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Biomedical subjects

M Turiel

Publications and source records attributed to M Turiel.

At least 37 records · Page 2Linked to original sources
PubMed1988

[Effect of the sympathetic activation and its inhibition on left ventricular mechanics in mitral prolapse. Echocardiographic study in 35 patients].

Mitral valve prolapse (MVP) is characterized by arrhythmias, atypical anginal chest pain and left ventricular (LV) wall motion abnormalities. The role of autonomic nervous system (ANS) as the origin of these disturbances is still debated. The aim of the study was to determine the possible interference between left ventricle (LV) mechanics and ANS. 35 consecutive patients with MVP (24 female, 11 male) (mean age 30 +/- 9 years), matched with a homogeneous control group, were examined by means of 2D-Echo during resting conditions and during sympathetic activation induced by passive orthostatism (90 degrees Tilting). At rest, no significant difference was found between the two groups regarding heart rate (HR), LV volume (LVV), ejection fraction (EF). Tilting produced a significant increase in HR (p less than 0.1) and LVV reduction (p less than .01) in both groups; on the other hand, EF did not change significantly. At 2D-Echo, LV abnormal wall motion at rest in 10/35 (29%) MVP, increasing to 17/35 (49%) was found during Tilting. This abnormality consisted in LV wall reduced systolic thickening and motion, localized in the antero-apical region in 11 patients (54%) and in the posterior wall in 6 patients (36%). Thirteen MVP patients with LV abnormal contraction patterns were re-examined after two weeks of beta-adrenergic blockade (200 mg Metoprolol orally per day). In all of them, LV abnormalities disappeared while LVV and EF remained unchanged. These data stress the role of the ANS in inducing LV abnormalities in patients with MVP.

Adolescent↗
PubMed1987

Pain threshold and tolerance in women with syndrome X and women with stable angina pectoris.

A recent report showed that during Holter monitoring of patients with syndrome X (typical anginal pain, positive exercise test response [at least 0.1 mV of ST-segment depression], no evidence of coronary spasm and angiographically normal coronary arteries), 50% of episodes of ischemic ST-segment depression were painful. This proportion is considerably higher than that in patients with chronic stable angina, which is about 30%. A significantly lower threshold and tolerance to painful stimuli was seen in a group of patients with chronic stable angina in whom 50% of episodes were painful compared with a group in whom only 5% of episodes were silent. Hence, patients with syndrome X may have enhanced sensitivity to painful stimuli. To investigate whether this difference was due to a lower threshold for painful stimuli in general, 12 patients with syndrome X and 10 (age- and sex-matched) with chronic stable angina were studied using the same battery of painful stimuli. Patients with syndrome X had a significantly lower threshold and tolerance for forearm ischemia (-36%, p less than 0.05, and -40%, p less than 0.001) and electrical skin stimulation (-37%, p less than 0.01, and -35%, p less than 0.001); the cold pressor test did not show significant differences (-7%, p = 0.391, and -1%, p = 0.818). Thus, patients with syndrome X in this study had significantly lower threshold and tolerance values for forearm ischemia and for electrical skin stimulation. These differences in sensitivity to pain may partly explain a higher incidence of painful ischemic episodes detected by ambulatory electrocardiographic monitoring during unrestricted daily life.

Angina Pectoris↗
PubMed1985

Informative value of simple multibreath nitrogen washout measurements for clinical and research purposes.

Some simple multibreath nitrogen washout indexes quantifying inspired gas distribution and ventilatory efficiency were obtained in a group of patients with mild to advanced chronic obstructive pulmonary disease (COPD) and studied in their relationships with routine pulmonary function tests. The indexes (lung clearance index (LCI), mixing ratio (MR) and data obtained by graphic analysis of the washout curve) were correlated with spirometric, pulmonary mechanics and arterial blood gas measurements, but only 8-38% of the interindividual variation in these indexes was explained by the above routine tests. An additional 5-13% of the variation was explained by the washout tidal volume (VT); this finding may reflect changes in gas distribution with VT and/or the influence of the dead space on ventilatory efficiency. Our data indicate that, in patients with COPD, nitrogen washout indexes tend to change in parallel with routine pulmonary function tests, reflecting the severity of the disease; these indexes also contain specific information (in addition to that provided by routine physiologic tests), presumably related to the distribution and efficiency of ventilation. Nitrogen washout measurements may thus represent a helpful adjunct to routine pulmonary function testing; LCI and MR appear to be particularly convenient for practical purposes because of their simplicity, and an informative content comparable with that of more complex indexes.

Adult↗
PubMed1983

Pulmonary resistance and dynamic compliance as functions of respiratory frequency.

The behavior of pulmonary resistance (RL) and that of dynamic compliance (Cdyn) as functions of respiratory frequency (f) were compared in normal subjects and in patients with chronic obstructive pulmonary disease (COPD). Although both RL and Cdyn varied with f in most COPD patients and in some normal subjects, Cdyn appeared to be more sensitive than RL to variations of frequency; no significant changes in RL could be demonstrated in subjects in whom Cdyn was frequency dependent. The degree of frequency dependence of Cdyn was correlated with the severity of respiratory impairment (as quantified by conventional pulmonary function tests); in contrast, RL was not detectably frequency dependent in some subjects with advanced COPD. Compared with Cdyn, RL was more commonly nonlinearly related to respiratory frequency, often increasing at high breathing rates. Our results indicate that changes in RL with frequency are less predictable and more difficult to detect than the corresponding changes in Cdyn.

Adult↗
PubMed1982

Hypocapnia and measurement of airflow resistance and dynamic compliance as functions of respiratory frequency.

Measurements of lung mechanical behaviour as a function of respiratory frequency may be associated with significantly increased ventilation at high breathing rates. It follows that these measurements may be influenced by hypocapnia which has been shown to increase airflow resistance and to decrease dynamic compliance. To examine this possibility we continuously monitored the end-tidal CO2 tension during the determination of pulmonary resistance and dynamic compliance as functions of frequency and we compared measurements obtained by the standard method and by a technique designed to prevent the development of hypocapnia at high breathing rates. We studied 11 patients with chronic obstructive pulmonary disease and also two smokers with normal spirometry and resistance. Although conventional measurements at frequencies higher than 40-45 breaths/min were associated with a significant decrease in end-tidal CO2, no systematic differences were found between the values of pulmonary resistance and dynamic compliance obtained by the two techniques. Our data indicate that the development of hypocapnia at high breathing rates does not significantly affect measurements of resistance and compliance as functions of frequency, at least when the duration of each period of hyperventilation is limited to the minimum necessary for a single determination, which was less than 30 seconds in the present study. A comparison of our results with previously published data suggests that the time factor may be critical with respect to the possible effects of hypocapnia on these measurements.

Adult↗
PubMed1982

Effects of bronchodilators on the behavior of pulmonary resistance and dynamic compliance as functions of respiratory frequency.

The effects of bronchodilator treatment (intravenous atropine or inhaled metaproterenol) on the behavior of pulmonary resistance (RL) and dynamic compliance (Cdyn) as functions of respiratory frequency were studied in patients with chronic obstructive pulmonary disease and in apparently normal smokers. No systematic changes in the frequency-dependent behavior of RL and Cdyn were observed after bronchodilator treatment; the degree of frequency dependence increased in some subjects, and decreased or remained unchanged in others. The present results suggest that the effects of bronchodilators on the relationships between lung mechanical properties and respiratory frequency are not based on a single mechanism, but probably reflect the interaction of multiple factors possibly associated with the bronchodilator treatment.

Adult↗
PubMed1976

Effects of an inhaled bronchodilator on gas distribution and over-all ventilatory efficiency in patients with chronic obstructive pulmonary disease.

The effects of an inhaled bronchodilator on the distribution of inspired gas and over-all efficiency of ventilation were studied by the nitrogen washout technic in 16 patients with chronic obstructive pulmonary disease; three normal subjects and two patients with asymptomatic asthma (and normal spirometric values) were also studied. In normal and asthmatic subjects and in patients with chronic obstructive pulmonary disease and mild to moderate functional impairment, the nitrogen clearance did not vary significantly or showed changes suggesting less uniform gas distribution and reduced ventilatory efficiency. In most patients with advanced chronic obstructive pulmonary disease, the bronchodilator caused changes suggesting more uniform distribution of inspired gas and increased efficiency of ventilation. Multiple regression analysis showed that the behavior of the nitrogen clearance after treatment was also related to the response of the anatomic dead space. The effects of the bronchodilator varied with time. The results are consistent with the assumption that the changes in nitrogen clearance after bronchodilator therapy reflect the concourse of multiple factors, which may be expected to have favorable or unfavorable effects on the distribution of inspired gas and the efficiency of ventilation.

Adult↗
PubMedDate not supplied

Hypersomnolence in fibromyalgia syndrome.

OBJECTIVE: To evaluate hypersomnolence in patients affected by fibromyalgia syndrome. METHODS: Thirty consecutive patients affected by fibromyalgia syndrome (FMS) (28 F) completed a sleep questionnaire and underwent the following evaluations: lung function tests; polysomnography; the Epworth sleepiness scale (ESS), which measures sleep complaints and daytime hypersomnolence; and the visual analogical scale (VAS) to detect subjective pain, fatigue, anxiety and depression. RESULTS: The FMS patients were divided into two groups based on their ESS score. Patients complaining of daytime hypersomnolence had a higher number of tender points (15 +/- 2 vs. 12 +/- 1, p < 0.01), a higher subjective pain score (72 +/- 15 vs. 52 +/- 13, p < 0.05), and more fatigue (p < 0.05). The diffusing capacity of the lung (Tlco) was more impaired and the occurrence of periodic breathing was higher. FMS patients complaining of daytime somnolence had significantly less efficient sleep than the FMS patients with no daytime somnolence (p < 0.05), i.e. a lower proportion of stage 3 sleep (5 +/- 2% vs. 12 +/- 3%; p < 0.001), stage 4 sleep (1 +/- 0.5% vs. 4 +/- 1%; p < 0.001), and twice as many arousals per hour of sleep (p < 0.01). The respiratory pattern of FMS patients with hypersomnolence showed a higher occurrence of periodic breathing (p < 0.05). The short length of apneas and hypopnoeas did not affect the apnea/hypopnea index (5.1 +/- 3 vs. 7 +/- 4; ns), but FMS patients with daytime hypersomnolence had a greater number of desaturations per hour of sleep (11 +/- 6 vs. 6 +/- 5; p < 0.05). Pulmonary volumes did not differ between the two groups. The EES score was significantly correlated in FMS patients, and even more markedly in the FMS patients with hypersomnolence, TLco, A/I, and disease duration. The ESS score was correlated significantly with the number of tender points only in FMS patients with daytime hypersomnolence. CONCLUSION: The occurrence of daytime hypersomnolence in FMS patients is linked to a greater severity of fibromyalgia symptoms and to more severe polysomnographic alterations.

Adult↗
PubMedDate not supplied

Validation of an Italian version of the Fibromyalgia Impact Questionnaire (FIQ-I).

OBJECTIVE: To validate a translated Italian version of the Fibromyalgia Impact Questionnaire (FIQ). METHODS: The Italian version of the FIQ was administered to 50 patients affected by fibromyalgia (FM) (48 patients filled out the questionnaire again 10 days later) together with the Italian version of the Stanford Health Assessment Questionnaire (HAQ), the Medical Outcomes Survey Short Form-36 (SF-36), and a tender point count (TPC) obtained by summing the score (0-3) of each tender point tested by thumb palpation. All patients were asked about the severity of pain today (10 cm visual analog scale) and the duration of symptoms. Test-retest reliability was assessed using Spearman correlations. Internal consistency was evaluated with Cronbach's alpha of reliability. Construct validity of the FIQ was evaluated by correlations between the HAQ and subscales of the SF-36 as well as the TPC. RESULTS: The mean duration of symptoms was 6.5 years and the mean age of the participants was 57.4 years. Test-retest reliability was between 0.74 and 0.95 for physical functioning as well as for the total FIQ and other components. Internal consistency was 0.90 for the overall FIQ. Significant correlations were obtained between the FIQ items, the HAQ and the SF-36. CONCLUSIONS: The Italian FIQ is a reliable and valid instrument for detecting and measuring functional disability and health status in Italian patients with FM.

Activities of Daily Living↗