Biomedical subjects

R Gesuita

Publications and source records attributed to R Gesuita.

25 records · Page 2Linked to original sources

PubMed1993

Camerano study on hypertension: association between arterial hypertension and cardiovascular risk factors.

The Camerano study on Arterial Hypertension (AH), was a cross-sectional study carried out on a population living in a small town in central Italy. Its aim was to show the prevalence of certain characteristics of AH. We studied the association between AH and other well-known cardiovascular risk factors (CRF) such as: hypercholesterolemia, hypertriglyceridemia, cigarette smoking, hyperglycemia, obesity and in particular the hereditary factor, evaluated as the degree of association between the AH of the subject and that of his parents. The results reveal a significantly high association between AH and all the CRF examined. Subjects suffering from AH had double the chance of concomitant another CRF compared to the normotensives. If three CRF are present at the same time, then the hypertensive subjects are three times as many. When hereditary factors are evaluated, then subjects with two hypertensive parents have twice as much probability of developing AH compared to subjects from a normotensive family.

Adult↗

PubMedDate not supplied

MRI in characterization of focal liver lesions: comparison of T2 weighting by conventional spin-echo and turbo spin-echo sequences.

Forty-one patients with 61 proved focal liver lesions underwent MRI of the liver at 1.0 T, with the aim of evaluating the usefulness of turbo spin-echo (TSE) sequences in characterizing focal liver lesions, by comparing them with conventional spin-echo (CSE) sequences. Two different TSE protocols were employed. with constant echo time and varying repetition time: TSE-S (3000 msec) and TSE-L (5100 msec). All images were evaluated quantitatively (signal-to-noise ration 'SNR') and qualitatively: because benign lesions were all liquid (12 cysts and 10 hemangiomas), they were well characterized morphologically on the basis of signal intensity. Mean SNR was significantly different between metastases and benign lesions (P < .0001) with all T2 sequences. Among the single T2 sequences tested, logistic regression analysis showed TSE-L to have the best predictive ability of the nature of focal lesions, with a G value of 42.02, compared to 29.87 of TSE-S and 25.55 of CSE second echo (SE II). The combination of TSE-L with TSE-S did not modify these results, whereas the combination of TSE-L with CSE only resulted in slight improvement (G = 46.95). Comparison of the receiver operating characteristic (ROC) curves showed only SE II (area under the ROC curve of .8312) to be significantly inferior to the best single sequence, or TSE-L (area under the ROC curve of .9176; P = .027). All sequences were equivalent in qualitative evaluation with good reproducibility, sensitivity ranging from .94 to 1.0 and specificity ranging from .86 to .93. This study confirms the value of TSE sequences in characterization of focal liver lesions. Time of acquisition is strongly reduced with these sequences, whereas results are fairly similar to those obtained with CSE. TSE sequences could therefore replace CSE for the study of focal liver lesions.

Adult↗

PubMedDate not supplied

Epidemiological aspects of isolated systolic hypertension in the elderly population as cerebrovascular risk factor.

A large number of studies indicate that isolated systolic hypertension (ISH) is an important cerebrovascular risk factor. This clinical state is very common in elderly people who are the most exposed to stroke risk. Therefore, it is important to know the real prevalence of ISH, in order to predict the possible incidence of cerebrovascular disease in the elderly population. In the Camerano study on hypertension, we have verified the prevalence of ISH in the elderly. ISH has been considered clinically when the systolic arterial pressure (SAP) was higher than 160 mmHg, and the diastolic arterial pressure (DAP) was lower than 90 mmHg. In our study population, an ISH prevalence of 11.9% was found in the elderly (above 60 years of age); whereas in the adult population (between 30 and 60 years), it amounted only to 4.5%.

Journal Article↗

PubMedDate not supplied

Congestive heart failure in the elderly requiring hospital admission.

Fifty consecutive elderly (> 60 years) patients admitted to our department with congestive heart failure (CHF) entered a prospective database, to define their main clinical, instrumental and cognitive characteristics. In addition we evaluated the patterns of drug therapy in this aged population. Eighty percent of this sample had been previously hospitalized for CHF. Two or more associated diseases were present in 92%. Heart disease was ischemic or hypertensive in etiology in 80% of patients. Acute dyspnea was the most common presenting symptom. Atrial fibrillation or flutter were found in 38% of patients. Ultrasound evaluation evidenced left ventricular dysfunction of a systolic type in 49% and of a diastolic type in 28.6% of subjects. Diuretics and cardiac glycosides were the most widely administered drugs, followed by ACE-inhibitors, nitrates and dobutamine. Older ( >or= 75 years) patients were treated with more agents, with a trend to a lesser use of dobutamine. Moderate to severe mental deficit was present in 20.8% of our sample, while significant depression was more common (54.2%). The main implications of the clinical profile of the elderly patient hospitalized for CHF are discussed.

Journal Article↗

PubMedDate not supplied

Sexual dimorphism in arterial hypertension: an age-related phenomenon.

Epidemiological, clinical and experimental evidence is available indicating that male subjects develop hypertension with a higher probability than age-matched females. The sexual dimorphism of blood pressure (BP) has been observed both in normotensive and hypertensive subjects. In order to analyze the presence of sexual dimorphism of arterial hypertension (AH) and its relationship to the aging process - particularly to the menopause - the population screened in the Camerano Study has been examined. In addition, to evaluate sex-related differences in the AH, another sample of 3765 patients from our Hypertension Centre has also been considered. Our samples displayed a real cross-over in the prevalence of arterial hypertension, hypercolesterolemia, hyperglycemia and obesity in women versus men, after the menopausal period. In fact, in the adult group (20-54 years) the prevalence of arterial hypertension was significantly higher (P<0.005) in males (9.2%) than females (6.4%), whereas in the older group (>54 years), we observed a significantly higher prevalence (P<0.001) in females (46.6%) than in males (34.7%). These results suggest that the menopause and age can play a separate role in the sexual dimorphism of arterial hypertension. A significant gender-related difference in hypertensive patients was found only in hypercholesterolemia above the age of 50 years, namely, females have this disorder more frequently.

Journal Article↗

PubMedDate not supplied

Advanced non-small cell lung cancer in the elderly: effective and well tolerated weekly gemcitabine and cisplatin regimen. A pilot study.

BACKGROUND: The frequency of advanced non-small cell lung cancer (NSCLC) increases with age and more effective and less toxic chemotherapy schedules are needed in elderly patients. Cisplatin-based regimens are considered the best treatment for advanced NSCLC, although they produce only a modest advantage in overall survival with considerable toxicity. METHODS: In the present study the activity and toxicity of a weekly gemcitabine and cisplatin schedule was evaluated in a small group of advanced NSCLC patients aged 68 years or more. Treatment consisted of gemcitabine 1000 mg/m2 i.v. and cisplatin 35 mg/m2 i.v., both given weekly on days 1, 8, 15 followed by 1 week of rest. RESULTS: Fifteen previously untreated patients entered the study; their median age was 72 years (range 68-76). One hundred and sixteen weekly administrations were delivered. The median dose-intensity was 614.5 mg/m2 per week for gemcitabine (82%) and 21 mg/m2 per week for cisplatin (80%). All the 15 patients were evaluable for response and toxicity. The overall response rate was 40% [95% CI = 16-68%]. The main toxicity was WHO grade III-IV thrombocytopenia that was recorded in 6 patients (40%). Other major toxicities were very low and no treatment-related deaths were reported. CONCLUSIONS: This schedule appears to be active, to have a favourable toxicity profile and can be considered in advanced NSCLC elderly patients. Of interest, the patients enrolled received high dose intensities of both drugs.

Aged↗

PubMedDate not supplied

[Defecography in the diagnosis of fecal incontinence: an analysis of the receiver operating characteristic (ROC)].

Two groups of patients with altered bowel habit and pelvic floor dysfunction, but comparable epidemiologic characteristics (i.e. n = 105 each; mean age and SD 47.3 +/- 15.8 yrs vs. 54.9 +/- 16.7 yrs; range 15-80 yrs vs. 9-88 yrs; F/M ratio 28:1 vs. 2.6:1) with the exception of the absence (or presence) of fecal incontinence, were examined with defecography, taking into account criteria other than anorectal angle values and anorectal junction mobility. At the Receiver Operating Characteristic (ROC) analysis a "barium leak sign", occurring either at rest or on straining was found to be a highly reliable index of fecal incontinence (specificity: 100% and 92-93%, respectively, intraobserver agreement K value = 0.82, Z = 21.58, p < 0.001). A false negative rate of 14.2% was limited to "minor" incontinence only, i.e., incontinence to gas and/or occasional staining episodes. In the search for an etiologic diagnosis, useful adjunctive criteria included (a) anal diameter > 10 mm at rest; (b) poor stop test (inability to interrupt the barium stream); (c) rectal diameter > 6.5 cm and < 4 cm (abnormally increased and reduced compliance, respectively). Defecography is a useful diagnostic tool in fecal incontinence and should precede anal endosonography, manometry and electromyography for proper therapeutic decision-making and in risk conditions, e.g., in the patients about to undergo elective pelvic surgery.

Adolescent↗