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Biomedical subjects

G Pinelli

Publications and source records attributed to G Pinelli.

At least 55 records · Page 3Linked to original sources
PubMed1994

Preoperative noninvasive coronary risk stratification in candidates for carotid endarterectomy.

BACKGROUND AND PURPOSE: Patients with symptomatic carotid stenosis who are candidates for carotid endarterectomy are at high short- and long-term risk of coronary events. To stratify patients at different risk of coronary events we investigated the usefulness of a noninvasive preoperative cardiological workup. METHODS: We studied 172 consecutive patients admitted to the Neurosurgical Department for symptomatic high-grade (70% to 99%) carotid stenosis (age, 42 to 74 years; mean, 57.8 years). Patients without history of coronary artery disease (CAD) and able to exercise were submitted to exercise electrocardiographic testing (EET) and, if abnormal, to exercise thallium myocardial imaging (TMI). Patients were classified into four groups: group 1, patients without CAD: no history of CAD, normal EET, or normal TMI in the presence of indeterminant EET (n = 93, 54%); group 2, patients with silent CAD: no history of CAD and concordant abnormal EET and TMI (n = 28, 16%); group 3, patients unable to exercise: no history of CAD and inability to perform adequate EET because of previous stroke or claudication (n = 29, 17%); and group 4, patients with known CAD: history of angina or myocardial infarction (MI) (n = 22; 13%). RESULTS: The four groups were comparable in regard to age, sex, and computed tomographic scan of the brain. The prevalence of stroke was higher in patients unable to exercise; hypercholesterolemia was more frequent in patients with known CAD. During the perioperative period (< or = 30 days after carotid endarterectomy), coronary events occurred in 3 patients (2%): fatal MI in 2 patients in group 4 and 1 patient in group 3. One hundred percent of patients were followed up for 6.2 years. Coronary events occurred in 23 of the 168 patients discharged from the hospital (13.7%); these were fatal in 11 (6.5%): 3 patients of group 1 (3%; sudden death in 2, fatal MI in 1), 8 patients of group 2 (29%; fatal MI in 5, unstable angina in 3), 8 patients of group 3 (28%; fatal MI in 4, nonfatal MI in 4), and 4 patients of group 4 (18%; fatal MI in 2, sudden death in 1, unstable angina in 1). Kaplan-Meier estimated curves of survival free from fatal and nonfatal coronary events were 97%, 51%, 49%, and 59%, respectively (P < .001, group 1 versus groups 2 and 3; P < .01, group 1 versus group 4). CONCLUSIONS: Among patients undergoing carotid endarterectomy, coronary events occurred twice as often as cerebral recurrences. A preoperative noninvasive cardiac investigation, including EET, can adequately identify groups of patients with diverse short- and long-term prognoses. In addition to patients with known CAD, those with silent CAD or who are unable to exercise represent, without the need of further investigation, groups at high risk of coronary events in long-term follow-up.

Adult↗
PubMed1994

Study of foetal hip: intrauterine positions and sonographic aspects.

The authors present their initial experience in the US Study of the foetal hip. Focusing on difficulties found and the possible advantages. The US foetal hip study shows that it is most likely to obtain qualitative morphologic data rather than quantitative that are interesting in case of occasional identification remark during US.

Female↗
PubMed1994

[Coronary artery surgery after 70 years: an analysis of the risk factors of operative mortality].

The risk factors of operative mortality after coronary bypass surgery in patients over 70 years of age were studied in a consecutive series of 109 patients operated in our department between January 1990 and June 1992. The anginal pain was classified stage III or IV in 92 cases. Seventy-nine patients had triple vessel disease, 36 patients had left main stem stenosis and 57 had previous myocardial infarction. Twenty-six patients had ejection fractions of less than 50% and 6 were less than 30%. The average number of bypass grafts was 2.35. Associated procedures included 9 endarteriectomies of the left main coronary, one endarteriectomy of the left anterior descending and right coronary arteries, 2 myotomies involving the left anterior descending artery, 3 ventricular remodeling procedures and 3 carotid endarteriectomies. Non-lethal postoperative complications were mainly pulmonary infections (19 cases). The operative mortality was 5.1% in the group with stable angina. On the other hand, the mortality was 31.2% in the group with unstable angina operated as an emergency or semi-emergency. The causes of death were mainly postoperative low output states (16 cases) and polyarteriopathy (mesenteric infarction: 6 cases). Although age was related to operative risk, the main prognostic factor was the preoperative cardiovascular status. The degree of emergency, unstable angina, left main coronary disease, duration of cardio-pulmonary bypass and the necessity for inotropic or mechanical support in the postoperative phase were significant risk factors for death. Sex, cardiovascular risk factors, previous myocardial infarction and duration of aortic clamping were not correlated to mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1994

[Clinical aspects of implantable defibrillators: indication].

The rapidity of technological progress has now made available a device which was only a dream a few years ago, a nearly ideal implantable defibrillator. Despite the persistence of a number of technical and clinical problems, the fourth generation defibrillators are multiprogrammable, with antitachycardia and antibradycardia functions, implantable by the endocavitary approach in most cases thanks to the introduction of biphasic shocks, fitted with constantly improving systems of telemetry, and are progressively smaller in size. The selection of a defibrillator device requires consideration of the patient's needs and the technical characteristics of the defibrillator. Apart from special situations in which the indications of the implantable defibrillator are generally accepted, it is only possible in the absence of results of prospective clinical trials, to use data accumulated on the place of defibrillation compared with other forms of management of severe ventricular arrhythmias. As there is a wide choice of treatment of these ventricular arrhythmias, the role of each must be defined for each individual patient. With regards to the implantable defibrillator, it is essential to take into consideration a number of clinical and paraclinical factors such as the clinical preservation of the arrhythmia, the underlying cardiac disease, left ventricular function and the type of arrhythmia induced by programmed ventricular stimulation.

Arrhythmias, Cardiac↗
PubMed1994

[Effectiveness of nasal positive pressure ventilation in the management of acute refractory left ventricular insufficiency].

BACKGROUND: Ehen refractory to optimal medical treatment cardiogenic pulmonary edema requires mechanical ventilation as a last therapeutic resource. In recent years an increasing number of authors reported their experience in the management of acute or subacute respiratory failure with non-invasive mechanical ventilation by nasal mask. MATERIALS AND METHODS: Encouraged by the first promising results reported in literature we experimented this new therapeutic tool in a first group of seven elderly patients (mean age: 76.57--range: 65-89); they all had been admitted for severe cardiogenic pulmonary edema unresponsive to maximal doses of the conventional drugs available for treating acute decompensated heart failure. The enrolled patients were treated with intermittent ventilation administered by nasal mask at selected values of inspiratory positive airway pressure (IPAP) that were comprised between 10 and 20 cm H2O. At the same time an expiratory positive airway pressure (EPAP) at values comprised between 3 and 8 cm H2O was applied. Ventilation was continued for variable periods of 3-24 hours until acceptable values of PaO2 and PaCO2 were obtained. The ventilation modality was spontaneous, spontaneous-time or timed depending on the patients' level of consciousness at starting time. RESULTS: A good short-term outcome was achieved in all the patients regardless of the ventilation modality applied. The main blood gas alteration was severe hypercapnia with acidosis in three patients, while the other four presented critical hypoxemia unresponsive to simple oxygen supply even if delivered by high-flow Venturi mask. Four of our seven patients were discharged from hospital in satisfactory haemodynamic conditions; the remaining three died during hospitalization from refractory heart failure. CONCLUSIONS: In this our preliminary experience the therapeutic approach with nasal positive pressure ventilation (NPPV) and EPAP proved to be very effective to improve the signs and symptoms of acute refractory cardiogenic pulmonary edema as it avoided the need of invasive mechanical ventilation. It was well tolerated by all our patients; besides it was not difficult to use or time-consuming for physician and nurses. On the other hand it didn't modify our patients' medium or long-time prognosis which was strictly related to their preexisting left ventricular pump derangement.

Administration, Intranasal↗
PubMed1994

[Tuberculosis of the spine in children. Personal experience].

We are currently witnessing a worldwide return of tuberculosis. An extremely rare form is tuberculosis of the spine which is reported above all in extra-European studies. The authors report a case of Pott's disease in a child aged 3 years and 3 months who was referred to their attention due to the appearance of left inguinal swelling, fever and anemia. Diagnostic tests (ETG, CT, MR) showed an abscess involving the L5-S1 intersomatic space, the intervertebral disc and osteolytic lesions of S1, with impairment of the left psoas muscle and diffusion as far as the inguinal region. Chemotherapy was commenced using isoniazid, ethambutol, rifampicin, and streptomycin and lasted 24 months associated with drainage of the ileopsoas abscess. Conservative orthopedic treatment lasting for one year initially took the form of decubitus in bed with hyperdistension of the vertebral column, followed by the creation of a plaster-cast cot on the back and lastly a glass-reinforced resin orthopedic jacket. The follow-up of 2 years and 10 months showed recovery with reconstruction of the vertebral elements and the preservation of intervertebral space.

Abscess↗
PubMed1994

[Recovery of pump function in ischemic hypokinetic cardiopathy subjects treated with weekly intermittent infusion of dobutamine. A clinical case].

The case is reported of a 69-year-old man with refractory heart failure due to ischemic cardiomyopathy. All other available treatments having failed and 250 mg doses of furosemide having been administered without success, dobutamine infusion was tried, at first with 72 hours of continuous infusion of 5 mcg/kg/min, followed by intermittent infusion at the same dosage, first with 12-h intervals, subsequently at the rate of 2-3 infusions weekly, and finally, after about 50 days, with a single weekly infusion. Clinical and hemodynamic results were brilliant with the patient passing from grade IV NYHA to grade II and from ejection fraction 21% (Teichholz M-mode measurement) to 55%, 14 months after the start of dobutamine treatment. Discussing the possible mechanisms of this favourable result, the authors stress the possible improvement of the contractility of the "stunned" or "hibernating" myocardial segments. On the basis of their experience and of data in the literature the authors underline the validity of a therapeutic protocol of intermittent dobutamine infusion for severe heart failure.

Aged↗
PubMed1993

Microdialysis in the estimation of interstitial myocardial neuropeptide Y release.

The purpose of this study was to investigate the feasibility of cardiac microdialysis for the in vivo estimation of cardiac interstitial peptide concentrations, and, to determine the changes in neuropeptide Y release in myocardial tissue during experimental brain death in pigs. Using a specifically designed concentric flexible probe, perfused with Ringer solution containing 0.5% of bovine serum albumin at a flow rate of 2 microliters/min, allowed us to obtain a 23 +/- 2% relative recovery rate in vitro. Based on these in vitro recovery data, a regional study of the kinetics of interstitial NPY levels following brain death was obtained by monitoring the changes in NPY dialysate levels recorded from dialysis probes implanted into the right and left ventricular walls of the beating heart in vivo. Basal dialysate NPY levels determined by radioimmunoassay were of 95.2 +/- 7.0 and 93.2 +/- 9.1 pmol/l in left and right ventricle, respectively. Brain death was followed by a sustained 2 h increase in NPY dialysate levels in both ventricles (peak levels: 173.2 +/- 30.9 pmol/l in left ventricle, and 149.7 +/- 23.9 pmol/l in right ventricle), which then returned to control levels. We conclude that cardiac microdialysis is a simple and promising new tool for evaluating the role of peptides in cardiovascular regulation.

Animals↗
PubMed1993

Malignant lymphoma in the donor heart after heart transplantation.

A case of post-transplant lymphoproliferative disease (PTLD) with donor heart involvement is reported. The 49-year-old patient presented with heart failure initially ascribed to acute graft rejection. The treatment with high doses of immunosuppressive agents was unsuccessful and the outcome rapidly fatal. This case suggests that cardiac failure occurring after high doses of immunosuppressive therapy could be a sign of early PTLD in heart transplant recipients.

Biopsy↗
PubMed1993

Slipped capital femoral epiphysis associated with Rubinstein-Taybi syndrome.

The association of Rubinstein-Taybi syndrome (RTS) and slipped capital femoral epiphysis (SCFE) is described in a girl aged 9 years and 10 months. SCFE has never been reported associated with RTS, neither as an isolated anomaly, nor in a familial pedigree. However, a "stiff gait" is frequently described in RTS patients and, furthermore, obesity is a frequent feature of RTS patients. Some reports in the literature suggest the need for an early diagnosis of SCFE among adolescent relatives of patients with SCFE. Since many SCFEs are asymptomatic and an early diagnosis is essential for a favorable prognosis, we suggest an annual echotomographic or radiological examination of the hips in RTS patients.

Child↗
PubMed1993

[Implantable defibrillator using epicardial and endocardial leads. Results of 36 implantations].

The authors report their experience of implantable defibrillators over a 5 year period. Between February 1988 and July 1992, 36 patients (25 men, 11 women, average age 51 +/- 11 years, range 18 +/- 71 years) underwent implantation of an automatic defibrillator with epicardial (n = 13, Group I) or endocardial leads (n = 23, Group II) without patch electrodes (n = 7), with subcutaneous patch electrodes (n = 12) or epicardial patch electrodes (n = 4). Three serious early complications were observed: 2 cardiogenic shocks in Group I, one of which died on Day 1 and one case of infection which required explanation of the defibrillator on Day 23 in Group II. Late complications in Group I included one case of disactivation of the defibrillator, 2 losses of output, one of which required replacement of the defibrillator and 2 increases of threshold treated by implantation of an endocardial lead. In Group II, 2 patients had inappropriate shocks due to overdetection (n = 1) and double counting (n = 1). During an average follow-up period of 28.5 +/- 9 months in group I and 13 +/- 6 months in Group II, 4 patients died, 2 from sudden death. Ninety seven shocks were delivered in 19 patients (56%), 5.1 shocks per patient. In the 17 patients with an antitachycardia function, 14 (82%) developed 947 episodes of VT treated successfully by antitachycardia pacing in 917 cases. This retrospective study confirms the efficacy of implantable defibrillators in the treatment of malignant ventricular arrhythmias. The efficacy of endocardial and epicardial leads seems to be the same but there seems to be a lower immediate mortality and morbidity with the endocardial system.

Adult↗
PubMed1993

[Atrial fibrillation: incidence and prognostic factors of embolic risk].

Atrial fibrillation (AF) carries a high risk of systemic embolism, in particular stroke. This is true not only when AF is associated with rheumatic valvular heart disease, but also in the so-called nonvalvular AF (NVAF). The recent randomized clinical trials assessing antithrombotic therapy as primary prevention in NVAF have shown that, untreated, disabling stroke occurs in 2.5%/year, ischemic stroke in 5%/year, stroke and transient ischemic attack in 7%/year, and stroke, transient ischemic attack and silent stroke in > 7%/year. All AF does not carry identical stroke risk. A risk stratification is important in order to decide long-term antithrombotic prophylaxis. A number of important clinical predictors of stroke have been identified. They include age, hypertension, congestive heart failure, previous arterial thromboembolism and previous myocardial infarction. Idiopathic or "lone" AF in patients < 60 years old, without hypertension and diabetes mellitus, carries an extremely low risk of stroke. Also in paroxysmal AF, when patients are < 60 years old and without organic heart disease, the embolic risk is low. The recent onset of AF does not seem to be associated with an excess of embolic risk, in comparison with long-standing AF. In conclusion, the underlying heart disease represents the main determinant of embolic risk. Within the broad spectrum of patients with NVAF a satisfactory risk stratification for thromboembolism can be accomplished by the analysis of clinical risk factors, possibly in association with echocardiographic variables.

Atrial Fibrillation↗