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Biomedical subjects

P Fioretti

Publications and source records attributed to P Fioretti.

At least 163 records · Page 9Linked to original sources
PubMed1986

Evidence of specific benzodiazepine binding to myometrial membrane preparations from human pregnant uterus.

The muscle relaxant effect of benzodiazepines (BDZ) is widely held to be mediated at central as well as at peripheral level. In this study we report that crude membrane preparations from the myometrium of pregnant women possess binding sites for [3H]-RO 5-4864, specific ligand for the peripheral type of BDZ receptor. Scatchard analysis shows a high affinity binding site (KD = 3.1 +/- 1.2 nM) and a class of low affinity binding sites (KD greater than 30 nM). Displacement experiments show that various BDZ are differently effective in inhibiting [3H]-RO 5-4864 binding: RO 5-4864 greater than diazepam greater than flunitrazepam greater than lorazepam greater than chlordiazepoxide. In conclusion, these data seem to demonstrate that human myometrium possesses specific binding sites of 'peripheral type' for BDZ. It may be suggested that these binding sites are involved in mediating the myometrial relaxant effect exerted by BDZ. Thus, peripherally active BDZ could be used as tocolytic agents, avoiding BDZ central effects.

Adult↗
PubMed1986

Rational management following diagnosis of myocardial ischemia.

Assuming one knows that myocardial ischemia is present, rational management will first require a careful history to assess the severity of symptoms, such as angina, the lifestyle of the patient, his/her age, and the availability of resources. When a patient is greater than or equal to 70 years, has little angina, even the demonstration of ischemia will not require early arteriography; pharmacological therapy on a trial basis is the preferred approach. Judging the response to oral nitroglycerine, isosorbide dinitrate, beta blockers and calcium antagonists, (often combined and in modest doses) is good rational management. If symptoms persist despite therapy or when the patient is younger and has symptoms which cannot be alleviated by changes in lifestyle and/or workload, the established ischemia assumes much greater significance and nearly always requires a coronary arteriogram for proper management. Once the coronary arteriogram has been analyzed in terms of severity of flow impairment, correlation with the tests showing the extent of myocardial ischemia must be made, best during exercise. If single vessel disease is found with a local dyskinetic (echo, scintigraphy, or angio) segment, which corresponds to a stenosis of greater than or equal to 70%, particularly when found in the anterior descending artery, balloon dilatation (PTCA) or bypass surgery (CABG) should follow. When tests, such as the ECG, are obtained during an attack of angina, the Chahine classification may be used first. In Class IIa with pure ST-segment elevation significant atherosclerotic lesions are absent in most patients, while local spasm can be shown upon provocation. Here rational management can be limited to calcium antagonists sometimes combined with beta blockers.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1986

Second look laparotomy in the management of malignant epithelial ovarian neoplasias.

In the present study we examined 15 patients with malignant epithelial ovarian neoplasms who underwent primary surgery and chemotherapy at the Institute of Obstetric and Gynecologic Clinic of the University of Pisa between 1983 and 1985. At the time of diagnosis and monthly during chemotherapy plasma levels of CEA, CA 19-9, CA 125 and TPA were detected. At the end of pharmacological treatment a second-look laparotomy was performed in each patient to assess the status of cancer. At this time the clinical response was complete in 13 patients and partial in 2. These results were confirmed at second-look laparotomy in 11 of 13 cases of complete clinical remission and in 1 of the 2 cases of partial clinical remission. Two patients in complete clinical remission showed persistent disease. The other one in partial clinical remission was surgically found to have unmodified tumor. Tumoral markers, and especially CA 125, have a good correlation with the clinical course of the disease. However these tumor associated antigens cannot replace second-look laparotomy for assessing the response to cytostatic drugs. In fact patients with normal serum levels of these markers at the end of chemotherapy, were surgically found to have both complete pathological remission and persistent disease. Therefore we have come to the conclusion that the second-look laparotomy and the evaluation of tumor markers have to be performed together in the management of malignant ovarian neoplasms.

Aged↗
PubMed1986

Combined evaluation of some tumor associated antigens in the monitoring of integrated surgical and chemotherapeutic treatment of epithelial ovarian cancer.

The authors measured the presurgical serum levels of some tumor associated antigens in 36 patients bearing primitive ovarian carcinoma and in 284 controls. Ca125, which has shown a sensitivity (SE) of 63.8% and a specificity (SP) of 92.6%, was elevated especially in serous and undifferentiated carcinomas, while Ca19-9 (SE = 33.3% and SP = 89.7%) and CEA (SE = 19.4% and SP = 96.4%) were more often pathological in mucinous ones. TPA (SE = 75.0% and SP = 81.3%) had no particular correlation with any histotype. Parallel assessment of Ca125 and Ca19-9 showed a SE = 83.3% and a SP = 83.8%. In patients with epithelial ovarian cancer, the circulating concentrations of tumor markers were periodically measured during and after chemotherapy. Ca125 levels correlated with the course of disease in 87.1% of instances, while Ca19-9 ones correlated in 72.2% and TPA ones in 78.6%. Constantly high concentrations of one or more markers during chemotherapy are indicative for unresponsiveness of cancer to cytostatic drugs. Serum levels of one or more tumor antigens elevated at diagnosis and in the normal range at the end of primary treatment can be associated both with a pathological complete regression and with a persistence of neoplastic disease at second look laparotomy. Considering the different sensitivity of every single marker in carcinomas of different histotype, the combined evaluation of multiple tumor associated antigens seems to offer the best information in the monitoring of epithelial ovarian cancer.

Adult↗
PubMed1986

Synchronous adenoacanthoma of the ovary and endometrial adenocarcinoma. Report of two cases.

Two cases of synchronous endometrioid adenocarcinoma of the endometrium and ovary are here presented. The clinical aspects and the pathologic findings support an autochthonous origin of these neoplasias. The existence of the extended Müllerian system can explain such a possibility. The recognition of this possible association is really important because it implies a different therapeutic approach.

Adenocarcinoma↗
PubMed1986

Parathyroid function and pituitary-gonadal axis in male uremics; effects of dietary treatment and of maintenance hemodialysis.

Parathyroid and pituitary-gonadal secretions were studied in 18 male uremics following a low protein diet supplemented with essential amino acids and ketoanalogues (SD), and in 8 subjects on maintenance hemodialysis (MHD). SD corrected high serum PTH and low serum testosterone (sT) levels, while pituitary hormones (LH, FSH, PRL) were elevated and did not change. Patients on MHD had very high siPTH, PRL and LH levels, while sT was markedly low. These data suggest that PTH is a prominent cause of sexual dysfunction in male uremics, since SD can restore sT secretion by correcting PTH levels, without improving pituitary dysfunctions. In dialyzed patients secondary hyperparathyroidism worsens and is an important cause of low sT secretion, but also a severe hyperprolactinemia develops, which may further impair gonadal function.

Adult↗
PubMed1985

Prediction of mortality during the first year after acute myocardial infarction from clinical variables and stress test at hospital discharge.

The predictive value of a predischarge symptom-limited stress test was studied in 405 consecutive survivors of acute myocardial infarction (AMI). Three hundred patients performed bicycle ergometry; 105 could not perform it. Among these latter 105 patients, the stress test was contraindicated in 43 because of angina or heart failure and in 62 because of noncardiac limitations. One-year survival was 44% in the "cardiac-limited" group (19 of 43) and 92% in the "non-cardiac-limited" group (57 of 62). One-year survival among the patients who performed an exercise test at discharge was 93% (280 out of 300). The best stress test predictor of mortality by univariate analysis was the extent of blood pressure (BP) increase: 42 +/- 24 mm Hg in 280 survivors vs 21 +/- 14 mm Hg in 20 nonsurvivors (p less than 0.001). Among the 212 patients in whom BP increased 30 mm Hg or more, mortality was 3% (n = 6), while it was 16% (n = 14) among the 88 patients in whom BP increased less than 30 mm Hg. Angina, ST changes and arrhythmias were not as predictive. Stepwise discriminant function analysis showed inadequate BP increase to be an independent predictor of mortality. A high-risk group can be identified at discharge on clinical grounds in patients unable to perform a stress test, whereas intermediate- and low-risk groups can be identified by the extent of BP increase during exercise.

Aged↗
PubMed1985

Postoperative regression of left ventricular dimensions in aortic insufficiency: a long-term echocardiographic study.

The ability of preoperative M-mode echocardiography to predict the clinical course and the decrease in left ventricular size was assessed in 42 patients after uncomplicated valve replacement for isolated aortic insufficiency. During follow-up study, one patient died of chronic heart failure. The New York Heart Association functional class of the 41 survivors improved from 2.4 to 1.2. All patients had a preoperative M-mode echocardiogram. Serial echocardiographic measurements, available in 33 patients, showed a sustained decrease in left ventricular end-diastolic dimension after the first postoperative year from 73 +/- 8 to 57 +/- 9 mm at 6 to 12 months and to 53 +/- 9 mm at 3 years postoperatively (p less than 0.01). Left ventricular cross-sectional area decreased from 31 +/- 8 to 26 +/- 7 cm2 and then to 23 +/- 5 cm2 at the latest follow-up study (p less than 0.01). At 3 years postoperatively, M-mode echocardiograms were available in 37 patients: 24 had a normal left ventricular dimension (group 1), while 13 still had an enlarged left ventricle (group 2). The clinical course in these two groups was similar. The best preoperative predictor of persistent left ventricular enlargement was the end-diastolic dimension (p less than 0.05), whereas fractional shortening and the end-diastolic radius/thickness ratio were not predictive.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Prognosis of patients with different peak serum creatine kinase levels after first myocardial infarction.

The extent to which patients with low peak serum creatine kinase (CK) at their first myocardial infarction differ from patients with high CK levels in terms of risk for subsequent ischaemic events was investigated in 266 patients who survived the first 48 h from the onset of infarction. All patients were followed up for one year. Four groups were formed based on peak CK less than or equal to 200, 201-400, 401-800 and greater than 800 IU l-1. During follow-up the incidence of mortality was 15% (N = 39), non-fatal re-infarction 9% (N = 23), and angina 53% (N = 140). Hospital mortality was significantly higher (P less than 0.02) in the highest CK-group (16%), but the incidence of non-fatal re-infarction, angina pectoris and late mortality was similar in the four groups. In hospital survivors, ischaemic ST-changes during pre-discharge symptom limited bicycle stress test and multiple vessel disease were equally distributed in all four groups. We conclude that while hospital mortality is directly related to peak CK, there is no relationship between peak CK and late mortality, non-fatal re-infarctions, or recurrent angina. Accordingly, diagnostic and therapeutic procedures in the individual patients are not influenced by the amount of serum CK released during acute infarction.

Creatine Kinase↗
PubMed1985

Limitations of a QRS scoring system to assess left ventricular function and prognosis at hospital discharge after myocardial infarction.

The value of a QRS scoring system derived from 12 lead electrocardiograms to estimate left ventricular ejection fraction was assessed in a prospective study of 285 hospital survivors of myocardial infarction. In these patients both the QRS score and ejection fraction were measured by radionuclide ventriculography at discharge. The correlation between ejection fraction and QRS score was weak. In 22 patients who died during six to 12 months follow up the ability of the ejection fraction and QRS score to predict mortality was assessed in terms of sensitivity, specificity, predictive value of a positive and negative test, and efficiency. For ejection fraction less than 40% and a QRS score greater than or equal to 6 sensitivity was respectively 73% and 64%, specificity 73% and 56%, predictive value of a positive test 18% and 11%, predictive value of a negative test 97% and 95%, and efficiency 73% and 56%. Both ejection fraction and QRS score may be used to identify patients at low and high risk during one year follow up, but, contrary to initial expectations, the QRS score appears to be of little value in estimating ejection fraction and is less accurate than ejection fraction in predicting late survival in hospital survivors of myocardial infarction.

Adult↗
PubMed1985

Surgical versus non-surgical management of patients soon after acute myocardial infarction.

Of 510 patients admitted to hospital with acute myocardial infarction, 34 had coronary artery bypass grafting before discharge (6-43 days (median 20) after infarction). The patients who were given grafts generally had a smaller infarction with less functional impairment than the 476 patients who were not. The outcome of coronary artery bypass grafting was investigated in a retrospective matched pair study. Patients were matched on the basis of the presence of postinfarction angina, left ventricular ejection fraction, location of the infarction, peak creatine kinase activity, Killip clinical class, and severity of coronary disease with 34 patients who were given medical treatment only. At one year follow up fewer of the operated patients had symptoms than did the matched non-operated patients. Survival at one year in the operated and non-operated groups respectively was 94% vs 91%; angina within one year occurred in 3% vs 68%; congestive heart failure in 3% vs 6%; and 0% vs 32% were referred for later bypass grafting or coronary angioplasty. It is concluded that coronary artery bypass grafting can be performed safely soon after myocardial infarction provided that left ventricular function is not seriously compromised. Such treatment is more effective than medical treatment for relief of angina during the first year after infarction.

Angina Pectoris↗
PubMed1985

Sex steroids modulate prolactin response to naloxone in postmenopausal women.

To evaluate whether ovarian steroids modify the prolactin (PRL) response to opioid receptor blockade, the effects of naloxone infusion (1.6 mg/h for 4 h) on PRL secretion were studied in 5 postmenopausal women. Naloxone infusion was performed in basal conditions and after chronic oral treatment with conjugated estrogens (CE) (1.25 mg/day, for 20 days) or CE plus medroxyprogesterone acetate (MPA) (10 mg/day, for 20 days). Under basal conditions, 17 beta-estradiol, estrone, gonadotropin, and PRL plasma levels were in the normal range for postmenopausal women, and naloxone failed to affect PRL secretion. Naloxone induced a significant PRL increase after CE treatment alone (p less than 0.001) or in combination with MPA (p less than 0.001). The increase was significantly higher (p less than 0.05) after CE + MPA treatment than after CE treatment alone. These data suggest that steroids modulate the stimulatory effect of naloxone on PRL secretion in postmenopausal women.

Endorphins↗
PubMed1985

Late results of reperfusion with intracoronary streptokinase.

Intracoronary streptokinase was infused to 152 randomly selected patients after acute myocardial infarction (MI). Control group consisted of 150 randomly selected patients after MI who were treated by conventional methods. Preliminary results indicate several beneficial effects of early reperfusion with intracoronary streptokinase.

Angioplasty, Balloon↗
PubMed1985

Wertheim's radical hysterectomy with pelvic lymphadenectomy in the treatment of cervical carcinoma at the Obstetric and Gynecological Clinic of the University of Pisa.

The Authors report their experience in 49 operations of radical hysterectomy with pelvic lymphadenectomy in the treatment of stage I b and stage II cervical cancer. They describe particularly the precocious and late urinary complications and the arrangements made for their prevention. We had no uretero-vaginal fistula in 21 of the 49 patients, on whom a kind of roof and floor around the terminal tract of the ureters was created by placing some surgical stitches between the posterior wall of the bladder and the anterior lateral wall of the rectum.

Adult↗