Search PubMed⌕ Search

Biomedical subjects

G Pinelli

Publications and source records attributed to G Pinelli.

143 records · Page 8Linked to original sources
PubMedDate not supplied

Prophylaxis of thromboembolic events in congestive heart failure.

In patients with heart failure the incidence of thromboembolism is 0.9-5.5%/year (mean 1.9%/year), but no randomized studies are available to support the indication for anticoagulant therapy in those patients. Atrial fibrillation and previous thromboembolic events seem to be the major risk factors, whereas the effect of ventricular dysfunction has not been independently evaluated; nonetheless several studies suggest that thromboembolism is more likely among those patients with lower ejection fraction and lower peak exercise oxygen consumption. Anticoagulant therapy seems to be indicated also in patients with left ventricular aneurysm with mobile and protruding thrombi. Several studies of patients with dilated cardiomyopathy show that the incidence of thromboembolism ranges from 1.6 to 4.5%/year in patients not treated with anticoagulants, while it is virtually absent in anticoagulated patients. The clinical opportunity of long-term anticoagulant treatment in heart failure patients should be weighted not only on the clinical markers of thromboembolic risk, but also on the relative risk/benefit ratio of the single patient.

Journal Article↗
PubMedDate not supplied

Cerebral ischemia and asymptomatic coronary artery disease: a prospective study of 83 patients.

A prospective cardiologic evaluation was performed in 83 consecutive patients with transient cerebral ischemia or mild stroke and without symptoms or electrocardiographic signs of ischemic heart disease. Patients were studied with an electrocardiographic exercise test; a positive test was followed by exercise Thallium-201 myocardial scintigraphy. Results were compared to those obtained in a group of 83 age and sex-matched healthy subjects submitted to the same study protocol. Asymptomatic coronary artery disease was detected in 28% of cerebrovascular patients with adequate electrocardiographic exercise test. A scintigraphic perfusion defect of variable extension was found in 19 of them. In the control group the electrocardiographic exercise test was positive in only 6% (p less than 0.01). Our results support the concept that: asymptomatic ischemic heart disease is often associated with cerebrovascular disease; therefore cerebral ischemic attacks may be a marker of coronary artery disease, an active investigation of the heart should be considered in cerebrovascular patients in order to plan optimal, comprehensive management.

Adult↗
PubMedDate not supplied

Subarachnoid hemorrhage: frequency and severity of cardiac arrhythmias. A survey of 70 cases studied in the acute phase.

The frequency and severity of cardiac arrhythmias were studied in 70 patients with spontaneous subarachnoid hemorrhage investigated prospectively with 24-hour Holter monitoring. Patients were less than 70 years old and without clinical and/or ECG signs of previous heart disease; Holter monitoring was initiated within 48 hours of subarachnoid hemorrhage. Arrhythmias were detected in 64 of the 70 patients (91%). Twenty-nine of the 70 patients (41%) showed serious cardiac arrhythmias; malignant ventricular arrhythmias, i.e., torsade de pointe and ventricular flutter or fibrillation, occurred in 3 cases. Serious ventricular arrhythmias were associated with QTc prolongation and hypokalemia. No correlation was found between the frequency and severity of cardiac arrhythmias and the neurologic condition, the site and extent of intracranial blood on computed tomography scan, or the location of ruptured malformation. The extremely high incidence of cardiac arrhythmias, sometimes serious, in the acute period after subarachnoid hemorrhage and the absence of clinical and radiologic predictors make systematic continuous ECG monitoring compulsory to improve the overall results of subarachnoid hemorrhage, irrespective of early or delayed surgical treatment.

Acute Disease↗
PubMedDate not supplied

[Applications of the ETCH technic and orthodontic brackets in some clinical cases].

The Authors shawed how the sealants having a resin base that can establish with tooth surfaces treated with acid, a sound connection among these and orthodontic brackets, originally used in orthodontic treatment, can also be used for fixation of fractures. The case described concern seven patients with a fracture of maxillaries. It was demonstrated that such a procedure was easy to execute for the operator and did not give any trouble to the patient. The results obtained were satisfactory.

Acid Etching, Dental↗
PubMedDate not supplied

[Dynamic left intraventricular obstruction in acute myocardial ischemia].

A case of a 60-year-old woman suffering from hypertension, who presented an episode of acute myocardial ischemia with an elevation of the ST segment in the anterior ECG lead, is reported. On examination, a transient loud systolic murmur was present; it completely disappeared soon after the cessation of acute myocardial ischemia. Doppler echocardiography was performed a few times, during and after the acute ischemia: it was able to show a sort of "hour-glass" deformation of the left ventricle due to the akinesia of the anterior and apical segments. This functional anatomic deformation hampers the outflow from the left ventricle thus creating a dynamic left intraventricular gradient, which is clearly shown by pulsed wave and continuous Doppler echocardiography.

Coronary Disease↗
PubMedDate not supplied

Left ventricular contractility after hypothermic preservation: predictive value of phosphorus 31-nuclear magnetic resonance spectroscopy.

Early graft failure accounts for a substantial portion of the mortality after heart transplantation. This factor underscores the need for the development of reliable methods for predicting graft performance and thus ensuring optimal clinical outcome. The aim of this study was to describe the link between myocardial metabolism evaluated throughout preservation with the use of phosphorus 31-nuclear magnetic resonance spectroscopy and ventricular contractility after reperfusion. Thirteen pig hearts were excised and preserved from 3 to 12 hours with clinical techniques. During preservation the hearts underwent phosphorus 31-nuclear magnetic resonance spectroscopy. After reperfusion, left ventricular contractility was evaluated with an isolated heart model undergoing isovolumetric contraction. Throughout storage, beta-adenosine triphosphate remained stable and intracellular pH and phosphocreatine decreased exponentially, whereas inorganic phosphate increased exponentially. Intracellular pH, phosphocreatine, inorganic phosphates measured at the onset of preservation, and intracellular pH and phosphocreatine measured at the end of preservation correlated significantly with the left ventricular contractility after reperfusion. We conclude that the metabolic state of myocardium at excision is especially important and that phosphorus 31-nuclear magnetic resonance evaluation of the heart during preservation appears to provide reliable indexes for predicting subsequent ventricular contractility after reperfusion.

Animals↗
PubMedDate not supplied

Endocrine response to plasma volume expansion during the early postoperative period in heart transplant recipients.

The purpose of this study was to investigate the changes in endocrine control of blood pressure and electrolyte homeostasis during the early postoperative period after heart transplantation. Dynamic testing using volume-expansion to increase cardiac filling pressures was performed to determine changes in alpha atrial natriuretic peptide, renin, aldosterone, and vasopressin secretion in response to a physiologic stimulus. Volume expansion was performed on five heart transplant patients each day from postoperative day 1 to postoperative day 5. Alpha atrial natriuretic peptide, renin, aldosterone, and vasopressin plasma levels were assessed by radioimmunoassay before and during the 6 hours after the beginning of infusion. No significant changes in the secretion of any of the various hormones studied were found after volume expansion. Moreover, we found that heart transplant recipients were unable to increase water and sodium renal excretion after volume expansion. The physiologic decrease in vasopressin release after volume expansion appears to be altered by graft denervation. Furthermore, persistently elevated alpha atrial natriuretic peptide plasma levels at rest despite improved patient hemodynamic status and the absence of enhanced hormone secretion after a physiologic stimulus are in favor of an intrinsic hypersecretion of this hormone. Moreover, the absence of an appropriate renal response could be a major consequence of both the lack of further increased alpha atrial natriuretic peptide secretion and the heart denervation resulting from transplantation. This blunted renal response should be taken into account when managing patients in the early period after transplantation.

Aldosterone↗