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Biomedical subjects

Rosario Rossi

Publications and source records attributed to Rosario Rossi.

16 recordsLinked to original sources
PubMed2006

Type 2 diabetes mellitus is a risk factor for the development of hypertension in postmenopausal women.

OBJECTIVE: Hypertension and type 2 diabetes mellitus are common diseases that are frequently found concomitantly in postmenopausal women. These findings suggest a close and/or synergistic nature in the relationship between the two disease processes; however, no prospective data exist on the incidence rate of hypertension in postmenopausal women with type 2 diabetes mellitus. METHODS: The present study assessed the risk of developing hypertension in 840 postmenopausal women: 102 women (12.1% of the cohort) with type 2 diabetes mellitus and 738 (87.9%) free of diabetes. The mean +/- SD follow-up was 3.2 +/- 0.9 years (range 0.5-6.0 years). RESULTS: The incidence rate (cases of hypertension per 100 person-years) was 1.1 for the group of women without diabetes versus 5.6 in women with diabetes (P < 0.0001). Compared with the non-diabetic group, women with type 2 diabetes mellitus had a statistically significant higher risk of developing hypertension. The relative risks for women with diabetes was 5.09 [crude: 95% confidence interval (CI) = 3.52-7.36; P < 0.0001]; 3.43 (adjusted for body mass index and waist circumference: 95% CI = 2.25-5.14; P < 0.001); and 2.95 (adjusted for all potential confounders: 95% CI = 1.86-4.32; P < 0.01). CONCLUSION: In our prospective study, on the incidence of hypertension, the presence of type 2 diabetes was found to be a potent independent risk determinant. This suggests that postmenopausal women affected by type 2 diabetes mellitus comprise a population at high risk for the subsequent development of hypertension.

Age Factors↗
PubMed2005

Subacute aseptic meningitis as neurological manifestation of primary Sjögren's syndrome.

Sjögren's syndrome (SS) is an autoimmune disease characterized by inflammatory infiltration and secondary chronic dysfunction of exocrine glands. Systemic (extraglandular) manifestations of the disease occur in one-third of the patients, including a wide spectrum of peripheral and central neurological disorders. We report a case of subacute afebrile aseptic meningitis (AM) as neurological manifestation of primary SS. The neurological symptomatology presented gradual onset and progression, including diplopia, mild headache, pain and stiffness of the neck. The clinical examination pointed out xerostomia and xerophthalmia. Diagnosis of SS was confirmed by Schirmer's tear test and histopathology of the labial salivary glands. The neurological involvement was highlighted by gadolinium-enhanced magnetic resonance imaging of the brain which displayed an increased diffuse leptomeningeal enhancement. Cerebrospinal fluid (CSF) analysis showed moderate pleocytosis with prevalence of polymorphonuclear leukocytes and increased protein level but no evidence of Ig intrathecal synthesis. A cycle of intravenous steroid therapy led to a complete disappearance of the neurological symptomatology and to normalization of the CSF inflammatory pattern. Given the unusual presentation of this case of AM, which resembled the characteristics of a chronic meningitis rather than those of an acute form, in patients affected by SS we must stress the importance of cephalic symptoms such as headaches and cervical stiffness (even if mild and without fever) as possible signs of central neurological involvement of the disease.

Anti-Inflammatory Agents↗
PubMed2005

Endothelial-dependent vasodilation and incidence of type 2 diabetes in a population of healthy postmenopausal women.

OBJECTIVE: Both postmenopausal state and diabetes are associated with endothelial dysfunction and are well-known risk factors for atherosclerosis. However, the relationship of endothelium-dependent vasodilation and diabetes has never been prospectively evaluated. This study provided the opportunity to assess the association between endothelial vasodilation function and the incidence of diabetes in a cohort of apparently healthy postmenopausal women. RESEARCH DESIGN AND METHODS: We conducted a prospective cohort study that began in 1997 with 840 apparently healthy, nonobese, postmenopausal women, aged 53 +/- 6 years, initially with normal glucose tolerance at the oral glucose tolerance test. All participants were followed up for a mean period of 3.9 +/- 0.7 years (range 0.5-6.9). Endothelial function was measured as flow-mediated dilation (FMD) of the brachial artery, using high-resolution ultrasound. RESULTS: There were no significant differences in demographic, blood pressure, and biochemical profiles among each tertile group at baseline or at follow-up review. During follow-up, 102 women developed type 2 diabetes. The adjusted relative risk (RR) for women with FMD </=4.3 (lowest tertile) was 5.87 (95% CI 4.34-8.10) versus women with FMD >/=5.6 (highest tertile reference). Each 1-unit decrease of FMD was associated with a significant 32% (22-48%) increase in the multiple-adjusted RR of incident diabetes. CONCLUSIONS: These prospective data indicate a significant increase in the RR of diabetes with each unit decrease of FMD. This could suggest that an impaired endothelial function may play a fundamental role in diabetogenesis in postmenopausal women.

Blood Glucose↗
PubMed2004

Effects of progestins on estrogen-induced increase in C-reactive protein in postmenopausal women.

BACKGROUND: C-reactive protein (CRP) represents an independent risk factor for coronary disease and stroke. Because oral estrogens increase CRP levels, with inflammatory and thrombotic consequences, we determined whether the co-administration of a progestin might modify the estrogenic effect on CRP. METHODS: In a non-randomized, non-blinded study, we measured C-reactive protein serum concentrations with high-sensitivity technique (hs-CRP) in 163 healthy postmenopausal women divided into groups as follow: 52 not taking hormones (referent group), and 111 taking hormone replacement therapy (HRT) (42 of whom treated with unopposed estrogen, and 69 with an estrogen/progestin combination). RESULTS: Compared with non-users of hormones, median CRP levels were 66% (95% confidence interval: from 44 to 89%) higher and 112% (95% confidence interval: from 89 to 168%) higher among women using a combined estrogen/progestin regimen and, respectively, among women taking unopposed estrogen [1.54 mg/L in the referent group; 2.56 mg/L in the estrogen/progestin group (P=0.032), and 3.27 mg/L in the unopposed estrogen group (P=0.004)]. Furthermore, there was no difference in CRP distributions between women taking different types of progestins. CONCLUSION: concurrent progestin administration may attenuate estrogen's pro-inflammatory effects, independently on the type of used progestin.

Administration, Oral↗
PubMed2004

Flow-mediated vasodilation and the risk of developing hypertension in healthy postmenopausal women.

OBJECTIVES: This study provided the opportunity to assess the relationship between endothelial vasomotor function and incidence of hypertension in a cohort of postmenopausal women. BACKGROUND: Both menopause and hypertension are associated with endothelial dysfunction and are well-known risk factors for atherosclerotic-related disease. METHODS: We conducted a prospective cohort study that began in 1996 on 952 apparently healthy postmenopausal women, age 53 +/- 5 years (range 44 to 60 years), with initially normal levels of blood pressure and no history of hypertension. All participants were followed up for a mean period of 3.6 +/- 0.7 years (range 0.5 to 6.9 years). Endothelial function was measured as flow-mediated dilation of the brachial artery using high-resolution ultrasound. RESULTS: During follow-up 112 women developed hypertension. The adjusted relative risk for women with flow-mediated dilation of 3.5 or less (lowest quartile) was 5.77 (95% confidence interval 4.34 to 8.10) versus women with flow-mediated dilation of 5.5 or greater (highest quartile, referent). Each one-unit decrease of flow-mediated dilation was associated with a significant 16% (95% confidence interval 12% to 33%) increase in the multiple-adjusted relative risk of incident hypertension. CONCLUSIONS: These prospective data indicate a significant increase in the relative risk of hypertension with each unit decrease of flow-mediated dilation that is independent of age and baseline systolic and diastolic pressure values. This could suggest that an impaired endothelial vasomotor function precedes and predicts the future development of hypertension in postmenopausal women.

Adult↗
PubMed2004

Transdermal 17-beta-estradiol and risk of developing type 2 diabetes in a population of healthy, nonobese postmenopausal women.

OBJECTIVE: Various observational and randomized studies have demonstrated a reduction in the incidence of type 2 diabetes in postmenopausal women who received estrogen orally. No studies have been performed on the incidence of type 2 diabetes in postmenopausal women treated with transdermal 17-beta-estradiol. The purpose of our study was to assess the influence of transdermal 17-beta-estradiol on the incidence of type 2 diabetes in a population of healthy, nonobese postmenopausal women. RESEARCH DESIGN AND METHODS: Between January 1998 and December 2002, 673 healthy, nonobese postmenopausal women (mean age 54 +/- 5 years) were enrolled: 144 (21.4%) of these took transdermal 17-beta-estradiol and 529 (78.6%) had never taken hormones during their postmenopausal period. Final elaboration of the data took place in July 2003, with a mean follow-up of 3.7 +/- 0.7 years (ranging from 0.5 to 5 years). RESULTS: Type 2 diabetes developed in 60 patients during the follow-up period, which is the equivalent of 22 cases per 1,000 women-years. In the "hormones nonusers" group, diabetes developed in 10% (54 of 529 women; equivalent of 26.5 cases/1,000 women-years), whereas in the "hormones users" group, diabetes developed in 4.16% (6 of 144 women; equivalent of 12.1 cases/1,000 women-years). Transdermal 17-beta-estradiol emerged as a treatment that significantly reduced the risk of developing diabetes (RR 2.19, 95% CI 1.79-3.56; P=0.006). CONCLUSIONS: Our results suggest a significant reduction in the incidence of type 2 diabetes in our population of nonobese, healthy postmenopausal women who used transdermal 17-beta-estradiol. This could suggest that, in some women, the estrogen deficiency that occurs after menopause could represent a fundamental step in the process of diabetogenesis.

Administration, Cutaneous↗
PubMed2004

Noninvasive assessment of coronary artery bypass graft patency by multislice computed tomography.

BACKGROUND: Follow-up of coronary artery bypass after cardiac surgery is routinely performed by means of X-ray coronary angiography. However, this is an invasive procedure, expensive and includes ionizing radiation exposure, hospitalization and a small risk of complications. Multislice computed tomography is a noninvasive diagnostic tool that permits the visualization of the cardiac structures, including the coronary arteries. The purpose of our study was to compare multislice computed tomography with conventional angiography for the evaluation of graft patency following cardiac surgery. METHODS: Forty-seven asymptomatic patients (44 men and 3 women, mean age 67 +/- 7 years) who had undergone coronary bypass surgery at least 10 years previously, were retrospectively investigated by means of ECG-gated multislice computed tomography, within 6 months of coronary angiography. RESULTS: Overall, 116 out of the possible 127 (91.4%) grafts were assessable at computed tomography, including 87 saphenous vein grafts, 26 left internal mammary artery, 2 right internal mammary artery, and 1 gastroepiploic artery. Coronary angiography showed that 79 of 116 grafts (68.1%) were patent and that 37 (31.9%) were occluded. All grafts which were patent and occluded at coronary angiography were correctly identified at multislice computed tomography, with a sensitivity and specificity of 100%. CONCLUSIONS: Multislice computed tomography with retrospective gating permits an accurate and noninvasive evaluation of coronary artery bypass patency, and could replace conventional angiography for the follow-up of asymptomatic, stable patients.

Aged↗
PubMed2003

Gender differences in diagnostic procedures.

This review examines the contribution of the literature to the controversial issue of diagnostic procedures in women affected by coronary artery disease (CAD), on which a large number of papers have been published. It has been reported that cerebro- and cardiovascular diseases represent the first cause of death in the New as well as in the Old World, Italy included. Some studies are conditioned by bias; one of these is the Framingham study, in which angina was reported and defined only clinically and for a relatively young age range, as a benign condition in women. Angiographic studies, such as the CASS, considered a super elected group of women referred to the hemodynamic laboratory for chest pain, which in the female gender often has atypical characteristics. In our opinion, it is mandatory to take into account: 1) what chest pain really means in women; 2) the fact that there are gender differences: women have a different biological and hormonal status, lifestyle, and perception of the disease; 3) that there is a different approach of the physicians to a woman with possible or suspected CAD. We suggest, therefore, a more peculiar and individualized diagnostic approach to women suspected as having CAD. This approach should also take the pre-test probability of disease into consideration. The first investigational step we recommend is the exercise ECG test; should this be unfeasible or not interpretable, an imaging and/or pharmacological stress test is advisable. In case of positive first test results, coronary angiography should be performed.

Aged↗
PubMed2003

Association of breast arterial calcifications detected by mammography and coronary artery calcifications quantified by multislice CT in a population of post-menopausal women.

PURPOSE: To assess the correlation between the presence and extent of breast arterial calcifications (BAC) detected at mammography and the extent of coronary atherosclerosis, as evaluated by multislice computed tomography (MSCT) coronary calcium quantification in a population of post-menopausal women. MATERIALS AND METHODS: Seventy-four post-menopausal women aged under 65 years who had undergone mammography at our Department were studied by MSCT for coronary calcium quantification. The mammograms were screened for vascular calcifications which were graded according to severity and extension. The presence of coronary artery calcifications was assessed by MSCT using the < > cardiac reconstruction software. The data obtained were analyzed using the statistical package SPSS (version 10.1) for Windows. RESULTS: The presence and severity of breast arterial calcifications showed a strong correlation with coronary calcifications in both models. DISCUSSION AND CONCLUSIONS: The study demonstrated that the presence of BAC is strongly correlated with the amount of coronary calcium detected by MSCT and therefore with the extent of coronary atherosclerosis. Moreover, there is a linear correlation between BAC severity and coronary calcium content, each incremental increase in BAC severity being associated with an average increase in coronary calcium content. Therefore, the presence and severity of BAC may provide indirect qualitative and quantitative information on the calcium present in the coronaries. As mammography is increasingly used as a screening test for breast carcinoma, breast arterial calcifications may represent an important sign with epidemiological and clinical significance for primary prevention.

Breast↗
PubMed2002

Prognostic role of reversible endothelial dysfunction in hypertensive postmenopausal women.

OBJECTIVES: ; The aim of the present study was to assess whether optimized antihypertensive treatment is effective in modifying endothelial function and whether an improvement in flow-mediated vasodilation (FMD) in response to treatment, as an expression of reversible endothelial dysfunction, could predict a more favorable prognosis in a population of postmenopausal women. BACKGROUND: Hypertensive postmenopausal women have been shown to have abnormal endothelium-dependent vascular function. However, FMD may change over time, according to antihypertensive treatment; the prognostic value of these changes has not been investigated. METHODS: A total of 400 consecutive postmenopausal women with mild-to-moderate hypertension and impaired FMD underwent ultrasonography of the brachial artery at baseline and after six months, while optimal control of blood pressure was achieved using antihypertensive therapy. They were then followed up for a mean period of 67 months (range 57 to 78). Endothelial function was measured as FMD of the brachial artery, using high-resolution ultrasound. RESULTS: After six months of treatment, FMD had not changed (< or = 10% relative to baseline) in 150 (37.5%) of 400 women (group 1), whereas it had significantly improved (>10% relative to baseline) in the remaining 250 women (62.5%) (group 2). During follow-up, we noticed 32 events (3.50 per 100 person-years) in group 1 and 15 events (0.51 per 100 person-years) in group 2 (p < 0.0001). CONCLUSIONS: This study demonstrates that a significant improvement in endothelial function may be obtained after six months of antihypertensive therapy and clearly identifies patients who possibly have a more favorable prognosis.

Antihypertensive Agents↗
PubMed2002

A comprehensive approach to target organ damage in hypertensive women.

PURPOSE: The aim of the present study was to demonstrate how the regression of target organ damage (TOD) in patients with hypertension really improves prognosis. This issue has already been demonstrated in the general population but no data have been provided in postmenopausal women, which represents a particular group of high-risk hypertensive patients. STUDY SELECTION: We initially chose to select a number of studies focused on the regression of left ventricular hypertrophy since this plays an extremely important prognostic role and is among the restricted number of risk factors that may be corrected with adequate treatment. We also focused our attention on the issue of endothelial dysfunction, considering that this relatively new pathophysiological entity may represent sensu strictu real organ damage of hypertension that has often been demonstrated in postmenopausal women. RESULTS OF DATA ANALYSIS: All the reviewed studies agree that the regression of left ventricular hypertrophy is a positive prognostic factor. Moreover, antihypertensive therapy itself is associated with some changes in the degree of endothelial dysfunction. Our preliminary data seem to suggest that the regression of endothelial dysfunction plays a very important prognostic role in terms of event reduction in postmenopausal patients with hypertension. CONCLUSION: Despite a large amount of research remaining to be carried out on the mechanism and the prognostic role of the modifications of TOD in patients with hypertension, the available data demonstrate that the achievement of a reduction in the extent of TOD is extremely important for the evaluation of the efficacy of the treatment in the general hypertensive population, and also in postmenopausal women.

Aged↗
PubMedDate not supplied

Noninvasive evaluation of coronary artery stents patency after PTCA: role of Multislice Computed Tomography.

PURPOSE: Restenosis of a coronary artery treated with stent implantation is a well-known process that can compromise over time the success of a coronary angioplasty and, accordingly, treated patients must undergo periodic controls. We have recently witnessed a shift towards a greater use of Multi-slice CT (msCT) in the study of coronary disease without its precise indications and limits having yet been underlined. The purpose of our study is to assess the role of msCT in the follow-up of patients treated with coronary angioplasty. MATERIALS AND METHODS: Forty-eight patients, for a total of 72 lesions, who underwent treatment with a slotted tube stent implant, had an msCT examination 1 week before scheduled coronary angiography, and the results were compared. 34 stents/72 (47.2%) were inserted on the left anterior descending; 21/72 (29.2%) on the right coronary; 17/72 (23.6%) on the circumflex artery or obtuse marginal branches. RESULTS: The observation of the opacification of the vessel located distally to treated segments allowed us to assess the patency of all stents. Coronary angiography identified a significant intrastent restenosis or a stent occlusion in 12 of the 72 stents analysed (16.7%). msCT enabled easier visualization of the lumen of the treated artery and its differentiation from the stent struts in the ones located on the left anterior descending artery than those on the circumflex (28 stents out of 34 [82.4%] vs 13/17 [76.5%]; p<0.05), and on the right coronary artery, which were difficult to evaluate (11/21 [52.4%]). We were also able to visualize the lumen of 14/15 stents with a calibre over 3.5 mm [93.3%] vs 35/45 stent with dimensions between 3.1 e 3.4 mm [77.8%], and only 4 stents <3 mm/12 [33.3%]. On multivariate analysis, the characteristics that were significantly and independently associated with accurate visualization of the lumen of a stented vessel were location on the proximal anterior descending artery (OR 4.03 [IC 95%: from 2.34 to 8.05]; p<0.0001) and stent size of >3.5 mm (OR 2.97 [IC 95%: from 1.67 to 4.86]; p<0.01). CONCLUSIONS: The msCT technology available at present makes the study of smaller stents and those positioned on the right coronary artery and circumflex rather complex; on the other hand msCT appears a promising study method for stents greater then 3.5 mm and for those positioned on the proximal segment of the left anterior descending artery.

Angioplasty, Balloon, Coronary↗