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Biomedical subjects

P Fioretti

Publications and source records attributed to P Fioretti.

At least 145 records · Page 8Linked to original sources
PubMed1987

Prognostic value of predischarge 12 lead electrocardiogram after myocardial infarction compared with other routine clinical variables.

The prognostic value of QRS score (Selvester), ST depression, ST elevation, extrasystoles, P terminal force in V1, and QTc derived from the predischarge 12 lead electrocardiogram was assessed after myocardial infarction in 474 patients without intraventricular conduction defects, ventricular hypertrophy, or atrial fibrillation. The usefulness of these results in risk assessment was compared with that of other clinical data. During follow up 45 patients died. Logistic regression analysis showed that QRS score, ST depression, and QTc were independently predictive of cardiac mortality. When multivariate analysis was applied to clinical and electrocardiographic data together, however, the 12 lead electrocardiogram did not provide independent information additional to that provided by other routine clinical findings and laboratory tests such as a history of previous myocardial infarction, clinical signs of persistent heart failure, indication for digitalis or antiarrhythmic drugs at discharge, and enlarged heart on chest x ray. In conclusion, the electrocardiogram has important prognostic value; however, it is not powerful enough to further improve the risk assessment of post-infarction patients.

Aged↗
PubMed1987

Dexamethasone reduces the postcastration gonadotropin rise in women.

To investigate the influence of glucocorticoids on gonadotropin release in humans, we studied the effects of dexamethasone (DXM) administration on basal and GnRH-stimulated gonadotropin secretion in normal women after bilateral ovariectomy (OVR). From the 7th to the 14th day after OVR, 9 women received DXM (2.25 mg/day) and 13 women received placebo (control women). Plasma FSH and LH concentrations were measured before OVR and daily from the 7th to the 14th day after surgery. In addition, the FSH and LH responses to exogenous GnRH (10 micrograms, iv bolus dose) were determined in all DXM-treated women and in 5 control women on the 7th and 14th days after surgery. Plasma gonadotropin levels increased similarly in all women on the 7th day after OVR. DXM administration significantly limited (P less than 0.001) the progressive rise of basal LH and FSH levels from days 7 to 14. DXM treatment also blunted (P less than 0.005) the OVR-induced increase in the responsiveness of both LH and FSH to exogenous GnRH. These findings suggest that glucocorticoids inhibit the secretion of both gonadotropins at the pituitary level in ovariectomized women.

Adult↗
PubMed1987

Pulsatile luteinizing hormone release in postmenopausal women: effect of chronic bromocriptine administration.

Pulsatile LH release was studied in 28 healthy postmenopausal women by obtaining blood samples every 5 min for 4 h either basally or after 30 days of bromocriptine (BCT; 3.75 mg/day; n = 14) or placebo (n = 14) administration. Basally, mean plasma LH levels were 46.3 +/- 3.5 (+/- SE) and 53.4 +/- 4.6 mIU/mL in the BCT and placebo groups, respectively. Mean LH pulse frequencies were 4.2 +/- 0.3 and 4.0 +/- 0.4 pulses/4 h, mean pulse amplitudes were 19.2 +/- 1.9 and 20.1 +/- 1.5 mIU/mL, and mean interpulse intervals were 54.3 +/- 3.1 and 54.6 +/- 3.2 min in the two groups, respectively. BCT administration induced no significant changes in mean plasma LH levels, but it significantly (P less than 0.01) decreased LH pulse frequency (1.7 +/- 0.3 pulses/4 h) and amplitude (12.7 +/- 0.8 mIU/mL) and significantly (P less than 0.01) increased mean interpulse interval (126.1 +/- 17.5 min). Placebo administration did not induce any significant changes in pulsatile LH release. These results demonstrate that in postmenopausal women LH secretion is circhoral, and BCT administration can blunt LH pulsatility, suggesting dopaminergic regulation of the GnRH-LH pulse generator.

Bromocriptine↗
PubMed1987

Dose-related prolactin inhibitory effect of the new long-acting dopamine receptor agonist cabergoline in normal cycling, puerperal, and hyperprolactinemic women.

Two different single doses (400 and 600 micrograms) of the new long-acting dopamine agonist cabergoline (CBG) were given to 12 normal cycling women, 17 puerperal women, and 24 hyperprolactinemic women (12 with idiopathic hyperprolactinemia and 12 with pituitary adenoma). Plasma PRL was determined in blood samples collected before and at frequent intervals for 5 days after CBG administration. Both CBG doses induced marked inhibition of PRL secretion in all women. A decrease in plasma PRL levels was evident 1-2 h after CBG administration and persisted for up to 5 days. The 600-micrograms CBG dose had a more potent (P less than 0.05) PRL inhibitory effect than the 400-micrograms dose in normal, puerperal, and hyperprolactinemic women. Moreover, while 400 micrograms CBG prevented lactation in 3 of 7 puerperal women, 600 micrograms CBG prevented lactation in 5 of 5 puerperal women. A moderate blood pressure decrease occurred 3-6 h after CBG treatment, but no other side-effects occurred. These results demonstrate that CBG induces a dose-related inhibition of PRL secretion in normal women as well as in puerperal and hyperprolactinemic women. The potent long-lasting PRL inhibitory effect of CBG in conjunction with the absence of side-effects typical of dopaminergic compounds suggest that this drug is an advance in the medical treatment of hyperprolactinemia.

Administration, Oral↗
PubMed1986

Involvement of endogenous gabaergic system in the modulation of gonadotropin secretion in normal cycling women.

To investigate whether endogenous GABA participates in the control of gonadotropin secretion during the menstrual cycle, placebo or sodium valproate (DPA), an anticonvulsant drug which enhances endogenous GABA content by blocking GABA degradation, were administered to regularly cycling women both during early follicular and midluteal phase. In a first set of experiments, the effect of DPA administration (400 mg, orally) on basal gonadotropin secretion was evaluated in 13 subjects. During early follicular phase (n = 6), no significant changes in plasma gonadotropin levels were observed after DPA or placebo administration. Conversely, during midluteal phase (n = 7), DPA administration resulted in a significant fall (p less than 0.01) in plasma LH concentrations, with a maximal percent decrease of 41.8 +/- 6.7% after 120 min. No changes in plasma FSH levels were observed. In a second set of experiments, the effect of DPA pretreatment (400 mg, orally) on gonadotropin release stimulated by a pulse of exogenous GnRH (10 micrograms, iv bolus) was studied in 11 subjects. During both follicular (n = 4) and luteal phase (n = 7), DPA did not modify gonadotropin response to GnRH injected 1h after pretreatment. Finally, 8 subjects were submitted to iv injection with 10 micrograms GnRH 2h after pretreatment with DPA (400 mg, orally) or placebo. During both follicular (n = 4) and luteal phase (n = 4), no statistical differences in gonadotropin response to GnRH were found between DPA and placebo pretreatment. These findings demonstrated that during the estrogen-progesterone (midluteal) phase of menstrual cycle, endogenous GABA is involved in the inhibitory regulation of LH secretion at a central level.

Adult↗
PubMed1986

Effects of different dopamine agonists and antagonists on post-menopausal hot flushes.

The dopaminergic system seems to be involved in both pulsatile luteinizing hormone (LH) secretion and hot flushes in post-menopausal women. With the aim of further clarifying its role, the effectiveness of dopaminergic and antidopaminergic drugs in the treatment of hot flushes was studied. Self-assessed scores for vasomotor symptoms were evaluated in 5 groups of 15 patients treated for 20 days with one of the following agents: placebo; the dopamine receptor agonist, bromocriptine; the indirect dopaminergic agent, Liposom; the antidopaminergic drug, veralipride or the peripheral antidopaminergic agent, domperidone. All of these treatment regimens were effective in alleviating hot flushes, but the pharmacological agents proved to be more effective than the placebo. A direct dopaminergic action is hypothesized in the case of bromocriptine and Liposom, while the antidopaminergic drugs might act through different indirect mechanisms such as the short-loop feedback exerted by hyperprolactinaemia on tuberoinfundibular dopamine (TIDA) neurons with a secondary dopamine-like activity, or stimulation of the opioid system.

Bromocriptine↗
PubMed1986

Hormone excretion during early pregnancy following spontaneous and clomiphene citrate-induced ovulation.

Endocrine changes during early pregnancy have been studied in 12 patients between days 35 and 91 from the last menstrual period. Ovulation had occurred spontaneously in five patients and was induced with clomiphene citrate (CC) in the remaining seven women. All the patients collected daily samples of early morning urine throughout the period of study; on each sample, human chorionic gonadotropin (hCG), pregnanediol-3-alpha-glucuronide (PGDG) and estrone-3-glucuronide (E1G) were measured by chemiluminescence immunoassay. No significant difference was observed between the two groups of patients with respect to the concentrations of hCG and PGDG. The excretion of E1G, however, was significantly higher in patients treated with CC. These data suggest that the induction of ovulation with CC may affect estrogen production in early pregnancy.

Adult↗
PubMed1986

Relative value of clinical variables, bicycle ergometry, rest radionuclide ventriculography and 24 hour ambulatory electrocardiographic monitoring at discharge to predict 1 year survival after myocardial infarction.

The relative value of predischarge clinical variables, bicycle ergometry, radionuclide ventriculography and 24 hour ambulatory electrocardiographic monitoring for predicting survival during the first year in 351 hospital survivors of acute myocardial infarction was assessed. Discriminant function analysis showed that in patients eligible for stress testing the extent of blood pressure increase during exercise slightly improved the predictive accuracy beyond that of simple clinical variables (history of previous myocardial infarction, persistent heart failure after the acute phase of infarction and use of digitalis at discharge), whereas radionuclide ventriculography and 24 hour electrocardiographic monitoring did not. The predictive value for mortality was 12% with clinical variables alone and 15% with the stress test added. Radionuclide ventriculography and 24 hour electrocardiographic monitoring were slightly additive to clinical information in the whole group of patients independent of the eligibility for stress testing (predictive value for mortality 24% with clinical variables alone and 26% with radionuclide ejection fraction and 24 hour electrocardiographic monitoring added). It is concluded that the appropriate use of simple clinical variables and stress testing is sufficient for risk stratification in postinfarction patients, whereas radionuclide ventriculography and 24 hour electrocardiographic monitoring should be limited to patients not eligible for stress testing.

Aged↗
PubMed1986

Early post-infarction angina. Incidence and prognostic relevance.

Early post-infarction angina (2-15 days after infarction) occurred in 132 out of 616 consecutive coronary care unit admissions for acute myocardial infarction within 24 h from onset of symptoms. Patients with early post-infarction angina more often had a history of stable pre-infarction angina as well as late post-infarction angina. Coronary artery disease was more extensive in patients with early post-infarction angina compared with those without angina. Forty-five patients with angina were treated before hospital discharge with coronary artery bypass (CABG) (N = 35) or percutaneous transluminal coronary angioplasty (PTCA) (N = 10). Survival and incidence of non-fatal reinfarctions during 1-year follow-up was similar in patients with and without early post-infarction angina (respectively 83% versus 82% and 13% versus 11%). The incidence of angina in the follow-up was higher in the whole group of patients with early post-infarction angina then in patients without angina (53% versus 32%, P less than 0.001), but was lowest (22%) in the subset who underwent CABG or PTCA before discharge. In patients with early post-infarction angina, age, left ventricular dysfunction, extensive coronary artery disease, stable pre-infarction angina and electrocardiographic ischaemic changes distant from the infarct zone during angina were significantly associated with a poor survival.

Adult↗
PubMed1986

Echocardiographic demonstration of free wall vegetative endocarditis complicated by a pulmonary embolism in a patient with ventricular septal defect.

A defect in the muscular part of the interventricular septum in a 19 year old man was complicated by infective endocarditis caused by Staphylococcus aureus. The lesion was a large right ventricular free wall vegetation which embolised to the lungs. The vegetation was displayed by cross sectional echocardiography, which also confirmed the clinical diagnosis of ventricular septal defect. This case confirms the concept that the jet stream causes endocarditis at its point of impact. After six weeks' treatment with antibiotics the ventricular septal defect was repaired at operation.

Adult↗
PubMed1986

Prolactin-releasing action of a low dose of exogenous gonadotropin-releasing hormone throughout the human menstrual cycle.

Pharmacological doses of gonadotropin-releasing hormone (GnRH) are known to induce prolactin (PRL) release in different pathological states. The same effect can be observed in postmenopausal women and during the phases of menstrual cycle characterized by high estrogen levels. With the aim to evaluate whether nonpharmacological doses of GnRH are also able to induce PRL release, gonadotropin and PRL response to a low dose of GnRH (10 micrograms, i.v. bolus) was evaluated in 70 normal women during different phases of their menstrual cycle. A significant PRL increase was observed in 33% of subjects during the first days of the cycle (menstrual phase; days 1-3 from the beginning of menstrual bleeding: n = 6), in 24% of subjects during early follicular phase (days -10 to -8 from LH peak: n = 17); in 38% of subjects during midfollicular phase (days -6 to -4 from LH peak: n = 8); in 78% of subjects during preovulatory phase (days -2 to -1 from LH peak; n = 9); in 67% of subjects during postovulatory phase (days +1 to +2 from LH peak; n = 6) and in 42% of subjects during midluteal phase (days +5 to +8 from LH peak; n = 24). In brief, the increase of mean PRL levels after GnRH administration was only significant (p less than 0.05) during pre- and postovulatory phases. The percentage of patients who showed a PRL response during the different phases of menstrual cycle was significantly correlated to the mean maximal net increase of LH (r = 0.927; p less than 0.01) and to the mean maximal net increase of FSH (r = 0.926; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

An elusive persistent left superior vena cava draining into left atrium.

A case report of a persistent left superior vena cava draining into left atrium with a fibromuscular left ventricular outflow tract obstruction and a small atrial septal defect. The anomalous vessel escaped detection during two right and left heart catheterizations from the right arm and open heart surgery. It was an incidental finding during cardiac catheterization from the left arm and the anatomy was confirmed by contrast echocardiography.

Echocardiography↗
PubMed1986

Assessment for prognosis during and after myocardial infarction. A plea for a stratified approach.

Right after the first signs and symptoms of acute myocardial infarctions the prognosis is determined by the interventions which are carried out at that time. Preservation of as much myocardial tissue is the key element. Early deobstruction and reperfusion of the myocardium at jeopardy can lead to limitation of the ultimate infarct size, improved ventricular function and a halving of the 1-year mortality. Early supportive therapy with beta-blockade and calcium antagonists may enhance this effect. Data in 533 patients randomized to either a reperfusion strategy or to conventional therapy, combined with those from the recent literature on thrombolysis and early beta-blockade, provide the basis for this point of view. Once infarction is unavoidable and in the process of completion, probably 3-4 h after onset of symptoms, only supportive therapy is recommended, which will hardly change the outcome except for interventions during clinical care such as defibrillation. In 351 other survivors of myocardial infarction the value of clinical variables, a symptom-limited bicycle stress test at discharge, radionuclide ventriculography and 24-hour ambulatory electrocardiogram was compared in predicting 1-year survival. A history of previous myocardial infarction and heart failure during the current episode proved to be the strongest clinical predictors of death. Similarly, a low ejection fraction (less than 40%) and an insufficient blood pressure rise during stress testing (less than 30 mm Hg) identified a high risk group. Stress-test-induced angina and ST depression as well as ventricular arrhythmias from 24-hour electrocardiography were less good as predictors. In these patients treatment should be individualized and may require arteriography. Patients eligible for and completing a normal bicycle stress test after myocardial infarction proved to be a low risk group, which may constitute 65% of the total, seen in tertiary referral centers and even more in community hospitals. They neither require therapy nor further investigation. A subgroup with an intermediate risk can be identified when clinical variables, stress testing and/or resting radionuclide ventriculography are abnormal. This group requires 'tailored' therapy. Therefore, after infarction recovery, we recommend a pre-discharge stress test routinely to complement the clinical evaluation, since it also provides information on physical capacity, the indication of arrhythmias and the presence of myocardial ischemia. Thus, optimal management of acute myocardial infarction requires a stratified approach, which does not require expensive testing procedures.

Female↗