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Biomedical subjects

G Pinelli

Publications and source records attributed to G Pinelli.

At least 73 records · Page 4Linked to original sources
PubMed1993

Immunoradiometric assay of serum myosin as a marker of myocardial cell damage: methodological and clinical evaluation.

We evaluated the performance and analytical parameters of a one-step magnetic IRMA kit for the measurement of myosin in serum. The method uses two monoclonal antibodies selected for their high affinity to the heavy chains of human ventricular myosin. The first antibody is coupled to a magnetic solid phase and the second one is labeled with 125I. The working range of the IRMA (range of myosin concentrations measured with an imprecision < 10% CV) was 250-3600 microU/L and the sensitivity 20.8 +/- 7.2 microU/L. The between-assay variability, evaluated from replicate measurements in different runs of two serum pools was 14.6 CV% for the first pool (259.1 +/- 37.8 microU/L) and 14.3 CV% for the second pool (442.0 +/- 63.1 microU/L), respectively. To evaluate the clinical usefulness of myosin as a marker of myocardial cell damage, serum myosin was measured in patients with acute myocardial infarction (AMI) (n = 9) or subarachnoid hemorrhage (n = 20). The results obtained with the myosin assay were compared with those of two other markers considered specific for myocardial necrosis (CK-MB and myoglobin). In eight patients with AMI, serum myosin was elevated 24-36 hours after the onset of chest pain and reached a maximum at 4-7 days, returning to control levels at 8-11 days. The one remaining AMI patient showed two subsequent peaks in serum CK-MB and myoglobin concentrations (thus suggesting an extension of myocardial necrosis), the myosin concentrations reaching their peak only after 9 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomarkers↗
PubMed1992

Frequency and prognostic significance of silent coronary artery disease in patients with cerebral ischemia undergoing carotid endarterectomy.

To evaluate the prevalence and prognostic role of silent coronary artery disease (CAD) in patients with symptomatic high-grade carotid stenosis (70 to 99%) undergoing carotid endarterectomy, and with neither history nor symptoms of CAD, 106 patients (76 men, 30 women, mean age 58.7 years [range 42 to 71]) with recent cerebral ischemia were prospectively studied. Patients were stratified as to the presence (n = 27, 25%) or absence (n = 79, 75%) of silent CAD defined by concordant abnormal exercise electrocardiographic testing and thallium-201 myocardial scintigraphy. The male sex, the severity of the symptomatic carotid lesion (greater than 90%), and the coexistence of contralateral carotid disease identified patients with higher probability of coexisting CAD. The 106 patients underwent 121 operations (bilateral in 15). In the perioperative period, no deaths or cardiac events occurred, 1 patient suffered a recurrent stroke and 3 had a transient ischemic attack. During a mean follow-up period of 5.4 years, 9 patients died (1.7%/year): fatal myocardial infarction occurred in 5 (all in the silent CAD group), cancer in 3 and vertebrobasilar stroke in 1. Nonfatal events occurred in 9 patients: myocardial infarction in 1 (without silent CAD), unstable angina in 3 (with silent CAD), and cerebral ischemic attacks in 5. After 7 years, the Kaplan-Meier estimated survival free from coronary events was 51% in patients with silent CAD, and 98% in patients without CAD (p less than 0.01). In conclusion, among patients with symptomatic high-grade carotid stenosis undergoing carotid endarterectomy, even in absence of history or symptoms of CAD, a silent CAD is detectable in one fourth of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Congenital absence of pericardium as unusual cause of T wave abnormalities in a young athlete.

The congenital absence of pericardium is a rare condition which may determine electrocardiographic ST-T abnormalities. The case of a 16-year-old athlete who presented T-wave abnormalities at standard electrocardiogram performed during a physical checkup is reported. Ventricular repolarization tended to normalize during exercise and in right lateral decubitus. Chest x-ray and echocardiography showed typical signs of complete absence of the left pericardium. The definite diagnosis was made by computer tomography (CT) scan. The importance of a complete investigation of athletes with T-wave abnormalities is emphasized. Diagnostic and therapeutic features of the congenital absence of pericardium are discussed.

Adolescent↗
PubMed1992

Heart-brain interactions in cerebral ischaemia: a non-invasive cardiologic study protocol.

The cardiologic evaluation of patients with cerebral ischaemia should be aimed at: (1) identifying potential cardiac sources for cerebral emboli, (2) detecting a coexisting ischaemic heart disease, even asymptomatic. The present data concerns a ten-year experience of a systematic cardiologic evaluation of patients admitted to the 1st Division of Neurosurgery, Bellaria Hospital, Bologna, Italy, for cerebral ischaemia. A two-dimensional echocardiography was carried out in 344 consecutive patients (mean age 53 years), cardiac abnormalities were observed in 92 (28%) out of the 328 cases with technically adequate examination, embologenic lesions in 57 (17%). In 18 cases the cardiac lesion was unknown before the cerebral event. An exercise ECG testing was carried out in 322 patients (mean age 56 years), resulting in abnormal in 69 out of the 258 with adequate examination (17%). A subsequent exercise 201Tl myocardial scintigraphy confirmed the presence of ischaemic heart disease in 58 cases. Among patients unable to perform an adequate exercise, a dipyridamole 201Tl myocardial scintigraphy was performed in 38 cases showing perfusional defects in 23 (60%), while a dipyridamole echocardiography was performed in 25 cases showing wall motion abnormalities in 9 (36%). A 24-h Holter monitoring was performed in 65 cases: arrhythmias were detected in 27 patients (41%), but a correlation with the cerebral event was suggested only in 3 cases with atrial fibrillation. According to our experience patients with recent ischaemia should be submitted to the following non-invasive cardiologic screening: (1) exercise ECG testing followed, if abnormal or indeterminant, by 201Tl myocardial scintigraphy in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Ischemia↗
PubMed1992

Penetration of ofloxacin into heart valves, myocardium, mediastinal fat, and sternal bone marrow in humans.

Ofloxacin penetration into heart tissue (valve and myocardium), mediastinal fat, and sternal bone marrow was the object of a prospective nonrandomized study. Thirty-six patients undergoing mitral and/or aortic valve replacement were included. Patients were divided into two groups of 18 patients each. Group 1 patients were administered a single 400-mg intravenous dose of ofloxacin over a 30-min period upon anesthesia (n = 6) or at 1 h (n = 6) or 6 h (n = 6) prior to surgery. Group 2 patients received a 200-mg oral dose of ofloxacin every 12 h during the 48 h preceding surgery. In this group, the final dose of ofloxacin was administered 3 h (n = 9) or 8 h (n = 9) before anesthesia. Plasma and tissue ofloxacin concentrations were assayed by high-pressure liquid chromatography. In group 1 patients, the peak level in plasma was 15.9 +/- 2.5 micrograms/ml. Peak ofloxacin levels in tissue were reached by hour 1 and were 8.89 +/- 2.16 micrograms/g in myocardium and 5 +/- 0.75 micrograms/g in heart valves. A significant decrease in ofloxacin levels in heart valve tissue and sternal bone marrow was observed after hour 3. Nevertheless, ofloxacin myocardial, heart valve, and sternal bone marrow levels remained higher than the MICs for the usually susceptible pathogens for at least 3 h. In group 2 patients, myocardial levels were long lasting (6.46 +/- 1.92 micrograms/g [4 to 8 h] and 5.92 +/- 0.95 micrograms/g [8 to 12 h]) and remained higher than those observed in the other tissues over the entire study period. A progressive but insignificant decrease in ofloxacin heart valve levels was observed (from 2.46 +/- 0.40 micrograms/g [4 to 8 h] to 1.57 +/- 0.22 micrograms/g [8 to 12 h]). In both groups, concentration in mediastinal fat were lower and tended to decrease with time. These were 1.83 +/- 0.61 micrograms/g with the first hour and 0.85 +/- 0.43 micrograms/g between hours 8 and 12 in group 1 and 1.74 +/- 0.52 micrograms/g between hours 4 and 8 and 0.67 +/- 0.11 micrograms/g between hours 8 and 12 in group 2. In conclusion, satisfactory diffusion of ofloxacin into heart tissue seems to favor use of the drug in the treatment of bacterial endocarditis due to susceptible pathogens. Furthermore, the progressively decreasing concentrations observed in heart valve and sternal bone marrow and the poor levels achieved in mediastinal fat suggest the need for renewing injection 3 h following initial infusion if the drug is used as an antibiotic prophylactic agent during cardiovascular surgery.

Adipose Tissue↗
PubMed1992

Nuclear magnetic resonance spectroscopy of excised human hearts.

BACKGROUND: Phosphorus nuclear magnetic resonance spectroscopy has been proposed as a method of studying the metabolism of the myocardium in patients. Little is known about 31P nuclear magnetic resonance spectroscopy of diseased human hearts. METHODS: Two donor hearts meeting the requirements for heart transplantation and 11 diseased hearts were removed during a transplantation procedure and were studied in a horizontal 2.35 T superconducting magnet. Spectra were obtained at 0 degrees C about 30 minutes after the excision. The areas of the inorganic phosphate peak (Pi) and of the phosphocreatine peak (PCr) were summed and expressed as a ratio with respect to the area of the beta ATP peak. RESULTS: The ratio (Pi + PCr)/beta ATP was found to be significantly lower in five hearts with a myocardial infarct (0.77 (0.18)) than in hearts with dilated cardiomyopathy (1.25 (0.29)) and in normal hearts (1.69 (0.11)). The area of the phosphodiester peak was expressed as a ratio with respect to the area of the beta ATP peak: no differences were found between the three groups. CONCLUSIONS: These results suggest that the phosphocreatine concentration is lower in ischaemic heart disease than in dilated cardiomyopathy and that the phosphodiester peak is probably not useful in distinguishing between these two types of heart disease.

Adenosine Triphosphate↗
PubMed1992

Changes in endocrine control of electrolyte homeostasis and blood pressure following heart and heart-lung transplantation. A comparative study.

The purpose of this study was to compare the early postoperative effects of heart and heart-lung transplantation on the secretion of atrial natriuretic peptide (alpha-ANP), renin, aldosterone, and vasopressin. This was carried out from the first to the eighth postoperative day in ten heart and five heart-lung recipients. The changes in the release of these hormones were similar in both groups. Vasopressin release remained stable while that of the renin-angiotensin-aldosterone system progressively returned to more normal levels. Grafted heart tissue was capable of high alpha-ANP release early on in both heart and in heart-lung recipients. This sustained alpha-ANP release was not a function of the resulting overall atrial tissue mass. Our findings suggest that it might be the consequence of an intrinsic hypersecretion of alpha-ANP resulting from the loss of normal heart innervation occurring in both heart and heart-lung transplantation.

Adult↗
PubMed1991

[Atrial natriuretic factor after heart-lung transplantation. Consequences of cardiac denervation].

Due to the discovery and elaboration of alpha ANP, the heart can be considered a veritable endocrine gland involved in fluid and electrolyte homeostasis as well as blood pressure regulation. Nevertheless, the mechanisms regulating the synthesis and release of this new hormone are far from being understood. Heart-lung transplantation provides an interesting research model for evaluating the consequences of allograft denervation on alpha ANP synthesis and release, without the disadvantage of significantly increasing the overall atrial tissue mass, as observed in orthotopic heart transplantation. To appreciate better these consequences, we studied the changes in alpha ANP release following heart-lung transplantation. Five patients were included in the study. It began during the immediate postoperative period and went on to the 8th postoperative day. Alpha ANP levels were determined using radioimmunoassay. The postoperative course was characterized by a rapid significant increase in hormone levels as of the 6th postoperative day (45.6 +/- 5.5 fmol/ml). These findings were comparable to those found in a previous study involving orthotopic heart transplantation alone. Thus, the heart-lung group was also capable of high levels of alpha ANP release from the onset. However, this rapidly increasing release was not found to be correlated with the changes in hemodynamic parameters observed postoperatively (blood and cardiac filling pressures). Moreover, we observed no episodes of rejection which might explain the increased release of this hormone. Finally, the fact that increased alpha ANP release occurs despite a smaller increase in the overall tissue mass is more than noteworthy. In conclusion, as we found in our initial study involving heart transplant recipients, the sustained high levels of alpha ANP observed following heart-lung transplantation are in favour of a possible modulating role played by cardiac innervation on the release of this hormone.

Adult↗
PubMed1991

Etiopathogenesis and prognosis of cerebral ischemia in young adults. A survey of 155 treated patients.

Etiology and long-term prognosis were prospectively investigated in 155 consecutive patients (96 men and 59 women), aged 16 to 45 years, referred to our Neurosurgical Unit with cerebral transient ischemic attacks or infarction during the period 1978-1988. All patients underwent neurological and medical-cardiological evaluation, cerebral computerized tomography scanning, electrocardiogram, and laboratory tests. Two-dimensional echocardiography was performed in 123 cases (79%), cerebral angiography in 147 (95%). Atherosclerosis was the leading etiology occurring in 48 patients (31%). A cardioembolic disorder was considered the probable cause of ischemia in 8 cases (5.1%). Further possible etiologies were contraceptive pill assumption (5.8% of the total, but 15.3% within the female group), spontaneous arterial dissection (4.5%), migraine (4%), puerperium (2.6%), cervical trauma (2.6%), and other, more uncommon conditions. Despite extensive evaluation, the cause of cerebral ischemia remained unknown in 40% of cases. All patients received antiplatelet medication and 16 underwent surgery. The long-term outcome at a mean follow-up of 5.8 years was favorable: 91% of subjects resumed their work on a full or part-time basis.

Adolescent↗
PubMed1991

A double-blind crossover comparison of flecainide and slow-release mexiletine in the treatment of stable premature ventricular complexes.

In 24 patients with stable premature ventricular contractions (PVCs) greater than or equal to 100/h, Lown class greater than or equal to 2 the relative anti-arrhythmic efficacy of flecainide 150 mg twice daily and slow-release mexiletine 360 mg twice daily was evaluated in a double-blind placebo-controlled randomized crossover study. All the patients had normal ventricular function. Criteria of efficacy were: reduction greater than or equal to 70% of PVCs or reduction greater than or equal to 50% with abolition of Lown class greater than 2 arrhythmias or suppression of non-sustained ventricular tachycardias (nSVT). Twenty-two patients completed the study protocol. The placebo phases showed comparable results and no carry over effect. The criteria of efficacy were fulfilled in 20 of the 22 patients (91%) on flecainide and in 12 of the 22 (55%) on mexiletine. The absolute reductions of PVCs, couplets and nSVT obtained on flecainide and mexiletine, in comparison to the placebo, were statistically significant (p less than 0.01 for flecainide, p less than 0.05 for mexiletine). Flecainide was superior to mexiletine in overall PVC reduction (p less than 0.05). In the 17 patients with couplets the reduction obtained with flecainide was superior to mexiletine (p less than 0.05). Both drugs were highly effective on nSVT. At steady state, the mean plasma levels of both drugs were within the range of clinical efficacy. The drugs were well tolerated and no patient withdrew because of side-effects. It was concluded that at the dosages employed flecainide was superior to mexiletine in reducing premature ventricular contractions and in abolishing couplets. The efficacy of both drugs for non-sustained ventricular tachycardias was comparable. Both drugs were highly effective by comparison with the placebo.

Cardiac Complexes, Premature↗
PubMed1991

Langerhans' cell histiocytosis: a case report.

The authors describe the morphologic features of Langerhans' cell histiocytosis and discuss the main prognostic factors which divide patients into two groups requiring different treatment. They then describe a case of multifocal Langerhans' cell histiocytosis due to pelvic osteolysis and early diabetes insipidus, emphasizing the effectiveness of the combination of surgery and chemotherapy and the rapid reparative new bone formation.

Child↗
PubMed1990

Felodipine in chronic stable angina: a randomized, double-blind, placebo-controlled, crossover study.

To investigate the antianginal efficacy and tolerability of felodipine, a new dihydropyridine calcium antagonist, 20 patients with stable exertional angina, not completely controlled by beta-blocker monotherapy, entered a randomized, double-blind, placebo-controlled, crossover study. Patients on standard beta-blocker therapy, who had at least 3 weekly anginal episodes and a reproducible exercise test (stopped for angina and ECG signs of ischaemia) at the end of 2 weeks placebo treatment, were eligible for the study. They were randomized to one sequence of treatment: felodipine 5 mg twice daily for 2 weeks followed by placebo for a further 2 weeks, or vice versa. Beta-blocker treatment was unchanged throughout the study. A treadmill test was carried out at the end of each crossover period, 2-4 h after drug administration. The number of anginal attacks and nitroglycerin consumption was recorded on a diary card. At rest, felodipine significantly (P less than 0.05) reduced standing systolic but not diastolic blood pressure. Heart rate was not modified by the active treatment. At ischaemic threshold and at peak exercise, heart rate, systolic blood pressure and rate-pressure product remained unchanged. Exercise duration was increased by felodipine (P less than 0.01) and maximal ST change was reduced (P less than 0.01). Time to 1 mm ST depression was prolonged non-significantly by felodipine (basal 5.7 +/- 1.5, felodipine 7.4 +/- 2.0, placebo 6.6 +/- 1.5 min). The number of patients who stopped exercise due to angina and ST change was 20/20 at baseline, 16/20 with placebo and 10/20 with felodipine. Felodipine significantly reduced weekly anginal episodes (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Ellis-Van Creveld syndrome: description of four cases. Orthopaedic aspects.

Four cases of Ellis-Van Creveld syndrome are reported in which three were in the same family. The clinical and radiological findings were characteristic of the traditional features of the disease. The authors discuss the role of the orthopaedic surgeon in correcting the skeletal deformities.

Adolescent↗
PubMed1990

Maguelone plaster braces for the reduction of scoliotic curves: methods and results.

The authors discuss the basic principles in the reduction of scoliotic curves using the Maguelone method devised by Perdriolle and Vidal. The mechanical concepts of this method derive from corrective forces characteristic of the E.D.F. method but are used differently in terms of direction and quantitative relationships, namely derotation-de-flexion-kyphotisation replaces the elongation-de-flexion-derotation which characterizes the E.D.F. method. This modification is based on the assumption that in the pathogenesis of scoliosis the stages involve rotation, flexion and lordosis in that order. The method is discussed in detail as are the principles on which it is based. Finally, a group of cases are presented demonstrating the percentage gain after reduction, expressed in Cobb angles and degrees of torsion. The results appear to provide significant support for the effectiveness of the method.

Adolescent↗