Biomedical subjects

R Antonelli Incalzi

Publications and source records attributed to R Antonelli Incalzi.

31 records · Page 2Linked to original sources

PubMed1988

Clinico-pathological correlations in the diagnosis of acute myocardial infarction in the elderly.

A series of 200 consecutive patients with autopsy-proven acute myocardial infarction (AMI) was retrospectively studied in order to assess the degree of clinico-pathological agreement and to detect the reasons for disagreement. A correct clinical diagnosis of AMI was made in 86 cases (Group A = 43%) and was missed in 114 cases (Group B = 57%). Atypical presentation and concealed history were more common in group B. The AMI qualified to be the main disease in 83 patients of group A and in 81 of group B and was considered a contributory cause of death in three of group A and in 33 of group B (P less than 0.01). The mean number of diseases coexisting with the main disease for each patient was significantly lower in group A than in group B (P less than 0.01). The mean age was 65.2 +/- 12 years for group A patients and 69.1 +/- 12 years for group B patients (P less than 0.02). With the patients grouped according to age (group I: less than 60 years = 46 cases; group II: greater than or equal to 60 years = 154 cases), the diagnostic accuracy was 61% in group I and 38% in group II (P less than 0.01). Groups I and II did not differ in clinical presentation, ECG and enzyme diagnostic accuracy, while the number of diseases coexisting with the AMI was significantly higher in group II (P less than 0.001). Ageing, the atypical presentation and the coexistence of several diseases seem to account for most of the unrecognized AMI.

Age Factors↗

PubMed1988

[Quantitative study of mucociliary clearance using static scintigraphy].

Mucociliary clearance can be evaluated by radionuclide techniques, but such approaches have been usually implemented only in research-oriented laboratories because of technical difficulties. A very practical radionuclide method is here presented which requires only three static acquisitions after the inhalation of a polydisperse radioaerosol produced by a commercial generator. Data processing is also very simple. The diagnostic performance of the method was tested on a study population of 10 healthy subjects and 10 patients with atrophic bronchitis; a highly significant difference between normal and pathological patients was found. Its simple implementation and diagnostic yield recommend this radionuclide method for the routine assessment of mucociliary clearance also in busy clinical-oriented laboratories.

Adult↗

PubMed1987

[Dynamic pulmonary scintigraphy with Tc99m radioaerosol for the evaluation of the permeability of the alveolo-capillary barrier].

Pulmonary clearance of small droplet 99mTc-DTPA radioaerosol was studied in 100 patients (12 normal subjects, N; 10 asymptomatic healthy smokers, FA; 31 patients with interstitial lung diseases, IP; 47 patients with chronic obstructive lung disease, BPCO). The first seven minutes of clearance were described with the function At = Ao*exp (-K*t) and the time constant K was considered representative of the 99mTc-DTPA clearance rate and hence of the alveolar-capillary barrier permeability. Groups FA, IP and BPCO showed a significant (p less than 0.05) or a highly significant (p less than 0.01) increase in permeability when compared to group N. No correlation was found between permeability and bronchial obstruction tests. The following conclusions were drawn: --99mTc-DTPA dynamic lung scanning is an easy, non-invasive method to assess derangements of alveolar-capillary barrier permeability secondary to epithelial damage; --permeability increase is a very early effect of cigarette smoke damage to the epithelium; --other mechanisms of epithelial injury are present in diffuse lung disease; --while the clinical role of this new pathophysiological test is not yet clear, it is likely that it may become a very early marker of pulmonary epithelial damage in diffuse lung disease.

Adult↗

PubMed1986

Correlation of functional parameters derived by equilibrium radionuclide angiocardiography and left ventricular size in patients with old myocardial infarction.

A total of 131 patients with old (over 6 months) myocardial infarction (MI) and 18 normal subjects underwent equilibrium radionuclide angiocardiography at rest (rERNA). The following rERNA parameters were assessed: left ventricular ejection fraction (LVEF), peak ejection rate (PER), peak filling rate (PFR), regional wall motion and a left ventricular size index. The patients with old MI were divided into four groups (I to IV) according to increasing left ventricular (LV) size, and the behaviour of the numerical parameters (LVEF, PER, PFR) was evaluated in each group. LVEF proved to be the most sensitive numerical parameter of overall LV performance. PFR decreased significantly from group I to group III but not from group III to group IV, suggesting that for extreme degrees of left ventricular enlargement some compensatory mechanism acts to prevent a too large fall in LV compliance. The effects of the site of the previous MI on LV performance were also evaluated. Both LV size and performance were least affected by postero-inferior MI. The LVEF was, however, a better predictor of LV size than the site of the MI.

Adult↗

PubMed1986

Inapparent pulmonary vascular disease in an ex-heroin user.

A severe pulmonary vascular derangement, usually reported in drug addicts, was diagnosed in a 28-year-old asymptomatic ex-heroin user by means of fortuitously performed pulmonary perfusion imaging. Neither physical findings nor pulmonary function tests, aroused suspicion of the diagnosis. A search for asymptomatic pulmonary vascular disease probably should be undertaken in drug addicts.

Adult↗

PubMed1986

Equilibrium radionuclide angiocardiography to select inotropic therapy in patients with left ventricular aneurysm.

Fourteen patients with postinfarctual ventricular aneurysm underwent equilibrium radionuclide angiocardiography at rest (ERNA) before and after oral digoxin administration in order to evaluate the effects of increasing myocardial contractility upon both ventricular aneurysm mechanical behaviour and global ventricular function. The ejection fraction (EF) was not significantly affected by digoxin therapy. However, digoxin induced changes in EF (delta EF) correlated inversely with changes in aneurysm size and directly with changes in the extent of the hypokinetic area. Two types of aneurysm were observed: high-compliance aneurysm the size of which increased after digoxin administration while both EF and the extent of the hypokinetic area fell, and low compliance aneurysm for which opposite changes occurred. This different behaviour of ventricular aneurysm may have important practical implications as surgery would be probably more effective than medical treatment in improving resting ventricular function in patients with high-compliance aneurysm.

Adult↗

PubMed1986

The use of digitalis in patients with chronic respiratory failure.

The effect of slow digitalization was tested by radioisotopic angiocardiography in 33 patients with stable and compensated chronic obstructive pulmonary disease (COPD); most of these had severe chronic respiratory failure (CRF). After a 10 days course of digoxin, 0.25 mg/die per os, both the left ventricular ejection fraction (LVEF) and the peak ejection rate (PER), initially slightly abnormal, improved significantly (t = -3.474, p less than 0.005; t = -2.438, p less than 0.025), while right ventricular ejection fraction (RVEF) and peak filling rate (PFR) did not. Ventricular diastolic interdependence and abnormal myocardial calcium kinetic are likely to account for PFR behaviour. Digoxin effects upon RVEF and LVEF suggest that the right ventricular systolic function is to some extent independent from the left one when blood gas derangement and abnormal thoracopulmonary mechanics are the major determinant of right ventricular afterload. The lack of significant correlation between digoxin effects on right and left ventricular function indices confirms this hypothesis. Digoxin can improve the left ventricular ejection phase indices, when these are initially abnormal, while its effect on RVEF is unpredictable.

Adult↗

PubMed1986

[Scintigraphy of pulmonary ventilation with 99mTc-DTPA radio-aerosol. I. Semiotics of the static images].

Papers on deposition pattern analyses of radio-aerosol lung scans are few and not easy to interpret as there is a general lack of technical standardization and the number of patients studied is not large. Moreover these reports have been generally obtained with non-hydrosoluble radioaerosols. In the present study 43 patients underwent conventional pulmonary function testing and lung scanning using small droplet (equal or less than 2 microns) polydisperse 99mTc-DTPA radioaerosol produced with the "Settling Bag System"--Medi 400 (Sorin). The scans were analysed by two methods: a semiquantitative method proposed by Taplin (SQT); an original simpler semiquantitative method (SQM). Correlations of SQT and SQM with FEV1 and MEF75 resulted highly significant (p less than 0,001). SQM proved to be superior to SQT as far as reproducibility is concerned. The following conclusions can be drawn: small particle 99mTc-DTPA aerosol can be easily and cheaply produced by a commercial device; such a radioaerosol is well suited for the evaluation of small and large airways patency, as reflected by MEF75 and FEV1 respectively, with a diagnostic yield comparable to non-hydrosoluble radioaerosols; the original semiquantitative description of the deposition patterns proposed and validated in this study is quite easy to implement and it yields a high correlation with pulmonary function tests; moreover such an approach does not require digital data processing; the sensitivity of 99mTc-DTPA for the diagnosis of bronchial obstruction is very high and superior to routine pulmonary function tests; in addition the ventilation scan allows the topographical localization of the obstructions themselves.

Adult↗

PubMed1986

Right ventricular wall motion and performance in stabilized chronic respiratory failure evaluated by equilibrium radionuclide angiocardiography.

Equilibrium radionuclide angiocardiography (ERNA) was performed at rest in 30 patients with chronic respiratory failure (CRF) in order to evaluate right ventricular performance and wall motion. The usual indices of left ventricular performance were also recorded and correlated with right ventricular parameters. Only CRF patients without clinical, electrocardiographic or echocardiographic criteria suggestive of congenital, valvular, hypertensive or ischemic heart disease were studied. A RV dyskinesis was detected in 5 of the 30 patients, occurring however only in stage II-III CRF, as if a longstanding RV pressure overload were necessary for a RV dyskinesis to develop. No significant differences were found between patients with and without RV dyskinesis for all the functional ERNA parameters (i.e. LVEF, RVEF, PER, PFR). On the other hand, a significant correlation between the stage of the CRF and RVEF was observed.

Cardiac Output↗

PubMed1985

A simple method of predicting left ventricular function in stabilized chronic respiratory failure.

A simple method of assessing left ventricular function in stabilized chronic respiratory failure (CRF) is proposed. 21 patients with CRF were ranked according to the prediction of left ventricular function derived from eight elementary clinical criteria including standard chest X-ray and conventional basal electrocardiography. Equilibrium radionuclide angiocardiography was performed at rest (rERNA) for the evaluation of left ventricular systolic function (ejection fraction, LVEF; peak ejection rate) and diastolic function (peak filling rate). Right ventricular ejection fraction (RVEF) was also measured. The clinical evaluation of the left ventricular function showed a high correlation with rERNA data (p less than 0.01 by Spearman's rank test). No correlation was found between rERNA parameters and PaO2 and between RVEF and LVEF. The clinical criteria proposed can thus predict left ventricular function in stabilized CRF with a high degree of confidence.

Angiocardiography↗

PubMed1985

99mTc-DTPA clearance in bullous emphysema.

The degree of permeability of the alveolar-capillary barrier to low molecular weight solutes has been supposed to depend upon the radius of the epithelial pores. The bullous emphysema is a natural model in which this radius may increase because of the high tension in the bulla. Accordingly, the 99mTc-DTPA clearance may be expected to be faster than normal in lung fields including bullae. Results of the present study in which 99mTc-DTPA clearance was measured in six patients with bullous emphysema, seem to confirm this hypothesis at least to some extent. In fact, either increased or normal 99mTc-DTPA clearances were found over the lung fields including bullae communicating with the bronchial tree. Differences in both the size and the inner tension of the bullae as well as in the anatomical and functional conditions of the surrounding parenchyma are likely to account for such varying behaviour.

Capillary Permeability↗

PubMed1985

Left ventricular diastolic performance at rest in patients with angina and normal systolic function--assessment by equilibrium radionuclide angiography.

The aim of the study was to correlate diastolic function, as evaluated by peak filling rate (PFR) and relative time (TPFR), with the severity of ischemic heart disease, as evaluated by exercise electrocardiography. Accordingly, 83 ischemic patients with effort angina, but normal ejection function at rest and normal left ventricular size, were studied by equilibrium radionuclide angiocardiography within two weeks from the exercise ECG. Diastolic dysfunction, as determined from PFR and, to a lesser extent, from TPFR, is common in patients with ischemic heart disease and normal systolic function. The prevalence and severity of such dysfunction is related more to the severity of the ischemia, as evaluated by the exercise ECG, than to the presence of an old myocardial infarction. Such findings are consistent with the hypothesis that PFR reflects mainly the early diastolic active uncoupling process.

Adult↗

PubMedDate not supplied

[Malnutrition in the acute care hospital: a very common problem].

The adequacy of caloric intake of geriatric patients in medical and surgical wards in the acute care hospital was assessed in a prospective, observational study. Fifty-one surgical and 80 medical nonterminal patients aged over 70 years underwent a multidimensional assessment on admission and a nutritional reassessment on discharge. The average daily caloric intake was also measured. Patients were divided into two groups according to whether the ratio of the actual to the needed caloric intake was inferior to 40% or not, and their differences, with regard to baseline values, were assessed. Patients whose caloric intake was inferior to 40% of the needed were older than the remaining ones (79.4 +/- 6.6 vs 76.6 +/- 4.9 years, p < 0.05), had higher prevalence of preadmission functional dependency (21.6% vs 15%, p < 0.001), lower body mass index (22.9 +/- 5.4 vs 24.8 +/- 3.9, p < 0.004) and higher comorbidity (coexisting diseases: 3.6 +/- 1.9 vs 2.8 +/- 1.6, p < 0.02) on admission. In conclusion, a simple assessment on admission allows targeting geriatric patients at risk for in-hospital starvation. No difference exists between surgical and medical wards in the quality of nutritional support.

Acute Disease↗