[The rhino-sinuso-bronchial syndrome and thermal therapy].
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Adult↗
Biomedical subjects
F Avanzini
Publications and source records attributed to F Avanzini.
Antiarrhythmic drug prescription in patients after myocardial infarction in the last decade. Experience of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico (GISSI).
BACKGROUND: Recent clinical trials have shown increased, rather than decreased, mortality in patients treated with antiarrhythmic drugs after acute myocardial infarction. OBJECTIVE: To determine whether these findings had an impact on prescription of antiarrhythmic drugs after acute myocardial infarction. METHODS: We retrospectively analyzed the class I and III antiarrhythmic prescription data of 38,072 patients with acute myocardial infarction enrolled in three large randomized clinical trials endorsed by a highly representative sample (about 75%) of Italian coronary care units during the last 10 years. The first study was conducted in 1984 to 1985; the second, in 1988 to 1989; the pilot for the third, in 1991; and the third, in 1991 to 1994. RESULTS: Total class I and III antiarrhythmic prescriptions after acute myocardial infarction was halved during the last decade, from 11.9% at discharge and 14.4% at follow-up in 1984 to 1985 to 5.8% and 5.8%, respectively, in 1991 to 1994. The trend was independent of the different distributions in the three studies of the patients' characteristics associated with antiarrhythmic use (ie, age > or = 70 years, anterior acute myocardial infarction, ventricular fibrillation during hospitalization, and Killip class > or = 2 at randomization). The same decreasing trend was observed for each antiarrhythmic drug. The drug most widely used was amiodarone, accounting for about half of the antiarrhythmic prescriptions, followed by mexiletine hydrochloride and propafenone hydrochloride; flecainide acetate was dropped from the prescription list after the publication of the Cardiac Arrhythmia Suppression Trial results. CONCLUSION: The negative results of the recent clinical trials on class I antiarrhythmic drug use after acute myocardial infarction have been rapidly transferred into routine clinical practice in Italy, since the proportion of patients who received class I and III antiarrhythmic drugs after acute myocardial infarction was halved from the early 1980s to the early 1990s.
Aged↗
[The predictive value for major arrhythmic events of ventricular arrhythmias, particularly nonsustained ventricular tachycardias, in the subacute phase of a fibrinolyzed infarct. An analysis of GISSI-2 data. Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico].
BACKGROUND: The relationship between ventricular arrhythmias (VA) in the subacute phase of a myocardial infarction (MI) and subsequent major arrhythmic events, i.e. sustained ventricular tachycardia (SVT) and sudden death (SD), is well known. The importance of left ventricular dysfunction in the same context is also well established. The vast majority of the data in the literature come from the prefibrinolytic era and/or are derived from limited data bases. MATERIALS, METHODS AND RESULTS: We examined the large, uniform GISSI-2 population of acute fibrinolysed myocardial infarctions in order to evaluate the significance and predictive power of VA detected by Holter monitoring during the subacute phase. Particular attention was paid to the occurrence of nonsustained ventricular tachycardias (NSVT) since their role is still uncertain, so it is hard to assess the utility of invasive measures such as programmed electrical stimulation (PES). Left ventricular function was evaluated by mono-, and two-dimensional echocardiography. Holter monitoring was available in 8,676 patients; a six-month follow-up, as regards mortality was completed in 8,552 patients (98.5%) and, as regards SVT incidence, in 7.713 (88.9%). During the follow-up 256 patients died (3%), 84 out of them suddenly (1%). Twenty-six [corrected] patients out of 7,713 (0.3%) experienced one or more SVT. The relationship between VA, left ventricular dysfunction and major arrhythmic events was evaluated by odds ratios (OR) and their confidence intervals (CI). Odds ratios for the combined end-point (SD and/or SVT) was 4.49 (CI 95% 2.69-7.51) if the Holter showed > 10 VEB/hour; 2.34 (CI 1.48-3.68) if couplets were present; 3.26 (1.52-6.99) if NSVT were present; 3.02 (2.02-4.50) if any complex ventricular arrhythmia was detected. Left ventricular disfunction seemed to exert a more powerful influence: OR 9.80 (CI 5.75-16.69) for SD and/or SVT. Any arrhythmic parameter had very low positive (< or = 3%) and very high (approximately 99%) negative predictive power. Multivariate analysis (Cox Model) including major prognostic factors confirmed the independent prognostic value of frequent VA (RR 2.75; 95% CI 1.58-4.79), couplets (RR 1.91; CI 1.28-2.86); complex VA (RR 2.02; CI 1.36-3.00). NSVT, after adjusting for the selected risk factors, was not independently associated with a worse prognosis. CONCLUSIONS: Ventricular arrhythmias detected by Holter monitoring during the subacute phase of a MI still have prognostic significance for major arrhythmic events in the fibrinolytic era. The presence of NSVT triples the risk of SD and/or SVT in the six months after an acute MI, but loses any predictive power in a multivariate analysis. Only 6.6% of the patients showed one or more episodes of NSVT in the Holter recording. If the ongoing clinical trials, MUSTT and MADIT, will confirm the usefulness of PES in such patients, the benefit will be confirmed to a very small proportion of the patients at risk of specific diagnostic tests. The positive predictive power of VA is very low and it is therefore mandatory to add other non-invasive variables to the screening to identify the subgroups at greatest risk. On the other hand the very high (99%) negative predictive power of VA and left ventricular dysfunction enables us to identify a large population of infarcts with a negligible risk, who need no further sophisticated investigations. From the point of view of the cost/benefit evaluation this seems to be an outstanding result.
Arrhythmias, Cardiac↗
Effects of lisinopril and nitroglycerin on blood pressure early after myocardial infarction: the GISSI-3 pilot study.
OBJECTIVES: To evaluate the safety in terms of hypotensive action of nitroglycerin and lisinopril started early after myocardial infarction. PATIENTS AND METHODS: One thousand five hundred twenty-six patients with suspected myocardial infarction were randomized by 174 centers within 24 hours from the onset of symptoms to receive oral lisinopril (5 then 10 mg/day), nitroglycerin (intravenous infusion during the first 24 hours, then 10 mg/day transdermal), or neither. RESULTS: Systolic blood pressure, intensively monitored during the first 72 hours, decreased sharply by 11 mm Hg during the first 2 hours, then more slowly to an average value of 120 mm Hg. Nitroglycerin lowered systolic blood pressure during the first 24 hours by 2.7 mm Hg versus control subjects, and it was similar to control subjects from 24 hours. Lisinopril reduced systolic blood pressure by 4.2 mm Hg over 72 hours compared with control subjects. Persistent hypotension was significantly more frequent in the lisinopril group (21.4%) than in the nitroglycerin group (10.9%) or control group (9.8%), but absolute numbers of deaths in patients with persistent hypotension were almost identical. CONCLUSIONS: Lisinopril and nitroglycerin are both safe and effective in reducing blood pressure in the first day after myocardial infarction. However, the effect is lost thereafter with transdermal nitroglycerin, but persists with lisinopril.
Aged↗
Antihypertensive efficacy and tolerability of different drug regimens in isolated systolic hypertension in the elderly.
The pharmacological treatment, mainly based on diuretics, of isolated systolic hypertension (ISH) has recently been shown to reduce the risk of stroke and coronary heart disease in the elderly. The purpose of this study was to compare the antihypertensive effect and tolerability of different drug regimens in elderly subjects with ISH (systolic blood pressure--SBP-- > or = 160 mmHg and diastolic blood pressure--DBP-- < 90 mmHg). A multicentre, randomized, controlled open trial was planned in the general practice setting. Four widely used treatment schedules were tested: hydrochlorothiazide 25 mg plus amiloride 2.5 mg (H+Am), nifedipine slow release 20 mg (N), atenolol 50 mg (At) and atenolol 25 mg plus chlorthalidone 6.25 mg (At+C). After a baseline evaluation, 308 patients (76.3% female, mean age 75.3 +/- 7.1 years) were randomized and followed up for 6 months. After 3 months the drug dosage was doubled if the systolic blood pressure goal (SBP < 160 mmHg and SBP reduction of at least 20 mmHg) had not been reached. Ninety-four subjects (30.5%) presented contraindications to beta-blockers. At the 3rd- and 6th-month visits all treatment groups, except At, showed a significant reduction in SBP compared to the control group; DBP showed no significant reduction in any group at any time. At the end of the follow-up the percentage of hypertensives who had reached the BP goal was 14.6% in the control group, 52.9% in H+Am, 54.8% in N, 28.6% in At and 52.2% in At+C.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
[The noninvasive quantitative evaluation of the acute hemodynamic effects of sublingual and transdermal nitroglycerin in man].
BACKGROUND: Organic nitrates are complex vasodilators: the hemodynamic action of these drugs is different in the venous and arterial resistance and capacitance beds. The aim of our study was to obtain a quantitative, noninvasive evaluation of the acute effects of sublingual and transdermal (td) nitroglycerin (NTG). METHODS: Twenty-one pts (mean age 49 years) underwent strain-gauge plethysmography and digital photoplethysmography under control conditions, 5 min after sublingual NTG (0.4 mg), 1 hour thereafter and 2 hours after NTG td (10 mg patch). Forearm venous capacitance (CV, ml.100 ml-1) and arteriolar resistance (RA, mmHg.ml-1.100 ml.min) and the b/a ratio of arterial pulse wave (%) were measured. RESULTS: After sublingual NTG, CV increased (+24%, p < 0.01) and b/a was reduced (-35%, p < 0.01), while heart rate and RA increased (+9% and +36% respectively, both p < 0.01). Two hours after NTG td, CV increase was not statistically significant (+11%, p = 0.056), b/a was reduced (-31%, p < 0.01), heart rate and RA did not change. CONCLUSIONS: The combined use of plethysmography and digital photoplethysmography is suitable for the evaluation of vasoactive drugs such as nitrates, which have a complex profile of action on arterial and venous beds. By this method we have shown that NTG td 10 mg dilates venous beds to a low extent; this approach will be utilized in future studies aimed at elucidating dose-response and regimen effect of these drugs.
Administration, Cutaneous↗
Prevalence and variability of orthostatic hypotension in the elderly. Results of the 'Italian study on blood pressure in the elderly (SPAA)'. The 'Gruppo di Studio Sulla Pressione Arteriosa nell'Anziano'.
The prevalence of orthostatic hypotension (OH) in an elderly outpatient population was assessed according to the most common criteria given in the literature. Short-term OH variability and relationships between OH and its known risk factors were also analysed. A sample of 3858 elderly outpatients aged 65 years or more was randomly recruited by 444 Italian general practitioners. The patients' blood pressure (BP) and heart rate were recorded in both lying and standing positions at two visits 7 days apart. Three definitions were used for the identification of OH: (1) a decrease in systolic BP greater than 20 mmHg (SOH); (2) a decrease in both systolic (greater than 20 mmHg) and diastolic (greater than 10 mmHg) BP (SDOH); (3) any decrease in systolic BP associated with symptoms (SyOH). Prevalence figures for SOH were 13.8% at the first and 12.6% at the second visit, and respectively 5.3 and 4.8% for SDOH, 14.1 and 11.8% for SyOH. All the criteria were met by less than 2% of subjects at each visit. The diagnosis of OH was confirmed at both visits in 36.3% of cases for SOH, in 25.7% for SDOH, and in 43.9% for SyOH. Each different OH definition identifies a population subgroup characterized by different sets of risk-factors. The presence and prevalence of OH is difficult to define because different people may be identified by the currently accepted criteria or by the same criterion over a short time.
Aged↗
Feasibility of a long-term low-sodium diet in mild hypertension.
The present study set out to assess the feasibility of long-term moderate dietary sodium restriction in patients with mild hypertension in general practice. After screening and a run-in phase of 6-8 weeks, a total of 77 previously undiagnosed mildly hypertensive patients were identified. Half of them were randomized to receive a few simple dietary instructions from their general practitioners in order to reduce salt usage; the others were randomized to receive no advice. The patients were followed up for 12 months with quarterly visits. A total of 56 patients (72.7%) completed the study, 26 on a low-sodium diet (LD) and 30 on their usual diet (UD). At each visit in the diet phase, patients provided 24h urine, which was analysed for volume and sodium concentration in order to assess their sodium intake. Blood pressure, heart the rate and body weight were recorded. The mean urinary sodium excretion for all diet phase visits overlapped in the two groups (177.0 +/- 32.9 vs. 169.3 +/- 49.4 mEq/24h respectively in the LD and UD groups). Nevertheless the mean systolic and diastolic blood pressures for all diet phase visits were significantly lower in the LD than in UD group (144.2 +/- 11.1/91.6 +/- 6.4 and 148.0 +/- 13.7/95.6 +/- 4.7 mmHg respectively, P less than 0.01). Our data suggest that it is not feasible at present to reduce sodium intake in mild hypertensives with simple and inexpensive dietary instructions, the only ones suitable for widespread application in general practice.
Adult↗
Randomised clinical trials in general practice: lessons from a failure.
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Aged↗
Effects of a screening program for hypertension in a community.
The effect of a population screening for hypertension was assessed through a subsequent survey performed 1 year later. All the hypertensives identified at the first visit (239 subjects, 15.6% of the whole screened population) were invited for a re-examination: the adhesion rate was 84.5%. After the screening, a high proportion of subjects (74.7%) had contacted their physicians because of their blood pressure. The most common advice physicians gave was to have further measurements of blood pressure (72.8%). Laboratory tests were prescribed in 62 patients (41.1%), but a complete assessment of a target organ damage was carried out in few cases (1.9%). Only 19.5% of patients started a course of treatment during the year following the screening and no more than one-third of those with moderate to severe hypertension. Out of the 176 subjects showing other cardiovascular risk factors at the screening, only 12 reported they had modified their habits 1 year later. Our results suggest that a screening for hypertension, when performed without any liaison with other medical facilities, seems to have a poor impact on physicians' and patients' attitudes towards hypertension.
Adult↗
Left ventricular diastolic function in normotensive adolescents with different genetic risk of hypertension.
Abnormalities of the diastolic function of the left ventricle are the first sign of cardiac involvement in arterial hypertension. We have studied the diastolic function in a group of normotensive adolescents with confirmed family history of hypertension. M-mode echocardiography was performed in 86 normotensive males aged 14-19 years: 41 sons of at least one hypertensive parent (SHT) and 45 sons of normotensive parents (SNT). Cross-sectional area of the left ventricle and left ventricular (LV) mass index were significantly greater in the SHT than in the SNT group (10.05 +/- 1.84 vs. 8.9 +/- 1.56 cm/m2, p less than 0.01 and 129.3 +/- 296.3 vs. 109.23 +/- 25.7 g/m2, p less than 0.002, respectively). No significant difference between the two groups was observed in the indices of left ventricular diastolic function, except for mitral valve opening rate (463.51 +/- 90.45 in SHT vs. 416.71 +/- 78.84 mm/s in SNT; p less than 0.02). From the analysis of the subgroup of adolescents having left ventricular mass greater than the upper normal value, we observed that they showed mean time of rapid filling significantly longer than SNT: this could represent an early marker of the pathological character of such hypertrophy. Our results suggest that the higher LV mass observed in the SHT is not associated with chamber and myocardial stiffness abnormalities.
Adolescent↗
Awareness, treatment, and control of hypertension in the elderly in a general practice experience. Study Group on Hypertension in the Elderly.
In 3858 ambulatory elderly people (age greater than or equal to 65 years) prevalence of hypertension was 67.8%. The hypertensive status was unknown to both the doctor and the patient in 21.4% of cases. More than 90% of known hypertensives were treated, but hypertension could be considered as controlled in less than 30% of them.
Aged↗
Antihypertensive treatment of the elderly in general practice.
In order to assess the antihypertensive care received by the elderly, where clear therapeutic guidelines are lacking, a population of 3,858 aged over 64 years was studied. Data were derived from a large Italian 'Study on Blood Pressure in the Elderly', carried out in general practice. Over 90% of the 2,059 known hypertensive patients were receiving drug treatment, with no age or sex-related differences. A single drug was prescribed to 50.2% of treated patients; only 5.5% were receiving three or more drugs. Diuretics and older sympatholytic agents were by far the most frequently prescribed categories, with four drugs (hydrochlorothiazide, amiloride, methyldopa and chlorthalidone) accounting for over 50% of all prescriptions. Low-dosage treatment schedules were frequently used, often associated with less-often-than-daily drug administration. Our study shows that physicians' attitudes to the treatment of arterial hypertension in the elderly are fairly uniform, with treatment of all subjects but with low drug dosages.
Aged↗
Prevalence of symptoms generally attributed to hypertension or its treatment: study on blood pressure in elderly outpatients (SPAA).
A number of symptoms that appear to be associated with high blood pressure (headache, dizziness, epistaxis, tinnitus, weakness, drowsiness), and are usually regarded as secondary to hypertension or to antihypertensive drug therapy, were studied in 3858 elderly patients, 67.8% of whom were hypertensive. Of the hypertensive patients, 71.2% were under treatment. Headaches and dizziness were significantly more prevalent in the hypertensive than in the normotensive subjects (32.5 versus 27.4% and 41.5 versus 35.3%, respectively; P less than 0.05) and in treated compared with untreated hypertensives (33.3 versus 29.4% and 43.3 versus 37.1%; P less than 0.05). These differences disappeared after statistical correction for 'awareness of hypertension'. In multiple logistic analysis, female sex, age and awareness of hypertension were significantly associated with a higher prevalence of symptoms, whereas hypertension and antihypertensive treatment were not. We conclude that the presence of these symptoms does not constitute a reliable criterion for starting antihypertensive treatment or judging its efficacy.
Aged↗
[Protective activity of tiopronin in relation to the acute exacerbation of chronic bronchitis].
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Aged↗
Feasibility of a large prospective study in general practice: an Italian experience. Gruppo di Studio sulla Pressione Arteriosa nell'Anziano.
A study of blood pressure control in elderly outpatients was carried out with the participation of 444 Italian general practitioners. Of 4096 patients aged 65 years or over who were considered for recruitment, 3959 (96.7%) fulfilled all the criteria of admission and were followed up for 12 months. The findings regarding one of the aims of the study--that is, to assess the feasibility of a large scale trial in general practice--are reported. Most (87%) of the doctors completed the study. Their adherence to the protocol was highly satisfactory, leading to an acceptable quality of work. Patients' compliance was also good; 98.6% (3898) of the patients who had fulfilled the admission criteria agreed to participate in the study, and only 4% (158) dropped out. Both of these observations support the feasibility of carrying out prospective studies in general practice. The creation of networks of general practitioners who are prepared to carry out research in their practices would allow treatment and preventive measures to be studied simply and at low cost in the appropriate setting.
Aged↗
Arm position as a source of error in blood pressure measurement.
The present study was designed to assess the value of correct positioning of a patient's arm when measuring blood pressure (BP). A total of 181 subjects were examined, 141 hypertensives on treatment, 25 untreated hypertensives, 15 normotensives. All the subjects underwent three BP measurements after a 5-min resting period in supine position. Then two BP readings were recorded in standing position with the arm either positioned by the patient's side or supported passively at patient's heart level. Average systolic BP (SBP) in standing position were 144.6 +/- 20.2 mmHg with the arm at the side and 136.4 +/- 21.1 mmHg with the arm at the heart level (p less than 0.001); average diastolic pressures were 99.0 +/- 12.0 mmHg and 90.2 +/- 12.3 mmHg (p less than 0.001), respectively. A fall in SBP greater than or equal to 20 mmHg from the supine to the upright position was detected in 18.2% of cases when measurement was performed at heart level; such a reduction was inapparent in two-thirds of cases when the arm was placed at the patient's body side. Incorrect positioning of a patient's arm during BP measurements in standing position leads to overestimation of BP values and masks the presence of postural hypotension.
Adult↗
Immunocytochemical localization of pyrazine-binding protein in bovine nasal mucosa.
Polyclonal antibodies have been raised against purified bovine pyrazine-binding protein, a protein that binds the odorant 2-isobutyl-3-methoxypyrazine. These antibodies have been utilized in immunocytochemical experiments to localize the pyrazine-binding protein in bovine nasal mucosa. Tissue fragments, macroscopically identified as olfactory and respiratory mucosa, were fixed in Bouin's fluid and embedded in paraffin. Consecutive serial sections were processed for immunofluorescence studies and restained either with haematoxylin-eosin or with periodic acid Schiff-Alcian Blue. In both olfactory and respiratory mucosa, only seromucous tubulo-acinar glands were specifically labelled. These glands are located in the lamina propria underlying typical respiratory epithelium, even in those tissues that are macroscopically defined as olfactory mucosa.
Animals↗