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Biomedical subjects

M Santini

Publications and source records attributed to M Santini.

At least 91 records · Page 5Linked to original sources
PubMed1999

Multisite stimulation in refractory heart failure.

Since the early nineties, the employment of DDD pacing from a right ventricular site with a short AV delay in patients with severe heart failure has led to considerable conflicting results, so that the real benefit of this method remains to be defined even in selected patients, such as those with first-degree AV block, QRS duration > 140 ms due to left bundle branch block (LBBB), mitral regurgitation time > or = 450 ms and diastolic filling time < or = 200 ms. Indeed, the asynchronous activation induced by pacing the right apex is the most important limitation to the technique, particularly in patients without an LBBB pattern or in those with an incomplete LBBB pattern. Recent studies have also shown that pacing of the right interventricular septum provides no better results than pacing of the right apex, at least in selected patients with no LBBB pattern and no significant mitral regurgitation. Today, it has been suggested that permanent biventricular pacing could be proposed as a feasible and reliable approach to improving ventricular function through the synchronization of the septum and the apex of the left ventricle, particularly in patients with a marked delay in ventricular activation sequence. This technique may be performed by means of transvenous leads inserted through the coronary sinus into the cardiac veins to stimulate both ventricles simultaneously, starting from the right apex and left lateral wall. Consequently, this approach supplies a strong basis for initiating further studies to examine the chronic effects of left ventricular pacing in patients with severe heart failure. We also suggest that the new tissue Doppler imaging techniques could usefully be applied to accurately select candidates to biventricular pacing.

Cardiac Pacing, Artificial↗
PubMed1999

[The management of syncope in the hospital: the OESIL Study (Osservatorio Epidemiologico della Sincope nel Lazio)].

BACKGROUND: While syncope is generally considered a frequent finding in clinical practice, no clear epidemiological evidence is available about the relevance of such an event in the general population of Italy. METHODS: The OESIL Study was designed and undertaken in 15 hospitals of the Italian region of Latium in order to assess the percentage of emergency-room visits and admissions due to syncope, as well as to analyze the in-hospital diagnostic work-up performed for this condition. RESULTS: During a two-month observation period, 781 (372 males and 409 females, mean age 55.2 (22.8 years) consecutive patients came to the emergency rooms of the 15 hospitals included in the investigation due to a syncope spell (0.9% of emergency room visits); 450/781 patients (57.6%) were subsequently hospitalized (1.3% of all admissions): 48.0% of the admissions were admitted to a general medical ward, 29.3% to an observation ward, 13.3% to a cardiology section, 1.6% to a neurology section and 7.8% to other clinical sections (neurosurgery, general surgery). The mean duration of in-hospital stay was 6.9 (5.8 days; range 1-40 days). During the hospitalization period, 93.1% of patients underwent an ECG, 51.0% an EEG, 44.3% a CT scan of the central nervous system, 40.2% an echocardiogram and 19.5% a tilt-test. The syncope spell was considered to have a cardiovascular origin in 33.8% of the cases and a non-cardiovascular in 11.6% of the cases, while the origin was unknown in 54.4% of the cases. CONCLUSIONS: Collected data support the idea that syncope represents a frequent event in the general population and is responsible for a significant percentage of emergency-room visits and hospital admissions. However, the performance of conventional diagnostic work-ups is far from being satisfactory.

Adult↗
PubMed1999

[Pleural mesothelioma. A case report].

Malignant mesothelioma can be considered a rare neoplasm, very aggressive, chemo- and radio-resistant, characterized by high percentage of mortality and precarious quality of life. Surgery, radio- and chemo-therapy must be administered with articulate strategy and with realistic objective of palliation. Our experience can represent a model in this direction: we treated a patient with palliative surgery and following loco-regional and "maintenance" systemic chemotherapy with taxol at minimal efficacious dosage (135 mg/m2 every 3 weeks). After 27 months the patient is alive and with a good quality of life.

Combined Modality Therapy↗
PubMed1999

Relapsing pneumothorax due to Ascaris lumbricoides larvae.

We describe a case of relapsing pneumothorax occurring in a male child aged 11 yrs, resulting from the mechanical inflammatory action of Ascaris lumbricoides larvae localized in the pleuropulmonary tissue. Pulmonary ascariasis should still be considered today in the differential diagnosis of spontaneous pneumothorax occurring in children.

Animals↗
PubMed1998

Intraoperative detection of lung cancer by octreotide labeled to Indium-111.

The contribution of radio surgery (RGS) using octreotide labeled with Indium-111 (In111) has been studied for surgical treatment of lung cancer. Thirteen patients were administered 111 Mbq of In111 octreotide intravenously. Scintigraphic images were preoperatively taken at 4, 24, and 48 hours after the tracer injection. Pulmonary resection and intraoperative evaluation by RGS technique were then performed to set the section limits. Histological staining of all the resected specimens and resection margins were assessed and their results were used as a confirmation of the RGS intraoperative findings. RGS is a simple method that can help the surgeon in the intraoperative assessment of bronchial, parenchymal, and parietal resection margins. Further research is needed to verify whether this method also may be useful in the intraoperative definition of the extent of mediastinal lymph node dissection.

Adult↗
PubMed1998

Head-up tilt testing potentiated with low-dose sublingual isosorbide dinitrate: a simplified time-saving approach for the evaluation of unexplained syncope.

BACKGROUND: Head-up tilt testing is widely used in the clinical assessment of patients with unexplained syncope. However, the lack of a standard methodology and the conflicting results concerning sensitivity and specificity of the procedure have prompted further studies to define a more cost-effective approach for tilt testing. OBJECTIVES: Our clinical investigation was undertaken to assess the diagnostic value in unexplained syncope of a simple and time-saving protocol for head-up tilt testing, including low-dose sublingual isosorbide dinitrate administration. PATIENTS AND METHODS: A group of 73 consecutive patients (43 women and 30 men, mean age 39.6+/-21.8 years) with unexplained syncope despite conventional clinical cardiovascular and neurologic assessment and 10 asymptomatic control subjects underwent head-up tilt testing with isosorbide dinitrate challenge. Participants were tilted at 60 degrees for 30 minutes without medication; if no symptoms occurred, 1.25 mg of isosorbide dinitrate was administered sublingually and tilting was continued for an additional 15 minutes. RESULTS: During the drug-free phase of the test 14 (19.2%) patients had syncope. After isosorbide dinitrate administration syncope occurred in another 28 patients (38.3%); minor symptoms in association with hypotension developed in 10 (13.7%) patients. The test result was negative in all control subjects. The positive rate and specificity of head-up tilt testing with isosorbide dinitrate provocation were 57.5% and 100%, respectively. CONCLUSIONS: This new practical diagnostic procedure was found to be fairly sensitive and clearly specific in inducing a vasovagal reflex in patients with syncope of uncertain origin. Consequently, such approach could give a significant contribution in the diagnostic workup of these patients.

Administration, Sublingual↗
PubMed1998

Cardiac autonomic dysfunction in patients with Alzheimer disease: possible pathogenetic mechanisms.

We studied a possible correlation between autonomic cardiac activity and the level of the red blood cell acetylcholinesterase (AChE) in patients with probable Alzheimer disease (AD). The influence of cholinesterase inhibitor treatment on this autonomic activity was evaluated. Twelve patients satisfying the NINCDS-ADRDA criteria of probable AD and 10 healthy controls were studied. Autonomic cardiac activity was evaluated by means of power spectral analysis (PSA) of heart rate variability (HRV) using an autoregressive algorithm on 250 consecutive electrocardiographic R-R intervals. All patients received oral eptastigmine, a new cholinesterase inhibitor, for 1 month. Before treatment, a simultaneous recording of the electrocardiographic and respiratory activities was performed at rest and subsequently during head-up tilt test at 700. Recording was repeated on the last day of treatment. The level of AChE activity during each recording was also evaluated. Spectrum power was calculated in three main frequency bands: high frequency (HF), 0.15-0.4 Hz; low frequency (LF), 0.04-0.15 Hz; very low frequency (VLF), <0.04 Hz. In addition, we calculated the total spectrum power (TSP) and the LF/HF ratio. The TSP and the absolute value of each spectral component were significantly lower in AD patients than in controls. In contrast with controls, AD patients did not show any significant change before treatment in either the LF and HF components or in the LF/HF ratio during the tilt test. However, the modification in the LF component, induced by tilting, showed a significant correlation with the level of AChE activity (p < 0.03). During the tilt test, the treatment caused changes in LF and HF components and in the LF/HF ratio similar to those observed in controls. These results suggest that the presence of autonomic cardiac dysfunction in AD patients might be due to a cholinergic deficit in the peripheral autonomic nervous system. Some aspects of this autonomic dysfunction can be normalized by cholinesterase inhibitor treatment.

Acetylcholinesterase↗
PubMed1998

Low energy intracardiac cardioversion of persistent atrial fibrillation.

The aims of the study were to verify the efficacy and safety of low energy internal cardioversion (LEIC) in patients with persistent atrial fibrillation (AF) and to identify the factors affecting the atrial defibrillation threshold (ADT). Forty-nine patients with persistent (lasting > or = 10 days) AF underwent LEIC. In each patient, two 6 Fr custom-made catheters with large active surface areas were positioned in the coronary sinus (cathode) and the lateral right wall (anode), respectively, for shock delivery, and a tetrapolar lead was placed in the right ventricular apex for R wave synchronization. Truncated, biphasic (3 ms + 3 ms), exponential shocks were used, beginning at 50 V and increasing in steps of 50 V until sinus rhythm had been restored. Mild sedation (diazepam 5 mg i.v.) was administered to 12 patients. Sinus rhythm was restored in all the subjects with mean voltage and energy levels of 352.0 +/- 80.3 V and 8.2 +/- 3.4 J, respectively. The ADT in patients pretreated with amiodarone (6.4 +/- 1.8 J) was lower than that of patients who had not received any antiarrhythmic drugs (9.2 +/- 3.7) (P = 0.04). No ventricular arrhythmias were induced by any of the atrial shocks, and no other complications were observed. During a mean follow-up of 162.9 +/- 58.7 days, AF recurred in 21 (43%) patients; 71% of these occurred in the first week after cardioversion. LEIC is effective in restoring sinus rhythm in patients with persistent AF. The technique seems to be safe and does not require general anesthesia or, in most cases, sedation. Patients pretreated with amiodarone have lower ADTs.

Adult↗
PubMed1998

DDD pacing with rate drop response function versus DDI with rate hysteresis pacing for cardioinhibitory vasovagal syncope.

BACKGROUND: The effectiveness of cardiac pacing in preventing vasovagal syncope remains controversial. However, DDI pacing with rate hysteresis has been reported to prevent the recurrence of cardioinhibitory vasovagal syncope in up to 35% of affected subjects and to reduce the overall incidence of syncopal episodes in the others. Recently, DDD pacing with a new promising rate drop response function (Medtronic Thera-I model 7960) has become available in clinical practice. AIM OF THE STUDY: The aim of the present open trial was to test the effectiveness of this new pacing modality in patients with cardioinhibitory vasovagal syncope. STUDY POPULATION AND METHODS: The study population included 20 patients (12 males and 8 females; mean age 61.1 +/- 14 yrs) with recurrent syncope (mean number of prior episode = 6.8, range 5-11) and cardioinhibitory responses during two head-up tilt tests: the first diagnostic and the second during drug therapy with either beta-blockade or etilephrine. The study patients were randomized to receive either DDI pacing with rate hysteresis (8 patients) or DDD pacing with rate drop response function (11 patients). The head-up tilt test performed 1 month after pacemaker implantation was positive in 3 of 12 patients (25%) with DDD pacing with rate drop response function and in 5 of 8 patients (62.5%) with DDI pacing with rate hysteresis. The mean duration of follow-up was 17.7 +/- 7.4 months. During follow-up no patients with a DDD pacemaker with rate drop response function had syncope, while 3 of 8 patients with a DDI pacemaker with rate hysteresis had recurrence of syncope (P < 0.05). CONCLUSIONS: These data suggest that DDD pacing with rate drop response function is effective in cardioinhibitory vasovagal syncope and may be preferable to DDI pacing with rate hysteresis.

Cardiac Pacing, Artificial↗
PubMed1998

Variable cerebral dysfunction during tilt induced vasovagal syncope.

Electroencephalographic (EEG) monitoring was performed during head-up tilt testing (HUT) in a group of 63 consecutive patients (27 males, 36 females, mean age 41.5 years) with a history of recurrent syncope of unknown origin despite extensive clinical and laboratory evaluation. Syncope occurred in 27/63 patients (42.8%) during HUT and was cardioinhibitory in 11/27 (40.7%) and vasodepressor in 16/27 (59.3%). All patients with a negative response to HUT had no significant EEG modifications. In patients with vasodepressor syncope a generalized high amplitude 4-5 Hz (theta range) slowing of EEG activity appeared at the onset of syncope, followed by an increase in brain wave amplitude with a reduction of frequency at 1.5-3 Hz (delta range). The return to the supine position was associated with brain wave amplitude reduction and frequency increase to 4-5 Hz, followed by restoration of a normal EEG pattern and arousal (mean total duration of syncope 23.2 s). In patients with cardioinhibitory syncope, a generalized high amplitude EEG slowing in the theta range was noted at the onset of syncope, followed by a brain wave amplitude increase and slowing in the delta range. A sudden reduction of brain wave amplitude ensued leading to the disappearance of electroencephalographic activity ("flat" EEG). The return to the supine position was not followed by immediate resolution of EEG abnormalities or consciousness recovery, both occurring after a longer time interval (mean total duration of syncope 41.4 s). EEG monitoring during HUT allowed the recording and systematic description of electroencephalographic abnormalities developing in the course of tilt induced vasovagal syncope.

Adult↗
PubMed1998

Electroencephalographic correlates of vasovagal syncope induced by head-up tilt testing.

BACKGROUND AND PURPOSE: We sought to determine whether the introduction of EEG monitoring during head-up tilt testing could significantly improve the understanding of the cerebral events occurring during tilt-induced vasovagal syncope and the potential danger to the patient of this diagnostic procedure. METHODS: EEG monitoring was performed during head-up tilt testing in a group of 63 consecutive patients (27 males and 36 females; mean age, 41.5 years) with a history of recurrent syncope of unknown origin despite extensive clinical and laboratory assessment. RESULTS: Syncope occurred in 27 of 63 patients (42.8%) during head-up tilt testing and was found to be cardioinhibitory in 11 of 27 (40.7%) and vasodepressor in 16 of 27 (59.3%). All patients with a negative response to head-up tilt testing showed no significant EEG modifications. In patients with vasodepressor syncope, a generalized high-amplitude, 4- to 5-Hz (theta range) slowing of EEG activity appeared at the onset of syncope, followed by an increase of brain-wave amplitude with the reduction of frequency at 1.5 to 3 Hz (delta range). The return to the supine position was associated with brain-wave amplitude reduction and frequency increase to 4 to 5 Hz, followed by restoration of a normal EEG pattern and arousal (mean total duration of syncope, 23.2 seconds.). In patients with cardioinhibitory syncope, a generalized high-amplitude EEG slowing in the theta range was noted at the onset of syncope, followed by a brain-wave amplitude increase and slowing in the delta range. A sudden reduction of brain-wave amplitude then ensued, leading to the disappearance of electrocerebral activity ("flat" EEG). The return to the supine position did not allow either the immediate resolution of EEG abnormalities or consciousness recovery, both of which occurred after a further time interval (mean total duration of syncope, 41.4 seconds.). CONCLUSIONS: EEG monitoring during head-up tilt testing allowed recording and systematic description of electrocerebral abnormalities developing in the course of tilt-induced vasovagal syncope.

Adult↗
PubMed1998

Symptomatic abdominal aortic aneurysm and "situs viscerum inversus." Diagnostic and therapeutic approach.

BACKGROUND: We report one case of symptomatic aneurysm of infrarenal abdominal aorta in a patient symptomatic for acute abdomen. METHODS: The patient was accepted at the Emergency Care Unit and the routine admission tests were taken. US of the abdomen revealed a < > (SVI) disposition of the organs and an aneurysm of the abdominal aorta below the renal arteries. Patient underwent an aorto-aortic straight graft CONCLUSIONS: In this case-report we show SVI cannot be considered a problem in the surgical treatment of symptomatic abdominal aortic aneurysms.

Abdomen, Acute↗
PubMed1998

Intra-atrial defibrillation of human atrial fibrillation.

Low-energy intra-atrial defibrillation is a new therapeutic option for restoring sinus rhythm in patients with atrial fibrillation (AF). The success rate is quite high when right atrium-coronary sinus or right atrium-pulmonary artery electrode configurations are used, although the former is associated with a slightly lower defibrillation threshold. Several issues regarding the safety and tolerability of the procedure remain unresolved. Our experience and that of others indicate that low-energy intra-atrial cardioversion is safe even during exercise, provided the shock is well synchronized with the QRS and the preshock RR interval is > 500 msec. Reported defibrillation thresholds in patients with persistent AF range from 4 to 8 J, and shocks of this type inevitably are associated with some degree of discomfort. Measures aimed at lowering the defibrillation threshold (e.g., use of biphasic waveforms, antiarrhythmic pretreatment, and use of a single effective shock, as opposed to the multiple shocks delivered in research settings) can be expected to increase patient tolerance and extend the indications for low-energy intra-atrial cardioversion. The procedure currently is indicated for patients with persistent AF who are resistant to external defibrillation unable or unwilling to undergo general anesthesia. The procedure could be expanded to patients affected by obesity in whom the efficacy of external cardioversion is lower.

Atrial Fibrillation↗
PubMed1998

[The efficacy of high- and low-energy intracavitary cardioversion in chronic atrial fibrillation refractory to transthoracic cardioversion].

BACKGROUND: The purpose of our study was to evaluate the efficacy and safety of intracavitary cardioversion (IC) with either high (HEIC) or low (LEIC) energy in patients with chronic atrial fibrillation (AF) refractory to external cardioversion. METHODS: Forty patients underwent IC with either high (30 pts) or low energy (10 pts); HEIC was performed by delivering one or more shocks between one electrode of the lead positioned in the right atrium and a back plate. The following energy values were used in sequence: 100, 200, 300 joules. In LEIC shocks were delivered between two custom-made decapolar leads (one in the coronary sinus and another one in the right lateral atrial wall) beginning from 50 Volts and increasing the voltage by steps of 50 Volts. Another catheter in the right ventricular apex was used for ventricular synchronization. RESULTS: Sinus rhythm was restored in 24/30 (80%) patients undergoing HEIC and in 10/10 (100%) patients undergoing LEIC. No serious or permanent complications occurred. CONCLUSIONS: HEIC and LEIC are effective in patients with AF refractory to external cardioversion. Both the procedures seem to be safe.

Adult↗