Biomedical subjects

E Ponte

Publications and source records attributed to E Ponte.

At least 37 records · Page 2Linked to original sources

PubMed1998

[Vascular manifestations in systemic sclerosis (scleroderma)].

Progressive systemic sclerosis (PSS), a disease still of unknown origin, is a generalized autoimmune disorder characterized by immunological abnormalities, microvascular dysfunction, and tissue fibrosis. The mechanism leading to selective microvascular injury in PSS is not completely known, however it is now clear that neuropeptides, vascular endothelium, and disturbances in the regulation of fibroblast function are the three major contributors to the increased fibrosis of skin and internal organs. Thus, endothelial cell and fibroblast dysfunction may be linked through the paracrine activity of soluble endothelial cell products: the cytokine cascade (IL-1, TGF-beta-1, PDGF, TNF, etc.). In systemic sclerosis, the exaggerated generalized vasospastic tendency is clinically represented by Raynaud's phenomenon as shown by an early digital arterial closure after cold stimulation, and by an inadequate vasodilatory response to heat. In this review we summarize recently established data that center around the role of adhesion molecules, immune reactions, and aberrant fibroblast biology and metabolism in effecting vascular and connective tissue alterations in this disease. Only a better knowledge of the pathophysiological process involved in scleroderma might lead to the development of new therapeutic approaches.

Adult↗

PubMed1997

[Vascular "remodeling"].

Vascular remodeling means a specific organization of the vascular wall around a diminished lumen as to the before existing conditions, with consequent vascular geometry modification. This organization comes from the response of all vascular components (endothelium, muscular cells, connective component, etc.) to physical and chemical stimuli. Particular behaviour of the vascular wall has lately been pointed out, both in long known pathologies (arteriosclerosis, arterial hypertension, diabetes mellitus, arteriosclerotic aneurysms) and in situations involving both physiopathology (ischaemia-reperfusion, angiogenesis) as therapy (angioplasty).

Aneurysm↗

PubMed1997

[The concept of quality of life in cardiac failure].

Chronic congestive heart failure is a common yet devastating syndrome and is a leading cause of morbidity and mortality in the industrialised countries. The incidence and prevalence of chronic congestive heart failure is increasing, placing a growing burden on the health care system. Despite many advances in treatment for heart disease, chronic heart failure is a terminal condition with a death rate as high as that for many malignant tumours. Patients suffering from chronic congestive heart failure report a poor quality of life because of physical symptoms, functional disability, emotional and economic burdens, frequent hospitalisations, and poor prognosis. In the context of heart failure, mortality risk (prognosis quoad vitam) can be measured using a variety of physiological variables; left ventricular (LV) dysfunction plays a primary role in the pathogenesis of congestive heart failure and correlates with prognosis, but a strong quantitative relation between exercise performance and indexes of LV function has not been demonstrated. This finding underscores the importance of psychosocial interventions in improving the quality of life and care outcomes for patients with heart failure. For this reason, questionnaires of quality of life, assessed by direct patient self-reports, have recently been imposed in cardiology, they have been used specially for evaluating most treatment of cardiac failure. The refinement of a definition of quality of life improved methods to study quality of life will contribute to a better understanding of this complex concept in heart failure patients.

Activities of Daily Living↗

PubMed1997

[Horton's giant cell arteritis].

Giant cell arteritis (GCA) is a spontaneous vasculitic syndrome specifically involving the walls of medium and large arteries. While involvement of other arterial beds is occasionally identified, this syndrome is most frequently recognized when symptomatic involvement of the temporal arteries occurs. Vascular lesions are characterized by patchy granulomatous infiltrates composed of T cells, macrophages, histiocytes, and giant cells. A better prognosis depends on early recognition of the clinical symptoms and prompt treatment. Diagnosis was based on the 5 clinical criteria previously used by the American College of Rheumatology (1990): 1) age 50 years or older; 2) new localized headache; 3) temporal artery tenderness or decrease in temporal artery pulse; 4) erythrocyte sedimentation over 50 mm/ hour; 5) abnormal result on artery biopsy. Giant cell arteritis was considered a rare disease under age 50; however, it is now known to be an important and significant cause of morbidity and mortality in elderly people. Therefore early recognition and treatment with corticosteroid are very important. There is no general agreement concerning the initial dosage, 40-65 mg/day are commonly recommended. After a few months the majority of patients can be treated with a low maintenance dosage of prednisolone (5 to 7.5 mg/day). The mean duration of treatment is about 5 years. The literature is reviewed and the clinical implications of this disease are discussed.

Giant Cell Arteritis↗

PubMed1997

[Cardiovascular disease and omega-3 fatty acids].

Fish oil is rich in the long chain omega-3 (omega-3) polyinsaturated fatty acids (PUFA), Pioneering studies of Dyerberg and Bang primarily originate interests in this way. The low incidence of acute myocardial infarction they verified within the Greenland Eskimos suggested that a high dietary omega-3 PUFA intake due to marine food might protect against coronary heart disease. They showed that the Eskimos had a beneficial lipid pattern and that their balance between pro-aggregatory thromboxanes and anti-aggregatory prostacyclins was shifted towards an anti-thrombotic state. The two major omega-3 fatty acids are decosapentaenoic acid (EPA C 20:5, omega 3), with five double bonds, and docosahexaenoic acid (DHA C 22:6, omega 3), with six double bonds. These fatty acids' significant effects include reduction of plasma triglycerides and lipoprotein levels as well as of platelets thrombogenicity in the microcirculation, which is due to effects on the mediators production derived from arachidonic acid (prostaglandins and leucotrienes), meddling in inflammatory and immune cell function, retarded atherosclerosis development. Experimental studies of atherogenesis and arterial thrombogenesis support the hypothesis that dietary omega-3 PUFA intake may play a leading role in primary or secondary prevention of coronary heart disease.

Angioplasty, Balloon, Coronary↗

PubMed1997

[Morphological and functional aspects of the cardiovascular system related to aging: does "aging heart" exist?].

Elderly people are the most rapid growing segment of society, and heart disease is the most common cause of death in this population. The aging process is associated with anatomic and physiologic alterations in the cardiovascular system; consequently, the manifestations of disease in the geriatric population differ from those involving younger patients. To formulate diagnosis of "aging heart" in older patient may be difficult, because of atypical symptoms or of the acceptance of symptoms as manifestations of old age. Aging is, moreover, often associated with a decline in physical activity, which may result in cardiovascular "deconditioning". The treatment strategy is the same as in younger patients, but the higher incidence of adverse effects and complications demands special awareness. In this article we discuss about age-related structural and functional changes that occur in the cardiovascular system, including changes in the heart muscle, valves, conduction system and major arteries.

Adaptation, Physiological↗

PubMed1997

[Pulmonary embolism of paraneoplastic origin].

Thromboembolic disease (TE) is an important cause of in-hospital morbidity and mortality. The relationship between cancer and abnormalities of blood coagulation has been recognized for well over a century. Deep venous thrombosis (DVT) of the lower extremities is the most common cause of thromboembolic disease, but pulmonary embolism, upper extremity vein thrombosis, disseminated intravascular coagulation, and other, more unusual, clinical events, may occur. Unexplained TE may serve as a marker for the presence of a hidden tumor. The frequency of pulmonary embolism (PE) among patients with a malignant neoplasm at necropsy is highly increased in the elderly patients. Among subjects with a malignant neoplasm, patients with pancreatic and gastric cancer (mucin-secreting adenocarcinomas), cancer of the large bowel and women with ovarian cancer had the highest frequency of PE. Old age, female sex, gastrointestinal and ovarian cancers must be considered as a significant risk factor for PE. The potentially responsible mechanisms for the thrombotic events, clinical manifestations, diagnostic implications and aspects of treatment of TE in malignant disease are discussed.

Age Factors↗

PubMed1996

Quality of life in a group of patients with intermittent claudication.

In view of the increasing importance of chronic diseases in recent years, not only quantity but also quality of life has been taken into consideration. The aim of this study was to verify the quality of life in patients with peripheral obstructive arteriopathies of second degree according to the Leriche-Fontaine classification. Therefore, the authors administrated three different questionnaires to patients selected among those who came to the Angiology Ambulatory Care of the Medical Clinic of the University of Trieste. The questionnaires used were the following: McMaster Health Index Questionnaire (MHIQ), "Squibb" Quality of Life, General Health Index Questionnaire (GHIQ). The analysis of the results of the questionnaires shows the severe limitation of physical capacities of this kind of patients (overall mean functional limitation of 69% of the maximum value of 1, corresponding to an ideal state of well-being, with negative peaks of 50%). A negative tendency regarding social life and relationship is represented by different scores (from 52% to 66% of ideal maximum) from different items and questionnaires. Also the items concerning somatic disorders, sleeplessness, and states of anxiety gave results near the percentage of 70% and for this reason were indicative of a state of unwell-being. The data obtained from the items regarding the presence of a state of depression gave a result less predictable: a score of 87% with peaks over 90% could be indicative of a positive tendency. This last result, consistent with others of analogous studies in the literature, seems to indicate that peripheral arterial disease, even if physically restricting, does not have a strong impact on the psychological and emotional equilibrium of the patients.

Activities of Daily Living↗

PubMed1996

[Neurocardiogenic (or vasovagal) syncope].

Syncope is a common clinical problem in a general population that is responsible for a significant number of emergency department visits (3%) and hospitalizations (1%) each year. The clinical spectrum of etiologies of syncope includes disorders classified as cardiovascular, noncardiovascular and unexplained. A majority of syncopal events are believed to be caused by vasovagally mediated episodes by hypotension and bradycardia. Although vasovagal syncope is essentially equivalent to simple fainting, the physiologic events that lends to this phenomena are complex. Although not completely understood, the most commonly held theory explaining vasovagal syncope involves a series of reflexive interactions between cardiac mechanoreceptors and the autonomic nervous system. Until the advent of head upright tilt table testing, diagnosis of vasovagal syncope has been an assumption, made when all other causes have been eliminated. Frequently an accurate history, a physical examination and a standard ECG are enough to formulate a correct diagnosis. Head-up tilt test must be considered in patients with an unknown diagnosis, before starting invasive investigation. Tilt table testing, either alone or with a graded-dose infusion of isoproterenol, allows reproduction of the syncopal event in susceptible individuals and monitoring of the patients physiologic responses during the episode. Direct observation and documentation of symptoms permit accurate diagnosis and yield information vital to treatment and symptom control. This article reviews our current understanding of the mechanisms involved in the development of neurally mediated syncope.

Autonomic Nervous System↗

PubMed1996

[Liver cirrhosis and cardiovascular system].

The patient with hepatocellular disease shows marked vasodilatation, accompanied by hyperdynamic circulation and opening of arteriovenous shunts. The effect of these circulatory changes and especially the profound vasodilation has only recently been investigated in detail. In patients with hepatocellular failure the extremities are flushed, the pulses bounding, the cardiac output increased and the blood pressure low. The circulation resembles what found with systemic arteriovenous fistulae. The peripheral vasodilatation and splanchnic venous pooling reduce the effective blood volume so activating baroreceptors. The secondary events which follow the vasodilation include stimulation of the sympathetic nervous system. This serves to counteract the tendency to arterial hypotension and probably contributes to renal hypoperfusion and to the hepatorenal syndrome development. The nature of the concerned vasodilators remains speculative, but is likely to be multiple. Whatever its nature, the substance might be formed by the sick hepatocyte, fail to be inactivated by it or bypass it through intra- or extra-hepatic portal systemic shunts. In cirrhosis the cardiac index and reduced systemic vascular resistance correlate with the Child's grade of liver failure. This article provides an overview of the general vasodilatory state and its effects on various organs. The mechanisms and the different vasoactive substances that might be responsible are also discussed.

Ascites↗

PubMed1996

[The medical angiology outpatient clinic today. The authors' personal experience and operational proposals].

Over the past two decades the demographic characteristics of our population have changed resulting in a major increase in older age groups and a consequent real increase in the prevalence of vascular diseases' of an atherosclerotic type. This had led to an almost exponential increase in the number of requests for instrumental tests, such as Doppler. The aim of this study, the outcome of a review of the patients attending our outpatient clinic over the past twelve months, was to evaluate the current role of a clinic specialising in medical angiology compared to the changing requests for assistance and to elaborate operating proposals for clinics at various levels, aiming to attain the efficacy and efficiency of outpatient activity in accordance with the objective limitations of health spending and current legislation.

Adolescent↗

PubMed1996

[The evaluation of rehabilitative therapy in peripheral arteriopathy. Our experience].

Motor rehabilitation alone is considered and effective treatment for patients affected by claudicatio intermittens although underlying diseases may often influence but not exclude its efficacy. According to the literature no agreement exists about rehabilitative methods. The authors, in order to contribute to a standardization of rehabilitative methods, report their experience characterized by good results. Moreover, the authors stress the importance of the treatment in desisting from habits like cigarette smoking.

Aged↗

PubMed1996

[Non-vascular claudication or "painful leg syndrome"].

All angiologists commonly find that a considerable proportion of the persons referred to an angiology clinic are in fact suffering from other pathologies. Many of these patients often complain of polyhedric, vague symptoms, sometimes pyrotic and sometimes disguised as cramps, frequently accompanied by paresthesia or hypasthenia of the lower limbs which is generally justified, above all in elderly patients, as being caused by "circulation disorders". The authors felt the need to perform this study with the aim of both evaluating the prevalence of so-called non-vascular claudication or pseudo-claudication, defined here as "painful leg syndrome", and to identify simple and low-cost clinical and instrumental parameters, which may be useful not only to the general practitioner but also to the angiologist. A large number of patients with "false claudication" (43%) was diagnosed in this series and the most frequent cause was neurological pathology (68%). Anamnesis and an objective examination should, if correctly performed, be sufficient for a rapid diagnosis of non-vascular pathology and should therefore be useful in limiting the number of requests for Doppler tests, thus reducing waiting times and management costs.

Adult↗

PubMed1996

[Arterial hypertension in an ambulatory population of elderly subjects. Epidemiologic and clinical study in Isonzo].

The authors examine the clinical connotations of arterial hypertension in a geographical population of 1002 patients attending the Cardiological Outpatient Clinic of Unit no.2 in the Isonzo area (Monfalcone) using the most appropriate statistical methods, such as SPSS (Statistical Package for the Social Sciences) implemented on PC IBM AT 286, for multiple linear regression using a stepwise method. 1) Arterial hypertension was the result of a phenomenon which was striking owing to its mean value of 184.7 +/- 20.915 mmHg with equal mode and median of 180 mmHg. In the subgroup of 720 elderly patients this mean value differed slightly, 186.9 +/- 20.648 mmHg, with the same mode and median, whereas in the group of 282 adults the mean was 170.0 +/- 20.540 mmHg with a mode and median of 160 and 175 mmHg respectively. In the overall population 154 cases (15.4%) were affected by slight arterial hypertension with a mean of 158.9 mmHg, and 848 cases (84.8%) presented moderate-severe arterial hypertension with mean values of 189.4 mmHg. In elderly patients the mean rose to 190.4 mmHg whereas it was 186.3 mmHg in adults. 2) Mean age was 65.3 +/- 11.093 years: 70.7 +/- 7.396 years in older patients and 51.7 +/- 6.106 years in adults. Surface ECG showed signs of left ventricular hypertrophy in 292 elderly patients (40.5%) and 85 adults (30.0%), signs of ischemic cardiopathy due to T wave alteration in 246 elderly patients (34.1%) and 101 adults (35.7%), and due to ST tract in 340 (47.2%) and 102 (36.2%) respectively, with equal involvement of the free surface of the left ventricle. The radiographic enlargement of the cardiac shadow in elderly patients was observed in slight form in 153 cases (21.3%) and in moderate and marked form in 222 cases (30.8%), and in adults in 36 (12.8%) and 43 (15.2%) cases respectively. 3) Body weight was normal on average and equivalent to 77.3 +/- 13.578 kg, but of this series 713 cases were overweight and 237 were obese; 504 of elderly patients (70%) were pathological with 346 (48.1%) overweight and 158 (21.9%) obese, and of 209 pathological adults (74.1%), 130 (46.1%) and 79 (28.0%) were respectively overweight and obese. BMI oscillated from 1.70 to 5.60 with a mean of 2.80 +/- 0.409: from 1.70 to 4.21 in elderly patients with a mean of 2.70 +/- 0.379 and in adults from 2.00 to 5.60 with a mean of 2.90 +/- 0.460. 4) Mean cholesterolemia was 237 +/- 48.029 mg% and levels were normal in 203 cases and high in 799 subjects. Elderly patients showed the same mean level with a total of 580 pathological cases (80.5%) divided into 305 (42.3%) cases of slight hypercholesterolemia with a mean of 227.2 mg% and 275 (38.2%) severe cases with levels of 283.7 mg%. Adults presented a mean serum level of 236 +/- 47.588 mg%: 63 (22.3%) cases of normocholesterolemia, 117 (41.5%) cases of slight cholesterolemia with mean serum level of 224.8 mg%, and 102 (36.2%) severe cases with a mean level of 286.2 mg%, resulting in a total of 219 pathological cases (77.7%).

Adult↗

PubMed1996

[Circadian patterns of ischemic events].

These is evidence of circadian variations in the occurrence of ischemic events such as: silent myocardial ischemia, stable angina, instable angina, acute myocardial infarction, sustained ventricular tachycardia, cerebral infarction, transient ischemic attack (TIA) and sudden cardiac death. In the general population many cardiovascular disorders occur with the greatest frequency between 6 and 12 a.m. (i.e. after awakening). Blood pressure, too, follows a distinct circadian pattern. Factors affecting circadian variations in cardiovascular disorders include physiological determinants, such as heart rate, catecholamine release, and platelet aggregation-which themselves cyclically vary-, and exogenous factors such as mental stress, anxiety, and physical activity. In chronotherapy, circadian variations in disease states and in the pharmacodynamic properties of drugs are exploited to improve prevention and treatment. Characterization of diseases states with this approach allows more accurate determination of the times when patients are at highest risk and therefore in greatest need of preventive measures; it also provides a mechanism for designing optimal drug regimens. In this review we therefore describe recent findings about the effects of biorhythms on cardiovascular disorders and their implications for optimal drug therapy.

Chronotherapy↗

PubMed1995

Cell adhesion in the life cycle of Dictyostelium.

Three forms of cell adhesion determine the life cycle of Dictyostelium: i) adhesion of bacteria to the surface of the growing amoebae, as the prerequisite for phagocytosis; ii) cell-substrate adhesion, necessary for both locomotion of the amoebae and migration of the slug; iii) cell-cell adhesion, essential for transition from the unicellular to the multicellular stage. Intercellular adhesion has received the most attention, and fruitful approaches have been developed over the past 25 years to identify, purify and characterize cell adhesion molecules. The csA glycoprotein, in particular, which mediates adhesion during the aggregation stage, is one of the best defined cell adhesion molecules. The molecular components involved in phagocytosis and cell-substratum adhesion are less well understood, but the basis has been laid for a systematic investigation of both topics in the near future.

Animals↗

PubMed1995

[The vascular changes in arterial hypertension].

Although the causes of high blood pressure vary, it is becoming clear that sustained hypertension is associated with changes in cardiovascular structure: left ventricular hypertrophy, decrease in big-medium arteries compliance and increased wall thickness of small arteries. To some extent, these alterations are natural physiological responses and are protective. However, the risk of circulatory death is closely related to left ventricular hypertrophy, and therefore, it is suggested increasingly that effective antihypertensive treatment requires normalization not only of blood pressure but also of vascular structure. The purpose of this brief review is to identify the type of functional and structural changes that are found in arteries of hypertensive individuals.

Arteries↗

PubMed1994

[Hasharon hemoglobinopathy in a family].

The authors describe an 18 year old athlete, a carrier of Hasharon haemoglobinopathy, pathology which had been checked in some ascendants too. Such a haemoglobinopathy, which has at first been verified in Ashkenazy Hebrew people and is nowadays rather common in North East Italy, shows clinical and laboratory features which are slightly or not at all mentioned in the literature. The leading reference point in the disease's development is the connection between splenomegaly and repetitive low erythrocytosis with serum iron deficiency and increase of the reticulocyte number. The same laboratory data had been observed in his father and in his paternal grandmother; both of them proved to te heterozygous carriers of Hasharon haemoglobinopathy. In all cases we caught the diagnostic validation by the means of isoelectrophoresis involving haemoglobin lysate in polyacrylamide gel. The authors think that the Hasharon shape they verified may be a variant of the classic phenotype: the splenomegaly and erythrocytosis may signify a brisk and primitive erythropoiesis with increasing reticulocytes, which might compensate for the anomalous synthesis of the alpha chains. Serum iron deficiency may signify an increase of the iron consumption. Moreover, the authors do not exclude the possibility of further associational abnormalities.

Adolescent↗