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Biomedical subjects

P Zeppilli

Publications and source records attributed to P Zeppilli.

At least 19 recordsLinked to original sources
PubMed2005

Boxing and "commotio cordis": ECG and humoral study.

The objective of the study was to analyze the presence of myocardial damage in relation to official boxing matches. Low-energy chest wall impact could be responsible for sudden cardiac death, i.e. commotio cordis. As boxing is a traumatic sport in which thoracic hits usually occur, it seems interesting to know if there are any significant cardiac changes during official bouts. Fifteen amateur boxers, participating in the semifinals of the Italian Championship were investigated. A standard ECG before, immediately after, 1 hour and 12 hours after the match were obtained from each athlete to analyze atrio-ventricular conduction, QRS axis and duration, and ventricular repolarization. A blood sample was also obtained before and 12 hours after the match for analysis of total-creatin-phosphokinase, myoglobin, and T-troponin. After the fight, the following significant changes were encountered: higher QRS voltages, lowering of J-point and ST segment in lateral leads, higher ST-slope, lower T-wave amplitude, shorter T-wave peak time, and shorter QT interval. When the last 2 parameters were corrected for heart rate, no differences were observed for QTc, while T-wave peak time significantly increased. All these changes persisted until one hour after the match. Moreover, 3/15 boxers (20 %) showed marked ventricular repolarization anomalies in lateral leads after the contest, persisting for 12 hours in one case. However, no athlete had clinical and humoral signs of myocardial damage following the match. It was concluded that no clinical and humoral signs of myocardial damage were found after amateur boxing matches, although ventricular repolarization abnormalities can be found on ECG in 20 % of boxers, probably due to sympathetic hyper-activity related to the agonistic event.

Adult↗
PubMed2005

Ocular complications of boxing.

OBJECTIVES: To investigate the prevalence of ocular injuries in a large population of boxers over a period of 16 years, in particular, the most severe lesions that may be vision threatening. METHODS: Clinical records of the medical archive of the Italian Boxing Federation were analysed. A total of 1032 boxers were examined from February 1982 to October 1998. A complete ophthalmological history was available for 956, who formed the study population (a total of 10 697 examinations). The following data were collected: age when started boxing; duration of competitive boxing career (from the date of the first bout); weight category; a thorough ocular history. The following investigations were carried out: measurement of visual acuity and visual fields, anterior segment inspection, applanation tonometry, gonioscopy, and examination of ocular fundus. Eighty age matched healthy subjects, who had never boxed, formed the control group. RESULTS: Of the 956 boxers examined, 428 were amateur (44.8%) and 528 professional (55.2%). The median age at first examination was 23.1 (4.3) years (range 15-36). The prevalence of conjunctival, corneal, lenticular, vitreal, ocular papilla, and retinal alterations in the study population was 40.9% compared with 3.1% in the control group (p< or =0.0001). The prevalence of serious ocular findings (angle, lens, macula, and peripheral retina alterations) was 5.6% in boxers and 3.1% in controls (NS). CONCLUSIONS: Boxing does not result in a higher prevalence of severe ocular lesions than in the general population. However, the prevalence of milder lesions (in particular with regard to the conjunctiva and cornea) is noteworthy, justifying the need for adequate ophthalmological surveillance.

Adolescent↗
PubMed2005

Medical survey of female boxing in Italy in 2002-2003.

BACKGROUND: Female boxing has been permitted in Italy since 2001. According to the latest Italian laws, athletes applying to become boxers have to pass a pre-participation medical examination. OBJECTIVE: To collect novel medical information from the pre-participation visits and mandatory pre-competition and post-competition examinations for all fights involving Italian female boxers in 2002-2003. METHODS: A retrospective study on all official female boxing competitions in Italy from January 2002 to October 2003 was conducted. A prospective study on 28 amateur female boxers was also carried out. RESULTS: Retrospective study: data from 664 examinations were collected. Pre-match examinations were negative. After competitions, 19/645 visits showed some injuries, with mild, soft tissue facial lesions, epistaxis, and hand-wrist problems being the most common. Prospective study: no major lesions were found during the study. One fibroadenoma, one ovarian cyst, and one intramural uterine myoma were found. One boxer was referred to a neurologist because of non-specific electroencephalographic (EEG) abnormalities, which persisted six months later. On a re-admission examination, which was needed because of a contest that was stopped because the referee judged that she was receiving blows to the head that were dangerous, one boxer showed non-specific EEG alterations and nystagmus. A cerebral magnetic resonance imaging scan was normal. She was allowed to participate in competitions again when her EEG returned to normal and clinical signs disappeared. Deviation of the nasal septum was quite common (68%). No major eye injuries were reported. CONCLUSION: Probably because of the correct preventive medical approach, female boxing is much safer than expected, and no major lesions (requiring hospital admission) were reported. Any lesions to the breast and reproductive system could not be considered to be boxing related.

Adult↗
PubMed2004

Prolonged asystolia in a young athlete: a case of sinus arrest during REM sleep.

A young asymptomatic male athlete came to our laboratory to be enrolled in a research protocol on physical fatigue. Routine clinical and cardiological evaluations including echocardiogram were in the normal range. Several consecutive cardiopulmonary tests showed a fairly good tolerance to exercise, with no symptoms even when the effort was abruptly arrested. On the other hand, Holter ECG recordings showed long nocturnal sinus pauses. As he was absolutely asymptomatic and free from any structural heart disease, he underwent a follow-up with repeated Holter monitorings for one year. During this period he decided on his own to stop practising sports; in spite of this sharp reduction in his overall physical activity, consecutive Holter monitorings showed that the sinus pauses were progressively increasing in duration (up to 9.2 seconds). With the hypothesis of a malignant vagotonia, he underwent a tilt test; however, we could not elicit any pauses or symptoms. The pauses grew longer over time; a endocavitary electrophysiologic test was performed, which showed no evidence of disease. To rule out the hypothesis of a sleep apnoea syndrome, he also underwent a polysomnography, including EEG, eye movement electromyography, arterial blood oxygen saturation and thoracic impedance: no alterations were detected with the exception of the sinus pauses, which appeared to be strictly linked to REM sleep, as suggested by the concurrent increase in rapid eye movements and desynchronized EEG. We hence made a diagnosis of sinus arrest during REM sleep (SAdRS), a very uncommon disease belonging to the parasomnias. Pauses were then quantified for one month by implanting a ECG loop recorder. As the patient became more and more upset and worried, and the pauses increased to nearly 12 seconds, we decided to implant a pacemaker, which is the only therapeutic option established in the literature for patients with SAdRS.

Adult↗
PubMed2001

Does early repolarization in the athlete have analogies with the Brugada syndrome?

AIMS: To re-examine the prevalence and presentation of early repolarization in athletes and to compare it with electrocardiographic abnormalities observed in patients with the Brugada syndrome. METHODS: Electrocardiograms of 155 male athletes and 50 sedentary controls were studied. Early repolarization was considered present if at least two adjacent precordial leads showed elevation of the ST segment > or =1 mm. Amplitude and morphology of ST elevation, the leads where it was present and the lead in which it showed its maximum value were analysed together with QRS duration, the presence of right ventricular activation delay, QT and QTc duration. Data were compared with those obtained by electrocardiograms of 23 patients with the Brugada syndrome. RESULTS: Early repolarization was found in 139 athletes (89%) and 18 controls (36%, P< or =0.025), being limited to right precordial leads in 42 (30%) athletes and 13 (72%) controls (P< or =0.001). Only 12 (8.6%) athletes and one control (5.5%) with early repolarization had an ST elevation 'convex toward the top' in right precordial leads, similar to that seen in the Brugada syndrome. In athletes the maximum ST elevation was greater (2.3+/-0.6 mm) than in the controls (1.2+/-0.8 mm; P< or =0.004) but significantly lower than in patients with the Brugada syndrome (4.4+/-0.7 mm; P< or =0.0001). Patients with the Brugada syndrome also had a greater QRS duration (0.11+/-0.02 s) than athletes (0.090+/-0.011 s; P< or =0.0001) with early repolarization. CONCLUSIONS: Early repolarization is almost always the rule in athletes but it is also frequent in sedentary males. Tracings somewhat simulating the Brugada syndrome were observed in only 8% of athletes without a history of syncope or familial sudden death. Significant differences exist between athletes with early repolarization and patients with the Brugada syndrome as regards the amplitude of ST elevation and QRS duration.

Adult↗
PubMed2001

Food-dependent exercise-induced anaphylaxis: clinical and laboratory findings in 54 subjects.

BACKGROUND: In some subjects, specific foods trigger anaphylaxis when exercise follows ingestion (specific food-dependent exercise-induced anaphylaxis, FDEIAn). Skin test and/or RAST positivity to foods suggest an IgE-mediated pathogenic mechanism. Others suffer from anaphylaxis after all meals followed by exercise, regardless of the food eaten (nonspecific FDEIAn). We sought to identify the culprit foods with a diagnostic protocol. METHODS: We collected detailed histories and performed skin prick tests (SPT) with 26 commercial food allergens, prick plus prick tests (P+P) with 15 fresh foods (including 9 assessed with SPT), and RAST for 31 food allergens. Treadmill stress tests were administered after a meal without any positive food (food plus exercise challenge, FEC). RESULTS: Among the 54 patients, 6 could not recall any suspect food. The other 48 suspected a specific food in at least one episode. The most frequent were tomatoes, cereals and peanuts. Fifty-two subjects were positive to at least one food (22 to more than 20), whereas 2 showed no positive results. All suspect foods were positive. SPT, P+P and RAST displayed different degrees of sensitivity. Each test disclosed some positivities not discovered by others. Two subjects reacted to FEC. Overall, 48 patients probably had specific FDEIAn and the other 6 nonspecific FDEIAn. CONCLUSION: It is useful to test both in vivo and in vitro an extensive panel of foods. Avoidance of foods associated with skin test and/or RAST positivity for at least 4 h before exercise has prevented further episodes in all our patients with specific FDEIAn.

Allergens↗
PubMed1998

In vivo detection of coronary artery anomalies in asymptomatic athletes by echocardiographic screening.

BACKGROUND: Anomalous origin of coronary arteries (AOCA) is a rare congenital disease. Although it may have a benign course, it has been identified as a frequent cause of sports-related sudden death. Unfortunately, in vivo detection of AOCA is not easy, as individuals with this anomaly often are asymptomatic and show no signs of myocardial ischemia. Presently, transthoracic two-dimensional echocardiography (TTE) is the only noninvasive, widely available tool to visualize the ostia and first tracts of coronary arteries. OBJECTIVE: To assess the efficacy of TTE in the screening of AOCA in a large athletic population. STUDY DESIGN: In a prospective study, we assessed the ostia and first tracts of coronary arteries in 3,650 subjects (mean age, 30+/-12 years) practicing different sports at various competitive levels. Subjects underwent a TTE examination in our laboratory for scientific or diagnostic purposes. RESULTS: Technically satisfactory echocardiograms were obtained in 3,504 subjects (96%); a clear visualization of the ostia and first tracts of both coronary arteries was obtained in 3,150 cases (90%). Three asymptomatic athletes (0.09%) were suspected to have an AOCA; two with a right coronary artery origin from the left sinus, and one with a left coronary artery origin from the right sinus. Diagnosis was confirmed by coronary angiography. CONCLUSIONS: Our study indicated that AOCA is rare in asymptomatic athletes. Systematic and accurate exploration of coronary anatomy in athletes referred for a diagnostic TTE examination may be useful in identifying those with AOCA.

Adolescent↗
PubMed1997

Brief report: healed myocarditis as a cause of ventricular repolarization abnormalities in athlete's heart.

In the past myocarditis has been suggested as a possible cause of repolarization abnormalities in sportsmen, but, to our knowledge, no direct in-vivo demonstration of this relationship has so far been found. We report the cases of three professional athletes with repolarization changes at rest and/or during exercise and mild segmental wall motion anomalies in the left ventricle on echocardiography, in whom myocarditis was diagnosed by non-invasive and invasive clinical investigations, including endomyocardial biopsy. We think that probably the frequency with which myocarditis is responsible for electrocardiographic and echocardiographic abnormalities in athletes has so far been underestimated, and that caution must be employed when interpreting minor segmental wall motion abnormalities on resting and exercise echocardiograms in trained subjects as being due to athlete's hart, especially when they present with repolarization changes.

Adult↗
PubMed1997

Eosinophil-derived proteins in postprandial (food-dependent) exercise-induced anaphylaxis.

BACKGROUND: Postprandial exercise-induced anaphylaxis (PPEIAn) is a form of EIAn in which the ingestion of food before the exercise is associated with the onset of symptoms. Skin reactivity and the presence of specific serum IgE to several food allergens suggest the occurrence of food-dependent allergic mechanisms. METHODS: In order to study the involvement of eosinophils in the pathogenesis of PPEIAn we measured the changes in serum eosinophil cationic protein (ECP) and eosinophil protein X/eosinophil-derived neurotoxin (EPX/EDN) levels in 6 patients with PPEIAn, subjected to three separate challenges with either suspected foods only, exercise after a meal without or with suspected food ingestion. RESULTS: We found serum levels of both eosinophil-derived proteins increased only in challenges including both exercise and suspected food ingestion. Symptoms of anaphylaxis occurred in 3 of these patients. CONCLUSIONS: The increased release of eosinophil basic proteins in PPEIAn patients, caused by physical exercise following ingestion of suspected foods, is not obligatory for the definition of the syndrome.

Adolescent↗
PubMed1995

Echocardiographic size of conductance vessels in athletes and sedentary people.

The purpose of the present study was to assess the size of great and medium caliber arterial and venous vessels (conductance vessels) in athletes of different sports and sedentary people. Vessel size was measured by two-dimensional echocardiography in 15 professional cyclists, 15 highly-trained long-distance runners, 15 professional volley-ball players, 10 wheelchair basketball players, 11 wheelchair distance runners and 20 sedentary controls. The following vessels were imaged and measured: aortic arch, left carotid and left subclavian artery, right pulmonary artery, abdominal aorta and mesenteric artery, superior and inferior vena cava. Vessel size was considered in absolute value and normalized for body surface area (BSA). Among the able-bodied athletes, both cyclists and long-distance runners showed a generalized increase in vessels size in respect to controls, either absolute or normalized for BSA. The increase was highly significant for normalized inferior vena cava: cyclists, mean 15.1 mm, 95% confidence intervals 14.2 to 15.8 mm; long-distance runners, 15.8 mm, 15.3 to 16.4; controls, 10.5 mm, 9.8 to 11.3. Volleyball players also showed larger vessels than controls, but this feature was clearly related to their greater body size because statistical differences were attenuated or abolished by normalization for BSA. Wheelchair athletes exhibited significantly larger upper-body vessels but significantly smaller lower-body vessels than controls when normalized for BSA. In addition, wheelchair distance runners, who trained more intensively, had larger abdominal aorta and inferior vena cava than wheelchair basket players. Long-term endurance training leads to a generalized increase in arterial and venous conductance vessels size.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Diagnostic work-up for food-dependent, exercise-induced anaphylaxis.

Fourteen patients with suspected food-dependent, exercise-induced anaphylaxis (EIAn) were subjected to prick tests with commercial food extracts and common airborne allergens, prick + prick tests with fresh foods, determination of total IgE levels, and specific IgE for 31 foods (CAP System FEIA RAST). All were positive for two or more foods; 10 presented hypersensitivity to 11 or more foods. On the basis of these findings, history data, and responses to food-exercise challenges (treadmill stress tests 90 min after meals containing none of the suspected foods and none associated with skin-test and/or RAST positivity) and suspected food-exercise challenges (SFECs - administered after meals containing the suspected food), three patients were diagnosed as having specific food-dependent EIAn (for wheat in two cases, tomato in one). In nine others, the presence of specific IgE for numerous foods (including those suspected on the basis of histories and utilized in the SFECs) suggests involvement of specific food hypersensitivity, although SFEC confirmation could not be obtained. Avoidance of all foods associated with test positivity 4 h before exercise has prevented all further EIAn episodes in these 12 patients. In two others, the reactions did not appear to be related to IgE directed against specific food allergens, and these subjects have eliminated further reactions by avoiding all meals for the 4 h preceding exercise. These findings emphasize the importance of allergologic testing with a wide panel of food allergens (including foods used for seasoning, such as garlic or parsley) in all patients with suspected food-dependent EIAn. Prick + prick tests with fresh foods and the CAP System RAST disclosed numerous hypersensitivities.

Adolescent↗
PubMed1995

Biopsy evidence of atrial myocarditis in an athlete developing transient sinoatrial disease.

Atrial myocarditis causing transient sinoatrial disease (incessant atrial tachycardia alternating with sinoatrial pauses of up to 6 s in duration) in an athlete is reported. Diagnosis was undertaken by endomyocardial biopsy; biventricular and right atrial specimens were obtained. After a 6-month rest period, the atrial arrhythmias disappeared, and the athlete was able to resume his professional sporting activities.

Adult↗
PubMed1994

Role of myocarditis in athletes with minor arrhythmias and/or echocardiographic abnormalities.

We report the clinical and instrumental data, including the endomyocardial biopsy findings, of six young athletes presenting with minor arrhythmias and/or echocardiographic abnormalities. In one of them, a left ventricular dilation with moderate depression of the systolic function had been attributed to an athlete's heart. A diagnosis of arrhythmogenic right ventricular dysplasia had been made in three others, one with right ventricular dilation and apical hypokinesia, and two with ventricular arrhythmias with QRS morphology of left bundle branch block. A myocarditis could be unequivocally established in four athletes (two with and two without fibrosis). In the remaining two, with a clinical history strongly suggesting a previously acute myocarditis, the endomyocardial biopsy specimen revealed a nonspecific fibrosis compatible but not definitely pathognomonic of a healed myocarditis. Our report suggests that a myocarditis may be a cause of minor rhythm disturbances and/or echocardiographic abnormalities in athletes. A prevalent localization of the inflammatory process in the right ventricle with or without the occurrence of ventricular arrhythmias with left bundle branch block morphology can mimic an arrhythmogenic right ventricular dysplasia. An early diagnosis of myocarditis in athletes is useful to avoid the risk of fatal arrhythmias, also considering that rest still keeps on being one of the most effective strategies in myocarditis management.

Adolescent↗
PubMed1992

Food-dependent exercise-induced anaphylaxis: report of two cases.

Exercise-induced anaphylaxis (EIAn) is a rare condition characterized by giant urticaria, angioedema and acute gastrointestinal symptoms that develops on exertion. In the most severe forms it may be associated with acute cardiorespiratory symptoms (laringeal stridor, wheezing), profound hypotension or syncope. In some individuals, EIAn characteristically occurs after a meal suggesting that the anaphylactic reaction is provoked by both exercise and ingestion of a foodstuff to which the patient has become sensitized. Two representative cases of severe food-dependent EIAn are described, which emphasize the need of performing a careful allergological evaluation in sportsmen with unexplained cardiovascular and/or respiratory symptoms during effort, especially when associated with other allergic manifestations and/or occurring in the post-prandial period.

Adult↗
PubMed1990

Lactate and glucose electrochemical biosensors for the evaluation of the aerobic and anaerobic threshold in runners.

Lactate and glucose are measured in whole blood of athletes running on a treadmill by using two extracorporeal electrochemical biosensors. The lactate sensor was fixed to an endocrine artificial pancreas (Betalike) which had been used in previous extracorporeal experiments. The lactate sensor gave a signal which resulted in a well defined curve that allowed the evaluation of the aerobic as well as the anaerobic threshold. The results obtained with the glucose sensor supported the theory that muscle anaerobic glycolysis is dependent on muscle glycogen rather than on blood glucose.

Adult↗
PubMed1989

Coronary arteries and athlete's heart.

An increase of coronary artery size after endurance training has been suggested by experimental data on animals and anecdotal autopsy reports in men. However, systematic studies on in vivo coronary anatomy of athletes have been lacking so far. We utilized two-dimensional echocardiography (2DE) to explore non-invasively the coronary anatomy of endurance athletes. Twenty long-distance runners (LDR) and 20 matched sedentary controls (SC) were studied initially. Visualization of the ostia and main trunks of-right (RCA) and left coronary artery (LCA) was obtained in 90-100 p. 100 of LDR and 70-75 p, 100 of SC. Collateral branches of LCA (anterior descending artery and circumflex branch) and RCA were visualized respectively in 60-70 p. 100 and 30-40 p, 100 of cases. The very good quality of images made possible the measurement of LCA and RCA size. LDR as a group had significantly larger coronary arteries than SC: this was associated with significant left and right ventricular enlargement and hypertrophy. These results have been further confirmed in a large survey of triathletes, swimmers, water-polo players, young LDR and prepubescent football players. Increase of coronary artery size is a well-documented effect of endurance training which can be easily investigated with 2DE, However, the large interindividual variability and the observation of very large coronary arteries in adolescent subjects suggest that genetic factors may also play a role in determining the final size of the coronary vessels.

Cardiomegaly↗