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Biomedical subjects

S Romano

Publications and source records attributed to S Romano.

At least 91 records · Page 5Linked to original sources
PubMed1994

Intraamniotic infection with Candida albicans successfully treated with transcervical amnioinfusion of amphotericin.

We present a case in which a pregnant woman was seen at 27 weeks' gestation with premature rupture of membranes and intraamniotic infection with Candida albicans, which was treated with transcervical amnioinfusion of amphotericin B. After 7 days of treatment spontaneous vaginal labor developed. A female newborn of 1030 gm was delivered. The infant was normal and did well.

Adult↗
PubMed1994

Ventilatory response to spontaneous resistive load variations during sleep.

We investigated the ventilatory response to spontaneous changes in resistive load during sleep in nine adult asthmatic patients, four of whom were snorers. All patients had a history of nocturnal worsening of respiratory symptoms and were submitted to a nocturnal polysomnographic study in a sleep laboratory. During the night, all patients showed spontaneous increases in pulmonary resistance due to bronchoconstriction. A temporary additional increase in inspiratory resistance (RI) was observed as a result of snoring. In all patients, a highly significant inverse linear relationship was found between ventilation (VE) and RI, but the slopes of the regressions varied considerably among patients; the decrease in VE was due to a reduced mean inspiratory flow. The most effective ventilatory compensation to increasing resistive load (lowest absolute values in the VE/RI slopes) was observed in two patients: one nonsnorer and one snorer. Effective VE compensation appeared to be dependent on the individual's combined adjustments of transpulmonary pressure (Ptp) and duty cycle (TI/TT). In fact, an increase in Ptp, linearly related to RI, was observed in all patients except one (a snorer during nonsnoring breathing); however, the Ptp increase was able to compensate VE only when TI/TT increased. We conclude that, in sleeping asthmatic patients, VE adaptation to increased spontaneous load is highly variable among patients and its effectiveness is related to individual strategies on the basis of adequate adjustments of neuromuscular output and timing of the breathing cycle.

Adult↗
PubMed1994

Time course of right ventricular stroke volume and output in obstructive sleep apneas.

Because the behavior of right ventricular stroke volume (RVSV) in the obstructive sleep apnea syndrome (OSAS) is undefined, we studied the time course of RVSV by right heart catheterization during sleep in five OSAS patients. In 55 obstructive apneas, heart rate (HR) and RVSV were calculated beat-by-beat. RVSV was estimated by integrating the area under the pulmonary arterial (PA) blood velocity signal obtained by a velocity sensor-/micromanometer-tipped catheter. Compared with preapnea, mean RVSV did not change significantly during apnea, but decreased by 15% during postapnea. Analysis of RVSV in the respiratory cycle showed that postapneic RVSV was mostly reduced at maximal inspiration, suggesting a role of increased lung volume in decreasing RVSV. As for HR, it decreased significantly during apnea in four out of five patients. In all patients, HR returned to preapneic values during postapnea. Therefore, right ventricular output decreased slightly in most patients during late apnea because of decreased HR, whereas it decreased in all patients during postapnea because of decreased RVSV. These results, together with the known finding that PA pressure increases towards the end of apneas and remains elevated in the immediate postapnea, suggest that the most relevant changes in the pulmonary circulation occur at the resumption of ventilation, not during the apneic phase.

Adult↗
PubMed1994

Slow and fast changes in transmural pulmonary artery pressure in obstructive sleep apnoea.

Our purpose was to assess how pulmonary artery pressure changes in relation to hypoxia and oesophageal pressure during obstructive sleep apnoeas. Transmural systolic pulmonary artery pressure (Ppa,STM), oxyhaemoglobin saturation (SaO2) and oesophageal pressure were analysed in two samples of consecutive obstructive apnoeas in each of four patients. In the first samples (samples A; probably recorded during non-rapid eye movement (NREM) sleep), SaO2 swings were small and repetitive. In the second samples (samples B; probably recorded during rapid eye movement (REM) sleep), they were large and more variable. Oesophageal pressure oscillated similarly in the two groups of samples. In all cases, transmural systolic pulmonary artery pressure progressively increased throughout apnoeas, and subsequently decreased in the interapnoeic periods. However, both early and end-apnoeic transmural systolic pulmonary artery pressure, remained stable in samples A; whilst they progressively increased in samples B. Transmural systolic pulmonary artery pressure at the beginning of each apnoea was inversely correlated with SaO2 at the end of the preceding apnoea. These results suggest that transmural systolic pulmonary artery pressure is influenced by SaO2, but does not vary at the same speed as SaO2. In all cases, beat-by-beat analysis showed, as expected, that the lower the oesophageal pressure, the higher the transmural systolic pulmonary artery pressure however, at each oesophageal pressure level, transmural systolic pulmonary artery pressure was more variable and higher, in samples B. In conclusion, transmural systolic pulmonary artery pressure in obstructive apnoeas shows rapid changes, which reflect oesophageal pressure variations, and slower changes, which are likely to be caused by SaO2.

Blood Pressure↗
PubMed1994

Cytokines in acute myocardial infarction: selective increase in circulating tumor necrosis factor, its soluble receptor, and interleukin-1 receptor antagonist.

Cytokines play a pathogenetic role in a variety of infective and inflammatory diseases. In the present study, we had two objectives: (a) to define the kinetics of tumor necrosis factor (TNF) in plasma after acute myocardial infarction (AMI) in patients treated with early thrombolysis, and (b) to measure other cytokines, interleukin-1 (IL-1) and TNF receptor antagonists, in plasma. TNF-alpha, but not IL-1 beta or IL-8, was present in plasma of 6 of 7 patients with severe AMI (Killip class 3 or 4). No TNF (< 50 pg/ml) was detected in a group of 11 patients with uncomplicated myocardial infarction (Killip class 1) or in control patients without AMI. Soluble TNF receptor type I and IL-1 receptor antagonist (IL-1Ra) were also significantly increased in the group with severe AMI compared with those with uncomplicated AMI. Circulating TNF is increased only in AMI complicated by heart failure at hospital admission. This finding may have diagnostic and therapeutic relevance.

Aged↗
PubMed1994

[ACE-inhibitors after infarction: current knowledge and future prospects].

Experimental and clinical findings showing a beneficial effect on ventricular remodelling have led to a widespread use of ACE-inhibitors in myocardial infarction. Recent trials (SAVE, AIRE, GISSI 3, ISIS 4) have clearly demonstrated that in patients with left ventricular dysfunction and/or heart failure the treatment with ACE-inhibitors is mandatory, although several questions remain unanswered. Recent experimental observations on the relationship between ACE and endothelial function, and between ACE and intimal proliferation have gone forward leading to new perspectives on the potential use of ACE-inhibitors in all patients with acute myocardial infarction.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1994

[Influence of the early mother-infant contact in the delivery room on short or long term breast feeding].

Two groups of mothers and their children were followed up in order to assess the influence of early mother-child contact on breast-feeding; a first control was carried out at discharge from the nursery and a follow-up 6 months later. All the mothers were in good health and pregnancy was physiological with uncomplicated eutocic delivery; none of the babies presented pathologies during the period of their stay in the nursery and in the subsequent 6 months. Group A comprised 126 mothers who had had contact with their babies in the delivery room for at least one hour; group B comprised 109 mothers whose first contact with their baby was only 3-6 hours after birth. Significant differences between the 2 groups were observed as early as the first control which took place at discharge from the nursery: 69.1% of the babies in group A against 51.3% in group B had taken mother's milk exclusively (p < 0.01). Equally significant differences emerged from the subsequent control at 6 months: 70 babies out of 116 (60.4%) were breast fed exclusively or partially, against 42 out of 101 (42.4%) in group B (p < 0.01). Furthermore, important data emerged from the duration of breast-feeding, whether this was exclusive or otherwise, in the first 6 months of life: group A differed significantly from group B (p < 0.002). Our figures suggest a positive influence of early mother-child contact on breast-feeding and on its duration. Notwithstanding the fact that there is no unanimous confirmation in the literature, it is considered that such behaviour will bring benefits to both mother and child.

Age Factors↗
PubMed1994

[Thallium-dipyridamole in acute myocardial infarction treated by thrombolysis: diagnostic and prognostic value].

BACKGROUND: The management of patients who received thrombolytic therapy for acute myocardial infarction is still controversial. It is not clear if the strategies usually followed after myocardial infarction for risk stratification have the same value when applied to patients treated with thrombolysis. METHODS: To assess the diagnostic and prognostic value of dipyridamole thallium-201 scintigraphy in the "thrombolytic era", we studied 110 consecutive patients younger than 75 recovering from first uncomplicated acute myocardial infarction treated with thrombolytic agents. Patients with early angina, recurrent acute myocardial infarction, heart failure, life-threatening arrhythmias, non Q wave myocardial infarction were excluded. Ninety patients were treated with streptokinase, 14 with rtPA, 6 with APSAC: All patients underwent dipyridamole thallium scintigraphy with standard dose and coronary angiography before discharge (10-20 days). Ninety-nine patients underwent exercise test. All patients were followed-up for 22 +/- 9 months (range 8-42). Perfusion abnormalities were classified as reversible (totally or partially) defects or persistent defects and within or outside the infarct zone. RESULTS: Fifty-eight patients developed anterior and 52 inferior acute myocardial infarction. Coronary angiography showed single vessel coronary artery disease in 66 patients, multivessel disease in 34, and normal coronary arteries or sub-critical stenosis in 10. No major complications (death, myocardial infarction, threatening arrhythmias, prolonged severe hypotension) occurred after dipyridamole infusion. Sixty-two patients had reversible perfusion defects at thallium scanning (34 within the infarct zone, 21 within and outside the infarct zone, 7 outside); 38 patients had persistent defects; 10 patients had a normal scintigraphic pattern. The diagnostic value of homozonal perfusion reversible defects for identifying a patent infarct-related vessel was poor (sensitivity 69.7%, specificity 64.7%). The diagnostic values of the same scintigraphic pattern improved in detecting patent infarct-related artery with residual critical stenosis (sensibility 75.4%, specificity 77.3%); in all the false positive cases (reversible defects within the infarct zone and occluded infarct-related artery) a good collateral flow was present. The sensitivity of reversible defects outside the infarct zone in detecting multivessel disease was 64.7% vs 56.3% of exercise test; the specificity was 92% vs 64%; the positive predictive value 78.6% vs 44%; the negative predictive value 85.3% vs 74.5%; the diagnostic accuracy 83.6% vs 61.4%. During the follow-up 2 deaths, 7 recurrent myocardial infarction, 1 sustained ventricular tachycardia, 1 heart failure, 13 recurrence of unstable angina and 9 revascularization procedures occurred among patients with reversible defects (either within or outside the infarct zone) at thallium scanning. One recurrent myocardial infarction, 4 recurrence of unstable angina and 2 revascularization procedures were the events among patients with persistent defects or normal scintigraphic pattern (p < 0.001). Ischemic events occurred with similar frequency in patients with reversible perfusion defects within the outside the infarct zone (55% vs 50%, NS). CONCLUSIONS: Dipyridamole thallium-201 scintigraphy performed after uncomplicated myocardial infarction treated with thrombolytic agents is a valuable diagnostic tool in identifying viable jeopardized myocardium within the infarct zone perfused by a patent but critically narrowed vessel; it shows better diagnostic accuracy in detecting multivessel disease than does the exercise test and is able to identify a subset of patients at risk for future ischemic events after thrombolytic therapy.

Adult↗
PubMed1993

Comparison of frequency, diagnostic and prognostic significance of pericardial involvement in acute myocardial infarction treated with and without thrombolytics. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI).

Data from the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI) trial were reviewed to describe the epidemiology of pericardial involvement in patients treated with or without thrombolysis, and to establish its role as a marker of the extent of myocardial infarction and its prognostic value. In both GISSI-1 (n = 11,806) and 2 (n = 12,381), a specific item regarding presence/absence of clinically detected pericardial involvement was included in the study forms. In GISSI-1, patients with ST elevation and depression at the onset of myocardial infarction were admitted, whereas GISSI-2 included only those with ST elevation. Results of univariate analysis are presented as Mantel-Haenszel-Peto odds ratios with 95% confidence intervals. Cox proportional hazards models were used to assess the independent prognostic significance of pericardial involvement for in-hospital and long-term mortality. The main results indicate that: (1) the incidence of pericardial involvement in patients treated with thrombolytic agents is approximately half of that in the control group (6.7 vs 12.0%); (2) the earlier is the treatment, the lower is the incidence of pericardial involvement; (3) pericardial involvement is strongly associated with infarction size, evaluated by electrocardiograms, creatine kinase peak and echo assessments; and (4) pericardial involvement is associated with a higher long-term mortality, but is not an independent prognostic factor (RR 1.02; 95% confidence interval 0.82-1.26). Pericardial involvement is a reliable bedside, cost-free marker of myocardial infarction size and poorer outcome. Because it may elude detection owing to its transitory and often short duration, it should be given greater attention.

Heparin↗
PubMed1993

Influence of reperfusion induced by thrombolytic treatment on natural history of left ventricular regional wall motion abnormality in acute myocardial infarction.

Although several studies have investigated left ventricular (LV) function after reperfusion interventions, it is still unclear whether benefits result from successful therapy or whether such benefits only reflect the natural history of a subgroup of patients with acute myocardial infarction (AMI). This study evaluates the unique effect of thrombolytic therapy on the natural history of regional LV wall motion dysfunction. One hundred seventy-six patients with AMI were studied: 82 patients (group A) underwent conventional treatment and 94 (group B) thrombolytic therapy. LV regional improvement, evaluated by changes in echo score between admission and predischarge examination, was present more frequently in group B (28%) than in group A (17%). Furthermore, improved patients in group B had higher admission echo scores (7.5 +/- 3.5 vs 6.3 +/- 3.1), a prevalence of anterior AMI (68 vs 30.1%) and a higher rate of coronary patency (92 vs 58% in patients who had no improvement). In group A patients the rate of coronary patency was similar in those who did (46.1%) and did not have (36.1%) improvement. Observations at 12 to 18 months showed similar data in group A patients and in group B patients without improvement, whereas a marginal additional improvement was observed in group B patients who had in-hospital improvement. These observations demonstrate that LV function recovery is more frequent and marked in treated than in untreated patients. Follow-up results suggest a prolonged beneficial effect of thrombolytic treatment on LV function. The highest rate of coronary patency in improved group B patients underline the role of reperfusion on natural history of LV dysfunction after AMI.

Coronary Angiography↗
PubMed1993

Effectiveness of thrombolysis is associated with a time-dependent increase of malondialdehyde in peripheral blood of patients with acute myocardial infarction.

By using a highly sensitive, high-performance liquid chromatographic technique, plasma values of malondialdehyde (MDA), adenosine and oxypurines were determined in 10 healthy subjects, 10 patients with noncardiac illness, and 20 patients with acute myocardial infarction (AMI) observed within 6 hours from the onset of symptoms. Patients with AMI received fibrinolytic treatment. Peripheral blood was obtained before and serially after thrombolysis (1, 2, 3, 6 and 24 hours). Coronary patency was assessed by timing of peak creatine phosphate kinase and by predischarge angiography. MDA (mean +/- SD) in healthy subjects, noncardiac patients, and immediately before thrombolytic treatment in patients with AMI was 0.051 +/- 0.013, 0.066 +/- 0.020 and 0.397 +/- 0.326 mumol/liter of plasma, respectively. A progressive increase in plasma MDA after thrombolysis was observed only in reperfused patients, whose values at the third, sixth and 24th hours were also significantly greater than those of nonreperfused patients. Time-dependent variations of xanthine and adenosine were also observed in the same group after thrombolysis. The data appear to indicate that a relevant increase in plasma MDA, mostly originating due to phospholipid derangement of postischemic myocytes, occurs only in patients with successful thrombolysis, thus suggesting that if properly assayed, it may represent reliable biochemical evidence of tissue injuries after myocardial reperfusion in humans.

Adenosine↗
PubMed1993

Altered platelet function associated with the bronchial hyperresponsiveness accompanying nocturnal asthma.

BACKGROUND: Nocturnal awakening is a common feature of bronchial asthma, and yet the mechanisms underlying this phenomenon are poorly understood. We investigated whether nocturnal awakening is associated with changes in platelet function with the use of a variety of markers of platelet activation. METHODS: Ten patients with a history of nocturnal asthma and 10 age- and sex-matched healthy control subjects were studied at 10:00 PM, 4:00 AM, and 10:00 AM on 2 consecutive days. The following parameters were tested: forced expiratory volume in 1 second (FEV1), log dose of methacholine inducing a 20% fall in FEV1, platelet count and volume, platelet aggregation induced by collagen or activating factor, and plasma and intraplatelet levels of beta-thromboglobulin and platelet factor 4. RESULTS: We have demonstrated that altered platelet function and platelet activation occurs at 4:00 AM in patients with nocturnal asthma and is associated with the maximum increases in bronchial reactivity. Such changes were not observed in 10 control subjects. Platelet dysfunction has been detected as a reduced aggregatory response of platelets to collagen and platelet activating factor such that up to 5 times more platelet activating factor and 1.5 times more collagen were required to elicit a threshold aggregatory response in asthmatic subjects when compared with control subjects; this difference was evident at all time points tested. Furthermore, at 4:00 AM there were significantly lower levels of intraplatelet beta-thromboglobulin corresponding to the maximum reduction in peak expiratory flow and to the maximal increase in bronchial responses to inhaled methacholine. CONCLUSIONS: These results suggest that platelet activation accompanies nocturnal asthma and further suggest that platelets may play a role in this common clinical condition.

Adult↗