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Biomedical subjects

R Pistelli

Publications and source records attributed to R Pistelli.

At least 73 records · Page 4Linked to original sources
PubMed1990

Cardiac arrhythmias and left ventricular function in respiratory failure from chronic obstructive pulmonary disease.

In 22 patients with COPD, we studied the relationship between left ventricular function and cardiac arrhythmias. Ventricular arrhythmias were detected on a 24-h ECG recorded at the beginning of the observation period and after a stable improvement of RF. Left ventricular function was evaluated by equilibrium-gated radionuclide angiocardiography measuring LVEF, PER and PFR. We found a significant decrease in the arrhythmia score after improvement of RF; LVEF and PFR were slightly depressed in six and nine patients, respectively. A "step-up" multiple regression analysis revealed a significant inverse correlation between PFR and ventricular arrhythmias during worsened RF, whereas LVEF, arterial blood gases and clinical data were not significantly predictive variables. Thus, a depressed left ventricular diastolic performance seems to be a predictive factor for arrhythmias during RF from COPD. The poor definition of the statistical model suggests that other presently unknown factors contribute to the genesis of ventricular arrhythmias.

Arrhythmias, Cardiac↗
PubMed1989

Comparison of the performance of two mini peak flow meters.

Two mini peak flow meters commonly used to monitorize the peak expiratory flow rate (PEFR) are compared to assess their agreement, precision and, with respect to a standard pneumotachygraph, accuracy. Precision of the mini-Wright peak flow meter is greater, possibly as result of a systematic overestimation of PEFR values. The Assess peak-flow meter is more accurate, but its ability to reproduce the actual well-known PEFR variability is dependent from the absolute level of air flow. The agreement between two instruments is very poor, both in asthmatics and in normals, so that it is mandatory to use always the same mini peak flow meter in population studies and during the follow-up of asthmatic patients.

Adolescent↗
PubMed1987

Pulmonary involvement in progressive systemic sclerosis: a multidisciplinary approach.

In an attempt to define the early features and the natural evolution of lung involvement in progressive systemic sclerosis (PSS), we planned a multidisciplinary study of these patients using radiological, scintigraphic and functional methods. As yet we have studied 21 subjects, all affected by PSS according to the American Rheumatism Association criteria. A well-defined restrictive functional pattern was present only in 10 patients out of 21; an increased elastic recoil may be present before a significant decrease of the transfer test for carbon monoxide; an increased alveolar-capillary permeability assessed by the 99mTc-diethylene-triamine-pentacetic acid (99mTc-DTPA) clearance rate has been detected in almost all the patients (13 out of 14) in at least one lung field; no significant correlation has been found between the radiological lung involvement and the 99mTc-DTPA clearance rate. We think that these preliminary results are consistent with an alveolar and interstitial inflammation rather than with a vasculitic process.

Adult↗
PubMed1987

[Dynamic pulmonary scintigraphy with Tc99m radioaerosol for the evaluation of the permeability of the alveolo-capillary barrier].

Pulmonary clearance of small droplet 99mTc-DTPA radioaerosol was studied in 100 patients (12 normal subjects, N; 10 asymptomatic healthy smokers, FA; 31 patients with interstitial lung diseases, IP; 47 patients with chronic obstructive lung disease, BPCO). The first seven minutes of clearance were described with the function At = Ao*exp (-K*t) and the time constant K was considered representative of the 99mTc-DTPA clearance rate and hence of the alveolar-capillary barrier permeability. Groups FA, IP and BPCO showed a significant (p less than 0.05) or a highly significant (p less than 0.01) increase in permeability when compared to group N. No correlation was found between permeability and bronchial obstruction tests. The following conclusions were drawn: --99mTc-DTPA dynamic lung scanning is an easy, non-invasive method to assess derangements of alveolar-capillary barrier permeability secondary to epithelial damage; --permeability increase is a very early effect of cigarette smoke damage to the epithelium; --other mechanisms of epithelial injury are present in diffuse lung disease; --while the clinical role of this new pathophysiological test is not yet clear, it is likely that it may become a very early marker of pulmonary epithelial damage in diffuse lung disease.

Adult↗
PubMed1986

Inapparent pulmonary vascular disease in an ex-heroin user.

A severe pulmonary vascular derangement, usually reported in drug addicts, was diagnosed in a 28-year-old asymptomatic ex-heroin user by means of fortuitously performed pulmonary perfusion imaging. Neither physical findings nor pulmonary function tests, aroused suspicion of the diagnosis. A search for asymptomatic pulmonary vascular disease probably should be undertaken in drug addicts.

Adult↗
PubMed1986

Equilibrium radionuclide angiocardiography to select inotropic therapy in patients with left ventricular aneurysm.

Fourteen patients with postinfarctual ventricular aneurysm underwent equilibrium radionuclide angiocardiography at rest (ERNA) before and after oral digoxin administration in order to evaluate the effects of increasing myocardial contractility upon both ventricular aneurysm mechanical behaviour and global ventricular function. The ejection fraction (EF) was not significantly affected by digoxin therapy. However, digoxin induced changes in EF (delta EF) correlated inversely with changes in aneurysm size and directly with changes in the extent of the hypokinetic area. Two types of aneurysm were observed: high-compliance aneurysm the size of which increased after digoxin administration while both EF and the extent of the hypokinetic area fell, and low compliance aneurysm for which opposite changes occurred. This different behaviour of ventricular aneurysm may have important practical implications as surgery would be probably more effective than medical treatment in improving resting ventricular function in patients with high-compliance aneurysm.

Adult↗
PubMed1986

The use of digitalis in patients with chronic respiratory failure.

The effect of slow digitalization was tested by radioisotopic angiocardiography in 33 patients with stable and compensated chronic obstructive pulmonary disease (COPD); most of these had severe chronic respiratory failure (CRF). After a 10 days course of digoxin, 0.25 mg/die per os, both the left ventricular ejection fraction (LVEF) and the peak ejection rate (PER), initially slightly abnormal, improved significantly (t = -3.474, p less than 0.005; t = -2.438, p less than 0.025), while right ventricular ejection fraction (RVEF) and peak filling rate (PFR) did not. Ventricular diastolic interdependence and abnormal myocardial calcium kinetic are likely to account for PFR behaviour. Digoxin effects upon RVEF and LVEF suggest that the right ventricular systolic function is to some extent independent from the left one when blood gas derangement and abnormal thoracopulmonary mechanics are the major determinant of right ventricular afterload. The lack of significant correlation between digoxin effects on right and left ventricular function indices confirms this hypothesis. Digoxin can improve the left ventricular ejection phase indices, when these are initially abnormal, while its effect on RVEF is unpredictable.

Adult↗
PubMed1986

[Scintigraphy of pulmonary ventilation with 99mTc-DTPA radio-aerosol. I. Semiotics of the static images].

Papers on deposition pattern analyses of radio-aerosol lung scans are few and not easy to interpret as there is a general lack of technical standardization and the number of patients studied is not large. Moreover these reports have been generally obtained with non-hydrosoluble radioaerosols. In the present study 43 patients underwent conventional pulmonary function testing and lung scanning using small droplet (equal or less than 2 microns) polydisperse 99mTc-DTPA radioaerosol produced with the "Settling Bag System"--Medi 400 (Sorin). The scans were analysed by two methods: a semiquantitative method proposed by Taplin (SQT); an original simpler semiquantitative method (SQM). Correlations of SQT and SQM with FEV1 and MEF75 resulted highly significant (p less than 0,001). SQM proved to be superior to SQT as far as reproducibility is concerned. The following conclusions can be drawn: small particle 99mTc-DTPA aerosol can be easily and cheaply produced by a commercial device; such a radioaerosol is well suited for the evaluation of small and large airways patency, as reflected by MEF75 and FEV1 respectively, with a diagnostic yield comparable to non-hydrosoluble radioaerosols; the original semiquantitative description of the deposition patterns proposed and validated in this study is quite easy to implement and it yields a high correlation with pulmonary function tests; moreover such an approach does not require digital data processing; the sensitivity of 99mTc-DTPA for the diagnosis of bronchial obstruction is very high and superior to routine pulmonary function tests; in addition the ventilation scan allows the topographical localization of the obstructions themselves.

Adult↗
PubMed1985

A simple method of predicting left ventricular function in stabilized chronic respiratory failure.

A simple method of assessing left ventricular function in stabilized chronic respiratory failure (CRF) is proposed. 21 patients with CRF were ranked according to the prediction of left ventricular function derived from eight elementary clinical criteria including standard chest X-ray and conventional basal electrocardiography. Equilibrium radionuclide angiocardiography was performed at rest (rERNA) for the evaluation of left ventricular systolic function (ejection fraction, LVEF; peak ejection rate) and diastolic function (peak filling rate). Right ventricular ejection fraction (RVEF) was also measured. The clinical evaluation of the left ventricular function showed a high correlation with rERNA data (p less than 0.01 by Spearman's rank test). No correlation was found between rERNA parameters and PaO2 and between RVEF and LVEF. The clinical criteria proposed can thus predict left ventricular function in stabilized CRF with a high degree of confidence.

Angiocardiography↗
PubMed1985

Detection of ventilation unevenness by nitrogen washout and forced vital capacity manoeuvres: its limits and reliability.

We investigated the behaviour of several indices of ventilation unevenness in a sample of 234 normal subjects aged between 20 and 80 years, divided into 12 classes of 5 years each. The aim of the present study was to find out whether it is possible to predict a reliable value for each of these indices as a function of age, height and TLC. For each index a large dispersion of experimental points and a high unexplained variance was found, so that it does not seem worthwhile predicting its value as a function of age, height and TLC. We concluded that there is no reason to employ these indices to detect the beginning of a lung function impairment.

Adult↗
PubMed1985

99mTc-DTPA clearance in bullous emphysema.

The degree of permeability of the alveolar-capillary barrier to low molecular weight solutes has been supposed to depend upon the radius of the epithelial pores. The bullous emphysema is a natural model in which this radius may increase because of the high tension in the bulla. Accordingly, the 99mTc-DTPA clearance may be expected to be faster than normal in lung fields including bullae. Results of the present study in which 99mTc-DTPA clearance was measured in six patients with bullous emphysema, seem to confirm this hypothesis at least to some extent. In fact, either increased or normal 99mTc-DTPA clearances were found over the lung fields including bullae communicating with the bronchial tree. Differences in both the size and the inner tension of the bullae as well as in the anatomical and functional conditions of the surrounding parenchyma are likely to account for such varying behaviour.

Capillary Permeability↗
PubMed1984

Respiratory function during pregnancy.

We studied the respiratory mechanics, acid-base status, alveolar ventilation and ventilatory response to hypercapnia in pregnant women at the first and third trimesters and postpartum. We found alveolar hyperventilation and hypersensitivity of the respiratory centers to carbon dioxide with no significant differences between the first and third trimesters. After delivery we found a sudden decrease in these parameters. The changes seem to be due to a direct primary (probably hormonal) stimulation on the medulla oblongata and cannot be correlated to the metabolic needs of the fetus and are aimed at favoring placental gas exchanges, especially at the beginning of the pregnancy, when the fetal cardiovascular system is not yet developed.

Acid-Base Equilibrium↗
PubMed1980

[Orthogonal ECG and a statistical system for computer diagnosis with ECG in chronic obstructive pneumopathy].

In 92 patients affected from chronic obstructive pulmonary disease (C.O.P.) undergoing spirometric evaluation, the ability of the Pipberger computer program for electrocardiographic interpretation to predict the presence of pulmonary disease with or without right ventricular hipertrophy was compared with that of the manually measured conventional and orthogonal (Frank system) electrocardiogram. The patients were classified as having mild, moderate and severe C.O.P. on the basis of spirometric data. Each system predicted the presence of C.O.P. with low sensitivity. P voltage in D2 greater than or equal to 2 mm (27,1%) and R/S voltage ratio in V5-V6 greater than or equal to 1 (22,8%) were the single conventional criteria more frequently satisfied. Results for 3 lead manual readings were only slightly lower: recognition rate of the R/S voltage ration in x lead less than or equal to 1,3 was 15,7%. The Pipberger program probabilistic answers were divided in "completely" and "partially" correct. Combined completely or partially correct diagnoses were made by the program 14,3% of patients with mild C.O.P., 17,2% of moderate and 48,8% of severe C.O.P. These results suggests that the Pipberger program has at least similar ability to predict C.O.P. compared with the 12 lead and orthogonal manually measured electrocardiogram.

Aged↗
PubMedDate not supplied

Questionnaire data as predictors of urinary cotinine levels among nonsmoking adolescents.

The strength of association between urinary cotinine and questionnaire data on passive smoking among 542 adolescents was evaluated. There were 103 individuals with urinary cotinine higher than 30 ng/ml; they were compared with all other subjects. The single variable that best predicted the urinary cotinine level was maternal smoking. A strong effect was made by house size and, consequently, house crowding. Maternal smoking and house crowding had a synergic effect. The subject's perception of passive smoking at home also was an independent indication of a high cotinine level. The final model had a fairly good sensitivity, whereas the specificity was somewhat lower. The results suggest that maternal smoking, house crowding, and subject's perception of a smoky environment could be surrogate indices of high passive smoking exposure in this age group and could be useful for epidemiologic studies.

Adolescent↗
PubMedDate not supplied

Bronchial responsiveness in children living in areas with different air pollution levels.

This study evaluated the prevalence of increased bronchial responsiveness (BR) in children living in two areas with different air pollution levels. A total of 1,215 methacholine challenge tests were performed among a random sample of primary schoolchildren in an industrial town polluted by oil-fired thermoelectric power plants and in a rural area chosen as a control. The two groups showed similar lung function data (forced vital capacity [FVC] and forced expiratory volume in 1 s [FEV1.0]) and prevalence of positive prick tests to common aeroallergens. All children responding with a 20% drop in FEV1.0 to a methacholine concentration < or = 64 mg/ml, "all responders" (PC20FEV1.0 < or = 64 mg/ml), and the subgroup of "strong responders" (PC20FEV1.0 < or = 4 mg/ml) were compared separately with "nonresponders" (PC20FEV1.0 > 64 mg/ml), calculating odds ratios (ORs). There were more "all responders" (57.2% versus 41.4%) and "strong responders" (20.0% versus 14.8%) among subjects living in the industrial area; the excess remained when several potential confounders were taken into account ("all responders": OR = 2.0, 95% confidence interval [95% CI] = 1.5-2.6; "strong responders": OR = 1.9, 95% CI = 1.3-2.8), and it was even more pronounced among girls. When the effect of clinical predictors of increased airways responsiveness (history of asthma, allergic rhinitis, baseline airways caliber, skin reactivity, recent respiratory infection) was considered through multiple logistic regression, the odds ratios associated with living in the industrial area were still significantly increased in girls. The cross-sectional approach and the lack of individual exposure data limit the interpretation of the findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗