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M Traina

Publications and source records attributed to M Traina.

At least 19 recordsLinked to original sources
PubMed1992

Prevention of first bleeding in cirrhosis. A meta-analysis of randomized trials of nonsurgical treatment.

OBJECTIVE: To assess the effectiveness of beta-blockers and endoscopic sclerotherapy in the prevention of first bleeding and reduction of mortality in patients with cirrhosis and esophagogastric varices. DATA SOURCES: Pertinent studies were selected using MEDLINE (1980 to 1990), reference lists from published articles or reviews, and congress abstract lists. STUDY SELECTION: Randomized trials comparing beta-blockers or sclerotherapy with a nonactive treatment. Nine randomized clinical trials of beta-blockers and 19 trials of sclerotherapy were reviewed. Seven trials of beta-blockers and 15 of sclerotherapy were published as full papers. DATA EXTRACTION: Crude rates of bleeding and death in treated and control groups were extracted from each trial by three independent observers according to the intention-to-treat principle. The quality of published papers was systematically assessed and scored. DATA SYNTHESIS: The Mantel-Haenszel-Peto method was used for statistical evaluation of heterogeneity and for pooling of the results. No substantial heterogeneity was found, and the incidence of bleeding in trials of beta-blockers was significantly reduced (pooled odds ratio, 0.54; 95% CI, 0.39 to 0.74), particularly in patients with large or medium-sized varices or in those with varices and a hepatic vein pressure gradient above 12 mm Hg; however, only a trend toward reduced mortality was obtained. Sclerotherapy trials were highly heterogeneous in the direction of the treatment effects on both bleeding (pooled odds ratio, 0.6; CI, 0.49 to 0.74) and mortality (pooled odds ratio, 0.76; CI, 0.61 to 0.94). The quality of the trials and the rate of bleeding in the untreated groups were the major sources of heterogeneity. The favorable results of sclerotherapy were obtained in trials with high bleeding rates among controls; several of these trials had a low quality score. CONCLUSIONS: Beta-blockers may be recommended for prevention of first bleeding in cirrhotic patients with varices who have a high risk for bleeding. The effectiveness of sclerotherapy remains undetermined. Further trials in high-risk patients may prove useful if improved criteria to predict bleeding risk become available.

Adrenergic beta-Antagonists↗
PubMed1990

Quantitative analysis of ventricular late potentials in healthy subjects.

Signal averaging is a technique that improves the signal-to-noise ratio. Obscuring random noise, it allows the detection of low-amplitude wave forms in the terminal portion of the QRS complex, also known as ventricular late potentials. A higher incidence of arrhythmic events has been found in patients with abnormal ventricular late potentials after an acute myocardial infarction. Few studies have been conducted in healthy subjects to assess normal values. Sixty-one healthy subjects were enrolled in our study (33 men and 28 women). The results (mean +/- standard deviation) are as follows: duration of the filtered QRS (QRS duration) was 95 +/- 10 ms; duration of the low-amplitude signals in the terminal portion of QRS less than 40 microV (LAS less than 40) was 32 +/- 8 ms; and root-mean-square voltage in the last 40 ms (RMS - 40) was 33 +/- 16 microV. A significant difference was noted in QRS duration between men and women (98 +/- 11 vs 92 +/- 6 ms, p = 0.006); no difference was found in LAS less than 40 (31 +/- 8 vs 34 +/- 8 ms) and in RMS-40 (36 +/- 17 vs 30 +/- 13 microV). QRS duration confidence limits of 95% were less than or equal to 114 ms for the total group, less than or equal to 120 ms for men and less than or equal to 104 ms for women. Normalization of QRS duration for height (normal value less than 66 ms/m) eliminated any difference between men and women.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Natural history of congestive gastropathy in cirrhosis. The Liver Study Group of V. Cervello Hospital.

In a prospective study of the natural history of congestive gastropathy, 212 consecutive cirrhotic patients (75 treated with sclerotherapy) were included. Mean follow-up was 46 months. Mild gastropathy (mosaiclike pattern) was found in 110 patients and severe gastropathy (granular mucosa with cherry spots) was found in 20. Prevalence of Helicobacter pylori, formerly Campylobacter pylori, was 50% in patients without, 43% in those with mild, and 28% in those with severe gastropathy. Congestive gastropathy was significantly more frequent in patients treated with sclerotherapy (83% vs. 50%, P less than 10(-5)). Sixty-month actuarial proportions of patients free of anemia (in the absence of hematemesis or melena), were 17% with severe, 62% with mild, and 93% without gastropathy (P less than 10(-8]. Corresponding figures for overt bleeding were 25%, 73%, and 87% (P less than 10(-7], whereas those for survival were 46%, 72%, and 85% (P = 0.0005), respectively. A multivariate regression analysis supported the following conclusions: (a) sclerotherapy and the presence of large esophageal varices significantly increase the risk of congestive gastropathy, which (b) is a significant risk indicator of both chronic and overt bleeding but does not independently affect survival.

Adult↗
PubMed1990

[Electrocardiographic indices of reperfusion and limitation of the necrotic area in acute myocardial infarct].

The aim of this study was to assess the evolution of ST segment displacement and the formation of new Q waves in relation to the late angiographic demonstration of recanalization of the infarct-related vessel in 36 patients with acute myocardial infarction admitted in our Institution within 8 hours from the onset of symptoms. Eighteen patients were treated with intravenous urokinase (200,000 + 1,200,000 UI) followed by sodium-heparin 1,000 U/ev/hour for 48 hours and calcium-heparin 3,000 UI/10 Kg/12 hours from the third day to discharge. Eighteen patients were treated from admission only with calcium-heparin as seen before. All the patients have been followed with serial electrocardiograms; we evaluated the sum of ST displacements (ST12) and Q waves score (Q12) in the 12 standard leads on admission, and on the twelfth, twenty-fourth, forty-eighth hour, and on discharge. On the basis of the late angiographic findings and apart from the treatment, we divided the patients into 2 groups: patients with recanalization of infarct-related vessel (20 patients, 55.5%) and patients with occlusion of the infarct-related vessel (16 patients, 44.6%). We did not observe statistically significant differences between the 2 groups for decrease of ST segment displacement of formation of new Q waves, even if reperfused patients showed a more rapid and complete decrease of ST segment displacement and a more rapid formation of new Q waves with respect to occluded patients. Our data indicate that from a clinical point of view electrocardiographic indices are not a sensitive marker of recanalization of infarct-related vessel.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1990

[Short- and long-term effects of enalapril on the left ventricular function in patients with congestive heart insufficiency].

Several studies have demonstrated that enalapril causes a clinical and hemodynamic improvement in patients with congestive heart failure. Nevertheless, the drug capability of influencing left ventricular systolic and diastolic indexes has not been evaluated. In 12 patients with severe congestive heart failure (NYHA class III-IV), treated with digitalis and diuretics, we performed a baseline evaluation through a right heart catheterization, echocardiography and radionuclide ventriculography. The effects on left ventricular systolic and diastolic function indexes after the administration of enalapril 5 mg by oral route have been evaluated. After 3 months of chronic therapy with enalapril 5 mg twice daily, we performed a further evaluation through echocardiography and radionuclide ventriculography. At the acute test we observed a significant improvement of left ventricular ejection fraction (EF), left ventricular stroke index (LVSI), and peak of filling rate (PFR), with a significant reduction of pulmonary wedge pressure (PWP) and peripheral vascular resistance (PVR). After 3 months of chronic therapy EF was significantly increased with respect to baseline values (37 +/- 6.9% vs 28.7 +/- 7.9%, p less than 0.05) and showed a further increase after the drug administration (from 37 +/- 6.9% to 48 +/- 5.4%, p less than 0.001). PFR showed a similar behaviour and reached at the follow-up evaluation normal values (from 1.97 +/- 0.7 edv/s to 2.57 +/- 0.6 efv/s, p less than 0.001). Furthermore, the echocardiographic dimensions of the left ventricle decreased significantly with a significant increase of shortening fraction. In conclusion, our study demonstrates that in patients with severe congestive heart failure enalapril improves the left ventricular systolic and diastolic function indexes and this improvement is persistent.

Aged↗
PubMed1986

[Controlled study of the effect of long-term administration of canrenoate potassium in cirrhotic ascites].

Two groups of patients with water retention due to ascites in cirrhosis of the liver were treated with antialdosterone diuretics (42 cases with K-canrenoate and 48 cases with spironolactone) for prolonged periods of time (an average of more than 5 months). Both substances were seen to be active, re-equilibrating sodium and water balance, bearing in mind a few methodologic limitations described in the text. Investigation of possible side effects showed that the incidence of gynecomastia, which is fairly common with spironolactone, was considerably reduced or practically absent with K-canrenoate.

Adult↗
PubMed1986

Predictive value of ultrasonography in the screening of non-ascitic cirrhotic patients with large varices.

To evaluate the accuracy of ultrasonography in the screening of cirrhotic patients with large varices, the receiver operator characteristic (ROC) curves of the portal, mesenteric, and splenic veins of 215 consecutive non-ascitic patients were plotted in order to select the most indicative optimal threshold. The contribution of respiratory variations of splenic and mesenteric veins was also evaluated. Taking 13 mm as the limit for the normal diameter of the portal vein, 10 and 9 mm for the upper limits of the mesenteric and splenic veins, respectively, and respiratory variations being absent, the positive rates were 91, 88, and 92 per cent and the false-positive rates were 44, 38, and 42 per cent, respectively. The predictive values of a positive test were 0.34, 0.33, and 0.34, respectively, and the predictive values of a negative test were 0.96 for the portal and mesenteric veins and 0.97 for the splenic vein. Because the portal vein is always visible, the portal diameter may be employed in the screening through the presence of large varices in association with the assessment of respiratory variation in the splenic or mesenteric diameter. A cut-off point of 13 mm and the absence of respiratory variations precludes the need for endoscopy in 47 per cent of patients.

Endoscopy↗
PubMed1984

Circulating immune complexes containing IgG, IgA and IgM in patients with myocardial infarction: detection with C1qSP and anti C3SP.

Immunological reactions have been recognized in cardiac disease and immune complexes (ICs) have been suggested to be of pathogenetic significance in the occurrence of post-myocardial infarction syndromes. ICs of IgA, IgG, IgM class have been detected in myocardial infarction utilizing a C1qSP and an anti C3 assay. A poor concordance was found between the two methods. Early pericarditis was found to be associated with the presence of ICs, suggesting that ICs may play a role in developing pericarditis or that they may be considered a marker of pericarditis by an immunological mechanism.

Aged↗
PubMed1984

[Training effect and hemodynamic parameters in myocardial infarct patients undergoing rehabilitation].

Thirty-five patients with previous myocardial infarction underwent a programme of supervised physical rehabilitation. Twenty-two patients achieved a training effect (TE), after rehabilitation, i.e. a decrease of the double product (DP) for corresponding work loads and an increase of their physical work capacity (PWC). Thirteen patients, despite the absence of any clinical signs of decreased performance, did not obtain the above mentioned haemodynamic effects. In all of the patients the ejection fraction (EF) both at rest and during exercise was measured using a nuclear stethoscope. In patients with TE, the EF was 57 +/- 5% at rest, and 64 +/- 9% during exercise; in patients without TE the EF was 52 +/- 8% at rest and 46 +/- 10% during exercise. The correlation between TE (delta% PWC) and EF at rest and during exercise respectively, is positive and statistically significant, but there is a higher (r = 0,73) and more significant (p less than 001) correlation between delta% PWC and EF during exercise.

Adult↗