PubMed Health⌕ Search

Biomedical subjects

M Merlo

Publications and source records attributed to M Merlo.

At least 37 records · Page 2Linked to original sources
PubMed1997

Measuring anteversion and femoral neck-shaft angle in cerebral palsy.

Femoral anteversion was measured by computed tomography (CT) in 40 children with cerebral palsy, however an accurate measurement was possible in only 59 of the 80 hips. Flat-surface measurement of anteversion was possible in 72 of 80 hips by CT, and in 36 of 40 hips by ultrasound. A high neck-shaft angle correlated with an inability to measure anteversion by CT. Measuring by ultrasound allowed subjects to be positioned in internal rotation and in this way accurate measurements of neck-shaft angles were obtained.

Adolescent↗
PubMed1997

Combined surgical and endovascular treatment of a traumatic pseudo-aneurysm of the brachiocephalic trunk with anatomical anomaly.

The authors report a case of combined surgical and endovascular treatment of a traumatic pseudo-aneurysm of the innominate artery in which the left common carotid artery originated from the brachiocephalic trunk. After a conventional surgical intervention with the implantation of the left common artery on the left subclavian artery, to correct the anatomic anomaly, a safe and effective endovascular stent-graft placement excluded the aneurysm. This new technique proposes a good chance for polytraumatized patients to receive a better prognosis and a much faster rehabilitation.

Adult↗
PubMed1997

Exclusion of an internal carotid aneurysm by a covered stent.

The authors report a case of a patient with thromboembolic strokes caused by a high internal carotid artery aneurysm. Considering the position and the anatomic structure of this aneurysm the sac was excluded transluminally by placing an endovascular covered stent.

Aneurysm↗
PubMed1996

Arterial switch operation: myocardial ischemia reversed by internal mammary artery graft.

We report a case in which an internal mammary artery graft to the left anterior descending coronary artery was successfully used in a newborn boy to reverse life-threatening myocardial ischemia 24 hours after arterial switch operation. One year later, angiography showed patency of both the graft and the transposed coronary ostium with normal left ventricular function. A brief review of the literature shows encouraging results of internal mammary artery grafts in pediatric patients.

Aorta↗
PubMed1995

Antihypertensive treatment with verapamil and amlodipine. Their effect on the functional autonomic and cardiovascular stress responses.

Many biological and psychological factors induce haemodynamic and extra-cardiovascular functional changes mediated by the autonomic nervous system. Pharmacological blood pressure reduction, as a neurovegetative stimulus, can change the arousal of the sympathetic nervous system. We evaluated the effects of two calcium channel blockers, verapamil and amlodipine, both administered as monotherapies, upon the sympathetic stress response in 23 randomized mild-to-moderate essential hypertensives (161 +/- 2/98 +/- 1 mmHg). Patients performed four stress tests (mental arithmetic, colour word Stroop, cold pressor and handgrip) while extracardiovascular and haemodynamic functions were assessed non-invasively at every heart beat, during baseline, stress and recovery phases. The sympathetic response was evaluated by computing the 'area-under-the-curve' (value x time) measured during the psychophysiological session. The session was repeated at run-in, after placebo and during treatment. After one month's treatment, baseline blood pressure was significantly reduced in patients treated with amlodipine (139 +/- 1/84 +/- 1 mmHg; P < 0.001) and verapamil (140 +/- 2/85 +/- 1 mmHg; P < 0.001). The emotional arousal (frontalis muscular contraction, skin conductance) was unchanged, but the cutaneous vascular response was reduced (P < 0.05) in patients treated with verapamil. No changes in systolic or diastolic blood pressure were detectable, but amlodipine increased the heart rate response (P < 0.05). In contrast, verapamil reduced the heart rate (P < 0.05) without depressing the cardiac output response, which was increased with amlodipine (P < 0.05). Total vascular resistance was significantly (P < 0.001) reduced with both the treatments. Consequently, functional cardiac load, expressed by pressure-rate product and cardiac power, was significantly enhanced with amlodipine and reduced with verapamil. In conclusion, the abnormal sympathetic stress response, which characterizes the hypertensive patient, might be affected by the choice of medication. Verapamil in particular, moderated emotional arousal, the vasoconstrictive response and reduced cardiac load without lowering cardiac output demands. In contrast, in patients treated with amlodipine, in whom the cardiac output response was increased, the pattern was reversed and the functional cardiac load was also increased.

Adult↗
PubMed1995

[Bioadhesives: rationale, state of the art and therapeutic potential].

Pharmaceutical research is going on the way to formulate drugs in dosage forms and delivery systems able to improve their biopharmaceutical properties. For some routes of administration, among them the transmucosal ones, such improvements may be reached by increasing the time and the nature of the contact between mucosal tissues and drug dosage forms via chemical or physical bioadhesive links. Biopharmaceutical AFI Study Group efforts were oriented in analyzing the actual state of the art in the field of bioadhesive drug delivery. Rationals of use of drug dosage forms with bioadhesive properties, analytical method of control of bioadhesion (both in vitro and in vivo) and therapeutical potentialities are the matter of this review.

Animals↗
PubMed1994

Single-donor platelet concentrates produced along with packed red blood cells with the Haemonetics MCS 3p: preliminary results.

There has been an increasing interest in recent years over the qualitative superiority of single-donor platelets in the management of hemato-oncologic patients. The reasonable desire of both patients and physicians to limit the risks of transfusion along with the need for limiting the costs involved in this kind of therapy have led to application of multicomponent donations both in terms of double platelet concentrates and double products such as red blood cells (RBC) and platelets from the same donor. Single donor platelets and RBC have been collected in a semi-automated mode and only the very recent introduction of the Haemonetics MCS 3p with its SDP/RBC protocol provides a totally closed-system automated protocol for this combined collection. Twenty procedures have been carried out so far at our unit. In a mean of 87 minutes (6-7 passes), a mean of 3.1 x 10(11) platelets were collected along with approximately 220 mL of packed RBC. The leukocyte contamination of the platelet product was in the range of 0.4-1.1 x 10(7) (99% lymphocytes), and the quality of platelets was very satisfactory as measured by the hypotonic shock response, aggregation induced by ADP, collagen and ristocetin, morphology score, and membrane glycoproteins modifications. Equally satisfactory was the quality of the RBC concentrate, suspended in 80 mL of SAG-M, with a total hemoglobin (Hb) content approaching 55 g as compared to the normal Hb content of a standard RBC concentrate that is approximately 62 g.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[The new role of psychiatry in the management of mentally retarded patients].

The areas of remedial education and special education have profoundly changed the psychiatric care of mentally retarded persons. Desinstitutionalisation, normalisation and integration are widely recognised concepts today and have since gained relatively substantial empirical support. Definition of these concepts has been broadened to include consideration of the optimal management of environmental conditions as an integral part of the comprehensive living environment. The systemic-ecological approach dislodges psychiatry from its central position in the treatment of the mentally ill retarded, and invests a greater degree of trust in remedial educations and special education. Effective treatment thus involves a joint effort on the part of various mental health professionals working towards a common goal, grounded on the coexistence of mental retardation and mental illness. Psychotherapy should be devised so as to address cognitive deficits no longer considered to be contraindicative to the therapy process. The purpose of pharmacotherapy is to finetune psychotropic medication with pedagogical, psychoeducational and psychotherapeutic methods. Although community-based mental health delivery systems and comprehensive (institutional based) services both show promise for the care and treatment of mentally retarded persons there is evidence for the particular viability of the latter model due to prevailing present conditions and to the aspect of cost effectiveness, particularly due to its utility in promoting still acquisition relevant to workers in this field of mental health.

Activities of Daily Living↗
PubMed1994

[Post-traumatic pseudoaneurysm of the common carotid artery].

The authors report their experience of one single case of carotid pseudo-aneurysm consequent on cervical trauma. The treatment required the substitution of the interested carotid segment by PTFE no. 6. This case is a rare event but the surgeon must always keep it in mind in the presence of cervical trauma.

Accidents, Traffic↗
PubMed1994

Diabetes modifies cardiovascular reactivity during hypertension.

Hypertension and diabetes often occur in the same patient, and this observation inspired the search for a new common pathogenetic hypothesis. The onset of diabetes during hypertension also could modify cardiovascular autonomic arousal. To identify a peculiar hemodynamic and psychophysiologic reactivity, a male population of mild essential hypertensive (166 +/- 6/102 +/- 8 mm Hg) patients (EH) and non-insulin-dependent hypertensive (169 +/- 10/101 +/- 7 mm Hg) diabetic subjects (HD) underwent a session of stress tests. Four tests, Mental Arithmetic, Incomplete Phrases, Cold Pressor, and Handgrip, were preceded and followed by a 10-minute recovery period. Functional tests were performed to identify any possible cardiac autonomic neuropathy. During the entire session, by means of a beat-to-beat noninvasive computerized device, hemodynamic and extracardiovascular functions were measured. The findings suggested the presence of a sympathetic hyperactivity in both HD and EH. In particular, HD showed a peculiar "tropism" for the peripheral vasculature. In these patients, in fact, total vascular resistance and peripheral temperature responses were 89.2% and -64.2%, respectively, versus 33.7% and -50.6%, which were found in EH. On the other hand, the ejection ventricular index was more depressed in HD (-27.9%) than in EH (-23.8%), although they did not seem to be affected by cardiac autonomic damage. The different profiles appear to confirm the increase of functional vascular damage in diabetic hypertensive patients, probably because of the insulin resistance or obsolete muscular cardiac damage.

Autonomic Nervous System↗
PubMed1994

Lipids and cardiovascular reactivity changes in hypertensive cigarette smokers: enalapril versus nifedipine treatment effects.

Cigarette smoking has many effects on the cardiovascular system, psyche, and serum lipids, which can create a vicious circle that is pejorative to the well-being of hypertensive patients, even if they are under pharmacologic treatment. To investigate the effect of two different antihypertensive agents, nifedipine and enalapril, on cardiovascular reactivity and lipoprotein patterns in cigarette smokers with hypertension, 92 essential hypertensive (175 +/- 11/103 +/- 8 mm Hg) subjects were studied, who had no sign of lipidosis, and subdivided into four groups in order of smoking habit and therapy. Over a 30-month follow-up period, the percentage changes in blood pressure (BP), heart rate (HR), triglycerides, total cholesterol, high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol were evaluated while the patients underwent a session of psychophysiologic tests to assess sympathetic reactivity. The response was calculated through the difference in cumulative percentage changes (DC%) in systolic blood pressure (SBP), diastolic blood pressure (DBP), HR, muscular contraction (EMG), skin conductance (SCL), and peripheral temperature (TP). The office BP was reduced significantly in all groups. In the nonsmokers, enalapril reduced (p < 0.05) the SCL-, TP-, SBP-, and DBP-DC% reactivity, lowered (p < 0.05) TR, C-tot, and LDL, and increased (p < 0.05) the HDL. However, nifedipine magnified the sympathetic responses and the atherosclerotic lipoproteins and decreased (p < 0.05) the HDL.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Stress response and antihypertensive treatment.

Results from many studies suggest that the central nervous system may play an important role in enhancing and maintaining sympathetic, metabolic and haemodynamic effects in patients with hypertension. Likewise, emotional and mental stresses may provoke phasic and sustained adrenergic responses in normotensive and untreated hypertensive patients. Because the various antihypertensive medications have different mechanisms of action, and elicit different neurovegetative responses, it is useful to distinguish between the effects of different treatments on sympathetic activity. To identify the effect of stress on sympathetic reactivity, we evaluated the extracardiovascular and haemodynamic responses to various stressor agents using noninvasive techniques. This psychophysiological approach allowed us to standardise stress, to identify individual cardioneurovegetative responses both before and during treatment, and to establish the effects of various treatments on the cardioneurovegetative response. The extracardiovascular psychophysiological response of patients with a family history of hypertension and of normotensive patients who later became hypertensive was characterised by an inability to recover after mental challenge. Therefore, prolonged sympathetic activity resulting from mental stimulation may contribute to the development of hypertension. Antihypertensive medications affected sympathetic reactivity differently. For example, nifedipine worsened sympathetic reactivity, while verapamil was able to correct abnormal neuroadrenergic responses. Furthermore, verapamil was successfully combined with enalapril in patients whose hypertension was resistant to monotherapy with the angiotensin converting enzyme (ACE) inhibitor. Therefore, the functional and structural consequences of sympathetic stimulation resulting from daily activation and pharmacological blood pressure adjustments are important in hypertensive patients, because they may have abnormal sympathetic reactivity to various stimuli.

Antihypertensive Agents↗
PubMed1992

[Carotid-subclavian bypass. Our experience with locoregional anesthesia].

Carotid-subclavian bypass has been adopted since 1956. The commonest indication is to abolish arterial occlusion or stenosis in patients with subclavian steal syndrome. Ten patients were submitted to carotid-subclavian bypass under regional anaesthesia: block of anterior rami of spinal nerves C3-C4 and block of cervico-brachial plexus by injection into the continuous perineural connective tissue space at the level of C6. The surgical procedure required carotid occlusion and cerebral function monitoring. The advantages of regional anaesthesia are the ability to monitor the patient's cerebral perfusion and function, to detect intraoperative ischaemia and embolisation and minimal interference with the cardiovascular and respiratory function.

Aged↗
PubMed1992

Borderline hypertension: relationship between job and psychophysiological profile.

To identify relationships among hypertension, job and cardiovascular reactivity we studied 81 borderline hypertensives divided into labourers (L), white collars (W) and managers (M). After behavioral analysis, they underwent 4 tests: arithmetic, Sacks, acoustic, electric. Along the entire sitting, muscular contraction, skin conductance (SCL), peripheric temperature (THP), SBP, DBP and HR were taken, every 30". Depression, obsessive-compulsive, anxiety and neurotic traits were found in W. SBP, DBP and HR were not significantly different. Failed recovery curves of SCL were identified in M and W, but the presence of abnormal response profile, of both, SCL and THP, only in W. This autonomic dysreactivity, previously recognized as a possible characteristic of the prehypertensive condition, could uncover the role of certain work stressful condition to increase the sympathetic drive underlying hypertension.

Adult↗
PubMed1992

[Left ventricular hypertrophy: physiopathological signs using a hemodynamic and cardio-autonomic approach].

The presence of left ventricular hypertrophy (LVH) in either hypertensives -H- or in normotensives -N-, suggests that not only blood pressure is determining this anatomic change, but various factors, as neural or endocrine ones, could be involved in its genesis. In order to evaluate the role of sympathetic dys-reactivity on LVH, we studied three groups of subjects: a) 12 -H- (SBP 159+/-9; DBP 99.6+/-7; FC 80+/-7) with LVH, diagnosed by echocardiogram. b) 12 -N- (SBP 138.2+/-8; DBP 83+/-2; FC 75.6+/-4) with LVH. c) 12 -N- (SBP 136.6+/-11; DBP 81.8+/-5; FC 76.3+/-5) without LVH. Using computer interfaced equipment, we measured beat to beat, hemodynamic and extra-cardiovascular autonomic functions, during a session of stressors (Mental Arithmetic, Color Word Stroop, Cold Pressure and Handgrip Tests), preceded and followed by 10' of observation. Among the various considered indexes, we evaluated the Percentual Total Activity Index (PTAI), as percentual total activity change + percentual total recovery change. Our findings point out that the PTAI of N with LVH is significantly higher for SCL, PHT, HR, SV, CO, TPR than either in H with LVH or N without LVH. These data seem to demonstrate a prolonged reactivity in N without LVH and are according to the hypothesis that LVH could also be supported by a hyper-adrenergic state with sympathetic dys-reactivity, independently from high blood pressure values.

Heart Conduction System↗
PubMed1992

[Loco-regional anesthesia vs general anesthesia in carotid endarterectomy. Response to the surgical stress].

The advantages of performing carotid endarterectomy in the awake patient, perioperative analgesia, circulatory parameters, plasma cortisol and PRL response to surgery have been evaluated. Ten patients were submitted to general anaesthesia and ten patients to superficial and deep cervical block. The Authors conclude that, although the number of patients studied is limited, there are no significant differences between the two groups for intraoperative analgesia, hemodynamic imbalance and plasma cortisol and PRL. This result support the belief that carotid endarterectomy in awake patients can be safely performed on patients with chronic obstructive pulmonary disease.

Aged↗