Biomedical subjects
Publications and source records attributed to A Giunta.
We describe the computed tomographic findings in two cases of bilateral hydronephrosis due to hydatid cyst located in the pouch of Douglas. In both cases this location was secondary to the spontaneous rupture of an hepatic cyst.
Serum conjugated cholic acid (CCA) and conjugated chenodeoxycholic acid (CCDCA) fasting levels were measured in 30 children with cystic fibrosis (CF) without liver involvement, and mean levels were not significantly different from control values. In seven children (four with partially corrected pancreatic insufficiency and three without pancreatic insufficiency) serum levels of both primary bile acids (BAs) were also measured after the ingestion of a standard liquid meal; the values were then compared with those for total and fractional fecal BA excretion. The CCA mean peak increase was significantly reduced in patients with pancreatic insufficiency (p less than 0.01), as well as in those without pancreatic insufficiency (p less than 0.05), as compared to controls. The CCDCA mean peak increase was reduced only in patients with pancreatic insufficiency (p less than 0.01). Fecal results confirmed serum data, showing a significantly increased excretion of cholic and deoxycholic acids in patients without pancreatic insufficiency as compared to controls (p less than 0.02), despite a similar total BA excretion. In patients with pancreatic insufficiency, total fecal BA levels were markedly increased compared to control values (p less than 0.001); the fecal percentage of chenodeoxycholic and lithocholic acids was greater than that recorded in patients without pancreatic insufficiency (p less than 0.05), in agreement with the different behaviour of serum CCDCA postprandial curves for the two groups of patients. The results are consistent with selective malabsorption of cholic acid in CF, independent of the presence of pancreatic insufficiency; they confirm the usefulness of serum BA postprandial determinations in measuring BA malabsorption.
HLA phenotypes of 64 Italian pediatric patients with celiac disease (CD) were compared with those of a group of healthy controls. DR3 and DR7 are significantly increased as reported in other populations. In addition an increase of heterozygotes DR5/DR7 was observed in our patients. The Hardy-Weinberg distribution in the patients group shows a disequilibrium due to the genotype DR5/DR7. Our data confirm that more than one HLA gene product is associated with CD: one with DR3 and the other with DR7.
The pharmacokinetics and clinical efficacy of ceftazidime, a cephalosporin with activity against Pseudomonas aeruginosa, were studied in children with cystic fibrosis. Ceftazidime had high in vitro activity against P. aeruginosa strains isolated from our patients, with a mean MIC90 of 8 micrograms/ml. The first dose of 50 mg/kg IV of ceftazidime achieved serum concentrations of 40.8 +/- 19.7 micrograms/ml at one hour and 3.8 +/- 1 micrograms/ml at four hours after administration (mean values +/- SD). The MIC90 was exceeded by serum concentrations for up to three hours. The elimination of the drug from the blood followed a biexponential decay with an elimination half-life of 60.4 +/- 6.8 min and a total body clearance of 6.0 +/- 3.1 ml/min/kg. Renal clearance of the drug accounted for 75% of the total clearance; these are higher values than those reported for adults. Peak concentrations of ceftazidime in the sputum two hours after a single administration were 4.13 +/- 2.06 micrograms/ml; after seven and 14 days of treatment, sputum concentrations were significantly lower. Eleven children with acute pulmonary exacerbation were treated for 14 days with ceftazidime at a dose of 150 mg/kg/day (12 treatment courses). Significant clinical and radiologic improvements were obtained in nine of 12 patients. In six of 11 cases the P. aeruginosa count decreased by 10(4) CFU/ml. Ceftazidime was well tolerated, and no side effects appeared during treatment.
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A retrospective approach has been adopted to investigate the frequency and duration of breast feeding and the time of gluten introduction in the diet in 216 celiac children and their healthy siblings of three different centers--Naples, Milan, and Turin. In this matched case-control study, the selected controls were healthy siblings of the cases. Children formula-fed from birth, or breast-fed for less than 30 days, were found to have a relative risk of developing symptoms of celiac disease four times higher than children breast-fed for more than 30 days (p less than 0.0001). To investigate more deeply the effect of the duration of breast feeding as a possible protecting factor, the linear trend for different periods of breast feeding was tested and found to be highly significant (G1: 18.3 with 1 df). Therefore, increased duration of breast feeding is associated with decreased risk of developing celiac symptoms. On the contrary, there was no apparent relationship between early introduction of gluten into the diet and frequency of celiac disease. Our findings are consistent with the hypothesis that a wider diffusion of breast feeding is a factor underlying the recently reported decrease of the incidence of celiac disease in children.
A 36-year-old woman was admitted to our hospital with exertional dyspnea, palpitation and cardiac enlargement on standard chest X-ray. Physical examination did not reveal any significant abnormality and routine laboratory tests were normal. ECG showed atrial fibrillation and negative T waves in lead III and a VF, with a stiffened ST segment. M-mode echocardiography showed absence of pericardial effusion and normal size of both ventricular chambers. Two-dimensional echocardiography showed a large saccular dilation of the right atrium without significant enlargement of other cardiac chambers. A slight displacement of tricuspid valve leaflets was also present. Cardiac catheterization was effective in the diagnosis of idiopathic enlargement of the right atrium. Although two-dimensional echocardiography has some limitations in the diagnosis of this unusual malformation, it may prove useful in the noninvasive follow-up of these patients, in order to monitor the eventual increase of atrial size and to promptly detect late complications.
18 patients with coronary artery disease (CAD) and 21 normal subjects underwent a triangular bicycle exercise test. Systolic time intervals (STI) were calculated at rest and every 2 min during exercise. Under resting conditions, STI were similar in the two groups. During exercise, the ejection time index (ETI), i.e. left ventricular ejection time (LVET) corrected for HR, rose significantly more in CAD patients, as compared to normals. Pre-ejection period (PEP) was also differently affected by exercise in CAD patients, who showed a more shortened PEP (p less than 0.001) in the early stage of dynamic stress. PEP/LVET ratio, which in the control group decreased continuously, in CAD patients fell during exercise at lower work loads (p less than 0.001), whilst rose during strenuous exercise. Finally, significant differences (p less than 0.001) were found in the percent change (% delta) PEP/LVET ratio between the two groups during the early phase of exercise, in which no superimposition of single values was present. Therefore, this last parameter seems the most reliable to differentiate clearly CAD patients from normal subjects, but its use must be limited at early exercise.
We correlated the incidence and degree of exercise induced ventricular arrhythmias (EIVA) with the angiographic severity of coronary artery disease (CAD) in 162 patients with a history of stable effort angina, all showing a positive exercise stress test for myocardial ischemia and a greater than or equal to 70% stenosis of a major coronary artery. Patients were grouped according to the following criteria: presence of electrocardiographic evidence of old transmural myocardial infarction (MI), number of significant coronary stenoses and number of left ventricular (LV) areas showing abnormal segmental wall motion (ASWM). The incidence of EIVA in patients with multivessel CAD was higher than in patients with single vessel CAD, but this difference was not statistically significant. The number of LV areas with ASWM was better correlated with the frequency of EIVA, which was 20.0% in patients with normal LV wall motion, 31.2% in patients with 1 area of ASWM, 54.0% in patients with 2 areas of ASWM (p less than 0.005 vs normal LV wall motion), 74.1% in patients with 3 or more areas of ASWM (p less than 0.001 vs normal LV wall motion and 1 area of ASWM), and 81.8% in patients with LV aneurysm (p less than 0.001 vs normal LV wall motion and 1 area of ASWM, p less than 0.005 vs 2 areas of ASWM). Patients with old MI showed a significantly higher incidence of EIVA than those without MI (p less than 0.001), but this difference was due to the more severe LV asynergy in the MI group. In conclusion, our results show that, in a selected population of patients with CAD, the incidence of EIVA correlates better with the extent of LV segmental wall motion abnormalities than with the number of diseased coronary arteries or the presence of an old transmural MI.
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The incidence of ventricular arrhythmias observed during exercise (EVA) was correlated with the presence of previous myocardial infarction (IM) and angiographic severity of coronary artery disease (CAD) in 162 patients (pts.) with stable angina on effort, who had a positive stress test and greater than 70% stenosis of a major coronary artery. Our study population was divided in two groups: the first was composed of 95 pts. with previous MI, the second of 67 pts. without previous MI. Pts. of both groups were subdivided according to severity of CAD and to presence and degree of abnormal segmental wall motion (ASWM). In the MI group only 11.5% of pts. had single vessel disease, and 86.3% had ASWM. In pts. without MI 28.6% had single vessel disease; ASWM was found in 59.7% (p less than 0.001 vs MI pts.). Pts. with MI showed a higher incidence of EVA than pts. without MI (60% vs 32.8%, p less than 0.001). In both groups EVA were more frequent among pts. with double, triple vessel and main left CAD, than in pts with single vessel disease, but the difference was not significant. In general, EVA were found to correlate better with the number of areas with ASWM: in both groups significant differences of EVA frequency were found when pts. with normal left ventricular function were compared to those with more severe ASWM, while no difference was found between pts with and without MI who had the same degree of CAD. The most severe EVA (Tilkian's classification), were found in pts with a previous MI and a high ASWM score. In conclusion, our results show that a previous MI affects the development of EVA in pts. with stable effort angina. However EVA seem to be better correlated with the severity of LV impairment than with the extent of CAD.
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In order to assess the effects of oxyfedrine in ischaemic heart disease, echocardiographic evaluation of left ventricular function was performed 2,5,10,15 and 20 minutes after the intravenous administration of 12 mg oxyfedrine in 15 patients with coronary artery disease without angiographic abnormalities of left ventricular wall motion. The following parameters were measured: heart rate, mean arterial blood pressure, internal dimension in diastole (LVIDd) and in systole (LVIDs) of the left ventricule and the percentage shortening of the LVID (%LVID). There was a significant increase in %LVID (peak 10 minutes after drug administration; p less than 0.001) indicating improved left ventricular function, associated with slight changes in pre-load (LVIDd) and in heart rate, and no variation in mean blood pressure. No abnormalities of contraction were observed after the administration of oxyfedrine. These results suggest that oxyfedrine exerts a direct positive inotropic effect of the myocardium in patients with significant coronary artery stenoses.
The purpose of this study was to evaluate the reliability of two non-invasive techniques (STI and echocardiography) in assessing cardiovascular response during exercise. STI were obtained using a new carotid pulse transducer (thermistor pulse) proved to be reliable in exercise recording. The study population included 12 male rowers (age 15-20 years), who performed supine bicycle exercise; STI and echocardiographic recording of left ventricle were simultaneously obtained at rest and continuously throughout the exercise period. A negative linear correlation (r=-0.782; p less than 0.001) was found between PEP (pre-ejection period) and %LVID (fractional shortening of left ventricle), reliable indexes of cardiac contractility measured by the two techniques. A lower, but significant correlation (r=0.643; p less than 0.001) was present between ETI (left ventricular ejection time corrected by heart rate) and SV (stroke volume) indexes of pump function. The present study shows that STI measured with this new technique, can be employed in evaluating left ventricular function in those patients in whom a good echocardiogram is difficult to record during exercise.
To assess whether echocardiography may represent a useful mean to evaluate the degree mitral regurgitation (DR), left ventricular diastolic internal dimension (LVIDd), left atrial dimension (LAD), and velocity of circumferential fiber shortening (Vcf) were compared to DR assessed by left ventriculography in 48 patients with primary (n = 21) and cardiomyopathic (n = 27) valvular incompetence. In patients with good left ventricular contractility, i.e. with Vcf values above 1.02, a significant positive linear correlation was found between LVIDd and DR (LVIDd = 5.38 + 0.45DR; r = 0.72; p less than 0.001). In contrast, in patients with depressed left ventricular function, i.e. with Vcf values below 1.02, LVIDd did not correlate to DR. In either group LAD and Vcf did not correlate to DR. Thus, echocardiography may provide useful semiquantitative information concerning DR only in patients with preserved left ventricular performance.
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Exercise-induced changes of R wave amplitude (delta R) during exercise has been employed to improve the reliability of stress testing in detecting patients with coronary artery disease. Several authors postulated that delta R are related to changes of ventricular volumes. Furthermore Valsalva Maneuver (VM) is able to induce a decrease of left ventricular volumes induced by VM and the variations of R wave. Echocardiographic method was used to determine left ventricular volumes and R wave amplitude changes were evaluated by Frank's lead. Our findings suggest that R wave amplitude changes are not related to variations of cardiac volume. Electrophysiological mechanisms of delta R need further investigation.