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Biomedical subjects

M Margheri

Publications and source records attributed to M Margheri.

35 records · Page 2Linked to original sources
PubMed1991

[The mobile coronary unit of Florence: an evaluation of 10 years of prehospital cardiac care].

In order to reduce the high mortality from ischemic heart disease, a mobile coronary care unit manned by a cardiologist has been operating in Florence since 1979. From 1980 to 1989 there were 13,029 interventions, 8,718 (66.9%) of which were cardiac emergencies. 1,718 (19.7%) patients showed acute myocardial infarction while in 2,274 angina was diagnosed (26.1%). Acute pulmonary edema and paroxysmal supraventricular tachyarrhythmias accounted, respectively, for 6.2% and 18.3% of total cardiac emergencies; moreover there were 753 (5.8%) attempted resuscitations in sudden cardiorespiratory arrest from cardiac causes. In acute myocardial infarction, the median time between the onset of symptoms and mobile coronary care unit arrival was 85 minutes, and 69.9% of patients were reached within 3 hours from the onset of symptoms. Ventricular fibrillation, ventricular tachycardia and asystole were observed respectively in 80 (4.6%), 42 (2.4%) and 50 (2.9%) patients. Success rate of emergency treatment was 81.3% for ventricular fibrillation, 88.1% for ventricular tachycardia and 18% for asystole. Prehospital mortality was 4.06%. The ECG picture of the 753 patients found in cardiac arrest showed sustained ventricular tachycardia in 12 (1.6%), ventricular fibrillation in 198 (26.3%), bradyarrhythmia in 28 (3.7%), and asystole in 431 (57.2%). Cardiopulmonary resuscitation was successfully performed in 230 patients (30.5%). Finally, more than 50% of the patients with angina, 20% of the patients with acute pulmonary edema, and 70% of the patients with paroxysmal supraventricular tachyarrhythmia were adequately treated at home and needed no hospitalization. The ten years experience of Florence Mobile Coronary Care Unit suggests that a community wide emergency cardiac care system can significantly reduce the pre-hospital mortality and the time delays preceding thrombolysis and intensive care in acute myocardial infarction. Moreover, the cardiac "sudden death" can often be successfully treated. Most other cardiac emergencies may be adequately treated at home and unnecessary hospitalizations can be avoided.

Arrhythmias, Cardiac↗
PubMed1990

Effect of heparin, aspirin, or alteplase in reduction of myocardial ischaemia in refractory unstable angina.

399 out of 474 inpatients with unstable angina were monitored for 48 h and 97 of these were found to be refractory to conventional antianginal treatments and entered a randomised double-blind study. With the initial protocol heparin infusion or bolus were compared with aspirin; with a modified protocol, heparin infusion, the best of these three treatments, was compared with alteplase. Patients were monitored for 3 days after starting treatment and then observed clinically for 4 more days. On the first days of treatment heparin infusion significantly decreased the frequency of angina (by 84-94%), episodes of silent ischaemia (by 71-77%), and the overall duration of ischaemia (by 81-86%). Heparin bolus and aspirin were not effective. Alteplase caused small (non-significant) reductions on the first day only. Only minor bleeding complications occurred.

Administration, Oral↗
PubMed1989

Prognostic significance of early clinical manifestations in postanoxic coma: a retrospective study of 58 patients resuscitated after prehospital cardiac arrest.

The neurologic progress for 58 patients resuscitated after prehospital cardiac arrest was analyzed in order to evaluate their prognostic significance. Twenty-four patients were conscious on admission; their inhospital mortality rate was 4%. Thirty-four patients showed alterations of their state of consciousness; their inhospital mortality rate was 53%. On admission, only the absence of spontaneous breathing was significantly predictive of an unfavorable outcome. The failure of response to painful stimulation and pupillary light reflex became significantly predictive of an unfavorable outcome only in the late inhospital course. The time delay before onset of CPR was significantly longer in unconscious patients, but in this group no difference was observed between survivors and nonsurvivors. At discharge, no patient was in a comatose or vegetative state; three patients showed severe neurologic impairment. These data indicate that, in patients with postanoxic coma, early clinical evidence of severe neurologic dysfunction is predictive of neither inhospital death nor neurologic sequelae.

Aged↗
PubMed1988

[Significance of QT interval as a premonitory sign of severe ventricular arrhythmia in the early phase of myocardial infarct].

In order to evaluate the relationship between the length of the corrected QT interval (QTc), calculated according to Bazett's formula, and the incidence of ventricular fibrillation (V.F.) in the early phase of acute myocardial infarction (A.M.I.), the QTc interval was measured in 494 patients (mean age 66.42 +/- 11 years; 357 males and 137 females) assisted by the Mobile Coronary Care Unit of Florence. A.M.I. was anterior in 269 patients, inferior in 177 and non-Q in 34. The QTc interval measured on E.C.G. was recorded within the first hour after the onset of pain in 203 patients and between the first and sixth hour in 291 patients. The QTc interval was also measured in a control group consisting of 96 non A.M.I. patients with no history of coronary artery disease. 43 patients with A.M.I. (8.6%) developed V.F. in the first 24 hours. It was observed that: 1) The QTc interval of patients with A.M.I. was longer than that in patients without A.M.I. (432 +/- 34.18 msec. versus 425.37 +/- 25, p less than 0.02). 2) The QTc interval of patients with A.M.I. who developed V.F. was the same as that of patients with A.M.I. but without V.F., (432.6 +/- 34.18 msec. versus 438.11 +/- 34.13, N.S.). 3) 60.46% of patients with V.F. had a value of QTc less than 440 msec.; the incidence of QTc greater than 440 msec. showed no difference in the groups with or without V.F. (41.86% versus 41.11%). 4) The QTc interval length was greater in anterior than in inferior A.M.I. (435.12 +/- 30.81 msec. versus 429.05 +/- 34.5, p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

[Cardiac sudden death. Testing of an extra-hospital emergency system].

From December 1979 to April 1984, 266 victims of cardiac arrest outside the hospital in the metropolitan area of Florence received advanced cardiopulmonary resuscitation by a system for medical emergencies. 69 patients (25.9%) were successfully resuscitated and 42 (15.7%) were discharged alive from hospital without any neurological damage. The time delay between the onset of the cardiac arrest and the cardio-pulmonary resuscitation, the cardiac rhythm present on arrival of rescue squad, the degree of congestive heart failure immediately before the cardiac arrest and the neurological deficit after resuscitation significatively influenced immediate and late outcome.

Ambulances↗
PubMed1985

[Ventricular fibrillation in the initial phase of acute myocardial infarct].

In order to determinate the incidence, predictivity and prognosis of ventricular fibrillation in the early phase of acute myocardial infarction a series of 301 patients with acute myocardial infarction consecutively assisted by the Mobile Coronary Care Unit of Florence was analyzed. 151 patients (50.2%) received intensive care within 2 hours from the onset of the symptoms, 75 patients (24.9%) received intensive care between the second and sixth hour. 38 patients (12.6%) had at least one episode of ventricular fibrillation. 30% of the episodes of ventricular fibrillation happened within 1 hours from the onset of the symptoms, 47.4% within 2 hours, 74% within 6 hours. Serious arrhythmias complicated the early phase of acute myocardial infarction, but only sinus bradycardia seems to have a significant predicativity of ventricular fibrillation (P less than 0.05). We found that hospital survival resuscitated patients is strictly related to the time between early symptoms and the episode of ventricular fibrillation: 91% of the patients with ventricular fibrillation within 1 hour were discharged alive from hospital, 71% of those with ventricular fibrillation within 6 hours, 20% of those with ventricular fibrillation beyond 6 hours (P less than 0.01). The high rate and the favourable prognosis of ventricular fibrillation in the early phase of acute myocardial infarction must lead to a widespread implementation of rapid response emergency care systems away from hospital.

Humans↗
PubMed1982

[Mobile coronary unit of Florence: early care of arrhythmias not due to acute coronary insufficiency].

The aim of Mobile Coronary Care Units (M.C.C.U.) is to reduce the delay in delivering intensive care to patients with a heart attack. In the city of Florence a M.C.C.U. has been available since November 1979. During the first year the staff of the M.C.C.U. has treated 158 cases of serious cardiac arrhythmias which occurred among 486 interventions. In 94 patients cardiac arrhythmias followed an acute coronary attack. In 64 patients coronary heart disease could not be demonstrated. This study concerns the latter group of patients. The mean age was 65.2 years and 39 patients (61%) were women. The mean time from the onset of the symptoms to the arrival of the M.C.C.U. team was 3h and 2 min, whereas the mean time from the call to the arrival was 14 min. Sixty patients had atrial arrhythmias (29 atrial fibrillation, 2 atrial flutter, 22 atrial tachycardia, 7 premature atrial contractions) and 4 patients had ventricular arrhythmias (1 ventricular tachycardia, 1 ventricular flutter, 2 premature ventricular contractions). In thirty-nine patients (61%) the cardiac arrhythmia was abolished by the staff of the M.C.C.U.. Of the remaining 28 patients, 10 were brought to the hospital and 18 were left at home. None of these needed later admission to the hospital. So the treatment at home of cardiac arrhythmias has been successful in the majority of patients. Bunaftine was the antiarrhythmic drug more frequently used (23 cases, 34%) with a high percentage of success (87%). In planning medical emergency services to the community, one can envisage the use of the M.C.C.U. facilities to treat at home those arrhythmias that are not associated with an acute coronary attack.

Adult↗
PubMed1978

[The oxygen pulse for evaluation of the response to exercise in rehabilitation of patients with myocardial infarct].

A program of physical conditioning for the rehabilitation of the patients affected by myocardial infarction is founded on a preliminary ergometric evaluation and on following examinations of the effects of the prescribed treatment. Submaximal ergometric stress tests utilizing non invasive methods which contain sufficient information about the cardiocirculatory response to the physical effort are required. Sixteen patients underwent hemodynamic evaluation, during ergometric stress test, two months after myocardial infarction. A statistical analysis of the results shows a significant correlation between stroke volume and oxygen pulse. The oxygen pulse, under an increasing effort, describes a curve; the end of its ascending limb may be regarded as the point of the maximal stroke volume. The workload where the curve of oxygen pulse changes the slope can be used as the caloric expense which should be safely attained during the physical conditioning.

Cardiac Output↗
PubMedDate not supplied

Neuropsychological outcome of survivors of out-of-hospital cardiac arrest.

Thirty patients resuscitated from out-of-hospital cardiac arrest (15 with and 15 without postanoxic coma on admission) underwent a clinical examination and neuropsychological testing. In order to assess quality of life, they were compared to two matched control groups; 15 patients with previous myocardial infarction and 15 healthy subjects. None of the survivors showed severe neurologic impairment, and all had returned to self-sufficient physical activity. However, the behavior rating scale scores were significantly worse in patients with postanoxic coma. The processing ability linked to memory was significantly worse in the postanoxic coma group. Mood disorders were also observed in this group, but they did not have pathological significance. The remarkably low incidence of neurologic and psychological sequelae in these resuscitated patients, particularly in those with early clinical evidence of severe cerebral damage, is an encouraging result that supports the therapeutic systems development and efforts in the management of out-of-hospital cardiac arrest.

Activities of Daily Living↗
PubMedDate not supplied

Propafenone versus amiodarone in field treatment of primary atrial tachydysrhythmias.

Thirty-nine patients with paroxysmal atrial fibrillation or supraventricular tachycardia randomly received amiodarone or propafenone intravenously at home. Fifteen patients received amiodarone and 24 received propafenone; 87.5% of the patients who received propafenone and 40% of the patients who received amiodarone were converted at home to sinus rhythm (P less than .005). The median time of conversion was 10 minutes (range 5 to 35) for propafenone and 60 minutes (range 20 to 130) for amiodarone (P less than 0.005). When either drug failed to terminate atrial tachydysrhythmias at home, the same drug always restored sinus rhythm with subsequent oral treatment during hospitalization. No major side effects were observed after the infusion of either drug. The incidence of minor side effects was not significantly different between the two drugs. Both the drugs are efficacious and safe in the acute management of primary supraventricular tachydysrhythmias. Propafenone showed a greater rapidity of action.

Aged↗
PubMedDate not supplied

[Acute dimethylformamide (DMF) poisoning: a case report].

This paper describes a case of acute occupational intoxication by dimethylformamide in a worker assigned to polyurethanic resin preparation in a simulated leather factory. The peculiarity of this case is constituted by the association of a dimethylformamide classic clinical syndrome, frequently described in the scientific literature (alcohol intolerance, gastroenteric manifestations with liver injury), with coagulation alterations and thrombocytopenia. Measurement of environmental concentrations of the solvents and biological monitoring revealed high levels of exposure to dimethylformamide at the workplace. Our observations confirm the effects of dimethylformamide on hemostasis reported by other authors in previous studies. It is possible to speculate that the effects of dimethylformamide on coagulation and platelets strictly depend on the amount of solvent accumulated in the body.

Acute Disease↗