Biomedical subjects

S Battista

Publications and source records attributed to S Battista.

42 records · Page 3Linked to original sources

PubMed1992

Abnormal left ventricular intracavitary flow acceleration in patients undergoing aortic valve replacement for aortic stenosis. A marker for high postoperative morbidity and mortality.

BACKGROUND: We examined the clinical and echocardiographic characteristics of patients undergoing aortic valve replacement for aortic stenosis whose continuous wave Doppler studies showed abnormal intracavitary flow acceleration. METHODS AND RESULTS: The clinical and Doppler echocardiographic records of 53 consecutive patients undergoing aortic valve replacement for aortic stenosis were reviewed. Doppler echocardiography was performed at a mean of 6.6 days (range, 0-22 days) after surgery. Thirteen patients (group 1) had a dagger-shaped high-velocity systolic flow signal indicative of abnormal intracavitary flow acceleration on their postoperative Doppler study; group 2 comprised 40 aortic stenosis patients who underwent aortic valve replacement but had no postoperative evidence of abnormal intracavitary flow acceleration. Group 1 postoperative abnormal intracavitary flow velocities ranged from 1.8 to 6.8 m/sec (mean, 4.9 +/- 0.9 m/sec): Resulting dynamic gradients ranged from 10 to 184 mm Hg (mean, 104.6 +/- 32 mm Hg). Compared with group 2, group 1 patients had a distinctive ventricular geometry with more-pronounced hypertrophy, smaller cavities, and higher ejection fraction. Systolic anterior motion of the mitral valve did not accompany abnormal intracavitary flow acceleration in any patient. Six of 13 group 1 patients suffered postoperative hemodynamic compromise characterized by severe hypotension despite adequate pulmonary capillary wedge pressures; group 1 postoperative mortality was significantly greater than that seen in group 2 patients (38% versus 12%, p less than 0.05). CONCLUSIONS: Abnormal intracavitary flow acceleration after aortic valve replacement for severe aortic stenosis is associated with a distinctive ventricular geometry and supernormal systolic function but not systolic anterior motion of the mitral valve. Such flow acceleration appears to be a marker for increased postoperative morbidity and mortality. Preoperative and postoperative Doppler echocardiography may be useful in risk stratification and guiding therapy.

Aged↗

PubMedDate not supplied

A systems approach in hepatology.

Systems analysis has been applied to hepatology with the aim of providing a reasonable organisation of domain knowledge and supporting the improvement of clinical performance. To this extent liver structures and functions have been classified and defined, clinical parameters have been carefully selected and suitably associated to describe individual liver functions, and methodological criteria for clinical evaluation have been assessed. Three major outcomes of such an approach, respectively concerning the development of a shareable clinical database, the application of a suitable methodology for clinical reasoning, and the computer-based support to medical decision-making, have been discussed.

Biotransformation↗

PubMedDate not supplied

Scoring procedures in clinical hepatology.

A major problem in the assessment of liver function is represented by the quantification of the different aspects on which it relies (biosynthesis, drug metabolism, bile secretion, etc.) and of the clinical severity, with important prognostic implications. Another field that can be supported by quantification procedures is the histological evaluation of chronic hepatitis (necro-inflammatory activity and fibrosis). Finally, scoring systems can be usefully applied in clinical practice as a tool which supports medical decisions in very difficult diagnostic processes. In all the above considered fields, the scoring procedures have the important advantage to allow the standardisation of clinical procedures as well as to facilitate the statistical manipulation of data in controlled clinical trials. This paper reviews numerical scoring systems utilised in hepatology and their clinical applications.

Decision Support Techniques↗

PubMedDate not supplied

[HEPASCORE: a decision-support system for the identification, clinical staging and functional assessment of hepatopathies].

A decision support system (HEPASCORE) has been developed to optimize the application of objective criteria for qualitative and quantitative assessment of liver function; clinical and laboratory data are automatically processed, and conclusions are explained. Early recognition of abnormal liver states is performed according to a sequential approach, based at first on clinical rules utilizing data from history and physical examination, then confirming or denying the hypothesis by means of selected laboratory tests. Once an abnormal condition is defined, clinical severity can be evaluated by use of suitable scores, either prognostic or focused on major clinical complications. In addition, selected sets of biochemical tests can be used to score one or more functional aspects. Lastly, whenever quantitative estimates of residual liver function are requested, dynamic tests can be applied to measure meaningful parameters such as functioning liver mass and functional hepatic plasma flow. HEPASCORE has been successfully applied to exclude liver abnormalities in subjects at risk, to follow up liver patients, to predict the natural outcomes of severe liver diseases, to foresee the adverse effects of drugs undergoing first-pass liver extraction and the side effects of invasive procedures. While the proposals contained in the system could be further modified for specific needs, they reflect a satisfactory methodological approach, and the program serves as a useful support to decisions regarding the identification and functional evaluation of hepatopathies. The system was developed with Microsoft Access 7.0 and runs on a personal computer under Windows 95.

Decision Support Systems, Clinical↗

PubMedDate not supplied

[Use of an automatic blood glucose measurement system for the assessment of insulin resistance during the oral glucose tolerance test].

An automatic glycemic control system (Beta-like, Esaote) was used to calculate the insulin area (IA) required to keep glycemia within the normal range during OGTT (using NDDG criteria). IA was calculated by adding total endogenous insulin to insulin infused by the Betalike system (Actrapid HM, Novo). During the test, glycemia was obliged to follow a mean normal curve using an insulin infusion according to a special algorithm which automatically adapted to individual parameter variations during the different stages of OGTT. Fourteen blood samples were collected to assay metabolites (glucose, NEFA, lactate and alanine) and hormones (insulin, C peptide, glucagon). Data on insulinemia and glycemia were used to calculate the respective areas under the total and incremental curve (IA expressed in UL-1 min-1 and GA expressed in mM.L-1.min-1); an insulin resistance index was then calculated (total and incremental) using the following formula: IA/(normal GA/patient GA). This test allows us: a) to evaluate the insulin secretory response to a standard glycemic stimulus represented by a glycemic curve within the normal range; b) to calculate the quantity of insulin necessary to maintain the glycemic curve within the normal range; c) to evaluate the body's total insulin resistance according to an index calculated on the basis of the insulin area required; d) to compare the calculated insulin resistance index with NEFA and glucagon data obtained during the test; e) to identify the exact evolution of these events over time during OGTT.

Blood Glucose↗

PubMedDate not supplied

[Reduced glutathione and anaerobic threshold].

In this study the authors evaluate the relationship existing between reduced glutathione (GSH) and increased indexes of muscle performance. GSH has a protective action on the cell either against the oxidative stress or for its ability of removing through out the body xenobiotic substances circulating. 15 male competitive pentathlon athletes were the sample of this research. The aim of the research is to evaluate the possible role of GSH to determine the anaerobic threshold through its blotting function.

Adult↗