[Secondary pseudohyperaldosteronism syndrome].
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Humans↗
Biomedical subjects
M Romano
Publications and source records attributed to M Romano.
Exercise-induced changes of left ventricular ejection time in noninvasive evaluation of chest pain.
Significance and clinical usefulness of exercise-induced changes of noninvasive left ventricular ejection time, recorded by mechanocardiography, in detecting coronary artery disease is still controversial. We investigated the changes of the left ventricular ejection time (LVET), corrected for heart rate as ETI (LVET/square root RR), after a standard 4-min exercise by bicycle ergometer (50 W/min for 2 min, increased by 20 W after 2 min) in 56 male volunteers. They were invasively studied for typical or atypical chest pain. Thirty-four had coronary artery disease (CAD) and the others served as controls. Immediately after exercise LVET shortened according to the rise in heart rate in both groups. ETI increased similarly. After 2 minutes from exercise ETI increased only in the CAD group, according to a longer LVET, in spite of the rise in heart rate. In contrast, ETI was unchanged in controls, according to a shortened LVET. Totally, 27/34 CAD patients and 9/22 controls had a greater ETI than at rest. Employing this delta ETI as a "marker" of CAD we found a predictive accuracy of 74%. We suggest postexercise ETI could be a simple and inexpensive support to electrocardiogram in basic evaluation of subjects with chest pain.
Angina Pectoris↗
Abnormal systolic time intervals in obesity and their relationship with the amount of overweight.
We studied 17 severely obese subjects (age range 26 to 42 years), without hypertension, diabetes mellitus, angina, or clinical signs of heart failure or respiratory disease, and 16 age-matched control subjects. X-teleroentgenographic findings (transverse cardiac diameter and cardiothoracic ratio), blood pressure, and mechanocardiographic parameters were analyzed in both groups. By means of conventional simultaneous recordings of ECG, phonocardiogram, and carotid pulse (100 mm/sec), systolic time intervals were calculated as mean values from 10 beats in the morning. The following comparisons were made by means of analysis of variance: heart rate, preejection period (PEP), rate-corrected PEPI (PEPI), left ventricular ejection time (LVET), and QS2 interval (QS2); the latter two were both corrected for heart rate, respectively, as LVETI and QS2I and the PEP/LVET ratio. Abnormal x-ray data were shown in the obese group along with higher values for heart rate, PEP, PEPI, and PEP/LVET and a shorter LVETI; there were no differences in QS2I or blood pressure. There was a correlation between the amount of overweight and, respectively, transverse cardiac diameter (r = 0.84), heart rate (r = 0.69), PEP (r = 0.49), PEPI (r = 0.59), LVETI (r = -0.61), and PEP/LVET ratio (r = 0.72). A correlation was also found between transverse cardiac diameter and PEP/LVET (r = 0.67). We conclude, therefore, that abnormalities in the mechanocardiographic parameters are related to cardiac enlargement, suggesting a preclinical cardiac dysfunction secondary to chronic cardiocirculatory overload in severe obesity. Thus systolic time intervals appear to be affected by preclinical abnormalities of cardiac performance in these subjects.
Adult↗
Biochemical characterization of the hepatic effects in mice and rats of 1,4-bis[2-(3,5-dichloropyridyloxy)]benzene, a hepatic neoplasm promoter.
The biochemical effects on the liver of 1,4-bis[2-(3,5-dichloropyridyloxy)]benzene (TCPOBOP), a phenobarbital-like enzyme inducer, were studied in the mouse and rat. In mice a single dose of TCPOBOP (3 mg/kg, ip) caused marked and long-lasting (at least 7 days) induction of liver cytochrome P-450, 7-ethoxycoumarin-O-deethylase, and epoxide hydrolase. TCPOBOP had much less effect in rats than in mice, even at a higher dose (30 mg/kg) TCPOBOP also induced DNA synthesis in mice and rats but ornithine decarboxylase activity only in mice. In addition, in mice but not in rats, TCPOBOP increased microsomal membrane fluidity, as detected by fluorescence polarization measurements.
7-Alkoxycoumarin O-Dealkylase↗
An unusual case of cyproheptadine (Periactin) overdose in an adolescent female.
A 13-year-old female ingested an acute overdose of cyproheptadine hydrochloride (Periactin) and presented for treatment. She manifested all the classic signs and symptoms of an acute antihistamine overdose, including psychosis, except for miotic, minimally reactive pupils. The patient was supportively managed. All sequelae of the ingestion resolved within four days, and the child was released from the hospital. We discuss the unusual presentation of miotic pupils in an acute cyproheptadine overdose.
Adolescent↗
Metabolic reduction of chromium by alveolar macrophages and its relationships to cigarette smoke.
Pulmonary alveolar macrophages (PAM), obtained by bronchoalveolar lavage from 47 individuals, reduced hexavalent chromium [Cr(VI)] and decreased its mutagenicity. Their specific activity--mostly mediated by cytosolic, enzyme-catalyzed mechanisms--was significantly higher than in corresponding preparations of mixed-cell populations from human peripheral lung parenchyma or bronchial tree, or from rat lung or liver. At equivalent number of PAM, Cr(VI) reduction, total protein, and some oxidoreductase activities were significantly increased in smokers. No appreciable variation could be detected between lung cancer and noncancer patients. In rats, the Cr(VI)-reducing activity of PAM preparations was induced by Aroclor 1254. Thus, alveolar macrophages provide crucial defense mechanisms not only by phagocytizing metals, but also by metabolically reducing Cr(VI). The epithelial-lining fluid (ELF) also displayed some Cr(VI) reduction. Together with already investigated metabolic processes occurring inside lung cells, these mechanisms are expected to determine thresholds in the pulmonary carcinogenicity of chromium.
Animals↗
Relation between QT and QS2 intervals during exercise and recovery. Response in patient with coronary artery disease and age-matched control subjects.
We investigated the relationship between QT interval and QS2 (electromechanical systole) during exercise and recovery in patients with coronary artery disease (CAD) and exercise-induced myocardial ischemia (n = 12), and in age-matched controls (n = 20). Upright bicycle exercise was performed (50 watts/min + 20 watts/min every 2 min), recording electrocardiographic lead 2 (100 mm/sec) for QT and QS2 measurement at rest, at each step of uninterrupted exercise and every 60 sec during a 3-min recovery period. Resting data showed a QT less than QS2 finding in both groups; during exercise, QT and QS2 decreased. The values of QT and QS2, collected at each step of exercise and plotted against heart rate (HR) separately for both groups, showed a significant correlation coefficient. Comparing the regression lines of HR-QT and HR-QS2 separately for both groups, we found that both intervals decreased in parallel and the mean QT remained shorter than QS2 in both groups during exercise. The QT/QS2 ratio remained unchanged significantly during exercise and recovery in CAD. In control subjects, the ratio remained unchanged during exercise and the first min of recovery, while a significant change was detected in late (2,3 min) recovery from an adrenergic-induced effect. The mean exercise-induced response of QT-QS2 relationship includes a QT less than QS2 pattern in both groups. In CAD patients, an abnormal pattern was found in two patients during recovery by a relative prolongation of QT, suggesting the possibility of a risk factor for dangerous arrhythmias or sudden death.
Blood Pressure↗
[Treatment of anterior mitral valve prolapse by partial transposition of the posterior leaflet. Apropos of 7 cases].
Seven patients aged 8 to 62 years with massive mitral regurgitation due to anterior leaflet prolapse related to rupture or elongation of the chordae tendinae underwent reconstructive mitral valvuloplasty between June 1984 and September 1985, consisting in transposition of a bandlet of the posterior leaflet and its chordae to the free edge of the anterior leaflet. Medium term results with 2 to 16 months follow-up (average 8 months) showed all patients to have returned to Class I of the NYHA Classification; 5 patients had no systolic murmur, a mild systolic murmur 1 and 2/6 was present in 2 cases. The quality of the repair was confirmed by pulsed Doppler examination in all patients and by catheterisation and angiography in 3 cases. This surgical technique offers a good solution to the problem of mitral regurgitation due to severe prolapse of the anterior leaflet caused by rupture or elongation of the chordae tendinae.
Adolescent↗
Maternal antibodies arm neonatal leukocytes against "Salmonella typhi" at birth.
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Blood Bactericidal Activity↗
Noninvasive techniques in clinical pharmacology. Time intervals in assessment of vasodilators in coronary artery disease.
We enrolled 15 male volunteers with angiographic evidence of coronary artery disease (CAD) to investigate the effects of sublingual administration, on different days, at random, of placebo and three drugs with different action such as isosorbide dinitrate, nifedipine and molsidomine. We recorded simultaneously electrocardiogram, phonocardiogram and carotid pulse at paper speed of 100 mm/s; blood pressure was measured by auscultatory method. We calculated the systolic time intervals (STI) being noninvasive indices of left ventricular function and the ratio of diastolic time to heart rate (%D), well related to coronary blood flow in patients with severe obstructive lesions. Placebo decreased heart rate (HR) without effects on STI or %D. Isosorbide dinitrate induced a prolonged pre-ejection period (PEP) (by decreasing preload), tachycardia and a significantly decreased %D, suggesting a fall in coronary blood flow time. Nifedipine decreased diastolic blood pressure and values of PEP (by decreasing afterload) without effects on %D. Finally, molsidomine prolonged PEP (by decreasing preload) without reflex induced tachycardia and changes of %D. In conclusion, mechanocardiography can be useful in noninvasive assessment of vasodilators in CAD patients.
Blood Pressure↗
Low profile bioprostheses for mitral valve replacement.
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Adult↗
Long-term management of exercise-induced myocardial ischemia. Diltiazem versus propranolol, a double-blind, crossover study.
The authors performed a long-term, double-blind, crossover study on the effect of two drugs (propranolol, 40 mg t.i.d. or diltiazem, 60 mg t.i.d., each administered for 2 months) on their exercise tolerance in 13 patients with stable angina (mean age 52 +/- 7 years, 9 males and 4 females), after exertion and documented significant (greater than or equal to 70%) obstructive coronary lesions at angiography. Only propranolol, by decreasing heart rate and rate-pressure product, improved maximal sustained work load and duration of exercise (measured by a bicycle ergometer) versus the placebo (p less than 0.05). In both cases, however, they did not find any significant difference between propranolol and diltiazem. ST segment depression was decreased by both drugs (-1.73 +/- 0.95, baseline, vs -0.94 +/- 1.01, propranolol, and -0.95 +/- 0.76, diltiazem, p less than 0.5, for both). Long-term management of stable angina on effort therefore, can be usefully performed using propranolol or diltiazem.
Adult↗
Relation between heart rate and QT interval in exercise-induced myocardial ischemia.
The relation between heart rate and QT interval during dynamic upright exercise on a bicycle ergometer was investigated in control subjects (n = 18) and in patients with coronary artery disease (CAD), stable angina on effort, and angiographically documented significant coronary stenoses (n = 23). Both groups had a significant negative linear relation between heart rate and QT, with a higher correlation coefficient in control subjects (r = -0.78) than in patients with CAD (r = -0.64). This response may be a result of the nonhomogeneous response to ischemia in patients with CAD, particularly with regard to the different impact of exercise-induced ischemia. When the 2 regression lines were compared, a flatter slope was found in the CAD group (p less than 0.001) as a consequence of a faster decrease in the QT-increasing rate in control subjects. It is suggested that in control subjects exercise-induced increase in adrenergic tone causes a rapid and relevant decrease in QT-interval duration. In the CAD group, exercise-induced ischemia relatively prolonged the QT interval; this may have been the result of an impairment of myocardium in response to catecholamines release during exercise or the consequence of a direct effect of exercise-induced ischemia prolonging the duration of myocardial tension.
Adult↗
Polyamines and nucleic acids in gestational trophoblastic tumors.
To test the relationship between tumor malignancy and content and distribution of polyamines and nucleic acids, 2 forms of human gestational trophoblastic tumors were examined: the hydatidiform mole (self-limited form) and the human chorio-carcinoma (invasive form) xenografted into nude mice. The results indicate that there are 2 significant differences between the choriocarcinoma and the mole: 1) the choriocarcinoma is characterized by increased polyamine and nucleic acid levels, 2) tissues differ in their putrescine:spermidine and spermidine:spermine ratios. There is an increase in polyamines in the urine of mole-bearing patients over that of normal controls. The correlation between putrescine and spermidine with the chorionic gonadotropin indicates that these 2 polyamines reflect the biological activity of the mole.
Adult↗
Controlled clinical trial of cadralazine as a second-step drug in the treatment of hypertension.
The antihypertensive efficacy of a new long-lasting vasodilator, cadralazine, and the diuretic chlorthalidone have been compared in hypertensive patients receiving concurrent treatment with atenolol. After a 4-week run-in period with atenolol alone 100 mg/day, two groups of 10 patients whose diastolic blood pressure exceeded 100 mm Hg were given for a period of 65 days either cadralazine 15 mg/day or chlorthalidone 25 mg/day, according to a randomized, double-blind, between-patients design. Compared to atenolol alone, both cadralazine and chlorthalidone induced a statistically and clinically significant decrease in blood pressure. The antihypertensive effect did not differ significantly between groups. Good compensation of the atenolol-induced decrease in heart rate was obtained with cadralazine, whereas during atenolol + chlorthalidone treatment at times the standing heart rate was significantly lower than during treatment with atenolol + cadralazine. Side-effects, many of which were already present during atenolol treatment, occurred with a similar frequency in both groups. It is concluded that atenolol + cadralazine and atenolol + chlorthalidone are equally well tolerated, acceptable and effective in the treatment of hypertension, but that further studies are warranted to explore the potential haemodynamic advantages of the cadralazine + atenolol combination.
Antihypertensive Agents↗
Asymptomatic transient ST changes during ambulatory ECG monitoring in diabetic patients.
The reported higher incidence of painless myocardial infarction in diabetic patients suggests that asymptomatic transient myocardial ischemia may also be frequent in diabetes. To explore this possibility 51 subjects with type II diabetes, aged 43 to 71 years (mean +/- SEM 56 +/- 8), 70 nondiabetic patients with coronary artery disease (mean age 55 +/- 5), and 40 nondiabetic patients without overt coronary disease (age 54 +/- 9) were studied. Thirty-eight of the 51 diabetic patients (74%) had evidence of associated coronary disease and 19 (37%) had evidence of previous myocardial infarction. All subjects underwent continuous 24-hour ambulatory ECG monitoring. In 18 of 51 diabetic patients 93 episodes (73% of the total number) of asymptomatic ST segment changes were recorded; the total number of symptomatic episodes was 36, and they were observed in seven patients (27%). Forty-eight (60%) asymptomatic and 32 symptomatic episodes of significant ST changes were found in nondiabetic patients with coronary artery disease. When patients with previous myocardial infarction were examined separately, asymptomatic episodes of significant ST changes were observed in 10 of 19 diabetic patients and in 5 of 25 nondiabetic patients with coronary artery disease (p less than 0.05). In an additional 28 diabetic patients who underwent exercise stress test, 15 exhibited an abnormal ECG response; however, only five of them (33%) were symptomatic. This study suggests that the incidence of transitory myocardial ischemia, as assessed by ambulatory ECG monitoring and exercise stress test, is higher in type II diabetic patients than in nondiabetic control subjects with coronary artery disease.
Adult↗
A factor from bursa of Fabricius inhibits in vitro the chorionic gonadotropin response of the chick testis.
The effect of bursa of Fabricius on the endocrine function of the chick testis was studied using an isolated testis cell preparation. Testosterone secretion, both basal and under hCG stimulation, was measured in the incubation medium. The bursal extract inhibited the response of the testis cells to hCG detected as a reduced testosterone secretion. The normal basal secretion of the testis cells was not modified by the bursal extract. To analyze some characteristics of the bursal factor, fractions of approximately known molecular weight were obtained by filtering through Amicon membranes. The active factor was found in the fraction corresponding to 1000-10000 Da. Its activity disappeared after heating of trypsin incubation, suggesting the peptidic nature of the bursal factor. Tissue extracts from gut and spleen did not modify the hCG response of the testis cells. There was inhibition of the hCG response by thymus extracts of the newly hatched chicken. These results add new evidence of a modulatory effect of the immunogenic organs on the endocrine function of the testis in the newly hatched chicken.
Animals↗
Metabolic activation of hepatocarcinogens in chronic hepatitis B.
S9 fraction pools of liver biopsy samples, collected from 129 patients in two consecutive studies, were comparatively assayed for their ability to activate aflatoxin B1 (AFB1) and a tryptophan pyrolysate product (Trp-P-2) in a miniaturized Salmonella mutagenicity test system. Metabolic activation was not affected to a significant extent by most of the monitored variability factors, such as sex, alcohol, cigarette smoking and liver histology (minimal changes, chronic persistent (CPH) or active (CAH) hepatitis, CAH steatosis, or cirrhosis). Conversely, a significant enhancement of activation was observed for AFB1 in cases of mild CAH and especially for Trp-P-2 in hepatitis B virus carriers, irrespective of their histologic diagnosis.
Aflatoxin B1↗