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Biomedical subjects

R Esposito

Publications and source records attributed to R Esposito.

At least 55 records · Page 3Linked to original sources
PubMed1996

Rifabutin versus placebo in combination with three drugs in the treatment of nontuberculous mycobacterial infection in patients with AIDS.

The aim of this double-blind, randomized, placebo-controlled, 12-week study was to assess the efficacy of rifabutin (450 or 600 mg/d) in the treatment of disseminated nontuberculous mycobacterial infection in patients with AIDS. Companion drugs in both arms of the study were ethambutol, clofazimine, and isoniazid. Because of low accrual, the study was prematurely terminated when a total of 382 patients had been enrolled, of which 200 were eligible (i.e., their specimens were culture-positive for Mycobacterium avium complex [MAC] or Mycobacterium xenopi at baseline) and 102 were evaluable (i.e., they were eligible, were treated for a minimum of 6 weeks, and had at least one culture assessment after baseline). The original protocol called for a total of 220 evaluable patients. At week 12, rifabutin treatment was associated with higher, although nonsignificant, rates of bacteriologic conversion than was the placebo arm, with regard to both the eligible patients (25% vs. 18%) and the evaluable patients (45% vs. 38%). Corresponding median times to culture conversion were 42 vs. 63 days (eligible patients) and 43 vs. 69 days (evaluable patients). No significant difference was observed in clinical improvement, mortality, or toxicity between the two treatment arms. The addition of rifabutin to a triple-drug regimen may contribute to the clearance of disseminated MAC infection in patients with AIDS, without causing additional toxicity.

AIDS-Related Opportunistic Infections↗
PubMed1996

[The pharmacological treatment of supraventricular atrioventricular nodal reentry or accessory pathway reentry tachycardias: the usefulness of transesophageal electrophysiological study in the selection of therapy].

Transesophageal atrial pacing is a diagnostic and therapeutic tool in patients with supraventricular reciprocating tachycardia (SVRT). The aim of the present study was to evaluate the effectiveness of transesophageal atrial pacing in the selection of the chronic treatment of SVRT. Between June 1993 and March 1995 we have performed transesophageal atrial pacing in 44 patients affected by atrioventricular nodal reentry tachycardia (AVNRT: n = 28) or atrioventricular reentrant tachycardia (AVRT) using a concealed or manifest bypass tract (n = 16). After a basal (free drug state) transesophageal atrial pacing, we performed serial electropharmacological tests during chronic treatment with sotalol (160 mg/die), flecainide (200 mg/die) and propafenone (450 mg/die). At the end of these tests, the patients were finally discharged with the drug that allowed a more difficult induction or a wider cycle length, and that showed a better clinical tolerance. At the end of the electropharmacological tests 53.6% of the patients affected by AVNRT were discharged with sotalol, 17.8% with propafenone and 28.6% with flecainide. The follow-up of these 28 patients is 11.4 +/- 1.7 months. In the 79.2% of the patients the drug is still effective (absence of whatever episode of SVRT in the follow-up period). In the AVRT group, at the end of the electropharmacological tests, 25% of the patients were discharged with sotalol, 6.25% with propafenone, and 68.75% with flecainide. The follow-up of these 16 patients is 11.7 +/- 1.8 months. In the 78.6% of the patients the drug is still effective (absence of episode of SVRT in the follow-up period).

Adolescent↗
PubMed1996

[An unusual case of ectopic atrial tachycardia: triggered activity as an arrhythmogenic mechanism].

We report a rare case of ectopic atrial tachycardia induced by ergometric stress test whose arrhythmogenic mechanism, after transesophageal electrophysiological study, seemed to be triggered activity. The patient was successfully treated with a beta-blocker (metoprolol), confirming the importance of autonomic modulation in the genesis of arrhythmias caused by afterdepolarizations.

Adrenergic beta-Antagonists↗
PubMed1996

[Sotalol, propafenone, and flecainide: compared multiparametric analysis of ventricular repolarization in subjects without organic cardiopathy].

Antiarrhythmic drugs are known to affect depolarization and repolarization time in a different fashion. The aim of the present study was to compare the effects of sotalol, flecainide and propafenone on some common (mean QT and QTc, mean JT and JTc), or uncommon (QTc dispersion, T-peak to T-end interval-Tp-Te) electrocardiographic parameters in order to evaluate the effects of these antiarrhythmic drugs on repolarization time. QTc dispersion, defined as the difference between maximum and minimum QTc calculated from the standard 12 ECG leads, and the average Tp-Te interval, reflect regional variation in ventricular repolarization. We have analyzed retrospectively the standard 12-lead electrocardiograms of 28 patients (15 females and 13 males, age 36.11 +/- 16 years, range 11-67 years), recorded in the free-drug state and at the steady state after oral treatment with sotalol (160 mg/ die), flecainide (200 mg/die) and propafenone (450 mg/die). These drugs were prescribed, separately, for the treatment of patients with supraventricular tachycardia without underlying structural heart disease. Sotalol treatment prolongs ventricular repolarization times (QT, p = 0.0001; JT, p = 0.0001 and JTc, p = 0.0001) in an homogeneous fashion, as showed by the significant decrease in QTc dispersion (p = 0.026) and Tp-Te interval (p = 0.011). On the contrary, flecainide treatment is associated with an increase in QTc dispersion (p = 0.039) and Tp-Te interval (p = 0.0001), mean QT (p = 0.0001), QTc (p = 0.0001) and QRS (p = 0.0001), with no significant changes in JT and JTc (NS). Propafenone treatment does not affect repolarization time indexes, affecting only depolarization time as expressed by an increase in QRS (p = 0.046).

Adolescent↗
PubMed1995

Tuberculosis cutis miliaris disseminata due to multidrug-resistant Mycobacterium tuberculosis in AIDS patients.

Two patients with AIDS and disseminated tuberculosis characterized by cutaneous involvement are reported. They developed a maculopapular skin eruption, from which a multidrug-resistant Mycobacterium tuberculosis strain was isolated. In both cases the clinical course was rapidly fatal. Tuberculosis cutis miliaris disseminata should be differentiated from the skin lesions frequently seen in HIV-infected patients, especially from folliculitis. In patients with tuberculosis, the appearance of cutaneous lesions may be due to the haematogenous dissemination of mycobacteria. Therefore, early identification of the causative organism by use of optimal microbiological methods is fundamental.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Prevention of symptomatic recurrences of esophageal candidiasis in AIDS patients after the first episode: a prospective open study.

OBJECTIVES: To evaluate the efficacy and safety of low-dose antifungals as prophylaxis of recurrent esophageal candidiasis after the first episode in patients with AIDS. METHODS: After the first episode of esophageal candidiasis, 122 consecutive AIDS patients were randomly assigned to two different regimens of continuous long-term antifungal prophylaxis (ketoconazole 200 mg or fluconazole 50 mg/day p.o.) or no antifungal therapy over a period of 2 yr. Patients were followed up by monthly clinical controls and upper GI endoscopy in the case of recurrence of esophageal symptoms. RESULTS: One hundred and six patients were clinically evaluable over a mean observation time of 7.5 months. Prophylaxis with oral antifungals significantly reduced symptomatic relapses of esophageal candidiasis, the cumulative probability of relapse at 12 months being 38% in the prophylaxis group, compared with 84% in the untreated group. Both antifungals were sufficiently safe and well tolerated. The clinical response of a second episode of candidiasis to the reintroduction of standard oral antifungals was markedly worse in patients on prophylaxis (especially with ketoconazole) than in untreated patients, presumably due to the development of resistance to the antifungal. CONCLUSIONS: Continuous prophylaxis with both-fluconazole and ketoconazole is effective in preventing recurrences of Candida esophagitis in AIDS patients; however, the possible emergence of strains resistant to these antifungals, as well as the high cost of the therapy, should raise doubts as to whether or not this type of prophylaxis should be extended to all AIDS patients with Candida esophagitis, rather than to limit its use to specific subgroups of patients, such as those with frequent symptomatic relapses.

AIDS-Related Opportunistic Infections↗
PubMed1993

Treatment of AIDS-related refractory diarrhoea with octreotide.

We evaluated the effect of octreotide, a long-acting synthetic analogue of native somatostatin, on bowel frequency in 13 patients with AIDS-associated refractory diarrhoea. Cryptosporidium enteritis and cytomegalovirus colitis were the most common causes of diarrhoea. All patients received 100 micrograms t.i.d. octreotide subcutaneously for 1 week; those who did not improve were given 250 micrograms t.i.d. for a further 7 days. Bowel frequency returned to normal in 1 patient, who was affected with cryptosporidiosis, and decreased by more than 50% in 7 others, another patient improved on the higher dose. In 1 case, the beneficial effect disappeared after 10 days of treatment. No major adverse events due to the therapy were observed. We conclude that octreotide has a potential therapeutic use in severe AIDS-related refractory diarrhoea. How to identify patients who may respond remains unknown at present.

AIDS-Related Opportunistic Infections↗
PubMed1993

Role of amino acids and enhancement cardioplegia in routine myocardial protection. Experimental results.

The purpose of this study was to determine the effects of the addition of amino acids to blood cardioplegic solution and the value of terminal cardioplegia enhancement techniques in routine myocardial protection. Forty-five open-chest adult dogs were instrumented with sonomicrometry crystals to measure left ventricular long axis, midequatorial short axis, and wall thickness. The aorta was clamped for 120 minutes of cardiopulmonary bypass. Animals were randomly separated into four myocardial protection groups: (1) blood cardioplegic solution with amino acids and no terminal cardioplegia (n = 12); (2) blood cardioplegic solution with amino acids and warm amino acid terminal cardioplegia (n = 11); (3) blood cardioplegic solution with amino acids and cold amino acid terminal cardioplegia (n = 12); and (4) blood cardioplegic solution plus cold terminal cardioplegia (no amino acids, n = 10). Data for preload recruitable stroke work were obtained by inflow occlusion before bypass (baseline) and at 30 and 60 minutes after reperfusion and analyzed for changes in x-intercept and slope. A significant rightward shift in x-intercept did not occur in any group. When cardiac function was expressed as a percentage of baseline preload recruitable stroke work slope, improved functional recovery was seen at both 30 and 60 minutes in groups 2 (88.6% and 91.8%), 3 (85.8% and 86.9%), and 4 (88.6% and 92.6%) compared with group 1 (77.3% and 79.2%, p < 0.05). No significant difference was found in the degree of functional recovery among groups 2, 3, and 4. These results suggest that for myocardial protection of 2 hours in nonischemic hearts, a terminal dose of blood cardioplegic solution before unclamping is beneficial, but this positive effect is independent of amino acid supplementation and temperature.

Amino Acids↗