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Biomedical subjects

A Palamara

Publications and source records attributed to A Palamara.

At least 19 recordsLinked to original sources
PubMed1998

The spatial distribution of visual attention in hemineglect and extinction patients.

We studied the visual field distribution of speed and accuracy of manual responses to small brief light flashes, in patients with left hemineglect or extinction resulting from right hemisphere vascular lesions and in brain-damaged and healthy control subjects. All patients with right hemisphere lesions showed a greater impairment in both the speed of response and the detection rate in the contralesional than in the ipsilesional hemifield. This interfield difference increased with the eccentricity of stimulus presentation and was especially pronounced in neglect patients who showed a paradoxical increase in speed of response and detection rate at increasingly larger eccentricities in the ipsilesional hemifield. We hypothesize that both the contralesional slowing down and the ipsilesional speeding up of the response depends upon an exaggerated gradient of attention towards the ipsilesional hemifield. To assess whether these abnormalities concern automatic or controlled attentional processes, in a second experiment, we manipulated the predictability of the side of the stimulus presentation by using blocked rather than randomized stimulus presentations. This resulted in a speeding up of responses in both hemifields thus showing that the patients were able to focus attention to the side of stimulus presentation voluntarily. However, there was no modification of the contra-ipsilesional differences which, therefore, are likely to be related to abnormal automatic processes rather than controlled attention.

Aged↗
PubMed1998

[The effects of the ablation of atrial flutter in patients with and without a clinical history of paroxysmal atrial fibrillation].

BACKGROUND: Although the safety and effectiveness of radiofrequency (RF) transcatheter ablation in patients with atrial flutter (AFL) is well established, little attention is paid to previous history of associated paroxysmal atrial fibrillation (AF) and the recurrence of AFL after RF ablation. In addition, it is not known whether the elimination of AFL can modify the natural history of AF in patients who experience both of these arrhythmias. Accordingly, the aim of this study was to evaluate the effect of RF ablation of AFL in patients with or without a previous history of AF in terms of the incidence of both arrhythmias in the follow-up. METHODS: RF ablation of the atrial isthmus between tricuspid ring, coronary sinus os and inferior vena cava was performed in 27 patients (23 males, 4 females; mean age 61 +/- 9 years) according to the technique described by Cosio. Based on ECG pattern, twenty patients exhibited common or type 1 AFL (negative F waves in the inferior leads with a sawtooth morphology), while seven patients had both common and uncommon AFL (various surface F wave morphologies, generally positive F waves in the inferior leads). A history of association between AFL and paroxysmal AF was documented in 48% of patients, but AFL was the major arrhythmia. After ablation, the patients were followed up and the clinically documented occurrence of arrhythmias was determined. RESULTS: Based on clinical history before ablation, we compared patients with an association between AFL and AF (Gr AFL + AF; n = 13) vs patients with only AFL (Gr AFL; n = 14). The characteristics of the two groups were similar regarding age, sex, duration of symptom, structural heart disease, left atrial size, P-wave duration, AFL interruption during RF procedure, antiarrhythmic treatment before and after RF procedure, and duration of follow-up. During a follow-up of 12 +/- 6 months, AFL recurred in 10 patients (37%), 4 from Gr AFL + AF, and 6 from Gr AFL (p = NS). Episodes of paroxysmal AF occurred in 6 patients (22%), 5 from Gr AFL + AF and 1 from Gr AFL (p < 0.05). In Gr AFL + AF, the incidence of AF after ablation was significantly lower (1.8 +/- 0.6 vs. 0.7 +/- 1 episodes/year; p < 0.02). Characteristics of patients with or without AFL recurrence in the follow-up were similar. The percentage of patients with the occurrence of AFL or AF, associated or unassociated in the follow-up, was 55%. CONCLUSIONS: A history of paroxysmal AF before RF ablation of AFL is not predictive of long-term success or failure of the procedure when considering the recurrence of AFL alone. Nevertheless, the general results are disappointing because the majority of patients have arrhythmias, AFL or AF, associated or unassociated in the follow-up. A clinical history of AF before ablation is correlated with a higher incidence of AF in the follow-up. In any event, the incidence of AF episodes is lower in the follow-up, indicating a possible beneficial effect of AFL ablation on AF mechanisms.

Adult↗
PubMed1998

[The role of an electropharmacological transesophageal test in the prevention of paroxysmal atrial fibrillation. Experience with flecainide].

BACKGROUND: The management of patients with paroxysmal atrial fibrillation (AF) is unsuccessful, because AF recurs in about 50% of patients despite an antiarrhythmic treatment. Usefulness of non-pharmacological strategies is available in a limited subset of patients and it does not present a global solution to the problem. At present, treatment with antiarrhythmic agents is the only available tool in patients with AF recurrence. The aim of this study was to assess the predictive value of the electropharmacological transesophageal (TE) test in the management of patients with paroxysmal AF treated by flecainide. METHODS: In 32 patients, ranging in age from 38 to 70 years (mean: 59 +/- 12 years), with documented episodes of paroxysmal AF (mean: 5.6 +/- 3.7 episodes/last year), we performed an electrophysiological transesophageal (TE) test following pharmacological wash-out. An aggressive protocol was used: step A: 10 sec atrial burst at Wenckebach point + 10 bpm, 200 and 250 bpm; step B: 10 sec atrial bursts at 300, 400, 500 and 600 bpm; step C: 8 sec increasing rate burst from 200 to 800 bpm. Induction of sustained AF (> 1 min) was considered the end-point. Patients were treated with flecainide 100 mg bid and a second TE test was performed at the steady-state, with an identical induction protocol and end-point. Based on the response of the second test, patients were divided into responders (R Group: non-inducible AF) and non-responders (NR Group: inducible, sustained AF). Patients were followed-up by periodical controls and contacted by telephone to confirm their clinical status. RESULTS: Sustained AF was induced in 30 patients (94%) at the first TE study. Eight of them dropped-out at the time of the second TE test (6 patients for lack of consent, 1 patient for side-effects and another one for proarrhythmic effects). In the mean follow-up of 15 +/- 6 months, among patients who underwent a second TE test, AF recurrence was documented in 2 out of 14 patients from the R Group and in 7 out of 10 patients from the NR Group (p < 0.01). There were 4 AF episodes in the R Group and 19 in the NR Group (p < 0.001). We did not find significant statistical differences between the two groups in terms of age, sex, body weight, AF episodes/past year, P-wave duration, left atrial dimension, structural heart disease, AF duration at the first TE test and follow-up duration. In five patients from the NR Group with induced AF lasting > 5 min, the percentage of recurrence was 100% and there were 16 AF episodes. Global percentage of patients with recurrence was 37%. CONCLUSIONS: Flecainide is effective in reducing the incidence of AF and results are similar to other antiarrhythmic agents generally used. The electropharmacological TE test might be a useful tool to predict the response to an antiarrhythmic treatment.

Adult↗
PubMed1998

[Idiopathic atrial fibrillation of recent onset and atrial stunning: the echocardiographic evidence after pharmacological cardioversion].

Successful cardioversion of atrial fibrillation may result in prolonged recovery of normal atrial mechanical function. This prolonged recovery of atrial contraction (so-called atrial stunning) might depend on: the amount of energy delivered during direct current cardioversion; the time course between the onset of atrial fibrillation and the conversion to sinus rhythm; the size of the left atrium; the underlying cardiac disease. The aim of this study was to evaluate, in subjects with normal atrial size and without heart disease, the phenomenon of atrial stunning soon after pharmacological cardioversion of an episode of atrial fibrillation of recent onset. Twenty-five patients with an acute episode of atrial fibrillation, without evidence of heart disease and M-mode left atrial dimension (< or = 40 mm received i.v. propafenone or flecainide 2 mg/kg/10 min in order to restore sinus rhythm. Atrial fibrillation lasted < 48 hours in all patients. Doppler echocardiography was used to assess atrial function, by recording the peak velocity of atrial contraction (A wave). An echocardiographic study was performed within 12 hours of successful cardioversion and was repeated on day 3, 12 and 30. The size of the left atrium (37 +/- 3.9; 37.57 +/- 2.9; 37.4 +/- 4; 37.82 +/- 3.7 mm) and peak E velocity (57.97 +/- 18.3; 59.4 +/- 18.3; 59.0 +/- 16; 59.07 +/- 16.7 cm/s) did not show any significant differences over the time, as demonstrated by the serial echocardiographic evaluations. In contrast, both peak A velocity (cm/s) and E/A ratio evaluated within 12 hours of cardioversion (60.29 +/- 12.3 and 1.0 +/- 0.37) and on day 3 (73.71 +/- 10.7 and 0.82 +/- 0.27) were statistically different (p < 0.000001 and p < 0.00001). No further statistically significant increase was found in subsequent examinations (respectively 76.31 +/- 12 and 0.78 +/- 0.24 on day 12, and 76.91 +/- 14.8 and 0.78 +/- 0.21 on day 30). In conclusion, this study suggests that patients with alone atrial fibrillation of recent onset have a delayed recovery of normal atrial systolic function even after pharmacological cardioversion.

Adult↗
PubMed1997

Prognostic value of dobutamine echocardiography early after uncomplicated acute myocardial infarction: a comparison with exercise electrocardiography.

OBJECTIVES: This study sought to assess the relative prognostic power of dobutamine echocardiography and exercise electrocardiography after acute myocardial infarction. BACKGROUND: The prognostic value of dobutamine echocardiography early after acute myocardial infarction has not yet been reported. METHODS: One hundred seventy-eight patients (mean age 58 +/- 9 years) with a first uncomplicated acute myocardial infarction underwent predischarge dobutamine echocardiography (5 to 40 micrograms/kg body weight per min, plus atropine if needed) and symptom-limited bicycle exercise electrocardiography and were followed up for 17 +/- 13 months. Stress-induced dyssynergy and ST segment depression > 1 mm were considered criteria of positivity for dobutamine echocardiography and exercise electrocardiography, respectively. RESULTS: Dobutamine echocardiography was positive in 83 patients and exercise electrocardiography in 60. At follow-up there were 5 deaths, 6 nonfatal myocardial infarctions (11 hard events) and 20 cases of unstable angina. Dobutamine echocardiography and exercise electrocardiography had similar negative predictive values both for all events (88% and 86%, respectively) and for hard events (98% and 95%, respectively). The hard events rate was significantly higher in patients with positive rather than negative dobutamine echocardiography (relative risk [RR] 5.15, 95% confidence interval [CI] 1.14 to 23.16), although there was no difference between patients with positive and negative exercise electrocardiograms. When Cox analysis was performed, dobutamine echocardiography had an independent prognostic value both for all events (RR 2.88, 95% CI 1.37 to 6.08) and for hard events (RR 6.56, 95% CI 1.42 to 30.46). CONCLUSIONS: After uncomplicated acute myocardial infarction, dobutamine echocardiography and exercise electrocardiography have a similar high negative predictive value for both all events and hard events only. Positive dobutamine echocardiography, but not positive exercise electrocardiography, identifies a group of patients at higher risk of subsequent cardiac events.

Aged↗
PubMed1997

Cardiac arrest during dobutamine stress echocardiography.

In this report, we describe the case of a woman with normal coronary arteries who experienced a cardiac arrest during a dobutamine stress test. The patient was successfully treated with external cardiac massage. The possible mechanisms underlying this unusual life-threatening side effect of dobutamine infusion are discussed.

Adrenergic beta-Agonists↗
PubMed1997

[Prognostic stratification after acute uncomplicated myocardial infarction: exercise test, echo-dobutamine test or both?].

OBJECTIVES: The aims of this study were: 1) to assess the relative prognostic value of predischarge dobutamine echocardiography (DE) and exercise electrocardiography (EE) in patients after a first uncomplicated acute myocardial infarction (AMI), and 2) to evaluate the optimal prognostic strategy by using the two tests in different combinations. METHODS: DE (dobutamine infusion 5 to 40 micrograms/kg/min plus atropine 0.25 to 1 mg, if needed) and symptom-limited bicycle EE were performed in 208 patients (mean age 58 +/- 9 years, 90% males), on different days and in random order, 12 +/- 4 days after a first uncomplicated AMI and after pharmacological washout. A stress-induced dyssynergy and ST segment depression > 1 mm were considered criteria of positivity for DE and EE, respectively. Only spontaneous cardiac events were considered: cardiac death, reinfarction (= hard events), and unstable angina requiring hospitalization (= soft events). RESULTS: Thirty-eight events occurred during follow-up (16 +/- 13 months; range: 1-44 months); 5 cardiac deaths, 6 reinfarctions and 27 unstable angina. Patients with a positive DE had a twofold increase in all event rates (26 vs 12%, p < 0.01) and a fourfold increase in the rate of hard events (9 vs 2%, p < 0.05). In contrast, no statistically significant difference was observed in the distribution of the same events between patients with positive and negative EE. Both tests showed similar negative (DE 88%, EE 85%) and positive (DE 26%, EE 24%) predictive values. Among six different strategies (performing either DE or EE only in all patients; EE in all patients; EE in all patients and DE only in those with a positive EE; and DE only in those with a negative EE; EE in all patients and DE only in those with anterior AMI), EE only in patients with inferior or non-Q AMI and DE only in those with anterior AMI), performing DE only in patients with a positive EE gave the highest predictive accuracy-74% (95% confidence intervals 68 to 80) for all events and 77% (95% confidence intervals 71 to 83) for hard events. CONCLUSIONS: In patients with a first uncomplicated AMI, DE is useful in identifying patients at high and low risk of future spontaneous cardiac events. The optimal strategy for prognostication of these patients is to perform EE in all and DE only in the ones with a positive EE.

Acute Disease↗
PubMed1997

[Feasibility and safety of dobutamine/atropine echocardiography following acute myocardial infarct].

BACKGROUND: Due to the increased utilization of this test for the evaluation of chest pain and for prognostic stratification in patients with a recent myocardial infarction, the results of 235 consecutive tests have been analyzed to evaluate the incidence and clinical significance of side effects induced by dobutamine. A potential limitation to the clinical utilization of dobutamine stress echocardiography is the higher incidence of side effects comparison with to other non invasive tests for the diagnosis of coronary artery disease reported by some authors. METHODS: Dobutamine/atropine stress echocardiography was performed in 256 patients affected by acute myocardial infarction. Dobutamine was infused starting with the dose of 5 micrograms/kg/min over 3 minutes with incremental steps of 10-20-30-40 micrograms/kg/min over 3 minutes and atropine, in cases of poor chronotropic response, under 2D-echocardiographic and 12-lead electrocardiographic monitoring. RESULTS: The test was interrupted only in 4 cases for atrial fibrillation (2 patients) and symptomatic hypotension. Patients were divided according to the absence (G1) or presence (G2) of cardiac arrhythmias during the test. Patients of G2 differred from patients of G1 only in respect of the maximal dose of dobutamine infused and the incidence of a wall motion abnormality in the basal echocardiogram. CONCLUSIONS: Dobutamine/atropine echo stress test may be considered a safe test for the evaluation of the presence and severity of coronary artery disease in patients with a previous or recent myocardial infarction.

Acute Disease↗
PubMed1996

Implicit redundant-targets effect in visual extinction.

Patients with left visual extinction as a result of unilateral right hemisphere damage were tested on a redundant-targets effect paradigm (RTE). LED-generated brief flashes were lateralized either to the left or to the right visual hemifield or presented bilaterally. Subjects were asked to press a key as fast as possible following either unilateral or bilateral stimuli and immediately afterwards to report on the number of stimuli presented. As previously found in normal subjects, bilateral stimuli were responded to faster than unilateral ones, and this was evidence of a RTE. The main thrust of this study was that extinction patients showed a RTE not only for correctly perceived bilateral stimuli but also in trials in which they extinguished the stimulus on the field contralateral to the lesion. This result is compatible with a preserved processing of the extinguished input at least up to the stage at which it may interact with the input from the normal side to yield a speeded motor response. Interestingly, the implicit redundancy gain of extinction patients was found to fit a coactivation (i.e. neural) rather than a probabilistic model.

Aged↗
PubMed1996

Effect of combined alpha IFN and prostaglandin A1 treatment on vesicular stomatitis virus replication and heat shock protein synthesis in epithelial cells.

The antiviral activity of prostaglandin A (PGA) and interferons (IFNs) has been widely described. In the present report, we investigated the effect of combined alpha IFN and PGA1 treatment on vesicular stomatitis virus (VSV) replication and on heat shock protein (HSP) induction in monkey epithelia cells. In uninfected cells, PGA1 caused a dose-dependent induction of HSP70, HSP90 and HSP110, while alpha IFN did not affect HSP synthesis. Alpha-IFN suppressed VSV replication dose-dependently, even when cells were treated after virus infection. VSV protein synthesis was not affected by alpha IFN, indicating a block at the level of virus assembly or maturation. PGA1 caused a dose-dependent inhibition of VSV replication, and suppressed VSV protein synthesis at concentrations which induced the synthesis of high levels of HSP70. The combined treatment with low doses of alpha IFN or PGA1, which only moderately inhibited VSV replication when administered separately, was found to suppress VSV production by more than 95%, and resulted in a 3-fold increase of HSP70 synthesis as compared to PGA1 alone. These results demonstrate a co-operative effect of PGA1 and alpha IFN against VSV infection and suggest that alpha IFN can potentiate the cellular response to HSP induction in virus-infected cells.

Animals↗
PubMed1990

[Electrocardiographic evaluation of myocardial co-involvement in Duchenne muscular dystrophy: prognostic implications in a case with multiple localizations].

After a review of the literature on myocardial involvement (MI) in Duchenne's progressive muscular dystrophy (DMD), the authors report a case with an extensive MI. This severe myocardial functional impairment is a poor index in the prognosis of DMD. The authors emphasize the use of echocardiography in the screening of MI in DMD.

Adolescent↗
PubMed1980

[Phono-mechano-cardiographic assessment in hypertensive heart disease: value of the apex cardiographic parameters (author's transl)].

In 15 normal subjects and in 19 patients with essential hypertension (NYHA I-II) systolic time intervals (STI) and diastolic more expressive parameters of the left ventricular performance were studied by phono-meccano-cardiography. ICT, LVET, ICT/LVET, iso-volumic relaxation period (A2-0) and rapid filling time (O-F) were measured. On the apexcardiogram relative height of rapid filling (RF) and atrial (A) waves measured too. "Diastolic index", a ratio between this two phenomena (hRFw/hAw) was calculated. Results were evaluated in relation with ECG, arterial pressure and subjective sympthoms. There were no statistically significant differences in mean values of the STI among normotensive and hypertensive subjects. On the contrary the parameters which explore into diastolic period result in disagreement and significantly influenced by diastolic arterial pressure. Comparison showed that patients in the hypertensive group had longer mean isovolumic relaxation period (P < 0.01), longer mean O-F time (P:ns), lower mean RF wave (P < 0,01) and higher mean atrial wave (P < 0,01). Consequently hRFw/hAw mean ratio was lower (P < 0,01) and frequently reversed. The lengthening of iso-volumic relaxation period and reduction of diastolic index were more consistent in the symtomatic patients (P:ns). It is concluded that poligraphic research, in patient with hypertensive heart disease, must not be restricted to the STI but it has to include a poliparametric evaluation of all phases of cardiac circle. The diastolic index may prove a simple, readily available and noninvasive guide in the assessment of left ventricular function.

Adult↗
PubMedDate not supplied

Corneal topography and astigmatism after superior sutured 8 mm scleral tunnel incisions.

OBJECTIVES: To verify corneal topography and astigmatism after cataract surgery with 8 mm scleral tunnel incisions closed with a continuous 10-0 nylon suture. SETTING: Institute of Ophthalmology, University of Verona, Italy. METHOD: Twenty eyes were studied for 12 months after cataract extraction with 8 mm, sutured, scleral tunnel incisions. Corneal topography (EyeSys 2.1) was evaluated for the first 5 months. Astigmatism (absolute and induced) was measured by Javal ophthalmometry preoperatively and 1, 7, 30, 60, 90, 150, and 360 days after surgery. RESULTS: In the week following surgery, corneal shape was minimally affected and uncorrected visual acuity was not compromised. Mean with-the-rule induced cylinder was less than 1.00 diopter (D). After 5 and after 12 months, the mean induced cylinder was still less than 1.50 D but with an against-the-rule shift in almost all eyes. CONCLUSIONS: Sutured 8 mm tunnel incisions showed good results in terms of absolute cylinders but late against-the-rule shift could not be avoided.

Aged↗
PubMedDate not supplied

[Left ventricular thrombosis in acute myocardial infarction: incidence, complications, and clinical effects of calcium heparin].

It is known that the myocardial infarction may be associated with left intraventricular thrombosis (LIT) as the anatomopathologic studies and the heart surgery operations confirmed. The authors verified in this study the incidence and the complications of de LIT in the patients with acute myocardial infarction treated with low-dose heparin.

Acute Disease↗
PubMedDate not supplied

[Assessment of the ejection fraction in ischemic cardiopathy with two-dimensional echocardiography. Validity and limits of the method].

In this study the authors compare the Ejection Fraction (EF) as determined by the Single Plane Ellipse Echocardiographic method versus the Ventriculographic EF. The authors emphasize the validity of the two-dimensional echocardiography to assess left ventricular EF in order to improve the clinical and pharmacologic management of the patients with the cardiac ischaemic disease.

Aged↗