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1.
Ann Oncol ; 29(8): 1800-1806, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29860358

RESUMO

Background: Non-randomized studies showed that temozolomide (TMZ) achieves an average 10% response rate in heavily pretreated metastatic colorectal cancer (mCRC) patients with promoter methylation of the DNA repair gene O6-methylguanine-DNA methyltransferase (MGMT). In this phase II trial, irinotecan and temozolomide (TEMIRI) combination regimen was assessed in irinotecan-sensitive, MGMT methylated/microsatellite stable (MSS) pretreated mCRC patients. Patients and methods: Key inclusion criteria were centrally confirmed MGMT methylation by methylation-specific PCR, MSS mCRC, progression after at least two prior chemotherapy regimens for advanced disease and irinotecan-free interval >3 months. TEMIRI (TMZ 150 mg/m2 on days 1-5 plus irinotecan 100 mg/m2 on days 1, 15 q28 days) was administered for six cycles, followed by maintenance with TMZ. The primary end point was overall response rate (ORR). Exploratory translational analyses included MGMT immunohistochemistry (IHC) and methyl-BEAMing (MB). Results: Between December 2014 and June 2017, 25 patients were enrolled. The primary end point was met, since six patients achieved a partial response [ORR 24%, 95% confidence interval (CI) 11% to 43%]. At a median follow-up of 15.6 months, median progression-free survival (mPFS) and overall survival (mOS) were 4.4 and 13.8 months, respectively. Only four (16%) patients had ≥ grade 3 (CTCAE 4.0) adverse events. All patients whose cancer was MGMT-positive IHC were non-responders. Consistently, patients with MGMT-negative/low tumors had a significantly longer mPFS than others (6.9 versus 2.0 months; hazard ratio = 0.29, 95% CI 0.02-0.41; P = 0.003) and a non-significant trend for longer mOS. MB testing showed similar accuracy. Conclusions: TEMIRI regimen is a safe and active option in pre-treated, irinotecan-sensitive mCRC patients with MGMT methylation.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias Colorretais/tratamento farmacológico , Irinotecano/administração & dosagem , Terapia de Salvação/métodos , Temozolomida/administração & dosagem , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Colorretais/genética , Neoplasias Colorretais/mortalidade , Metilação de DNA , Metilases de Modificação do DNA/genética , Enzimas Reparadoras do DNA/genética , Esquema de Medicação , Feminino , Seguimentos , Humanos , Irinotecano/efeitos adversos , Quimioterapia de Manutenção/efeitos adversos , Quimioterapia de Manutenção/métodos , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Regiões Promotoras Genéticas/genética , Terapia de Salvação/efeitos adversos , Temozolomida/efeitos adversos , Proteínas Supressoras de Tumor/genética
2.
ESMO Open ; 6(5): 100246, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34416469

RESUMO

BACKGROUND: The safety and efficacy outcome of elderly metastatic colorectal cancer (mCRC) patients fit enough to receive combination chemotherapy plus biological agents is an issue of growing interest. Also, gender-specific differential toxicity and efficacy of anti-epidermal growth factor receptor (EGFR)-based upfront treatments need to be explored. PATIENTS AND METHODS: Valentino was a multicenter, randomized, phase II trial, investigating two panitumumab-based maintenance strategies following first-line panitumumab plus FOLFOX in RAS wild-type mCRC patients. We carried out a subgroup analysis, aimed at assessing the differences in efficacy, safety and quality of life (QoL) according to age (<70 versus ≥70 years) and gender (male versus female). Efficacy endpoints were progression-free survival (PFS), overall survival (OS) and overall response rate (ORR); safety endpoints were rates of any grade and grade 3/4 adverse events (AEs). RESULTS: No significant differences in terms of PFS, OS and ORR were observed between patients aged <70 or ≥70 years and the effect of the maintenance treatment arm on survival outcomes was similar in the two subgroups. The safety profile of both induction and maintenance treatment and the impact on QoL were similar in elderly and younger patients. No significant differences in PFS, OS, ORR or clinical benefit rate were observed according to gender. A significantly higher rate of overall grade 3/4 AEs (P = 0.008) and of grade 3/4 thrombocytopenia (P = 0.017), any grade and grade 3/4 neutropenia (P < 0.0001) and any grade conjunctivitis (P = 0.033) was reported in female as compared to male patients. Conversely, we reported a significantly higher incidence of any grade skin rash (P = 0.0007) and hypomagnesemia (P = 0.029) in male patients. CONCLUSIONS: The upfront choice of an anti-EGFR-based doublet chemotherapy followed by a maintenance strategy represents a valuable option in RAS wild-type mCRC irrespective of gender and age, though a careful evaluation of patients to maximize the risk/benefit ratio is warranted.


Assuntos
Neoplasias Colorretais , Qualidade de Vida , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Colorretais/tratamento farmacológico , Feminino , Fluoruracila/efeitos adversos , Humanos , Masculino , Panitumumabe/uso terapêutico
3.
J Am Coll Cardiol ; 12(2): 463-9, 1988 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-3392340

RESUMO

In 26 consecutive cases with acquired immunodeficiency syndrome (AIDS) the main cardiac findings were Kaposi's sarcoma in 2 cases, microfocal myocardial abscess in 1, subendocardial infarct necrosis in 2, contraction band necrosis in 13, lymphocytic myocarditis in 9, intramyocardial lymphocytic infiltrates without myocell necrosis in 7 and epicardial lymphocytic infiltrates in 4. No patient had congestive heart failure. However, two-dimensional echocardiography performed in eight patients demonstrated functional abnormalities in six (fractional shortening ranging from 18 to 30%, globular shape, hypokinesia, mild ventricular dilation). Four of these six patients had lymphocytic myocarditis and two had lymphocytic infiltrates in the myocardium and epicardium without myocell necrosis. No lymphocytic infiltrates were seen in the two cases with a normal echocardiogram. Quantitative analysis indicated that involvement of the heart by lymphocytic myocarditis is inadequate in itself to explain dysfunction. It remains to be established 1) whether lymphocytic myocarditis is a possible indication of a more widespread molecular disorder, and 2) what its eventual relation with dilated cardiomyopathy will be.


Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Linfócitos/patologia , Miocardite/patologia , Adulto , Vasos Coronários/patologia , Feminino , Fibrose/patologia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/patologia , Valvas Cardíacas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/complicações , Miocárdio/patologia , Necrose , Tamanho do Órgão , Sarcoma de Kaposi/complicações , Sarcoma de Kaposi/patologia
4.
J Int Med Res ; 4(1): 42-9, 1976.
Artigo em Inglês | MEDLINE | ID: mdl-799978

RESUMO

In coronary artery disease the patients usually manifest both anxiety and depression disturbances. A controlled clinical study was conducted to test the efficacy of a new antidepressant agent, maprotiline, in the early stages of acute myocardial infarction. The sample consisted of 126 patients, sixty-three receiving orally 25 mg of maprotiline twice daily and the remainder 5 mg of diazepam twice daily. Treatment lasted on an average two weeks (ten days to eight weeks). The depressive and/or anxiety conditions were rated on the basis of a questionnaire administered before and after treatment. Depression improved markedly in patients receiving maprotiline, while the two drugs developed a comparable anxiolytic action. Tolerability was good. No clinical or ECG evidence of cardiotoxic signs was detected. The importance of a drug with these characteristics in the management of emotional disturbances in the early stages of coronary artery disease is emphasized.


Assuntos
Sintomas Afetivos/tratamento farmacológico , Antracenos/uso terapêutico , Antidepressivos/uso terapêutico , Maprotilina/uso terapêutico , Infarto do Miocárdio/complicações , Doença Aguda , Adulto , Idoso , Ansiedade/tratamento farmacológico , Ansiedade/etiologia , Ensaios Clínicos como Assunto , Depressão/tratamento farmacológico , Depressão/etiologia , Diazepam/uso terapêutico , Avaliação de Medicamentos , Humanos , Masculino , Maprotilina/farmacologia , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários
5.
J Hypertens Suppl ; 3(3): S339-41, 1985 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-2856733

RESUMO

Left ventricular (LV) echocardiography and ambulatory monitoring of blood pressure (BP) were performed in 50 normal 20-year-old subjects previously followed longitudinally for 4 years with annual measurements of basal BP (BBP). The relationship of basal, casual and mean 24-h non-invasive ambulatory BP (ABP) with echo findings, blood chemistries and body fatness was evaluated. Subjects with mean BBP on the 4 years above the 85th percentile showed significantly higher blood levels of urea and glucose and of body fat than subjects below this BP level. Left ventricular echo measurements did not differ in the two groups. Left ventricular diameters and volumes were not correlated with basal, casual or ambulatory BP. Interventricular septum (IVS), LV posterior wall (LVPW) and LV mass were correlated with ambulatory systolic but not with basal or casual BP. A significant increase of wall thickness and LV mass was associated with a mean 24-h ambulatory systolic BP (ASBP) above 129 mmHg. It is concluded that random BP and ABP tend to identify hypertensive subjects with different features.


Assuntos
Pressão Sanguínea/fisiologia , Função Ventricular Esquerda/fisiologia , Adulto , Monitores de Pressão Arterial , Composição Corporal , Ecocardiografia , Humanos
6.
G Ital Cardiol ; 16(6): 496-8, 1986 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-3758582

RESUMO

Among the gonadal dysgenesis, Turner's syndrome (T.S.) is often associated with cardiovascular malformations, mainly of the aorta. In order to assess noninvasively the incidence of those abnormalities we have evaluated 36 consecutive female patients (pts) with gonadal dysgenesis, mean age 13.3 +/- 2 years, range 3-24 years, without a prior history of cardiovascular disease, by clinical examination chromosomal karyotyping, 12 leads electrocardiography (ECG), and by Time Motion (TM) and Two-Dimensional (2D) Echocardiography (Echo). The following parameters were considered: presence of an auscultatory systolic ejection click (SEC); evidence of a bicuspid aortic valve (BAV); aortic valve stenosis (AVS); aortic valve eccentricity index (AVEI); left ventricle wall hypertrophy (LVWH). 9 pts out 36 (25%) presented a BAV at the 2D Echo; 8 pts out of 36 (22%) presented a SEC, 3/9 (33%) mild AVS, 2/9 (22%) displayed AVEI on TM study and 3/9 (33%) had LVWH. These findings indicate that an isolated BAV is present in a high percentage of pts with gonadal dysgenesis, more than before suspected. Echocardiography shows to be particularly useful and reliable in the assessment of that abnormality.


Assuntos
Valva Aórtica/anormalidades , Ecocardiografia , Disgenesia Gonadal/complicações , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Disgenesia Gonadal/genética , Humanos , Cariotipagem , Síndrome de Turner/complicações , Síndrome de Turner/genética
7.
Arch Inst Cardiol Mex ; 46(2): 222-31, 1976.
Artigo em Espanhol | MEDLINE | ID: mdl-938161

RESUMO

Two homogeneous groups of patients with acute myocardial infarction were observed within the first six hours from the coronary attack. On admittance and for ten days, 105 patients were treated with C3: the mortality rate resulted in 13.3%. The control group of 108 patients showed a mortality of 18.5%. Strict criteria of randomization were followed in allocating patients to the two groups. Although the difference is not statistically significant it is however interesting since it confirms a previous research. Statistically significant differences between the two groups were observed in all surviving patients in the injury signs regression time and in the cardiac volume in favour of the group treated with C3.


Assuntos
Aminocaproatos/uso terapêutico , Infarto do Miocárdio/tratamento farmacológico , Adulto , Idoso , Aminocaproatos/efeitos adversos , Volume Cardíaco/efeitos dos fármacos , Avaliação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
G Ital Cardiol ; 6(6): 987-93, 1976.
Artigo em Italiano | MEDLINE | ID: mdl-1022619

RESUMO

Serial determinations of CPK enzyme were performed every 4 hours during a 72 hour period in 40 patients with acute myocardial infarction (AMI) admitted to the Coronary Care Unit in the first 6 hours (average 2.6) from the appearance of symptoms. The peak ratio of activity of CPK was 708 mU/ml +/- 48 E.S. as medium value in the whole group was reached in a medium period of 21,1 +/- 0,74 E.S. hours from the attack. Half value of the peak ratio activity was reached after a medium time of 19,1 +/- 1,0 E.S. hours. A significant statistical correlation between the CPK peak ratio and the prognostic index of Selvini et al. was found. The peak ratio resulted in 571 +/- 41 E.S. in patients with uncomplicated AMI, whereas in those with complications such as arrhythmias and heart failure the average value was 901 +/- 136 E.S. No significant correlation between CPK values and ST wave evolution of the ECG peak ratio of 1638 mU/ml was found; however, one patient who died of cardiac rupture showed a low level of 395 mU/ml. The diagnostic and prognostic value of the serial determination of CPK during the first 48 hours of a coronary attack is emphasized.


Assuntos
Creatina Quinase/sangue , Infarto do Miocárdio/diagnóstico , Doença Aguda , Ensaios Enzimáticos Clínicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/enzimologia , Prognóstico
9.
G Ital Cardiol ; 18(1): 25-31, 1988 Jan.
Artigo em Italiano | MEDLINE | ID: mdl-2898413

RESUMO

Mitral valve prolapse (MVP) is characterized by arrhythmias, atypical anginal chest pain and left ventricular (LV) wall motion abnormalities. The role of autonomic nervous system (ANS) as the origin of these disturbances is still debated. The aim of the study was to determine the possible interference between left ventricle (LV) mechanics and ANS. 35 consecutive patients with MVP (24 female, 11 male) (mean age 30 +/- 9 years), matched with a homogeneous control group, were examined by means of 2D-Echo during resting conditions and during sympathetic activation induced by passive orthostatism (90 degrees Tilting). At rest, no significant difference was found between the two groups regarding heart rate (HR), LV volume (LVV), ejection fraction (EF). Tilting produced a significant increase in HR (p less than 0.1) and LVV reduction (p less than .01) in both groups; on the other hand, EF did not change significantly. At 2D-Echo, LV abnormal wall motion at rest in 10/35 (29%) MVP, increasing to 17/35 (49%) was found during Tilting. This abnormality consisted in LV wall reduced systolic thickening and motion, localized in the antero-apical region in 11 patients (54%) and in the posterior wall in 6 patients (36%). Thirteen MVP patients with LV abnormal contraction patterns were re-examined after two weeks of beta-adrenergic blockade (200 mg Metoprolol orally per day). In all of them, LV abnormalities disappeared while LVV and EF remained unchanged. These data stress the role of the ANS in inducing LV abnormalities in patients with MVP.


Assuntos
Antagonistas Adrenérgicos beta/farmacologia , Ecocardiografia , Prolapso da Valva Mitral/fisiopatologia , Postura , Sistema Nervoso Simpático/fisiopatologia , Adolescente , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Pressão Sanguínea/efeitos dos fármacos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Prolapso da Valva Mitral/tratamento farmacológico , Volume Sistólico/efeitos dos fármacos , Sistema Nervoso Simpático/efeitos dos fármacos
10.
G Ital Cardiol ; 19(2): 123-7, 1989 Feb.
Artigo em Italiano | MEDLINE | ID: mdl-2788107

RESUMO

Blood autotransfusion has entered a new phase in blood transfusion technique, since it represents an important alternative in eliminating the risks connected with blood transfusion: viral hepatitis, AIDS, blood transfusion reactions, and alloimmunization. Transfusion requirements during cardiac surgical procedures have steadily decreased; nowadays most adult patients require no transfusion during surgery. Patients (pts) receiving bank-blood may develop infectious diseases (hepatitis, AIDS, etc.). We have studied how to avoid the risk of infections with homologous blood transfusions. We present our experience of day-hospital pre-operative autologous blood collection. One-hundred-eighty-nine patients undergoing primary myocardial revascularization or valvular replacement were submitted to the drainage of 350 ml of blood three times every four days before surgery. The blood was centrifuged at once, to separate red cells from plasma. Surgeries were performed 21 days after the first drainage; iron therapy was recommended. After surgery pts received blood only if haematocrit was lower than 28%. The following data were recorded: no. of pts who received homologous blood; blood loss and homologous total blood volume used for each pt. Average blood loss was 1230 cc for ischemic pts and 701 cc for valvular pts. Non-A non B hepatitis occurred in 3/189 pts (1.5%). All of them had received homologous blood transfusions. Our data show clearly that autotransfused pts had a better post-operative period; less bank-blood and fewer transfusions have been used. No pt had collateral effects such as angina or hypotension from blood drawing. Our data show that severe cardiac diseases do not represent an absolute contraindication to heavy blood drainage.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Transfusão de Sangue Autóloga , Procedimentos Cirúrgicos Cardíacos , Ponte de Artéria Coronária , Doença das Coronárias/cirurgia , Estudos de Avaliação como Assunto , Feminino , Cardiopatias Congênitas/cirurgia , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Fatores de Risco
11.
G Ital Cardiol ; 7(12): 1200-6, 1977.
Artigo em Italiano | MEDLINE | ID: mdl-598639

RESUMO

A revision of 1300 echocardiograms of adults showed 14 patients whose echocardiographic diagnosis of aortic root dissecting aneurism (D.A.). Of these, 8 didn't have any anamnestic, clinical or instrumental evidence of D.A. In the other 6, admitted to our department with a suspected D.A., echocardiography proved to be useful in confirming such diagnosis in 4, in excluding it in 1, but gave a false positive diagnosis of D.A. in the sixth, affected by a diffuse carcinomatosis with pleuropericardial blood effusion. From the examination of the present experience, the Authors deem echocardiography is a useful diagnostic tool in the screening of D.A. when the following conditions are fulfilled: 1) presence of all the major criteria of Nanda and Gramiak, especially the aortic root anterior wall dilatation beyond 16 mm; 2) an almost suggestive story and clinical evidence of D.A. The usefulness of an echocardiographic pattern recently described as diagnostic of D.A. (loss of continuity between the borders of the anterior aortic wall with interventricular septum, and/or posterior aortic wall with mitral anulus) was confirmed: it was detected in 3 of the 4 D.A. patients but in none of the others. The presence of a false positive and the possibility of technical artifacts nevertheless induce caution in the interpretation of the echocardiographic pattern alone.


Assuntos
Aneurisma Aórtico/diagnóstico , Ecocardiografia , Adulto , Idoso , Aneurisma Aórtico/complicações , Estudos de Avaliação como Assunto , Humanos , Masculino , Pessoa de Meia-Idade
12.
G Ital Cardiol ; 19(4): 345-9, 1989 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-2753278

RESUMO

Cardiac hydatid disease represents 0.02-2% of the possible locations of the parasite. In these last few years we have seen an increase in the percentage of cardiac hydatid disease treated with surgery. The Authors report on two patients who underwent surgery for the excision of cardiac hydatid cysts. The Authors agree that in spite of the rarity of cardiac hydatid disease it should be investigated routinely by two-dimensional echocardiography in the presence of hepatic or pulmonary hydatid disease in order to prevent the possible spread of the parasite throughout the body.


Assuntos
Cardiomiopatias/cirurgia , Equinococose/cirurgia , Adolescente , Cardiomiopatias/fisiopatologia , Equinococose/fisiopatologia , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
13.
G Ital Cardiol ; 10(4): 405-13, 1980.
Artigo em Italiano | MEDLINE | ID: mdl-6969197

RESUMO

30 coronary artery disease (CAD) patients (pts) were studied by echocardiography before and after left anterior descending (LAD) coronary bypass graft in order to evaluate left ventricular (LV) behaviour. Echocardiograms were recorded early pre- (48 hours) and post-operatively (mean 12 days) and at a mean distance of 12 months (6 to 15) after operation. The following parameters were considered: left ventricular end diastolic dimension (LVDD), right ventricular diastolic dimension (LVDD), right ventricular diastolic dimension (RVDD), diastolic thickness, systolic thickening and motion of the interventricular septum (IVS) and of the LV posterior wall (LVPW). 21 pts (70%) showed reduced systolic thickening (RST less than or equal to 30%) and 17 (57%) reduced systolic motion (RSM less than or equal to 3 mm) of the septum. Before surgery no patient showed IVS paradoxical movement, left bundle branch block, valvular regurgitation, shunt, LV aneurysm. A previous myocardial infarction was present in the story of 7 pts: anterior location in 4 pts, inferior in 3 pts. Soon after operation (mean 12 days) 4 pts showed normal IVS motion; in 7 pts it was reduced (less than or equal to 3 mm) and in 19 IVS was paradoxical. In 15 pts of this last group LVPW motion resulted remarkably increased after the bypass graft. The other echo parameters didn't show significant variation. Averaging 12 months after operation, IVS systolic thickening resulted normal in 21 of the 30 pts. (70%); in 14 of the last group of 21 there was a RST preoperatively. IVS motion resulted normal in 21 of the 30 pts (70%), reduced in 5 (17%), paradoxical in 4 (13%). LVPW motion returned to the preoperative value in all but 3 pts, in whom it remained elevated. The other echo parameters didn't show any significant variation. We conclude that: 1) IVS paradoxical motion is frequently recorded by echo shortly after coronary bypass graft surgery. 2) In most pts it is accompanied by an increased excursion of LVPW, probably compensatory in origin. Both tend to normalize within few months in most of the subjects.


Assuntos
Ponte de Artéria Coronária , Ecocardiografia , Coração/fisiopatologia , Angina Pectoris/diagnóstico , Angina Pectoris/cirurgia , Doença das Coronárias/diagnóstico , Doença das Coronárias/cirurgia , Seguimentos , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/cirurgia , Período Pós-Operatório
14.
G Ital Cardiol ; 9(2): 161-9, 1979.
Artigo em Italiano | MEDLINE | ID: mdl-540689

RESUMO

Results about an echocardiographic study of 20 patients with Ebstein's anomaly diagnosed by cardiac catheterization and angiography, are referred. In 8 patients an echocardiogram and phonocardiogram were recorded and in five patients an echocontrast examination was performed. The echocardiographic features constantly recorded in Ebstein's anomaly are represented by anterior chamber dilatation, interventricular septum paradoxical movement, anterior tricuspid leaflet wide excursion, decreased diastolic closure rate and delayed closure of tricuspid valve compared to mitral valve. The reduced left ventricular dimension and frequent incidence of "hammock-like" shape of mitral valve during systole and reduced diastolic closure rate of anterior mitral leaflet are pointed out. Possible causes of anterior chamber dilatation, of interventricular septum paradoxical motion and delayed tricuspid closure are discussed. According to the previous study no echocardiographic pattern is surely diagnostic of the disease by itself; a delayed tricuspidal closure (more than 70 msec) when associated to an anterior tricuspid leaflet wide excursion and decreased E-F slope, is of particular value for diagnosis.


Assuntos
Anomalia de Ebstein/diagnóstico , Ecocardiografia , Adulto , Angiocardiografia , Cateterismo Cardíaco , Feminino , Humanos , Masculino , Fonocardiografia
15.
G Ital Cardiol ; 6(1): 26-34, 1976.
Artigo em Italiano | MEDLINE | ID: mdl-943354

RESUMO

An anabolic hormone, methandrostenolone, was shown to be able to decrease significantly the cicatrization-time on animals with induced sperimental acute myocardial infarction (AMI). A controlled clinical trial was performed on group of 246 patients affected by AMI, giving them methandrostenolone at dose of 25 mg im.m. per day, for the first ten days from the beginning of symptoms. An omogeneous group of 240 patients with AMI was used as control. The mortality rate resulted 13,4% in the treated group 18,7% in the control's. 10 patients in the treated group (4,2%) died of cardiac failure versus 17 (7,1%) in the control group, 9 (3,7%) of cardiac rupture in the former versus 6 (2,4%) in the latter. As far as these differences are concerned statistical significance was not reached. A larger number of patients would be requested.


Assuntos
Metandrostenolona/uso terapêutico , Infarto do Miocárdio/tratamento farmacológico , Idoso , Avaliação Pré-Clínica de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações
16.
G Ital Cardiol ; 6(8): 1333-44, 1976.
Artigo em Italiano | MEDLINE | ID: mdl-1010244

RESUMO

21 patients with acute myocardial infarction (A.M.I.) were studied by echocardiography (Echo) and 131CS myocardial scintigraphy (M.S.). Some months after discharge from Hospital (mean value = 10 months), the echocardiograms and myocardial scintigrams were taken again. M.S. resulted modified in 13 patients (62%); in 7 of these there was a reduction of the "cold" area due to M.I.; in 6 an extension with scintigraphic pattern of left ventricular aneurysm was shown. Echo showed in the first group of 7, with normal ventricular cavity (L.V.C.), dimension and good movement of the walls affected by A.M.I. In the second group of 6, L.V.C. dilatation (mean value = 5,6 cm) and reduction of L.V. walls movements gave noticeable results. In the patients (8 = 38%) with unchanged M.S., Echo showed an L.V.C. dimensions increase and L.V. wall movement reduction. The most important results of the present study is the sensitivity of the M.S. and Echo to picking up left ventricular aneurysm by means of non-invasive techniques. The Authors emphasize the availability of Echo and M.S. in the follow up of M.I.


Assuntos
Aneurisma Cardíaco/etiologia , Coração/fisiopatologia , Infarto do Miocárdio , Radioisótopos de Césio , Ecocardiografia , Feminino , Seguimentos , Aneurisma Cardíaco/diagnóstico , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/fisiopatologia , Cintilografia
17.
G Ital Cardiol ; 6(4): 601-12, 1976.
Artigo em Italiano | MEDLINE | ID: mdl-976657

RESUMO

Previous parallel echocardiographic-angiocardiographic studies have proven specificity and sensitivity of ultrasonography in diagnosing prolapse of the mitral valve. Echocardiograms and phonocardiograms from 68 patients with mitral valve prolapse were studied. Echocardiograms suggestive of mitral valve prolapse were obtained in 66 patients. The typical abnormality consisted of an abrupt posterior displacement of the mitral valve leaflets, either late systolic or pansystolic. Moreover a new pattern not previously described was observed, i.e. an abrupt isolated early systolic posterior motion of the mitral leaflets ("early prolapse"). Phonocardiography, on the other hand, showed a variable spectrum of acoustic findings: non-ejection systolic click and/or late systolic murmur, pansytolic murmur, early systolic click,ejectioarly systolic click, ejection murmur, in variable association, and finally no abnormal sound at all ("silent prolapse"). The authors conclude that mitral valve prolapse may be suspected, whatever the auscultatory finding. Echocardiography provides a useful, non invasive method for detecting those forms which also present an uncommon auscultatory pattern.


Assuntos
Auscultação Cardíaca , Sopros Cardíacos , Ruídos Cardíacos , Insuficiência da Valva Mitral/diagnóstico , Valva Mitral/fisiopatologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Ecocardiografia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/fisiopatologia , Fonocardiografia
18.
Eur Heart J ; 9(8): 887-92, 1988 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-3181175

RESUMO

Few data are available about cardiac involvement in AIDS. We examined 102 consecutive patients with AIDS diagnosed clinically and serologically (Walter Reed Stage 5 and 6), by means of TM and cross-sectional echocardiography with the aim of detecting cardiac abnormalities. None of the patients had overt clinical signs of heart failure. Fifty-five (54%) patients showed persistent tachycardia, diminished left ventricular (LV) wall thickness (mean 7.6 +/- 0.2 mm) and decreased percentage LV fractional shortening (27 +/- 5). In 42 (41%) there was a globular and poorly contracting LV. Thirty-nine (38%) patients had pericardial effusion which was moderate in 30 and small in nine. In four patients, valvular endocarditic vegetation was shown--on the tricuspid valve in three, on the aortic valve in one: all of them were drug addicts; in three (2.9%) patients a cardiac mass was found which proved to be a localization of Kaposi's sarcoma in two. Twenty-five (24.5%) patients died; necropsy showed cardiac chamber dilation, and thin LV walls in 18. On microscopic examination, myocardial fibrosis and lymphocyte infiltration with cell necrosis were observed. We conclude that cardiac abnormalities are common in AIDS. Impairment in LV contractility as assessed from fractional shortening appears to be the most common echocardiographic finding, followed by LV wall thinning, pericardial effusion and eventually by LV cavity dilation. This evolution is suggestive of myocardial damage and supports the hypothesis that dilated cardiomyopathy may be a cardiac complication of AIDS.


Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Ecocardiografia , Cardiopatias/diagnóstico , Adulto , Cardiomiopatia Dilatada/etiologia , Feminino , Cardiopatias/etiologia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/etiologia , Humanos , Masculino , Miocardite/diagnóstico , Miocardite/etiologia , Estudos Prospectivos , Sarcoma de Kaposi/diagnóstico , Sarcoma de Kaposi/etiologia
19.
G Ital Cardiol ; 16(3): 213-23, 1986 Mar.
Artigo em Italiano | MEDLINE | ID: mdl-3732714

RESUMO

26 patients (pts) (8 males and 18 females), mean age 50 +/- 9 years, with rheumatic valve (MV) disease, candidates to MV replacement, were examined by contrast echocardiography (CE) before and after surgery. This was done in order to assess pre and postoperatively the presence of associated tricuspid regurgitation (TR) and to evaluate the short and long-term results of the operation on the TR itself. For assessing TR, the systolic presence, intensity and persistence of the microbubbles of the contrast medium injected into an antecubital vein, were observed within the inferior vena cava (IVC). We used synchronous time motion (TM) and two dimensional (2D) echocardiography from subcostal view. TR was classified as follows: severe (massive systolic opacification and persistence of the microbubbles in the IVC for at least 20 seconds); moderate (moderate systolic opacification lasting less than 20 seconds); mild (slight systolic opacification lasting less than 10 seconds); insignificant TR (sporadic appearance of the contrast medium into the IVC). On the average, the examination was carried out 48 hours before surgery, 15 days after and, in pts undergoing De Vega tricuspid valvuloplasty, 14 months after the operation. At pre-operative examination, massive TR was found in 16 pts, only 6 of whom showed clinical signs of TR. The findings were confirmed at surgery in 15 pts who underwent not only MV replacement but also tricuspid repair. In the other pts, agreement was found between CE and surgery as far as moderate TR was concerned, meanwhile mild CE TR was not confirmed at surgery. Sensitivity (SN) was 100%, specificity (SP) 38%, positive predictive value (PPV) 78%, negative predictive value (NPV) 100%. Excluding CE mild TR, SP and PPV raised to 75% and 95% respectively, meanwhile SN and NPV remained 100%. Short term post-operative follow-up CE performed on 13 out of the 15 pts with tricuspid repair showed no signs of TR in 7 and slight signs in 6. Furthermore, in those pts undergoing simple MV replacement, CE showed a marked reduction of the contrast echographic effect. Long term post-operative follow-up CE performed in the 13 pts with tricuspid repair showed no signs of TR in 9, slight signs in 3. Moreover in two pts massive TR due to late mitral prosthesis detachment was diagnosed by means of CE and confirmed at cardiac catheterization and surgery.(ABSTRACT TRUNCATED AT 400 WORDS)


Assuntos
Ecocardiografia/métodos , Insuficiência da Valva Tricúspide/diagnóstico , Adulto , Feminino , Seguimentos , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Insuficiência da Valva Tricúspide/cirurgia
20.
G Ital Cardiol ; 11(8): 1072-82, 1981.
Artigo em Italiano | MEDLINE | ID: mdl-7327323

RESUMO

Twelve healthy volunteers, mean age 25.4 +/- 4.18 years, performed sitting bicycle ergometer graded exercise to exhaustion. Recordings of left ventricular echocardiographic dimension, heart rate, arterial blood pressure, were obtained at rest and at two minutes intervals during exercise and recovery. Echocardiographic tracings were digitized and the values of three complexes were combined and means determined for the overall analysis. Heart rate increased from 76.92 +/- 15.09 to 154.91 +/- 12.13 (p less than 0.001) at peak exercise and decreased to 98.50 +/- 11.60 (P less than 0.001) at six minutes recovery. Similarly behaved blood pressure. End diastolic Echo dimension varied significantly from 46.50 +/- 4.66 mm to 51.44 +/- 5.38 mm (P less than 0.005) at peak exercise and to 45.91 +/- 4.52 mm (P less than 0.005) at six minutes recovery, but resulted unchanged at lower levels of exercise. It started to return towards resting values, from two to four minutes of recovery. End systolic dimension did not change significantly at any heart rate. Shortening fraction increased progressively and significantly at every step of exercise, decreasing in the same way during recovery: rest 38.42 +/- 3.62%; peak exercise 44.28 +/- 5.32% (P less than 0.005); end recovery 39.28 +/- 5.89% (P less than 0.001). So did respectively: Stroke volume (Teichholtz) 69.50 +/- 12.16 cc; 84.92 +/- 24.14 cc (P less than 0.005); 67.64 +/- 16.48 cc (P less than 0.005). Cardiac output 5.27 +/- 1.18 lt/min; 12.46 +/- 3.83 (P less than 0.001); 6.25 +/- 1.00 (P less than 0.005). Ejection fraction 68.33 +/- 4.68%, 78.58 +/- 8.80 (P less than 0.001); 68.82 +/- 8.16 (P less than 0.005). Mean normalized velocity of circumferential fibre shortening 1.33 +/- 0.25 circ/sec; 2.37 +/- 0.33 (P less than 0.001); 1.55 +/- 0.031 (P less than 0.001). These results indicate that in untrained healthy subjects, variations of cardiac output during exercise and recovery depend mainly on heart rate and left ventricular fibre shortening rate. Severe exertion produces an increase of left ventricular dimension due to a Frank-Starling effect. Sitting bicycle exercise Echocardiography appears to be a suitable method to assess Left ventricular performance with a chest position relevant to normal human conditions.


Assuntos
Ecocardiografia , Função Ventricular , Adulto , Pressão Sanguínea , Débito Cardíaco , Teste de Esforço , Frequência Cardíaca , Humanos , Contração Miocárdica , Descanso , Volume Sistólico , Fatores de Tempo
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