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Biomedical subjects

G De Simone

Publications and source records attributed to G De Simone.

At least 55 records · Page 3Linked to original sources
PubMed1993

Zinc supplementation restores plasma concentrations of zinc and thymulin in patients with Crohn's disease.

The aim of this work was to evaluate whether oral supplementation with zinc sulphate (ZnSO4) could restore thymic endocrine function in patients with Crohn's disease who showed decreased plasma concentrations of zinc and active thymulin, a zinc-dependent thymic hormone. Twenty-seven patients in clinical remission were randomly assigned to receive, for 3 months, one of the following treatments: 60 mg/day ZnSO4; 200 mg/day ZnSO4 or placebo. Plasma thymulin activity and zinc concentrations significantly increased only in patients treated with 200 mg/day ZnSO4. Lymphocyte subpopulations, within the range of normality before zinc supplementation, were unaffected by any of the administered treatments. In conclusion, low plasma concentrations of zinc and thymulin in Crohn's disease patients were restored by the administration of high doses of zinc.

Adult↗
PubMed1993

Tricuspid valve vegetation in a child with periarteritis nodosa.

We report a case of a child who was first seen for acute renal failure and periarteritis nodosa. Angiography findings confirmed this diagnosis. Ultrasound scan revealed large tricuspid valve vegetation, as well as minute vegetation on the right ventricular wall. All vegetation disappeared after 12 months of immunosuppressive therapy. Serology findings for lupus were negative. All clinical and laboratory findings strongly support the hypothesis that this previously undescribed heart involvement is caused by PAN.

Acute Kidney Injury↗
PubMed1993

[A clinical instrumental assessment of professional ex-athletes: the long-term effects on the cardiovascular system].

BACKGROUND: Although many authors have been interested in the athlete's heart since the 1899, several aspects are still being debated. Among them, the issue concerning long-term morphologic and functional cardiac changes induced by vigorous physical activity can be considered of great importance. The aim of this study was to use Doppler echocardiography to evaluate the association of vigorous physical activity with morphologic and functional cardiac modification. METHODS: A total of 30 healthy ex-professional athletes who had discontinued their activity at least 10 years previously, and 30 healthy subjects without a history of regular physical exercise were recruited for the study. Clinical examination, thorax radiography, routine laboratory tests and ergometric test were performed. Morphologic and functional cardiac modification were evaluated by using Doppler-echocardiography. Data were analysed by performing the Student's t-test for unpaired samples and the Kruskall-Wallis' test. RESULTS: Radiologic and echocardiographic findings showed a complete regression of potential morphologic modifications which had occurred during the period of physical activity. The ergometric data showed both a normal working capacity and a reduced energetic demand. Doppler flow shapes were consistent with a normal pattern, although significantly reduced compared to controls. Doppler data of intracardiac flow showed a reduction of peak flow velocity (PFVA) and acceleration time (AccTA) across the aortic valve, and, across the pulmonary valve, a reduction of peak flow velocity (PFVP), flow velocity integral (FVIP) and acceleration time (AccTP). These data give evidence of a reduction in both left and right systolic ventricular function. In diastole the Doppler flow across mitral valve shows an increase in peak flow velocity E (PFVEM), E velocity--A velocity ratio (E/Am) and deceleration time (DecTM). The Doppler flow across the tricuspid valve shows a reduction in peak flow velocity E (PFVET) and in diastolic slope (slopeT) with an E velocity--A velocity ratio (E/AT) increased. Overall, these findings are consistent with an increase in left ventricular parietal stiffness, while the right ventricular wall shows a reduced active relaxation. Nonetheless, an overall diastole disfunction could not be excluded. CONCLUSIONS: Our findings on ex-professional athletes in resting conditions support a "non pathological" ventricular function modification measured with echocardiographic and Doppler flow methods. The ergometric data showing both a normal working capacity and a reduced energetic demand, and morphology of the Doppler flow shape that is (in absolute) normal would seem to confirm the results. We hope that our data will stimulate future trials on larger populations in order to increase the knowledge of the long-term effects of regular physical activity.

Adult↗
PubMed1992

Weight reduction lowers blood pressure independently of salt restriction.

The existence of a link between obesity and hypertension is nowadays universally accepted; however, there are still some doubts about the fact that weight reduction induces a significant long-term decrease in blood pressure. This clinical trial aimed at evaluating the effects of marked weight loss (at least 30% of excess body weight) induced by a low-energy (600 Kcal), normal sodium diet in severely obese patients, on blood pressure at rest and during sympathetic stimulation. Eight of the 20 patients initially recruited for the study were able to reach the therapeutical goal and brought their body weight from 107 +/- 6 to 91 +/- 4 kg. Their blood pressure (BP) at rest was at the same time reduced from 137/81 +/- 5/4 to 122/74 +/- 4/4 mmHg. Also, blood pressure measured during three different stimuli (cold pressor test, handgrip and mental arithmetic test) was lowered by this nonpharmacological means. These effects are related solely to weight reduction, since no change in salt intake occurred, as demonstrated by measurements of the 24-h sodium excretion test (191 +/- 13 vs 185 +/- 10 mEq/24 h). In conclusion, these results support the hypothesis that a drastic weight loss, independently of salt restriction, significantly reduces BP at rest and during stimulation of the adrenergic nervous system.

Adult↗
PubMed1992

Early congestive heart failure due to origin of the right coronary artery from the pulmonary artery.

We describe a two-month-old infant with early congestive heart failure due to anomalous origin of the right coronary artery from the pulmonary artery. The diagnosis was made by two-dimensional and color flow Doppler echocardiography, confirmed by angiocardiography, and the case was successfully corrected at surgery. As opposed to the more frequent anomalous origin of the left coronary artery from the pulmonary trunk, this anomaly generally does not cause any typical clinical finding, often becoming an autoptic or surgical surprise after infancy or in adult age.

Coronary Vessel Anomalies↗
PubMed1992

Influence of steroid treatment's duration in patients with active Crohn's disease.

Steroids are very useful drugs in the treatment of active Crohn's disease (CD), but clinical relapses after steroid withdrawal may be very high. We investigated the efficacy of two steroid regimens of different duration in inducing remission and in maintaining it after drug suspension. Patients with active CD were randomly assigned to scheme A, lasting 7 weeks (27 patients), or to scheme B, lasting 15 weeks (27 patients). Remission rates at the end of the treatment were 81% for scheme A and 85% for scheme B. Relapse rates at 6 months after stopping the treatment were 50% (11 patients) and 52% (12 patients), respectively. Remission rates seem not to be influenced by the duration of the treatment, but patients recently treated with steroids showed a higher relapse rate if they received the short-duration treatment.

Adult↗
PubMed1992

[Normal anatomy and findings in traumatic pathology of the popliteal system. A MR study].

To date, the lesions of the popliteal system, which are responsible for the so-called postero-lateral knee instability, are still an imperfectly known chapter of knee conditions. We retrospectively analyzed 215 consecutive MR examinations performed May-August 1991 to evaluate MR capabilities in correctly depicting both the normal anatomy and the pathologic conditions of the popliteal system. Using our standard protocols for knee study and two different magnets (0.064 and 0.5 T), we identified 23 lesions of the popliteus and of its meniscal and peritoneal insertions, and 17 lesions involving also other capsular and ligamentous structures of the knee. Coronal T1-weighted images were the best ones to correctly identify normal knee anatomy, whereas sagittal T2-weighted images were more sensitive in detecting popliteal lesions. Our results had clinical or surgical confirmation in all cases.

Humans↗
PubMed1991

Comparative effects on blood pressure and regional hemodynamics of nicardipine and captopril.

This randomized, double-blind, crossover study was aimed at detecting efficacy differences in blood pressure control and peripheral circulation in cerebral aortic and femoral districts of slow-release nicardipine, 40 mg, and captopril, 50 mg, given twice daily to 20 primary hypertensive patients (9 male, 11 female; age range 33-60 years) for a period of 4 weeks for each treatment. Blood flow velocities in the aorta, common carotid artery, internal carotid artery, middle cerebral artery, and common femoral artery were noninvasively measured using a 2.0- or 5-MHz Doppler probe. Systolic blood pressure fall was similar with nicardipine (from 156 +/- 12 to 139 +/- 8 mm Hg, p less than 0.001) and captopril (from 158 +/- 13 to 146 +/- 13 mm Hg, p less than 0.001) while significant efficacy difference (p less than 0.005) in diastolic pressure control was detected (from 104 +/- 6 to 91 +/- 8 mm Hg, p less than 0.001 with nicardipine and from 102 +/- 6 to 98 +/- 7 mm Hg with captopril). Regarding regional hemodynamics, nicardipine increased (from 119 +/- 24 to 133 +/- 27 cm/s), and captopril did not affect systolic velocity in the aorta (difference between final data, p less than 0.03). In the common carotid artery systolic velocity was increased solely by nicardipine. No significant changes were detected in the other vessels explored.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Cardiovascular response to adrenergic stimulation during treatment with tertatolol. A new non-cardioselective beta-blocking agent in primary hypertensive patients.

The antihypertensive effects of tertatolol, a new non-cardioselective beta-blocking drug, were investigated in 20 patients with mild to moderate primary arterial hypertension, in a placebo controlled double blind randomized study. After tertatolol 5 mg o.d. significant decreases in both systolic and diastolic blood pressure and in heart rate were observed at rest (BP from 155/103 +/- 3/1 to 139/91 +/- 4/3 mmHg p less than 0.01; HR from 79 +/- 2 to 60 +/- 2 bpm p less than 0.01). Peak blood pressure, heart rate and myocardial O2 consumption, indirectly measured as cardiac workload, determined during adrenergic stimulation by 70 degrees head-up tilt, cold pressor test, mental arithmetic stress, isometric exercise and bicycle exercise were also reduced by 4 weeks of tertatolol treatment in comparison to pretreatment levels. No significant changes in the same parameters were induced by placebo. No side effects were observed during treatment.

Adolescent↗
PubMed1990

Percutaneous balloon valvuloplasty of pulmonary valve stenosis, dysplasia, and residual stenosis after surgical valvotomy for pulmonary atresia with intact ventricular septum: long-term results.

Eight-six children (aged 20 days to 14 years, 20 under age 1 year) underwent 94 percutaneous balloon valvuloplasty for pulmonary valve stenosis. The patients were divided into three groups: typical pulmonary valve stenosis (71), pulmonary valve dysplasia (9), and residual stenosis after surgical valvotomy for pulmonary atresia with intact ventricular septum (PAIS) (6). Each of the three groups was divided into two subgroups. In the early cases, balloon catheters with diameter 10-20% exceeding pulmonary valve annulus were used and the drop of the gradient was 39.5%. In the later cases, balloon diameters 30-40% greater than the valve anulus or double balloons were used and a drop of 66.7% in the RV-PA pressure gradient was achieved. The dilation in patients with dysplastic valve and residual stenosis after surgical valvotomy for PAIS was less effective. Doppler echocardiography was the technique used to evaluate residual gradient. Six months to 4 years follow-up demonstrated a persistent decrease of the valve gradient.

Adolescent↗
PubMed1990

Cardiac function and sympathetic activity in young diabetics.

This study was aimed at evaluating cardiac function, both systolic and diastolic, in young type 1 diabetics with a mean duration of the disease of 10.9 +/- 6 years and without evidence of cardiac autonomic neuropathy and micro- or macroangiopathy. Thirteen diabetics, with good metabolic control, and 10 normal matched subjects were studied by echocardiography at rest and by radionuclide ventriculography both at rest and during effort. The level of plasma catecholamines was also determined. The echocardiographic data were comparable in the two groups. Scintigraphic data showed an increased peak ejection and peak filling rate (P less than 0.001) in diabetics while the other indices of cardiac function were comparable. Norepinephrine (P less than 0.01) and epinephrine (P less than 0.001) were higher in diabetics. A hypothesis is formulated that the higher indices of flow velocities in type 1 diabetics are supported by a sympathetic overactivity.

Adult↗
PubMed1990

Pediatric cardiac surgery guided by echocardiography. Established indications and new trends.

Cardiac surgery in 602 children was not preceded by cardiac catheterization, the diagnosis being based on clinical findings and two-dimensional and Doppler echocardiography. In the 355 operations without cardiopulmonary bypass there were nine major and seven minor diagnostic errors (2.5% and 2%). Among the 247 cases with open-heart surgery there were no major and eight (3.2%) minor errors. The malformations most suitable for nonbypass surgery without catheterization seem to be those with reduced pulmonary blood flow requiring systemic-pulmonary artery shunt, aortic coarctation and patent ductus arteriosus. For open-heart surgery without invasive investigation, atrial septal defect, partial atrioventricular canal, aortic and pulmonary stenosis, cardiac tumor and isolated valve disorder are 'classic' candidates. Recent experience indicated that selected cases of complete atrioventricular canal, tetralogy of Fallot, truncus arteriosus, total anomalous pulmonary venous connection and transposition of the great arteries may safely undergo primary repair without cardiac catheterization. Because of its diagnostic potentialities, pediatric cardiac surgeons must become familiar with echocardiography.

Cardiac Catheterization↗
PubMed1990

[Surgical correction of atrioventricular canal without heart catheterization].

In our department, 35 patients with atrioventricular canal underwent elective surgery between June 1983 and May 1989. The diagnosis was based on clinical and echocardiographic assessment without cardiac catheterization. Nineteen patients (age 2-12 years; mean 6.6 years) had a partial atrioventricular canal and 16 (age 5-8 months; mean 7 months) presented a complete atrioventricular canal. The echocardiographic diagnosis was confirmed at surgery in all but one patient (2.8%). The latter was diagnosed as having a complete canal but at surgery a transitional canal with a restrictive ventricular septal defect was found. We based our patient selection on the natural history which excluded cases with early heart failure and pulmonary hypertension. We also relied on an accurate morphological study using two-dimensional echocardiography which excluded cases with associated cardiac malformations. Our recent experience (1986-1989) showed that 50% of the patients with complete canal and 60% of patients with partial canal underwent surgery without cardiac catheterization.

Age Factors↗
PubMed1989

[Hemodynamic adaptation in severe obesity with or without arterial hypertension].

Hypertension and obesity are 2 common pathological conditions that have been directly related. The incidence of hypertension in an obese population is far greater than in otherwise normal people. Nevertheless, a causal relationship between the 2 disorders has not been established. But their coincidence in the same patient carries increased risk of cardiovascular morbidity and mortality. In the present study we have studied a group of normotensive obese patients (21 patients, Group A), a group of hypertensive obese patients (19 patients, Group B) and a group of normal subjects (11 patients, Group C) by radionuclide ventriculography with Tc 99m to visualize the different hemodynamic adaptation to these different conditions. Overweight causes an increased preload while hypertension causes an increased afterload. In response to the increase in preload the heart of obese patient undergoes eccentric hypertrophy; when an increase in afterload is present at the same time, the left ventricle develops concentric hypertrophy. We found an increased preload in both the obese groups (A and B) testified by increased blood volume and end diastolic volume. Heart rate was higher in the 2 populations of obese patients. As a result, cardiac output was significantly increased in Group A and B. But the stroke index is decreased in Group A and B with respect to Group C. The ejection fraction is reduced in Group A with respect to Group B and C. The contractility index (systolic blood pressure/end systolic volume) is higher in Group B in comparison with Group A. Thus, hypertensive obese patients seem to have a better cardiac performance respect to the normotensive obese patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Echocardiographic analysis of anatomical and functional changes in the left heart ventricle during antihypertensive treatment with nicardipine].

Changes in hemodynamic variables regulating systolic function were assessed by M-mode echocardiography, under 2D control, in 11 patients with primary uncomplicated hypertension treated with nicardipine (60 mg/daily). At the end of treatment (8 weeks) blood pressure and end-systolic stress were greatly reduced (p less than 0.001), and systolic fractional shortening was increase (p less than 0.02). The percentage increase in fractional shortening was correlated with a decreased in end-systolic stress (r = 0.67). The index of left ventricular performance (systolic pressure/end-systolic dimension ratio) was reduced: no variation was found in the hypertrophy-independent index of the inotropic state (systolic pressure/end-systolic dimension ratio normalized for posterior wall thickness). No change in the inotropic state was caused by a negligible sympathetic reflex outflow: heart rate also remained unchanged. The only index of left ventricular hypertrophy which was slightly reduced after two months of treatment was left ventricular mass (p less than 0.001). In conclusion, the short-term treatment with nicardipine, in hypertensive patients, showed powerful effects in the improvement of systolic function; the possible regression of left ventricular hypertrophy must be confirmed in long-term therapy.

Adult↗