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Biomedical subjects

A Drago

Publications and source records attributed to A Drago.

At least 19 recordsLinked to original sources
PubMed2007

Astrophysics: quark matter in compact stars?

In a theoretical interpretation of observational data from the neutron star EXO 0748-676, Ozel concludes that quark matter probably does not exist in the centre of neutron stars. However, this conclusion is based on a limited set of possible equations of state for quark matter. Here we compare Ozel's observational limits with predictions based on a more comprehensive set of proposed quark-matter equations of state from the literature, and conclude that the presence of quark matter in EXO 0748-676 is not ruled out.

Comment↗
PubMed2006

Tracheobronchial stenosis: role of virtual endoscopy in diagnosis and follow-up after therapy.

PURPOSE: This study was done to evaluate whether virtual endoscopy can be employed as a preliminary technique to shorten the time required for the subsequent endoscopic procedure and be proposed for treatment planning and, postoperatively, for evaluating response to treatment in patients with cancer or severe stenotic lesions. MATERIALS AND METHODS: From December 2004 to October 2005, 25 patients with suspected obstructive tracheobronchial stenosis were studied by contrast-enhanced computed tomography (CT) with multiplanar reconstruction (MPR) and virtual bronchoscopic navigation, after a preliminary clinical and conventional radiology assessment. RESULTS: Quality of the virtual endoscopy images was excellent in all cases. Out of the 25 patients, four were affected by benign lesions and 21 by malignant lesions. With regard to lesion site, virtual endoscopy proved to be as informative as real endoscopy. The virtual endoscope was able to cross severe stenoses with a residual lumen of 3 mm. Follow-up studies were performed in 15 patients treated with laser and cryotherapy. In all cases, evaluation of the degree of post-treatment stenosis was similar to that obtained with conventional endoscopy. CONCLUSIONS: Our study indicates that virtual bronchoscopy has a high diagnostic potential. The technique, with the integration of MPR images, can be proposed as a preliminary study to obtain accurate characterisation of stenoses, to shorten the time required for the subsequent endoscopic procedure and to plan the most appropriate treatment.

Aged↗
PubMed2004

Cardiac and vascular effects of diltiazem, dobutamine and amrinone, drugs used after myocardial revascularization.

Hemodynamic care during postoperative management of myocardial revascularization should include vasorelaxing drugs to insure adequate graft and coronary flow, and stimulation of stroke volume to maintain vascular perfusion pressure. We tested the cardiac (inotropic and lusitropic) and vascular (relaxant) effects of diltiazem (0.1 nM to 0.1 mM), dobutamine (10 microM to 10 mM) and amrinone (10 microM to 1 mM) on isolated rat atria and thoracic aorta, and also on isolated human saphenous vein (HSV) and human mammary artery (HMA). Dobutamine produced a maximal positive inotropic effect (+dF/dt max = 29 +/- 7%) at its ED50 for aortic relaxation (88 +/- 7 microM). Conversely, at their ED50 for aortic relaxation diltiazem depressed myocardial contractility and amrinone did not exhibit myocardial effects. In HSV and HMA contracted with 80 mM potassium, diltiazem and dobutamine (but not amrinone) had a vasorelaxant activity similar to that in rat aorta. Norepinephrine-contracted human vessels were significantly more sensitive than potassium-contracted vessels to the relaxant effect of amrinone (ED50 HMA = 15 +/- 5 microM, ED50 HSV = 72 +/- 31 microM, P < 0.05). We conclude that at concentrations still devoid of myocardial effects dobutamine and amrinone are effective dilators in graft segment vessels and rat aorta contracted by membrane depolarization. If the difference between aortic and myocardial tissue still holds in human tissues, at the appropriate concentrations these drugs should be expected to improve cardiac performance while still contributing to the maintenance of graft patency.

Amrinone↗
PubMed2004

Comparison of three rapid detection systems for type A influenza virus on tracheal swabs of experimentally and naturally infected birds.

The present paper reports of the comparison between three rapid virus detection systems and virus isolation (VI) from pooled tracheal swabs collected from naturally and experimentally infected birds with a low pathogenicity avian influenza virus of the H7N3 subtype. The relative sensitivity, specificity and agreement (K value) were calculated for a commercial antigen capture enzyme immunoassay (AC-EIA) and for two nucleic acid detection tests, a one-step reverse transcriptase-polymerase chain reaction (RT-PCR) and a real-time RT-PCR (RRT-PCR), both targeting the M gene. The results indicate that in experimentally infected turkeys VI was positive from the pooled tracheal swabs collected from day 3 to day 10. One-step RT-PCR was able to detect influenza RNA from samples collected from day 3 to day 12, while RRT-PCR amplified influenza RNA in swabs collected from day 3 to day 15. The AC-EIA test yielded positive results between day 5 and day 10 post-infection. On field samples, the K value between the AC-EIA and VI tests was 0.82. Compared with VI, the relative sensitivity of this test was 88.9% (CI95 = 85.2-92.6) and the relative specificity was 95.7% (CI95 = 93.7-97.7). The K value between the RT-PCR and VI tests was 0.88. Compared with virus isolation, the relative sensitivity of the one-step RT-PCR was 95.6% (CI95 = 93.1-98.0) and the relative specificity was 96.3% (CI95 = 94.4-98.1). The K value between the RRT-PCR and VI tests was 0.92. Compared with virus isolation, the relative sensitivity and specificity of RRT-PCR was 93.3% (CI95 = 90.4-96.3) and 98.4% (CI95 = 97.2-99.6), respectively. Generally speaking, comparison between virus isolation, the AC-EIA test and the two nucleic acid detection methods indicated excellent agreement. Data obtained from both experimental and field study suggest a higher sensitivity of the PCR-based methods compared with the AC-EIA. The economical and practical implications of using one of the rapid tests as an alternative to VI during an avian influenza epidemic are discussed.

Animals↗
PubMed2001

Effects of in vitro treatment with fluticasone propionate on natural killer and lymphokine-induced killer activity in asthmatic and healthy individuals.

BACKGROUND: Topical corticosteroids are beneficial in the treatment of allergic respiratory disorders; they exert effects on a number of cells involved in allergic inflammatory reactions. On the other hand, major histocompatibility complex (MHC)-unrestricted cytotoxicity (i.e., natural killer [NK] cell activity) may play a role in the inflammatory allergic reaction. The objective was to gain insight into the mechanisms of the therapeutic effects of fluticasone propionate (FP), an inhaled corticosteroid used in asthma and rhinitis therapy. Therefore, we evaluated the NK and lymphokine-activated killer (LAK) activity of effector cells in vitro treated or not with FP. METHODS: Evaluations were made on peripheral blood mononuclear cells (PBMNCs), obtained from healthy volunteers (n = 10) and from asthmatic atopic subjects (n = 10) with allergy to Parietaria. RESULTS: Asthmatic patients had significantly increased NK activity (P= 0.0008), and interleukin (IL)-2- (P=0.0005) and interferon (IFN)-alpha-induced LAK activities (P=0.0005). In both groups, FP 10(-7) M significantly reduced NK activity (P<0.0001), IL-2-induced LAK activity (P<0.0001), and IFN-alpha-induced LAK activity (P<0.0001). Similar results were obtained with FP 10(-8) M. CONCLUSIONS: Since MHC-unrestricted cytotoxicity has been implicated in the development of allergen-induced eosinophilic airway inflammation, inhibition of NK and LAK activity by FP may contribute to the steroid therapeutic effect in asthma.

Androstadienes↗
PubMed2001

Measurement of inflammatory mediators of mast cells and eosinophils in native nasal lavage fluid in nasal polyposis.

BACKGROUND: Nasal polyposis (NP) often coexists with asthma, rhinitis and sinusitis. Polyp histology typically shows chronic, eosinophilic inflammation. The inflammatory cell infiltrate generally includes eosinophils, lymphocytes, plasma cells and mast cells. OBJECTIVE: To gain insight into the natural history of NP, we analysed mediator levels and leukocyte values in nasal fluids and eosinophil cationic protein (ECP), total IgE levels and eosinophils in the blood in several groups of both allergic and non-allergic patients with nasal polyps and in patients with allergic rhinitis (AR). METHODS: Thirty-two patients with nasal polyps entered the study. As a control group, we studied 55 patients with AR, i.e. 20 patients with seasonal AR to grass pollen, 24 with AR sensitive to Parietaria and 11 with AR sensitive to house dust mite (HDM). Eighteen patients with nasal polyps were also allergic patients (8 were sensitive to Parietaria and 10 were sensitive to HDM), whereas 14 were non-allergic patients. Tryptase and histamine values were assayed in nasal fluids, whereas total IgE was determined in serum. ECP values were assayed both in nasal fluids and serum. Eosinophils were quantified both in the blood and nasal fluids. RESULTS: Tryptase levels were significantly higher in the nasal lavages from patients with NP than in those from patients without NP (4.7 vs. 3.5 U/l, p < 0.001) and correlated with symptom scores (r(s) = 0.42, p < 0.0001). The median levels of histamine in nasal fluids from patients with NP were also significantly higher than those observed in patients without NP (50.0 vs. 21.3 ng/ml, p < 0.001), but did not correlate with symptom scores. Finally, the median levels of ECP in nasal fluids from patients with NP were significantly higher than those observed in patients without NP (38.1 vs. 16.1 ng/ml, p < 0.001) and correlated with symptom scores (r(s) = 0.38, p < 0.001). Analysis of variance showed that, among the variables studied, the presence of nasal polyps was the factor responsible for the higher levels of tryptase, histamine and ECP in nasal fluids. With regard to leukocyte counts in nasal fluids, no significant differences were observed between rhinitis patients with NP and those without NP. With regard to serum ECP and serum total IgE, no significant differences were detected between the two groups under study. Blood eosinophil levels in patients with NP were significantly higher than those observed in patients without NP (5.8 vs. 5.6, p = 0.002). Analysis of variance showed that both the presence of nasal polyps and the type of sensitisation were important. Considering the total symptom scores, no significant differences were observed between rhinitis patients with NP and those without NP. CONCLUSIONS: The present findings are consistent with the view that chronic eosinophil mucosal inflammatory disease in NP involves a self-sustaining mechanism, i.e. local release of inflammatory mediators, independent of allergen stimulation of nasal mucosa. Increased release of inflammatory mediators contributes to the development of nasal polyps, determining oedema and an increased recruitment of inflammatory cells. Besides eosinophils, mast cells also play a key role in this process.

Adolescent↗
PubMed2001

[Structural and functional aspects of the human saphenous vein used as aorto-coronary graft in myocardial revascularization].

The human saphenous vein (HSV) is currently used as a graft in coronary revascularization as well as in some other vascular beds, namely those of the inferior limbs. Since a significant proportion of HSV grafts develop stenosis, many studies have focused on the factors that could promote graft failure. This article reviews the results on structural and functional features that might be concurrent in the production of saphenous vein graft stenosis. The reactivity of HSV to several physiological agonists is analyzed, including those derived from the endothelium with contractile or relaxing properties, since these are relevant inducers of graft spasm and/or modifiers of the expression of graft factors involved in either tissue growth or thrombotic-atherosclerotic processes. Mechanisms that regulate vascular smooth muscle contractile state, in particular the activity of K+ channels of the plasma membrane, are described.

Coronary Artery Bypass↗
PubMed1999

Comparison of the effects of fluticasone propionate, aqueous nasal spray and levocabastine on inflammatory cells in nasal lavage and clinical activity during the pollen season in seasonal rhinitics.

BACKGROUND: Treatment options for allergic rhinitis include antihistamines, decongestants, anticholinergics, cromolyn sodium and corticosteroids. As the nose is a small organ, comprising less than 1% of total body mass and surface area, it seems logical to confine treatment of rhinitis to the diseased organ. OBJECTIVE: To evaluate the effects of therapy with intranasal fluticasone propionate (FP), both on subjective symptoms and pathophysiological mechanisms, in rhinitis patients during pollen season when the patients were symptomatic. METHODS: We used a double-blind, placebo (PLA)-controlled, randomized, double dummy, parallel group study of the effect of 6 weeks treatment. The double-blind comparison was made between the following three treatments: FP aqueous nasal spray, 200 microg taken once daily, levocabastine (LEV) nasal spray, 200 microg taken twice daily and PLA nasal spray. Clinical evaluation and the levels of cells and mediators in nasal washing were performed before and after treatments. Twenty-four patients (11 men and 13 women, aged 17-50 years, mean age 30.1 +/- 8.5) with strictly seasonal allergic rhinitis to Parietaria entered the study. Clinical evaluation and the levels of inflammatory cells (eosinophils and activated eosinophils, i.e. EG2+) and their mediators (tryptase, eosinophil cationic protein, eosinophil protein X and neutrophil myeloperoxidase) in nasal-lavage were performed before and after treatments. RESULTS: Treatment with FP significantly increased, with respect to placebo, the percentage of days without sneezing (P < 0. 001), nasal blockage (P < 0.001), rhinorrhea (P < 0.001), nasal itching (P < 0.001). Furthermore, treatment with FP showed additional benefits with respect to LEV. The percentage of days without nasal blockage was significantly higher in the FP group that in the placebo group (P = 0.018). The same applied to rhinorrhea (P = 0.009). The percentages of days without sneezing and itching were instead not significantly different between the two groups. As expected, no significant differences were observed in baseline medians of the rhinitis symptom scores as well as in mean values of all mediators and eosinophils in nasal lavages of the various groups under study. After treatment the mean of subjective symptoms as well as all values in nasal lavage level fell significantly only in the FP group, whereas no significant changes were observed either in LEV or PLA groups. Accordingly, significant differences were observed at the end of the treatments between the values of fluticasone group vs LEV and PLA group values. Significant correlations between these values and symptom scores were found, according with literature data suggesting a pathogenetic role for these mediators and eosinophils in rhinitis. CONCLUSION: FP (200 microg once daily) affords a significant degree of improvement in rhinitis control during pollen season, as measured by subjective and objective parameters, compared with LEV (200 microg twice daily) and PLA. The therapeutic benefits of intranasal FP are reflected in, and may be caused by, the decrease in nasal inflammatory cells.

Administration, Topical↗
PubMed1998

Bronchial reactivity and intracellular magnesium: a possible mechanism for the bronchodilating effects of magnesium in asthma.

1. Increased bronchial smooth muscle contractility with consequent bronchial hyperreactivity are characteristic physiopathological events of asthma. Since magnesium intervenes in calcium transport mechanisms and intracellular phosphorylation reactions, it constitutes an important determinant of the contraction/relaxation state of bronchial smooth muscle. In the present study we investigated the relationship between bronchial reactivity, assessed by methacholine-provocation test, and magnesium concentrations both at extracellular and intracellular levels measured by spectrophotometry. Twenty-two patients with mild-to-moderate asthma and 38 non-asthmatic subjects with allergic rhinitis (24 allergic to Parietaria pollen and 14 allergic to Grass pollen) were recruited to the study. Exclusion criteria included renal failure, hepatic diseases, heart failure and arterial hypertension. 2. The salient finding of our study is that there is a strong positive correlation between bronchial reactivity and the level of intracellular magnesium (r=0.72, P<0.0001), both when the groups are analysed separately or together. Intracellular magnesium concentrations in the group of patients with asthma were significantly lower (1.8+/-0. 01 mmol/l; n=22) when compared with levels in rhinitis subjects allergic to Parietaria (1.9+/-0.01 mmol/l; n=24, P<0.05), and with levels in rhinitis subjects allergic to Grass pollen (2.0+/-0.03 mmol/l; n=14, P<0.05). Serum levels of the ion were similar in all groups. 3. We conclude that the level of intracellular magnesium may be an important determinant of bronchial hyperreactivity, as supported by the significant positive correlation between these two parameters in allergic patients with known bronchial hyperresponsiveness. This finding, in addition to reports of the bronchodilating effects of magnesium administration in patients with asthma, confirms the proposed role of this ion in the pathogenesis and treatment of asthma.

Adult↗
PubMed1998

[Dynamic obstruction to left ventricular outflow during dobutamine stress echocardiography: the probable mechanisms and clinical implications].

We observed the development of left ventricular outflow tract dynamic obstruction in some patients during dobutamine stress echocardiography. The purpose of this study was to identify the possible mechanisms and to consider the clinical implications. From 11/04/94 to 01/09/97 we studied 547 patients; 42 patients developed dynamic obstruction, defined as a late peak Doppler velocity profile that exceeded baseline outflow velocity by at least 1 m/s. The encountered mechanisms were: increased myocardial contractility; systolic anterior motion of the mitral valve; decreased venous return to the left ventricle, and peculiar characteristics of the left ventricular geometry. The results of this study show that the dynamic obstruction is mainly due to the first mechanism and secondarily to some characteristics of the left ventricular geometry. The hypotension observed in a few cases is not related to the dynamic obstruction but to beta 2 receptor hypersensibility to dobutamine. The symptoms, like dyspnea and chest pain, experienced by these patients are related to the dynamic obstruction rather than to the presence of coronary artery disease. In conclusion, we think that patients who develop dynamic obstruction, without wall motion abnormalities, during dobutamine stress echocardiography, may behave pathophysiologically as patients with obstructive hypertrophic cardiomyopathy, in whom diastolic dysfunction and outflow tract obstruction are responsible for symptoms. Therefore, these patients require a pharmacological treatment with beta blockers and/or non-dihydropyridine calcium channel blockers.

Aged↗
PubMed1997

Prevalence of organ-specific and non organ-specific autoantibodies in healthy centenarians.

In the present study we have investigated the prevalence of organ-specific and non organ-specific autoantibodies in 26 healthy centenarians (6 men, 20 women; age range 101-106 years), using as controls 54 healthy old (33 men and 21 women, age range 71-93) and 56 young subjects (29 men and 27 women, age range 26-60). We assayed sera of each group for the following organ-specific autoantibodies, anti-gastric mucosa (anti-PCA), anti-thyroglobulin (anti-Tg) and non organ-specific autoantibodies, anti-cardiolipin (anti-APA IgG and IgM), anti-nuclear antigens (anti-ANA), anti-double strand DNA (anti-ds-DNA), anti-extractable nuclear antigens (anti-ENA). Finally, natural anti-alpha-galactosyl (anti-alpha-GAL) antibodies were also analyzed. As expected, in the old subjects there was a significant increase of prevalence of anti-Tg and anti-PCA autoantibodies. By contrast, in centenarians the prevalence of organ specific anti-Tg and anti-PCA antibodies was not significantly different from that observed in controls aged less than 60 years. The prevalence of non organ-specific autoantibodies anti-APA (IgG), anti-APA (IgM), anti-ANA, was significantly increased both in the elderly and centenarians when compared with the prevalence observed in sera from the young. Anti-ENA and anti-dsDNA antibodies were not detected in all groups studied. Finally, the prevalence of natural anti-alpha-GAL antibodies significantly increases with age, including centenarians. In conclusion, we confirm and extend the results previously obtained by other authors. In fact, as already described, the prevalence of organ-specific autoantibodies in the elderly is not seen after the tenth decade of life. Interestingly, the prevalence of non organ-specific autoantibodies is instead increased in these subjects, suggesting that different mechanisms are involved in the pathogenesis of these autoantibodies. Particularly, these autoantibodies could be the expression of a damaged tissue process rather than of an autoimmune one, as suggested by data concerning natural antibodies.

Adult↗
PubMed1997

Allergic rhinitis to grass pollen: measurement of inflammatory mediators of mast cell and eosinophils in native nasal fluid lavage and in serum out of and during pollen season.

BACKGROUND: In allergic rhinitis, mast cells, activated by cross-linking of allergen to mast cell-bound specific IgE, release both vasoactive mediators related to the early nasal symptoms and chemotactic mediators that attract inflammatory cells, such as eosinophils, related to the late-phase response. OBJECTIVE: We have analyzed, during and out of pollen season, in blood and nasal fluid from patients allergic to grass pollen, histamine and tryptase to monitor the early phase markers and eosinophil and eosinophil cationic protein (ECP) to monitor the late phase. METHODS: Twenty patients were enrolled in the study. As a control, we studied 10 nonatopic subjects. Mediators and eosinophils were assessed in blood and nasal fluid. Histamine was tested only in nasal fluid. RESULTS: During pollen season, tryptase but not histamine increased in nasal fluids from patients (2.96 vs 0.22 U/ml, p = 0.001) and correlated with symptom scores (r(s) = 0.63, p = 0.003). Tryptase was not detected in serum. Eosinophils increased in nasal cytology (17.0% vs 2.0%, p = 0.001) and in the blood (265 vs 12.7 x 10(6) L, p = 0.001) from patients, but they did not correlate with symptom scores. ECP increased only in the nasal lavage (1633 vs 1.30 ng/ml, p = 0.001) and correlated with symptom scores (r(s) = 0.53, p = 0.016). CONCLUSIONS: Both ECP and tryptase increase in nasal secretion in natural disease. Therefore the measurement of tryptase and ECP levels in nasal fluid might be a useful clinical test for monitoring disease activity and the effects of therapeutic agents.

Adult↗
PubMed1997

[Significance of hypotension and vasovagal reflex during echo-stress using high doses of dobutamine].

Coronary artery disease (CAD) is one of the main causes of cardiovascular morbility and mortality. Actual research lines are directed towards the discovery of silent CAD before hard events as myocardial infarction and sudden death. Dobutamine stress echocardiography is an useful method to assess patients with suspected CAD who, are not able to stand an effort because of physical reasons. During the test, hypotension and/or bradycardia may occur and may cause interruption of the test. The aim of our study was to consider prevalence, meaning and clinical implications of hypotensive, sometimes associated to bradycardia, during dobutamine stress echocardiography. From April 1994 to June 1996, 363 consecutive patients (267 men and 96 women with an average age of 59.3 +/- 10 year) were examined because of suspected or known ischemic cardiopathy. All patients underwent dobutamine stress echocardiography and coronary arteriography. Neither hypotension nor bradycardia was noted in 285 of our patients (78.51%), while in the remaining 78 patients (21.48%) there was a pressure drop > or = 20 mmHg; bradycardia appeared in 6 patients. The study shows that it does not exist a statistically significant difference between the percentage of the patients with CAD of the control group and those of the hypotensive group (91.9 vs 83.3%, NS). As for the changes in well motion score index, there was not a statistically significant difference between patients improved score index in the control group and in the hypotensive group (80 vs 74.3%, NS). The 6 patients with hypotension and bradycardia had normal coronary arteries. In the light of these results hypotension, alone or associated with bradycardia, should not be considered as a negative prognostic factor and should not induce to the interruption of the dobutamine stress echocardiography.

Aged↗
PubMed1997

[Stress echocardiography with dobutamine in the identification of coronary disease in patients with left bundle branch block].

Left bundle branch block does not permit an easy diagnosis of coronary heart disease (CAD) with provocative non-invasive test such as bicycle or treadmill stress test. Echocardiography allows the identification of segmental wall motion by evaluating the movement as well the thickness of the segment examined. Due to its agonist action on beta 1 receptors, dobutamine causes an increase in myocardial oxygen consumption and, as a consequence, may reveal myocardial ischemia; on this basis, we evaluated the sensibility, specificity and diagnostic accuracy of dobutamine stress-echo in identifying CAD in patients with left bundle branch block, and compared results with those obtained from coronary catheterization. From February 1994 to September 1995 we observed 25 patients with left bundle branch block (17 men, 8 women, mean age 61.8 +/- 8.4 years, range 43.75), affected or suspected for CAD. All patients underwent dobutamine stress-echo test and coronary arteriography. We divided patients into two groups: the first one (11 patients) with acute myocardial infarction, the second one (14 patients) without previous ischemic episodes. Diagnostic accuracy, specificity and sensibility of the stress-echo test were evaluated in order to identify significant stenosis of the left anterior descending (LAD), right coronary (RCA), and/or circumflex artery (CA). Dobutamine stress echocardiography showed in all patients, from basal to peak, an increase in blood pressure (from 121.2 +/- 17.4 to 141.8 +/- 23.6 mmHg), heart rate (from 81.3 +/- 10.9 to 140.7 +/- 8.9 b/min), and double product (from 9861.1 +/- 1898.1 to 19976.6 +/- 3603.6). In 8 (32%) patients who had typical chest pain, 7 had CAD. In 17 (68%) patients without chest pain, 5 had CAD and 12 had normal coronary arteries. Dobutamine stress echocardiography showed segmental wall motion variations only in 13 patients; 12 of them had a significant stenosis of coronary artery relative to the ischemic area, the other 1 was a false positive. Coronary arteriography showed stenosis of LAD in 10 and of RCA and/or CA in 12 patients, in both groups dobutamine stress-echo test had 1 false negative. Dobutamine stress echocardiography showed high diagnostic value as a provocative non-invasive test for CAD in patients with left bundle branch block. In conclusion, or study shows that no statistical difference exists in identifying ischemia in identifying ischemia in the LAD territory compared to RCA and/or CA. Further investigations are need to confirm the higher diagnostic accuracy in patients with left bundle branch block and to establish whether lower specificity in patients with a previous myocardial infarction is due to the smaller number of patients or to methodology.

Adrenergic beta-Agonists↗
PubMed1996

[Bronchial involvement in sarcoidosis. Study with high resolution computerized tomography].

We investigated the HRCT findings of bronchial abnormalities in thoracic sarcoidosis, the post-treatment reversibility of such patterns and their specificity for sarcoidosis. Sixty-one sarcoidosis patients were submitted to chest radiography and HRCT at onset. The diagnosis had transbronchial biopsy confirmation in all patients. HRCT was repeated in 21 patients after a cycle of steroid therapy. Sarcoidosis patients were randomized with 29 patients with diffuse infiltrative lung diseases of different nature. The HRCT findings of bronchial abnormalities follow: extrinsic bronchial compression or displacement by lymphadenopathies (regular/irregular), bronchial wall thickening (regular/irregular), bronchial lumen abnormalities, traction bronchiectasis and bronchiolectasis. Bronchial abnormalities were found in the first HRCT study in 44/61 sarcoidosis patients (72.1%), in 18 patients with extrinsic bronchial compression or displacement by lymphadenopathies (40.9%), in 2 with bronchiectasis or bronchiolectasis (4.5%) and in 24 with one or more other abnormalities (54.5%). Bronchial signs were found in 16/21 patients examined with HRCT after steroid therapy (76.1%). Bronchial abnormalities remained unchanged in 11 patients (68.7%), they improved or disappeared in 5 patients (31%) and appeared ex novo in 2 patients. HRCT patterns of bronchial abnormalities were found in 17/29 patients with other diseases (58.6%), with high rates of bronchial wall thickening and bronchiectasis or bronchiolectasis. The most common HRCT bronchial finding in sarcoidosis was extrinsic bronchial compression of displacement by lymphadenopathies. This was the only sign which could actually differentiate sarcoidosis from other patients (p < 0.01). Other signs (bronchial lumen abnormalities and bronchial wall thickening) were frequently found in both sarcoidosis and non-sarcoidosis patients and did not permit to distinguish the former from the latter. In our experience, HRCT findings of bronchial abnormalities were frequently observed in sarcoidosis patients, but they are not specific enough to diagnose sarcoidosis and their usefulness is limited in predicting posttreatment reversibility (activity evaluation) of this condition.

Adult↗
PubMed1995

[Diagnostic accuracy of transesophageal echocardiography in the diagnosis of aortic dissection: comparison with computerized axial tomography].

This study was designed to assess the sensibility, specificity and diagnostic accuracy of transesophageal echocardiography (TEE) and X-ray contrast enhanced computed tomography (CT) in the diagnosis of aortic dissection and its complications. Fifty patients with clinically suspected aortic dissection were examined. Imaging results were validated in each case by intraoperative and/or autopsy findings and/or the results of cineangiography. The Stanford and DeBakey classifications were used to differentiate the dissection type; the patients were also subdivided by TEE according to a modified DeBakey classification. The sensibility of TEE to detect aortic dissection was 100%, significantly higher (p < 0.05) than that of CT for type A dissections (77.2%). The two imaging procedures did not statistically differ (NS) in the detection of type B dissection (CT sensibility 87.5%). The specificity of TEE for the detection of type A aortic dissection was 94%; it was not significantly higher (NS) than that of CT (CT specificity 86.6%). Both TEE and CT had no false negative findings in the diagnosis of type B aortic dissection (100%; TEE vs CT, NS). TEE was reliable in the correct identification of the primary entry site in the ascending aorta (80%), the arch (62.5%) and descending aorta (71.4%), and also in the involvement of coronary arteries (62.5%), and aortic arch branch vessels (71.4%); CT scanning was not effective in detecting any of these complications. Aortic regurgitation was accurately identified by TEE in each case. Both TEE and CT scanning correctly identified thrombosis of the false lumen and pericardial effusion. Intraoperative TEE documented in all patients postrepair persistence of the intimal flap in aortic segments that were not operated; flow in the false lumen was detected in 46.6% of the patients; in 26.6% of them secondary tears, not seen before surgical treatment, were detected. In conclusion, TEE allows a bedside, safe and accurate diagnosis and classification of aortic dissection. It also provides the diagnostic information necessary for the therapeutical decision making. Intraoperative TEE allows improvement in preoperatory diagnosis and gives important information for the management of the patient immediately after cardiopulmonary bypass and in the follow-up.

Adult↗