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Biomedical subjects

G Pinelli

Publications and source records attributed to G Pinelli.

At least 91 records · Page 5Linked to original sources
PubMed1989

Ischemic stroke in young adults: the relevance of migrainous infarction.

Sixty-one consecutive patients, less than or equal to 40 years old, were hospitalized for cerebral infarction between 1977 and 1985. Evaluation included computed tomographic brain scan, arteriography, echocardiography, and blood tests. A probable migrainous infarction was diagnosed in six patients (10%) (all women with a history of migraine) who survived the initial stroke and were followed-up for an average of four years. In five patients the stroke occurred during a common migraine attack and in one patient during a classic migraine attack. The site of infarction was invariably the occipital lobe. During the follow-up, no subject had a further stroke. All six women had a permanent hemianopic deficit.

Adult↗
PubMed1989

Cardioembolic stroke in primary oxalosis with cardiac involvement.

Primary oxalosis is a rare disorder of oxalate metabolism, characterized by nephrocalcinosis, nephrolithiasis, and extrarenal deposition of calcium oxalate in several tissues, including the heart. We report the case of a 34-year-old man with sudden right hemiparesis and aphasia from the occlusion of the left middle cerebral artery. Clinical features and the results of laboratory investigations led to the diagnosis of primary oxalosis. Two-dimensional echocardiography disclosed the presence of massive intracardiac calcifications compatible with deposition of calcium oxalate. The absence of other causes of stroke strengthened a cause-and-effect relation between cardiac oxalosis and cerebral infarction. Consequently, cardiac oxalosis should be considered among possible occult cardiac sources of cerebral embolism.

Adult↗
PubMed1989

Congenital pseudarthrosis of the tibia: treatment with local steroid infiltration.

A new treatment was used for 3 cases of congenital pseudarthrosis of the tibia based on the method used for the treatment of simple bone cysts by local infiltration of steroids. All 3 cases achieved consolidation and had no recurrence. This method may be used in association with the numerous other methods used in the treatment of congenital pseudarthrosis of the tibia (bone transplants, vascularized transplants using microsurgical techniques, electromagnetic induction, and the use of external fixators). It is particularly useful for cases treated at a very early age (even at a few months) when other types of treatment could be difficult to carry out and usually fail.

Child, Preschool↗
PubMed1989

[Angina pectoris caused by dynamic coronary obstruction and beta-blockers].

This review of the literature covers the clinical results of treatment with beta-blockers in those forms of cardiac ischaemia characterised by a coronary vasomotor component. Particular consideration is given to a paper by Mulcahy et al. which confirms and reinforces the results of other clinical works on the therapeutic effectiveness of the cardioselective beta-blocker atenolol in these mixed forms of ischaemia (fixed coronary stenosis plus dynamic coronary stenosis). The effectiveness of atenolol proved greater or at least on a par with that of the calcium antagonist nifedipine. The probable mechanisms underlying these clinical results are described and it is concluded by noting the therapeutic potentiation obtainable using the beta-blocker together with nifedipine.

Angina Pectoris↗
PubMed1988

Torsade de pointes and ventricular flutter-fibrillation following spontaneous cerebral subarachnoid hemorrhage.

Five cases (3.8%) in a series of 132 patients with spontaneous subarachnoid hemorrhage, studied by 24-hour Holter monitoring, presented with ventricular tachycardia of torsade de pointes variety. In all cases, the arrhythmias were observed within 24 hours after the bleeding. The QTc interval was prolonged more than 0.55 sec, and hypokalemia of less than 3.5 mEq/liter was present in all patients. The clinical status was not significant. Torsade de pointes occurred in comatose patients (3 cases) as well as in alert patients (2 cases). The arrhythmia was reversed by therapy in 3 patients, one of whom survived while 2 died due to cerebral damage. Our observations confirm the presence of life-threatening ventricular arrhythmias in the acute phase of subarachnoid hemorrhage. Continuous electrocardiographic monitoring is therefore advisable in view of its potential role in alerting to the need for treatment.

Adult↗
PubMed1988

Incidence of silent myocardial ischaemia in patients with cerebral ischaemia.

In order to assess the incidence of silent myocardial ischaemia, 190 consecutive patients with cerebral ischaemia and without symptoms or electrocardiographic signs of ischaemic heart disease, underwent a maximal exercise treadmill test. Patients with a positive exercise test were submitted to exercise thallium myocardial scintigraphy. Results were compared with those obtained in a control group of 113 healthy subjects submitted to the same study protocol. An adequate exercise test was obtained in 140 patients with cerebral ischaemia. The exercise test was positive in 36 cases (26%). The end points were exhaustion in 24 patients, ST segment depression greater than or equal to 3 mm in seven and systolic blood pressure greater than or equal to 240 mmHg in five. The exercise thallium myocardial scintigraphy was normal in three and abnormal in 33: reversible perfusion defects were detected in 26 cases and fixed defects in seven. In the control group, matched for age and sex, the exercise test was positive in only seven cases (6%; P less than 0.01); the exercise myocardial scintigraphy was normal in five and abnormal in two subjects. In conclusion, in a remarkable proportion of middle-aged patients with cerebral ischaemia, silent myocardial ischaemia can be detected by means of noninvasive cardiologic investigations.

Adult↗
PubMed1988

Cardioembolic stroke from atrial septal aneurysm.

Atrial septal aneurysm is an uncommon occult cardiac source of cerebral embolism. It is usually asymptomatic, and clinical cardiologic examination and electrocardiography fail to reveal its presence. We report a case of a 34-year-old woman with sudden right hemiplegia and aphasia from occlusion of the left carotid siphon in whom an atrial septal aneurysm was detected by two-dimensional echocardiography. The absence of atherosclerotic risk factors and vascular lesions proximal to the carotid occlusion strengthened a causal relation between atrial septal aneurysm and cerebral infarction. Consequently, two-dimensional echocardiography may be advisable in every patient with unexplained ischemic stroke to detect possible occult embolic cardiac abnormalities.

Adult↗
PubMed1987

Holter detection of cardiac arrhythmias in intracranial subarachnoid hemorrhage.

To determine the frequency and severity of cardiac arrhythmias in intracranial subarachnoid hemorrhage, 120 nonselected patients were prospectively studied by 24-hour Holter monitoring. Arrhythmias were found in 96 of 107 patients (90%) with adequate Holter recording: ventricular premature complexes in 49, nonsustained ventricular tachycardia in 5, supraventricular premature complexes in 29, paroxysmal supraventricular tachycardia or atrial fibrillation in 9, sinoatrial block and arrest in 29, second-degree atrioventricular block in 1, atrioventricular dissociation in 4 and idioventricular rhythm in 2. Life-threatening ventricular arrhythmias (torsades de pointes-type ventricular tachycardia) occurred in 4 patients, degenerating into either ventricular flutter or fibrillation in 2. ST-segment changes suggestive of acute transitory myocardial ischemia were found in 8 patients (1.5 mm or more of ST depression in 7 patients and 1.5 mm or more of ST elevation in 1 patient). The frequency and severity of arrhythmias were significantly higher in patients studied within 48 hours of subarachnoid hemorrhage; serious ventricular arrhythmias were associated with QTc prolongation more than 550 ms and with hypokalemia less than 3.5 mEq/liter. No correlation was found between age, clinical condition, site and extent of subarachnoid hemorrhage and either the occurrence or severity of arrhythmias. The results of our study indicate an extremely high incidence of arrhythmias, sometimes serious, in subarachnoid hemorrhage, especially in the first 48 hours after hemorrhage. Continuous electrocardiographic monitoring is therefore mandatory.

Adolescent↗
PubMed1987

[Prognosis of silent myocardial ischemia: follow-up of 100 patients with positive treadmill test and exertion myocardial scintigraphy].

Prognosis of asymptomatic myocardial ischemia is largely unknown and the opportunity is still controversial of seeking for patients with silent ischemia. Aim of the present study is to evaluate the prognosis of painless myocardial ischemia documented by exercise test and myocardial scintigraphy. From June 1981 through November 1986, 206 patients without angina, history or ECG signs of old myocardial infarction, presenting a positive (decreases ST greater than or equal to 1.5 mm) exercise treadmill test, underwent exercise Thallium 201 myocardial imaging. Myocardial scintigraphy showed a normal scan in 85 cases and a reversible or fixed perfusion defect in 121. Patients with abnormal scan presenting ischemia at a low to moderate ergometric work-load were treated with betablockers or calcium-antagonist drugs. Out of patients with positive myocardial scintigraphy a sample of the first 100 consecutive subjects was considered. They were 87 men and 13 women aged 28-72 years (mean 54.8) observed during a mean follow up period of 33.1 +/- 1.6 months. Seven patients underwent coronary angiography which showed 3-vessel critical stenosis in 3 cases, 3-vessel lesions plus critical stenosis of the left main coronary-artery in 1 and 2-vessel lesions in 3. Two patients underwent coronary artery bypass surgery. A non fatal myocardial infarction occurred in 1 and 1 became symptomatic for angina, 11 and 20 months respectively after the diagnosis of ischemia. Three patients with ischemia at a low work-load and extensive scintigraphic perfusion defects died of sudden death and one of cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Cardiologic evaluation in a family with Emery-Dreifuss muscular dystrophy].

Emery-Dreifuss muscular dystrophy is an X-linked recessive condition characterized by mild muscular weakness predominantly in a humero-peroneal distribution with variable facial involvement. Onset is in childhood with slow progression of weakness. The disease is often associated with cardiac involvement, mainly with bradyarrhythmias which might be responsible for sudden death. The most striking finding derived from the literature is the high incidence of sudden death; in the 7 large families described, out of the 79 reported patients 32 died suddenly at a young age (between 25 and 56 years). We performed a cardiologic evaluation of 11 subjects of a large italian family with affected males in four generations: 5 affected males (3 adults and 2 boys), 3 carriers and 3 healthy relatives (2 females and 1 male). Supraventricular arrhythmias were documented either in the dystrophic males or in the carriers. There was no correlation between the severity of cardiac rhythm abnormality and the severity of muscular weakness in the affected males, 3 of whom required pacemaker insertion. All the carriers were free of muscular involvement, but showed arrhythmias of variable degree, in one case requiring pacemaker insertion. In conclusion our data indicate an extremely high incidence of bradyarrhythmias, sometimes serious, in patients with Emery-Dreifuss muscular dystrophy. Holter monitoring is therefore mandatory and electrophysiological study is sometime necessary. Because of the high risk of sudden death in adult patients, we recommend permanent pacemaker implantation even in asymptomatic subjects, as soon as bradyarrhythmias are detected.

Adolescent↗
PubMed1986

Effort angina pectoris without electrocardiographic changes in coronary disease patients: correlations between scintigraphic and coronary angiographic findings.

The absence of electrocardiographic changes during angina is an unusual occurrence. In 15 male patients with exercise-induced angina, the electrocardiogram failed to show the usual ischemic ST-T changes. The exercise thallium-201 myocardial imaging was employed as indicator of the ischemia and the results were correlated with coronary angiographic findings. The exercise thallium-201 myocardial imaging showed an exercise-induced reversible defect in 14 patients and a fixed defect in the remaining 1. Out of 15 patients, 13 had defects involving the infero-apical, posterior and postero-lateral segments. The coronary angiography, performed in all patients but 2, showed single-vessel coronary artery disease in 8 patients and double-vessel disease in 5. A significant circumflex or right coronary artery stenosis was found in all cases except 1; 2 patients had a coexistent left anterior descending coronary artery stenosis and 1 an isolated stenosis of this vessel. It is concluded that the myocardial scintigraphy is useful to assess the ischemic myocardial origin of chest pain in the absence of ST-T changes. The silence of the electrocardiogram might be due to the production of ischemia in not well explored areas, such as the inferior and posterior myocardial segments, and possibly to a smaller extension of ischemia.

Adult↗
PubMed1986

[Early identification of ischemic cardiopathy in patients with cerebrovascular insufficiency.A prospective study with exertion test and perfusion myocardial scintigraphy].

In patients with cerebral transient ischemic attacks or stroke myocardial infarction is the leading long-term cause of death. Despite the importance of coronary artery disease, patients with cerebrovascular insufficiency are seldom evaluated for the detection of ischemic heart disease and usually the cardiological evaluation is limited to the patients with angina or previous myocardial infarction. In order to identify asymptomatic coronary artery disease 74 consecutive patients with cerebral ischemia, and without symptoms or electrocardiographic signs of ischemic heart disease, underwent a maximal exercise treadmill test according to the Bruce protocol. An exercise Thallium myocardial scintigraphy was performed in patients with positive exercise test. A control group of 74 asymptomatic subjects underwent the same study protocol. The study population (Group I) included 57 men and 17 women; the age ranged from 22 to 72 years (mean age 54 years). An adequate exercise test was obtained in 67 patients. Exercise test was positive (ST-segment depression greater than or equal to 1.5 mm) in 19 cases (28%). The end points were exhaustion in 15 patients, ST-segment depression greater than 3 mm in 2 and systolic blood pressure greater than 240 mmHg in 2. The exercise Thallium myocardial scintigraphy was normal in 2 and abnormal in 17: reversible perfusion defects were detected in 12 cases and fixed defects in 5. In the control group (Group II), comparable for age and sex, exercise test was positive in 4 cases (5%; p less than 0.01 percentage of positive exercise tests in Group I vs Group II); the exercise myocardial scintigraphy was normal in 1 and abnormal in 3 subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Evidence that 2-phenylpyrazolo[4,3-c]-quinolin-3(5H)-one antagonises pharmacological, electrophysiological and biochemical effects of diazepam in rats.

The effects of the acute administration of 2-phenylpyrazolo[4,3-c]quinolin-3(5H)-one on diazepam-induced behaviour and electrophysiological activity were studied in rat. The compound, in doses of 5-10 mg/kg (i.p.), which per se did not induce alterations in spontaneous locomotor activity, antagonised the sedative effect induced by 5-10 mg/kg (i.p.) of diazepam. The injection of diazepam in rats, induced a profound reduction in the first negative wave of the recording of the visual evoked potential used as a sensitive electrophysiological test, in vivo. 2-Phenylpyrazolo[4,3-c]quinolin-3(5H)-one (10 mg/kg, i.p.) caused a recovery of the amplitude of the first negative wave within a few minutes. This result was confirmed by the finding that 2-phenylpyrazolo[4,3-c]quinolin-3(5H)-one, injected acutely in rats, pretreated with diazepam exhibited the capacity to antagonise the binding of [3H]diazepam determined in vitro on synaptic membrane preparations from cortex. The comparison of the pattern of the visual-evoked potential, recorded after the injection of 2-phenylpyrazolo[4,3-c]quinolin-3(5H)-one (50 mg/kg) with the patterns recorded after the injection of ethyl-8-fluoro-5,6-dihydro-5-methyl-6-oxo-4H-imidazolo(1,5a) (1,4)benzodiazepine-3-carboxylate (50 mg/kg) and ethyl-beta-carboline-3-carboxylate and 1-methyl-beta-carboline demonstrated that 2-phenylpyrazolo[4,3-c]quinolin-3(5H)-one is devoid of intrinsic activity.

Animals↗
PubMed1985

Opiate receptors and beta-endorphin levels in brain areas of dogs with portal-systemic encephalopathy.

Clinical observation has indicated a supersensitivity to morphine in patients with hepatic encephalopathy. With the aim of clarifying the issue, radioreceptor binding studies of opiate receptors were performed in frontal cortex and hypothalamus of 6 dogs with mild portal-systemic encephalopathy induced by chronic treatment with dimethylnitrosamine followed by porto-caval shunt end-to-side. beta-Endorphin assays were performed in the same areas with radioimmunoassay. Opiate receptors labeled with [3H]naloxone in both areas showed a significant increase in the receptor densities (Bmax) without changes in the dissociation constant (KD). In parallel beta-endorphin levels showed a decline during the development of encephalopathy in both areas. The increased densities of opiate receptors in the mild stage of encephalopathy may explain the supersensitivity to morphine in patients with liver diseases.

Animals↗