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Biomedical subjects

G Tommasini

Publications and source records attributed to G Tommasini.

34 records · Page 2Linked to original sources
PubMed1981

Congenital mitral stenosis. Anatomical and functional assessment by echocardiography.

Digitised left ventricular echocardiograms were studied in nine children with congenital mitral stenosis to assess the severity of inflow obstruction. In six children the two prime indices of mitral stenosis were abnormal, with a prolonged time from minimum dimension to 20 per cent dimension change and a reduced peak dimension change during diastole. In three, however, these values did not suggest inflow obstruction, depsite significant gradients at cardiac catheterisation. Two-dimensional echocardiography was performed in 10 children with congenital mitral stenosis to determine the mitral annular size and the morphology of the valve and subvalvular apparatus. The annular size and number of papillary muscles could be assessed along with the detection of combined mitral abnormalities. Two-dimensional studies can reliably delineate the type of mitral abnormality, and should be performed in all cases with congenital heart disease having a high incidence of associated left ventricular inflow obstruction. Digitised M-mode left ventricular echocardiography is in general unreliable in assessing congenital obstruction, though it may be of some value in individual cases.

Adolescent↗
PubMed1981

Two-dimensional echocardiographic assessment of common atrioventricular valves in univentricular hearts.

Twelve patients with univentricular heart and common atrioventricular valve were identified by two-dimensional echocardiography. Seven had an ostium primum atrial septal defect and five a common atrium. The common atrioventricular valve had the appearance of a free floating anterior leaflet flanked by two lateral leaflets. The position of the rudimentary chamber in relation to the atrioventricular valve was posterior in six and anterior in two; no chamber was identified in four. Two-dimensional echocardiography provides a reliable method for the identification of common atrioventricular valve in univentricular heart.

Child↗
PubMed1981

Detection and assessment of straddling and overriding atrioventricular valves by two dimensional echocardiography.

Sixteen patients with a straddling tricuspid and two with a straddling mitral valve were identified by two dimensional echocardiography. In all but one the atrioventricular valves appeared at the same level, indicating absence of the ventriculoatrial septum. A straddling valve was diagnosed by identifying subvalvular apparatus from one atrioventricular valve in both chambers, independent of whether they were ventricles or rudimentary chambers. Further confirmation was obtained during real time study where the valve leaflets appeared to fly through the ventricular septal defect. Overriding of the valve annulus was greater than 50% in 12 and less than 50% in five, with one other patient having none detectable. The relation of the central fibrous body to the tip of the interventricular septum was reliable in assessing overriding of greater than 50%, but where it was less than 50% other views were necessary to detect its presence. The diagnosis of straddling with or without overriding of an atrioventricular valve can be reliably made by two dimensional echocardiography, and carries important implications relating to the type of surgical intervention possible, and in those with a straddling tricuspid valve, the position of the atrioventricular node.

Echocardiography↗
PubMed1981

Assessment of total anomalous pulmonary venous connection by two-dimensional echocardiography.

Twenty-three patients with total anomalous pulmonary venous connection were studied by two-dimensional echocardiography. In all cases the diagnosis was made before invasive procedures, with surgical or angiocardiographic confirmation. Eleven patients had supracardiac drainage (three to the coronary sinus, two to the right atrium,) and seven had infracardiac drainage. In the majority of cases the precise pattern of drainage could be identified by combining suprasternal, praecordial, and subcostal views. In 12 cases where the suprasternal cut was used a pulmonary venous confluence could be identified, having a cross-like structure in nine, with three others appearing as a dilated channel behind and separate from the left atrium. Thus, two-dimensional echocardiography reliably makes the diagnosis of total anomalous pulmonary venous connection and in the majority the precise pattern of drainage can be determined.

Echocardiography↗
PubMed1979

PRediction of infarct size by enzymatic techniques: modification of a method and clinical application.

In an attempt to develop improved methods of prediction of infarct size by enzymatic methods, Shell's original algorithm has been critically evaluated in an unselected series of patients. Poor performance of the model is partly the result of a systematic source of error associated with its mathematical formulation. A new model devoid of such limitations has therefore been developed. Residual deviations between predicted and observed CK release seem to be related to frequent and unpredictable extensions of infarction which could be verified by independent clinical, electrocardiographic, and enzymatic criteria. The modified model may possibly be applied to the evaluation of agents aimed at limiting the spread of irreversible injury.

Clinical Enzyme Tests↗
PubMed1978

[Long term electrophysiological study on patients with acute myocardial infarction and complete heart block. Is cardiac pacing always necessary? (author's transl)].

UNLABELLED: Of 335 consecutive patients (pts) admitted to the coronary care unit (CCU) for acute myocardial infarction (AMI), 34 (10%) evidenced complete heart block (HB). The overall inhospital mortality was 14% (47 pts) versus 39% of the HB group (13 pts). No previous conduction disturbances were documented in 58% of pts before appearance of complete HB. Complete HB was preceded in 52% of pts by first or second degree HB or bundle branch block. Of 21 pts with HB discharged from the hospital, 5 (23%) died between 5 and 24 months (mean 12): no patients had sudden death; 16 pts (76%) are still alive after 13 to 45 months (mean 30). His bundle electrophysiologic (HBE) study was performed in 10 pts of the HB group after 4 to 40 months: 4 pts with anterior versus 6 with inferior AMI. Conduction disturbances were no longer present in all but one pt who had H-V 60 msec. Ajmaline (50 + 50 mg iv) prolonged A-H over 130 msec in 4 pts; H-V was not significantly increased in 8 of the 10 pts, while in two pts was 100 msec. One pt in the acute phase and one pt 12 months later, required pacemaker (PM) implant (both had inferior MI). IN CONCLUSION: no sudden death was documented during the follow-up period. The late HBE study, before and after ajmaline, did not allow to recognize critical conduction abnormalities suggessting prophylactic PM implantation.

Adult↗
PubMed1977

[CK MB versus total CK in the estimation of myocardial necrosis. Comparative kinetic analysis and evaluation of an immunological method].

It has been suggested that the adoption of a relatively specific marker of the myocardial cell, such as creatine kinase MB isoenzyme, can yield improved accuracy in estimating infarct size by serial serum sampling and compartmental analysis. Nevertheless, current methods for the evaluation of isoenzyme activity are cumbersome and unsuitable for clinical use. We have therefore employed a new test for the rapid determination of CK MB activity, based on the immunological inhibition of M subunities. In 19 patients not submitted either to intramuscular injection or to repeated defibrillations, a good correlation was found between indexes of necrosis based on MB and total CK determination (r = 0.94), with the cumulative MB release amounting to 16 +/- 4% of total CK. Significant differences were observed in 3 patients submitted to external cardiac massage (MB = 9 +/- 1% of total CK) thus suggesting a considerable extracardiac source of total CK due to the trauma of the skeletal muscle. The comparative kinetic analysis shows substantial differences between the two isoenzymes, not only concerning the greater disappearance rate of CK MB but, more significantly, related to a faster release of this isoenzyme from the myocardium, which has not been previously reported. The good correlations found between maximal appearance rate and cumulative enzyme release (r = 0.86) suggest that the former may represent an index of the rate of degradation of cellular membranes. Practical implications of these data are discussed.

Creatine Kinase↗
PubMed1977

["Pericarditis epistenocardica" as as a marker of extensive myocardial infarction. Clinical, electrocardiographic and enzymatic study (author's transl)].

Pericarditis may complicate the early phase of myocardial infarction (MI). It occurs when necrosis involves the epicardial surface. To verify if pericarditis may be regarded as a marker of extensive MI, 60 patients with anterior or inferior MI admitted to the Coronary Care Unit within 6 hours from onset of symptoms, were studied by clinical, electrocardiographic and enzymatic parameters. 20 patients developed left ventricular failure (LVF) assessed by clinical, radiologic and hemodynamic indexes (15 mmHg has been considered the upper normal value for mean wedge pulmonary pressure). 9 of the 11 patients with pericarditis (PP) had LVF, versus 11 of the 49 non PP group (P = 0.002). Life threatening arrhythmias (ventricular tachicardia and fibrillation) appeared in 5 of the 11 PP versus 7 of the 49 non PP group (P = 0.04). No significant difference has been found between the two groups concerning the inhospital mortality. In a follow-up of 3 to 18 months, no difference in mortality was observed, while the functional recovery in the PP group was significantly worse (I and II versus III and IV New York Heart Association classes P = 0.003). Higher sigmaST values were found in precordial maps of the PP group, on admission (P = 0.03). After a deep spontaneous fall, sigmaST showed a reelevation which was similar in the two groups. SigmaR showed a greater % decrease however not statistically significant in PP. Creatinekinase enzymatic infarct size was significantly higher in PP group (P = 0.0002). It is concluded that pericarditis is a clinical marker of extensive MI and may be useful in evaluating prognosis and effectiveness of therapeutic interventions in MI.

Adult↗
PubMed1976

[Precordial mapping and enzymatic analysis for estimating infarct size in man. A comparative study (author's transl)].

To investigate the relationships between electrocardiographic and enzymatic indexes of infarct size (I.S.), a group of 19 patients with anterior infarction was studied by serial precordial mapping and CPK curves analysis. The time course of ST and QRS changes was examined and a sharp, spontaneous fall of sigmaST was shown to occur within 10-12 hours after onset of symptoms, followed by a gradual rise. sigmaST on admission appears to be a poor predictor of subsequent enzymatic I.S. (r=0.49). Good correlations with I.S. were observed, for sigmaST at 48-96 hours (r=0.82) and, especially, for the percent decrease of sigmaR, with respect to the initial values (deltaR%), (r=0.94).

Adult↗
PubMedDate not supplied

[Computerized tomography of the skull in children with lymphoblastic leukemia treated with prophylactic cranial radiation].

Thirty asymptomatic patients with acute lymphoblastic leukemia who had received prophylactic cranial irradiation (16 pts had 2400 cGy, 14 pts 1800 cGy) and intrathecal methotrexate were studied by computed tomography of the brain 60 to 148 months after initiation of prophylaxis. Three of 30 (10%) patients presented abnormal findings: widening of frontal subarachnoid space (1 patient), little area of decreased attenuation coefficient (1 patient), and intracerebral calcifications (1 patient Tomography abnormalities could be detected either in patients treated with 2400 cGy and in those treated with 1800 cGy. None of our patients showed central nervous system dysfunctions on physical examination. The results of our study suggest that tomography findings have a poor clinical significance.

Adolescent↗
PubMedDate not supplied

[Enoximone in weaning from mechanical circulation support in pediatric patients].

OBJECTIVE: To assess and record the response to continuous infusion of the phosphodiesterase inhibitor enoximone during weaning from mechanical circulatory support (MCS) and to verify the possibility of success with this indication in pediatric patients. DESIGN: Retrospective study. SETTING: Pediatric cardiac surgery intensive care unit. PATIENTS: Two pediatric patients operated for complex congenital heart disease with low cardiac output syndrome in the immediate postoperative period, evolved in cardiocirculatory arrest despite massive inotropic pharmacological support, and then assisted by mechanical circulatory support. INTERVENTIONS: Weaning from mechanical circulatory support with continuous infusion of enoximone, only in one case preceded by a loading dose and associated with catecholamine infusion. MEASUREMENTS AND MAIN RESULTS: During weaning hemodynamic parameters (LAP, CVP, MAP, HR), SvO2, diuresis, rectal and cutaneous temperatures were assessed and recorded. A serial echocardiographic assessment of left ventricular systolic and diastolic diameters and ejection fraction (EF%) has also been performed every 12 hours. Weaning from MCS using enoximone as inotropic support was possible in both cases. CONCLUSIONS: Enoximone proved to be useful in weaning from MCS in two pediatric patients, despite the difficulty to assess its effect in one of the two cases in which enoximone was used together with high dosages of other inotropic drugs. These initial positive results urge us to further investigate applications of this drug in pediatric patients.

Assisted Circulation↗