Search PubMed⌕ Search

Biomedical subjects

S Romano

Publications and source records attributed to S Romano.

At least 73 records · Page 4Linked to original sources
PubMed1997

Evaluation of diaphragmatic fatigue in obstructive sleep apnoeas during non-REM sleep.

BACKGROUND: Resistive load applied to the airways may induce diaphragmatic fatigue, and hypoxaemia has been shown to predispose to the development of fatigue. Inspiratory muscle fatigue may occur in patients with obstructive sleep apnoea syndrome (OSAS), as these patients repetitively develop both inspiratory loading and hypoxaemia. The results of previous studies on this topic are inconclusive, probably because of the methodological approaches used. METHODS: Six obese patients with OSAS underwent a polysomnographic study. The diaphragmatic pressure time index (PTI) was evaluated as an indicator of diaphragmatic contraction, and the mean frequency of the diaphragmatic electromyogram power spectrum (Fm) and the maximum relaxation rate of transdiaphragmatic pressure (MRR) as indices of a fatiguing diaphragm. A total of 119 randomly selected apnoeas (each including 5-13 occluded efforts) were analysed throughout the night in non-REM sleep to assess possible muscle fatigue due to the high pressure generation in each apnoea. A breath-by-breath within-apnoea analysis was performed on the first three pre-apnoeic breaths, on all the occluded efforts, and on the first three unoccluded breaths following the apnoea interruption. Possible fatigue development due to the cumulative effect of apnoeas over the night was also evaluated. RESULTS: A progressive increase of Fm and MRR was found during the obstructive phase in all the subjects in the within-apnoea analysis. The overnight analysis did not show a reduction in either PTI, Fm, or MRR secondary to recurrent upper airway obstruction during the night. CONCLUSIONS: No evidence of diaphragmatic fatigue or impaired diaphragmatic contraction was found either within each apnoea or throughout the whole night, despite the generation of high PTI values during the apnoeic occluded phases. It is concluded that diaphragmatic fatigue does not occur in OSAS during non-REM sleep.

Adult↗
PubMed1997

Comparative study of papaverine plus phentolamine versus prostaglandin E1 in erectile dysfunction.

PURPOSE: We compared the efficacy and short-term adverse effects of 1 ml. 30 mg./ml. papaverine plus 0.5 mg./ml. phentolamine versus 1 ml. 30 micrograms./ml. prostaglandin E1 in patients undergoing pharmacological erection testing. MATERIALS AND METHODS: A total of 60 patients (mean age 58 years) with a history of sexual erectile dysfunction longer than 6 months was randomly classified into 6 groups to be tested 1 week apart with the 2 solutions and with placebo to evaluate erection response and short-term adverse effects. RESULTS: Of the patients tested with papaverine plus phentolamine 54% responded with erections adequate for penetration, compared to 50% of those tested with prostaglandin E1 (p > 0.05). Prolonged erection occurred in 18% of patients tested with papaverine plus phentolamine and 15% of those tested with prostaglandin E1 (p > 0.05). Pain was reported by 15 and 35% of patients, respectively (p < 0.05). CONCLUSIONS: One ml. 30 mg./ml. papaverine plus 0.5 mg./ml. phentolamine has the same efficacy and equal prolonged erection rate as 1 ml. 30 micrograms./ml. prostaglandin E1 but the latter agent induces significantly more pain.

Adult↗
PubMed1997

Different heart rate patterns in obstructive apneas during NREM sleep.

Both bradycardia and a trend to tachycardia have been reported in obstructive sleep apneas (OSA). Because heart rate (HR) behavior may yield information on parasympathetic activity during OSA, we analyzed HR in samples of consecutive apneic cycles in non-rapid eye movement (NREM) sleep, recorded in normotensive patients breathing room air (n = 7) and supplemental O2 (n = 4). In air, the patients showed different HR trends during apnea, as HR decreased (HR decreased), remained constant (HR=), or increased (HR increased). By multiple regression analysis, development of HR trends correlated with the HR fall in the late interapneic period, HR at first effort, the decrease in esophageal pressure, and the lengthening of inspiration during apnea (R2 = 0.42). O2 abolished HR decreased-OSA, whereas HR= and HR increased-OSA still occurred but at higher HR than in air. In both the air and O2 series, the HR fall preceding apnea correlated significantly with the degree of hypoxia reached in the previous apneic cycle. These data indicate a complex modulation of HR during OSA, with the HR fall in the late interapneic period possibly reflecting the effectiveness of parasympathetic cardiac control in OSA patients during sleep.

Adult↗
PubMed1996

Respiratory mechanics during exhaustive submaximal exercise at high altitude in healthy humans.

1. The present investigation was conducted to test the hypothesis that the respiratory system is stressed more during exhaustive exercise in chronic hypoxia than in normoxia. 2. Four healthy male subjects (aged 33-35 years) exercised on a cycle ergometer at 75% of the local maximum oxygen consumption (Vo2,max) until exhaustion, at sea level (SL) and after a 1 month stay at 5050 m (HA). 3. Airflow at the mouth (V), oesophageal (Po) and gastric (Pg) pressures were measured at rest, during exercise and recovery. Minute ventilation (VE), respiratory power (Wresp), respiratory frequency (f) and transdiaphragmatic pressure (Pdi) were calculated from the measured variables. 4. The subjects' mechanical power output of cycling at HA was 23.7% lower than at SL. In spite of this reduction, time to exhaustion at HA was 55.3% less than at SL. VE increased slightly during exercise at SL, but showed a marked increase at HA, and at the end of exercise at HA was 47.3% higher than at SL. 5. Respiratory power increased more at HA than at SL (77.3% higher at the end of exercise) due to the increase in f needed to sustain the high VE. 6. Gastric pressure swings were negative at the end of HA exercise but always positive at SL. The Pai:Po ratio reached values below 1 at HA but never at SL. 7. These data seem to indicate that the respiratory system is stressed more during submaximal exercise at HA than at SL. We suggest that the exceedingly high VE demand, requiring an excessive Wresp, may lead to fatigue of the diaphragm.

Adult↗
PubMed1996

Training to criterion in eyeblink classical conditioning in Alzheimer's disease, Down's syndrome with Alzheimer's disease, and healthy elderly.

The cholinergic antagonist scopolamine delays acquisition of eyeblink classical conditioning (EBCC) in rabbits and humans, but scopolamine-treated organisms eventually acquire conditioned responses (CRs). Patients with probable Alzheimer's disease (AD) and older adults with Down's syndrome (DS/AD) have disrupted cholinergic systems and perform EBCC very poorly. It was hypothesized that patients with probable AD and DS/AD, like scopolamine-injected organisms, would acquire CRs if given sufficient training. Twelve probable AD patients, 12 DS/AD patients, and 6 healthy elderly control individuals participated in 5 daily 90-trial sessions of EBCC. Fifty-eight percent of the probable AD, 92% of the DS/AD, and 100% of the control participants achieved learning criterion. Probable AD, DS/AD, and control participants had statistically significant increases in the percentage of CRs produced over 5 EBCC sessions. The neural substrate for EBCC was not eliminated in probable AD or DS/AD patients, although the learning mechanism was disrupted.

Adult↗
PubMed1996

Adjuvant chemotherapy after gastric resection in node-positive cancer patients: a multicentre randomised study.

After curative resection for gastric adenocarcinoma, 103 patients, all with positive nodes, were randomised so that 48 received adjuvant chemotherapy of epidoxorubicin (EPI) 75 mg m-2 on day 1, leucovorin (LV) 200 mg m-2 on days 1-3 and 5-fluorouracil (5-FU) 450 mg m-2 on days 1-3, every 21 days for 7 months, whereas the remaining 55 did not. During the first year of observation, 21 control patients (38%) and five treated patients had recurrences. After a follow-up period of 36 months, 12 of the treated patients (25%) and only seven controls (13%) were still alive. At that point, the median survival was 13.6 months for the 55 untreated patients and 20.4 months for the 48 treated patients, a significant difference. We found a survival advantage for patients treated with the EPI-LV-5-FU regimen and a consistent delay in the appearance of recurrent or metastatic cancer. Acute toxicity was mild and treatment was well accepted by all patients. There was no long-term toxicity or any cardiac toxicity. We conclude that this particular chemotherapy, administered shortly after gastric resection, improves survival rate in node-positive gastric cancer patients, even although final assessment of this particular adjuvant approach must await completion of the trial.

Adenocarcinoma↗
PubMed1996

Pharmacokinetics of amikacin in intensive care unit patients.

OBJECTIVE: To characterize the population pharmacokinetics of amikacin in intensive care unit (ICU) patients and to analyse whether these patients show different kinetic behaviour on the basis of their clinical diagnoses. METHOD: The patient population comprised 104 medical ICU patients on amikacin treatment for several presumed or documented Gram-negative infections. Four study groups were defined according to patients' clinical diagnosis: sepsis group (n = 39), trauma group (n = 20), pneumonia group (n = 21) and 'other diagnosis' group (n = 24). The pharmacokinetic parameters for amikacin in these patients were then compared. RESULTS: The ICU patients were found to have increased values for the amikacin volume of distribution (0.52 +/- 0.21 litres/kg), whereas total amikacin clearance expressed as a linear function of creatinine clearance was Cl (ml/min/kg) = 0.13 +/- 0.86 ClCR, which is not significantly different from other estimations reported in the literature. However, this relationship revealed statistically significant differences among the four groups of ICU patients. Moreover, the septic and trauma patients showed higher (but not statistically significant) values for the amikacin volume of distribution. CONCLUSION: The amikacin pharmacokinetic parameters obtained should allow Bayesian individualization of amikacin doses in patients admitted to medical ICUs, on the basis of their clinical diagnoses.

Adult↗
PubMed1996

Cardiovascular and ventilatory response to isocapnic hypoxia at sea level and at 5,050 m.

To assess the effect of chronic hypoxic conditions on ventilatory, heart rate (HR), and blood pressure (BP) responses to acute progressive isocapnic hypoxia, we studied five healthy Caucasian subjects (3 men and 2 women). Each subject performed one rebreathing test at sea level (SL) and two tests at the Pyramid laboratory at Lobuche, Nepal, at the altitude of 5,050 m, 1 day after arrival (HA1) and after 24 days of sojourn (HA2). The effects of progressive isocapnic hypoxia were tested by using a standard rebreathing technique. BP, electrocardiogram, arterial oxygen saturation, airflow and end-tidal CO2 and O2 were recorded. For each subject, the relationships between arterial oxygen saturation and HR, systolic BP and minute ventilation (VE), respectively, were evaluated. At HA1, the majority of subjects showed a significant increase in VE and BP response and a decrease in HR response to progressive isocapnic hypoxia as compared to SL. At HA2, VE and BP responses further increased, whereas the HR response remained similar to that observed at HA1. A significant relationship between hypoxic ventilatory responses and both systolic and diastolic BP responses to progressive hypoxia was found. No significant correlation was found between hypoxic ventilatory and HR responses.

Adult↗
PubMed1996

Prostaglandin E1 versus mixture of prostaglandin E1, papaverine and phentolamine in nonresponders to high papaverine plus phentolamine doses.

PURPOSE: We evaluated the efficacy of 40 micrograms/ml, prostaglandin E1 versus a combination of 17.64 mg./ml. papaverine hydrochloride, 0.58 mg./ml. phentolamine mesylate and 5.8 micrograms/ml. prostaglandin E1 (3-drug mixture). MATERIALS AND METHODS: A total of 32 patients randomly received 1 ml. of either medication by the intracavernous route. All patients had presented with erectile dysfunction longer than 6 months in duration and had failed to respond to high doses of papaverine (60 mg.) plus phentolamine (1 mg). RESULTS: Of 32 patients 7 (22%) responded to prostaglandin E1 and 16 (50%) to the 3-drug mixture, achieving erections allowing penetration (grade E4 or E5, p < 0.05). Pain was reported by 41% of the patients receiving prostaglandin E1 and 12.5% administered the 3-drug mixture. CONCLUSIONS: The 3-drug mixture may be regarded as more effective than prostaglandin E1 alone in inducing an erectile response with a decreased incidence of pain.

Adult↗
PubMed1996

[Comparison of electrocardiographic and echocardiographic findings in acute myocardial infarct].

The aim of this study was to evaluate, in a large series of patients (420 males, 104 females, mean age 59 +/- 9.4 years) with acute myocardial infarction (AMI), the role of electrocardiography and two-dimensional echocardiography in identifying the site and the extension of the necrotic area, with regard to the treatment (thrombolysis or not) and the extent of coronary artery disease. Our results have shown a good correlation between ECG and echo in evaluating the infarct size, with a larger extension in echo examinations. Regarding the infarct site, a good correlation was found in anterior AMI, but not in inferior AMI. Thrombolytic therapy does not seem to introduce significant variations in this regard. Furthermore, the results of coronary angiography have shown that two-dimensional echocardiography allows us to identify the infarct-related coronary artery in a larger number of patients (90%) compared to ECG (80%). On the contrary, the two methods are similar in evaluating the extent of coronary artery disease, with correct identification of only one third of patients, the majority of them with single-vessel disease. Finally, we observed that the presence of abnormal apical wall motion is frequent (47%), in the majority of cases associated with anterior wall motion abnormalities, while in 5% of the cases the apex alone is involved. This finding suggests an analogy between these "apex infarctions" and the non Q wave infarctions, in which necrosis is present only in a little zone of a larger area at risk.

Aged↗
PubMed1996

[At risk myocardium after acute infarct treated with fibrinolysis: assessment using exertion echocardiography and clinico-prognostic significance].

Several studies have been carried out on the role of exercise echocardiography for risk stratification after uncomplicated myocardial infarction. However, the diffusion of thrombolysis has entailed a remarkable change in the characteristics of these patients, with a major incidence of recurrent ischemic events or reinfarction in the follow-up. To test whether the predictive value of exercise echocardiography may be modified by thrombolytic treatment, we have studied 62 patients with acute myocardial infarction undergoing lytic therapy (Group A), compared to 153 conventionally-treated patients (Group B). All patients were asymptomatic at the time of the test, performed by cycloergometer 14 days after hospital admission. In 125 patients (47 Group A and 78 Group B) predischarge coronary angiography was performed. The exercise test showed a lower, but not significant, rate of positive tests in Group A patients (51.6 vs 58.8%). However, a positive test was more frequent in the homozonal area among patients who underwent thrombolytic therapy (50% of positive tests vs 18% in Group B; p < 0.001). Follow-up data (23 +/- 17 months) showed a higher but not significant rate of coronary events (cardiac death, reinfarction, severe angina, coronary bypass or angioplasty) in Group A patients with a positive test (62 vs 39% in Group B); however, in the subgroup with homozonal positive test, the event rate was much higher in Group A (77 vs 18% in Group B; p < 0.01). Furthermore, among patients with negative exercise test, coronary events were observed in 8% Group A and in 10% Group B patients. Therefore, our results show a higher percentage of homozonal exercise-induced ischemia with subsequent higher rate of coronary events in the thrombolyzed patients with respect to controls. This pattern is probably due to a higher rate of significant infarct-related residual stenosis, as coronary angiography have demonstrated. In conclusion, exercise echocardiography is useful in thrombolyzed patients, since it may better explore, rather than ECG, peri-necrotic areas.

Coronary Angiography↗
PubMed1995

Intravenous administration of gentamicin once daily versus thrice daily in adults.

The efficacy and safety of intravenous gentamicin administered once daily versus thrice daily was evaluated in adults. Patients over 16 years of age with a suspected or documented gram-negative infection were randomly divided into two groups: one group received gentamicin intravenously 4.5 mg/kg once daily (n = 48), and the other received 1.5 mg/kg every eight hours (n = 52). Baseline characteristics were comparable in the two groups. The mean peak level of gentamicin in the once daily group was significantly higher than that in the thrice daily group, 8.7 +/- 2.3 mg/l versus 4.6 +/- 1.2 mg/l (p < 0.005), and the trough level lower, 0.7 +/- 0.3 mg/l versus 1.1 +/- 0.9 mg/l (p < 0.005). The clinical cure rate was significantly higher in the once daily group, 42 of 48 (87.5%) versus 36 of 52 (69.2%). The microbiological cure rate was also better in the once daily group than in the thrice daily group (31 of 36 versus 28 of 38 patients evaluated), although this difference was insignificant. Nephrotoxicity was not observed in either group, but ototoxicity was present in three of the patients treated thrice daily. A once daily dosing regimen of gentamicin is more effective and less ototoxic than a thrice daily regimen.

Adolescent↗
PubMed1995

Spontaneous resolution of ectopic tubal pregnancy: natural history.

OBJECTIVE: To determine the characteristics and long-term outcome of women succeeding or failing expectant management of ectopic pregnancy (EP). DESIGN: Prospective, defined protocol. SETTING: University-affiliated gynecology department. PATIENTS: We used a protocol that selected women with laparoscopic confirmed ectopic tubal pregnancy and declining plasma hCG values. Over a 5-year period, 60 women representing 20.1% of EPs fulfilled the inclusion criteria. Women were followed with serial hCG testing and transvaginal ultrasound. MAIN OUTCOME MEASURE: Success or failure of expectant management. RESULTS: Expectant management was successful in 28 (47.7%) of the patients. Thirty-two (53.3%) failed expectant management, and a treatment procedure was required. There was no difference in the resultant ipsilateral tubal patency or 1-year fertility rates of those women succeeding or failing expectant management. Analysis showed that in the face of declining values and with a starting hCG > 2,000 mIU/mL (conversion to SI unit, 1.00), 93.3% failed expectant management, whereas < 2,000 mIU/mL, 60.0% succeeded. CONCLUSION: We conclude that expectant management should be offered as a treatment option only in those women fulfilling the criteria for a good prognosis.

Adnexa Uteri↗
PubMed1995

Limited role for intratubal methotrexate treatment of ectopic pregnancy.

OBJECTIVE: To test the effectiveness of laparoscopic intratubal methotrexate (MTX) injection or salpingostomy in the treatment of ectopic pregnancy (EP). DESIGN: Prospective predefined protocol. SETTING: Department of Obstetrics and Gynecology of a university-affiliated hospital. PATIENTS AND INTERVENTIONS: Between January 1988 and December 1993, we treated 342 women with EP, of which 99 were treated by either laparoscopic salpingostomy (n = 55) or intratubal MTX injection (n = 44). MAIN OUTCOME MEASURES: The success and failure rates were calculated for each treatment protocol. Also analyzed were subsequent tubal patency and fertility rates. RESULTS: Salpingostomy was successful in 51 of 55 patients (92.7%), whereas intratubal MTX injection was successful in only 27 of 44 women (61.4%). Methotrexate injection particularly was unsuccessful if the initial hCG was > 2,000 mIU/mL (conversion factor to SI unit, 1.00) or the size of the tubal mass was > 2.0 cm as measured during laparoscopy. There was no difference in the subsequent tubal patency rates of fertility rates between women undergoing MTX injection or salpingostomy. CONCLUSIONS: These results suggest that salpingostomy is effective in the treatment of EP. Methotrexate injection failed in more patients despite preferential selection criteria, suggesting that its use should be limited to the subgroup of women with initial hCG < 2,000 mIU/mL and size at laparoscopy < 2.0 cm.

Adult↗
PubMed1995

Respiratory sinus arrhythmia during obstructive sleep apnoeas in humans.

Respiratory sinus arrhythmia (RSA) reflects parasympathetic modulation of heart rate (HR) during the respiratory cycle. Since the time-course of RSA during obstructive sleep apnoea (OSA) is not known, an analysis was made of ECG in samples of consecutive OSA recorded in 5 patients during NREM sleep while breathing room air (OSA-AIR, mean lowest SaO2 83.0 +/- 6.5%) or supplemental oxygen (OSA +/- O2, mean lowest SaO2 91.7 +/- 2.2%), respectively. For each breath, HR at the transition from expiration to inspiration (HRei), and HR at maximal inspiration (HRie) were calculated, and the inspiratory increase in HR estimated as the ratio: HRie/subsequent HRie. Similarly, the expiratory decrease in HR was estimated as: HRie/subsequent HRei. RSA was identified by an inspiratory increase in HR (HRei/HRie < 1), and an expiratory decrease in HR (HRie/HRei > 1). OSA-AIR and OSA + O2 did not differ for duration or oesophageal pressure nadir. During OSA-AIR, the inspiratory increase in HR became progressively more marked from the first occluded to the first open breath, whereas during OSA + O2 it remained stable throughout the apnoeic cycle. The expiratory decrease in HR remained constant during the apnoeic phase, but was blunted in the first open breaths irrespective of O2 administration. In summary, hypoxia appeared to affect inspiratory, but not expiratory HR. Instead, the expiratory slowing of HR transiently disappeared in the immediate post-apnoeic phase, suggesting a possible effect of arousal or pulmonary inflation. These data suggest that the parasympathetic system may contribute to cardiovascular regulation during OSA.

Journal Article↗
PubMed1995

[The usefulness of noninvasive diagnostic methods in postinfarct prognostic stratification].

We have studied 455 consecutive patients with acute myocardial infarction to assess the early and mid-term prognostic value of clinical and laboratory findings in the acute (i.e. Killip classification, arterial PO2, echocardiographic extent of necrotic area) and subacute phase (exercise test, ambulatory ECG). Results showed that clinical examination, blood gas analysis and two-dimensional echocardiography have a high predictivity for in-hospital risk stratification. In particular, two-dimensional echocardiography showed that patients with diffuse wall motion abnormalities had a worse prognosis during the follow-up. Exercise test and, to a lesser extent, ambulatory ECG have well identified patients at risk for new coronary events.

Adult↗
PubMed1995

[Frequency and mode of use of testing for HIV infection in women hospitalized for childbirth].

OBJECTIVE: To assess the use of HIV testing "because of pregnancy". DESIGN: Cross-sectional study. PATIENTS: Parturients admitted to the obstetric divisions of a public hospital located in Rome (February-April 1994). INTERVENTION: Standardized interview during post test counseling. OUT-COMES: Frequency and characteristics of HIV testing "because of pregnancy" and women's know ledge on HIV sexual and vertical transmission. RESULTS: Among the 506 women admitted all consented to be tested and 3 were found HIV seropositive (0.6%). A total of 239 (47%) unselected parturients were interviewed; the remaining differ only for a lower rate of cesarean delivery (13% vs 54%). Of the interviewed, 140 (58%) had been already tested for HIV infection, 91 (38%) during the current pregnancy according to gynaecologist's prescription (79.87%) and without counseling (55.60%) or ascertained risk factors (82.90%); 40% had been tested after the first trimester of pregnancy. Rate of vertical transmission was estimated higher than 50% in 147 cases; 150 women knew the "window period" but less than half estimated it correctly. CONCLUSIONS: The study showed a unsatisfactory use of HIV testing "because of pregnancy" and suggests the need for implementing in Italy information campaigns targeted both to women and gynecologists.

Adult↗