Biomedical subjects

A Nappi

Publications and source records attributed to A Nappi.

At least 37 records · Page 2Linked to original sources

PubMed1994

Ambulatory monitoring of left ventricular function in patients with Parkinson's disease and postural hypotension.

Left ventricular (LV) function was continuously monitored using a radionuclide detector (VEST) after intravenous injection of 25 mCi technetium-99m labelled red blood cells in nine patients with Parkinson's disease and postural hypotension (group 1) and ten patients with Parkinson's disease but without postural hypotension (group 2). LV function and blood pressure were monitored in the supine position for 15 min (period A), upon changing posture from the supine to the upright position for 10 min (period B), and upon returning to the supine position for 10 min (period C). In group 1, the passage from period A to period B induced a significant decrease in end-diastolic volume, end-systolic volume and ejection fraction (all P < 0.01). In group 2, ejection fraction increased (P < 0.05) upon changing posture from the supine to the upright position. Ejection fraction (F = 33, P < 0.01), end-diastolic volume (F = 9, P < 0.05) and end-systolic volume (F = 10, P < 0.05) were significantly different between the two groups. In group 1, stroke volume, cardiac output and vascular peripheral resistance decreased from period A to period B (all P < 0.001). In group 2, no changes in stroke volume, cardiac output and vascular peripheral resistance were observed from period A to period B. All parameters were similar in the two groups during the periods A and C. Upon changing posture from the supine to the upright position, patients with Parkinson's disease and postural hypotension showed marked changes in parameters of LV function induced by vascular abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Electrocardiography, Ambulatory↗

PubMed1994

Noninvasive evaluation of cardiac hemodynamics during exercise in patients with chronic heart failure: effects of short-term coenzyme Q10 treatment.

In patients with chronic heart failure (CHF), the addition of coenzyme Q10 to conventional therapy reduces the hospitalization rate for worsening of heart failure and the incidence of serious cardiovascular complications. The present study was planned to assess the hemodynamic mechanisms underlying this phenomenon. Cardiac hemodynamics was evaluated continuously using an ambulatory radionuclide detector (VEST) which allows a noninvasive monitoring of left ventricular function. Six patients wit CHF (mean ejection fraction (EF): 29%) clinically documented were studied. This study was organized as a randomized double-blind, placebo controlled, cross-over trial. The enrolled patients, after a washout period, underwent the first hemodynamic evaluation with VEST. Subsequently they were randomized to receive placebo or coenzyme Q10 for 4 weeks. At the end of this period they underwent the second VEST study. The third VEST study was performed after a further 4-week period with inverted treatment. Cardiac hemodynamics were evaluated during bicycle exercise. The EF in control conditions (CC) changed from 27 +/- 11%, at rest, to 24 +/- 8%, at peak exercise. During coenzyme Q10 treatment EF showed a significant increase both at rest (33 +/- 13%, P < 0.05 vs CC) and at peak exercise (30 +/- 12%, P < 0.05 vs CC). The same trends were recorded for the stroke volume and the cardiac output. Our results demonstrate that coenzyme Q10 improves cardiac hemodynamic response to exercise in patients with CHF and suggest that noninvasive monitoring of left ventricular function allows a more reliable assessment of therapy efficacy.

Adult↗

PubMed1994

Technetium-99m methoxy isobutyl isonitrile simultaneous evaluation of ventricular function and myocardial perfusion in patients with congenital heart disease.

The authors evaluated the clinical applications of Tc-99m methoxy isobutyl isonitrile (MIBI) in the simultaneous assessment of ventricular function and myocardial perfusion in patients with congenital heart disease. Global ventricular function was assessed by first-pass ECG gated study. Myocardial perfusion was evaluated on images performed 1 hour after the injection of the tracer. Regional wall motion and systolic thickening were assessed by gated study acquired after the perfusion study. Two young patients were studied after a surgical Glenn procedure. The first patient, with a history of transposition of the great vessels and univentricular heart, had an ejection fraction of 44%. The left ventricle was dilated and the right ventricle was not appreciable. The septal and inferoapical regions showed reduced perfusion and reduced systolic thickening. The second patient, with a history of pulmonary atresia, septal defect and left ventricular hypoplasia, had a right ventricular ejection fraction of 37%. Regional wall motion, systolic thickening, and myocardial perfusion were normal. The right ventricle was hypertrophic and larger than the left ventricle. Thus, a single injection of Tc-99m MIBI allows noninvasive simultaneous assessment of global and regional ventricular function and myocardial perfusion in young patients with complicated congenital heart disease.

Child, Preschool↗

PubMed1994

Reverse redistribution in Tl-201 stress-redistribution myocardial scintigraphy. Effect of rest reinjection.

To clarify the clinical significance of Tl-201 reverse redistribution (RR), 33 patients with chronic coronary artery disease (CAD) underwent stress-redistribution Tl-201 cardiac imaging with rest reinjection, coronary arteriography, and 2D-echocardiography. Rest Tc-99m MIBI scintigraphy was also performed in 27 of the 33 patients. A total of 495 segments were analyzed for Tl-201 scintigraphy (405 for Tc-99m MIBI). Each segment was assigned to one of the major coronary artery territories. Two patterns of RR were identified; 1) pattern A (RR-A) showed normal Tl-201 uptake on stress images and lower than normal on redistribution images, and 2) pattern B (RR-B) showed lower than normal Tl-201 uptake on stress images with further decrease on redistribution images. The RR phenomenon was found in 46 (9% of the total) segments; 25 with RR-A and 21 with RR-B. Reverse redistribution pattern A segments had lower Tc-99m MIBI uptake (84 +/- 9% versus 92 +/- 10%, P < 0.0001) and a higher percentage of stenosed coronary arteries (80% versus 49%, P < 0.05) compared to normal segments (n = 204, 41% of the total). No difference in wall motion was observed between RR-A and normal segments. Of the 25 segments with RR-A, 14 showed enhanced Tl-201 uptake after reinjection (Re+) and 11 remained unchanged after reinjection (Re-). Segments that were Re- showed significantly (P < 0.05) lower Tc-99m MIBI uptake (79 +/- 9%) compared to Re+ segments (87 +/- 8%) and normal segments (92 +/- 10%).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Catheterization↗

PubMed1994

[Ambulatory monitoring of left ventricular function in patients with ischemic heart disease: effects of coronary revascularization].

The aim of this study was to assess the efficacy of coronary artery bypass using an ambulatory radionuclide monitoring system of left ventricular function (VEST) during daily activities in patients with previous myocardial infarction and coronary artery disease. Ten patients with previous myocardial infarction, clinical evidence of residual angina and angiocardiographically proven coronary artery disease of at least two epicardial vessels were studied by VEST 8 +/- 2 days before and 15 +/- 3 days after surgical myocardial revascularization. VEST allows to monitor both left ventricular function and 2 ECG leads. During the radionuclide monitoring (at least 60 min) all patients underwent handgrip test (compression of a dynamometer for 2 min at the 75% of maximal capacity), a mental stress (arithmetic operation consisting in subtracting 17 from 17,000 for 4 min), walking (140 yards) and climbing stairs (8 flights). No significant changes in left ventricular function during mental stress and handgrip both before and after the surgical procedure were observed. In the preoperative evaluation, walking induced a significantly increase in heart rate from rest to peak exercise (73 +/- 13 versus 79 +/- 11 b/min, respectively; p < 0.01). After coronary artery bypass, heart rate (rest: 92 +/- 18 b/min, effort: 98 +/- 19 b/min; p < 0.01), ejection fraction (rest: 47 +/- 8%, effort: 53 +/- 10%; p < 0.01), cardiac output (rest: 43 +/- 8 edv/min, effort: 51 +/- 11 edv/min, p < 0.01), and stroke volume (rest: 47 +/- 9%, effort: 53 +/- 9%; p < 0.01) increased at maximal effort compared to the control conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1994

Adenosine technetium-99m-methoxy isobutyl isonitrile myocardial tomography in patients with coronary artery disease: comparison with exercise.

UNLABELLED: We compared the results of adenosine and bicycle exercise 99mTc-methoxy isobutyl isonitrile (MIBI) myocardial SPECT in 22 patients (18 males and 4 females, mean age 51 +/- 11 yr) with angiographically documented coronary artery disease (CAD). METHODS: All patients were submitted on separate days to three intravenous injections of 99mTc-MIBI (20 mCi); one at rest, one during exercise and one during adenosine (140 micrograms/kg per min for 6 min with injection of 99mTc-MIBI at 4 min). A total of 484 myocardial segments were quantitatively analyzed. RESULTS: Adenosine induced a significant increase of heart rate (94 +/- 16 bpm at peak versus 70 +/- 13 bpm at rest, p < 0.01). Systolic and diastolic blood pressure were not significantly different after adenosine infusion compared to rest. In all segments, a significant relationship between exercise and adenosine 99mTc-MIBI uptake was observed (r = 0.90, p < 0.0001). Concordance between the two studies for identification of perfusion status was observed in 438 (90%) of the 484 segments (kappa value of 0.81). Agreement on localization of the perfusion defect to a specific vascular territory was 92%. CONCLUSION: Despite different hemodynamic effects, adenosine and exercise 99mTc-MIBI SPECT imaging provide similar information in the diagnosis and localization of CAD.

Adenosine↗

PubMed1994

Enhanced thallium-201 uptake after reinjection: relation to regional ventricular function, myocardial perfusion and coronary anatomy.

The aim of this study was to clarify the significance of enhanced thallium-201 (201Tl) uptake after reinjection following 4-hour redistribution imaging. Thirty-four patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction (ejection fraction 32 +/- 10%) underwent exercise-redistribution (ER) 201Tl scintigraphy with rest injection, resting technetium-99m methoxy isobutyl isonitrile (MIBI) imaging, 2D-echocardiography, and coronary angiography. Wall motion (WM) was graded on echocardiographic images. A total of 510 myocardial segments were quantitatively analyzed. A total of 267 (52%) segments had normal (N) 201Tl uptake, 53 (10%) reversible (RD), and 190 (37%) irreversible (ID) 201Tl defects on ER images. Of these 190 ID, 84 (44%) showed enhanced 201Tl uptake after reinjection (Re+) and 106 (56%) remained unchanged after reinjection (Re-). MIBI uptake was significantly higher in RD compared to Re+ and Re- (both p < 0.01), and in Re+ compared to Re- (p < 0.01). The WM score was significantly lower in RD and Re+ compared to Re- (p < 0.01), while no difference was observed between RD and Re+. The severity of coronary artery stenosis was significantly lower in RD compared to Re+ and Re- (both p < 0.01), but no difference was observed between Re+ and Re-. The occurrence of collaterals was significantly higher (p < 0.01) in Re+ (69%) compared to Re- (38%). In conclusion, in patients with CAD and impaired LV function, enhanced 201Tl uptake after reinjection in myocardial segments with ID on ER images was associated with less severe WM abnormalities, higher MIBI uptake and the presence of collaterals.(ABSTRACT TRUNCATED AT 250 WORDS)

Collateral Circulation↗

PubMed1993

Resting technetium-99m methoxyisobutylisonitrile cardiac imaging in chronic coronary artery disease: comparison with rest-redistribution thallium-201 scintigraphy.

We studied 19 patients with angiographically proven coronary artery disease and left ventricular dysfunction (ejection fraction 33% +/- 8%) by resting technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) and rest-redistribution thallium-201 cardiac imaging. Thallium and 99mTc-MIBI studies were visually analysed. Of 285 segments, 203 (71%) had normal thallium uptake, 48 (17%) showed reversible thallium defects and 34 (12%) showed irreversible thallium defects. Of these 34 irreversible thallium defects, 19 (56%) were moderate and 15 (44%) were severe. Of the corresponding 285 segments, 200 (70%) had normal 99mTc-MIBI uptake, while 37 (13%) showed moderate and 48 (17%) showed severe reduction of 99mTc-MIBI uptake. Myocardial segmental agreement for regional uptake score between initial thallium and resting 99mTc-MIBI images was 90% (kappa = 0.78). Segmental agreement between delayed thallium and resting 99mTc-MIBI images was 77% (kappa = 0.44). In particular, in 26 (9%) segments 99mTc-MIBI uptake was severely reduced while delayed thallium uptake was normal or only moderately reduced. These data suggest that although rest-redistribution thallium and resting 99mTc-MIBI cardiac imaging provide concordant results in the majority of myocardial segments, some segments with severely reduced resting 99mTc-MIBI uptake may contain viable but hypoperfused myocardium. Thus, conclusions on myocardial viability based on 99mTc-MIBI uptake should be made with caution in chronic coronary artery disease.

Adult↗

PubMed1993

Rest-injected thallium-201 redistribution and resting technetium-99m methoxyisobutylisonitrile uptake in coronary artery disease: relation to the severity of coronary artery stenosis.

To compare rest-injected thallium-201 (Tl) redistribution and resting technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) myocardial uptake in chronic coronary artery disease (CAD), 15 patients with angiographically proven CAD and left ventricular (LV) dysfunction (ejection fraction 34% +/- 9%) were studied. All patients underwent rest-redistribution Tl and resting 99mTc-MIBI cardiac imaging. Gated 99mTc-MIBI images were also acquired to assess regional LV wall motion (WM). Myocardial segments (n = 225) were divided into three groups on the basis of the degree of coronary artery stenosis: group 1 (total occlusion, n = 82), group 2 (50%-99% of stenosis, n = 84) and group 3 (< 50% of stenosis, n = 59). WM was significantly worse in groups 1 and 2 compared to group 3 (P < 0.001), but no difference was observed between groups 1 and 2. Tl and 99mTc-MIBI uptake were significantly lower in groups 1 and 2 compared to group 3 (P < 0.001), and in group 1 compared to group 2 (P < 0.001). When Tl and 99mTc-MIBI uptake were directly compared. Tl uptake was higher than 99mTc-MIBI uptake in group 1 (P < 0.001), while no significant difference was observed in groups 2 and 3. Thus, both rest-injected Tl redistribution and resting 99mTc-MIBI uptake reflected the severity of coronary artery stenosis in CAD. However, in myocardial segments with total coronary occlusion Tl uptake was significantly higher than 99mTc-MIBI uptake.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Repeatability of haemodynamic responses to cardiac stimulations by ambulatory monitoring of left ventricular function.

Ambulatory monitoring (VEST) of left ventricular (LV) function has been shown to be accurate and repeatable. The aim of this study was to assess VEST repeatability in the evaluation of haemodynamic responses to different cardiac stimulations. Twelve patients (all men, mean age 59 +/- 8 years) underwent two separate VEST studies 5-day apart. In both studies, LV function was continuously monitored at rest and during different cardiac stimulations: 1) changing position from supine to upright (tilt); 2) sustained isometric exercise (handgrip); and 3) sublingual administration of 5 mg of nitroglycerin (NTG). Changes from baseline to peak response (delta) in the heart rate, ejection fraction, end-diastolic volume, end-systolic volume, stroke volume and cardiac output were evaluated. Reproducibility was assessed by computing, the coefficient of repeatability. In addition, the differences between the delta values obtained with the two VEST studies were plotted against their mean. This plot allowed us to detect whether there was any relationship between the error in the measurements and the best estimate of the "true value". No statistically significant differences between the two VEST studies were found in the haemodynamic changes in heart rate, ejection fraction, end-diastolic volume, end-systolic volume, stroke volume and cardiac output induced by handgrip, tilt and NTG. For each parameter the mean difference was not significantly different from zero and no significant relationship between the error and the "true value" was observed. Our results demonstrate that VEST has a good repeatability in measuring cardiac haemodynamic responses to different types of stimulations.

Exercise↗

PubMed1993

Left ventricular systolic and diastolic function measurements using an ambulatory radionuclide monitor: effects of different time averaging on accuracy.

The accuracy of an ambulatory radionuclide detector (VEST) for left ventricular systolic (ejection fraction, EF) and diastolic (peak filling rate, PFR) measurements was assessed at different time averaging of the nuclear and electrocardiographic data. Fifty-one patients, in a total of 67 studies, underwent equilibrium radionuclide angiography (RNA) immediately before a VEST study. VEST data were analyzed using single-beat analysis and different time averaging of 5, 10, 15, 30 and 60 sec. Agreement between VEST and RNA in estimating EF and PFR was evaluated by computing limits of agreement (LA). These were computed as 1.96 times the s.d. of the mean differences between the two methods, expressed in the same unit as EF and PFR. Differences between the two methods were plotted against their mean, allowing investigation of any possible relationship between measurement error and the true value (whose best estimate is the mean between the two methods). The entire statistical analysis was repeated at each different time averaging. LAs for EF measurement by VEST were -10.4:8.8 (single-beat analysis), -11.2:9.9 (5-sec averaging), -5.4:4.8 (10-sec averaging), -4.9:4.5 (15-sec averaging), -6.2:5.6 (30-sec averaging), -6.9:4.5 (60-sec averaging). Results indicate good agreement between VEST and RNA in measuring EF, at least for time averaging > or = 10 sec. LAs for PFR ranged from -0.6:0.6 (single beat) to -1.0:0.6 (60-sec averaging), which was considered a clinically acceptable agreement between VEST and RNA. No relationship between measurement error and true value was found either for EF and PFR.

Electrocardiography, Ambulatory↗

PubMed1993

Reverse redistribution in resting thallium-201 myocardial scintigraphy in patients with coronary artery disease: relation to coronary anatomy and ventricular function.

We studied 25 male patients, with coronary artery disease, mean age 56 +/- 8 yr. All underwent 201Tl rest-redistribution and resting 99mTc methoxyisobutyl isonitrile (MIBI) cardiac imaging. Regional 201Tl and MIBI uptake were quantitatively analyzed. Regional left ventricular wall motion (WM) was visually assessed on MIBI gated images using a three-point scale (0 = normal, 1 = hypokinetic, 2 = a/dyskinetic). Two patterns of reverse redistribution (RR) were identified: RR-A when 201Tl uptake was normal on rest images and abnormal on redistribution images, and RR-B when 201Tl uptake was abnormal on rest images and a significant decrease in uptake was observed on redistribution images. Of the total 375 myocardial segments analyzed, 229 were classified as normal (Nl), 40 as reversible defect (RD), 74 as irreversible defect (ID); 26 showed RR-A while 6 myocardial segments had RR-B. Myocardial segments with RR-A differed from NI in the degree of coronary artery stenosis (81% +/- 33% versus 57% +/- 39%, respectively, p < 0.05), in WM score (1.1 +/- 0.7 versus 0.5 +/- 0.6, respectively, p < 0.01), and in MIBI uptake (81% +/- 10% versus 92% +/- 9%, respectively, p < 0.0001). Moreover, the percent of myocardial segments supplied by a totally occluded coronary artery was significantly higher (p < 0.05) in myocardial segments with RR-A (46%) than in NI (22%). Segments with RR-B did not show any significant difference either from RD and ID. These results suggest that myocardial segments with RR-A on resting 201Tl images have impaired function and are supplied by severely stenosed coronary arteries and should not be considered normal.

Adult↗

PubMed1992

Accuracy and repeatability of left ventricular systolic and diastolic function measurements using an ambulatory radionuclide monitor.

The accuracy and repeatability of a new ambulatory radionuclide detector (VEST) for left ventricular systolic (ejection fraction) and diastolic (peak filling rate) measurements were assessed. Seventeen patients underwent equilibrium radionuclide angiography immediately before and immediately after a VEST study. The accuracy was evaluated at the beginning and at the end of the VEST studies. Limits of agreement for the ejection fraction were -1%:2% at the beginning of the VEST study and -4%:4% at the end. Limits of agreement for the peak filling rate were -0.6:0.6 at the beginning of the VEST study and -0.7:0.5 at the end. For both measurements the limits of agreement were well within the clinical range. Repeatability was evaluated in a second group of 11 patients who underwent VEST studies in 2 separate days. The coefficient of repeatability (twice the standard deviation of the differences between the 2 studies) was 13 for the ejection fraction and 0.4 for the peak filling rate. Thus, the VEST is an accurate and repeatable method to measure both the ejection fraction and peak filling rate.

Coronary Disease↗

PubMed1992

Comparison between exercise and trans-oesophageal atrial pacing in patients with coronary artery disease: technetium-99m methoxy isobutyl isonitrile simultaneous evaluation of ventricular function and myocardial perfusion.

In this study we compared the results of exercise and trans-oesophageal atrial pacing (TAP) technetium-99m methoxyisobutyl isonitrile (99mTc-SESTAMIBI) cardiac imaging in the evaluation of left ventricular (LV) function and myocardial perfusion in patients with angiographically proven coronary artery disease. Ten patients (8 men and 2 women, mean age 59 +/- 6 years) were submitted to 3 separate injections of 99mTc-SESTAMIBI, one under control conditions, one after exercise and one after TAP. LV ejection fraction, as measured by electrocardiogram (ECG) gated first pass, decreased from 49 +/- 5% under control conditions to 42 +/- 6% during exercise (P less than 0.05 versus control) and to 43 +/- 8% during TAP (P less than 0.05 versus control and insignificant change versus exercise). Segmental myocardial perfusion analysis was performed on a total of 150 myocardial segments. On both exercise and TAP 99mTc-SESTAMIBI studies, 103 segments (69% of the total) were normal, 32 (21%) had reversible, and 15 (10%) irreversible, perfusion defects. Relative regional tracer uptake was not statistically different between exercise and TAP in normal regions (91.1 +/- 9.1% versus 90.7 +/- 8.5%, respectively), in regions with reversible (61.9 +/- 12% versus 62.4 +/- 10.4%, respectively) and irreversible perfusion defects (55.8 +/- 7.8% versus 58.8 +/- 9.5%, respectively). Our results demonstrated that 99mTc-SESTAMIBI TAP cardiac imaging shows similar results to 99mTc-SESTAMIBI exercise myocardial scintigraphy in the assessment of LV function and myocardial perfusion in patients with coronary artery disease.

Cardiac Pacing, Artificial↗

PubMed1992

Genetic determinism of the cellular immune reaction in Drosophila melanogaster.

Larvae of Drosophila melanogaster produce a haemocytic reaction against eggs of the parasitoid Leptopilina boulardi, which leads to the formation of a multicellular capsule surrounding the foreign object. Melanization resulting from the conversion of phenol to o-quinones frequently accompanies the cellular reaction. Although various cytological and biochemical aspects of this reaction have been investigated, very little is known about genetic determinism of the insect immune response. The heredity of the capacity to encapsulate was analysed by comparing 16 reciprocal crosses made using inbred resistant and susceptible parental strains. We conclude that differences in the encapsulation capacity of D. melanogaster are inherited autosomally, with the reactive phenotype showing complete dominance over the non-reactive one. There were neither sex-linked nor maternal effects. The results of all crosses suggest a single major segregating locus with two alleles and complete dominance of the resistant allele, with cytoplasmic factors and minor modifying genes acting on the major locus.

Animals↗

PubMed1992

[Ambulatory monitoring of left ventricular function: the assessment of transient episodes of ventricular dysfunction in patients with ischemic cardiopathy].

BACKGROUND: The recent development of an ambulatory radionuclide detector (VEST) to assess left ventricular (LV) function may enhance the detection of ischemia during routine daily activities in patients with coronary artery disease (CAD). The aim of this study was to evaluate the usefulness of VEST in monitoring LV ejection fraction (EF) responses to daily activities and sustained handgrip test (HG) in patients with CAD. METHODS: 13 patients (12 men and 1 woman) with angiographically proven coronary artery disease were studied by VEST (mean 162 min, range 120 to 250 min). LV responses to different daily activities (walking and climbing stairs) and to HG were evaluated. RESULTS: Walking on a level surface and climbing stairs did not induce significant change in mean LVEF. However, a transient decrease in EF was observed in 4 (31%) and in 5 (38%) of the 13 patients during walking and climbing stairs, respectively. HG induced a significant (p < 0.01) reduction in mean EF. In particular, during HG, EF decreased > or = 5% in 11 (85%) of the 13 patients. A transient spontaneous decrease in LVEF lasting > or = 1 min was observed on 18 occasions in 11 patients with CAD; 5 episodes were symptomatic and 13 asymptomatic. ECG ST segment depression was recorded in 4 of the 5 symptomatic and in 5 of the 13 asymptomatic episodes. CONCLUSIONS: These results suggest that simultaneous monitoring of LV function and ECG may permit a better understanding of the incidence and severity of ischemic symptomatic and asymptomatic episodes.

Aged↗

PubMed1991

Relative protection from cerebral atherosclerosis of young patients with homozygous familial hypercholesterolemia.

It is well known that hypercholesterolemia is correlated with coronary atherosclerosis, but no definite information is available on its association with cerebrovascular atherosclerosis. We studied 10 young patients (age 3-32 years) with homozygous familial hypercholesterolemia (FH), together with 3 normal relatives as healthy controls. Extra- and intracranial Doppler examination, MRI and cerebral blood flow by SPECT and 99mTc-HM-PAO were performed on all. Six out of 10 patients already had signs and symptoms of coronary heart disease, but all patients were free from ischemic brain lesions, as small as detectable at MRI, and had normal cerebral blood flow. Two patients presented significant stenosis of the carotid arteries at Doppler examination. Young patients with homozygous FH have early and clinically evident coronary atherosclerosis, while overt disease in the cerebral district is delayed despite the extremely elevated plasma cholesterol concentration. This was also confirmed by the autopsy of two patients, who died after the study and whose cerebral arteries were totally free from atherosclerotic lesions. The age, at which flow-reducing atherosclerotic lesions develop in hypercholesterolemic patients, differs with regard to the arterial district involved.

Adolescent↗

PubMed1991

[The clinico-instrumental evaluation of the efficacy of picotamide in treating chronic obstructive arteriopathies of the lower extremities].

In 25 patients (19 males and 6 females) suffering from chronic arteriopathy of lower extremities at Fontaine stage II, the clinical efficacy of picotamide was investigated in double blind, cross over placebo-controlled study. Patients were assigned randomly to the treatment with placebo or picotamide (900 mg/die) for three months and, after 15 days of wash-out, to the treatment with picotamide or placebo for the same period. Painfree walking distance and ankle/arm systolic pressure ratio improved significantly only during picotamide treatment. Laboratory monitoring revealed a significant decrease in platelet aggregation and an increase of fibrinogen degradation products only during picotamide treatment. Three patients during picotamide treatment referred transient gastrointestinal discomfort (nausea, vomiting and diarrhoea); however in no case the treatment was suspended because of the appearance of these symptoms. These results indicate that picotamide is an effective drug in the management of chronic arteriopathy of lower extremities.

Aged↗