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Biomedical subjects

R Giubbini

Publications and source records attributed to R Giubbini.

At least 55 records · Page 3Linked to original sources
PubMed1987

[Acute and chronic effects of verapamil on indices of systolic and diastolic function of the left ventricle in patients with hypertrophic cardiomyopathy].

The aim of this study has been the analysis of acute and chronic effects of Verapamil on resting left ventricular (LV) systolic and diastolic function indices derived from ECG gated radionuclide Angiocardiography (GRA) in patients (pts) affected by Hypertrophic Cardiomyopathy (HCM). 18 pts with HCM were imaged in basal conditions (twice in two different days) and after i.v. infusion of Verapamil 0.1 mg/kg (1st acute test); than chronic oral treatment of Verapamil (240 mg/die) was started. Three months later 14 pts were studied again, during oral chronic therapy and after a second administration of Verapamil i.v. 0.1 mg/kg (2nd acute test). After acute infusion we observed a significant increase of the peak filling rate (PFR) (from 3.3 +/- 0.9 to 3.51 +/- 0.71 EDV/sec, P less than 0.01) and a shortening of the time to PFR (from 188.1 +/- 24.9 to 165 +/- 30 msec, P less than 0.005). No significant variations of the contribution of atrial systole to the ventricular filling (AS) (from 17.03 +/- 5.96 to 18.15 +/- 6.91%), of the heart rate (from 70 +/- 12 to 69 +/- 12 bat/min), and of systolic function indices, ejection fraction (EF) (from 74.4 +/- 9.7 to 74.30 +/- 10.02), peak ejection rate (ER) (from 4.17 +/- 0.92 to 4.10 +/- 0.9), ejection time (ET) (from 307.4 +/- 46.4 to 322.22 +/- 48.6) were noticed. After chronic oral therapy we observed a significant shortening of the time to PFR (from 197.5 +/- 16.7 to 182.8 +/- 13.7 msec, P 0.01), while the remaining indices of diastolic function we analyzed (PFR from 3.2 +/- 0.6 to 3.3 +/- 0.8 EDV/sec; AS from 17.1 +/- 4.9 to 17.1 +/- 6.6%), the systolic function indices (EF from 74.4 +/- 10.5 to 75.4 +/- 9.4%; ER from 4.2 +/- 0.8 to 4.2 +/- 0.6 EDV/sec; ET from 309.6 +/- 48.5 to 308.9 +/- 40.5 msec) and the heart rate (from 67.7 +/- 8 to 66 +/- 8) were not modified. If a 30 msec time to PFR variation was considered significative (confidence limit of 95% between absolute changes measured on two basal studies) the 1st acute test was predictive of chronic efficacy in 10/14 (71%) pts. Four of five pts in which a shortening of TTPFR was observed during the 2nd acute test, showed the same effect with a higher chronic dose of Verapamil (360 mg/die). Our results suggest that Verapamil after acute or chronic treatment improves diastolic filling of LV, without worsening systolic indices.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1985

[Evaluation of the interventricular septum in left bundle branch block using basal echocardiography (M-mode) and myocardial stress scintigraphy (thallium-201)].

In thirty-six consecutive subjects, with left bundle branch block (LBBB) of the interventricular septum (IS), septal perfusion and/or viability was verified by M-mode echocardiography and by stress redistribution 201 TI-scintigraphy. After the early systolic "dip", a characteristic pattern of interventricular septum in left bundle branch block, we observed: a) an anterior paradoxical movement (A-type) during the ejection phase in 5 subjects; b) hypokinetic posterior movement (B-type) in 10 subjects and c) a normal motion (C-type) in 21 subjects. All the subjects with an A-type paradoxical anterior motion of the interventricular septum, showed a persistent defect of T1 uptake both during exercise and after redistribution. Of 31 patients with posterior interventricular septum motion (B and C types), 21 showed normal septal TI uptake and 10 reversible, exercise-induced perfusion defect, with complete redistribution on scintigrams at rest. In conclusion the analysis of our data demonstrates that in patients with left bundle branch block 1) the motion of the interventricular septum is not merely due to the anomalous electrical activation, but to other different factors, such as the anatomical and functional changes underlying the conduction pathology, 2) an A-type motion by M-mode echocardiography is highly predictive of interventricular septum damage.

Adult↗
PubMed1984

[Acute myocardial infarction in a 13-year-old boy with Duchenne's disease].

A 13-year-old boy with Duchenne's muscular dystrophy suffered an acute myocardial infarction as shown by typical electrocardiographic and enzyme changes, and by the results of radionuclide studies. this is the third reported case of the acute myocardial infarction in a patient with Duchenne's muscular dystrophy.

Adolescent↗
PubMed1981

[The association of lymph nodes scintigraphy with 99Tcm-sulfur-microcolloid and ultrasounds scan in stage diagnosis of lymphomas (author's transl)].

Thirty seven patients with lymphomatous disease were studied to detect abdominal lymph nodes involvement by means of lymph nodes scan with 99Tcm-sulfur-microcolloid, ultrasounds scans, lymphangiographies. Lymphangiography was considered as reference standard in patients which explorative laparotomy was not performed in. Isotopic method demonstrated high sensitivity, despite low specificity. Opposite results were obtained by ultrasounds. We concluded that isotopic abdominal lymph nodes scan is a clinically valuable test, if negative, while ultrasounds are, if positive. Both methods, specially if associated, proved quite useful in restaging after therapy, where important parameters are low risk and stress for the patients, easy execution, low costs.

Aged↗
PubMedDate not supplied

A method for simultaneous measurements of body water compartments and potassium pool in anuric subjects.

A method is described for simultaneous measurement of total body water, extracellular body water, plasma volume, exchangeable potassium pool employing radioactive tracers (3H2O, Na235SO4, 42KCl and 125I human serum albumin). Some suggestions are made that are particularly applicable to routine use in anuric and/or dialyzed patients. The observed values fit well with the values predicted for a reference subject.

Anuria↗
PubMedDate not supplied

Prognostic value of tomographic rest-redistribution thallium 201 imaging in medically treated patients with coronary artery disease and left ventricular dysfunction.

BACKGROUND: Previous studies show that rest-redistribution thallium imaging is useful in the assessment of myocardial viability. The impact of such studies on patient outcome is not well defined. This study examined the prognostic value of tomographic rest-redistribution 201T1 imaging in 81 medically treated patients with coronary artery disease and left ventricular dysfunction. METHODS AND RESULTS: Rest-redistribution single-photon emission computed tomographic images were obtained and analyzed quantitatively. The segmental thallium uptake (20 segments per patient) was interpreted as normal, reversible defect, mild to moderate fixed defect, or severe fixed defect. The thallium images were abnormal in 80 patients, with no redistribution (no ischemia) in 43 patients and redistribution (ischemia) in 38 patients. The left ventricular ejection fraction was 27% +/- 8% in patients with no redistribution and 26% +/- 7% in patients with redistribution (difference not significant). In patients with no ischemia, there were 7 +/- 5 severe fixed defects and 5 +/- 4 mild to moderate fixed defects per patient. In patients with ischemia there were 7 +/- 4 reversible defects, 3 +/- 3 mild to moderate fixed defects, and 5 +/- 4 severe fixed defects per patient. The number of any abnormal segments was 11 +/- 5 in patients with no ischemia and 14 +/- 4 in patients with ischemia (p = 0.03). During a mean follow-up of 31 +/- 24 months, there were 11 cardiac deaths in patients with no ischemia (26%) and 22 in patients with ischemia (58%); the survival rate was worse in patients with than without ischemia (p < 0.05). Multivariate Cox survival analysis on important clinical, angiographic, and thallium variables showed that the presence of redistribution was an independent predictor of death (x2 = 5; p = 0.03). CONCLUSIONS: Patients with left ventricular dysfunction and redistribution on rest thallium imaging, a marker of hibernating myocardium, have a higher mortality rate with medical therapy than do patients with a comparable degree of left ventricular dysfunction but with fixed defects only. Thus observations similar to those made with positron emission tomography can be made in a much more straightforward, simple, and probably cost-effective manner with single-photon emission computed tomography.

Aged↗
PubMedDate not supplied

A cost-effective sestamibi protocol in the managed health care era.

BACKGROUND: In the managed health care era a need exists to lower the cost of diagnostic tests for coronary artery disease. One possible approach is to eliminate the rest study in the conventional stress-rest perfusion imaging protocol with single photon emission computed tomography. OBJECTIVE: The aim of the study was to determine the frequency with which single stress single photon emission computed tomography acquisition can be used to diagnose disease in normal patients compared with dual stress-rest protocol. STUDY GROUP: Two hundred patients without history of myocardial infarction, coronary revascularization, valvular disease, dilated cardiomyopathy, or left bundle branch block undergoing 1-day (n = 86) or 2-day (n = 114) stress-rest sestamibi imaging were studied. The stress was exercise in 147 patients and pharmacologic in 53 patients. RESULTS: On the basis of the stress study, 112 patients had normal images, and 88 patients had abnormal images. On the basis of the combined stress-rest images, 131 patients had normal images, and 69 patients had abnormal images (agreement 85%, kappa 0.68 +/- 0.05). Only 6 (5%) of the 112 patients with normal images based on the stress images were considered to have abnormal images by the combined stress and rest images. CONCLUSIONS: In patients with normal stress images elimination of the rest study rarely alters interpretation. Rest studies are most useful in patients with abnormal or equivocal stress images. Such selective elimination of the rest studies may decrease the cost of nuclear procedures and should be considered in the current managed care health system.

Adult↗
PubMedDate not supplied

Electrocardiographic evolution after Q-wave anterior myocardial infarction: correlations between QRS score and changes in left ventricular perfusion and function.

BACKGROUND: In the thrombolytic era, conflicting data have been reported on the usefulness of the QRS score in estimating the amount of left ventricular (LV) damage after acute myocardial infarction (MI). METHODS AND RESULTS: We correlated the QRS score with the extent of LV hypoperfusion and ejection fraction (EF) in 95 consecutive male patients with a first anterior Q-wave MI; the 6-month evolution of QRS score and changes in LV perfusion and function were also compared. The Selvester-Wagner QRS score was computed from the digitized 12-lead electrocardiogram, both at predischarge and 6 months later; at the same time, resting sestamibi first-pass ventriculography and single photon emission computed tomography imaging were performed. A reduction in QRS score occurred at 6 months (6.7 +/- 3.4 vs 7.8 +/- 2.9 at predischarge; P <.001); the perfusion defect extent also decreased (P <.01), and LV EF improved (P <.05). At predischarge, no correlation was found between QRS score and hypoperfusion extent or EF; in contrast, a weak correlation was observed 6 months later (r = 0.55; P <.001; and r = 0.48; P <.01, respectively). QRS score changes from predischarge to 6 months showed limited accuracy in predicting clinically meaningful changes of perfusion or EF (receiver operating characteristic area under the curve, 0.58 and 0.61, respectively). Thrombolytic therapy did not influence the relationship between QRS score and scintigraphic findings. CONCLUSIONS: In patients with recent anterior Q-wave MI, QRS scoring showed a weak, delayed correlation with the amount of LV damage, as estimated by radionuclide techniques. Spontaneous changes in QRS score from predischarge to 6 months seem to be of limited value in identifying patients with late improvement in LV perfusion and function.

Adult↗
PubMedDate not supplied

Sentinel node biopsy in breast cancer: the experience of Brescia Civic Hospital.

The accuracy of the sentinel node technique in the evaluation of axillary node involvement in breast cancer was evaluated in 83 consecutive patients with monofocal T1-2 carcinoma, who were clinically N0 and who underwent lymphoscintigraphy with 99mTc-colloid integrated with intraoperative sentinel node detection by a portable probe. Lymphoscintigraphy revealed at least one sentinel node in 75 patients (90.4%), always identified by the probe. In eight patients (9.6%) the sentinel node was detected neither by lymphoscintigraphy nor by the probe. All removed lymph nodes were analyzed by hematoxylin-eosin histology and the sentinel node by immunostaining. In 28/75 patients (37.3%) at least one metastatic axillary lymph node was detected; in 16 of the 28 N+ subjects (57%) only the sentinel node was positive. The false negative rate (sentinel node negative/other axillary lymph nodes positive) was 17.85% (5/28 patients). In 9/23 patients (39%) micrometastases were found in the sentinel node only. In conclusion, specific sentinel node positivity in 57% of cases supports the validity of the sentinel node concept. Moreover, nine patients would have been considered N0 by standard hematoxylin-eosin histology without sentinel node-aided immunostaining. A 17.8% false negative rate calls for caution in patients with negative sentinel nodes.

Adult↗
PubMedDate not supplied

Sentinel node biopsy in melanoma: the experience of Brescia Civic Hospital.

The accuracy of the sentinel node (SN) technique in the evaluation of lymph node involvement in melanoma was evaluated in 71 consecutive patients with localized disease and Breslow index >1 mm. Lymphoscintigraphy identified at least one SN in 70 of the 71 patients (98.5%). The following day 69 patients underwent selective SN excision. The SN was identified by portable probe. One hundred and twenty-two lymph nodes were removed, 14 (11.4%) of which were metastatic in 9 patients (13%). No metastases were found in 40 patients with Breslow <2 mm. Eight of the 9 patients with positive SNs underwent lymphadenectomy of the whole basin and in two patients new metastatic nodes were found. At 4-26 months' follow-up 1 of the 60 patients with negative SN (scalp melanoma with Breslow 6.2 mm) developed bilateral cervical metastatic nodes. Two more patients with Breslow 3.7 and 5 mm, respectively, developed liver and lung metastases. The remaining 57 patients are still disease free. Among the 9 patients with tumor-positive SNs, 1 was lost to follow-up, 3 died and 5 are still alive. Our data confirm the clinical reliability of the SN technique in melanoma; we feel the technique should be considered a standard tool in the evaluation of melanoma patients.

Adolescent↗
PubMedDate not supplied

Coronary revascularization and recovery of function: the ultimate target.

Recovery of contraction in the akinetic segments represents an important target of coronary revascularization, and the preoperative recognition of viable dyssynergic (hibernating) myocardium is a crucial point in the preoperative investigation of patients with chronically depressed left ventricular function. Dobutamine-echocardiography was utilized in 14 patients to study the contractile reserve retained by viable segments. Redistribution of thallium-201 after rest injection was also used to assess the viability of these areas. The wall motion response to dobutamine infusion predicted immediate postoperative improvement in 85 of 93 segments (sensitivity 91%) and identified 25 of 32 segments which did not exhibit early postoperative improvement (specificity 78%). Rest-redistribution of thallium-201 demonstrated high sensitivity (93%) but low specificity (44%) for predicting the early recovery of regional wall motion. When late recovery was also considered, the specificity of this method increased to 64%. Recovery of function following coronary revascularization can be predicted in patients in whom hibernating myocardium is recognized preoperatively.

Adult↗