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Biomedical subjects

C Pascale

Publications and source records attributed to C Pascale.

16 recordsLinked to original sources
PubMed2006

Prevalence of silent myocardial ischaemia in new-onset middle-aged Type 2 diabetic patients without other cardiovascular risk factors.

AIMS: Coronary artery disease (CAD) is the leading cause of death in patients with Type 2 diabetes and is often asymptomatic. Silent myocardial ischaemia (SMI) is frequent in diabetic subjects and is responsible for a late diagnosis of CAD; its early detection is important. There are some data about the prevalence of SMI in Type 2 diabetic patients at high risk for cardiovascular disease, while no data are available in subjects at the onset of diabetes without other cardiovascular risk factors. METHODS: We screened 274 consecutive patients (mean age 64.3 +/- 8.4 years, 66% male) at the time of diagnosis of Type 2 diabetes; we enrolled 111 subjects without other cardiovascular disease risk factors (dyslipidaemia, hypertension, peripheral vascular disease, retinopathy, microalbuminuria, history of heart disease) and with normal resting electrocardiogram (ECG). Participants performed a maximal ECG exercise protocol and, if positive, underwent coronary angiography. RESULTS: The ECG exercise test was positive in 19 patients (17.1%); of those 14 (13%) had angiographic coronary disease (one with three-vessel disease, three with two vessels and 10 with one vessel involved). The positive predictive value of the exercise ECG for predicting angiographic coronary disease was 73%. CONCLUSIONS: The prevalence of SMI was 17% and angiographic coronary disease was found in 13% of middle-aged subjects with new-onset Type 2 diabetes without other cardiovascular risk factors. This prevalence is similar to that observed in studies of subjects with long duration diabetes who have additional cardiovascular risk factors.

Age of Onset↗
PubMed2001

Nephrotic edema.

This article starts with a concise synopsis of the history of edema. The role of underfilling, overflow, antidiuretic hormone, and acquaporins is subsequently discussed. Emphasis is given to the use of diuretics in edematous patients. The role and risks of albumin infusion are illustrated. The new hypothesis of pulse reverse osmosis is discussed. The final section deals with the measurement of colloid osmotic pressure in the clinical setting.

Edema↗
PubMed1999

Measurement of glomerular filtration rate by the 99mTc-DTPA renogram is less precise than measured and predicted creatinine clearance.

The work was devised to compare measurements of glomerular filtration rate (GFR) by technetium-99m-diethylenetriaminepentacetic acid (99mTc-DTPA) renogram to those by creatinine clearance (measured and predicted by Cockroft and Gault) and by inulin clearance. A total number of 65 individuals were enrolled: 15 healthy controls and 50 patients with renal disease. Compared to inulin clearance used as the gold standard, 99mTc-DTPA overestimated at low and underestimated at high GFRs. 99mTc-DTPA measurements were less precise than creatinine clearance except for individuals with GFR >100 ml/min x 1.73 m2. Measured creatinine clearance had the highest correlation coefficient with inulin clearance, 99mTc-DTPA clearance the lowest. In correlation analyses, 81.5% of the interindividual variability for measured creatinine clearance could be explained by true differences in inulin clearance; this value dropped to 59.1 and 57.4% for predicted creatinine clearance and 99mTc-DTPA, respectively. In patients with GFR <25 ml/min x 1.73 m2, all 99mTc-DTPA measurements were out of the 95% confidence interval for the inulin measurement. It can be inferred that 99mTc-DTPA clearance from the renogram is less precise than measured and predicted creatinine clearance.

Adult↗
PubMed1999

Effects of advanced glycation end products on cytosolic Ca2+ signaling of cultured human mesangial cells.

Advanced glycation end product (AGE) accumulation in a high glucose (HG) environment is thought to mediate some of the vascular complications of diabetes. Transmembrane signaling of contractile cells is generally inhibited by HG, with implications for systemic and target organ hemodynamics. In the kidney, glomerular mesangial cells grown in HG media are hyporesponsive to the effects of vasoconstrictor agents, possibly explaining the hyperfiltration and increased capillary pressure that eventually lead to diabetic glomerulopathy. To verify whether AGE binding to specific mesangial receptors could mediate these effects of HG, cultured human mesangial cells (HMC) were exposed to in vitro glycated bovine serum albumin (BSA) for 60 min at 37 degrees C before measurement of cytosolic Ca2+ ([Ca2+]i) by microfluorometric techniques in monolayers or single cells. AGE-BSA (2 mg/ml) reduced Ca2+ release from intracellular stores by 1 microM angiotensin II from peak [Ca2+]i levels of 843+/-117 to 390+/-50 nM in monolayers and from 689+/-68 to 291+/-36 nM in individual cells (P < 0.05). Nonglycated BSA and BSA exposed to 250 mM glucose-6-phosphate for 30 d in the presence of 250 mM aminoguanidine (AMGD), an inhibitor of nonenzymatic glycation, had no effect on the angiotensin II-induced [Ca2+]i spike (peak 766+/-104 and 647+/-87 nM, monolayers/ single cells, respectively, P = NS). AGE also inhibited store-operated Ca2+ influx through plasma membrane channels, assessed by addition of 1 to 10 mM extracellular Ca2+ to cells previously held in Ca2(+)-free media (control 339+/- 46/593 +/- 51, +AGE-BSA 236 +/- 25/390 +/- 56, +AMGD 483+/-55/ 374+/-64 nM [Ca2+]i, monolayers/single cells at 10 mM Ca2+, respectively; +AGE-BSA, P < 0.05 versus control). Contrary to HG, AGE-BSA did not translocate protein kinase C isoforms alpha, zeta, and delta to the plasma membrane. Culture of HMC in HG supplemented with 1 mM AMGD prevented downregulation of [Ca2+]i signaling. These data suggest that glycated macromolecules or matrix components may inhibit transmembrane Ca2+ signaling of glomerular cells through binding to a specific AGE receptor, thus mediating some of the known functional effects of HG on the kidney.

Animals↗
PubMed1996

Hypertensive urgencies and emergencies. Prevalence and clinical presentation.

The prevalence and clinical picture of hypertensive urgencies and emergencies in an emergency department are poorly known. The aim of the present study was to evaluate the prevalence of hypertensive crises (urgencies and emergencies) in an emergency department during 12 months of observation and the frequency of end-organ damage with related clinical pictures during the first 24 hours after presentation. Hypertensive crises (76% urgencies, 24% emergencies) represented more than one fourth of all medical urgencies-emergencies. The most frequent signs of presentation were headache (22%), epistaxis (17%), faintness, and psychomotor agitation (10%) in hypertensive urgencies and chest pain (27%), dyspnea (22%), and neurological deficit (21%) in hypertensive emergencies. Types of end-organ damage associated with hypertensive emergencies included cerebral infarction (24%), acute pulmonary edema (23%), and hypertensive encephalopathy (16%) as well as cerebral hemorrhage, which accounted for only 4.5%. Age (67 +/- 16 versus 60 +/- 14 years [mean +/- SD], P < .001) and diastolic blood pressure (130 +/- 15 versus 126 +/- 10 mm Hg, P < .002) were higher in hypertensive emergencies than urgencies. Hypertension that was unknown at presentation was present in 8% of hypertensive emergencies and 28% of hypertensive urgencies. In conclusion hypertensive urgencies and emergencies are common events in the emergency department and differ in their clinical patterns of presentation. Cerebral infarction and acute pulmonary edema are the most frequent types of end-organ damage in hypertensive emergencies.

Age Factors↗
PubMed1994

The use of lacidipine in the management of hypertensive crises: a comparative study with nifedipine.

This study estimated the efficacy of sublingual nifedipine 10 mg vs. sublingual lacidipine 4 mg in the management of hypertensive crises. We studied 40 patients with diastolic blood pressure > or = 120 mm Hg, who were divided into two groups of 20. Blood pressure and heart rate were assessed in the recumbent position before treatment and after 30, 120, and 240 min. Comparison of the effectiveness of these drugs was analyzed by Student's t test. Both drugs tested revealed a statistically significant hypotensive effect on diastolic and systolic blood pressure, and few side effects. Compared with lacidipine, nifedipine had a greater hypotensive effect on diastolic and systolic blood pressure in the first 30 min and on the diastolic blood pressure after the first 120 min. However, the hypotensive effect of lacidipine is statistically significant. After 4 h, both drugs showed a similar efficacy without significant statistical variations. We concluded that in the management of hypertensive crises the use of each of these drugs can have a particular range: nifedipine can be used when a pronounced and rapid blood pressure decrement is necessary, whereas lacidipine can be used when a more gradual effect is preferable.

Administration, Sublingual↗
PubMed1994

[Hypertensive emergencies. Clinical evaluation and therapeutic methods].

Hypertensive crisis may be defined as a condition characterized by a sudden rise in blood pressure, of varying length, that can damage arteries, arteriolas, and capillary vessels, producing impairment of end-organs. Hypertensive crises may occur under different clinical conditions, for this reason it is necessary to classify them according to their clinical context. Hypertensive crises are generally classified as hypertensive emergencies or urgencies on the basis of the clinical evaluation and according to the level of blood pressure and the presence of acute or ongoing end-organ damage. Hypertensive emergencies are conditions characterized by a great rise in blood pressure in the presence of acute or ongoing end-organ damages. A severe elevation of blood pressure is considered an emergency if there is an evidence of rapid or progressive damage to the central nervous system and myocardial, or renal deterioration. These are situations in which greatly elevated blood pressure must be lowered within one hour in order to reduce actual risk for the patient. Hypertensive urgencies are conditions in which severe elevations in blood pressure do not cause immediate end-organ damages but should be controlled within 24 hours in order to reduce potential risk for the patient. This group includes accelerated hypertension, severe elevation of blood pressure with minimal end-organ damages and no impending complications. In order to formulate a correct therapeutic plan and make the best use of the powerful antihypertensive drugs at our disposal, it is therefore necessary to distinguish hypertensive emergencies from hypertensive urgencies.

Antihypertensive Agents↗
PubMed1990

[The prevention of bacterial endocarditis].

The paper examines the prevention of bacterial endocarditis in risk patients undergoing outpatient treatment. The hypothesis of possible bacteremia provoked by either diagnostic or therapeutic surgery should be carefully assessed. For this purpose antibiotic prophylaxis should be commenced, using different methods and doses according to the type of patient, in association with hygienic and behavioural norms which the specialist will recommend and monitor.

Anti-Bacterial Agents↗
PubMed1983

[Hypotensive effect of sotalol under basic conditions and during exercise. Clinical cases].

An assessment was made of the efficacy of Sotalol, a beta1 selective beta blocker, in the management of essential arterial hypertension. A single 160 mg dose per diem was administered per os to 34 patients over a period of 14 weeks. Arterial pressure and heart rate were checked periodically. In addition, SAP, DAP and heart rate were evaluated before and during the third week of treatment in 8 subjects under maximum ergometric test conditions. Excellent tolerance was observed. Under basal conditions, all subjects displayed good reduction of SAP and DAP. This was highly significant. During exercise, it was less evident, and the results were only significant for low work loads. It is nevertheless felt that the simple dose protocol of the drug, its good tolerance and its effectiveness under basal conditions suggest that more extensive ergometric studies should be conducted.

Female↗
PubMed1979

[The electrocardiogram and arterial hypertension in primary hyperparathyroidism].

Cardiovascular conditions of 27 patients with primary hyperparathyroidism have been examinated. Hypertension has been found to be the only alteration significantly present (33,33% of patients), while heart disease are uncommon. Hypertension is often present without concomitant disease of the kidney. Blood pressure became normal in only one case over nine (11,11%) after parathyroidectomy.

Adult↗
PubMedDate not supplied

Renal reserve is normal in patients with dilative cardiomyopathy waiting for heart transplantation.

Renal reserve was explored by means of an oral protein load (2 g/kg body weight) under the form of cooked red meat in a group of 9 patients with end-stage heart failure (ESHF), class III of the New York Heart Association receiving loop diuretics and angiotensin-converting enzyme (ACE) inhibitors, and in a group of 18 healthy controls (HC) matched for age, gender, and height under an identical dietary regimen providing 40 cal/kg per day, 1 g/kg body weight of protein per day, Na 120 mmol/day, and K 50 mmol/day. Baseline glomerular filtration rate averaged 109.5+/-9.89 ml/min x 1.73 m2 in HC and 71.9+/-8.8 ml/min x 1.73 m2 in ESHF. Renal plasma flow averaged 540+/-27 ml/min x 1.73 m2 in HC and 235+/-47 ml/min x 1.73 m2 in ESHF. The filtration fraction was significantly higher in ESHF (p<0.01). Renal reserve averaged 26.03+/-3.28 ml/min x 1.73 m2 in HC and 27.2+/-7.12 ml/min x 1.73 m2 (not significant). Renal reserve averaged 123.9+/-2.9% in HC and 137.3+/-6.68% in ESHF (not significant). The filtration capacity was significantly higher in HC (p<0.001). The data point to a normalcy of renal reserve in ESHF which may depend on the chronic use of ACE inhibitors.

Adult↗