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Biomedical subjects

G Specchia

Publications and source records attributed to G Specchia.

At least 235 records · Page 13Linked to original sources
PubMed1983

Variable threshold exertional angina in patients with transient vasospastic myocardial ischemia. Repeat exercise test results and therapeutic implications.

Thirty-five of 70 patients with vasospastic angina at rest complained of chest pain during exercise or during usual daily activity. In 22, the angina threshold was described as variable during exercise: that is, the amount of exertion that induced angina was not always the same. In 12 patients with variable threshold exertional angina, 3 exercise tests performed in the morning on different days yielded different results, because chest pain and ischemic electrocardiographic changes occurred at different work loads with a wide range in heart rate-systolic pressure product. Two patients, in whom great cardiac vein flow was measured during exercise before and after taking nifedipine, tolerated heavier work loads after receiving the drug, with a more marked increase in flow during exercise. It is concluded that variable threshold exertional angina can be objectively demonstrated by repeat exercise tests in patients with vasospastic angina. Variability of the angina threshold may be due to a functional mechanism that causes myocardial ischemia in addition to the increased myocardial metabolic requirements provoked by exercise. Because in such patients fluctuations in coronary arterial tone play an important role in determining the response to exercise, calcium antagonistic drugs, which lower coronary tone and prevent the occurrence of coronary spasm, are effective in increasing exercise capacity.

Adult↗
PubMed1983

Efficacy, duration and mechanism of action of nifedipine in stable exercise-induced angina pectoris.

The duration of effect of single oral doses of 10 and 20 mg of nifedipine was studied in 10 patients with angiographically proven coronary artery disease and with stable exercise-induced angina pectoris. In a randomized double-blind manner exercise tests were carried out 1 hour before and 1, 2, 4 and 6 h after the administration of placebo, nifedipine 10 mg(N10) and nifedipine 20 mg(N20). Compared with the placebo both N10 and N20 produced a statistically significant increase in exercise tolerance at 1(P less than 0.05), 2(P less than 0.01), 4(P less than 0.01) and 6(P less than 0.05) hours after N10 and at 1(P less than 0.01), 2(P less than 0.01), 4(P less than 0.01) and 6(P less than 0.05) hours after N20. At peak exercise the product of heart rate X systolic blood pressure (RPP) was significantly increased compared with placebo at 2, 4 and 6 h after N10 and at 2, 4 and 6 h after N20 with maximal ST-segment depression unchanged. At the same duration of exercise at which angina had occurred during control studies the RPP was unaffected by nifedipine while a statistically significant reduction of ST-segment depression was seen at 1, 2 and 4 h after N10 and at 1, 2 and 4 h after N20. Direct measurements of great cardiac vein flow during exercise in two patients showed that nifedipine is effective in preventing the abnormal increase of exercise-induced coronary tone in the area supplied by stenotic vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Effects of nifedipine on coronary hemodynamic findings during exercise in patients with stable exertional angina.

To investigate the mechanism by which nifedipine improves exercise tolerance in patients with coronary artery disease, we studied 14 patients with stable exertional angina and left anterior descending artery disease by measuring great cardiac vein flow (GCVF) and calculating anterior regional coronary resistance (ARCR) during exercise before and after sublingual administration of 20 mg of nifedipine. After nifedipine seven patients (group I) had no increase in exercise capacity and showed a similar magnitude of ST segment depression at peak exercise, while another seven patients (group II) had prolonged exercise duration (p less than .001) with less ST segment depression at peak exercise (p less than .01). Such effects were achieved despite a significant increase in double product, an indirect index of myocardial oxygen consumption. In group I patients no significant change was induced by nifedipine in GCVF or in ARCR either at rest or at peak exercise. In contrast, in group II patients nifedipine significantly increased GCVF at rest (p less than .05) and at peak exercise (p less than .001). Moreover, resting ARCR was decreased (p less than .01) and remained significantly lower at peak exercise (p less than .01) compared with the prenifedipine values. These data show that nifedipine may increase GCVF and decrease ARCR at rest and at peak exercise in patients with left anterior descending artery disease. Such increase in myocardial oxygen supply seems the most likely mechanism by which nifedipine may improve exercise capacity in patients with stable exertional angina.

Adult↗
PubMed1983

[Hypotensive response to the exercise test after recent myocardial infarct: prognostic implications].

The incidence and the prognostic value of exertional hypotension was studied in 488 consecutive patients admitted to the Montescano Rehabilitation Center after acute myocardial infarction. During a symptom-limited bicycle ergometric test performed 28 to 60 days after acute myocardial infarction 33 patients (6.8%) showed exertional hypotension. These patients were grouped according to effort S-T segment modifications: Group A (n = 13) with S-T segment depression in ECG-leads without Q waves; Group B (n = 11) with S-T segment elevation in leads where Q waves were present; Group C (n = 9) with no exercise S-T changes. Group B patients had a larger infarct size by ECG criteria and a lower maximal work capacity at the functional stress test. The follow-up of the patients after discharge was 28.3 +/- 13.2 months. During rehabilitation and follow-up, 2 patients of Group B died and 5 suffered an acute pulmonary oedema; 3 patients of Group A and 1 of Group B had angina at rest. Group C patients had no complications. Thus, exertional hypotension and S-T elevation appear to be predictive of future cardiac event.

Exercise Test↗
PubMed1982

Dipyridamole test in angina pectoris: diagnostic value and pathophysiological implications.

The value of the dipyridamole test (0.75 mg/kg i.v.) in the diagnosis of angina pectoris was studied in 54 patients with angina pectoris (35 with angina on effort associated or not associated with rest angina and 19 with angina only at rest) and in 12 control subjects. The test induced electrocardiographic signs of ischemia (positive test) in 74% of patients with angina on effort, while it was negative in all cases with angina only at rest and in control subjects. All anginal patients with normal coronary arteries or less than 50% stenosis had a negative test; a positive response was observed in 36, 79 and 60% of cases with one-, two-or three-vessel disease, respectively. Hemodynamic changes with a marked arteriolar vasodilatation were observed both in the negative and in the positive tests. In the positive tests no significant change of double product, blood pressure and left ventricular end-diastolic pressure occurred before ischemia appeared. The results of the study show that dipyridamole as a diagnostic test in angina pectoris has a high specificity but a lower sensitivity than exercise test. The hemodynamic and eletrocardiographic findings in the positive tests suggest that dipyridamole-induced ischemia is due to a flow maldistribution with selective subendocardial ischemia secondary to the coronary arteriolar dilatation caused by the drug.

Adult↗
PubMed1982

[Electrophoretic mobility in acute null cell lymphoblastic leukemia].

The electrophoretic mobility (E.M.) (evaluated by cytopherometer) of human normal lymphocytes, shows a group of cells with a fast mobility, identifiable as T lymphocytes, and a second group with a slow mobility which can be characterized as B lymphocytes. Six cases of Acute Lymphoblastic Leukaemia characterized by negativity of immunological markers and classified as "Null Cells", and ten cases of B cell Chronic Lymphocytic Leukaemia were studied in order to investigate the E.M. behaviour of leukaemic cells and so a comparison with T and B normal lymphocytes migration. The blasts of Acute Lymphoblastic Leukaemia show a E.M. nearly similar to the fast group of normal lymphocytes, while lymphocytes of the B cell Chronic Lymphocytic Leukaemia migrate as the slow component of normal lymphocytes. The possibility of the utilization of cell E.M. in addition to immunological and cytochemical data, into the characterization of Acute Leukaemias is suggested.

Adolescent↗
PubMed1982

In vitro studies of anti-inflammatory activity of carprofen.

In vitro activity of carprofen on some cellular mechanisms of the inflammatory response has been investigated in comparison with hydrocortisone and ibuprofen. The drugs were studied in two ways: (a) by adding progressive concentrations ranging from 0.1 to 1000 micrograms/ml to triplicate cell samples, for the determination of the dose/response curve, and (b) by using a fixed concentration to study the variations in the effect of the different drugs. The results obtained showed that carprofen was able to exert a dose-dependent inhibition on neutrophil phagocytosis and particularly on their chemotaxis. Its activity was higher than that observed with ibuprofen and almost comparable with that of hydrocortisone. These results suggest that anti-inflammatory activity of carprofen is probably performed through a dose-dependent inhibition of some neutrophil-macrophage function.

Adult↗
PubMed1981

Treatment of vasospastic angina pectoris at rest with nitroglycerin ointment: a short-term controlled study in the coronary care unit.

The effectiveness of nitroglycerin ointment in vasospastic angina pectoris at rest was evaluated in 10 patients selected for study. The study was performed after a 24 hour control period, and a randomized single-blind crossover experimental design was followed. Two percent nitroglycerin ointment (15 mg) or placebo ointment was administered every 6 hours for a period of 48 hours each; the first treatment period was followed by a second in which each preparation was used for a 24 hour period. All patients were hospitalized in the coronary care unit; an objective evaluation was carried out using a multichannel electrocardiographic recording to assure recognition of the painless ischemic episodes. Coronary angiography showed critical stenosis of one or two vessels in 9 of the 10 patients; spasm was demonstrated in 3. Results of the ergonovine test were positive in nine of nine patients. Nitroglycerin ointment produced a significant reduction in the mean daily number of episodes during the first (12.5 +/- 3.9 versus 0.5 +/- 0.4, p less than 0.02) as well as the second treatment period (10.6 +/- 3.8 versus 0.6 +/- 0.4, p less than 0.02). These results demonstrate that nitroglycerin ointment provides effective, long-lasting protection against angina due to coronary spasm.

Adult↗
PubMed1981

Variable threshold of angina during exercise: a clinical manifestation of some patients with vasospastic angina.

Two patients complained of chest pain while at rest and during physical activities. However there seemed to be no direct relation between exertional angina and an increasing level of work performed, indicating that these patients had a variable threshold of angina during exercise. In one patient spontaneous chest pain was associated with transient S-T segment changes in precordial leads, and during coronary arteriography the administration of ergonovine induced spasm of the left anterior descending coronary artery. The other patient showed S-T segment elevation in inferior leads during an ergonovine-induced anginal attack and coronary arteriography revealed a spontaneous spasm of the right coronary artery. In both patients repeated exercise tests yielded different results, because the chest pain and S-T segment depression occurred at different work loads with large differences in heart rate-systolic blood pressure product. It is concluded that a variable threshold of angina during exercise is a clinical manifestation in some patients with vasospastic angina and is probably due to the difference in coronary arterial tone at the onset of exercise.

Angina Pectoris↗