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Biomedical subjects

L Milani

Publications and source records attributed to L Milani.

At least 19 recordsLinked to original sources
PubMed2006

The BNP assay does not identify mild left ventricular diastolic dysfunction in asymptomatic diabetic patients.

AIMS: We examined the usefulness of BNP for screening for left ventricular (LV) diastolic dysfunction in a sample of type 2 diabetic patients, without structural heart disorder, who have never presented symptoms or signs of heart failure (HF). METHODS AND RESULTS: Seventy-six consecutive patients admitted to the Outpatient Diabetes Clinic were studied. Blood samples were analyzed using the Triage BNP fluorescence immunoassay (Biosite Diagnostics, La Jolla, CA, USA). Echocardiography examinations were performed, with no knowledge of the BNP value. A total of 39 patients out of 76 (51%) were diagnosed with LV diastolic dysfunction and 23 (30%) with LV hypertrophy. Of the patients with LV diastolic dysfunction, impaired relaxation and pseudonormal pattern accounted for 97 and 3% of the cases, respectively. BNP levels among subjects with LV diastolic dysfunction (26+/-22 pg/ml, n=39) were not significantly different from patients with normal LV function (24+/-23 pg/ml, n=37 pg/ml; Mann-Whitney U-test, Z=-0.4, n.s.). CONCLUSIONS: Our data confirm alarmingly high prevalence of LV diastolic dysfunction in asymptomatic individuals with diabetes. Identification of patients with preclinical diabetic cardiomyopathy should be a research and clinical priority. BNP levels cannot be used to detect mild LV diastolic dysfunction in this subset of patients, which requires Doppler echocardiography to be detected.

Aged↗
PubMed2001

[Heart failure in nursing homes: prevalence, hospitalization, compliance to guidelines].

BACKGROUND: The prevalence of heart failure, the hospitalization rates for DRG 127 and the adherence to the recommendations included in the guidelines on pharmacological treatment among very old persons are poorly known. METHODS: We screened 141 very old subjects (75% females, aged 87+/-4 years), living in 2 nursing homes. Heart failure was defined according to clinical criteria and on the basis of administrative databases and chart reviews. The latter were also used to collect data on hospitalization rates and pharmacological therapy. RESULTS: We found that: 1) 23% of the subjects were affected by heart failure; 2) with regard to such patients, 26 hospital admissions for DRG 127 occurred in 1999 (18 admissions and 8 readmissions; 3) ACE-inhibitors have been prescribed to 54% of patients with a diagnosis of heart failure. CONCLUSIONS: Heart failure affects a huge number of very old persons living in nursing homes. These patients have high hospitalization rates for DRG 127. The adherence to the recommendations included in the guidelines on the pharmacological therapy for very old persons is poor.

Aged↗
PubMed1998

Structural abnormalities and not diastolic dysfunction are the earliest left ventricular changes in hypertension. HARVEST Study Group.

It has been claimed that diastolic dysfunction is the earliest cardiac abnormality in hypertension, preceding the development of left ventricular (LV) structural abnormalities. To detect early signs of hypertensive cardiac involvement 722 subjects (533 men and 189 women), 18-45 years old, with stage I hypertension, were studied by M-mode and Doppler echocardiography. Blood pressure was measured by 24-h ambulatory monitoring. Ninety-five normotensive individuals of similar age and gender distributions were studied as controls. Significant, though modest, changes of LV mass and geometry were found in the participants in comparison with the normotensive controls. The increment was +10.4 g/m2 for LV mass index, +1.8 mm for LV wall thickness, and +0.032 for relative wall thickness. A slight increase in atrial filling peak velocity was found in the hypertensive subjects at Doppler analysis of transmitral flow, but the ratio of early to atrial velocity of LV diastolic filling did not differ between the two groups. In multiple regression analyses, which included age, body mass index, heart rate, smoking, and physical activity, 24-h mean blood pressure emerged as a significant predictor of LV mass index (men, P = .003; women, P = .04) and wall thickness (men, P = .03; women, P = .004) in the hypertensive subjects, whereas no index of diastolic filling was significantly associated with ambulatory blood pressure in either gender. The present data indicate that changes in LV anatomy are the earliest signs of hypertensive cardiac involvement. Left ventricular filling is affected only marginally in the initial phase of hypertension.

Adolescent↗
PubMed1998

The effects of alcohol consumption on ambulatory blood pressure and target organs in subjects with borderline to mild hypertension. HARVEST Study Group.

The objective of this study was to examine the relationship of alcohol consumption to target organ involvement and ambulatory blood pressure (BP) in a population of young borderline to mild hypertensive subjects. Participants were 793 male subjects, aged 18-45 years, from the HARVEST Study. The analysis was performed in three age-matched groups with similar body mass index. Casual and 24-h ambulatory BP monitoring, routine biochemistry, echocardiography, and albumin excretion rate were measured. The men were divided into three groups: 1) nondrinkers, 2) drinkers of < 50 g/day, and 3) drinkers of > or = 50 g/day. Office systolic BP was not significantly different among the three groups, whereas 24-h and daytime BPs increased progressively from the first to the third group (group 1 v 3; P = .01 for 24-h systolic BP and P = .02 for daytime systolic BP). These differences remained significant even after adjusting for smoking. Left ventricular mass index, interventricular septum thickness, and wall thickness increased progressively from group 1 to group 3; this difference also remained significant after adjusting for smoking and 24-h BPs. The albumin excretion rate was much higher in group 3 than in group 1 (P = .003), but when 24-h BP was added to the model the difference was no longer significant. These results indicate that alcohol has a detrimental effect on the heart and the kidney. Alcohol's effect on LV wall thickness appears to be direct, whereas its action on albumin excretion rate seems to be mediated mainly by its effect on BP.

Adolescent↗
PubMed1997

Target organ damage and ambulatory blood pressure in stage I hypertension. The Hypertension and Ambulatory Recording Venetia Study.

According to recent international guidelines the decision on whether to treat young subjects during the early phase of hypertension should be based not only on their office blood pressure but also on their ambulatory blood pressure and whether target organ damage has occurred. Few data on the prevalence of hypertensive complications in young subjects with mild hypertension are available. In the Hypertension and Ambulatory Recording Venetia Study (HARVEST), a multicenter trial conducted in northeast Italy, the percentage of young borderline-to-mild hypertensive subjects with echocardiographic left ventricular hypertrophy was 4.5% and the percentage with concentric remodeling was 4%. Clear differences in cardiac size and geometric adjustment to ambulatory systolic pressure between the two sexes were found. The impact of blood pressure on the walls of the left ventricle and on the left ventricular mass was remarkable in women but weak in men. The assessment of left ventricular systolic function confirmed that many young mild hypertensive subjects have an increased ejective performance. The left ventricular contractility evaluated by midwall measurement was, however, found to be depressed in 9.2% of the HARVEST participants. Their left ventricular diastolic function was similar to that of 50 normotensive controls. The prevalence of microalbuminuria [albumin excretion rate (AER) > 30 mg/24 h) was 6.1%, only slightly higher than that found by other authors among normotensive subjects and much lower than that observed among patients with more severe hypertension. For our stage I hypertensives, however, the AER was correlated to the 24 h blood pressure with high statistical significance, whereas we found no relationship between the AER and left ventricular mass index either for all of the subjects taken together or for the men and women considered separately. The results suggest that renal and cardiac involvement do not occur in parallel during the initial phase of hypertension.

Journal Article↗
PubMed1995

Relation between family history of hypertension, overweight and ambulatory blood pressure: the HARVEST study.

The aim of the present paper was to evaluate the influence of a family history of hypertension and the degree of obesity as indicated by tertiles of body mass index on ambulatory blood pressure (BP) values in large number (n = 406) of young mild essential hypertensives. Positive family history of hypertension was associated with a significant increase in 24h ambulatory systolic blood pressure (SBP). The difference was most pronounced in the upper tertile of body mass index with almost 6 mm Hg difference between patients with and without a family history of hypertension. Both the degree of obesity and family history of hypertension had significant effects on 24h diastolic blood pressure (DBP). Twenty four hour DBP was highest in the upper tertile of body mass index in the hypertensives with a positive family history, representing an increase of 5 mm Hg compared with patients with a negative family history in the lower tertile. We conclude that mild hypertensives with a positive family history of hypertension are characterised by higher ambulatory BP than patients without parental hypertension and similar supine BP. Furthermore, our results indicate that in mild hypertensives the increase in DBP with body mass index is underestimated by conventional sphygmomanometry.

Adult↗
PubMed1994

Bilateral, reversible, selective thalamic involvement demonstrated by brain MR and acute severe neurological dysfunction with favorable outcome.

We report on two children who presented acute, severe, neurological dysfunction with bilateral, reversible, selective thalamic lesions demonstrated by brain MRI. In both children neurological symptoms appeared two weeks after a febrile respiratory illness. Clinical conditions worsened in a few days to a stuporous state and tetraplegia in one and to coma with decerebrate posturing in the other. Three weeks after the onset, both children improved and recovered within one month. During the acute phase, brain MRI showed in both children bilateral hyperintense areas on T2-weighted sequences limited to both thalamic regions. During the follow-up, repeated brain MRI showed complete disappearance of abnormalities in one patient and a small residual left thalamic lesion in the other. In both patients hematological routine exams were normal. Bacterial and viral studies of serum and CSF were negative. CSF findings showed elevated white blood cell count and protein levels, with no oligoclonal IgG bands. Urine and CSF organic acids by GC/MS and plasma as well as CSF amino acids were normal. We believe that the benign evolution of this disorder and CSF findings strongly suggest a postinfectious process of the central nervous system.

Child, Preschool↗
PubMed1992

Modulation of neutrophil functions by activated platelet release factors.

Platelets activated with physiological agonists, such as thrombin, ADP, or collagen, released products able to modulate neutrophil functions. In particular, platelet supernatant contained an inhibitor of superoxide anion generation induced by phorbol ester and a chemotactic factor for human neutrophils. The proteolytic digestion of platelet supernatant completely abrogated chemotactic activity without interfering with the inhibitory effect, indicating the presence of different molecules involved in the modulation of different neutrophil functions. This was further confirmed by the pretreatment of platelets with aromatic benzamidine which abolished chemotactic activity, but did not affect superoxide inhibition of neutrophils. This report provides evidence for interaction of platelets and inflammatory cells, suggesting that platelets are able to induce accumulation of neutrophils and control their respiratory burst, which also has a critical role in tissue damaging in inflammation.

Benzamidines↗
PubMed1992

[The monitoring of plasma digoxin levels during acute digitalis poisoning treated with Fab anti-digoxin fragments].

Life-threatening digitalis intoxication is treated using digoxin specific antibody fragments (Fab) that bind and inactivate the drug. The free digoxin serum concentration could be useful in the management of Fab-treated patients, but the standard methods of measurement can be clinically misleading because Fab anti-digoxin interferes with digitalis immunoassay measurements. A case involving Fab therapy of a digoxin overdosed patient, in which two laboratory methods gave very different results, is reported. The radioimmunologic assay (RIA), widely used in laboratories, yielded high values without relation to true serum free digoxin concentration. On the contrary, the recently introduced fluoroenzymatic sequential immunoassay (FEIA), which accurately measures free glycoside concentration, was a valuable aid in monitoring Fab treatment. Therefore, cardiologists' knowledge of a possible interference of specific anti-digoxin fragment treatment with many immunoassays may greatly enhance the rational management of these patients.

Acute Disease↗
PubMed1991

Echocardiographic findings in one case of Swyer-James syndrome.

The Swyer-James syndrome is an uncommon disease. The main finding is a hyperlucent lung with small hilar shadows on chest x-ray. This is due to a decrease in pulmonary artery size at its origin and in the number and size of pulmonary branches. Pulmonary angiography is the standard method for diagnosis. We report a case of a unilateral hyperlucent lung in which the diagnosis was suggested by an echocardiographic evaluation.

Adult↗
PubMed1990

Synthesis and platelet aggregation inhibitory effects of N-[(1H-pyrazol-1-yl)alkyl]benzoylamides.

A series of N-[(1H-pyrazol-1-yl)alkyl]benzoylamides was synthesized and tested in vitro for their inhibitory effects on adenosine diphosphate-, collagen-, arachidonic acid- and thrombin-induced aggregation of human platelets. Among them, N-[(1H-pyrazol-1-yl)butyl]benzoylamide (Ve) was found to have the most potent inhibitory activity. The structure-activity relationships are reported. The biological activity of the title compounds is reported in parallel with that of a known inhibitor of thromboxane A2 synthetase.

Chemical Phenomena↗
PubMed1989

Improvement of left ventricular function in chronic alcoholics following abstinence from ethanol.

Preclinical abnormalities of left ventricular function are frequently found in chronic alcoholics. In 12 chronic alcoholics without cardiomyopathy and in 12 healthy controls, systolic time intervals and echocardiograms were investigated before and after 12 months of abstinence from alcohol. In chronic alcoholics, an increase was found in the PEP/LVET ratio (0.31 +/- 0.06; in controls 0.24 +/- 0.05; t = 3.11; p less than 0.005), the diastolic interventricular septal thickness (6.0 +/- 2.0 mm/m2; in controls 4.1 +/- 1.0; t = 2.95; p less than 0.01), the left ventricular wall thickness (6.3 +/- 1.0 mm/m2; in controls 4.9 +/- 1.0; t = 3.43; p less than 0.005) and the left ventricular diastolic dimension (29 +/- 4 mm/m2; in controls 26 +/- 3; t = 2.08; p less than 0.05). The left ventricular mass (135 +/- 33 g/m2; in controls 113 +/- 40; t = 1.47) did not differ from the controls. After 12 months of abstinence a significant decrease was found in the PEP/LVET ratio (0.26 +/- 0.05, i.e. -16%; t = 3.59; p less than 0.005), the diastolic interventricular septal thickness (4.7 +/- 0.9 mm/m2, i.e. -22%; t = 2.73; p less than 0.02), the left ventricular posterior wall thickness (5.6 +/- 1.0 mm/m2, i.e. -11%; t = 4.08; p less than 0.001) and the left ventricular mass (109 +/- 24 g/m2, i.e. -21%; t = 6.53; p less than 0.001). The left ventricular diastolic dimension (27 +/- 2 mm/m2, i.e. -7%; t = 1.3) did not change. In conclusion, in chronic alcoholics, the abstinence from alcohol can be followed by an improvement of left ventricular function.

Adult↗
PubMed1989

4-(1H-pyrazol-1-yl)-2-butylamine derivatives as inhibitors of blood platelet aggregation.

Reaction of pyrazole and 3,5-dimethylpyrazole with methyl vinyl ketone gave 4-(1H-pyrazol-1-yl)-2-butanones which were converted to N-substituted 4-(1H-pyrazol-1-yl)-2-butylamines by reductive amination using ammonium acetate, primary or secondary amines and sodium cyanoborohydride as reducing agent. These new pyrazole derivatives were found to have an inhibitory effect on platelet aggregation in vitro.

Adenosine Diphosphate↗