PubMed Health⌕ Search

Biomedical subjects

R Molinari

Publications and source records attributed to R Molinari.

At least 37 records · Page 2Linked to original sources
PubMed1998

Short-term results of transdermal estrogen replacement therapy in cardiovascular disease-free postmenopausal females with and without hypertension.

BACKGROUND: Many studies have shown that estrogen replacement with oral micronized 17 beta-estradiol reduces the risk of cardiovascular disease. The aim of the present study was to evaluate the efficacy of transdermal estrogen replacement therapy in improving the risk profile of cardiovascular disease in postmenopausal women. METHODS: Two hundred and fifty postmenopausal women were enrolled from the "Bene Essere Donna" Center and grouped according to the absence (Group I, n = 175; mean age 54.6 +/- 3.5) or presence of mild to moderate hypertension (Group II, n = 75; mean age 54.1 +/- 4.5). Total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, glucose and fibrinogen levels were tested in all women. The total study population was treated with estrogen replacement therapy for 12 months: hysterectomized women received 17 beta-estradiol (0.05 mg/die), while non-hysterectomized women received 17 beta-estradiol 0.05 mg/die plus 5 mg/die of medroxyprogesterone acetate for 12 days during every 28-day cycle. After 12 months, blood pressure and blood chemistry were measured as baseline. RESULTS: Total cholesterol, LDL cholesterol and glucose levels decreased in both groups. HDL cholesterol levels increased significantly only in the sub-group of Group II treated with estrogen plus progesterone. Triglycerides glucose and fibrinogen blood levels decreased in both groups. No cardiovascular events were recorded during the first year of follow-up. CONCLUSION: Transdermal estrogen replacement therapy should be considered as a therapeutic support in order to contrast the elevated cardiovascular risk in postmenopausal women.

Antihypertensive Agents↗
PubMed1997

Short atrioventricular delay reduces the degree of mitral regurgitation in patients with a sequential dual-chamber pacemaker.

This study was performed in a population of sequential dual-chamber pacemaker-patients with isolated mitral regurgitation (MR) to identify the "ideal atrioventricular (AV) delay" and to determine the effect of sequential pacing with the ideal AV delay on MR degree. Twenty consecutive patients (age 69 +/- 7 years; 45% men) hospitalized at our institution for symptomatic III degree AV block and isolated MR were studied. All received a dual-chamber pacemaker programmed in DDD at a rate of 70 pulses/minute. The ideal AV delay was selected using echo-color Doppler parameters; it was defined as that resulting in a lower degree of MR and in the highest cardiac output. The mean "optimal short" AV delay resulted in 98 +/- 7 ms. At short AV delay we observed a significant reduction in MR severity (regurgitant fraction from 48 +/- 12% to 25 +/- 10% and jet area from 15 +/- 2 to 9 +/- 2 cm2; p <0.0001) together with an increase in stroke volume (68 +/- 16 vs 88 +/- 15 ml; p = 0.007) and mitral early-to-late peak velocity ratio (0.79 +/- 0.33 vs 1.38 +/- 0.37; p <0.0001). In conclusion, a short AV delay may be used to improve cardiac output in sequential paced patients with pure, isolated MR.

Aged↗
PubMed1997

Salivary duct carcinoma: clinical characteristics and treatment strategies.

BACKGROUND: Salivary duct carcinoma (SDC) is a highly malignant tumor of the salivary gland. METHODS: Twenty-six cases observed during the period 1975 to 1994 were selected from the pathology archives of the Instituto Nazionale Tumori of Milan. A review of all the similar cases published in the literature and comparison with the present series was performed. RESULTS: SDC was mainly a parotid gland tumor diagnosed at an advanced stage. Lymphatic involvement seems to be related to T stage. Distant spread was evidently related to the presence of lymph node metastasis. Surgery with radiotherapy was the standard treatment. The only demonstrable negative prognostic factor was the presence of node metastases (p = 0.01). CONCLUSIONS: Most patients died of disseminated disease in spite of an aggressive and often successful local-regional treatment. The role of a prophylactic ipsilateral neck dissection and adjunctive systemic treatment should be investigated.

Adult↗
PubMed1997

Early predictors of late dilation and remodeling after thrombolized anterior transmural myocardial infarction.

BACKGROUND AND HYPOTHESIS: Dilation of the left ventricle after myocardial infarction is associated with an adverse prognosis. There are no clinical studies on the role viable myocardium in the infarcted area assumes in relation to the development of late ventricular remodeling. The hypothesis of this study was to define the relation between remodeling and the presence of viable but akinetic myocardium in the infarct area and to identify early predictors of left ventricular (LV) dilation at 1 year. METHODS: In all, 92 consecutive patients with myocardial infarction were divided into two groups according to their ventricular volumes. Group I included 57 patients with normal volumes at discharge (9 +/- 3 days after acute infarction) and after 12 months or with LV dilation at discharge who had a normalization of their volumes over a 12-month period. Group II included 35 patients who, independent of their initial volumes, developed LV dilation during follow-up. Low-dose dobutamine infusion was utilized at discharge for echocardiographic evaluation of contractile recovery of viable myocardial segments. RESULTS: At the first control, patients in Group I presented an end-diastolic volume index (EDVI) of 100 +/- 7 ml/m2 which decreased to 68.8 +/- 6.5 ml/m2 12 months later (p < 0.0001), and an end-systolic volume index (ESVI) of 47.6 +/- 6.7 ml/m2 at the first control and 30.5 +/- 8.8 ml/m2 after 12 months (p < 0.001). Patients in Group II presented a mean EDVI of 116.2 +/- 8.1 ml/m2 at the first control and 138.8 +/- 8 ml/m2 12 months later (p < 0.001), and a mean ESVI of 68.8 +/- 6.5 ml/m2 at the first control and 79.5 +/- 5.4 after 12 months (p < 0.01). Ventricular mass index (VMI) in Group I increased from 106.4 +/- 11 to 122.3 +/- 15 g/m2 (p < 0.01), while in Group II it decreased from 101.1 +/- 10 to 98.7 +/- 8 g/m2 (p = NS). In Group I, mass-to-volume ratio was 1.15 +/- 0.1 g/ml at the first control and 1.67 +/- 0.1 g/ml 12 months later (p < 0.001), while in Group II it declined from 0.88 +/- 0.1 to 0.69 +/- 0.1 g/ml (p < 0.01). The multivariate analysis revealed that ejection fraction < or = 40%, restrictive filling pattern, wall motion score index > 2.5 in response to dobutamine infusion, and mass-to-volume ratio < or = 1 g/ml, all at discharge, as well as an occluded left anterior descending artery discriminate in favor of late LV dilation and remodeling. CONCLUSIONS: Correct use of noninvasive strategies should result in early identification of postinfarct patients who are at risk of developing LV remodeling.

Aged↗
PubMed1997

Left atrial size is the major predictor of cardiac death and overall clinical outcome in patients with dilated cardiomyopathy: a long-term follow-up study.

HYPOTHESIS: This study was undertaken to determine whether echo-derived left atrial dimension and other echocardiographic, clinical, and hemodynamic parameters detected at the time of entry into the study may influence prognosis in patients with dilated cardiomyopathy during a long-term follow-up. METHODS: This was a prospective cohort analysis of 123 patients with dilated cardiomyopathy. Clinical evaluation, chest x-ray, M-mode and two-dimensional echocardiogram, exercise test, 72-h ambulatory electrocardiogram monitoring, and cardiac catheterization study were performed in all patients. The study was divided into two phases: in the first phase, patients were divided into two groups according to the left atrial size (> or = 45 mm; < 45 mm), with cardiac death as the end point. In the second phase, all patients were further divided into two groups according to their clinical course. A multivariate analysis was performed to determine independent correlated parameters of cardiac mortality and overall clinical outcome. RESULTS: Cardiac mortality rate was 47.9%: 29% in the group without left atrial dilation and 54.3% in the group with dilated left atrium. Multivariate analysis revealed that left atrium > or = 45 mm, New York Heart Association functional classes III/IV, and the presence of one or more episodes of ventricular tachycardia at Holter monitoring were independent predictors of cardiac mortality, while left atrium > or = 45 mm, left ventricular end-diastolic pressure > 17 mmHg, and exercise tolerance < or = 15 min were independent predictors of poor clinical outcome. CONCLUSIONS: Our results revealed that left atrial size is the principal independent predictor of prognosis in patients with dilated cardiomyopathy in that patients with left atrial dilation had an increase in mortality and a worse clinical outcome compared with those without left atrial dilation.

Adult↗
PubMed1997

Biological indicators of survival in patients treated by surgery for squamous cell carcinoma of the oral cavity and oropharynx.

Squamous cell carcinomas of the head and neck are a heterogeneous group of tumours with regard to anatomical site, natural history and response to various treatments. Assessment of the role of biomarkers as indicators of prognosis or response to treatment is thus complex. In the last decade, different biomarkers have been investigated in the search for objective and reproducible indicators of prognosis. In 69 squamous cell carcinomas of the oral cavity or oropharynx from patients treated with radical surgery alone, we determined cell kinetics, evaluated as in vitro 3H-thymidine labelling index (TLI), p53, bcl-2 and glutathione S-transferase pi (GST pi) expression, by using immunohistochemical methods. The biological variables were unrelated to one another or to established clinical and pathological prognostic factors. Univariate analysis showed that a low proliferative activity was associated to a significantly higher risk of death than that observed in patients with a high TLI, whereas p53, bcl-2 and GST pi expression did not provide prognostic information. Multivariate analysis showed that cell proliferation, gender and nodal status retained their clinical relevance. In the subset of node-negative patients, TLI and p53 expression were indicators of survival. Moreover, the combined analysis of TLI and p53 expression identified a subgroup of node-negative patients with slowly proliferating and highly p53-expressing tumours who died within 1 year of radical surgery. These results indicate that in patients with operable oral cavity and oropharyngeal cancer, biomarkers can provide important information on clinical outcome.

Adult↗
PubMed1997

[Changes in serum levels of N-terminal procollagen type III propeptide as an index of postinfarction ventricular remodeling].

The levels of aminoterminal propeptide of type III procollagen (PIIINP) can be used as an index of collagen breakdown. The aim of our study was to evaluate modifications in serum concentration of PIIINP (PIIINPs) in patients with a first episode of myocardial infarction. We examined 70 patients admitted at our Institution for acute myocardial infarction and 10 normal subjects. PIIINPs dosage was obtained by radioimmunoassay method utilizing a commercial available kit. All patients underwent three PIIINPs dosages: within 24 hours after admission, at 6 and 12 months after myocardial infarction. Control values were 0.4 +/- 0.1 U/ml. In 38 patients (Group I) PIIINPs levels increased at 6 and 12 months after infarction: 0.53 +/- 0.2, 0.75 +/- 0.2 and finally 0.76 +/- 0.1 U/ml. In the remaining 32 patients (Group II) PIIINPs values increased at 6 months and then returned to baseline at 12 months: 0.56 +/- 0.2, 0.75 +/- 0.1 and then 0.46 +/- 0.1 U/ml. The end-diastolic volume index did not change significantly in Group I (from 93.7 +/- 21 to 79.7 +/- 20 ml/m2) while it decreased after 12 months in Group II (from 88.9 +/- 13 to 58.6 +/- 11 ml/m2; confidence interval 95% from 2 to 55 ml/m2; p = 0.03). Similarly, there was no significant variation in end-systolic volume index (ESVI, from 39.7 +/- 11 to 36.9 +/- 11 ml/m2) and ejection fraction (from 60 +/- 10 to 59 +/- 15%) in Group I; while in Group II ESVI decreased significantly (from 33.6 +/- 13 to 20 +/- 5 ml/m2, confidence interval 95% from 3 to 24 ml/m2; p = 0.02) and ejection fraction improved (from 62 +/- 11 to 72 +/- 15%; confidence interval 95% from -20 to -1%; p = 0.04). In conclusion, patients with elevated levels of PIIINPs at 12 months did not improve ventricular function while patients with PIIINPs returning to baseline at 12 months had an improvement. Our results suggest an active participation of newly formed collagen in post-infarct ventricular remodeling. Therefore PIIINPs may be a marker of this process.

Collagen↗
PubMed1996

Cisplatin, doxorubicin and cyclophosphamide in advanced salivary gland carcinoma. A phase II trial of 22 patients.

BACKGROUND: To evaluate the activity of CAP regimen in advanced salivary gland carcinomas. PATIENTS AND METHODS: Twenty-two patients with advanced salivary gland carcinomas were treated according to the CAP regimen. All patients were previously treated with surgery and/or radiotherapy and/or chemotherapy. Seven patients had local or locoregional disease, nine patients had local and metastatic disease, six patients had metastatic disease only. The most common histologies were included. RESULTS: Of 22 patients, six achieved a partial response (27%, 95% CI: 11%-50%): no complete response was observed. Response duration ranged between 3 and 13 months (median seven months). The median survival time for the entire series was 21 months. CONCLUSIONS: In this investigation, on 22 consecutive patients, CAP combination provided an overall response rate of 27%. This study confirms that, at present, available drugs yield poor results, either as single agents or as combination therapy.

Adult↗
PubMed1996

The importance of different atrioventricular delay for left ventricular filling in sequential pacing: clinical implications.

We assessed the influence and clinical consequences of different AV delay on ventricular filling in 30 patients (mean age 60 +/- 5 years) who had DDD pacemakers for AV block. All 30 patients presented a normal ejection fraction, but in 18 cases (Group I), an echo-Doppler examination revealed ventricular hypertrophy (mean end-diastolic wall thickness of 1.4 +/- 0.16 cm, LV mass index 155 +/- 17 g/m2), and an abnormal relaxation pattern (isovolumetric relaxation time = 124.72 +/- 11.82; early to late peak velocity = 0.6 +/- 0.03; deceleration time = 296.83 +/- 34.02 ms). Group II included the remaining 12 patients who had a normal filling pattern. In all 30 patients, the pattern was reassessed following modification of the AV delay (200, 150, 100, and 75 ms). Patients at baseline (AV delay of 200 ms) also underwent an exercise test with determination of respiratory gas exchange. In Group I, 13 (72.5%) patients were classified as Weber class B (VO2 Max 16.8 +/- 1.7 mL/min per kg); and 5 (27.5%) were Class A (VO2 Max 22.5 +/- 1.4 mL/min per kg). In Group II, all 12 patients were classified as Weber Class A. In Group II, changes in AV delay caused no consistent variations in filling pattern, and therefore AV delay was not modified. In Group I patients, since reduction to 100 ms resulted in normalization of the filling pattern, the AV delay was programmed to 100 ms. A graded exercise test repeated after 6 months' follow-up showed an improved Weber class in 13 patients (from B to A) and greater VO2 Max in the remaining five already in Class A. We concluded that, in sequential paced patients with normal ejection fraction but abnormal relaxation pattern, modification in AV delay can induce normalization of filling and improvement in cardiac functional capacity.

Aged↗
PubMed1996

[Shortening of atrioventricular interval improves ventricular filling and clinical outcome in patients with DDD pacemaker and left ventricular hypertrophy].

The influence and clinical consequences of different atrioventricular delays on ventricular filling have been studied in 30 patients (mean age 60 +/- 5 years) who implanted DDD pacemaker for complete A-V block. All patients presented a normal ejection fraction: 63.9 +/- 6.5%. In 18 subjects (Group I) an echo-Doppler examination revealed ventricular hypertrophy (mean end-diastolic wall thickness of 1.4 +/- 0.16 cm; left ventricular mass index 155 +/- 17 g/m2) and an abnormal relaxation pattern (isovolumic relaxation time 124 +/- 11: early to late peak velocity 0.6 +/- 0.03; deceleration time of the early diastolic peak 296 +/- 34 ms). Group II included the remaining 12 patients without left ventricular hypertrophy and normal filling pattern. In all 30 patients the filling pattern was reassessed following modification of the A-V delay (200, 150, 100 and 75 ms). Patients at baseline (200 ms of A-V delay) underwent an exercise test with determination of respiratory gas exchange. In Group I, 13 (72.5%) patients were classified as Weber class B (VO2 max 16.8 +/- 1.7 ml/min/kg) and 5 (27.5%) as class A (VO2 max 22.5 +/- 1.4 ml/min/kg). In Group II, all 12 patients were classified as Weber class A (VO2 max 23.1 +/- 1.1 ml/ min/kg). In Group II, changes in A-V delay caused no homogeneous variation in filling pattern. A-V delay was not modified in this group. In Group I, the reduction of A-V delay to 100 ms resulted in filling normalization. In this group A-V delay was programmed definitely to 100 ms. Graded exercise test repeated at 6 months follow-up showed an improved Weber class in 13 patients (from B to A) and greater VO2 max in the remaining 5 already in class A. We conclude that, in sequential paced patients with normal ejection fraction but abnormal relaxation pattern, a modification of A-V delay can induce filling normalization and improve cardiac functional capacity.

Atrioventricular Node↗
PubMed1995

[Stroke in pacemaker users for sinus node disease. Relevance of atrial function and clinical characteristics].

Several studies reported that the annual incidence of stroke in patients with sick sinus syndrome ranges from 6 to 10% while the incidence of stroke in patients with atrial fibrillation is about 2-4% and about 0.1% in the normal population. We evaluated the prevalence of cerebral ischemia and peripheral embolism and investigated the predictor factors in a population of 80 patients paced for sick sinus syndrome. The implanted pacemakers were 40 ventricular and 40 physiological stimulation mode was based on the physicians judgement. All patients had cerebral computed tomography scan at the time of implant and after 24 months. Statistical analysis included log-rank test and actuarial curve calculated with Mantel-Haenszel method. At the end of follow-up the end-point occurred in 15 patients: 2 patients had asymptomatic cerebral infarction, 2 had fatal stroke, 2 developed peripheral embolysm, 1 to the lower limb and 1 abdominal; in 4 patients a transient ischemic attack occurred, in 2 a minor stroke and in 3 a non invalidant stroke. No statistically significant difference was found among the subgroups; with different pacing modality. In conclusion, multivariate analysis underlines the role of age > 65 years, history of cerebral ischemia, low atrial ejection force and spontaneous echo contrast in the development of embolic episodes.

Aged↗
PubMed1995

[Atrial ejection force. Findings in healthy subjects].

Atrial ejection force was measured by Doppler echocardiography from the A-wave of the transmitral inflow pattern. Atrial ejection force was measured in 72 normal subjects, 36 males and 36 females aged 20 to 80 years, 12 patients for each decade. Using bivariate correlation we analyzed the relationship between atrial ejection force and biological parameters: age, height, weight, body surface; clinical parameters: heart rate, systolic, diastolic and mean blood pressure; echocardiographic measures: left atrial dimensions. A significant correlation between atrial ejection force and age (r = 0.9, p < 0.001) was found. The atrial ejection force was also correlated with left atrial dimensions (p < 0.01). No relations between atrial ejection force and other clinical parameters were found. The atrial ejection force is a potentially useful parameter for assessing the atrial contribution to diastolic performance, the age-corrected normogram is essential when assessing atrial ejection force in individual patients.

Adult↗
PubMed1994

[Recovery of mechanical atrial function following atrial fibrillation].

To evaluated the recovery of atrial function following atrial fibrillation, we followed 66 patients with atrial fibrillation cardioverted to sinus rhythm. Over 3 months of follow-up we performed transmitral pulsed Doppler echocardiography. The results were evaluated according to the etiology, duration of atrial fibrillation, left atrial dimension and modality of cardioversion. We observed a significant increase in both peak A wave velocity and percent atrial contribution to total left ventricular filling after 1 month in hypertensive patients and after 3 months in ischemic patients. The recovery of atrial mechanical function was earlier in patients with recent atrial fibrillation (< 24 hours) and in patients with normal left atrium. These results may have implications in guiding the duration of anticoagulant therapy after cardioversion.

Aged↗
PubMed1993

Mucosal malignant melanoma of head and neck: forty-eight cases treated at Istituto Nazionale Tumori of Milan.

A series of 48 cases of malignant mucosal melanomas treated at the Milan Cancer Institute from 1975 to 1990 is retrospectively reviewed. There were 34 males and 14 females, and their ages ranged from 21 to 79 years (mean, 58). The site of origin of the tumor was the nasal cavity in 26 cases, the oral cavity in 15, larynx in two, lip mucosa in two, pharynx in two and upper esophagus in one. At presentation, the neoplasm was limited to the primary site in 60.4% of the patients. Most patients (34) were treated with surgery alone. Nine were treated with surgery combined with chemo- and/or radiotherapy and five with radiotherapy combined with chemotherapy and/or immunotherapy. Only when surgery was part of the treatment (42 of 48 cases) the patients were rendered disease free, but no further relapse of disease was documented in only five of these patients. The observed 2- and 5-year survival rate of the entire group was 45% and 21%, respectively. The 4-year disease-free survival rate was 7%. The median interval between therapy and the first relapse was 8.5 months (range, 1-66). In 44% of the patients the first recurrence of the tumor was at the primary site.

Adult↗
PubMed1991

Cisplatin in advanced salivary gland carcinoma. A phase II study of 25 patients.

A prospective Phase II study was carried out to test cisplatin (CDDP) as a single agent in salivary gland carcinomas. CDDP was administered (100 mg/m2) every 3 weeks to 25 consecutive patients with either recurrent or locally advanced salivary gland carcinoma. Six patients had received prior chemotherapy, and the other patients had had only surgery or radiation therapy or no treatment at all. The response rate was 18% (95% confidence interval [CI], 6% to 41%). Response duration was between 5 and 9 months. Median overall survival time was 14 months. CDDP is a moderately active drug in salivary gland carcinomas. It should be included in multidrug regimens to be tested in prospective studies, which are difficult to carry out due to the rarity of these tumors.

Adult↗
PubMed1991

CO2 laser surgery in laryngeal cancers: three year results.

The purpose of this paper is to evaluate the relapse-free survival and the overall survival at three years of 39 laryngeal cancers (10 T1 and 29 small recurrent carcinomas with mobile vocal cord) operated on by CO2 laser surgery at the Istituto Nazionale Tumori in Milan from 1982 to 1987. The 10 patients with T1 cancers had two local recurrences, whereas the 29 patients with recurrent carcinomas had 14 local recurrences. Local relapses occurred in 2/16 patients with cancer limited to the vocal cord and in 9/17 patients with glottic tumors extended to the anterior commissure or to the ventricular band or to the arytenoid. Supraglottic cancers recurred in 3/4 patients. The authors conclude that transoral laser surgery is an effective modality for treatment of T1 primary and small recurrent carcinomas of the larynx, when limited to the middle third of the vocal cord.

Adult↗