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Biomedical subjects

R Manfredini

Publications and source records attributed to R Manfredini.

At least 73 records · Page 4Linked to original sources
PubMed1997

Relative influence of menopausal status, age, and body mass index on blood pressure.

The objective of this study was to assess the influence of menopausal status on blood pressure levels in a cross-sectional population study in the setting of a preventive health care program clinically conducted in Ferrara, Italy. The patients were 2397 healthy women 35 to 65 years old (489 in premenopause, 847 in perimenopause, 887 in spontaneous menopause, and 174 in surgical menopause); subgroups were also obtained with increasing duration of menopause (1 to > 5 years) matched with premenopausal and perimenopausal women by chronological age at onset of menopause. Measurements of sphygmomanometric blood pressure, age, age at menopause, duration of menopause, and body mass index were made. Postmenopausal women had higher blood pressure than premenopausal and perimenopausal subjects. After adjustment for body mass index, the blood pressure changes with menopausal status were still significant, but not after correction by age. The increased risk of hypertension of postmenopausal women also lost statistical significance after adjustment for age and body mass index. At multivariate analysis, blood pressure showed no significant relation with the duration of menopause, whereas age was a significant covariant for systolic blood pressure, and body mass index for systolic and diastolic blood pressure. A transient initial rise in blood pressure and body mass index was detected in surgical but not in spontaneous menopause. Blood pressure rises after menopause appear to be due more to increased body mass index and aging than ovarian failure per se.

Adult↗
PubMed1997

Seasonal variations in the rupture of abdominal aortic aneurysms.

From 1982 to 1994, 54 patients (47 men; mean age 72 years) were referred to the Hospital of Ferrara, Italy for spontaneous rupture of abdominal aortic aneurysm. Sixteen died in the emergency department and 38 underwent urgent surgery. Day and month of onset of acute symptoms leading to urgent surgery were recorded. A seasonal variation with significant peaks in spring and autumn was found. These findings are likely influenced by local environmental, social and epidemiological factors, but may be relevant for the appropriate timing of the follow-up and therapeutic strategies for abdominal aortic aneurysms.

Aged↗
PubMed1997

Alterations of sleep and circadian blood pressure profile.

The organization of sleep activity in stages of different depth is reflected by consistent changes in blood pressure that account for the major part of the day-night blood pressure difference. On the other hand, different mechanisms may underlie dysregulation of nocturnal blood pressure. Cyclic variations in autonomic nervous system activity play an important role in the mediation of the influences of sleep and wakefulness on blood pressure. In addition, several physiologic substances that are knoiwn to induce sleep or arousal are knoiwn to exert actions on blood pressure. Hence, derangements in autonomic nervous system activity, either primitive or secondary to alterations in the circadian rhythm of a variety of neurohumoral factors, are reflected in changes of the circadian blood pressure profile. Important additional influences of sleep on blood pressure may be exerted through respiratory variations, so that sleep-disordered breathing is bound to alter nocturnal blood pressure. Finally, insomnia has to be taken into account as a major cause of sleep-related alteration of the circadian blood pressure profile. The number of medical disorders that can cause insomnia is huge, and includes many if not all of the conditions in which a loss or reversal of the physiologic blood pressure fall at night is found to be prevalent. Unfortunately, objective sleep studies have been performed only in studies of a minority of these disorders, and further studies to assess the pathophysiologic mechanisms actually involved in causing sleep disturbances in each pathologic condition are necessary.

Journal Article↗
PubMed1996

Endocrine mechanisms of blood pressure rhythms.

The temporal organization of blood pressure is mainly controlled by neuroendocrine mechanisms. The monoaminergic systems appear to integrate the major driving factors of temporal variability, but evidence also indicates a role of the hypothalamic-pituitary-adrenal, hypothalamic-pituitary-thyroid, opioid, renin-angiotensin-aldosterone, and endothelial systems as well as other vasoactive peptides. Although their hormonal secretions are typically episodic, the probability of secretory episodes is "gated" by mechanisms that are coupled either to sleep or to an endogenous pacemaker which usually is predominantly (though not only) circadian. Many hormones with established actions on the cardiovascular system (arginine vasopressin, vasoactive intestinal peptide, melatonin, somatotropin, insulin, steroids, serotonin, CRF, ACTH, TRH, endogenous opioids, and prostaglandin E2) are also involved in sleep induction or arousal. Hence, physical, mental, and pathologic stimuli, which may drive activation or inhibition of these neuroendocrine effectors of biologic rhythmicity, may also interfere with the temporal blood pressure structure. On the other hand, the immediate adaptation of the exogenous components of blood pressure rhythms to the demands of the environment are modulated by the circadian-time-dependent responsiveness of the biologic oscillators and their neuroendocrine effectors. These notions may contribute to a better understanding of the pathophysiology and therapeutics of changes in blood pressure.

Animals↗
PubMed1996

Relationships of the circadian rhythms of thrombotic, ischemic, hemorrhagic, and arrhythmic events to blood pressure rhythms.

Convincing evidence has recently accumulated that several unfavorable cardiovascular events show a well defined pattern in their occurrence throughout the day. Myocardial angina and infarction, sudden cardiac death, arrhythmias, fatal pulmonary thromboembolism, and ischemic and hemorrhagic cerebrovascular accidents occur more frequently in the morning, after awaking, until noon. Diurnal variations in multiple biologic functions, such as assumption of an upright posture associated with increased platelet aggregability, changes in blood clotting, fibrinolysis, and vascular tone and resistance, may be potentially active triggering factors. Moreover, variations in sympathetic tone, catecholamine secretion, and blood pressure have to be considered. The role of triggering factors and their relationships with blood pressure patterns is discussed in view of an optimized pharmacologic treatment.

Animals↗
PubMed1996

[Fatal pulmonary embolism. Risk factors and anatomo-pathological findings related to gender and age].

OBJECTIVES: The aim of this study was to evaluate possible variations in clinical risk factors and anatomopathological findings in fatal pulmonary embolism in relation to sex and age. METHODS: The total sample consisted of 230 subjects (mean age 72 +/- 11 years), 103 males and 127 females, of which 74 died out-of-hospital and 156 in the course of hospitalization. 124 cases were then considered also separately as "sudden death group". The sample was stratified by sex and into 4 groups by age: subjects aged less than 60 years, between 60 and 69, between 70 and 79, and more than 80 years. RESULTS: Age at occurrence of pulmonary embolism was significantly higher in females, compared with males (75 +/- 11 vs 69 +/- 11 years, p < 0.001), and the men/women ratio was higher in younger age groups, tending to inversion with aging. An increased frequency of males was found between subgroups of subjects affected by valvular heart disease (10.6% vs 2.3%, p = 0.019), and chronic pulmonary disease (7.7% vs 1.8%, p = 0.049), whereas an increased frequency of women was found in a group of subjects suffering from trauma or fracture (12.6% vs 2.9%, p = 0.016). As concerns age subgroups, a significant increased frequency of subjects aged < 60 years was found in risk groups "surgery" (36%, p < 0.001) and "malignancy" (40%, p = 0.002). Moreover, in subjects aged less than 80 years, main predisposing factors were recent trauma and/or a fracture (16.2%, p = 0.013). CONCLUSION: The difference in frequency of risk factors between sexes could depend on the higher life expectancy in women, with consequent increase in likelihood of risk factors specifically related to the elderly.

Age Factors↗
PubMed1996

Inhibition of cell growth by accumulated spermine is associated with a transient alteration of cell cycle progression.

Exposure of HL-60 cells to millimolar levels of spermine resulted in the inhibition of cell growth. Flow cytometry revealed that the addition of exogenous spermine prevented the accumulation of cells in the S and G2/M phases of the cell cycle as observed in the control cells. High intracellular levels of spermine completely suppressed the early onset of ornithine decarboxylase activity and, consequently, the intracellular increase in spermidine and putrescine. On the other hand, the addition of exogenous spermidine or putrescine also abolished ornithine decarboxylase activity, but in this case neither the growth of spermidine- or putrescine-treated cells nor the cell cycle phase distribution was affected. In the latter cells, intracellular levels of spermidine were not significantly different from control ones. These results suggest that the addition of exogenous spermine inhibits cell proliferation by hindering the increase in cellular spermidine needed to accelerate the G1 to S phase transition.

Cell Cycle↗
PubMed1996

Out-of-hospital sudden death referring to an emergency department.

Over an 11-year period, autopsies were performed on 957 of 1038 nontraumatic deaths in the Emergency Department of the Central Hospital in Ferrara, Italy. Of these 957 cases, 732 (76.5%) met criteria for sudden death. In 100 (14%) of these cases, the death could be attributed to pulmonary embolism (55 cases), stroke (17), or rupture of aortic aneurysm (28). Acute myocardial infarction accounted for 403 (55%) of all sudden deaths. Severe coronary artery disease was found in 340 (84%) of these 403 deaths, with plaque fissuring or thrombi in 189 or 151 cases, respectively. Among the 229 sudden deaths for whom no immediate cause could be determined (31% of the total population), all had evidence of heart disease: 147 individuals had severe coronary artery disease, with plaque fissuring or thrombi found in 72 or 43, respectively. The remaining cases with no immediate cause of death had evidence of a cardiomyopathy (61) or valvular disease (21). We conclude that acute myocardial infarction accounts for the majority of cases of nontraumatic sudden death in our Emergency Department. Altogether, 84% of these patients had severe coronary artery disease. In approximately one-third of cases for whom no immediate cause of sudden death could be determined, all had evidence of heart disease, and about two-thirds had severe coronary artery disease.

Cause of Death↗
PubMed1996

The time for suicide.

To evaluate whether a time pattern exists in the occurrence of suicide, 223 cases observed in Ferrara, Italy, over a 10-year period were considered. The determination of the hour of suicide was precise in 99 cases, presumptive (within a range of 1 hour) in 53, while for another 44 cases it was possible to define a probable time of suicide, grouping into four 6-hour periods (night, morning, afternoon, and evening). The remaining 27 cases were excluded as it was impossible to determine the time reliably. The data were analysed both by means of chi 2 test for goodness-of-fit and by single cosinor. A specific pattern, characterized by a significant peak in the late morning -early afternoon hours was found for the entire sample and sex subgroups.

Adult↗
PubMed1996

Circadian rhythm of parasuicide in relation to violence of method and concomitant mental disorder.

Circadian occurrence of parasuicide was evaluated in relation to sex, violence of parasuicide method and psychiatric diagnosis. In all, 457 consecutive episodes of parasuicide were recruited during a 5-year period. Complete data for time of parasuicide, parasuicide method, parasuicide recurrency and psychiatric diagnosis (ICD-9) were available for 304 subjects. Parasuicide methods were classified into two groups depending on the violence of the method. Parasuicide occurred significantly more often in the afternoon and evening hours for both men and women, for both violent and non-violent methods, both in first-even cases and repeaters, and in the following diagnostic groups: organic mental and psychoactive substance disorders, neurotic disorders and personality disorders. The data support the hypothesis of a circadian rhythmicity of parasuicide, showing an area of chronobiological risk in the afternoon and early evening hours.

Adult↗
PubMed1996

Circadian and circannual rhythmicity in the occurrence of subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: Inconsistent data are available on the temporal pattern of onset of subarachnoid hemorrhage (SAH). We investigated the possible influence of vascular risk factors. METHODS: Of a consecutive series of 217 cases of SAH, precise determination (within 30 minutes) of the time of symptom onset was possible in 199 (91.7%). Partial Fourier series with up to six harmonics were applied to hourly and monthly data, and the best-fitting curves for circadian and annual rhythmicity were calculated. The amplitude-MESOR (rhythm-adjusted mean over the time period analyzed) ratio was used as a measure of temporal variability. RESULTS: In the total population, a significant circadian pattern of occurrence was demonstrated with major peaks in the morning (approximately 9 AM) and evening (approximately 9 PM) hours and a nocturnal trough (approximately 3 AM). Younger, male, and hypertensive subjects had lower amplitude-MESOR ratios; smokers had no significant rhythmicity. The annual pattern showed a 6-month periodicity with two major peaks in March and September and minor differences in the subgroups studied. CONCLUSIONS: Our study indicates that the temporal distribution in onset of SAH may be influenced by variable combinations of environmental and vascular risk factors.

Age Factors↗
PubMed1996

Chronobiologic aspects of ischemic coronary artery disease.

Convincing evidence is now available suggesting that several unfavorable cardiovascular events respect a well-defined diurnal pattern in their occurrence. In particular, ischemic heart disease has been widely investigated, and many data indicate a constellation of underlying risk factors whose temporal coincidence might act as triggering factors in the occurrence of acute events. In this paper, the recent knowledge concerning both epidemiology of ischemic heart disease and potentially favoring factors are reviewed from a chronobiological point of view.

Angina Pectoris↗
PubMed1996

The relationship between in vitro and in vivo venous compliance measurement.

OBJECTIVE: To assess the relationship between in vitro and in vivo venous compliance measurement. DESIGN: Prospective, blind study. MATERIALS AND METHODS: Patients affected by primary varicose veins and classified in accord with the new CEAP criteria (C2-6/S, Ep, AS1-4/p17-18, PR) underwent blind venous compliance measurements using two different methods. 1) In vivo assessment of the compliance of the greater saphenous vein by duplex scanning, for diameter, and a needle transducer, for venous pressure measurements. 2) In vitro standard compliance assessment of the same vein segment after its excision. RESULTS: The compliance values obtained with the two methods showed a significant degree of correlation, which improved with increasing intravenous pressures. CONCLUSIONS: In vivo compliance assessment of the saphenous vein was validated by the relationship with the standard in vitro measurement.

Elasticity↗
PubMed1996

[Use of esophageal atrial electrogram and an external Thera VDD pacemaker in atrial-triggered ventricular pacing in acute myocardial infarction complicated by total AV block and low cardiac output].

Aim of this short report is to present a simple and fast technique to pace in VDD mode patients with acute myocardial infarction associated with third degree AV block and haemodynamic deterioration. VDD pacing was obtained using atrial electrogram recorded by trans-oesophageal catheter and a Medtronic Thera VDD pace-maker as temporary pace-maker.

Aged↗
PubMed1995

Chronobiological aspects of pulmonary thromboembolism.

A growing body of evidence has recently accumulated suggesting that several unfavorable cardiovascular events, e.g., myocardial angina and infarction, sudden cardiac death, and stroke, present a specific temporal pattern in their occurrence. This has also been shown to be true for fatal pulmonary thromboembolism, with a high frequence peak in winter and in the morning hours. The authors report the circannual and circadian aspects of pulmonary thromboembolism, analysing both the temporal patterns of the underlying favouring or precipitating factors, and the possible therapeutic implications.

Anticoagulants↗
PubMed1995

Serum cholesterol concentrations in parasuicide.

OBJECTIVE: To evaluate whether people who have committed parasuicide have low serum cholesterol concentrations. DESIGN: Results of blood tests in subjects admitted to hospital for parasuicide compared with those of a control group of non-suicidal subjects; comparison in subgroup of parasuicide subjects of two sets of blood test results (one set from admission for parasuicide and the other from admission for some other illness). SETTING: General hospital, Ferrara, Italy. SUBJECTS: 331 parasuicide subjects aged 44 (SD 21) years (109 with two sets of blood test results) and 331 controls. MAIN OUTCOME MEASURES: Serum cholesterol concentrations and possible association with parasuicide, considering sex, violence of method of parasuicide, and underlying psychiatric disorder. RESULTS: Lower serum cholesterol concentrations (4.96 (SD 1.16) mmol/l) were found in the parasuicide subjects than in the controls (5.43 (1.30); P < 0.001), regardless of sex and degree of violence of parasuicide method. Both men and women with two sets of blood test results had lower cholesterol concentrations after parasuicide. Linear regression analysis showed that the difference in cholesterol concentrations was significantly related to the length of time between the taking of the two sets of blood samples. CONCLUSION: The study showed low cholesterol concentrations after parasuicide. This finding agrees with previous studies, which suggest an association between low cholesterol concentration and suicide.

Adult↗
PubMed1995

Non-haemorrhagic adverse reactions of oral anticoagulant therapy.

Oral anticoagulants are extensively used in everyday medical practice, especially for the prophylaxis of deep vein thrombosis and pulmonary thromboembolism. Bleeding is the major risk of such therapy. Although infrequent, however, non-haemorrhagic complications may also play a considerable role. The purpose of this paper is briefly to review the most important non-haemorrhagic adverse reactions and their clinical signs. Moreover, the pathogenetic hypotheses, the relationships with protein C and S levels, and the possibility of prevention and treatment are also discussed.

Administration, Oral↗