axial and oblique sagittal views, and in selected cases, coronal views. A high incidence of abnormalities was observed. Pericardial hematoma was observed in 11% of cases, aortic and branch involvement in 41%, abdominal aortic branch involvement in 47%, dilatation of native aorta in 58%, and extension of dissection in 10%. New complications were detected during follow-up in 53% of patients. MRI was helpful in the follow-up of patients operated upon for aortic dissections, owing to its noninvasiveness and multiplanarity. By means of this technique, it was possible to obtain information about the natural history of the disease, as well as information useful for subsequent treatment.

Adult↗
PubMed1996

[Dacryocystography in digital subtraction technique].

The authors emphasize the usefulness of dacryography to approach patients affected by epiphora. Digital dacryocystography had improved the anatomic and functional assessment of lacrimal apparatus. The methodology allowed in all patients an accurate visualization of the lacrimal system and the identification, in twenty cases, of pathological causes of epiphora. One patient was examined after dacryocystorinostomy. Digital dacryocystography is a very valuable technique for better contrast resolution, the subtraction of images, and continuous acquisition.

Adolescent↗
PubMed1996

[Left ventricular volumetric and contractility behavior during stress echocardiography with dobutamine].

Aim of this study was to assess the behaviour of left ventricular volumes during dobutamine echocardiography in patients with coronary artery disease (CAD) compared to subjects with normal coronary angiograms. We have measured the end-diastolic and end-systolic volumes and a non invasive index of myocardial contractility (the ratio between systolic blood pressure and end-systolic volume index, SBP/ESVI) in 67 patients undergoing dobutamine echocardiography and quantitative coronary angiography. Patients were divided into 3 groups: Control group (n = 10) without CAD; Group I (n = 30) with CAD but normal resting wall motion; Group II (n = 27) with CAD and resting wall motion abnormalities. Volumetric response to dobutamine was deemed abnormal when percent changes of left ventricular volumes from baseline to peak infusion were below 2 standard deviations of the mean values obtained in the control group. The normal or pathological volumetric response was compared with the extent of significant ( > 70% lumen stenosis) coronary artery disease. In the control group, dobutamine produced a significant decrease in both end-diastolic and end-systolic volumes, with percent changes from rest to peak of 24 +/- 5% and 29 +/- 5% respectively, and an average increase of 70 +/- 20% in the SBP/ESVI ratio. Among the 22 Group I patients who showed dobutamine-induced asynergies, volumetric response in those with multivessel disease was normal in 5/14 (36%) and abnormal in 7/8 (87%, p < 0.05), whereas among the remaining 8 patients who had no dobutamine-induced asynergies, an abnormal volumetric response was always associated with multivessel disease (n = 3/3, 100%). In Group II, the prevalence of abnormal volumetric responses in the presence (n = 15) or absence (n = 12) of dobutamine-induced new or worsening asynergies was respectively 92% and 87% in patients with multivessel disease, whereas in those with single vessel disease the prevalence was lower, although not significantly (8 and 13%, p = 0.08 vs multivessel CAD). Predictive accuracy of an abnormal volumetric response for identifying multi-vessel coronary artery disease in Groups I and II was not significantly different (77 and 85%, respectively, NS). Our preliminary data indicate that the evaluation of left ventricular volumes during dobutamine echocardiography yields additional information on myocardial intropic reserve, useful for diagnostic and functional assessment of patients with coronary artery disease. Moreover, this study emphasizes the importance of defining the "normal" left ventricular performance during DE to be able to regard an abnormal volumetric behaviour as a reliable marker of impaired inotropic reserve.

Cardiac Volume↗