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Biomedical subjects

E Piccolo

Publications and source records attributed to E Piccolo.

At least 19 recordsLinked to original sources
PubMed2003

Dog-ears: a useful artifice in the closure of extensive wounds.

BACKGROUND: Wounds too extensive to permit primary repair by suturing can be closed using a skin graft or skin flap and the choice of method depends on a series of factors. Practice and personal experience play a role, as well as the characteristics of the lesion and its site. Each case poses special problems, so it is not possible to establish firm rules. OBJECTIVE: To present a surgical technique for the closure of a circular defect located on the dorsum of the foot, which resulted from the extirpation of a melanoma by surgery. METHODS: In this case we used a mixed procedure consisting of skin flaps and a double full-thickness skin graft. For this operation we used dog-ears resulting from the circular exeresis performed for the extirpation of the tumour. RESULTS: The reconstructive results were good and there were no postoperative complications. CONCLUSIONS: We consider this procedure particularly suitable for certain anatomical sites, such as the dorsum of the foot, where the skin is less elastic and thinner; and for patients who are not willing to accept skin removal from other sites or for flaps to be made with more invasive operations and more constructed scars.

Aged↗
PubMed2001

[Controversies regarding distribution, instrumentation, and competence of hemodynamics laboratories].

In the last few years we have witnessed a substantial growth in the number of catheterization laboratories, especially in the northern regions of Italy, a phenomenon which has met some controversy and has been discussed in a Symposium at the ANMCO National Conference (Florence, May 20-23, 2000). The controversy is essentially between those who believe in the implementation of catheterization laboratories in all cardiology units equipped with a cardiological intensive care unit (and the creation of a functional network with the tutorial centers) and those who refer to the existing guidelines, standards and VRQ which envisage a geographical distribution of laboratories on the basis of a balance between needs of the population and the minimum quantity of procedures performed by each center in order to guarantee the best quality and cost-effectiveness. The aim of the Symposium was to clarify whether the two "innovations" of these last few years, namely the introduction of new portable radiological equipment on the one hand and the effectiveness of primary angioplasty in the treatment of acute myocardial infarction on the other, may influence the redefinition of criteria regarding the distribution of laboratories, taking into account as well the expansion of indications for coronary angioplasty and coronary angiography. After a lively discussion, the proceedings can be summed up as follows: no agreement was reached regarding the role of portable radiological equipment in the decisional process regarding the setting up of a new catheterization laboratory; primary angioplasty should be carried out in centers with an adequate volume of activity and a functioning inter-hospital organizational structure for this demanding activity; otherwise it does not offer any advantages over fibrinolytic therapy; the proposal of a new organizational model is based on the creation of transverse inter-hospital cardiology departments, the size of which is based on the overall size of the user population, with interventional laboratories distributed in the reference hospitals and diagnostic laboratories in hospitals equipped with a cardiologic intensive care unit (where there is a sufficiently large user population to guarantee at least the minimum number of procedures envisaged by the standards); both parts should work in close cooperation. On this last point there was a contrasting opinion and it was not possible to reach a consensus. The Scientific Societies should formally express their views on this controversial topic, so that guidelines, standards and VRQ can be updated rapidly. The latter should constitute the reference for the procedures of accreditation to which all laboratories and cardiology departments are subjected to, and it is likely that this will be the best way to overcome the present controversy.

Angioplasty↗
PubMed2000

[Electrocardiography and myocardial viability].

After an acute myocardial infarction, the cardiologist cannot discard data regarding myocardial viability. The most frequently used diagnostic methods for this are echocardiographic or scintigraphic techniques; unfortunately, these techniques are operator sensitive or expensive. However, also by simple electrocardiography is it possible to obtain important information about myocardial viability, in an objective and economic way. There are three electrocardiographic modifications potentially related to myocardial viability: 1) spontaneous modifications after an acute myocardial infarction: early or late T wave normalization, and Q wave regression; 2) exercise-induced modifications: ST segment elevation, T wave normalization, ventricular arrhythmias; 3) dobutamine-induced modifications: ST segment elevation and T wave normalization. In this editorial, the authors report the literature data on the various electrocardiographic signs and analyze their accuracy and utility in myocardial viability assessment.

Arrhythmias, Cardiac↗
PubMed1997

Effects of transdermal nitroglycerin on left ventricular function after acute myocardial infarction.

Progressive left ventricular dysfunction in acute myocardial infarction patients is associated with a poor prognosis. It has been shown that some therapeutic measures which have the potential for limiting the infarct size and preserving ventricular function, are also able to reduce the incidence of congestive heart and improve survival. The aim of this protocol was to assess the effects of transdermal nitroglycerin administered within 72 hours after the onset of acute myocardial infarction and for the following 6 months, on left ventricular function. A total of 98 consecutive acute myocardial infarction patients were randomly allocated, within 72 hours of onset of symptoms, to a double-blind 6-month-therapy with either 10 mg/24 hour transdermal nitroglycerin or placebo. Patients underwent two-dimensional echocardiography at entry, after 2 weeks, 3 months and 6 months. In the nitroglycerin group, end-diastolic volume increased during the follow-up (+6.7%, p < 0.05) while end-systolic volume remained nearly unchanged; ejection fraction and stroke volume increased progressively (+6.3%, p < 0.05, +14.2%, p < 0.05, respectively) and a important reduction of percent of dyssynergic segments was present (-19.2%, p < 0.005). In the placebo group end-diastolic volume and end-systolic volume slightly increased during the follow-up (+2% and +4.9% respectively); ejection fraction and stroke volume remained nearly unchanged during the study; percent of dyssynergic segments showed an important decrease after 2 weeks and 6 months (-21.3%, p < 0.005). A clinically relevant increase (> 20%) in ejection fraction was present more frequently in the nitroglycerin than in the placebo group (p < 0.001). In conclusion, the early (within 72 hours) and prolonged (6 months) administration of transdermal nitroglycerin in acute myocardial infarction improves ejection fraction and stroke volume but does not modify ventricular remodeling.

Acute Disease↗
PubMed1994

Nitroglycerin infusion during upright tilt: a new test for the diagnosis of vasovagal syncope.

The aim of our present study was to assess the value of nitroglycerin infusion during upright posture as a new provocative test for diagnosis of vasovagal syncope. To this purpose 40 patients with unexplained syncope (17 men and 23 women, mean age 47 years) and 25 asymptomatic control subjects with negative baseline head-up tilt underwent two other tilting tests, one during nitroglycerin infusion and one during isoproterenol infusion. The protocol of the nitroglycerin test consisted of a maximum of five successive stages of 5 minutes in the supine position plus 10 minutes 80-degree upright tilt at progressively increasing infusion rates (increments of 0.86 microgram/kg/hr every stage). During the nitroglycerin test a positive response (syncope in association with sudden hypotension and bradycardia) occurred in 21 (53%) patients with unexplained syncope, an exaggerated response (minor symptoms in association with slowly increasing hypotension alone) occurred in 10 (25%), a negative response in 9 (22%), and drug intolerance in 0. During the isoproterenol test these percentages were 25%, 25%, 32%, and 18%, respectively. Only 2 (8%) control subjects had a positive response to nitroglycerin test and 2 (8%) to isoproterenol test. Thus the nitroglycerin test seems to be a useful alternative tool for diagnosis of vasovagal syncope; it is equally specific but more sensitive and feasible than the isoproterenol test.

Adult↗
PubMed1993

[The usefulness of transesophageal echocardiography in the diagnosis of arrhythmogenic cardiomyopathy of the right ventricle].

OBJECTIVES: The aim of this study was to evaluate the usefulness of transesophageal echocardiography (TEE) for the diagnosis of arrhythmogenic right ventricle cardiomyopathy (ARVC). PATIENTS: Using TEE and the standard transthoracic echocardiography (TTE), we studied 19 patients affected with hyperkinetic ventricular arrhythmias with a LBBB pattern, as well as 10 normal control subjects (C). METHODS: We calculated the following parameters: the fractional area change (FAC) of the end-diastolic right ventricule (RV) area; the global wall motion score (WMS) by the algebraic sum of the score of each of the 9 wall segments including the inflow, outflow and apex of RV; the asynergy index (AI) by the percentage of the 9 segments with a score > or = 2; the average thickness of moderator band and papillar muscles (ATMP); the echo reflectivity score (ERS) and the structural abnormalities score (SAS) of RV. The diagnosis of ARVC was proposed when RV segmental wall motion abnormalities were visualized, or when a decrease of the ventricular FAC and dysmorphic aspects were contemporaneously present. The results of the two echocardiographic approaches were compared, and in arrhythmic patients (A) echocardiographic results were compared with those obtained by cineventriculography (CVG), which we had adopted as the reference diagnostic method. RESULTS: The comparison between A and C showed significant differences for all parameters if calculated by the TEE (p < 0.003-0.0001), except for ATMP if calculated by TTE (p < 0.003-0.0001). The comparison between TEE and TTE approaches did not show any difference in the C group while in the A group only FAC and ERS resulted similar; the values of the remaining parameters were significantly greater if calculated by TEE than by TTE (WMS = 7.3 +/- 4.1 vs 4.3 +/- 2.3: p < 0.01; AI = 22.6 +/- 18.5 vs 11.6 +/- 10.3: p < 0.05; ATMP = 6.1 +/- 0.9 vs 5 +/- 1.2 mm: p < 0.04; SAS = 2.2 +/- 0.8 vs 1.4 +/- 0.7: p < 0.002). In 17 of the 19 patients who were clinically suspected to be affected with ARVC the diagnosis was confirmed by CVG; 12 of them (70%) were correctly identified by TTE and 17 (100%) by TEE. One of the two negative patients was erroneously considered positive both by TTE and TEE. CONCLUSIONS: TEE is a usefull diagnostic tool for ARVC and is more accurate than TTE for the identification of the concealed or dubitative forms of the disease.

Adult↗
PubMed1992

[Efficacy and tolerability of nicardipine retard and captopril in hypertension in the aged. Results of a multicenter study].

The efficacy and tolerability of nicardipine retard and captopril were assessed in 174 over-60-year-olds suffering from slight or moderate essential hypertension. After 2-3 weeks of wash out the patients were randomly assigned to calcium antagonist (40 mg twice a day) or ace-inhibitor (25 mg twice a day) treatment which continued for 180 days. Monotherapy was combined with hydrochlorothiazide (12.5 mg/day) after 2 months in the event of an unsatisfactory reduction of arterial pressure in relation to basal values. Systolic and diastolic blood pressure was measured (1st and 5th Korotkoff's tone) at monthly intervals while lying and standing; heart rate was also measured using a palpatory method. Both nicardipine retard (no. 86) and captopril (no. 88) caused a significant reduction of clino- and orthostatic systolic and diastolic arterial pressure during the first two months of treatment. Respectively 70% and 51% of patients responded to treatment and the blood pressure reductions achieved using monotherapy remained unchanged during the course of the study. The association of hydrochlorothiazide resulted in a significant decrease in arterial pressure in non-responders, an effect which was observed with both nicardipine retard and captopril. No significant variation in heart rate was recorded between the two groups. Twenty-one patients in the nicardipine retard group and 16 in the captopril group suffered from slight to moderate side effects. Six patients dropped out of the nicardipine retard group and 15 patients out of the captopril group, an event for which side-effects were responsible in 1 and 3 cases respectively. In conclusion, nicardipine retard and captopril represent an efficacious form of treatment for geriatric hypertension and possess a satisfactory level of tolerability.

Aged↗
PubMed1991

Anabolic steroid use in body builders: an echocardiographic study of left ventricle morphology and function.

To ascertain the effect of anabolic steroids (AS) on left ventricle size and function, M-mode and 2D echocardiographic evaluation was carried out in 14 body builders at the end of a phase of AS self-administration (8 +/- 3 weeks, mean +/- S.D.) and after a period (9 +/- 2 weeks, mean +/- S.D.) of drug withdrawal, as well as in 14 other body builders who had never made use of AS, and in 14 sedentary individuals. All the subjects were also examined anthropometrically. Ventricular septal thickness index was slightly greater in athletes using AS, compared to the other two groups (p less than 0.05), while left ventricle mass, the end-diastolic volume indexes and isovolumetric relaxation time, (a parameter of left ventricle diastolic function) were significantly increased (p less than 0.001) as well as the fat free mass (FFM), a marker of skeletal muscle mass. The non-users showed no differences in echocardiographic parameters, compared to sedentary controls. During the off treatment phase, the percentage of adipose mass increased and FFM decreased, while echocardiographic parameters did not vary significantly from on treatment values. The findings indicate that AS can induce an unfavourable enlargement and thickening of the left ventricle, which loses its diastolic properties with the mass increase. These modifications tend to persist following a short period of drug withdrawal.

Adult↗
PubMed1991

Successful catheter ablation by radiofrequency energy of posteroseptal accessory pathway in a patient with drug refractory Wolff-Parkinson-White syndrome.

A 45-year-old patient with the Wolff-Parkinson-White syndrome suffering from recurrent intractable reciprocating atrioventricular tachycardia (RAVT) is reported. He used amiodarone, sotalol, quinidine, propafenone and flecainide unsuccessfully. An electrophysiological study (EPS) performed with four catheters localized the site of the anomalous pathway in the ostium of the coronary sinus. In this region we could also record a Kent potential. In the ostium of the coronary sinus, radiofrequency energy was repeatedly applied until the conduction over the accessory pathway was abolished both in the anterograde and the retrograde direction. The Kent deflection detectable before ablation, could not be detected after it. During follow-up (1 month) the patient remained asymptomatic and the control EPS showed no evidence of pre-excitation, either anterogradely or retrogradely.

Anti-Arrhythmia Agents↗
PubMed1991

[Supraventricular paroxysmal reentry tachycardia. Empirical and guided therapy].

The empirical therapy of reentrant supraventricular tachycardias (A-V and junctional tachycardia) is based on a preliminary diagnosis through standard ECG to evaluate, whenever possible, the relationship between P wave and QRS. In order to distinguish atrial tachycardias from other types, we must employ vagal manoeuvres or drugs. Often we use methods of recording and stimulation such as Holter monitoring and transesophageal technique which can provide useful information about the electrophysiological mechanisms and therefore can better guide our choice of drugs. The decision of undertaking pharmacologic treatment takes into account frequency, duration and tolerability of the crises and the patient's compliance. The most commonly used drugs are verapamil, diltiazem, propafenone, flecainide, sotalol and amiodarone. The percentage of success at 1 year ranges from 30 to 60%. Particularly in the Wolff-Parkinson-White (WPW) therapy must follow an accurate evaluation of the electrophysiological pattern through effort test, drugs test, transesophageal (ETS) or endocavitary (EPS) electrophysiological study. Indeed therapy aims not only at reducing arrhythmic relapses, but also preventing the potential risk of either death or severe damage. The useful drugs must have the property of acting at the same time upon at least one branch of the A-V circuit, on the atrium reducing its vulnerability and finally modifying the conductive anterograde capacity of the Kent bundle. They are quinidine, procainamide, propafenone (group I) sotalol and amiodarone (group III). The limitations of the empirical therapy are a high percentage of relapses and the difficulty in foreseeing the pro-arrhythmic effects. The guided by serial electrophysiologic testing implies artificial induction of spontaneous arrhythmia by repeating the test after acute or chronic assumption of drugs. Is this way it can be evaluated the efficacy as well as the tolerability of an antiarrhythmic drug which later will be taken for chronic prophylaxis. The percentage of inducibility of clinical arrhythmias is next to 100% both for EPS and TES. The number of patients for whom we can find an effective pharmacologic regimen through acute testing ranges from 30 to 100%, but is influenced by several factors such as aggressiveness of therapeutic protocol and type and dosage of drugs. The predictive value is high as it approaches 100% for a positive acute test. The elective indications for serial electrophysiologic study are: failure of empirical therapy; disabling and very frequent arrhythmias; arrhythmias provoking major disturbances (lipothymia, syncope, hypotension, shock); symptomatic WPW.

Anti-Arrhythmia Agents↗
PubMed1991

[Treatment of malignant ventricular tachyarrhythmia with amiodarone: comparison of empirical administration and administration guided by Holter or ventricular stimulation. Results of the parallel test].

To assess the most appropriate method of administering amiodarone and predicting its efficacy (empiric vs guided by Holter or by ventricular stimulation), 19 patients with sustained ventricular tachycardia or ventricular fibrillation underwent a "parallel study". Fifteen patients were men and 4 women, with a mean age of 65 years. A coronary artery disease with previous myocardial infarction was present in 15 patients, dilated cardiomyopathy in 3 and arrhythmogenic right ventricular dysplasia in 1 (mean left ventricular ejection fraction = 35%). All 19 patients had, as inclusion criteria, 1) frequent (greater than or equal to 30/hour) and/or repetitive (greater than or equal to 10/24 hours) ventricular premature beats during 24-hour Holter monitoring and 2) inducible sustained (greater than 30/sec) ventricular arrhythmias during programmed ventricular stimulation (1-3 extrastimuli from 2 right ventricular sites). Amiodarone was given at an initial dosage of 15 mg/kg/day for 2 weeks and then at a dosage of 5 mg/kg/day. After 15 days 24-hour Holter monitoring and programmed ventricular stimulation were repeated. The data of these tests, however, were not used to guide the therapy that remained empiric, but served only to assess retrospectively the predictive value of Holter monitoring and ventricular stimulation. The following main results were obtained: The mean duration of follow-up was 25 +/- 13 months. During this period 6 patients (32%) died, 3 from sudden and 3 from non-sudden cardiac death. Two other patients had recurrence of sustained ventricular arrhythmias. After 15 days of therapy amiodarone was effective at Holter monitoring in 15 patients (79%) and not effective in 4 (21%). Two of the 15 patients considered responders died suddenly during the follow-up and 2 had arrhythmic recurrence, vs 1 of the 4 non-responder patients who died suddenly (negative predictive value of Holter monitoring: 73%; positive predictive value: 25%; predictive accuracy: 63%). After 15 days of therapy amiodarone was effective at ventricular stimulation in 10 patients (53%) and not effective in 9 (47%). None of the 10 patients considered responders had arrhythmic events during the follow-up, vs 5 of the 9 non-responders, 3 of whom died suddenly and 2 of whom had arrhythmic recurrences (negative predictive value of ventricular stimulation: 100%; positive predictive value: 56%; predictive accuracy: 79%). Only 1 patient discontinued amiodarone after 25 months of follow-up because of development of an important blue-grey skin discoloration.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗