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Biomedical subjects

L Irace

Publications and source records attributed to L Irace.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Considerations on the pathogenesis, diagnosis and therapy of renal venous aneurysm].

An aneurysms of a renal vein is very uncommon an entity and even more so when a visceral vein is affected. The venous aneurysms are generally asymptomatic and are detected either at post-mortem examination or by Echography, CT scan or MR investigation. Occasionally they become symptomatic because of rupture, thrombosis and embolism, but even in those cases they are difficult to be diagnosed and can be life threatening particularly when bleeding occurs. Exceptionally an aneurysm of a visceral vein is an unexpected intraoperative finding and is detected during an abdominal procedure undertaken for other pathology. In our experience a true aneurysm of the main trunk of the left renal vein was detected during a procedure of aorto-bifemoral by-pass graft repair for chronic aorto-iliac occlusive disease. The aneurysm was resected and the vein repaired by direct suture. Congenital weakness of the vein wall was very likely the cause as suggested by the extreme thinness and media atrophy of the aneurysm and normal appearance of the wall of renal vein and inferior vena cava. Differences between varices and aneurysms of the renal veins are discussed as well as indications for surgical treatment.

Aneurysm↗
PubMed1994

[Cardiovascular adaptation to the stress test in subjects with Cooley's disease].

Thalassaemia major determines an impaired effort tolerance because of a condition of severe anaemia, progressive left ventricular dysfunction, pulmonary circulation compromise. The aim of our study is to evaluate haemodynamic response to exercise in thalassaemic patients without clinical features of heart failure. We have selected 13 patients affected by thalassaemia major (Thal+; 10-18 years). Each patient was transfused when haemoglobin values were < 9-9.5 g/dl and was treated with desferrioxamine (40 mg/kg sc) when serum ferritin values were > 2,000 ng/ml. Thal+ patients were compared with normal subjects (Thal- 10-16 years). No patient assumed hypotensive therapy, no had familiar history of hypertension. Both groups have undergone an ergometric stress test at the cycloergometer, with increase of 25 W every 2 min, up to the reaching of the maximum age-related heart rate, or up to muscle exhaustion or unbearable dyspnea, followed by a 10 min recovery phase. The following parameters were taken in consideration: systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), the product of the heart rate by the systolic blood pressure (DP), at rest, at the maximum common work (MCW), at maximum stress and in the recovery phases. At rest, only DP showed significant differences between the two groups: in Thal+ patients higher than in Thal- (p = 0.045). At the MCW, Thal+ patients had SBP (p = 0.019), DBP (p = 0.01), HR (p = 0.035) and DP (p = 0.003) higher than Thal- patients. At maximum stress only DBP showed significant differences in Thal+ patients (p = 0.019), although Thal+ patients achieved lower levels of workload (p = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗
PubMed1994

[Arterial pressure in obese subjects during ergometric stress test and recovery].

In obesity, the systemic resistances (SR) are reduced while the blood volume is increased. The rise of cardiac output (CO), stress-induced, produces an increase in blood pressure (BP), as an hypertensive behavior of the stress-response. The aim of our study is to evaluate if, in obese subjects, the considerable increase of BP is more related to the rise of CO than to the rise of SR. For this reason we studied the behavior of BP through indexes derived from the ratio of SBP values at the 1st, 3rd, 5th, 10th minutes of the recovery by the SBP value at the acme of stress. These indexes are under neurovegetative control, and were shown to be impaired in hypertensive pts. The results of ergometric stress test (EST) of 37 obese subjects (Ob+) (27 males and 10 females, mean age 46.2 +/- 7.3 years), determined according to Lorentz's formula, was compared with the parameters deduced from the EST of 18 normal subjects (Ob-) (13 males and 5 females, mean age 36.7 +/- 8.5). The exercise showed an increase, more pronounced in Ob+ subjects, of SBP and DBP, and this also persisted in the recovery phase. Although BP was significantly higher in the Ob+group, the SBP indexes did not differ in the two groups. Then, from these data it can be deduced that, although during EST in obese subjects there is an absolute increase of BP and this persists in the recovery phase, the behavior of this parameter probably cannot be related to alteration of neurovegetative system as demonstrated by the normal SBP indexes.

Adult↗
PubMed1993

[The stress test in adolescents with and without a family history of arterial hypertension: the prognostic role of a systolic arterial pressure index].

A family history of hypertension can influence the behaviour of blood pressure during ergometric stress test (EST) in normotensive subjects, so that it is also used in the assessment of risk of hypertension. To evaluate the relationship between parental history and blood pressure values during exercise, 57 consecutive adolescents (aged 10-16 years) were studied. Out of them, 25 patients have not been considered because of the presence of organic pathologies of various nature that could interfere with the pressure behaviour. All patients underwent EST with a load increase of 25 W every 3 min until the maximal age-related heart rate. The patients were divided in 2 groups based on the presence (PH+ 13 patients, mean age 13 +/- 2 years) or on the absence (PH- 19 patients, mean age 13 +/- 2 years) of parental history of hypertension. No difference in body surface and maximum workload was observed between the 2 groups. Exercise test induced an increase in systolic blood pressure (SBP) both in PH- and PH+ patients, but no significant differences were found in any stage of the exercise in the 2 groups. Maximum heart rate (HR) was not different in the 2 groups and diastolic blood pressure (DBP) was substantially unchanged during exercise. The variation of SBP (delta SBP) between maximum stress and first, third, fifth and tenth min of the recovery phase were considered. Besides, 4 SBP indexes were deduced from the ratio of SBP values at the first, third, fifth and tenth min of the recovery by the SBP value at the acme of stress.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

External carotid artery repair in cerebrovascular insufficiency.

From January 1985 to October 1992 ten patients were submitted to reconstruction of the external carotid artery (ECA). Nine were males and one female with age that ranged from 64 to 74 years, mean 68. All were symptomatic due to TIAs in seven and amaurosis fugax in four of this group, previous completed stroke plus TIAs in two and chronic low perfusion in one. Associated risk factors were smoking (8 pts: 80%), coronary disease (5 pts: 50%), hypertension (4 pts: 40%), diabetes (4 pts: 40%) and peripheral arterial obstructive disease (2 pts: 20%). All patients were submitted to non invasive (Doppler C. W., Echo-color Doppler) studies as well as angiography. All the patients had an occlusion of the internal carotid artery (ICA) unilateral and homolateral to external carotid stenosis in 8 and bilateral in 2; in addition three patients had a non haemodynamic stenosis of the contralateral ICA. One patient had an occlusion of the common carotid artery with collateral supply to the ECA; nine had severe stenosis of the ECA at the origin. In one case a homolateral vertebral stenosis was detected as well as a prevertebral contralateral subclavian stenosis in another one. Surgery was advised to correct amaurosis fugax, to increase external-internal collateral supply in order to avoid cerebral ischaemia and prior to contralateral ICA endarterectomy. All patients were operated upon under general anesthesia; an endarterectomy with a PTFE patch was performed in 9 cases, while in one a subclavian-ECA bypass was carried out using an autologous vein segment.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

[ST elevation during ergometric test: correlation with coronary angiography].

BACKGROUND: ST elevation during ergometric stress test (EST) is relatively rare. Its prevalence depends upon the tested population but occurs more frequently in patients who have had myocardial infarction or variant angina. This phenomenon is very rare in patients with typical exertional angina and its pathogenesis is still unclear. MATERIAL AND METHODS: We studied a group of 75 consecutive patients with exertional angina who underwent EST and coronary angiography. A symptom limited EST was performed in the upright position on a cycloergometer with load increases of 25 watts every 3 minutes and 12 leads were monitored during all test. Coronary angiography was performed according to Judkins technique. From these patients, according to Froelicher's criteria, a group of 49 patients (age 32-68, mean 51.6 years), without myocardial infarction and/or left ventricular asynergy, was selected. RESULTS: All patients had a coronary artery disease (16 patients with 3 vessels, 11 patients with 2 vessels and 22 patients with 1 vessel disease). The EST was positive for ST depression in 31 patients (63.3%) and for ST elevation in 5 patients (10.1%), while 13 patients (26.6%) had a non diagnostic EST. The ST elevation occurs in V1-V2 and it was associated in all cases with a stenosis in the left anterior descending (LAD) artery. Therefore we divided the 19 patients with LAD stenosis into two subgroups: subgroups A (9 patients, mean age 49.6 years) with LAD stenosis > or = 90% and subgroups B with LAD stenosis between 70% and 90%. ST elevation occurs in 5 patients (55.5%) of subgroup A and in no patient of the subgroup B. Moreover, in the subgroup A ST elevation seems to be related to the anatomic localization of the stenosis: in fact it appears in 83.3% of patients with LAD stenosis located before the onset of the first diagonal branch. CONCLUSIONS: From these data it can be desumed that ST elevation in V1-V2 that occurs in patients with exertional angina and without myocardial infarction or variant angina is strongly predictive of a very important LAD stenosis.

Adult↗
PubMed1993

[Effect of cilazapril therapy on diastolic filling and left ventricular hypertrophy in patients with arterial hypertension].

BACKGROUND: Of the main aspects of hypertension, left ventricular hypertrophy and appearance of cardiac dysfunction seem to be the most common and to produce an early and severe cardiac deterioration. Even in the presence of normal systolic function diastolic filling abnormalities are described. The efficacy of many antihypertensive drugs to decrease blood pressure and to reduce left ventricular hypertrophy has already been demonstrated. Cilazapril is a new ACE-inhibitor that in previous studies showed a very important antihypertensive effect. To assess its capacity, in long-term treatment, to reduce left ventricular hypertrophy we performed a prospective study on patients with mild hypertension. MATERIAL AND METHODS: Nineteen patients (aged 48 +/- 15 years) with mild hypertension (mean arterial pressure automatically recorded for 24 hours with blood pressure ambulatorial monitoring) were treated with cilazapril (5 mg/day) for 1 year. Doppler echocardiography was performed: at the beginning, after 6 months and after one year of therapy. The following parameters were evaluated: interventricular septal and posterior wall thickness, LV end-diastolic diameter, LV mass index, early (E) and late (A) diastolic filling flow velocities and the ratio E/A. RESULTS: A significant decrease was observed in mean arterial pressure (from 130 +/- 14 mmHg at beginning to 102 +/- 11 mmHg at six months of therapy and to 103 +/- 9 mmHg at one year of therapy). A significant reduction in LV hypertrophy and an improved diastolic filling pattern of the left ventricle was shown after six months of therapy with cilazapril; this improvement still remained after 1 year of therapy. CONCLUSIONS: In this study antihypertensive efficacy of cilazapril has been confirmed. Moreover, in long treatment, cilazapril has been useful to reduce left ventricular hypertrophy and to improve diastolic filling without significant side effects.

Adolescent↗
PubMed1992

[Mid-term clinical study of the effectiveness of and tolerability to simvastatin ++ in dyslipidemic patients].

The HGM-CoA reductase inhibitors, blaking up intracellular synthesis of cholesterol, support the receptorial captation of cholesterol with a reduction in plasma levels. The simvastatin efficacy was evaluated in 12 patients, mean age 59 +/- 10 years with a primary hypercholesterolemia. All the patients were on a pharmacologic wash out for at least 6 weeks and dietetic treatment (according to their weight and daily needs) for a week. Total cholesterol, HDL-cholesterol and triglycerides plasma levels were taken at time 0. Then a treatment with simvastatin 10 mg/die was begin for 4 weeks and than increased to 20 mg in patients with plasma cholesterol > 200 mg/100 ml at the end of fourth week. In some patients the dose was increased up to 40 mg for the elevated levels of plasma cholesterol at the end of the second month. All the parameters above were controlled monthly for three months. A control was performed at the end of sixth month of treatment. After 4 weeks treatment, simvastatin induced reduction in cholesterol plasma levels (p < 0.005), that continued during the whole time treatment (228 mg/dl at 24 week, p < 0.005 vs basal). The mean dosage of the simvastatin at fourth month was of 25 mg/die. During the treatment an increase of HDL plasma levels was noted, but this increment wasn't statistical significant (40 +/- 7 vs 45 +/- 9 mg/100 ml). No significant impairment of principal metabolic and laboratory parameters were observed during the treatment. These data indicate that simvastatin in small dose induce a reduction in cholesterol plasma levels with a significant increase in HDL without side effects.

Adult↗
PubMed1991

Aorto-iliac/femoral reconstructions in patients with vasculogenic impotence.

One hundred and forty-eight patients out of 386 undergoing aorto-iliac or aortofemoral bypass had preoperative impotence, 37 of these were diabetics. In all of them Doppler studies revealed a penile/brachial pressure index less than 0.6 and an abnormal waveform analysis. Nocturnal penile tumescence was investigated in 44 cases and found to be abnormal. Angiography showed unilateral or bilateral obstructive lesions of the hypogastric arteries in 80%, in addition to aortic, common and external iliac and femoral lesions. One hundred and thirty patients (87.8%) had straight aorto-iliac/femoral bypass grafts inserted without a direct attempt to revascularise the hypogastric arteries but 24 had distal anastomoses to the bifurcation of the common iliac artery. In the remaining 18 patients the hypogastric artery was reconstructed on one side by an additional bypass or reimplantation on the graft. In 22 of 106 patients (20.7%) undergoing aortofemoral bypass, 18 of 24 (75%) with the distal anastomosis to the iliac bifurcation, and 14 of the 18 (77.7%) with revascularisation of the hypogastric arteries, erectile function was regained. A good result was obtained in only five of the diabetic patients (13.5%). Our experience suggests that: (1) impotence, as indicated by non-invasive investigations, was vasculogenic in origin since patients with the most effective revascularisation of the hypogastric arteries had the best results; (2) when it is feasible, revascularisation of the hypogastric arteries should be carried out more often, during the aorto-iliac or aortofemoral reconstructions, particularly in younger impotent patients; (3) aorto-iliac revascularisation restores potency in only a few diabetic patients.

Aorta, Abdominal↗
PubMed1991

[Cardiovascular adaptation during cycloergometric exercise test in insulin-dependent diabetics with or without autonomic cardiopathy].

Sixty patients with type I diabetes mellitus underwent an ergometric stress test (EST) to evaluate the relationship between cardiac autonomic neuropathy (CAN) and hemodynamic changes during EST. All patients were divided into 2 groups: in the Group A were included 26 patients (mean age 43 +/- 9 years) with impairment of 2 or more autonomic tests according to Ewing (patients with CAN) and in the Group B were included 34 patients (mean age 38 +/- 13 years) without CAN. The EST was symptom-limited and performed with load increases of 25 W every 3 min. No positive EST were observed in both groups. Heart rate (HR) at rest and systolic blood pressure (SBP) at maximum common workload were significantly higher in Group A than in Group B. Moreover, a significant linear correlation was found between a CAN score and SBP x HR product at rest and at maximal workload. These findings are correlated with increased sympathetic activity due to a parasympathetic impairment. The data show the relationship between hemodynamic changes during EST and the Ewing test used in the diagnosis of CAN.

Adaptation, Physiological↗
PubMed1990

[Systemic effects of intravenous dipyridamole in patients of various age groups].

Aim of this study was to assess the role of age-related vascular response in the onset of i.v. dipyridamole effects. The results of 129 patients who underwent a dipyridamole infusion were reviewed. The patients were divided into three according to age: 47 patients of less than 50 years (group I), 54 patients aged between 50 and 60 years (group II) and 28 patients of more than 60 years (group III). For each group heart frequency (HF) and systolic blood pressure (SBP) were considered in basal conditions, at the end of infusion and at the minimum value of SBP (SBP min); moreover the time in reaching SBP min was considered (time to SBP min). At the end of the infusion no significant changes in SBP were observed in all groups while the SBP min value reached from group III were significantly lower than basal (142.6 +/- 20.4 mmHg, p less than 0.02). The HF, without significant differences among the three groups in basal conditions, increased significantly at the end of infusion only in group I and II, with a more significant increase in group I at the time of SBP min with respect to groups II and III. The group 3 showed moreover, a significant longer time to SBP min (286 +/- 208 sec) respect to the group I and II (145 +/- 130 and 160 +/- 177 sec respectively) (p less than 0.02). From these data it can resume that age could be a factor to determine hemodynamic response to intravenous dipyridamole.

Adult↗
PubMed1989

[Clinical usefulness of the Doppler-echocardiographic method for evaluating intracardiac shunts. Combined Doppler and hemodynamic study].

The purpose of this study was to assess the accuracy of a quantitative two-dimensional Doppler echocardiographic method for estimating systemic and pulmonary blood flows in atrial and ventricular septal defects. Twenty-eight patients (mean age 22 +/- 14), with atrial septal defect (ADS) or ventricular septal defect (VSD) underwent Doppler-echocardiography and cardiac catheterization in order to assess pulmonary blood flow (QP), systemic blood flow (QS), the left to right shunt (SH) and the ratio of pulmonary to systemic flow (QP/QS ratio). Cardiac output was also determined by the oximetry method according to Fick principle. Pulmonary output assessed by Doppler was 7.9 +/- 0.61/min, by catheterization 9.0 +/- 3.9. Linear regression analysis showed a low correlation coefficient (r = 0.10; p = NS). Systemic output evaluated by Doppler resulted 4.6 +/- 1.4 l/m, while at catheterization 5.1 +/- 1.5 l/min (r = 0.25; p = NS). Doppler evaluation of left-to right shunt was 3.3 +/- 1.5 l/min, at catheterization 3.9 +/- 3.1 (r = 0.74; p less than 0.001). Doppler QP/QS ratio resulted 1.7 +/- 0.5, at catheterization 1.8 +/- 0.5 (r = 0.96; p less than 0.0010. The results showed that, in spite of the lack of correlation between the pulmonary and systemic outputs assessed by Doppler vs catheterization, QP/QS ratio, as well as SH, are useful noninvasive indexes in order to evaluate intracardiac shunts.

Adolescent↗
PubMed1989

[A computerized system for the management of clinical data in a cardiology service].

The authors describe a computerized system for medical records built in order to obtain rapid information about the data of the overall patients and to quickly manage the clinical research of the Institution. The hardware, an Olivetti M 19 personal computer with a 10 Mbyte hard disk, can manage the clinical data on 3000 patients or more; the software, DBase III Plus, by Ashton-Tate, has a programming language easy to use, even by non-experts. The system allows immediate statistical analysis of all patients and of all 350 parameters included in the database.

Database Management Systems↗