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M Morpurgo

Publications and source records attributed to M Morpurgo.

At least 73 records · Page 4Linked to original sources
PubMed1985

[External post-infarction rupture of the heart. Retrospective anatomo-clinical analysis of 70 cases].

A retrospective comparison was made between the clinical and pathological findings pertaining to: a) 70 cases of rupture of the ventricular free wall following myocardial infarction (RC group), b) 70 cases of acute myocardial infarction (AMI) where death intervened in the absence of cardiac rupture (NR group) and c) 70 cases (clinical findings only) of patients with AMI admitted to the hospital (IM group). The history of the RC group disclosed a considerably lower percentage of previous myocardial infarctions (p less than 0,005) as compared to the control groups. In the same group systemic hypertension after myocardial infarction was more frequent (p less than 0,025) than in the others. Shock, heart failure, bundle branch blocks were significantly less common in the RC group than in the NR group, and severe arrhythmias were found in a significantly lower percentage than in both the control groups. An electrocardiographic pattern of anterior AMI was more frequent in the RC group than in the IM group (p less than 0,05). Death was preceded by sudden loss of consciousness in 83% of the RC cases and in 51% of the NR cases (p less than 0,005), by severe chest pain respectively in 19% and 9% of the two groups (p less than 0,05). More than 25% of the patients of both RC and NR groups died within the first 24 hours, almost half within the third day after the onset of AMI. On autopsy the AMI was anterior and/or lateral in 77% of the cases in the RC group and in 44% of the NR group (p less than 0,005). In all the cases except one rupture had occurred in the area of the infarction. The site of rupture was anterior in 64% of the cases, posterior in 16%, lateral in 11%, and apical in 9%. Scars larger than 5 mm were noted in 17% of the cases in the RC group as compared to 37% in the NR group (p less than 0,01). Left ventricular hypertrophy was present in 16% of the RC cases and in 31% of the NR group (p less than 0,05). Finally the characteristics of patients at risk of cardiac rupture following myocardial infarction seem to be: absence of previous infarctions, anterior localization of AMI, sustained hypertension after myocardial infarction, absence of serious hemodynamic and arrhythmic complications.

Adult↗
PubMed1984

Classification of respiratory functional impairment in chronic obstructive pulmonary disease.

Starting from a paper published in 1964 by Wilson et al., we explored the possibility of classifying the clinical and functional deficit of patients with chronic obstructive lung disease into six classes, class 0 representing normality and class 5 greatest severity. Each symptom or sign was classified into six degrees of increasing severity. Next, we looked for a possible dependence of the collegially assigned score on anthropometric, clinical, or instrumental data in each case. More particularly, we tried (1) to identify such combinations of variables as would permit classification of the patient with the smallest possible error, and (2) to determine which of the variables reflected the severity of the case more faithfully. The results emerging from this study suggest the possibility of evaluating and classifying respiratory impairment in three different ways, as follows: (1) On the basis of clinical data only. This method is the easiest to use and affords a fairly good determination coefficient (R2 = 0.812). (2) Using only some combinations of laboratory data (static and dynamic pulmonary volumes, blood gases, etc.), with or without the addition of vital statistics and anthropometric data. These subensembles would allow a posteriori estimates in cases where the subject is no longer available for questioning and examination. In that case the best multiple regression affords a determination coefficient R2 = 0.82. (3) Using all clinical and laboratory data available. In that case, the best multiple regression (R2 = 0.899) for predictive purposes is that which includes the sum of clinical data, the pulmonary volumes before and after pharmacological bronchodilation, and the PaCO2 value. For practical purposes, however, the most convenient function is the one that includes the sum of clinical data plus FEV1 and RV (R2 = 0.863). Even with the best of the three functions proposed in this paper, however, the standard error of estimate entails tolerance limits sometimes amounting to one whole class of severity. Still, the probability of making an error exceeding one class of severity occurs in only 3.7% of the cases, an average which seems quite acceptable from the clinical point of view.

Adolescent↗
PubMed1984

Two-dimensional echocardiography and radionuclide angiocardiography in pulmonary hypertension.

In precapillary pulmonary hypertension two-dimensional echocardiography documents anatomo-functional alterations of valvular and cavitary structures of the heart in real time. It supplies useful information on ventricular interdependence and on the motion of the interventricular septum. In the same kind of pathology first pass or equilibrium radionuclide angiocardiography has been used for the calculation of the ejection fraction of the right ventricle, both at rest and during exercise, breathing either air or pure oxygen. The Authors think that these two methods are complementary. For this reason they decided to associate them and they report here their preliminary experience. Their first observations seem to show that the association of the two techniques is useful in the study of the dimensions and shape of the two ventricles and for the visualisation of even regional abnormalities in motion of the interventricular septum.

Cardiomegaly↗
PubMed1984

Usefulness of xerotomography in the diagnosis of acute pulmonary embolism.

The Authors report their experience in the study of pulmonary embolism by xerotomography. The use of tomography for the study of pulmonary vascularization is well known, but this method is by far less frequently used than pulmonary angiography and pulmonary perfusion and ventilation scintigraphy. The enhancement of contrasts and contours and the ample area of exposure are the features which render the images obtained by xerotomography similar to those achieved by pulmonary angiography. Our experience up to the present time allows us to state that xerotomography may represent a valid diagnostic means in cases of acute pulmonary embolism, when scintigraphy is not feasible or following scintigraphy, when doubts regarding the clinical diagnosis still remain.

Acute Disease↗
PubMed1982

[Cardiologic aspects of Friedreich type heredoataxia].

The authors performed ambulatory electro-vectorcardiography polycardiography and echocardiography in 18 patients with typical Friedreich's disease, and 6 patients with atypical forms of hereditary spino-cerebellar ataxia classified on e basis of the degree of neurological involvement, without clinical signs of cardiocirculatory failure. The ECG and VCG recording commonly showed appearances suggestive of myocardial "necrosis" and were of little value in the differential diagnosis between typical and atypical forms of Friedreich's ataxia. This limitation also applied to the kinetocardiogramme which was sometimes pathological confirming the echocardiographic diagnosis of symmetric LV hypertrophy and of septal hypokinesia despite normal ECG and VCG. The systolic time intervals and echocardiographic parameters of the interventricular septum were more helpful in the differential diagnosis. Hypertrophic cardiomyopathy, usually symmetric, was observed in about 70 p. 100 of typical and only rarely in atypical forms of Friedreich's disease. The symmetric or asymmetric hypertrophy was associated with reduced left ventricular performance in less than 20 p. 100 of typical Friedreich's disease, systolic anterior motion of the mitral valve and other signs of dynamic left ventricular outflow tract obstruction were not observed in any of these patients. The correlations between the degree of neurological disability and the cardiac abnormalities, were, in general, disappointing compared with other reported series. The cardiac investigation of patients with Friedreich's disease remains valuable from the point of view of recent pathological hypotheses of a metabolic abnormality with eventual therapeutic implications.

Adolescent↗
PubMed1981

Myocardial infarction in a child aged ten with Duchenne muscular dystrophy.

The authors describe the clinical picture, ECG, vectorcardiographic, and serum enzyme assays in one case of acute myocardial infarction occurring after a severe physical exertion in a child aged 10 with progressive muscular dystrophy of the Duchenne type. The picture differs considerably from the electrical aspects of "pseudonecrosis" that interstitial fibrosis of some portions of the left ventricle may produce in this myopathy.

Child↗
PubMed1979

[The evolution of cardiac impairment in Duchenne's muscular dystrophy. Electrovector-cardiographic, polycardiographic and echocardiographic aspects (author's transl)].

The Authors have submitted to an electrocardiographic, vectorcardiographic, mechanocardiographic and echocardiographic investigation 4 cases with Duchenne's disease, which had already been studied by the Authors several years before. The longitudinal study has demonstrated, above all, the striking capacity of the electrocardiographic aspects of the disease to evolve from a normal to a "pseudo-necrotic" pattern. Such evolution, among other things, provides an important argument against the interpretation that attributes the electrocardiographic and vectorcardiographic changes in the initial stages of the disease to a persistence of a QRS loop of infantile type on a genetic basis. But for rare exceptions, the systolic time intervals and kinetocardiogram, which showed early indicative changes on the first examination, have successively shown easily predictable behavior considering the poor cardiovascular conditions of the patients on the second examination. The echocardiogram has proved useful in demonstrating the morphological and functional changes of the ventricular walls and of the interventricular septum, besides the eventual associated mitral valve prolapse. The echocardiographic evaluation of the left ventricular performance in quantitative terms, however, seems somewhat unreliable owing to the difficulty of obtaining technically good images, due to the thoracic deformity. The dystrophic changes recently observed in the myocardium even at ultrastructural level can probably explain not only the electrocardiographic and vectorcardiographic abnormalities but also the kinetocardiographic and echocardiographic changes. Among the above mentioned theoretical and practical considerations the possibility should be underlined that some cases of cardiomyopathy labelled as "primary" are in fact unrecognized dystrophic cardiomyopathies.

Adolescent↗
PubMed1979

[Predictability of electrocardiographic and vectorcardiographic criteria in pulmonary arterial hypertension caused by chronic bronchopneumopathies].

The Authors have verified in a group of 38 patients with chronic obstructive pulmonary disease (COPD) and suspected pulmonary arterial hypertension (PAH) of precapillary origin the possibility to forsee the pressure within the lesser circulation starting from some electrocardiographic and vectorcardiograhic criteria. The vectorcardiographic analysis has not been shown to be more reliable than the traditional ECG as far as the identification of an eventual PAH is concerned. The matching of both scalar and vectorial criteria has significantly increased the efficiency of the estimate, i.e. the possibility to foresee the right ventricular systolic pressure (RVSP) and the mean pulmonary arterial pressure (PAP), but the same efficiency has remained at unsatisfactory level (S = +/- 10,30 Torr as far as the PAP is concerned. With regard to the value of the various scalar and vectorial criteria or parameters, among the electrocardiographic criteria the most reliable has been the inversion of the T wave in the right precordial leads. This sign, however, did not often appear in the present series (18% of the cases). As to the VCG the analysis made by the Authors stresses as the most reliable criterion the direction of QRS loop rotation on the horizontal plane and the magnitude of the maximum rightward spatial vector. These two elements, among other things, escape detection on the traditional electrocardiographic investigation. The above mentioned conclusions, obviously, only apply to the PAH secondary to COPD, in which particular noncardiac (lung hyperinflation, lowering of the diaphgram, etc.) and cardiac (associated left ventricular hypertrophy) factors contribute to limit the diagnostic value of both the ECG and the VCG.

Adult↗
PubMed1979

On some cardiological aspects of Steinert's disease (myotonic dystrophy).

The authors investigated 10 ambulant patients with myotonic dystrophy, under 40 years of age (mean 22.3 years) and free of subjective heart complaints. Not only Ecg alterations but also kinetocardiographic changes and anomalies of the systolic intervals were rarer and milder than those found in patients with other neuromyopathies, namely Friedreich's disease and Duchenne's disease. This observation suggests that, at least in older patients, not all the cardiac alterations usually attributed to myotonic dystrophy are really imputable to the disease. On the other hand, the observed echocardiographic alterations (reduction of per cent systolic-diastolic variation of internal diameter of the left ventricle and/or the ejection fraction) apparently indicate an early tendency to modification of left ventricular function in patients with myotonic dystrophy. Since other authors have found cardiac anomalies in this disease before the onset of any neurological manifestations, the possibility emerges that some cases of myocardial disease interpreted as "primitive" might in reality be secondary to undetected myopathy.

Adolescent↗
PubMed1976

[Contribution of the mechanocardiography to the study of obstructive chronic bronchopneumopathy].

Kinetocardiography, ECG and radiography, were compared as ways of obtaining early diagnosis of chronic cor pulmonale in two series of patients (81 in all) with chronic obstructive bronchopneumopathy. Kinetocardiography proved markedly superior in this respect. It revealed right ventricular pressure overload in a higher percentage of cases and at an earlier stage, i.e. when PAP values were little above normal resting values, of even when their increase appeared only during physical effort.

Adult↗
PubMed1976

[The heart in myasthenia gravis. Electrocardiographic, cardiodynamic and kinetocardiographic aspects in 18 cases].

Eighteen patients with myasthenia gravis, second-stage (A or B) according to Ossermann and Genkins, and of young age, were examined as outpatients from the cardiological point of view. Clinical and radiological examination of the heart and large vessels revealed no pathological features. Electrocardiographic abnormalities (including one case of ventricular preexcitation syndrome and one of subepicardial ischemia) were detected in three patients (16,6%). Among the various left ventricular systolic time intervals, only the deformation time was somewhat off normal limits in some cases, but the difference was not statistically significant. In over one-third of the cases, conversely, the kinetocardiogram revealed paradoxical systolic outward movements, indicative of myocardial dyskinesis or dissinergy. The essential normality of systolic time intervals in the presence of manifest abnormalities of the kinetocardiographic curve may be explained by the smallness of hypokinetic or dyskinetic areas, whereby the ejection fraction was not reduced. In general, the ECG and kinetocardiographic tracings showed no tendency to change under the effect of orally administered pyridostigmine.

Adolescent↗
PubMed1976

Regional lung perfusion and pulmonary artery pressure in chronic obstructive lung disease.

In 22 chronic bronchitics with or without emphysema, the authors measured regional pulmonary perfusion in the supine position and calculated the ratios of radio-active tracer (131I-MAA) concentrations in the lung apices and bases (U/L ratio). This ratio was found to be normal in the right lung and tendentially high (though not to a statistically significant degree) in the left lung, this being probably due to the presence of an enlarged heart (13 patients showed evidence of right ventricle hypertrophy and/or overload). The correlation between the U/L ratio and functional impairment of respiration expressed spirometrically failed to reach statistical significance and the same was true of the correlation between the U/L ratio and mean pulmonary arterial pressure at rest.

Adult↗
PubMed1975

Can pulmonary artery pressure be predicted without right heart catheterization in chronic obstructive lung disease?

We have investigated the dependance of observed pulmonary artery mean pressure (PAP) on body surface, age, PaO2, pH, PaCO2, hematocrit, and spirometric data (VC, FEV1/VC, RV/TLC) in 70 patients with chronic obstructive lung disease (COLD). After elimination of all variables that failed to correlate with PAP, multifactorial analysis showed that only two of nine independent variables, namely PaO2 and body surface, correlated significantly with PAP. According to our calculations, 28.9% of total PAP is predictable by PaO2, 1.5% by H+ concentration, 2.8% by RV/TLC, and 2.5% by body surface. Fully 64.2% of total variability was not accounted for by our regression analysis; thus the error of predicted PAP was so great (+/- 17 mm Hg for P = 0.05) as to invalidate the method. We also recalculated our subjects' PAP values by applying Enson's and Grassi's equations to our own lung function and biochemical data, and compared the predicted PAP values thus obtained with those measured directly in our subjects. Both equations proved imprecise and/or inaccurate in the individual case. From this we conclude that whereas available equations may be suitable for predicting the mean PAP value of a large population sample, the same equations cannot give a reliable prediction in individual cases.

Adult↗