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Sandro Forconi

Publications and source records attributed to Sandro Forconi.

6 recordsLinked to original sources
PubMed2003

Pulmonary embolism in very old patients.

BACKGROUND AND AIMS: Diagnosis of pulmonary embolism (PE) in the elderly remains difficult and is often late, although its incidence increases steadily with age. Since few studies have reported the clinical picture of this disease in very old patients, the aim of our study was to focus on clinical, instrumental and laboratory aspects in patients 75 years of age and over with suspected PE. METHODS: Symptoms, signs, risk factors for venous thromboembolic diseases, 12-lead electrocardiograms, B-mode echocardiograms, chest X-rays, leg compression venous ultrasonography, latex-assay quantitative D-dimer, and arterial blood gas analyses were collected for 96 elderly patients of 75 years and over (mean age 81.22 +/- 4.81) with suspected PE, admitted to our acute geriatric ward from 1997 to 2000. Patients were divided into two groups: 59 patients with PE (PE+) confirmed by pulmonary angiography, scintigraphic lung scan or necropsy, and 37 patients with normal lung scan or without PE at necropsy (PE-). RESULTS: Dyspnea and chest pain were the most common symptoms in both groups, but significantly more frequent in the PE+ group. Tachycardia, fever, cyanosis, and tachypnea were the most common objective signs in both groups; tachycardia and tachypnea were not significantly different between the two groups. Bed rest, venous insufficiency and leg deep vein thrombosis were the most common venous risk factors in PE+ and significantly different with respect to PE-. Sinus tachycardia, ST-T abnormalities and right bundle branch block were the most common electrocardiographic aspects in PE+; echocardiograms showed significantly more frequent acute involvement of right heart in PE+, whereas chest X-rays were rarely compatible with PE and did not reveal differences between the two groups. D-Dimer was significantly higher in PE+ but was below 500 ng/mL only in 25% of cases in PE-. More severe hypoxemla, oxy-hemoglobin hyposaturation and increased alveolar-arterial oxygen gradients were found at arterial blood gas analysis in PE+. CONCLUSIONS: Although many analyzed clinical, instrumental and laboratory aspects were significantly more frequent in the PE+ group, they were all non-specific and not conclusive for diagnosis of PE. Our retrospective study focus may add information about the picture and diagnostic difficulties of PE in very old patients.

Age Factors↗
PubMed2003

[Diagnostic and therapeutic features of pulmonary embolism in elderly patients].

BACKGROUND: Pulmonary embolism (PE) is often underdiagnosed in the elderly for nonspecificity and atypicity of presentation. The aim of this study was to evidence, retrospectively, the clinical, instrumental and laboratory aspects in the diagnosis of elderly patients with suspected PE and to observe the antithrombotic primary prophylaxis, acute antithrombotic treatment and its hemorrhagic side effects in patients with confirmed PE (CPE). METHODS: We conducted an observational, retrospective, study on 118 hospitalized patients > or = 65 years (49 males and 69 females, mean age 77.76 +/- 7.17 years) during a 5-year period who underwent a scintigraphic lung scan for suspected PE. Clinical, instrumental and laboratory findings of 75 patients with CPE were compared with 43 patients with unconfirmed PE (UCPE). RESULTS: Symptoms of dyspnea and chest pain and all the considered signs, except tachycardia, were significantly more frequent in the CPE group. Bed rest > 4 days, venous insufficiency, deep vein thrombosis, obesity and stroke were the risk factors significantly more frequent in the CPE group. Sinus tachycardia, incomplete right bundle branch block, ST-T alterations were significantly more present in the CPE group. Cardiomegaly was the only significant more frequent chest X-ray finding in the CPE group, while echocardiography showed a significant involvement of the right ventricle in the CPE group. Plasma D-dimer levels were significantly higher in the CPE group but the mean values were > 500 micrograms/l in both groups. In arterial blood gas analysis we found more severe hypoxemia, arterial hyposaturation and higher alveolar-oxygen gradient in the CPE group, while we did not find a more frequent respiratory alkalosis in this group. Heart failure, ischemic heart disease and chronic obstructive pulmonary disease were the more frequent diagnoses in the UCPE group. None of the patients received thrombolysis. Seventy percent of the CPE patients received intravenous heparin; 9 hemorrhagic side effects occurred, 3 of them being major with one fatal in one patient treated with subcutaneous unfractionated heparin. CONCLUSIONS: Our study shows the diagnostic difficulties of PE in the elderly because of nonspecifcity of clinical, instrumental and laboratory aspects. Although many of these aspects are significantly more frequent in the CPE group, the same are often the main aspects also in the UCPE group. Moreover, our study reveals the low utilization of antithrombotic primary prophylaxis and high risk of hemorrhagic side effects of heparin in this subgroup of patients.

Age Factors↗
PubMedDate not supplied

High levels of human chromogranin A in umbilical cord plasma and amniotic fluid at parturition.

OBJECTIVE: The human placenta is a neuroendocrine organ that produces several hypothalamic and pituitary hormones that are secreted during pregnancy and parturition into maternal and fetal circulation and amniotic fluid. Human chromogranin A (CgA) is a glycoprotein mainly localized to the adrenal medulla and released in response to several stressful events. During pregnancy, intrauterine tissues express and synthesize CgA mRNA and peptide and secret it into the biologic fluids of pregnancy, so we investigated whether maternal, umbilical, and amniotic human CgA levels are affected by the stress of parturition. METHODS: We measured pregnancy CgA levels in maternal and umbilical cord plasma and in amniotic fluid at term (39-40 weeks), by enzyme-linked immunosorbent assay at elective cesarean (n = 16), after spontaneous vaginal delivery (n = 12), and longitudinally throughout labor and 2 hours postpartum. RESULTS: CgA levels were highest in umbilical cord blood (P <.001). Umbilical cord plasma and amniotic fluid CgA levels were significantly higher at spontaneous vaginal delivery than at cesarean (P <.001), and the levels were not changed in maternal plasma according to cervical dilatation and postpartum. CONCLUSIONS: The present findings showed that the stress of parturition increased CgA levels in umbilical cord plasma and amniotic fluid and was probably of fetal origin. Whatever the mode of delivery, CgA levels in infants were much more elevated than in mothers, providing evidence for an unusual and sustained high level of sympathoadrenal stimulation in full-term neonates.

Adult↗