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Biomedical subjects

L Boselli

Publications and source records attributed to L Boselli.

At least 37 records · Page 2Linked to original sources
PubMed1992

Echocardiographic and ultrasonographic evaluation of cardiac and vascular hypertrophy in patients with essential hypertension.

High-resolution ultrasonography is a noninvasive technique that allows to investigate the cardiovascular system, in particular the wall thickness and the lumen diameter of the arteries with accuracy and reproducibility. We measured the intima-media thickness of the common carotid artery (CCA) and of its bifurcation (BIF) in 40 patients with essential hypertension, 20 of them with left ventricular hypertrophy (LVH; age 42 +/- 10 years) and 20 without LVH (age 44 +/- 12 years); no other major cardiovascular risk factor was present in all the patients. Both carotid axes have been scanned from different views (anterior, lateral, posterior) on a transversal and longitudinal section using a high-resolution steerable linear array of 5.0 MHz. Carotid diameter and thickness were measured in the longitudinal section. CCA parameters were assessed 20 mm caudally to the flow divider. In patients with LVH, blood pressure (172 +/- 21/108 +/- 9 mm Hg) and left ventricular mass index (156 +/- 38 g/m2) were significantly (p < 0.01) higher than in patients without LVH (blood pressure: 158 +/- 11/99 +/- 12 mm Hg; left ventricular mass index: 98 +/- 10 g/m2), while there was no difference in serum glycemia, triglycerides, total and fractioned cholesterol levels. The intima-media thickness of both the CCA and BIF was significantly higher in the hypertensives with LVH (CCA: 0.85 +/- 0.02 vs. 0.65 +/- 0.02 mm; BIF: 0.93 +/- 0.04 vs. 0.70 +/- 0.03 mm, p < 0.01). There was a statistically significant correlation between the carotid wall thickness and the left ventricular mass index.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Prevalence of physiological valvular regurgitation in hypertensive patients: echocardiographic and color Doppler study.

Since the advent of the Doppler color flow echocardiography, the presence of a small degree of insufficiency of the cardiac valves has been detected with relative frequency in structurally and functionally normal hearts. Data about this so-called 'physiological' regurgitation are presently available only in normotensive subjects and athletes. We therefore studied the prevalence of this phenomenon in a group of patients with essential hypertension compared to a population of normotensive subjects. To this purpose, a Doppler color flow echocardiographic study was performed in 130 essential hypertensive patients (72M/58F; age 44.2 +/- 13.5 years; BP 154.3 +/- 12.8/98.3 +/- 7.1 mm Hg) without any evidence of left ventricular hypertrophy or cardiopathy and in 100 normal subjects (59M/41F; age 41.2 +/- 14.8 years; BP 119.1 +/- 8.1/79.2 +/- 8.1 mm Hg). We conclude that in patients with essential hypertension the physiological regurgitant jets are present in one or more cardiac valves; moreover, the regurgitation of the mitral and aortic valve is found with more frequency than in the normotensive control group (36.1 vs. 27.0% and 17.7 vs. 11.0%, respectively). These data suggest that the increased afterload of the left ventricle may play an important role in the pathogenesis of even minor degree of insufficiency of the cardiac valves. As this finding does not appear to have a pathological relevance, the main clinical implication of this study is that it is not advisable to create a jatrogenic heart disease in the hypertensive patients routinely screened by the echo-Doppler technique.

Adolescent↗
PubMed1992

[Ultrasonographic evaluation of cardiac and vascular hypertrophy in patients with essential hypertension].

High resolution ultrasonography allows the accurate and reproducible measurement of thickness and lumen diameter of carotid arteries. We investigated Common carotid (CCA) and bifurcation intima-media thickness in 40 hypertensive patients, 20 without left ventricular hypertrophy (LVH) (age 42 +/- 10 years) and 20 with LVH (age 44 +/- 12 years), all free from other important cardiovascular risk factors. Both carotid axes were scanned from different views (anterior, lateral, posterior) on traversal and longitudinal section, using a high resolution steerable (HRS) 5.0 MHz linear array. Carotid diameter and thickness from longitudinal section were measured. CCA parameters were taken 20 mm caudally to flow divider. Using the B-mode as a guide we assessed LVH presence with M-mode technique when left ventricular mass index (LVMI) > or = 135 g/m2 for men and > or = 110 g/m2 for women. In hypertensive patients with LVH, left ventricular mass was significantly higher than in those without LVH (156 +/- 38 vs 98 +/- 10 g/m2, p < 0.01). Even blood pressure was significantly higher in hypertrophic group (172 +/- 21/108 +/- 9 vs 158 +/- 11/99 +/- 12 mmHg, p < 0.01), while there was no difference in serum glycemia, triglycerides, total and fractioned cholesterol levels. The intima-media thickness scanned in both CCA and bifurcation resulted significantly higher in hypertensives with LVH (CCA: 0.85 +/- 0.02 mm vs 0.65 +/- 0.02 mm; BIF: 0.93 +/- 0.04 mm vs 0.70 +/- 0.03 mm, p < 0.01). We also noticed a statistically significant correlation between carotid wall thickness and left ventricular mass index.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Risk of postoperative epilepsy in acute surgery of cerebral aneurysms].

Forty-nine patients operated during an early clipping phase of cerebral aneurysm were reviewed; none had an associated ventricular flooding and/or intraparenchymal hematoma. Starting from the day of operation 37 patients were treated with anticonvulsant drugs using methods and dosages where were unlikely to guarantee efficacious cover. Forty-two patients made a satisfactory recovery, 5 patients died and 2 had severe neurological sequelae; 2 patients (4.4%) had early seizures during the first week after operation. In view of the inadequate cover of the anticonvulsant drugs and the homogeneous clinical characteristics of patients included in the study, the low number of attacks suggests an overall re-evaluation of anticonvulsant treatment and the need to select patients with a higher risk of an epileptic attack.

Adolescent↗
PubMed1992

[Early epilepsy in surgery of extra-axial supratentorial neoplasms].

A retrospective study was performed to evaluate the incidence of seizure and anticonvulsant prophylaxis in 138 patients operated from september 1987 to august 1989 for extra-axial supratentorial tumors. 15 patients (10.9%) developed seizures in the early post-operative period. We have considered the importance of histological type and side of lesions, a previous history of epilepsy and the pre and intraoperative prophylaxis. We can say that there is a statistical significance between sellar and middle cranial fossa tumors and the frequency of post-operative epilepsy and that anticonvulsant prophylaxis can reduce post-operative seizure. There is no statistical significance between the previous history of epilepsy the type of anesthesia and post-operative seizure.

Epilepsy↗
PubMed1992

[Continuous monitoring of O2 saturation in cerebral blood. A guide for the nursing of brain trauma patients in coma].

Manual ventilation is frequently performed by nurses to control increases in intracranial pressure (ICP) or during physiotherapy in head injured comatose patients. The effects of manual ventilation (n = 251) on ICP, cerebral perfusion pressure (CPP) and EEG have been studied in 18 mechanically ventilated patients. A fall in ICP was easily obtained but a fall in arterial blood pressure was often present at the same time. Thus a reduction in CPP resulted in 36% of occasions. Prophylactic boluses of thiopental (n = 67) before noxious stimuli obtained a fall in ICP in 99% of occasions but resulted in a decrease in CPP in 46%. The fall in ICP, due to the decrease in cerebral blood flow (CBF) by hypocapnia or metabolic depression and/or arterial hypotension, may be beneficial in hyperaemic brains but may precipitate cerebral hypoxia in ischaemic lesions. Relevant information about cortical metabolism (CMR) may be obtained from EEG monitoring by Cerebral Function Monitor but, unfortunately, no data about CBF are clinically available. The Authors suggest that the continuous monitoring of jugular bulb oxygen saturation (SjO2) may offer a clinically useful index of CBF adequacy to CMR. Findings from a preliminary study in 5 patients demonstrate that a severe decrease in SjO2 has been frequently caused by manual ventilation, hypothetically related to severe cerebral ischemia. High levels of SjO2 have been induced by endotracheal suction and physiotherapy, probably related to severe hyperemia. As prevention of ischaemic and hyperaemic insults is a major goal of treatment, the A. suggest that these undesirable effects of nursing might be avoided if nurses could take advantage of continuous monitoring of SjO2.

Adolescent↗
PubMed1991

Effects of long-term blood pressure control on left and right ventricular structure and function in hypertensive patients.

The functional and anatomical abnormalities of the right ventricle may occur in hypertensive patients with left ventricular hypertrophy (LVH). The present study was designed to assess the functional and structural changes in both left and right ventricles induced by chronic antihypertensive therapy. Doppler and standard echocardiography were performed in 10 hypertensive patients with LVH before and after 1 year of treatment with captopril alone (5 patients) or captopril plus nifedipine (5 patients). We found that the left ventricular mass index and right ventricular thickness were significantly reduced in all patients when compared with pretreatment values. Furthermore, the Doppler-derived diastolic filling indexes show a significant improvement of both ventricular chambers. Our data suggest that anatomical and functional changes induced by therapy in hypertensive patients are not limited to the left ventricle but also involve the right ventricle.

Blood Pressure↗
PubMed1991

Left ventricular diastolic function in athletes and borderline hypertensives with mild cardiac hypertrophy.

The aim of this study was to evaluate the diastolic function in athletes and in young borderline hypertensives with mild left ventricular hypertrophy. Left ventricular filling was assessed by echo Doppler measurement of transmitral flow velocity in 18 soccer players (age 22 +/- 4 years, left ventricular mass index, LVMI 136 +/- 12 g/m2), in 15 borderline hypertensives (age 21 +/- 3 years, LVMI 137 +/- 9 g/m2), and 20 normotensive subjects (age 22 +/- 4 years, LVMI 93 +/- 10 g/m2) as reference group. We found that left ventricular filling profile was similar in borderline hypertensives, in athletes and in normotensive subjects. These findings suggest that, at least in the early stage, mild cardiac hypertrophy secondary to borderline blood pressure elevation is characterized by indexes of diastolic function not different from those found in athletes with physiological hypertrophy.

Adult↗
PubMed1991

Cardiac structure and function before and after acute and chronic verapamil administration in hypertensive patients.

The aim of this study has been to analyze the acute and chronic effects of oral verapamil on diastolic function indices, derived from Doppler echocardiography, and left-ventricular (LV) dimensions and mass, assessed by M-mode echocardiography, in hypertensive patients without LV hypertrophy. 12 patients with essential hypertension were studied in basal conditions and (1) after a single oral administration of verapamil 160 mg and placebo in a double-blind protocol and (2) over chronic treatment (12 months) with verapamil 240 mg/day. At baseline, the ratio between early and atrial-induced transmitral velocities (E/A ratio) was lower in patients than in 12 age-matched normal subjects (1.08 +/- 0.2 vs. 1.51 +/- 0.3, p less than 0.01). Acute verapamil administration significantly decreased arterial blood pressure (162 +/- 26/101 +/- 8 to 142 +/- 12/88 +/- 7 mm Hg, p less than 0.01 after 2 h) and increased the E/A ratio to 1.26 +/- 0.3 (p less than 0.05) after 3 h. No change in ventricular dimensions and heart rate was observed. After chronic therapy, we found a further increase in the E/A ratio in 10 responder patients (1.49 +/- 0.3, p less than 0.01). The LV mass index, that was higher than in normal subjects before the treatment (118 +/- 16 vs. 91 +/- 11 g/m2, p less than 0.01), was significantly reduced (100 +/- 17 g/m2, p less than 0.05 vs. basal, nonsignificant vs. normal subjects). Our results demonstrate that acute administration of verapamil only partially improves the abnormal indices of diastolic function in hypertensive patients, whereas chronic treatment, by reducing LV mass indices and blood pressure to normal values, can completely normalize the indices of LV diastolic filling.

Adult↗
PubMed1991

Effects of thiopentone and mannitol on cerebral perfusion pressure and E.E.G. in head injured patients with intracranial hypertension.

The effects on intracranial pressure (ICP), cerebral perfusion pressure (CPP) and EEG monitored by Cerebral Function Monitor (CFM) were compared after bolus administration of mannitol (n = 55) and thiopentone (n = 67) to control intracranial hypertension in 18 severely head injured patients. Mannitol increased CPP in 89% of occasions and thiopentone in only 54% (p < 0.001). Thiopentone caused a mean increase in CPP +0.6 kPa (+5.0 +/- 1.6 mmHg) when the minimum pre-bolus voltage of CFM was above 4 microV and a fall in CPP -0.5 kPa (-4.1 +/- 1.6 mmHg) when cortical electrical activity was already severely depressed (p < 0.0002). When pre-bolus CFM was below 4 microV mannitol was superior to thiopentone. This different effect on CPP was due to a significantly greater fall in mean arterial pressure in the thiopentone sub-group -1.6 versus -0.3 kPa (-12.4 +/- 1.5 mmHg, -2.8 +/- 1.2 mmHg; p < 0.001). Severe and unpredictable hypotension occurred, particularly in the thiopentone low CFM sub-group. This symptomatic therapy seems inadequate but a targeted treatment of intracranial hypertension could be possible only with a more sophisticated monitoring, including continuous data on cerebral blood flow and adequacy to metabolic demand.

Adolescent↗
PubMed1991

[Effects of acute and chronic administration of verapamil on the anatomy and function of the left ventricle in essential hypertensive patients ].

The aim of this study was to analyze the acute and chronic effects of oral verapamil on diastolic function indices, derived from Doppler echocardiography and left ventricular (LV) dimensions and mass, assessed by M-mode echocardiography, in hypertensive patients (pts). Twelve essential hypertensive pts without LV hypertrophy were studied in basal conditions and 1) after a single oral administration of verapamil 160 mg and placebo, in double blind protocol and 2) over chronic treatment (six months) of verapamil 240 mg/day. At baseline the ratio between early and atrial-induced transmitral velocities (E/A ratio) was lower in pts than in 12 age-matched normal subjects (1.0 +/- 0.3 vs 1.5 +/- 0.3, p less than 0.01). Acute verapamil administration significantly decreased arterial blood pressure (162 +/- 26/101 +/- 15 to 142 +/- 12/88 +/- 7 mmHg, p less than 0.01) after two hours and increased the E/A ratio to 1.26 +/- 0.3 (p less than 0.05) after three hours. No change in ventricular dimensions or heart rate was observed. After chronic therapy we found a further increase in the E/A ratio (1.49 +/- 0.3, p less than 0.01) in 10 responder pts. The LV mass index, which was higher than in normal subjects before the treatment (118 +/- 16 vs 91 +/- 11 g/m2, p less than 0.01), was significantly reduced (100 +/- 17 g/m2, p less than 0.05 vs basal, ns vs normal subjects). Our results demonstrate that acute administration of verapamil only partially improves the abnormal indices of diastolic function in hypertensive pts, whereas chronic treatment, by reducing left ventricular mass indices and blood pressure to normal values, can completely normalize the indices of LV diastolic filling.

Adult↗
PubMed1990

[Morphofunctional characteristics of the left ventricle in arterial hypertension: echocardiographic and Doppler study].

The role of arterial hypertension in the development of left ventricular hypertrophy is well documented; in contrast, the characteristics of the right ventricle in this condition are poorly defined. To investigate whether structural and functional changes of the right ventricle are associated with systemic hypertension, we studied a total of 105 patients using M-mode, 2D and pulsed-Doppler echocardiography. Of these, 31 were hypertensive patients with left ventricular hypertrophy (III), 42 were hypertensives without left ventricular hypertrophy (II) and 32 were normotensive controls (I). Right ventricular anterior wall thickness was measured from the parasternal window, in long axis. The following left and right ventricular filling parameters were evaluated using Doppler mitral and tricuspid flow analysis: the early (E) and late (A) peak velocity, the ratio E/A. Our results show that: right ventricular anterior thickness was 5.7 +/- 0.9 mm in III, 4.3 +/- 0.8 in II and 3.7 +/- 0.8 in I (p less than 0.05 II vs I, p less than 0.01 III vs II and I). There is a significant correlation between right and left ventricular wall thickness in the hypertensive population (r = 0.75, p less than 0.01). Left ventricular filling shows a progressive reduction in E and an increase in A with a progressive reduction in the E/A ratio from 1.47 in I to 1.31 in II and 0.78 in III. Similarly E/A ratio for right ventricular filling decreases from 1.70 in I, 1.32 in II and 0.92 in III.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Changes in spinal reflex excitability in brain-dead humans.

The excitability of proprio- and exteroceptive spinal reflexes was monitored electrophysiologically and clinically during the occurrence of brain death (BD) in 8 patients. After a period of total reflex unresponsiveness, the soleus H reflex attained a steady-state excitability level in 2-6 h. The recovery cycle of this response regained its normal shape at 10-20 h. The threshold of the cutaneous reflex evoked in the biceps femoris by electrical stimulation of the sural nerve had become normal in 4-13 h, although the response displayed an abnormal multi-component pattern. Digital responses to mechanical stimulation of the foot sole were evident after 6-8 h. Knee and ankle jerks were never evoked during the time of monitoring. The time-courses of the changes in excitability were not directly correlated with the fall in the blood pressure which may occur during BD. It is concluded that the human spinal cord reacts to BD with a spinal shock, characterized by sequential recovery of reflex transmission. The overall timing of this process appears to be much shorter than that previously described for the spinal shock following traumatic transection of the cord, but the latter was never studied in the earliest phases.

Adult↗