Search PubMed⌕ Search

Biomedical subjects

F Romeo

Publications and source records attributed to F Romeo.

At least 55 records · Page 3Linked to original sources
PubMed1990

Hypertrophic cardiomyopathy: long-term effects of propranolol versus verapamil in preventing sudden death in "low-risk" patients.

The aim of this study was to evaluate retrospectively the outcome of 101 patients who were assigned to long-term therapy with propranolol (55 patients) or verapamil (46 patients) between 1980 and 1988. Baseline clinical, electrocardiographic, and echocardiographic data were similar in both groups. Exclusion criteria were the evidence of complex ventricular arrhythmias, a family history of the disease and/or sudden death, previous syncopal episodes, or left ventricular dysfunction. During a mean follow-up of 4 +/- 3 years (range: 1-9 years), side effects were more commonly recorded in patients who were treated with verapamil rather than in propranolol-treated patients (8 vs. 3, respectively), though the difference was not statistically significant. Sixteen patients (13 propranolol-treated patients and three verapamil-treated ones, p less than 0.05) died suddenly while on treatment. In addition, three patients who stopped verapamil because of adverse reactions died from heart failure after withdrawal, but before the end of the follow-up period. The assessment of total mortality on the intention-to-treat basis showed that death due to cardiac causes occurred in 13 propranolol-treated patients and in six verapamil-treated patients (ns). Thus, verapamil was more effective than propranolol in preventing sudden death during long-term therapy of "low-risk" patients with hypertrophic cardiomyopathy, though its administration was associated with the occurrence of non-sudden cardiac deaths and a high incidence of side effects.

Adult↗
PubMed1990

Electrocardiographic findings in patients with hypertrophic cardiomyopathy. Relation to presenting features and prognosis.

The relation of ECG findings to presenting features and prognosis was evaluated in 125 consecutive patients with hypertrophic cardiomyopathy (HC). Seventy-nine men and 46 women (mean age, 34 +/- 7 years) were studied since 1970. Most ECG features were similar in patients with and without a left ventricular outflow tract gradient. Those with obstruction had a higher prevalence of left ventricular hypertrophy according to ECG voltage criteria (54% vs. 28%, p less than 0.01), whereas higher grade ventricular arrhythmias were more common in patients without an outflow gradient (20% vs. 7%, p less than 0.05). The prevalence of ECG abnormalities was also similar in younger (less than or equal to 14 years) and older patients (greater than 14 years), and only repolarization abnormalities were more frequently detected in the older age group (56% vs. 32%, p less than 0.025). Stratification of patients according to the clinical state revealed that those who had moderate to severe functional limitation had a higher prevalence of atrial fibrillation than asymptomatic or mildly symptomatic patients (24% vs. 1%, p less than 0.001). There were no significant differences in most hemodynamic variables among patients dichotomized according to any specific ECG abnormality. Only patients with atrial fibrillation had significantly higher right ventricular end-diastolic pressure (10 +/- 7 vs. 6 +/- 4 mmHg, p less than 0.01), lower systolic index (22 +/- 8 vs. 37 +/- 15 ml/m2; beat, p less than 0.02) and lower ejection fraction (53 +/- 8 vs. 64 +/- 10%, p less than 0.001) than those in sinus rhythm.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

The progression of hypertrophic cardiomyopathy: dilatation of the left ventricle with supernormal systolic function.

We performed cardiac catheterisation in a man who had been diagnosed as having hypertrophic cardiomyopathy 7 years earlier. The repeat angiogram showed the maintenance of a "supernormal" systolic function (ejection fraction: 87%) although there was an increase of left ventricular end-diastolic volume (from 65 to 132 ml/m2). This case suggests that progressive left ventricular dilatation should not necessarily be considered a marker of the progression of hypertrophic cardiomyopathy into a hypokinetic left ventricle.

Cardiomegaly↗
PubMed1990

Hypertrophic cardiomyopathy: is a left ventricular outflow tract gradient a major prognostic determinant?

The relationship of left ventricular outflow tract gradient as well as of clinical, ECG and haemodynamic data to presenting features and prognosis was evaluated in 125 consecutive patients with hypertropic cardiomyopathy, 79 men and 46 women (mean age: 34 +/- 7 years) studied between January 1970 and December 1985. Most clinical, ECG and haemodynamic findings were similar in the 44 patients (35%) with a pressure gradient (greater than or equal to 30 mmHg) and in the 81 patients (65%) without. Those with obstruction had greater ECG voltage SV1 and RV5; however, higher grade ventricular arrhythmias were more common in patients without obstruction. During a mean follow-up period of 7.6 +/- 4.5 years (range 2-18 years), death from a cardiac cause occurred in 28 patients (21 died suddenly) and was significantly less common in patients with a pressure gradient than in those without (11% vs 28%, P = 0.039). Univariate analysis of survival curves showed that the most powerful predictors of a poor prognosis were ejection fraction P = 0.0001), mean pulmonary artery pressure (P = 0.0001), dyspnoea (P = 0.001), left ventricular end-diastolic pressure (P = 0.002), complex ventricular arrhythmias (P = 0.029) and severe mitral regurgitation (P = 0.037). Using multivariate analysis, a decreased ejection fraction (P = 0.006) and a raised mean pulmonary artery pressure (P = 0.022) were the only independent prognostic determinants. Thus, the presence of a left ventricular outflow tract gradient does not seem of adverse prognostic significance. Risk factor characterization in patients with hypertrophic cardiomyopathy may be improved by assessment of ventricular arrhythmias in the context of left ventricular function.

Adolescent↗
PubMed1990

Combined curietherapy and surgery in management of stage II.B cervical carcinoma.

The results are presented of ten patients with stage II.B cervical carcinoma, treated with pre-operative after-loading intra-cavitary Iridium 192 followed by radical surgery. The benefits of this combined technique are the reduction of tumor volume, whether in the cervix or in the parametrium. The surgical approach became easier and very few complications were noted. The survival rate after two years follow-up is 100% and no local or distant recurrences have been noted. The following treatment in patients with negative and positive lymph-nodes are discussed.

Brachytherapy↗
PubMed1990

[What happened to Zollinger-Ellison syndrome?].

Three Zollinger-Ellison syndrome patients were treated during the period January 1977 to June 1978. The first patient is in good health 11 years 3 months after a total gastrectomy as is the second patient, 11 year after the enucleation of a cephalo-pancreatic gastrinoma. However the third patient died from malignancy 5 years after a total gastrectomy and enucleation of a cephalo-pancreatic gastrinoma followed by therapeutic cycles with streptozotocin and 5-fluorouracil. The decline in the Zollinger-Ellison syndrome over the last ten years is examined and the type of surgical treatment is discussed. Total gastrectomy once advocated as the preferred treatment, is now reappraised because of the effectiveness of medical therapy in controlling ulcers and because of the frequent malignancy of pancreatic gastrinomas.

Adult↗
PubMed1989

Determinants of end-stage idiopathic dilated cardiomyopathy: a multivariate analysis of 104 patients.

Our purpose in this study was to investigate the correlation of clinical, electrocardiographic, hemodynamic, and histopathologic features at diagnosis with the long-term prognosis in 104 patients with idiopathic dilated cardiomyopathy to determine which factors are the independent determinants of the end-stage disease. During a mean follow-up of 3.8 +/- 3.5 years, 35 patients (33%) died, 14 (13%) suddenly and 21 (20%) from congestive heart failure. Univariate analysis of survival curves disclosed that clinical and electrocardiographic variables at diagnosis were similar in survivors and non-survivors. On the contrary, patients who subsequently died had higher mean right atrial pressure (p = 0.0001), right ventricular end-diastolic pressure (p = 0.0061), mean pulmonary artery pressure (p = 0.0001), and left ventricular systolic (p = 0.0049) and end-diastolic (p = 0.0021) pressure than survivors. They also exhibited larger left ventricular end-diastolic (p = 0.0046) and end-systolic (p = 0.0027) volumes, lower ejection fraction (p = 0.0001), and a greater proportion had severe mitral regurgitation (p = 0.0095). Univariate analysis of histologic findings collected in a subgroup of patients referred since 1984 revealed a mild degree of myocellular hypertrophy to be associated with a poor prognosis (p = 0.0217). Multivariate analysis selected only mean right atrial pressure (p = 0.0022), ejection fraction (p = 0.0089), and end-systolic volume (p = 0.0265) as independent determinants of cardiac death. Our results suggest that cardiac catheterization is mandatory for risk stratification of patients with idiopathic dilated cardiomyopathy, since it allows the assessment of hemodynamic, angiographic, and histopathologic features helpful in identifying patients with a poor prognosis.

Adult↗
PubMed1989

The glucose-6-phosphatase/glucokinase ratio in the liver of obese-diabetic subjects.

The study of G6Pase and GK activities in human liver (needle biopsies) in overnight fasted obese NIDDM patients has shown that, while G6Pase was unchanged, GK was higher (+ 55%, P less than 0.05) than in control subjects. Consequently, the G6Pase/GK ratio (which roughly reflects hepatic glucose production) was significantly reduced (-36%) in the obese diabetic group, due to more GK activity (glucose uptake). This contrasts with the activity in IDDM and nonobese NIDDM patients (where the G6Pase/GK ratio is elevated and normal, respectively) and would suggest that in the obese diabetic subjects, hepatic glucose production is not a major factor contributing to the maintenance of hyperglycemia in the overnight fasting state (leaving peripheral insulin resistance as the major cause of hyperglycemia).

Adult↗
PubMed1989

[Effects of slow-release isosorbide-5-mononitrate on ergometric parameters and cardiac output in stable effort angina pectoris: a double-blind randomized placebo study].

The effects of a single oral dose of 60 mg of sustained release (R) isosorbide-5-mononitrate (ISM) administered in 9 male patients (mean age: 53 +/- 7 years) with stable exercise-induced angina pectoris were studied in a randomized, double blind, cross-over study. The effectiveness of the drug was evaluated by concomitant ergometer exercise stress test and cardiac output determination (bioimpedance method, Bomed Med-Ltd) performed 1 hour before and 1, 4, 10 and 24 hours after acute administration of placebo (P) and ISM-R. After P, all patients showed a positive exercise test, whereas 3 patients during ISM-R treatment had a negative exercise stress test 1 and 4 hours after ISM-R administration. Compared with P, ISM-R produced a statistically significant improvement of exercise stress test parameters at peak exercise (maximum work load, heart rate, systolic and diastolic blood pressures and double product) up to 10 hours after drug administration. On the other hand, cardiac output did not significantly differ at any time after ISM-R compared with both control conditions and P treatment. Moreover, no side effect was detected in any patient during the study. In conclusion, a single oral dose of 60 mg of sustained-release ISM-R seems to be an effective drug in the treatment of effort angina, its effectiveness lasting more than 10 hours without side effects.

Adult↗
PubMed1989

[Idiopathic dilated cardiomyopathy: clinical and prognostic significance of the morpho-functional involvement of the right heart].

Aim of this study was to evaluate whether different severity of clinical and functional impairment of right heart in patients with idiopathic dilated cardiomyopathy (IDC) might condition distinct clinical features and prognosis. From 104 consecutive patients with hemodynamically assessed diagnosis of IDC studied between 1977 and 1987 in our Institute, 39 patients (28 males and 11 females, mean age 41 +/- 14 years) were selected on the basis of ejection fraction ranging from 35 to 50%, left ventricular end-diastolic pressure ranging from 13 to 20 mmHg and left ventricular end diastolic volume less than or equal to 150 ml/m2. A significant involvement of right heart (diagnosed according to a mean right atrial pressure greater than or equal to 9 mmHg, a right ventricular end-diastolic pressure greater than or equal to 9 mmHg and a right ventricular end-diastolic diameter greater than or equal to 30 mm) was assessed in 16 patients (41%), 11 males and 5 females, aged 40 +/- 15 years (Group A). On the contrary the remaining 23 patients (59%), 17 males and 6 females, aged 42 +/- 12 years, had a normal right heart (Group B). At entry into the study, clinical features appeared similar in the 2 groups of patients whereas patients of Group A had significantly higher incidence of atrial fibrillation (25% vs 4%, p less than 0.01) and complex ventricular arrhythmia (greater than or equal to 4 Lown class) (25% vs 4%, p less than 0.01) compared with patients of Group B. With respect to conduction defects no difference was found between Group A and Group B.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Predictive value of myocellular hypertrophy in idiopathic dilated cardiomyopathy].

The role of endomyocardial biopsy (EMB) in assessing of idiopathic dilated cardiomyopathy (IDCM) is a well-recognised one. On the contrary, the value of correlating histological features, such as myocellular hypertrophy, with functional evaluation and outcome is still controversial. It was the purpose of the present study to appraise the correlation with hemodynamic data and the predictive role of histological features in 32 consecutive patients affected by IDCM who underwent left ventricular EMB between January 1984 and December 1986. Light microscopy findings were graded by means of a semiquantitative score system. In comparison with the 19 patients with mild myocellular hypertrophy, the 13 patients with marked hypertrophy showed significantly lower right ventricular end-diastolic pressure (10.4 +/- 5.8 vs 6.6 +/- 3.6 mmHg, p less than 0.05) and left ventricular end-diastolic pressure (26.9 +/- 9.0 vs 16.5 +/- 8.8 mmHg, p less than 0.01). On the contrary, different degrees of interstitial fibrosis, as well as of the other morphologic findings, could not identify patients with distinct hemodynamic patterns. However, there was a direct correlation between the amount of myocellular hypertrophy and interstitial fibrosis (p less than 0.01). During a mean follow-up period of 32 +/- 11 months (range: 12-48 months), 6 patients died and 3 further patients underwent heart transplantation. Univariate analysis of histological features (log-rank test) showed a mild degree of hypertrophy alone to be significantly related to a poor outcome (p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

The role of monocytes in rheumatoid synovitis.

In non-specific and rheumatoid synovitis, the use of specific monoclonal antibodies against antigenic determinants of cells of the immune system showed that the characteristic changes of rheumatoid synovitis are located in the synovial internal layers. The monocytes were OKM1, OKM5, S100, OKDR positive, while the subintimal monocytes in non-specific synovitis were OKDR negative. We suggest that, in rheumatoid synovitis, the previously activated monocytes are transported by the bloodstream and pass through the so-called "sinovial barrier" to arrive in the subintimal layers ready to interact with T helper lymphocytes and initiate the immune response mechanisms responsible for lesions in rheumatoid synovitis.

Antibodies, Monoclonal↗