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Biomedical subjects

G Cataldo

Publications and source records attributed to G Cataldo.

15 recordsLinked to original sources
PubMed1990

A linear model suitable for assessing graft patency in controlled clinical trials. SINBA Group.

In clinical trials carried out to assess the efficacy of different drugs in reducing the frequency of occlusion after coronary artery bypass, the ratio of the number of patients with at least one occluded anastomosis to the number of patients catheterized up to a given day is a widely adopted statistic. In the early evaluation (at 1 or 2 months after surgery), this is affected by the distribution of timing of angiography and it tends to underestimate the cumulative probability of occlusion because patients whose anastomoses are all patent at angiography and occlude between angiography and the day at which the ratio is estimated do not contribute their events to the numerator of the ratio. One may sensibly assume that this underestimate does not affect the evaluation of the efficacy of treatments tested "within" the trial. In contrast, since the distributions of the timing of angiography vary substantially from trial to trial, it can make comparisons "between" trials unclear and possibly biased. The aim of this article is to suggest an alternative approach of statistical analysis in terms of logistic regression. By modeling the dichotomous response given by each patient in function of time at angiography, type of treatment, and other possible covariates, asymptotically unbiased estimates of the cumulative probability of occlusion are attained. Furthermore, the pertinent hazard function can be estimated. The main features of the model are discussed and the results obtained by fitting early data collected in the Studio Indobufen Nel Bypass Aortocoronarico (SINBA) are given.

Anastomosis, Surgical↗
PubMed1990

[Angina pectoris induced by oral administration of dipyridamole].

Five cases scheduled for myocardial elective coronary artery bypass (CAB), who developed angina and ischemic electrocardiographic changes, after oral administration of dipyridamole (100 mg) are reported. Dipyridamole induced myocardial ischemia has been demonstrated in subjects with coronary artery disease, if this drug is administered intravenously. To our knowledge, only one study reported this side effect, after oral route, in four patients awaiting urgent CAB, for unstable angina. Based on our and other Authors experience, preoperative dipyridamole should be used with caution, especially in patients with unstable angina.

Administration, Oral↗
PubMed1989

Echocardiographic assessment of cardiac allograft rejection.

Twenty-one patients surviving orthotopic cardiac transplantation were studied by serial M-Mode and cross-sectional echocardiography on the same day as endomyocardial biopsy (EBS) (n = 205) during a mean follow-up period of 7.7 +/- 6 months. Results of EBS and the corresponding echocardiograms were divided into three groups: (1) no rejection (62 patients); (2) onset of mild rejection (11 patients); (3) onset of moderate rejection (17 patients). Groups 1 and 3 differed significantly in interventricular septum plus posterior wall thickness (IVS + PWth) (P less than 0.001), LV mass (P less than 0.001), LV ejection fraction (LVEF) (P less than 0.001), increased myocardial echogenicity (ME) (P less than 0.01), impaired RV wall motion (P less than 0.001). Groups 1 and 2 differed significantly only in increased ME (P less than 0.01). Groups 2 and 3 differed significantly in IVS + PWth (P less than 0.05), LV mass (P less than 0.01), LVEF (P less than 0.01), and impaired RV wall motion (P less than 0.01). With acute rejection we observed (1) increase of greater than 4 mm in IVS + PWth (55%), (2) increase of greater than 30% in LV mass (34%), (3) reduction of greater than 10 points in LVEF (27%), (4) RV dilatation and wall motion impairment (31%), (5) appearance or marked increase of pericardial effusion (34%), (6) increased ME (58%). Specificity of the individual criteria ranged from 95.6% to 100%.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMed1988

[Cardiac transplantation: role of echocardiography in the diagnosis of rejection].

Sixteen patients surviving orthotopic cardiac transplantation were studied by M-Mode and two dimensional echocardiography (ECHO) on the same day of cardiac biopsy during (n = 138) a mean follow-up of 6.2 +/- 4 months (range 1-4 months). The following parameters were measured: right ventricular end diastolic internal diameter (RVdD) left ventricular end diastolic internal diameter (LVdD), interventricular septum (IVS) and posterior wall (PW) diastolic thickness, myocardial mass (MM); LV cross sectional area (CSA) and ejection fraction (EF). LV and RV wall motion, pericardial effusion and myocardial echogenicity (brightness) were evaluated by inspection. Every ECHO was compared with the previous one for qualitative and quantitative changes. In the absence of rejection, analysis of the data during the first postoperative week showed the following results: mean EF = 51 +/- 6.8%, dilated overloaded RV (30.4 +/- 4.8 mm), various amount of pericardial effusion; FE increased significantly (55.3 +/- 4%; p less than 0.001) and RVdD decreased (26.6 +/- 5mm; p less than 0.001) after the 2nd week and remained stable thereafter, while pericardial effusion decreased or disappeared. The mean values of the remaining ECHO parameters did not very significantly during the follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Indications for surgical treatment in post-infarction angina.

In order to evaluate whether or not criteria for surgical revascularization in patients with early post-infarction angina (EPIA) should be different from those commonly used for patients with angina, the incidence and prognostic implications of EPIA were analysed in 188 AMI patients in Killip's class I or II on admission. Sixty-two patients (33%) complained of EPIA (Group I) and 126 patients were symptom-free (Group II). There were no differences between the two groups in in-hospital and late mortality and reinfarction. On the contrary, severity of angina was significantly associated with the occurrence of in-hospital and late cardiac death, reinfarction and revascularization procedures. EPIA patients underwent revascularization procedures significantly more frequently than group II patients, both during hospitalization (29% versus 1%; P less than 0.001) and follow up (10% versus 1%; P less than 0.01). Coronary artery involvement was significantly more severe in group I than in group II and in the operated patients compared with the non-operated ones. Our data suggest that the severity of angina should be the leading criterion for surgery, as it is able to identify most of the patients with severe coronary artery disease and poor prognosis.

Aged↗
PubMed1979

[Single vessel coronary disease. I. Differences in clinical and prognostic aspects and in surgical results in isolated lesions of the anterior descending branch and of other coronary branches].

This study includes 290 patients having a 75% or greater stenosis of a sinlge coronary vessel, divided into two groups: 205 cases with isolated lesions of the left anterior descending coronary artery (LAD) and 85 with a stenosis of the circumflex (CF) or of the right (RCA) coronary artery. The following data have been compared in the two groups: -- characters of angina; -- results of stress testing; -- extent of left ventricular contraction impairment; -- natural history of unoperated patients; -- surgical risk; -- long term survival of operated patients; -- effect of medical or surgical treatment on symptoms. Results were as follows: -- LAD patients had slightly more severe symptoms and lower exercise tolerance than CF and RCA patients; -- no significant differences were noted as regards left ventricular contraction; -- five year survival rates were only slightly different both regarding unoperated patients (80 +/- 5% survival in LAD disease group; 86 +/- 5% in CF and RCA disease) and operated cases (83 +/- 5% in LAD lesions, 86 +/- 7% in CF and RCA disease); -- surgical risk was relatively low in both groups; -- progress of symptoms after bypass surgery was very favourable. Based on these results, indications for surgery in single coronary vessel disease are discussed.

Adult↗
PubMed1977

[Precordial ST segment elevation mapping: a new method for a technically easier recording (author's transl)].

Precordial ST segment maps are currently recorded using a 35 electrode blanket connected to an electrocardiograph through a switch box. Problems in adjustment to patients' chests and artifacts are frequently encountered. Other techniques using a single suction electrode placed on different reference points are time wasting. The authors suggest the use of 35 self-adhesive electrodes (3M "Red Dot" chloride free gel pediatric electrodes--cat N. 2243) connected by a press button to a multichannel EKG recorder. This technique prevents artifacts, assures constant arrangement of the electrodes, is suitable for different thoracic structures and does not need any additional device. The authors consider that such a practical method should make precordial ST mapping a more widespread clinical procedure.

Coronary Disease↗
PubMed1977

[Sublingual isosorbide dinitrate-induced severe hypotension, bradycardia and prelypothymia in patients with acute myocardial infarction (author's transl)].

100 patients with acute myocardial infarction were given 5 mg of sublingual isosorbide dinitrate within 36 hours by the onset of their symptoms. 86 patients did not show any unusual effect after the administration of the drug; their heart rate was only slightly increased and their arterial pressure slightly reduced. 14 patients developed severe systemic arterial hypotension, associated with absolute or relative bradycardia, within 30 minutes of receiving the drug. All the patients complained of fainting and sweating, 1 patient developed a syncope. Symptoms were relieved by raising patients legs in 10 cases, by 0.5 mg Atropina e.v. in 4 cases, 1 case required also external cardiac massage. There was no significant difference between the two groups as regard to the location of myocardial infarction nor to the functional class (according to Killip classification). Possible mechanism producing bradycardia, hypotension and lipothymia after nitrates administration are considered. A vagally mediate reflex possibly elicited by a fall in venous return is the most acceptable hypothesis. The study emphasizes the importance of carefull observation of patients receiving sublingual nitrates during acute myocardial infarction, and the rapid response of bradycardia, hypotension and lipothymia following nitrates administration, to a simple therapy, which avoids other potentially hazardous treatments.

Aged↗