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Biomedical subjects

G Bettelli

Publications and source records attributed to G Bettelli.

At least 19 recordsLinked to original sources
PubMed1992

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↗
PubMed1992

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↗
PubMed1991

Recurring osteoblastoma initially presenting as a typical osteoid osteoma. Report of two cases.

Two patients each underwent inadequate excision of an osteoid osteoma and some months later developed a large tumor in the same location showing the radiographical and histological features of osteoblastoma. This rare occurrence again suggests that osteoid osteoma and osteoblastoma are closely connected benign neoplasms. Indeed some authors in the past have suggested classification as a single tumor showing different clinical and radiographical patterns.

Adult↗
PubMed1991

Results of the multicentric Italian experience on the Gamma nail: a report on 648 cases.

In a multicentric study, the data of 628 trochanteric fractures, two non-unions, and 18 pathologic or impending fractures treated by Gamma nail in 13 Italian traumatology services were collected and analyzed. In 70% of the patients weight bearing was allowed in the first postoperative week and 78% of the controlled patients returned to their pretrauma walking ability. Complications included intraoperative (1.4%) and postoperative (1.2%) shaft fractures, "cut out" of the lag screw (2.6%), and nail failure (0.5%). There were no cases of infection. An analysis of complications showed that most of them were due to technical mistakes. The safest procedure is 2 mm diaphyseal overreaming, introduction of the nail without hammering, and distal locking; the lag screw should be placed in the lower part of the head of the femur.

Aged↗
PubMed1991

[Tolerance of beta blockader treatment in dilated cardiomyopathy].

We studied 78 consecutive patients with dilatative cardiomyopathy who were in our hospital because of heart failure. We wanted to evaluate which parameters could be useful in identifying patients who could be treated with betablockers. All patients were hemodynamically well balanced. They were treated with effective dosage of digoxin and diuretics. We evaluated the following hemodynamic parameters: heart rate, mean arterial pressure, mean pulmonary arterial pressure (MPAP), right atrial pressure, pulmonary wedge pressure, cardiac output, cardiac index, systemic vascular resistance, pulmonary vascular resistance, and also the neurohumoral parameters: VO2, max exercise duration, plasmatic norepinephrine levels (NE) and plasmatic renin activity (PRA). Then all patients were treated with atenolol 25 mg/die followed by 50 mg/die. In the overall population, 37 patients well tolerated the therapy with betablocker (Group A); 41 patients did not tolerate the therapy (Group B). Between the 2 groups we only found a significant difference in MPAP 31 +/- 20 vs 51 +/- 31 mmHg (p = 0.02), NE 781 +/- 467 vs 1551 +/- 1249 pg/ml (p = 0.01), PRA 1.8 +/- 2.9 vs 5.6 +/- 4.5 ng/ml/h (p = 0.02). On the basis of our results we hypothesize that patients with high neurohumoral activation do not tolerate betablocker treatment.

Adrenergic beta-Antagonists↗
PubMed1990

[Handicapped patients. General anesthesia or sedation?].

The Authors consider the problems involved in dental treatment of the handicapped patients. Accuracy in diagnosis of the handicap factor, knowledge about its consequences on pathophysiological status and about chronically assumed drugs are the first step: in fact these patients may be affected by a wide variety of physiopathologic and mental diseases. Failure of cooperation requires general anesthesia or sedation techniques. General anesthesia can be dangerous (malignant hyperthermia in myopathies, difficult intubation in facial anomalies, pharmacological interactions); furthermore, its frequent application even in order to perform minimal treatment is often unsuitable. Sedation techniques offer a more convenient possibility, but must be practised by trained operators. Nitrous oxide alone rarely produces in fact a sufficient degree of sedation and is suitable only in patients affected by very slight mental insufficiency. In the other cases, association with various drugs (as benzodiazepines, barbiturates etc) is needed. In such a situation, the active and continuous presence of the anesthesiologist becomes mandatory.

Anesthesia, Dental↗
PubMed1990

[Hemodynamic effects of the nitroprusside test in chronic congestive heart failure treated with long-term beta blocking therapy].

In patients with congestive heart failure (CHF) sympathetic reflexes are attenuated because of down regulation of beta receptors. Many Authors suggest that betablockers therapy can be useful in selected patients. We wanted to test if betablockers therapy could modify sympathetic reflex during nitroprusside test. We studied 20 patients: 10 were healthy volunteers and 10 were affected by CHF of different origin. They were divided in 4 groups in relation to therapy. During nitroprusside infusion we evaluated the following parameters: heart rate (HR), mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), cardiac index (CI), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR). In normal subjects we observed that the heart rate increased and the PAM and SVR decreased significantly. Betablockers therapy did not modify hemodynamic response of PAM and SVR, while we did not find any modification of the heart rate. In patients with CHF we observed a decrease of PAM, MPAP, SVR and PVR. Betablockers therapy in CHF did not modify the hemodynamic response to nitroprusside test. This effect is probably due to beta adrenergic receptor down regulation that decrease the responsiveness to sympathetic stimulation evoked by vasodilatation.

Adrenergic beta-Antagonists↗
PubMed1990

[Hemodynamic effects of the cold pressor test in patients with heart failure treated with beta blockers for a long time].

In congestive heart failure (CHF) the beta-adrenoceptor density and functional responsiveness is markedly reduced presumably due to endogenous down-regulation. In the last few years evidence has accumulated that betablockers therapy can improve clinical condition in selected patients with CHF. To evaluate sympathetic response in CHF we measured hemodynamic effects of cold pressor test. This study was composed by 20 patients, 10 with CHF of different origin and 10 healthy volunteers. They were divided into 4 groups in relation to therapy. We evaluated the modification of the following hemodynamic parameters during cold pressor test: heart rate, mean arterial pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, right atrial pressure, cardiac index, systemic vascular resistance, pulmonary vascular resistance. In normal subjects we observed hemodynamic modification of heart rate, mean arterial pressure and systemic vascular resistance according to many other Authors. In atenolol-treated subjects the sympathetic response is strongly attenuated. Patients with CHF not treated with betablockers showed an increase in heart rate and in systemic vascular resistance and a reduction of cardiac index. Chronic treatment with atenolol did not modify heart rate response to cold pressor test. The mean arterial pressure increased while the systemic vascular resistance did not show any significant modification. We observed a trend to increase of the cardiac index; this could explain the beneficial effect of betablockers therapy in selected patients.

Adrenergic beta-Antagonists↗
PubMed1989

Temporary resection-arthrodesis of the knee using an intramedullary rod and bone cement.

A temporary arthrodesis of the knee, using an intramedullary Küntscher rod and bone cement, was carried out in 76 patients after resection of tumours of the distal femur or proximal tibia. In contrast to primary arthrodesis with bone grafting, this procedure allows the patient to bear weight on a stable limb a few days after operation, reduces the risk of infection and avoids the negative effect of chemotherapy on graft incorporation. In 12 cases (16%) the implant failed mechanically by fracture, or by bending or migration of the rod, at from 13 to 54 months after operation. Deep infection occurred in 11 patients (14%). A second reconstruction was carried out in 14 patients, 10 using Kotz prostheses and 4 arthrodeses with bone grafting. The operation we describe has advantages for patients with high grade tumours which require chemotherapy and resection-arthrodesis of the knee joint.

Adolescent↗
PubMed1989

[The prevention of occupational exposure to anesthetics: the standards aspects].

Prevention of damage of occupational exposure to anaesthetic gases and vapors consists in limitation of pollution and in biological and environmental monitoring. Reduction of polluting concentrations can be obtained only by using both ventilation of the operating room and active scavenging; proper behaviour in accordance with prevention rules and psychologic involvement of personnel is also needed. Biological and environmental measurements are useful in order to evaluate the efficiency of prevention and to early detected overexposures. Acts and regulations in force at present in Italy and technical specifications concerning this problem are than reviewed. The author notices that in many cases, standards dealing with requirements to be satisfied should be established before performance standards; at any rate, regulations should also be more compulsive.

Air Pollutants, Occupational↗
PubMed1989

Vertebral needle biopsy with CT scan monitoring.

The authors report the method used and the results obtained in 42 vertebral needle biopsies with CT scan monitoring. Material sufficient for a positive histological diagnosis was obtained in 67% of the cases. Indications for the use of this method are conditioned by a suitable clinical and instrumental evaluation, and limited to cases where a histological monomorphous lesion or when en bloc resection are predicted. The need to follow precise rules in terms of technique and manual skill is emphasized.

Adult↗
PubMed1989

Osteoid osteoma and osteoblastoma of the pelvis.

Benign osteoblastic tumors of the pelvis are rarely encountered in orthopedic practice. In most of the cases they involve the acetabular area, as was the case in nine of 14 cases of osteoid osteoma and osteoblastoma presented in this study. Especially with small tumors, such as osteoid osteomas, such a rare occurrence together with difficulties in the interpretation of roentgenograms can lead to mistakes and delays in diagnosis. To reduce these risks, a high grade of clinical suspicion and the use of tomograms or computed tomography (CT) scan and isotope bone scan are required. CT scan is an invaluable tool also for planning the surgical treatment in cases in which the tumor involves the acetabulum. Whereas an intracapsular excision is an adequate treatment for pelvic osteoid osteoma, pelvic osteoblastoma due to its size may need more aggressive surgery, even leading in some cases to a partial pelvic resection. The risk of recurrence is higher for osteoblastoma than for osteoid osteoma, as well as the rate of complications.

Adolescent↗