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Biomedical subjects

G Olivo

Publications and source records attributed to G Olivo.

At least 19 recordsLinked to original sources
PubMed2000

Comparison of different methods of functional evaluation in patients with chronic heart failure.

BACKGROUND: Stratification of the severity of heart failure has major prognostic and therapeutic implications. AIMS: To prospectively compare different methods of assessment of functional capacity in patients with chronic heart failure (CHF). METHODS AND RESULTS: We studied 143 patients (78 male and 65 female) with CHF aged less than 70 years (mean 57.3 years). Functional assessment was made clinically according to NYHA classification and according to the Goldman Activity Scale Classification (GASC). Cardiovascular performance was measured by peak O(2) consumption (pVO(2)) and anaerobic threshold (AT) at cardiopulmonary exercise test and by the distance walked during a 6-min walk test (6-MWT). Clinical scales resulted significantly related. Peak VO(2) and AT showed a mild relation with distance covered at 6-MWT (r=0.56 and r=0.46, respectively). Concordance between NYHA classification and levels of performance at cardiopulmonary exercise test or at 6-MWT was less than 50%. CONCLUSION: Our results suggest that none of the usually employed methods give a definitive assessment of functional capacity of cardiovascular system and a high degree of discordance exists among the results of different tests in the same patient. Although NYHA classification maintains its value in clinical evaluation of patients with CHF, the 6-min walk test is recommended in patients with mild-to-moderate CHF (II-III NYHA classes) as a simple and useful screening test to select patients for further diagnostic evaluation.

Adult↗
PubMed1999

Peripheral vascular resistance limits exercise functional capacity of mild hypertensives.

To evaluate the physiological basis for suboptimal peak exercise oxygen consumption (VO2p) observed in the early stage of hypertension, 25 WHO Stage I hypertensive men with normal left ventricular mass and 10 healthy control subjects of equivalent age underwent the maximal cardiopulmonary exercise test with contemporary measurement of cardiac output with Tc99m angiocardiography. At peak exercise hypertensive patients had lower VO2p (p < 0.045) and cardiac output (p < 0.014) and higher vascular resistance (p < 0.010) than controls. At multiple regression analysis VO2 was positively related to cardiac output in controls (r = 0.80, p < 0.02), whereas in hypertensives the best (negative) correlation was observed with peripheral vascular resistance (r = -0.72, p < 0.04). Thus reduced cardiopulmonary function during physical exercise in hypertensives seems to be mainly related to impaired peripheral vascular autoregulation.

Adult↗
PubMed1999

Decreased baroreflex sensitivity assessed from phase IV of Valsalva maneuver in mild congestive heart failure.

Decreased sensitivity of cardiopulmonary and arterial baroreceptors has been hypothesized to sustain sympathetic activation in patients with heart failure. In the present investigation the relationship between the impairment of baroreflex sensitivity and clinical severity of congestive heart failure was investigated. The authors studied 58 patients with heart failure (14 in NYHA class I, 22 in NYHA class II, and 22 in NYHA class III), 38 women and 20 men, age range 28-65 years. Thirty-two patients suffered from idiopathic dilated cardiomyopathy and 26 from coronary heart disease. As control group they examined 21 age-matched subjects. Baroreceptor sensitivity was studied by using the Valsalva maneuver as stimulus. Arterial pressure and heart rate were measured noninvasively by Finapres instrument (Ohmeda) and signals were recorded and elaborated with a personal computer. A decrease of baroreflex sensitivity was already demonstrable in NYHA class I patients (4.72 +/- 3.31 vs 9.25 +/- 5.05 msec/mm Hg in control group) (p < 0.005). A further impairment of baroreceptor response was found in patients in NYHA class II (1.94 +/- 2.88 msec/mm Hg, p < 0.001) and class III (1.78 +/- 1.52 msec/mm Hg, p < 0.001). Baroreceptor response showed a significant correlation with functional NYHA class (r = 0.61, p < 0.001) and anaerobic threshold (r = 0.57, p < 0.001) while the correlation was less tight with left ventricular end-diastolic diameter, fractional shortening, left ventricular ejection fraction, pulmonary mean arterial blood pressure, cardiac index, distance at 6 minutes walk corridor test, and maximal oxygen consumption (VO2max). These results suggest that baroreceptor function may be impaired early in the clinical course of heart failure and may contribute to sympathetic activation.

Adult↗
PubMed1998

Relationship between depressed baroreflex function and exaggerated sympathetic response to exercise in patients with heart failure.

The relationship between impaired baroreflex sensitivity (BS) and the degree of sympathetic activation during exercise in patients with heart failure (HF) has not been studied in detail. For this purpose, we studied BS and measured plasma norepinephrine (NE) at rest, and during and after treadmill exercise in 15 patients and 10 controls. HF patients showed lower BS in comparison to controls (3. 51 +/- 3.62 vs. 9.74 +/- 4.56 ms/mm Hg; p < 0.001), and higher levels of plasma NE at rest (449.3 +/- 147.1 vs. 261.1 +/- 82.48 pg/ml; p < 0.001) and during exercise (1,542 +/- 361.2 vs. 524.6 +/- 92.61 pg/ml; p < 0.001). BS was directly related to pVO2 (r = 0.62; p = 0.0008) and inversely related to NE at peak exercise and to the increase in NE during exercise (r = 0.59, p = 0.005, and r = 0.53; p = 0.0058). Thus, during exercise, a marked sympathetic activation exists in patients with moderate HF. The relationship between increased plasma NE during exercise and decreased BS suggests that impaired baroreceptor function may be present in sympathetic activation in HF patients.

Adult↗
PubMed1998

Doppler echocardiography in suspected lone atrial fibrillation.

Echocardiography is frequently required in patients with atrial fibrillation (AF) to exclude underlying heart disease. In the present investigation the authors evaluated 56 patients with paroxysmal AF (PAF) (27 men, 29 women, mean age 54+/-11.3 years) in whom lone AF was suspected on clinical grounds. M-mode, B-mode, and Doppler examination were performed and measurements taken according to American Society of Echocardiography criteria. Left atrial diameter, left and right atrial volumes, left ventricular (LV) diameters, LV fractional shortening, and Doppler indexes of LV diastolic function were not different in patients with PAF in comparison with those of a control group of 56 age-matched subjects free from cardiovascular diseases. Echocardiographic examination results were entirely normal in 32/56 patients (57%) vs 39/56 of the control group (69%). Mitral valve prolapse was found in five patients (9%), but only one showed mild mitral regurgitation. Doppler examination disclosed a mild (+/++) mitral regurgitation in eight patients and a small aortic or pulmonary diastolic flow in four and two patients, respectively, in the absence of significant morphologic valvular abnormalities. In these patients the sizes of heart chambers were entirely normal. Aneurysm of the interatrial septum was found in one patient and an increased thickness of the epipericardial junction in another two patients. Finally two patients had a small increase of right atrial volume without demonstrable causes. The results suggest that lone AF can be correctly suspected on the basis of clinical findings (history, physical examination, and ECG) and that in these patients echocardiography rarely discloses organic heart disease.

Atrial Fibrillation↗
PubMed1996

C-reactive protein in viral and bacterial gastroenteritis in childhood.

To differentiate bacterial from viral infections the level of C-reactive protein in serum samples was studied in three groups of children under 5 years of age with gastroenteritis. Of the 53 children with bacterial infection, 41 (77%) had C-reactive protein levels > or = 12 mg1 -1, 32 (66%) > or = 20 mgl-1 and 24 (45%) > or = 35 mgl-1. Of the 35 patients with viral infection, 4 (11%) had C-reactive protein levels > or = 12 mgl-1, 3 (9%) > or = 20 mgl-1 and 1 (3%) > or = 35 mgl-1. The best balance between sensitivity and specificity of C-reactive protein was obtained for a cut-off level > or = 12 mgl-1 (sensitivity 77%, specificity 89%) as compared to > or = 20 mgl-1 (sensitivity 58%, specificity 97%) and > or = 35 mgl-1 (sensitivity 44%, specificity 97%). Our results suggest that the determination of C-reactive protein values may be a useful tool for predicting bacterial gastroenteritis in children.

Acute Disease↗
PubMed1996

Noninvasive evaluation of right ventricle systolic pressure during dynamic exercise by saline-enhanced Doppler echocardiography in progressive systemic sclerosis.

Progressive systemic sclerosis (PSS) is characterized in its first phases by vascular damage. Lungs are involved in two thirds of patients with initial progressive destruction of the capillary bed and consequent reduction of the functional reserve, which may lead to hypertension of the pulmonary circulation. For these reasons it is of great interest to have early information about the pressure of the pulmonary circulation, both at rest and during exercise, to follow the progression and the evolution of the illness independently from subjective symptoms. The aim of the study was to evaluate by a noninvasive method, saline-enhanced Doppler echocardiography, the behavior of the right ventricular systolic pressure in patients with PSS, at rest and during exercise, without clear instrumental or clinical signs of pulmonary involvement at rest. Nine patients (7 women and 2 men) with PSS, aged 55.7 +/- 8.7 years, and 9 control subjects were evaluated. All patients had normal pulmonary pressure at rest and negative history for effort dyspnea. Subjects underwent Doppler echocardiographic examination at rest and during exercise. Right ventricular systolic pressure was evaluated by saline-enhanced Doppler technique, at rest and throughout exercise. At rest the right ventricular systolic pressure was normal in all patients and controls. At the end of exercise, in 4 patients, values were still normal (40.7 +/- 2.2 mmHg); in the others pathologic values were recorded (59.8 +/- 3.9 mmHg). In the control group values were always normal (35.6 +/- 4.6 mmHg). In our study the saline-enhanced Doppler echocardiography has been demonstrated to be an important diagnostic tool for the noninvasive evaluation of right ventricular systolic pressure, both at rest and during exercise; it could be useful in monitoring the pulmonary vascular damage in patients with PSS.

Adult↗
PubMed1996

Left atrial size changes in patients with paroxysmal lone atrial fibrillation. An echocardiographic follow-up.

Left atrial enlargement has been demonstrated to occur as a consequence of the arrhythmia in patients with chronic atrial fibrillation (AF) in the absence of organic heart disease, whereas contrasting results have been reported in patients with paroxysmal lone AF. In the present investigation the behavior of left atrial size was followed up for an average period of 30.3 months in 20 patients with paroxysmal lone AF since their first arrhythmic episode. No significant changes in left atrial size were found at the end of the follow-up period. In 65% of patients the arrhythmia recurred at least once yearly. Left atrial size at enrollment was not significantly different in these patients from those without recurrences and did not change in either group during follow-up. The results suggest that in patients with lone AF left atrial dilatation occurs only after the arrhythmia becomes chronic. Early restoration of sinus rhythm may interrupt the vicious circle leading to atrial enlargement.

Adult↗
PubMed1996

[Oxygen therapy and pulmonary hypertension in chronic obstructive bronchopneumopathies].

Pulmonary hypertension has a negative prognostic value in the progression of chronic obstructive lung disease. The hypoxic vasoconstriction and subsequent morphological alterations that occur in the small arteries and in the pre-capillary arterioles may contribute to the reduction of the pulmonary vascular bed. The evolution of pulmonary hypertension in patients with chronic obstructive lung disease is not rapid except during relapses of the disease. Oxygen therapy reduces pulmonary arterial pressure values not only via a reduction in the functional abnormalities of the vessels but also via a regression in the anatomic changes induced by hypoxemia. Thus, long-term oxygen therapy may slow the progression of pulmonary hypertension in the course of chronic obstructive lung disease and the longer is oxygen administration the better haemodynamic results are obtained. The Medical Research Council (MRC) Study and the Nocturnal Oxygen Therapy Trial (NOTT) have clearly demonstrated that mortality among hypoxiemic patients treated with low-flow oxygen therapy is reduced; the NOTT also reported a reduction of about 10% in the levels of pulmonary vascular resistances in patients treated with long-term oxygen therapy, while an increase of about 7% has been observed in patients treated with oxygen therapy only during the night. Nevertheless, the reduction of mortality observed during long-term oxygen therapy not always is accompanied by an haemodynamic improvement; in particular a reduction in the pulmonary arterial pressure seems not to reduce mortality. In conclusion long term oxygen therapy may slow the progression of pulmonary hypertension during chronic obstructive lung disease while the improvement in pulmonary haemodynamic due to oxygen therapy is not strictly correlated with a reduction of mortality.

Hemodynamics↗
PubMed1994

Early impairment of the cardiopulmonary exercise capacity of hypertensive patients.

A reduction of functional capacity has been reported in severe hypertension. However, the reduced peripheral vasodilation observed in the early stages of hypertension, could also impair the blood supply to exercising muscles in mild hypertensives presenting a normal left ventricular mass. In this paper the cardiopulmonary exercise capacity of early hypertensives has been investigated. Thirty mild hypertensives (9 in stage I and 21 in stage II according to WHO) and 36 normotensives divided into two age and weight-matched groups, were investigated. All subjects underwent a stress test according to the modified Bruce protocol with contemporary assessment of breath-by-breath expiratory gas analysis and measurement of the anaerobic threshold (AT) and of the oxygen consumption at peak exercise (PVO2). Exercise duration and maximal workload, in stage I hypertensives, were similar to controls but the O2 consumption was significantly reduced in comparison to controls (P = 0.043). On the contrary, in stage II patients exercise duration, maximal workload, PVO2 and AT were significantly lower than in normotensives. No relationship between myocardial hypertrophy and ergometric or ventilatory (PVO2, AT, VE) parameters was found. In conclusion an early impairment of the aerobic exercise performance is detectable in uncomplicated (stage I WHO) mild hypertensives.

Adult↗
PubMed1994

Anaerobic metabolism in hypertensive patients during exercise stress test.

An impaired maximal vasodilating capacity has been reported in hypertensives. This study aimed to assess whether mild hypertensives depend on anaerobic metabolism more than do normal subjects during the exercise stress test. The oxygen uptake (VO2) and carbon dioxide output (VCO2) were measured at the anaerobic threshold (AT) and at peak exercise (VO2p and VCO2p) during the cardiopulmonary exercise test by breath-by-breath expiratory gas analysis in 21 mild hypertensives and 19 age-matched normotensives. AT was reached earlier in hypertensives than in normotensives, but with similar VO2 uptake, VCO2 output, and VCO2/VO2 ratio. At peak exercise, however, hypertensives showed lower VO2p than controls (29 +/- 5 v 33 +/- 5 mL VO2/kg/min, (P < .03) but similar VCO2p (36 +/- 6 v 39 +/- 6 mL VCO2/kg/min, P = .19). As a result, the slope of carbon dioxide output increase versus oxygen uptake after anaerobic threshold was steeper in hypertensives than in controls (P < .002). The higher CO2 production per unit of O2 in hypertensives as compared with controls seems to reflect a greater involvement of the anaerobic metabolism to supplement energy output.

Adult↗
PubMed1994

[Metabolic aspects of intestinal urinary diversion. Comparison with ileo-cecal bladder substitution and ileal conduct].

The aim of this study was the metabolic evaluation of 10 patients with 2 different types of urinary diversions, after cystectomy for infiltrating carcinoma. The patients were divided into two groups, homogeneous for age and follow up, according to the type of urinary diversion: group A (5 patients with ileo-cecal bladder) and group B (5 patients with ileal conduit). The follow up duration was 16.8 +/- 7.3 months in group A and 25.4 +/- 7.8 months, in group B. Even though the glomerular filtration rate (GFR) in both groups was within the normal limits, however - on closer evaluation - patients of A group revealed a slight functional damage, shown by reduced creatinine secretion, lower bicarbonatemia and lower urinary acid secretion when compared with ileal conduit patients. According to this study, the ileal conduit seems to be associated with a fairly good metabolic status while the ileo-cecal bladder could require closer clinical-metabolic follow up and bicarbonate supplementation.

Acidosis↗
PubMed1993

Thrombin generation after physical exercise.

Many investigators have studied the influence of physical exercise on hemostatic system and it is well accepted that exercise causes an activation of coagulation as indicated by a shortening of aPTT and by an increase in plasma factor VIII activity and levels. A controversial point remains whether this clotting activation leads to a significant thrombin generation and fibrin formation. The type of physical exercise performed and the methods used to study blood coagulation may be two major sources of discrepancies in different studies. In the last years sensitive and reliable methods became available to evaluate prothrombin activation and thrombin generation. Thus in this study we have investigated the influence of a well standardized treadmill stress test, controlled by the measurement of cardiorespiratory and metabolic parameters, on plasma concentration of different markers of clotting activation in healthy untrained young subjects. Blood samples were also withdrawn just before anaerobic threshold to investigate a possible role of metabolic acidosis in changes of clotting system.

Adult↗
PubMed1993

Metabolic complications of the urinary intestinal diversion: ileo-caecal bladder compared with ileal conduit.

Five patients with an ileal conduit and 5 with an ileo-caecal bladder substitute have been studied metabolically. All had undergone cystectomy for infiltrating carcinoma and they formed 2 homogeneous groups in terms of age and follow-up. Function in both groups was within normal limits but closer examination of patients with an ileo-caecal bladder revealed mild functional damage as shown by reduced creatinine secretion, a lower level of bicarbonate and lower urinary acid valency secretion. It was concluded that the ileal conduit is more satisfactory from a metabolic point of view than the ileo-caecal bladder, which requires closer follow-up and treatment with bicarbonates if necessary.

Acid-Base Imbalance↗
PubMed1992

Diagnostic and therapeutic problems in multicentric renal angiomyolipoma.

Multicentric renal angiomyolipoma is a rare form of benign tumor. However, its effective incidence as evaluated in autopsy studies may be as high as 8%. There are 2 main types of renal angiomyolipoma, that is isolated forms and those associated with other diseases, such as phakomatosis, polycystic kidneys and fibromuscular dysplasia. The tumor may also display malignant behavior with local invasiveness and regional lymph node involvement. However, the clinical course is benign and multicentricity is important for prognosis. Histopathological diagnosis often is difficult. Immunohistochemical analysis of surgical specimens using a panel of monoclonal antibodies, including HMB-45 and actin, enabled us to make a definitive diagnosis in 3 cases of multicentric renal angiomyolipoma.

Adolescent↗
PubMed1991

Uretero-ileocecocapsuloplasty. Preliminary reports.

A uretero-ileocecocapsulaplasty and ileal patch operation was performed on seven patients following cystectomy. All the patients were carefully selected cases of unifocal T2, T3 vesical carcinoma localized at least 2-3 cm from the bladder neck. Vesical mapping and intraoperative histological examination of resection edges were negative. The operative technique is described together with early clinical and urodynamic findings.

Adult↗
PubMed1988

[Aneurysms of the left sinus of Valsalva].

The acquired aneurysm of the left aortic sinus is a rare lesion. We observed two cases: the former ruptured in the left ventricle, the latter in the right ventricle. Both cases were identified by echocardiographic examination. The diagnosis was confirmed by the cardiac catheterization and aortography and then at cardiac surgery. In the latter case the diagnosis of rupture was done using Doppler technique. Our experience indicates that, at least in selected cases, the diagnosis of aneurysm of Valsalva sinus and that of rupture are possible by means of two-dimensional and Doppler echocardiography.

Adult↗