Search PubMed⌕ Search

Biomedical subjects

G Mattioli

Publications and source records attributed to G Mattioli.

At least 109 records · Page 6Linked to original sources
PubMed1990

[Hemodynamic effects of the nitroprusside test in chronic congestive heart failure treated with long-term beta blocking therapy].

In patients with congestive heart failure (CHF) sympathetic reflexes are attenuated because of down regulation of beta receptors. Many Authors suggest that betablockers therapy can be useful in selected patients. We wanted to test if betablockers therapy could modify sympathetic reflex during nitroprusside test. We studied 20 patients: 10 were healthy volunteers and 10 were affected by CHF of different origin. They were divided in 4 groups in relation to therapy. During nitroprusside infusion we evaluated the following parameters: heart rate (HR), mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), cardiac index (CI), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR). In normal subjects we observed that the heart rate increased and the PAM and SVR decreased significantly. Betablockers therapy did not modify hemodynamic response of PAM and SVR, while we did not find any modification of the heart rate. In patients with CHF we observed a decrease of PAM, MPAP, SVR and PVR. Betablockers therapy in CHF did not modify the hemodynamic response to nitroprusside test. This effect is probably due to beta adrenergic receptor down regulation that decrease the responsiveness to sympathetic stimulation evoked by vasodilatation.

Adrenergic beta-Antagonists↗
PubMed1990

[Hemodynamic effects of the cold pressor test in patients with heart failure treated with beta blockers for a long time].

In congestive heart failure (CHF) the beta-adrenoceptor density and functional responsiveness is markedly reduced presumably due to endogenous down-regulation. In the last few years evidence has accumulated that betablockers therapy can improve clinical condition in selected patients with CHF. To evaluate sympathetic response in CHF we measured hemodynamic effects of cold pressor test. This study was composed by 20 patients, 10 with CHF of different origin and 10 healthy volunteers. They were divided into 4 groups in relation to therapy. We evaluated the modification of the following hemodynamic parameters during cold pressor test: heart rate, mean arterial pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, right atrial pressure, cardiac index, systemic vascular resistance, pulmonary vascular resistance. In normal subjects we observed hemodynamic modification of heart rate, mean arterial pressure and systemic vascular resistance according to many other Authors. In atenolol-treated subjects the sympathetic response is strongly attenuated. Patients with CHF not treated with betablockers showed an increase in heart rate and in systemic vascular resistance and a reduction of cardiac index. Chronic treatment with atenolol did not modify heart rate response to cold pressor test. The mean arterial pressure increased while the systemic vascular resistance did not show any significant modification. We observed a trend to increase of the cardiac index; this could explain the beneficial effect of betablockers therapy in selected patients.

Adrenergic beta-Antagonists↗
PubMed1990

[Magnetic resonance imaging in non-Q wave infarction].

The aim of this study is to evaluate magnetic resonance (MR) as a clinical tool to identify the site of non-Q myocardial infarction, when other techniques are inadequate. Ten patients underwent MR examination 3 - 15 days after the onset of symptoms. The examinations were performed with a General Electric 1.5 Tesla II unit, by means of ECG-gated MR imaging. The 10 patients were 35 to 56 years of age, 9 were men. In 5 patients it was the first myocardial infarction, in 5 patients the second. MR allowed us to identify the site of myocardial infarction: 5 inferior, 1 posterior, 2 postero-inferior, 1 apical, 2 subendocardial. Thus the MR examination is suggested in non-Q myocardial infarction to detect the site and the extent of the infarct. The MR is useful when echocardiography is technically non adequate or when it is not possible to identify regional wall motion abnormalities. We suggest to use this technique in patients with coronary artery bypass and in patients with multiple infarctions.

Adult↗
PubMed1989

Echocardiographic monitoring of mental stress test in ischemic heart disease.

Mental stress testing can induce ischemia in coronary patients, but often may not induce chest pain and/or electrocardiographic changes. Therefore, we tested the utility of echocardiography to increase the sensitivity of the method. For this purpose, 56 patients undertook arithmetic mental stress tests and then were subjected to coronary angiography. During the test we evaluated left ventricular function, electrocardiography results, and emotional involvement measured by STAI (State Trait Anxiety Inventory). Echocardiography was positive in 21 patients, and electrocardiogram only in 2 patients. No patient complained of chest pain. The remaining 35 patients were negative. Comparing echo data with coronary angiography, in all the cases, sensitivity was 73.5%, specificity 93.3%. Analysis of the STAI revealed that the negative test we observed could be due to a low stressor efficacy. In conclusion, echocardiography in mental stress testing permits improved sensitivity, with loss of specificity in comparison with conventional electrocardiographic monitoring.

Coronary Disease↗
PubMed1989

The long-term efficacy of ibopamine in treating patients with severe heart failure: a multicenter investigation.

This randomized, double-blind, placebo-controlled, multicenter trial compared the effects of treatment with ibopamine with those of placebo in patients with severe heart failure who still showed symptoms although they were receiving standard therapy with digitalis and diuretics. The results showed a significant and sustained improvement in exercise tolerance (+70% about in average), clinical condition, and NYHA functional class and a decrease in cardiothoracic ratio and left ventricular end-systolic wall stress in patients treated with ibopamine, digitalis, and diuretics (group 1) compared with patients treated with digitalis, diuretics, and placebo (group 2).

Adult↗
PubMed1989

[Effects of infusions of different doses of dopamine in dilated cardiomyopathy. Observations during and after treatment with beta-blockers].

It is well known that there are abnormalities of the sympathetic nervous system in chronic congestive heart failure. The aim of our study was to verify the effects on heart rate, blood pressure and some echocardiographic parameters of performance and inotropic state of iv infusion of dopamine at different dosages in 14 patients affected by dilated cardiomyopathy. The patients were divided into 3 groups: the first one of patients on standard treatment, the second of subjects on standard treatment and beta blockers, the third of patients who stopped beta blocker therapy and remained on standard therapy. In the first group dopamine at low dosage did not significantly modify heart rate, blood pressure, performance and contractile state, while it did decrease end systolic wall stress. In the second group the same dosage significantly decreased blood pressure and stress, maintaining unchanged the other indexes; the same behaviour was presented by the third group. At high dosage dopamine in the first group significantly increased blood pressure, ejection fraction, contractility and stress. No modifications were observed in the second group, probably because of a pharmacological inhibition of beta receptors. The third group showed a significant increase in blood pressure, stress and inotropic state. From our data it appears that dopamine treatment in chronic congestive heart failure may reveal the presence of the so-called "down regulation" phenomenon.

Adrenergic beta-Antagonists↗
PubMed1989

[Acute hemodynamic effects of nicardipine in patients with chronic congestive heart failure].

We evaluated haemodynamic parameters in 13 patients suffering from chronic heart failure (CHF) in III and IV NYHA class. They were 10 males and 3 females, average age 57 +/- 11 years. Haemodynamic monitoring was made at basal condition and for 40 min after the administration of nicardipine (10 mg iv). We observed that mean arterial pressure and systemic vascular resistances (SVR) showed an important decrease (respectively -10.8%, p less than 0.001 and -22%, p less than 0.001); total pulmonary resistances (TPR) also decreased (-16.6%, p less than 0.001), while mean pulmonary pressure did not show significant reduction. Cardiac index increased with the highest value at the fifteenth minute (-11.7%, p less than 0.01). Pulmonary wedge pressure (PWP) did not show statistic variations, and heart rate too. Cardiac index (CI) did not rise in 3 patients with clinical worsening during the monitoring (patients non responders) (CI increase was less than 15%); while in 10 patients CI increased more than 15% (patients responders). Patients non responders did not show any decrease of TPR and only a transitory reduction of SVR; patients responders showed an important decrease of TPR, SVR, PWP. We observed that at baseline, the difference between the 2 groups was based on the value of TPR and PWP. We conclude that nicardipine is an efficient drug in patients affected by CHF without severe hemodynamic failure.

Aged↗
PubMed1989

[Delayed-action nicardipine in the prolonged treatment of chronic congestive heart failure in responsive subjects].

We performed hemodynamic monitoring in 13 patients, 10 males and 3 females, mean age 57 +/- 11 years, affected by congestive heart failure, NYHA class III and IV. Hemodynamic evaluation was made at basal condition and for 40 min after the administration of nicardipine (10 mg iv). We observed that in 3 patients cardiac index didn't rise (increase less than 15%) with clinical worsening during the monitoring (patients non responders), while in 10 patients cardiac index increased more than 15% (patients responders). Patients responders, 8 males and 2 females, mean age 57 +/- 10 years, have been treated with oral nicardipine administered at the dosage of 40 mg td for 3 months. Three months after nicardipine treatment we observed a significant increase of exercise capacity and O2 uptake (respectively p less than 0.05 and p less than 0.01); we noted also an improvement of cardio-thoracic ratio and of San Diego index (p less than 0.05). We conclude that patients responders to iv nicardipine receive beneficial clinical effects by chronic oral nicardipine.

Administration, Oral↗
PubMed1989

Pheochromocytoma during pregnancy.

A case of pheochromocytoma observed in a 31-year old woman at the sixth month of pregnancy is reported. The treatment was successful for both the mother and fetus. Oral phenoxybenzamine has allowed most favourable pressure control and completion of pregnancy at term with cesarean section and tumor resection performed at the same time. The prognostic role of early diagnosis is stressed and the therapeutic problems posed by this rare association at high maternal and fetal risk, are discussed.

Adrenal Gland Neoplasms↗
PubMed1988

Effect of amrinone on myocardial mitochondria function.

The effect of amrinone on cardiac mitochondria of guinea pig was studied. It was found that amrinone does not change the respiratory function of cardiac mitochondria in the presence of alpha-ketoglutarate, whereas it inhibits glutamate oxidation. It was also found that amrinone strongly inhibits the activity of glutamic dehydrogenase of both crude extract from sonicated heart mitochondria and of purified preparation from bovine liver. This inhibition may explain the effect of amrinone on the oxidation of glutamate in mitochondria. These results are discussed in view of the contradictory effects of amrinone on cardiac and other tissues.

Amrinone↗
PubMed1988

Pancreatic secretory response to ordinary meals: studies with pure pancreatic juice.

We have studied the pancreatic secretory response to a normal meal in 5 subjects with an external drainage of the main pancreatic duct carried out after biliary tract surgery. Pancreatic juice was collected at 60-min intervals from 10 AM to 7 PM, starting 2 h before and ending 7 h after lunch, and was analyzed for volume, bicarbonate content, and protein content. Large doses of pancreatic extract were given between and during meals. Both bicarbonate and protein output increased rapidly after the beginning of the meal and the increase persisted, with minor fluctuations, for the entire 7-h study period between lunch and dinner. The peak postprandial bicarbonate and protein outputs were higher (on average by 20% and 26%, respectively) than bicarbonate and protein outputs induced by exogenous infusion of submaximal doses of secretin and cerulein. The profile and magnitude of the bicarbonate secretory pattern elicited by food were not substantially different from those of protein secretion. In an additional patient who had undergone a duodenocephalopancreatectomy plus two-thirds distal gastrectomy before the study, the pancreatic response to meals showed an initial phase characterized by an increase in pancreatic secretion during the first postprandial hour followed by a tendency to decrease in the subsequent 2 h, and a later phase (from the fourth postprandial hour to the end of the study) characterized by a more marked and more persistent increase in pancreatic secretion than occurred in the initial 3 h. These data indicate that (a) the pancreatic secretory response to ordinary meals is much more prolonged than is generally believed. The late phase of the response is not dependent on gastric emptying of food into the duodenum, but is probably related to the arrival of chyme in the distal ileum. (b) The pancreatic secretory response to a normal meal is quantitatively slightly higher than that produced by exogenous pancreatic stimulation with submaximal doses of secretin and cerulein. (c) The pattern of postprandial bicarbonate secretion is similar to that for protein.

Adult↗
PubMed1987

A dose-response study of intravenous enoximone in congestive heart failure.

Previous clinical studies with intravenous enoximone have used cumulative dosing to quantify enoximone's hemodynamic effects. The magnitude and duration of the hemodynamic effects of single intravenous doses of enoximone were evaluated in patients with congestive heart failure. Sixty patients, who were in New York Heart Association functional classes III and IV, received single intravenous doses of enoximone, either 0.25 (12 patients), 0.5 (13 patients), 1 (14 patients), 1.5 (10 patients) or 2 mg/kg (11 patients). Cardiac index was increased by 20% with the 0.25 mg/kg dose and by 48% and 42% with the 1.5 and 2 mg/kg doses, respectively. These increases were statistically significant (Student's paired t test with Bonferroni's correction, p less than 0.007) for 1 hour after 0.25 and 0.5 mg/kg, for 2 hours after 1 mg/kg and for 4 hours after 1.5 and 2 mg/kg. Enoximone also reduced pulmonary artery diastolic pressure by 19% with 0.25 mg/kg and by 29% with 2 mg/kg. The duration of effect varied from 1 hour with 0.25 mg/kg to 4 hours with 2 mg/kg. Enoximone produced no consistent or dose-related effects on heart rate or blood pressure. Eighteen adverse reactions were reported by 15 patients, of which 11 were minor and transient (vein pain, flushes, nausea). In 5 patients ventricular or supraventricular arrhythmias were observed, including nonsustained ventricular tachycardia and extrasystoles; 3 of these patients had evidence of arrhythmias before enoximone. Laboratory studies before and after treatment showed no drug-related effects. Dose-related effects on the magnitude and duration of hemodynamic responses to intravenous enoximone were evident within the dose range of 0.25 to 2 mg/kg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Hemodynamic effects of transdermal nitroglycerin in subjects with angina and without congestive heart failure: comparison between never treated and chronically treated subjects.

Two groups of patients with angina were studied: Group A, 9 patients not treated previously with nitroderivatives; Group B, 8 patients, treated with transdermally administered nitroderivatives for at least 4 weeks. Hemodynamic parameters did not differ significantly in these groups under baseline conditions; only systolic blood pressure was higher in Group B (165 +/- 16 mmHg) than in Group A (144 +/- 15 mmHg). Hemodynamic modifications produced by administering nitroglycerin transdermally in these patient groups were evaluated 100 min after the transdermal application. In Group A significant reduction of systolic (144 +/- 15 to 126 +/- 18 mmHg, p less than 0.01) and diastolic blood pressure (83.36 +/- 70.1 +/- 13 mmHg, p less than 0.05), mean right atrial pressure (4.8 +/- 2.1 to 3 +/- 1.7 mmHg, p less than 0.005), mean pulmonary arterial pressure (18.6 +/- 2.6 to 16.7 +/- 2.8 mmHg, p less than 0.01), and significant increase of heart rate (72 +/- 10 to 83.5 +/- 12.4 beats/min, p less than 0.005) were noted. In Group B we noted only a significant reduction in systolic (170 +/- 25 to 150.5 +/- 16 mmHg, p less than 0.05) and diastolic blood pressure (88.7 +/- 15.5 to 77.5 +/- 9.2 mmHg, p less than 0.05) without other modifications. We conclude that prolonged treatment with adequate doses of transdermal nitroglycerin causes the hemodynamic effects of the medication to dissipate from the venous tone and significant arteriodilative effect to persist.

Administration, Cutaneous↗
PubMed1987

Effect of somatostatin 14 on pure human pancreatic secretion.

While it is well known that large doses of somatostatin inhibit human pancreatic enzyme secretion, it is still unknown whether low doses are also effective and whether the peptide is able to inhibit bicarbonate production. Eight subjects with external transduodenal drainage of the main pancreatic duct performed after biliary tract surgery were studied. Somatostatin was infused at progressively increasing rates of 0.05, 0.15, 0.45, and 1.35 micrograms/kg/hr, for 30 min/dose, during pancreatic stimulation with secretin, 25 ng/kg/hr, and cerulein, 10 ng/kg/hr. Somatostatin, at the dose of 0.05 microgram/kg/hr (shown to produce blood levels similar to those measured after a meal) did not affect pancreatic secretion in any of the subjects. The successive three higher doses caused a significant and dose-dependent inhibition of protein concentration and output and of bicarbonate output. Bicarbonate concentration was slightly but significantly reduced only by the two highest doses of somatostatin. At each dose level, the inhibition of protein output was much more marked than the inhibition of bicarbonate output. The maximal inhibition of protein output (at 1.35 micrograms/kg/hr somatostatin) was 73.9 +/- 5.4%, and that of bicarbonate output was 55.9 +/- 6.4%. The results demonstrate that: (1) the administration of somatostatin at a low dose level does not affect human exocrine pancreatic secretion, at least under the experimental conditions of this study; and (2) the administration of larger doses of somatostatin inhibits pancreatic secretion of both protein and bicarbonate dose-dependently. The inhibitory effect on protein output is significantly greater than that on water and bicarbonate production.

Adult↗