Biomedical subjects

C Milesi

Publications and source records attributed to C Milesi.

5 recordsLinked to original sources

PubMed2004

Neoadjuvant androgen deprivation before radical prostatectomy. A review.

Neoadjuvant androgen deprivation (NAD) using LH-RH analogues and antiandrogens before radical prostatectomy has been the object of several randomized trials over the last decade. From the pathological point of view they show that this treatment causes a significant reduction in the incidence of positive surgical margins compared to patients undergoing only surgery, and the optimal duration of preoperative treatment has not been determined yet. However the incidence of seminal vesicle invasion and metastases to the pelvic lymph nodes does not differ compared to controls. From the point of view of surgical technique no differences in operative time and blood loss have been recorded, while patients receiving NAD tend to present more difficult surgical dissections. The studies with longer follow-up uniformly fail to reveal an advantage in terms of PSA progression for treated patients, while data on cancer-specific survival have not been reported yet. Therefore the available information indicates that NAD before radical prostatectomy should not be considered outside clinical trials.

Androgen Antagonists↗

PubMed2003

Haemodynamic features during high-frequency oscillatory ventilation in preterms.

AIM: To compare the haemodynamic status during high-frequency oscillatory ventilation and conventional mechanical ventilation in very preterm infants with respiratory distress syndrome. METHODS: Thirty-two neonates of less than 30 wk gestation randomly assigned to high-frequency oscillatory ventilation (n = 15) or conventional mechanical ventilation (n = 17) had three echocardiographies and one cerebral Doppler-echography under the same ventilation during the first 48 h of life. RESULTS: Mean airway pressure was 2 cm H2O higher in infants ventilated with high-frequency oscillatory ventilation at the different echocardiographies. Comparable right ventricular indexes were observed in the two groups. Reduction of the ductus arteriosus diameter and ductal closure were significant only in neonates ventilated conventionally. Left ventricular performance and left ventricular contractility did not differ between the groups. The high-frequency group had lower end diastolic velocity and a higher resistance index in the anterior cerebral artery. CONCLUSION: Compared with conventional mechanical ventilation, high-frequency oscillatory ventilation was achieved without altering cardiac function. However, the inability of the left ventricle to improve its performance in the presence of a significant ductal shunt suggests a narrow range of optimal pressures under this ventilatory mode.

Blood Flow Velocity↗

PubMed1997

Blood-pressure control in the hypertensive population.

BACKGROUND: In large-scale surveys of individuals with hypertension those whose clinic blood pressure is reduced to 140/90 mm Hg or less have been found to represent only a small fraction of the hypertensive population. We assessed whether these results arise because of a white-coat effect elevating clinic blood pressure. METHODS: We randomly selected 2400 individuals from the town of Monza, Italy, and invited them to take part in our study. We measured clinic blood pressure as well as home (morning and evening measurements), and 24 h ambulatory blood pressure-ie, blood pressures largely devoid of a white-coat effect. Based on clinic blood pressure participants were then classified as normotensive, untreated hypertensive (clinic blood pressure > 140 mm Hg systolic and/or > 90 mm Hg diastolic), or treated hypertensive (having antihypertensive treatment). The mean blood pressures for each group were calculated. FINDINGS: 1651 people took part in the study. The clinic blood pressure of treated hypertensives (n = 207; 146.9 [SD 18] mm Hg/90.2 [8.6] mm Hg) was only slightly less than in untreated hypertensives (n = 402; 148 [15.2] mm Hg/93.3 [8] mm Hg) and in both groups the blood pressure values were much greater than those of normotensive individuals (n = 1042; 119.5 [10.3] mm Hg/78.1 [6.6] mm Hg) p < 0.001. Averaged home and 24 h blood pressures were lower than clinic blood pressures but similarly higher in untreated and treated hypertensive individuals when compared with normotensive individuals. This was also the case for day and night average blood pressures. The number of treated hypertensive patients found to have blood pressures within the normal limits was small not only when based on clinic blood pressure values but also when based on ambulatory blood-pressure values. INTERPRETATION: In the hypertensive population the number of patients with inadequate blood-pressure control is high not only when assessed in the clinic but also when assessed by ambulatory-blood-pressure monitoring or at home. The high blood-pressure values commonly found in treated hypertensive individuals cannot be accounted for by a white-coat effect but by a true lack of daily-life blood-pressure control.

Adult↗

PubMed1997

Ambulatory and home blood pressure normality in the elderly: data from the PAMELA population.

To determine ambulatory blood pressure (BP) means and distributions in an elderly population, we studied a random sample of 800 subjects stratified by sex and representative of residents aged 65 to 74 years of the city of Monza. Participation was 50%. Measurements consisted of clinic BP (average of three measurements with mercury sphygmomanometry), home BP (average of morning and evening measurements with a semiautomatic device), and ambulatory BP (SpaceLabs 90207). Clinic BP was obtained before and after home and ambulatory BP measurements. In normotensive and untreated hypertensive subjects (n=248), clinic, home, and ambulatory BPs were significantly related (P<.001). The means of the clinic BPs obtained on consecutive days were very similar and markedly higher than 24-hour average BP (+25 mm Hg systolic and + 10 mm Hg diastolic, P<.001). Nighttime BP was markedly less than daytime BP (-14 and -13 mm Hg, P<.001), whereas home BP values occurred approximately midway between clinic and 24-hour average BP values. Only minor differences existed between data in men and women, and the differences in clinic, home, and ambulatory BP values occurred in both normotensive and untreated hypertensive subjects. All BPs were similar in the untreated and treated hypertensive groups. Thus, as previously reported in subjects younger than 65 years, in the elderly fraction of the population, 24-hour average BP is much lower than clinic BP. The upper limit of normality for 24-hour average BP (calculated as the value corresponding to 140/90 mm Hg clinic BP) is about 120 mm Hg systolic and 76 mm Hg diastolic. At variance with data from younger subjects, home BP in the elderly is higher than 24-hour average BP. However, similar to data from younger subjects, clinic, home, and ambulatory BPs are higher in treated hypertensive than normotensive elderly subjects, indicating that in hypertensive elderly subjects, antihypertensive treatment does not commonly achieve full BP control both inside and outside the clinic environment.

Age Factors↗

PubMed1996

Job strain and ambulatory blood pressure levels in a population-based employed sample of men from northern Italy.

OBJECTIVES: The purpose of this cross-sectional study was to examine the associations between categories of perceived job strain and blood pressure, measured by clinical and ambulatory devices on a population-based sample of employed men in northern Italy. METHODS: The study included 527 employed normotensive or mild hypertensive nonmedicated men enrolled in an age-gender stratified random sample of 821 25- to 64-year-old residents of the city of Monza (in the vicinity of Milan). The job-strain categories were classified according to the traditional quadrant-term approach and also a new approach based on the comparison of extreme tertile categories in order to enhance contrasts. Clinical blood pressure was measured according to the standardized MONICA procedure; 24-h, work, leisure, and nighttime blood pressure values were obtained with an ambulatory device. Disparities, calculated as differences between clinical and ambulatory measurements, were also analyzed. RESULTS: Among normotensive working men the highest mean for systolic blood pressure was found in the high-strain group, and progressively lower values were found in the passive, active and low-strain categories. These patterns were observed for both the clinical and ambulatory measurements. Among the mild hypertensive subjects, lower mean values for ambulatory systolic and diastolic blood pressure were found in the passive and high job-strain categories when the tertile term approach was adopted. The passive group also showed the highest mean difference between the clinical and ambulatory measurements; this finding indicates that they may be more susceptible to alarm reactions. CONCLUSIONS: The results indicate that job strain affects blood pressure in population-based samples and the effect is consistent across sociocultural contexts.

Adult↗