PubMed Health⌕ Search

Biomedical subjects

L Niccoli

Publications and source records attributed to L Niccoli.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Fluoxetin combined with cyclobenzaprine in the treatment of fibromyalgia].

The aim of this study is to evaluate the effectiveness of fluoxetin associated with cyclobenzaprine vs cyclobenzaprine in the treatment of fibromyalgia. Twenty-one females with fibromyalgia were randomly assigned to 2 groups: group A (11 patients) was treated over 12 weeks with fluoxetin (20 mg/die) and cyclobenzaprine (10 mg/die), group B with cyclobenzaprine (10 mg/die). Basally and after 12 weeks patient self-assessment of pain, number of painful tender points, tender points index and morning stiffness were evaluated. The study has shown a significant improvement of the examined parameters in both treatment groups; however the comparison between the two groups showed a greater effectiveness, statistically significant, of the treatment with Fluoxetin associated with cyclobenzaprine.

Adult↗
PubMed1992

Combined invasive and noninvasive study of left ventricular systolic and diastolic function following acute administration of cicloprolol to subjects with normal cardiac function.

Cicloprolol is a new beta-blocking agent with high selectivity for beta 1 receptors and high intrinsic sympathomimetic activity. We studied the acute hemodynamic effects of cicloprolol in nine subjects with no evidence of left ventricular dysfunction who underwent cardiac catheterization for the evaluation of chest pain. All patients had normal coronary angiography and left ventriculography. Left ventricular pressure was determined throughout the cardiac cycle using a Millar 8Fr Minotip catheter; an echocardiogram, phonocardiogram, and ECG were simultaneously recorded to obtain left ventricular pressure-diameter loops. All the measurements were repeated before and after the intravenous administration of cicloprolol. Cicloprolol was administered at increasing doses of 0.05, 0.10, and 0.25 mg/kg until a cardiac output increase of at least 15% over basal values was achieved. A decrease of mean arterial pressure or cardiac output after cicloprolol was not observed in any patient. Cicloprolol administration significantly increased cardiac output (24%), stroke volume (22%), and peak positive dP/dt (25%); no significant changes in heart rate, systemic blood pressure, right atrial pressure, or pulmonary artery pressures were observed. No significant change in the echocardiographic parameters occurred. Among the indices of left ventricular diastolic function, the time constant of isovolumetric relaxation was significantly decreased (-43%) after cicloprolol; moreover, the left ventricular pressure-diameter loop in the protodiastolic phase was shifted to the left following cicloprolol infusion. This study confirms that in subjects with normal left ventricular function cicloprolol can improve resting left ventricular systolic function, and it shows that this action can also be attended by a more rapid isovolumetric relaxation, similar to what has been observed with other sympathomimetic amines.

Adrenergic beta-Agonists↗
PubMed1992

Invasive and echocardiographic evaluation of non-Q myocardial infarction with isolated stenosis of descending anterior coronary artery.

Prognostic and clinical characteristics of acute myocardial infarction (AMI) can usually justify surgical and/or angioplastic approach if the residual ventricular function is still good. Multivessel disease frequently complicates results interpretation. We studied with 2D echocardiography and coronary angiography two groups of patients with one vessel stenosis located on anterior descending (AD) and previous AMI (means 19 days): 23 patients with spontaneous non-Q infarction (group 1), and 23 patients with Q infarction. Left ventricular function was better in group 1. Percent occlusion of AD was lower in group 1 and angiographic AD caliber was significantly higher. Differences between groups were much more evident in subgroups with proximal stenosis of AD: patients of non-Q subgroups had very good left ventricular function but frequently had post-AMI instable angina (88%). Our results underline the usefulness of aggressive diagnostic and therapeutic approach in non-Q AMI, because of higher amount of myocardium at risk.

Adult↗
PubMed1991

[Echocardiographic and cardioangiographic evaluation of non-Q infarction with isolated stenosis of the anterior descending artery].

We studied with two-dimensional echocardiography and coronary angiography 2 groups of patients with one-vessel stenosis located on anterior descending (IVA) and previous acute myocardial infarction (AMI; means 19 days): 23 patients with spontaneous non-Q infarction (Group I), and 23 patients with Q infarction (Group II). Left ventricular function was better in Group I (echo score: 2.04 +/- 2.64, angiographic ejection fraction: 65.65 +/- 9.7 in Group I, echo score: 4.78 +/- 3.14, angiographic ejection fraction: 49.47 +/- 9.1 in Group II, p less than 0.001). Percent occlusion of IVA was lower in Group I and angiographic IVA caliper was significantly higher (p less than 0.05). Differences between groups were much more evident in subgroups with proximal stenosis of IVA: patients of non-Q subgroup had very good left ventricular function but frequently had post-IMA unstable angina (78%). Our results underline usefulness of aggressive diagnostic and therapeutic approach in non-Q AMI, because of higher amount of myocardial a risk.

Adult↗
PubMed1989

[Prognostic significance of clinical, ergometric and coronarographic data in patients soon after myocardial infarction].

The relative prognostic value of the clinical evaluation (Clin), exercise testing (ET), and cardiac catheterization (Cath), was assessed in 167 consecutive patients who underwent these exams within 40 days after an acute myocardial infarction. Each patient was followed at least 24 months; 12 patients died and 59 presented major cardiac events (angina, reinfarction and death). All the parameters were analyzed by univariate and discriminant and Cox regression analysis. For purposes of analysis, the predictive power of 3 sets of variables was analyzed separately: Clin, Clin + ET, Clin + ET + Cath. In the prediction of major cardiac events, only previous myocardial infarction was selected among the Clin parameters by multivariate analysis while ST segment depression, maximal systolic blood pressure, exercise duration and, though less significantly, coronary artery disease extension were selected among the ET and Cath var. The percentage of patients correctly classified was very low using only the Clin variables (60%) and significantly improved when ET and, to a lesser degree, Cath were added (77% and 80%, respectively). Multivariate discriminant analysis selected, as significant predictors of cardiac death, digitalis therapy, appearance of bundle branch block, previous myocardial infarction and anterior location of the myocardial infarction among the Clin variables, while exercise duration and LV ejection fraction were selected among the ET and Cath variables, respectively. The predictive power of the Clin variables alone was only slightly improved by the use of ET and Cath as the percentage of patients correctly classified was 76%, 81% and 84% using only the Clin, the Clin + ET and the combination of the Clin + ET + Cath var, respectively. In conclusion, the variables associated with a depressed LV function are the best predictors of future death and cardiac events; coronary angiography can only slightly improve the specificity of the exercise testing in the prediction of major cardiac events.

Angiography↗
PubMed1988

Importance of early recanalization of the occluded coronary artery in acute myocardial infarction for preservation of left ventricular function.

Ninety-two patients with acute myocardial infarction, treated with intracoronary thrombolysis within 3 h from the onset of ischemic symptoms, were studied with coronary arteriography and left ventriculography. These examinations were repeated after 2 to 4 weeks to assess the importance of duration of ischemia on recovery of regional and global left ventricular pump function. Patency was achieved acutely and maintained at control angiography in 73 patients (87%), who were subdivided into three groups according to duration of ischemia before reperfusion: group 1 (29 patients): revascularized within 3 h; group 2 (22 patients): revascularized between 3 and 4 h; group 3 (22 patients): revascularized after 4 h. Patency was acutely achieved, but not maintained at control angiography in 11 patients (group 4), while thrombolysis was unsuccessful in eight patients (group 5). In group 1 there was a significant reduction in the number of hypokinetic segments (P less than 0.001) and a significant increase in mean percentual area change of hypokinetic segments (P less than 0.001) and in global ejection fraction (P less than 0.001). A still significant, but less evident improvement in these parameters was also seen in group 2 (P less than 0.05, P less than 0.01, P less than 0.01 respectively). Insignificant changes, with only occasional improvements were observed on group 3, while a tendency toward deterioration was found in group 4. A clear and significant (P less than 0.001) worsening of local and global ventricular function was detected in group 5. Our results indicate a significant inverse relationship between duration of ischemia and left ventricular functional improvement. Particularly, the first 3 to 4 h after onset of ischemic symptoms are critical for preservation of left ventricular function (group 1 and 2). Reperfusion after 4 h (group 3) is only rarely associated with improvement of ventricular motion. The importance of very early pharmacological thrombolysis and of maintenance of coronary patency is stressed.

Aged↗
PubMed1988

[Coronary angiographic study of patients with non-Q myocardial infarct: correlations with the initial electrocardiographic aspect and prognosis].

The purpose of our study was to evaluate, during the early phase, the coronary anatomy of the patients who suffered from an acute non-Q myocardial infarction (non-Q MI) and to correlate it with the ECG findings and with clinical evolution. We studied 76 patients (pts.), mean age 56 +/- 9 years, who had their a first non-Q MI (reinfarctions non included). They all underwent angiographic examination within an average period of 18 days (range 5-30 days). In the whole group of patients it is worthwhile noting: A) the elevated occurrence of left main lesions (11% of pts.) and multivessel disease (60%); B) the great percentage (41%) of patients with open infarct-related vessel but with very critical residual stenosis (above 90% of total lumen); C) the presence of collateral vessels in almost all the pts. (91%) with totally occluded infarct-related artery. During the 12 month follow-up, in all groups was a high occurrence (above 70%) of coronary events (postinfarction angina, reinfarction, aortocoronary by pass or PTCA). Furthermore, it is possible to identify a subgroup of patients presenting ST-segment depression with very unfavourable coronary anatomy (80% had multivessel disease, 30% of which had a left main critical stenosis) and high prognostic risk (90% occurrence of coronary events). In the subgroup with ST-segment elevation there was an elevated percentage (65%) of open infarct-related vessel, but with an important residual stenosis. Considering the advantages of revascularization interventions in these high risk patients with extensive residual jeopardized myocardium, we conclude that it is important that all patients with non-Q MI undergo early coronary angiography.

Adult↗
PubMed1987

Diagnostic accuracy of rest-exercise first pass ventriculography with a fast single crystal gamma camera in detecting coronary artery disease. Study of a group of male subjects without previous myocardial infarction.

Rest and exercise radionuclide ventriculograms were performed in 61 non infarcted, male, patients who underwent cardiac catheterization for chest pain and in 16 normal control subjects. Studies were performed using the first pass method with a fast single crystal gamma camera, which allowed a count rate of 140 +/- 19 Kcounts/sec to be reached during left ventricular filling; the count integral on left ventricular area was 10.8 +/- 1.6 Kcounts and the maximum count/pixel 155 +/- 16. We analyzed sensitivity, specificity, positive and negative predictive value of global ejection fraction (EF) and of the regional wall motion in identifying ventricular function abnormalities due to obstructive coronary artery disease. The regional wall motion was evaluated with four functional images: regional ejection fraction (REF), amplitude (A) and phase (PH) from Fourier analysis and systolic transit times (TT). Sensitivity was near 90% for EF, REF, A and TT, while PH was less sensitive (80%); all functional images were more specific (nearly 90%) than EF (80%). Both sensitivity and specificity were lower for the exercise EKG (59% and 63%, respectively) in this patient group. Significant differences between single vessel and multiple vessel disease were also observed either for the EF increase/decrease (-1.34 +/- 7.4 and -7.82 +/- 9.96; P less than 0.05) or for the number of segments which developed wall motion abnormalities during exercise (1.22 +/- 0.73 and 2.15 +/- 1.04; P less than 0.02). In conclusion, with our method, a fast single crystal gamma camera is suitable for obtaining optimal first pass radionuclide ventriculograms with a count density sufficient either for global or regional left ventricular function evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Myocardial metabolism during intracoronary thrombolysis. Two illustrative cases.

Arterial and coronary sinus difference for potassium, lactate, glucose, free fatty acids and creatine kinase was measured every 5 minutes in two patients undergoing successful intracoronary thrombolysis of left anterior descending occlusion. In the first patient, reperfusion, 160 minutes after the onset of pain, was followed by a transient and limited release of creatine kinase in the coronary sinus, improvement in the electrocardiogram and restitution of left ventricular contraction. In the second patient, reperfusion 365 minutes after the onset of pain, was also accompanied by a limited release of creatine kinase. Reocclusion of the left anterior descending coronary artery, however, necessitated further thrombolysis which led to a massive release of creatine kinase and permanent loss of wall-motion. It is suggested that, in this case, reperfusion damage had occurred. The arteriovenous differences showed a wash-out of potassium and lactate during reperfusion in each case. The interpretation of the entire sequence of arteriovenous changes, however, could be shown to depend critically on the state of regional perfusion.

Blood Glucose↗
PubMed1985

Pre-operative sinus node function in adult patients with atrial septal defect (ostium secundum type).

The authors studied, pre-operatively, the sinus node function in adult patients with secundum atrial septal defect and large left-right shunts, using Holter ECG and electrophysiological tests. Sinus node electrophysiological tests were found abnormal in 17 out of 26 patients; on the contrary, Holter monitoring was always within normal limits. The authors believe that concealed sinus node dysfunction existing before surgical correction may be a cause of early, acute, and reversible, post-operative sick sinus syndrome.

Adolescent↗
PubMed1985

[Lower myocardial infarct with depression of the ST segment in anterior precordial leads. Correlation of the electrocardiogram, coronarography and ventriculography performed in the acute phase].

We report on 11 pts affected by acute inferior myocardial infarction (group A: 4 pts without precordial ST-segment depression; group B: 7 pts with ST precordial ST-segment depression). These pts underwent left and right coronarography and left ventriculography in the course of intracoronary thrombolysis. We did not observe, in the group B pts, an involvement of the LAD branch of the left coronary, neither contractility abnormalities of the left ventricular anterior wall. ST depression in the precordial leads was associated with severe and extensive abnormalities of left ventricular inferior wall contractility.

Adult↗
PubMed1985

[Evaluation of the interventricular septum in left bundle branch block using basal echocardiography (M-mode) and myocardial stress scintigraphy (thallium-201)].

In thirty-six consecutive subjects, with left bundle branch block (LBBB) of the interventricular septum (IS), septal perfusion and/or viability was verified by M-mode echocardiography and by stress redistribution 201 TI-scintigraphy. After the early systolic "dip", a characteristic pattern of interventricular septum in left bundle branch block, we observed: a) an anterior paradoxical movement (A-type) during the ejection phase in 5 subjects; b) hypokinetic posterior movement (B-type) in 10 subjects and c) a normal motion (C-type) in 21 subjects. All the subjects with an A-type paradoxical anterior motion of the interventricular septum, showed a persistent defect of T1 uptake both during exercise and after redistribution. Of 31 patients with posterior interventricular septum motion (B and C types), 21 showed normal septal TI uptake and 10 reversible, exercise-induced perfusion defect, with complete redistribution on scintigrams at rest. In conclusion the analysis of our data demonstrates that in patients with left bundle branch block 1) the motion of the interventricular septum is not merely due to the anomalous electrical activation, but to other different factors, such as the anatomical and functional changes underlying the conduction pathology, 2) an A-type motion by M-mode echocardiography is highly predictive of interventricular septum damage.

Adult↗