Biomedical subjects

R Valenti

Publications and source records attributed to R Valenti.

At least 55 records · Page 3Linked to original sources

PubMed1996

Early coronary angioplasty as compared with delayed coronary angioplasty in patients with high-risk unstable angina pectoris.

BACKGROUND: Percutaneous transluminal coronary angioplasty (PTCA) results in a higher complication rate in patients with unstable angina pectoris than in patients with stable angina. The current management approach is directed towards achieving stabilization by medical treatment in order to reduce the rate of major complications, but the value of a conservative strategy has not been proved by clinical trials, nor has the duration of therapy been established. On the other hand, the definition of unstable angina encompasses a heterogeneous spectrum of patients with different prognoses. It is more appropriate to stratify patients according to different risk in order to evaluate the results of different therapeutic strategies. The purpose of this study was the evaluation of the results of early and delayed coronary angioplasty in patients with high-risk unstable angina. METHODS: We compared immediate and follow-up results of early and delayed coronary angioplasty in a series of 263 patients with high-risk unstable angina because of prolonged (more than 15 min) angina or early post-infarction angina at rest. Early PTCA (within 4 h of the last ischaemic episode) was performed in 110 patients with unstable angina refractory to maximized medical treatment, whereas 153 patients with stabilized angina underwent delayed PTCA (at more than 72 h and less than 1 week from the last ischaemic episode). RESULTS: No significant differences between the two groups were found in primary lesion success rates (92.7% compared with 94.1%), major in-hospital adverse events such as reocclusion (5.4% compared with 2.6%), emergency coronary artery surgery (1.8% compared with 3.2%), myocardial infarction (3.6% compared with 2.6%) and death (1.8% compared with 0.7%). The rates of major adverse events during 6 months follow-up were similar in the two groups: recurrent ischaemia (13.4% compared with 19.7%), repeat coronary angioplasty (11.5% compared with 14.9%), coronary artery surgery (1.9% compared with 4.7%), myocardial infarction (0), and death (0). CONCLUSIONS: The results of this study suggest that an aggressive coronary angioplasty strategy in patients with high-risk unstable angina may result in a favourable outcome both immediately and at 6 months' follow-up, The achievement of a stabilization period seems neither to improve the clinical success rates nor to reduce major cardiac event rates.

Adult↗

PubMed1996

[Comparison of outcome of primary PTCA for acute myocardial infarction in patients younger and older than 70 years of age].

BACKGROUND: The Primary Angioplasty in Myocardial infarction Study Group reported that the benefit of primary PTCA was observed mainly among patients who were classified as "not low risk" including those over age 70, with anterior infarction and heart rate > 100 bpm. The present study compares procedural success rate and in-hospital and one-month clinical outcome of primary PTCA in acute myocardial infarction patients < 70 and > or = 70 years of age. METHODS AND RESULTS: During 1995 121 patients with acute myocardial infarction underwent primary PTCA within 6 hours of symptoms onset or within 24 hours in case of evidence of ongoing ischemia. Eighty-two patients (Group I) were < 70 (mean age 56 +/- 9) and 39 patients (Group II) were > or = 70 (mean age 75 +/- 3). In group II there was a trend, although not significant, toward a higher prevalence of prior angina and infarction. Multivessel disease was more frequent in group II than in group I (69% vs 48%; p = 0.041). Ejection fraction was markedly depressed in both groups (38 +/- 10% in group I vs 34 +/- 11% in group II). Ejection fraction < or = 30% and shock on admission were more frequent in group II (39% vs 15% and 36% vs 21%, respectively). Optimal angiographic success (< or = 30% stenosis associated with TIMI grade 3 flow) was achieved in 77% of group II and in 98% of group I (p = 0.00059). The in-hospital mortality rate was 26% in group II and 1.2% in group I (p = 0.000042). Shock on admission and PTCA failure predicted high mortality rates. There was no difference between the two groups as regards to non-fatal reinfarction, recurrent ischemia, life-threatening arrhythmias, severe heart failure, revascularization procedures. There were no strokes. At one-month follow-up, recurrence of ischemia or positive response to stress test were more frequent in group II (24% vs 8%; p = 0.039). CONCLUSIONS: In patients with acute myocardial infarction < 70 years of age primary coronary angioplasty is associated with low rates of mortality and cardiac events. Mortality rate remains high in patients over age 70, especially when shock is present on admission or PTCA falls.

Age Factors↗

PubMed1995

Idiopathic avascular necrosis of the scaphoid. A case report.

Avascular necrosis of the carpal scaphoid is a common disorder after a trauma, i.e. a fracture or mild and repetitive injury. Sometime it can be associated with a systemic disease or chronic steroid intake. Rarely avascular necrosis is found in the absence of a known etiology and so termed "idiopathic". We report a case of idiopathic avascular necrosis of the scaphoid. A painful wrist of six months' duration was observed in a 62-year-old housewife. No history of trauma or steroid administration could be elicited. X-ray showed an osteolytic area with irregular edges surrounded by a ring of osteosclerosis at the proximal pole of the left scaphoid. This datum was confirmed by the magnetic resonance imaging.

Carpal Bones↗

PubMed1995

[Primary coronary angioplasty for acute myocardial infarction associated with severe left ventricular dysfunction. Results in 50 patients].

BACKGROUND: Considerable controversy exists about the therapeutic value of primary coronary angioplasty for acute myocardial infarction. The available data suggest that primary angioplasty may improve the outcome in patients with cardiogenic shock, while some clinical studies have found no benefit in routine angioplasty in patients with acute myocardial infarction that were considered at high risk because of severe left ventricular dysfunction associated with myocardial infarction. METHODS AND RESULTS: During a 16-month period, 50 patients with acute myocardial infarction and severe left ventricular dysfunction underwent primary coronary angioplasty. Patients were enrolled if angiographic left ventricular ejection fraction was > or = 40% and symptom duration <6 hours, or >6 hours if there was evidence of ongoing ischemia. Optimal angiographic success (<30% stenosis associated with TIMI grade 3 flow) was achieved in 45 patients (90%), and a suboptimal result (>30% and <50% stenosis associated with TIMI grade 3 flow, or <30% stenosis associated with TIMI grade 2 flow) was achieved in 3 patients (6%), while in 2 patients angioplasty failed to reopen the infarct related vessel or was associated with a refractory no-reflow phenomenon. In 5 patients an optimal angiographic result was achieved after coronary stenting. Emergency repeated coronary angioplasty was required in 1 patient with reocclusion of a stented vessel, and after unsuccessful repeated coronary angioplasty, the patient underwent bypass surgery on a semi-elective basis. In 6 patients with multivessel disease, after successful primary angioplasty of the infarct-related vessel, a more complete revasculariziation was achieved with a second coronary angioplasty or bypass surgery before discharge. The in-hospital mortality rate was 6%. The follow-up of 47 patients surviving initial hospitalization was 171 +/- 163 days. There were 2 deaths (4%), both due to congestive heart failure, and 1 nonfatal reinfarction. Two patients (4%), were readmitted to the hospital for recurrent ischemia and both underwent successful repeated coronary angioplasty for restenosis. CONCLUSIONS: The results of this study suggest that in patients with acute myocardial infarction associated with severe left ventricular dysfunction, primary coronary angioplasty may be considered a first choice treatment because of high reperfusion rate, relative low in-hospital mortality and few recurrent myocardial ischemic events.

Adult↗

PubMed1994

Comparison of ambulatory blood pressure monitoring and conventional office measurement in the workers of a chemical company.

The aim of the present study was to define the different prevalence of hypertension when conventional office measurement and ambulatory monitoring are performed in a population of unselected workers. All the workers of a Florentine chemical company were invited to participate in the study. Enrolled subjects underwent blood pressure measurement using a conventional sphygmomanometer and ambulatory blood pressure monitoring. Of 191 workers, 145 agreed to participate in the study (76%). Six of the 145 were excluded from further analysis because they were undergoing antihypertensive therapy. Confidence limits for ambulatory monitoring were defined at 95% on normotensive workers. Thirty-five (25%) workers were found to be hypertensive according to World Health Organization parameters (diastolic pressure > 90 mmHg) but only 14 of the 35 had higher 24-h diastolic ambulatory blood pressure than the 95% confidence limits of controls.

Adult↗

PubMed1994

Calcium antagonist antihypertensive treatment of non-insulin-dependent diabetics: efficacy and safety of lacidipine versus nifedipine SR.

Arterial hypertension is a chronic condition regarded as one of the main risk factors for development of coronary atherosclerosis. As dyslipidemia and reduced glucose tolerance are also risk factors for coronary disease, it is considered important to use antihypertensive drugs having no negative effects on lipid and glucose metabolism when diabetic patients are treated for hypertension. Lacidipine, a new dihydropyridine-like calcium antagonist, has been shown in in vivo and in vitro preclinical studies to possess potent, long-lasting antihypertensive activity. The present study compared the efficacy and safety of once-daily treatment with lacidipine versus nifedipine SR given twice-daily in non-insulin-dependent diabetic patients. Results have shown a similar efficacy of the two treatments: 6 months later, both drugs had reduced blood pressure values [lacidipine from 184.8/105.2 mm Hg to 144.4/87.1 mm Hg; nifedipine slow-release (SR) from 182.3/106.8 mm Hg to 143.6/89.4 mmHg]. However, lacidipine exhibited a lower incidence of adverse events (particularly ankle edema and tachycardia) than nifedipine SR. Finally, both treatments showed no negative effect on metabolic parameters (total cholesterol, high-density lipoprotein cholesterol, triglycerides, and blood glucose).

Antihypertensive Agents↗

PubMed1994

Hypertension and ischemic heart disease. Role of dipyridamole echocardiography test.

The aim of this study is to try to evaluate the relationship between arterial hypertension and ischemic heart disease (IHD) in the light of the physiopathologic response pattern to the dipyridamole echocardiography test (DET) in hypertensive patients, in pharmacologic washout, without any electrocardiographic ST segment depression during exercise tests or at rest. Sixty patients affected by mild to moderate asymptomatic essential arterial hypertension were studied: the subjects had a sitting diastolic blood pressure > or = 95 < or = 114 mmHg; there were 38 men and 22 women with a mean age of 49.8 +/- 7.6 years (range twenty-nine to sixty-eight). All patients had undergone high-dose DET (0.84 mg/kg in ten minutes). No patients developed side effects or asynergy in cardiac contractility during the test. In the absence of any significant coronary artery obstruction assessed angiographically, 18 patients (30%) showed ST segment depression > 1.0 mV during DET, sometimes with the presence of ventricular and/or supraventricular extrasystoles. In this group of patients the left ventricular mass index (LVMI) and duration of hypertension (in months) were higher as compared with those of the other 42 patients (respectively: 160.2 +/- 5.1 vs 129.2 +/- 9.2 g/m2, P < 0.02; and 30 +/- 4.8 vs 9 +/- 5.4 months, P < 0.007). In conclusion it is reasonable to speculate from these data that the ischemic-like" dipyridamole-induced ST segment depression, like that shown by patients affected by Syndrome X, might involve a worse prognosis in hypertensive patients. This may be because of increased coronary resistance due to structural modification or anatomic background.

Adult↗

PubMed1992

Metabolic effects of rectal administration of unmodified eel calcitonin in humans.

To evaluate the metabolic effects of unmodified eel calcitonin, nine normal subjects and eleven patients with Paget's disease of the bone entered the study. Eel calcitonin was administered via rectal mucosa at the dosage of 100 and 200 MRCU. Plasma calcium, plasma phosphate and plasma cAMP were measured at a baseline and after 10, 20, 30, 60, 90, 120, 180, 240 min. Rectal administration of 100 MRCU of eel calcitonin decreased plasma calcium and phosphate levels in normal subjects; the hypocalcaemic and hypophosphatemic effects were more marked and statistically significant in Paget's disease patients. Using 200 MRCU of eel calcitonin, statistically significant reductions in plasma calcium levels were observed in controls and in Paget's disease patients. Plasma phosphate decreased after rectal administration of the hormone, but not significantly. A slight but not significant increase in plasma cAMP was observed in normal subjects after the administration of 200 MRCU. These data demonstrate that eel calcitonin administered via rectal mucosa can exert some of the known biologic effects of the peptide.

Administration, Rectal↗

PubMed1992

[An autopsy study of patients who died at the Medical Clinic of the University of Siena from 1986 to 1989].

In the past twenty years autopsies are performed much less frequently in the elderly than in younger patients. The clinical diagnostic error rate documented by autopsy studies ranges from 6% to 68%. We analyzed the clinical and autopsy records of 214 patients who died from 1 January 1986 to 31 December 1989 at our Institute to determine the accuracy of clinical cause of death with respect to the pathologic cause of death. The most common cause of death were bronchopneumonia (25.2%) followed by gastroenteric and lung cancer (20%), cerebrovascular accident (15.8%), myocardial infarction (8%) and pulmonary embolism (7.4%). Pulmonary embolism was correctly classified only in 25% of patients. The most accurately diagnosed condition were neoplastic diseases (88%) and cerebrovascular accident (84.8%) while bronchopneumonia were correctly diagnosed antemortem in 72.2% of the patients studied. Our data suggest that advances in diagnostic technology have not reduced the value of the autopsy and that a goal-directed autopsy remains a vital component in the assurance of good medical care.

Age Factors↗

PubMed1991