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T Moccetti

Publications and source records attributed to T Moccetti.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Smoking, blood pressure and body weight in the Swiss population: MONICA study 1988-89].

Two Swiss regions, the cantons of Vaud and Fribourg (VD-FR) and the canton of Ticino (TI), take part in the international research project MONICA (MONItoring trends and determinants in CArdiovascular disease). In this framework, three surveys are planned to monitor the prevalence of the principal risk factors. The second survey was carried out in 1988/89 on 2011 participants aged 25 to 74 for the VD-FR region and on 1458 participants aged 35 to 64 for the TI region. This article is devoted to the results concerning smoking habits, blood pressure, body height and weight. In the VD-FR region, the percentage of regular smokers steadily decreases with age, from 44% for men and 36% for women in the 25-34 age group to 15% and 10% respectively in the 65-74 age group. Inversely, the proportion of participants with high blood pressure rises steeply with age from nearly zero in the 25-34 group to more than a quarter in the 65-74 group. Similar risk factor levels are observed in the TI region. Two significant trends show up in comparison with the first survey (1984-86) for the latter region: the decreases in mean blood pressure levels for both sexes and in the proportion of regular smokers for men. However, these trends are to be interpreted cautiously because of potential measurement bias between surveys.

Adult↗
PubMed1990

[Gonococcal endocarditis: an infection as rare as it dangerous. Apropos of a case: the importance of suspicion in diagnosis and of immediate treatment].

Gonococcal endocarditis, although extremely rare, is increasing in frequency, particularly among young exposed patients. It has a distinct predilection for aortic and mitral valve involvement and tends to cause rapid valvular destruction and acute heart failure. Blood cultures are often negative during the first (3 to 31) days. Echocardiography with Doppler is helpful in detecting valvular vegetations, regurgitation and signs of hemodynamic deterioration. Early antibiotic treatment may stabilize the hemodynamic situation only in mitral but not in aortic valve involvement, which necessitates prompt valvular replacement in the event of perforation and/or annulus abscess. Gonococcal endocarditis should be the first item to be excluded in cases of fever with systemic symptoms in young people with a history of sex-transmitted disease. We present a typical case.

Adult↗
PubMed1988

[Initial experiences with thrombolysis in Swiss hospitals. Synopsis of a round-table discussion].

Thrombolytic therapy of acute myocardial infarction (AMI) has resulted in significant reduction of mortality, limitation of infarct size and preservation of left ventricular function. Among the panelists there was consensus with respect to the following recommendations for efficient thrombolytic therapy of AMI: the prehospital phase should be considerably shortened, especially by reducing patient delay. This can be achieved by rendering patients aware of symptoms of AMI and the need for immediate hospitalization on their occurrence. After contraindications have been ruled out, intravenous thrombolysis should be started in every case where the time elapsed since the onset of pain is not greater than 3 hours. In patients with large infarctions intravenous thrombolysis is indicated up to 6 hours after onset of pain. Accompanying medication should include heparinization and administration of aspirin. When reperfusion is achieved the patient should be monitored for recurrence of ischemia. Regardless of symptoms recurrence of ischemia requires immediate coronary arteriography with a view to revascularization by PTCA or bypass surgery. Patients without recurrence of spontaneous ischemia should undergo ergometric stress testing before leaving the hospital. Exercise-induced angina or ST segment depression are strong indications for coronary arteriography.

Acute Disease↗
PubMed1988

[Systemic thrombolysis using streptokinase. Experiences at the Civic Hospital of Lugano in the framework of the ISIS-2 study].

With a small group of Swiss hospitals we had an opportunity of participating in ISIS-2, the major study on thrombolysis in acute myocardial infarction. Experience with our microcosm (Ospedale Civico Lugano) was compared with the macrocosm of the results of ISIS-2 in 17,187 randomized patients (in brackets). Mortality was 5.1% (7.8%) in our streptokinase group and 15.8% (12.8%) in our placebo group. In the ISIS-2 study the combination of thrombolytic therapy with streptokinase, and of antiplatelet therapy with aspirin, showed a reduction of approximately one third in acute mortality of myocardial infarction, stroke and reinfarction. Our experience confirms the reduced incidence of allergic side effects (3.5%), major bleeding (0.3%) and minor bleeding (2.9%) during or after thrombolytic therapy.

Administration, Oral↗
PubMed1984

[Clinical picture and diagnosis of pulmonary embolism].

Despite technological progress, the clinical diagnosis of acute pulmonary embolism (APE) is often problematic, There are no typical or specific clinical cardiopulmonary symptoms or signs that serve for the diagnosis, and only the absence of tachypnea seems to be an important exclusion criterion. Electrocardiogram, laboratory tests (including circulatory markers of thromboembolic disease) and blood gas analysis are also unspecific. Chest X-ray provides a high incidence of suggestive abnormalities and remains the most helpful routine procedure. While the negative perfusion lung scan is the best procedure for exclusion of APE, the positive scan suffers from too low specificity to be of real interest. In contrast, pulmonary angiography is the diagnostic method of choice. Besides detection of pulmonary emboli and of the extent of perfusion abnormalities, pulmonary angiography allows measurement of useful parameters of cardiac and pulmonary function, precise monitoring of evolution and administration of selective thrombolytic therapy. The diagnostic value of recent noninvasive diagnostic procedures in APE (echocardiography, Doppler echocardiography, computer tomography, plethysmography) is briefly discussed.

Blood Gas Analysis↗
PubMed1982

[Digitalization without saturation dose using methyldigoxin. Experiences with 29 patients].

The indications and performance of oral digitalization without saturation dose are evaluated on the basis of clinical parameters and plasma digitalis levels. A group of patients with evident cardiac insufficiency received a daily maintenance dosage of digitalis (2 tablets of 0.1 mg methyldigoxin) from the outset. After 7, 15 and 30 days the plasma concentration of methyldigoxin was measured. Objective and subjective signs of cardiac insufficiency were noted. In 28 of 29 patients the therapeutic plasma level (0.8-2.0 ng/ml) was achieved with a mean plasma digitalis concentration of 1.47 +/- 0.4 ng/ml. A clinical improvement was observed in 18 patients. On the 15th and 30th day of treatment the mean plasma level of methyldigoxin showed no significant difference: X15 = 1.51 +/- 0.57 ng/ml and X30 = 1.40 +/- 0.46 ng/ml. The measured plasma values were not influenced by the patient's weight or age. In 6 patients with renal insufficiency a clear correlation between the plasma level of methyldigoxin and the creatinine level was observed. The evaluation of ECG signs showed only minimal alterations of conduction and repolarisation. On the basis of these results conclusions are drawn with regard to the clinical value and use of this therapy.

Aged↗
PubMed1982

[Clinical experiences with intra-aortic balloon pumping].

The clinical experience with intraaortic balloon pumping (IABP) in 16 patients in a hospital without cardiac surgery is described. The indications for IABP were cardiogenic shock in 8 cases, preshock in extensive myocardial infarction in 2 cases, unstable angina in 4 cases and ventricular septal rupture after acute myocardial infarction in 2 cases. The prognosis in cardiogenic shock after extensive acute myocardial infarction (CPK average 1545 U/l) or after reinfarction was poor in spite of treatment with IABP (survival only 25%). Important insertion of balloon pumping technique are percutaneous insertion of balloon catheters and transport of patients by ambulance with functioning IABP.

Adult↗
PubMed1980

[Sonography versus angiography in the diagnosis of abdominal aortic aneurysm].

Angiographic and sonographic examinations have been compared in 15 patients with abdominal aortic aneurysm. The maximal internal diameter seen in the sonographic examination correlated well with the result of the angiographic examination. Sonography, however, has the advantage that not only the internal but also the external diameter of the aneurysm can be seen. This has an important bearing on assessment of the prognosis. The importance of sonography as a rapid, noninvasive method for diagnosis of abdominal aneurysm is stressed. The role of angiography should be confined to preoperative assessment of the location of the renal arteries, the celiac artery and the superior mesenteric artery in relation to the aneurysm itself, and the patency of the latter two arteries.

Aged↗
PubMed1980

[Tricyclic antidepressants (TAD) as a cause of unexpected death (author's transl)].

This study points to the controversy over the anti-depressant efficacy of tricyclic antidepressant drugs (TAD) and emphasize their cardiotoxicity. The number of lethal poisoning cases--from the Swiss federal statistics on the cause of death--amounted to 54 for the period from 1967 to 1976. Ten of these 54 cases occurred in children who had ingested the drug accidentally; the remaining cases concerned adults who took an overdose of the drug intentionally. In addition, the authors reviewed the forensic medical examinations performed on 11 cases of unexpected death due to lethal poisoning with TAD. Our data indicated that fatality can follow drug intake quite rapidly. Autoptical and histological findings were not specific. To confirm a poisoning diagnosis, levels of TAD and their metabolites were therefore determined in nine cases in various organ tissues and body fluids. Poisoning was due to imipramine (3 cases), opipramol (2 cases), dibenzepine (3 cases), and amitriptyline (3 cases).

Accidents, Home↗
PubMed1980

[Electrocardiographical changes and rhythm disorders in Barlow's syndrome].

Mitral valve prolapse ( MVP ) , responsible for most of the symptoms which had previously been interpreted as being due to neurocirculatory disorders or cardiac neurosis , is being recognised more often and has an incidence of about 6-8 % in an unselected population . Although this condition was considered for a long time to be a benign auscultatory abnormality , it may be the cause of serious cardiac complication . Arrhythmias predominate with an incidence of 60 to 80 % on continuous electrocardiography . In a series of 245 patients with mitral valve prolapse confirmed on echocardiography , 52 patients chosen at random were studied to determine the incidence pf ST changes , disturbances of heart rate , QT interval , changes of QRS , arrhythmias with resting , exercise and continuous ECG over 24 hours ( HMS = Holter Monitoring System ) . Abnormalities of ventricular repolarisation , especially flattening of the T wave and , less commonly , St depression were observed in about one third of the patients . These changes were more common in the inferior but were also found in the left precordial leads . 73 % of the 52 patients had a heart rate of 75/mn and their QT intervals showed the following changes : 30.7 % Had a duration greater than the 120 th percentile ; 19.2 % had a duration greater than the upper limit of normal . The other 50 % had a QT interval of around the 100 th percentile . None had a duration of less than the 90 th percentile . In 22.5 % patients , QRS changes due to conduction defects were recorded ( 15 % right bundle branch block - RBBB - , 7.5 % incomplete RBBB ) . HMS is the method of choice for detection of arrhythmias . Resting ECG only showed premature ventricular contractions ( PVCs ) in 12.5 % , compared to 32.5 % on exercise ECG and 62.5 % on HMS . 50 % PVCs were monomorphic , 5 % polymorphic , 7.5 % in salvos and 7.4 % supraventricular in origin . The circadian variation of PVC was striking with a high incidence during periods of activity . There was no statistical correlation between the incidence of PVCs , age , sex , type of MVP and the symptoms and auscultatory findings . The theories on the pathogenesis of the arrhythmias are divided between that based on an underlying cardiomyopathy ( confirmed by the presence of degenerated myocytes on electron microscopy ) and the mechanical hypothesis ( chordae tendinae irritating the endocardium or traction on the papillary muscle with resulting ischaemia ) which provide a better explanation of the clear predominance of monomorphic PVCs . The treatment of Barlow's syndrome is discussed . In our opininon , therapy is only required for ventricular arrhythmias detected by a sufficiently sensitive method such as HMS . Most authors use beta blockers , eventually in association with quinidine Therapeutic successes have also been observed with mexiletine , amiodarone , aprindine and less commonly with disopyramide .

Adolescent↗
PubMed1979

[Iatrogenic chromodermatoses].

Generalized hyperpigmentation may be caused by internal diseases, by occasional or occupational intoxications, and by a group of drugs. Seven cases occurring after treatment with amiodarone (Cordarone) are reported, together with one case of argyria and one of mercury poisoning. Several of these cases were initially mistaken for cyanotic heart disease. Silver intoxication may occur after indiscriminate use of currently available silver-containing drugs. It may become even more frequent as a result of antismoking preparations.

Aged↗
PubMed1979

[Predictability of electrocardiographic and vectorcardiographic criteria in pulmonary arterial hypertension caused by chronic bronchopneumopathies].

The Authors have verified in a group of 38 patients with chronic obstructive pulmonary disease (COPD) and suspected pulmonary arterial hypertension (PAH) of precapillary origin the possibility to forsee the pressure within the lesser circulation starting from some electrocardiographic and vectorcardiograhic criteria. The vectorcardiographic analysis has not been shown to be more reliable than the traditional ECG as far as the identification of an eventual PAH is concerned. The matching of both scalar and vectorial criteria has significantly increased the efficiency of the estimate, i.e. the possibility to foresee the right ventricular systolic pressure (RVSP) and the mean pulmonary arterial pressure (PAP), but the same efficiency has remained at unsatisfactory level (S = +/- 10,30 Torr as far as the PAP is concerned. With regard to the value of the various scalar and vectorial criteria or parameters, among the electrocardiographic criteria the most reliable has been the inversion of the T wave in the right precordial leads. This sign, however, did not often appear in the present series (18% of the cases). As to the VCG the analysis made by the Authors stresses as the most reliable criterion the direction of QRS loop rotation on the horizontal plane and the magnitude of the maximum rightward spatial vector. These two elements, among other things, escape detection on the traditional electrocardiographic investigation. The above mentioned conclusions, obviously, only apply to the PAH secondary to COPD, in which particular noncardiac (lung hyperinflation, lowering of the diaphgram, etc.) and cardiac (associated left ventricular hypertrophy) factors contribute to limit the diagnostic value of both the ECG and the VCG.

Adult↗
PubMed1977

[Clinical experiences with the serum digitalis concentration. 1006 radioimmunological determinations].

Serum digitalis concentration was measured radioimmunologically on 1006 patients in the period from 1974-1976. The serum levels were correlated with the clinical signs of digitalis toxicity and the indications for determination of the serum digoxin concentration were established. Clinical signs of toxicity appear at a serum level of digoxin above 2.5 ng/ml. Therapeutic limits (range) are most influenced by individual factors. Serum digoxin determination is especially necessary in patients with renal failure and in undisciplined patients with erratic digitalis intake. It is a useful aid in controlling the course of digitalis intoxication, in "low dosage" digitalization and in the case of possible drug interactions.

Arrhythmias, Cardiac↗
PubMed1977

[Ventricular tachycardia "with reversal of points" and electrolyte disorders].

Ventricular tachycardia "with reversal of points" is described and its occurrence in electrolyte disorders (hypokalemia, hypomagnesemia), particularly in combination with antiarrhythmic drugs, is discussed. This ventricular tachykardia occurs in cases of disturbed and prolonged repolarization and is typified by periodically changing amplitude in the ECG ("reversal of points"). From the therapeutic point of view acceleration of heart rate by use of either sympathicomimetic drugs or pacemaker has proved successful. This distinguishes the treatment from that of other ventricular arrhythmias.

Aged↗