[Objective examination of the scoliosis patient].
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Biomedical subjects
Publications and source records attributed to G Bertini.
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Thirty patients with articular pain had been treated with proglumetacin during average 12 days. Twenty-three (77%) responded well to very well to the treatment. Total symptom score decreased by 49%, and each tested symptom (painful, inflammatory and functional) significantly improved, in spite of the short observation period. Tolerance was defined good to excellent in 26 patients (87%). Overall, 10 patients complained of mild to moderate accessory symptoms, mainly heartburn and epigastric pain. No C.N.S. symptoms were observed, nor variations of the laboratory tests, carried out in 16 patients. Proglumetacin, therefore, showed to be a suitable drug for the fast and safe management of articular pain of orthopedic interest.
Whether physical training, soon after myocardial infarction (MI), has effects upon intrinsic cardiac function at rest and during exertion remains unresolved. We have evaluated ventricular function using radionuclide angiography at rest and during stress testing before and after 3 months' physical training. This has been correlated with the site of MI and with changes in the ST segment during the maximal exercise test performed before the postmyocardial infarction rehabilitation program. We have studied 27 patients, mean age 54 +/- 10 years, in NYHA class I or II. Twelve showed no changes in the ST segment during erogmetric stress test (group 1); seven showed ST segment depression greater than 1 mm in leads different from those of MI (group 2); eight showed ST segment elevation of 2 mm (group 3). Twelve patients had had anterior MI only (AMI group); twelve inferior MI only (IMI group). After rehabilitation, all patients showed an increased work capacity and a decreased double product at the same work load. In the total group, significant increases were found in the left ventricular ejection fraction (LVEF) and in the contractile regional performance (LVwm) at rest, as well as a lesser decrease in the LVEF during handgrip test. Group 1 showed a significant increase in LVEF, associated with a decrease in left ventricular end-diastolic volume (EDV) at rest. Group 2 showed unchanged variables after rehabilitation. Group 3 showed a better LVEF during handgrip with an increase of EDV at rest. The AMI group showed a better LVEF and LVwm at rest and a better LVEF during handgrip. IMI group showed a better right ventricular ejection fraction during handgrip without improvement in LVEF. No patient with IMI had septal asynergy. We conclude that the effects of rehabilitation were linked to the site of MI and to the functional dynamic status of both ventricles.
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The aim of Mobile Coronary Care Units (M.C.C.U.) is to reduce the delay in delivering intensive care to patients with a heart attack. In the city of Florence a M.C.C.U. has been available since November 1979. During the first year the staff of the M.C.C.U. has treated 158 cases of serious cardiac arrhythmias which occurred among 486 interventions. In 94 patients cardiac arrhythmias followed an acute coronary attack. In 64 patients coronary heart disease could not be demonstrated. This study concerns the latter group of patients. The mean age was 65.2 years and 39 patients (61%) were women. The mean time from the onset of the symptoms to the arrival of the M.C.C.U. team was 3h and 2 min, whereas the mean time from the call to the arrival was 14 min. Sixty patients had atrial arrhythmias (29 atrial fibrillation, 2 atrial flutter, 22 atrial tachycardia, 7 premature atrial contractions) and 4 patients had ventricular arrhythmias (1 ventricular tachycardia, 1 ventricular flutter, 2 premature ventricular contractions). In thirty-nine patients (61%) the cardiac arrhythmia was abolished by the staff of the M.C.C.U.. Of the remaining 28 patients, 10 were brought to the hospital and 18 were left at home. None of these needed later admission to the hospital. So the treatment at home of cardiac arrhythmias has been successful in the majority of patients. Bunaftine was the antiarrhythmic drug more frequently used (23 cases, 34%) with a high percentage of success (87%). In planning medical emergency services to the community, one can envisage the use of the M.C.C.U. facilities to treat at home those arrhythmias that are not associated with an acute coronary attack.
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The authors have studied the correlation between digoxin clearance and glomerular filtration rate. This correlation was better than between digoxin clearance and creatinine clearance without reducing the error of a programed therapy.
Hemodynamic evaluations of 130 patients with acute myocardial infarction were performed by right and/or left heart catheterization. 115 patients were subdivided in six groups by the pulmonary artery mean pressure (PMP)-left ventricular stroke work index (LVSWI) relationship: 1) normal LVSWI in relation to PMP (14.8% of all cases); 2) increased LVSWI in relation to PMP (0.9%); 3) moderately reduced LVSWI with increased PMP (severe heart failure-cardiogenic shock) (7.0%); 5) reduced LVSWI with low or normal PMP (22.6%); 6) normal LVSWI with elevated PMP (reduced left ventricular compliance or high pulmonary vascular resistance) (15.7%). 28 cases were studied by right and left heart catheterization; in 10 cases only left heart catheterization was performed. Discriminant analysis on the values measured at the first stage of hemodynamic monitoring was conducted: this type of mathematical analysis seemed to provide a more useful prognostic index.
A program of physical conditioning for the rehabilitation of the patients affected by myocardial infarction is founded on a preliminary ergometric evaluation and on following examinations of the effects of the prescribed treatment. Submaximal ergometric stress tests utilizing non invasive methods which contain sufficient information about the cardiocirculatory response to the physical effort are required. Sixteen patients underwent hemodynamic evaluation, during ergometric stress test, two months after myocardial infarction. A statistical analysis of the results shows a significant correlation between stroke volume and oxygen pulse. The oxygen pulse, under an increasing effort, describes a curve; the end of its ascending limb may be regarded as the point of the maximal stroke volume. The workload where the curve of oxygen pulse changes the slope can be used as the caloric expense which should be safely attained during the physical conditioning.
Regional cerebral blood flow and its autoregulation after intravenous glycerol infusion have been studied in eight patients in the acute phase of cerebral infarction. Glycerol seems to improve the cerebral blood flow in the damaged region but does not seem to restore autoregulation.
39 patients, subdivided in four groups [I) previous myocardial infarction; II) ischaemic heart disease; III) hypertension; IV) cerebrovascular disease] were administered i.v. low molecular weight dextran in the course of right heart catheterization. The curves of the left ventricular function were determined by the LVSWI-LVFP relationship measured before the test, after the first 150 ml of dextran infusion, at the point of maximal increase of the LVSWI, and at the end of the infusion. The initial values of the LVSWI and SV were lower in the first group with respect to the other three (P less than 0.001), not significantly unlike those of the LVFP. During dextran infusion it is possible to observe an increase of the LVFP in all four groups (P less than 0.01), and of the SV (P less than 0.02) and LVSWI (P less than 0.01 and P less than 0.05, respectively) in the first and the third groups. At the end of the test, different values of the LVSWI (P less than 0.001) and the LVFP (P less than 0.01) were observed in the four groups. The calculated deltaSI/deltaLVFP indices were not significantly different in the four groups, whereas a P less than 0.001 was obtained for the values of the deltaV/deltaLVFP indices (56, 67, 73 and 138 ml/mmHg for the groups I, II, III and IV, respectively). Dextran infusion proved to be a useful test for the hemodynamic assessment of different cardiovascular diseases.