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Biomedical subjects

S Bergerone

Publications and source records attributed to S Bergerone.

At least 19 recordsLinked to original sources
PubMed1993

Atrial natriuretic peptide and bronchial hyperresponsiveness in patients with mitral stenosis.

Atrial natriuretic peptide (ANP) has been reported to have protective effects against methacholine-induced bronchoconstriction in asthmatics. The aim of the study was to evaluate the relationship between plasma ANP levels and bronchial responsiveness to methacholine in patients with mitral stenosis. In 12 patients with moderate mitral stenosis, age 35-58 years, 9 female, 8 in NYHA class 2, 4 in NYHA class 3 for symptoms, plasma ANP and bronchial threshold to methacholine (PD20FEV1) were determined. The same measurements were performed in 10 asthmatic patients, hyperresponsive to methacholine, and in 10 normal subjects, nonresponsive to methacholine. Mean +/- SE plasma ANP levels were significantly higher in patients with mitral stenosis in comparison with asthmatics and normals (159 +/- 41.8, 7.3 +/- 0.98, 7.6 +/- 1.3, respectively, p < 0.01). In patients with mitral stenosis there was a significant relationship between plasma ANP and PD20FEV1 (r = 0.81, p < 0.01). No relationship was found between ANP and PD20FEV1 in asthmatics. In conclusion, in patients with mitral stenosis ANP seems to play a protective role against bronchial hyperresponsiveness to methacholine.

Adult↗
PubMed1993

Streptokinase induces intravascular release of platelet-activating factor in patients with acute myocardial infarction and stimulates its synthesis by cultured human endothelial cells.

BACKGROUND: Reocclusion of a successfully recanalized infarct-related artery may account for failure of thrombolytic therapy. Evidence suggests that the intravascular activation of platelets may limit the response to this treatment. The aim of the present study was to investigate whether platelet-activating factor (PAF), an ether lipid mediator with multiple potent biological activities, is synthesized during therapy with thrombolytic agents. Two sets of experiments were performed: (1) we extracted and quantified PAF in blood of patients with acute myocardial infarction treated or untreated with streptokinase (SK), and (2) since the endothelium/platelet interaction is thought to be at the basis of vascular reocclusion, we studied whether cultured human endothelial cells synthesize PAF after stimulation with SK or plasmin. METHODS AND RESULTS: PAF was extracted from blood samples immediately after acidification to destroy the acid-labile PAF-acetylhydrolase in 25 patients with acute myocardial infarction treated (group A, n = 14) and untreated (group B, n = 11) with intravenous infusion of SK. PAF was detected in 10 of 14 patients of group A and none of group B. PAF began to be detectable 60 to 90 minutes after SK infusion and disappeared from the circulation within 120 to 180 minutes. Percent variation of platelet count over basal values correlated negatively with the amount of PAF present in the circulation at 90 minutes (r = -.719; P < .001) and at 120 minutes (r = -.652; P < .001). Cultured human umbilical cord vein-derived endothelial cells (ECs) synthesized PAF in a dose-dependent manner in response to SK and plasmin, with a synthesis that peaked at 15 minutes and persisted up to 30 minutes for SK and 2 hours for plasmin. PAF extracted from blood samples or from ECs was quantified by bioassay performed after purification by thin-layer chromatography and high-performance liquid chromatography (HPLC). PAF-bioactive material was characterized as PAF with physicochemical and enzymatic treatments, HPLC-tandem mass spectrometry, and specific PAF-receptor antagonists. CONCLUSIONS: The observation that PAF was detectable in the blood of patients of group A only after treatment with SK and was not detectable in patients with a comparable infarct not treated with SK (group B) suggested that SK stimulates the synthesis of this mediator either directly or via plasmin generation. Indeed, cultured human ECs synthesize PAF after stimulation with both SK and plasmin. PAF production by ECs may promote platelet activation and interaction of these cells as well as of circulating leukocytes with endothelium. These events may limit the beneficial effects of thrombolytic therapy.

Cells, Cultured↗
PubMed1992

Value of exercise stress test, radionuclide angiography and coronary angiography in predicting new coronary events in asymptomatic patients after a first episode of myocardial infarction.

One-hundred-and-fifty-five consecutive symptom-free patients underwent maximal treadmill exercise testing, rest and stress radionuclide angiography at least two months after an uncomplicated acute myocardial infarction; of these, 90 underwent coronary angiography. All patients were followed-up for a mean of 32 +/- 13 months regarding the prediction of hard (death and reinfarction) and soft (angina and coronary surgery) coronary events. The specificity, sensitivity, positive and negative predictive value of exercise stress test were 47%, 76% and 41% for any coronary events; none of the patients who incurred a hard coronary event showed ischemia during electrocardiographic exercise tests. Sensitivity, specificity and positive predictive value for failure to increase the ejection fraction of at least 5% were 60%, 45% and 30% for any coronary event and 25%, 49% and 2% for any hard coronary event. The presence of multivessel disease at coronary angiography showed a sensitivity of 62% for any coronary event and of 67% for hard coronary events; specificities were 66% and 57%, and predictive values were 52% and 10%, respectively. It is concluded that electrocardiographic exercise testing, radionuclide angiography and coronary angiography are not helpful two months after an episode of uncomplicated myocardial infarction in order to identify patients who will suffer a new coronary event.

Adult↗
PubMed1992

Atrial natriuretic factor and concomitant hormonal, hemodynamic and renal function changes after slow continuous ultrafiltration.

We treated a patient with refractory biventricular heart failure, dilutional hyponatremia and prerenal azotemia, by means of ultrafiltration. After ultrafiltration, gas exchange and cardiac output improved, with concomitant reduction of systemic and pulmonary vascular resistances. Despite a decrease of right atrial and wedge pressure, atrial natriuretic factor rose and plasma renin activity decreased.

Atrial Natriuretic Factor↗
PubMed1992

Bronchial responsiveness, oscillations of peak flow rate and symptoms in patients with mitral stenosis.

To better characterize airway hyperresponsiveness reported in cardiac patients questionnaire-recorded symptoms, bronchial responsiveness to methacholine (Mch) and to ultrasonically nebulized distilled water (UNDW), diurnal oscillations of peak expiratory flow (PEF) rate were evaluated in 32 patients with moderate mitral stenosis. Twenty patients were responsive to Mch (defined as provocative dose producing a 20% fall in forced expiratory volume in one second (PD20 FEV1) less than 3.2 mg) (geometric mean PD20 FEV1 851 +/- 154 micrograms SE). Only two patients showed a fall in FEV1 greater than 20% after UNDW challenge. Patients responsive to Mch challenge had lower FEV1 as percentage of vital capacity (FEV1/VC) (80 +/- 4.8 vs 83 +/- 3.8%, p less than 0.05), higher coefficient of variation of PEF (CV-PEF) (7.1 +/- 2.8 vs 5 +/- 2.4, p less than 0.05) and higher prevalence of wheeze (70 vs 25%, p less than 0.05) in comparison with patients non-responsive to Mch challenge. CV-PEF was significantly related to FEV1 (r = 0.347, p less than 0.05) and maximal expiratory flow at 50% expired volume (MEF50) (r = 0.405, p less than 0.05). The probability of responding to Mch bronchial challenge increased proportionally with the increase in CV-PEF and the decrease in FEV1, FEV1/VC and MEF50. Airway hyperresponsiveness of patients with mitral stenosis seems to be more similar to that reported in bronchitic than in asthmatic patients.

Adult↗
PubMed1991

Intracoronary streptokinase in unstable angina: a prospective randomised study.

Results of our prospective, randomised pilot trial to evaluate the clinical effects and the angiographic correlates of early thrombolysis in patients with unstable angina are reported. Sixty-seven patients had coronary angiography 10 +/- 8 (median 7) hours after an episode of transient chest pain at rest with reversible ischaemic changes on the electrocardiogram. Patients with left main disease (4), or diffuse coronary disease and unidentified ischemia-producing lesions (13) were excluded, as were those without severe (greater than or equal to 70%) stenosis (10). Intracoronary thrombus was identified at angiography in 7 patients (17%) and complex coronary lesions in 5 (12%) of the remaining 40 patients who were randomised to either intracoronary streptokinase 250,000 IU followed by intravenous heparin along with conventional treatment (20 patients), or to conventional treatment alone (20 patients). All patients received Aspirin. No differences between the streptokinase and the conventional treatment groups were observed with respect to demographic and clinical characteristics at admission to the study. During observation in the intensive care unit for 3 +/- 1 days, 8 patients (40%) with streptokinase and 10 (50%) with conventional treatment were free from angina and infarction (p = 0.75; 95% confidence interval for the difference in response rates = -20 to 40%). There were no bleeding complications and no patient died. Patients enrolled in our study had fewer coronary thrombi at angiography than currently reported. Our data did not show that adjunct treatment with streptokinase and heparin is superior to conventional treatment alone in these patients.

Aged↗
PubMed1990

[The midterm clinical results of myocardial revascularization with the internal mammary artery].

After a 3-year (1985-1988) experience of myocardial revascularization using internal mammary artery (AMI) grafts and after having excluded (1986) an higher operative mortality and morbidity, clinical medium-term results have been analysed. The first 144 patients discharged alive after AMI bypass surgery in 1985 were clinically evaluated, with a mean interval of 21 months from surgery (range: 5-29 months). Exercise electrocardiographic test was performed by 100 patients, and angiography repeated in 15. Actuarial survival function was estimated by Cutler-Ederer method: 2-year actuarial survival was 99.3 +/- 0.7% (94 +/- 1.8%, when operative deaths were included). Non fatal myocardial infarction occurred in 3 patients and, at follow-up, 26 were symptomatic for angina: 2 patients underwent re-operation and 2 angioplasty. Two years after AMI bypass surgery, actuarial estimate of ischemic event-free patients was 70.9 +/- 4.5% (67.7 +/- 4.5%, when operative deaths were included): 73 out of 100 exercise tests were negative for both angina and ischemia, although only 43 patients, reached maximal work load; 9 were positive for both angina and ischemia and 18 for ischemia only. All patients who underwent angiographic evaluation (15 patients, 11 of whom because of angina relapse) had AMI grafts open, while in only 4 patients all the implanted grafts were open.

Aged↗
PubMed1989

[Giant cell arteritis of cardiologic relevance: polymorphism of the clinical manifestations and therapeutic indications].

Three cases of giant cell arteritis have been admitted to our Institution from 1985 to 1989, with different diagnoses: aortic dissection, left atrial myxoma and fever of unexplained origin. The diagnosis of giant cell arteritis (GCA)/temporal arteritis (TA), biopsy proven, allowed us to institute an effective corticosteroid treatment. These 3 cases of TA permit us to emphasize the systemic vascular involvement in GCA/TA, with the aorta and its major branches being the districts mainly affected; the polymorphism of clinical manifestations at onset; the importance of constitutional symptoms that can dominate other clinical manifestations. Concomitant involvement of the aorta and its major branches, and of small sized arteries, permits regarding Horton's disease as an overlap syndrome between "pulseless disease" of Takayasu and systemic necrotizing vasculitides of the polyarteritis nodosa group. A prompt diagnosis of this arteritis is needed, because of the good therapeutic opportunities with corticosteroids, and because of the possibility of serious vascular and ocular complications without therapy.

Aged↗
PubMed1989

[Reliability of electrocardiographic criteria for the diagnosis of apical myocardial infarct].

Electrocardiographic criteria for the diagnosis of apical myocardial infarction are still debated. Aim of the present study is to evaluate if there is an electrocardiographic pattern useful in the diagnosis of apical AMI using biplane ventriculography as "gold standard" technique. For this reason, we studied 75 patients at the first AMI with a-dyskinesis in the apical zone on biplane ventriculography (segments 3 and 7 according with CASS nomenclature). By the means of ventriculography we have selected 2 groups: a first group of 19 patients with a-dyskinesis confined to apical zone and a second group of 56 patients with a-dyskinesis in the apical zone and surrounding regions. In the 2 groups we found different electrocardiographic changes. In the first group (a-dyskinesis in the apical zone only) we found the ECG pattern of anterior AMI in 14 (73.7%), antero-inferior AMI in 2 (10.5%), antero-lateral AMI in 1 (5.3%) and inferior-posterior AMI in 2 patients (10.5%), respectively; in the second group (a-dyskinesis in the apical and surrounding zones) we observed 31 (55.4%) anterior, 7 (12.5%) antero-lateral, 7 (12.5%) antero-inferior and 11 (19.6%) inferior-posterior myocardial infarctions. Our study did not allow to recognize a "typical" ECG pattern associated with the "apical" infarction seen at ventriculography.

Electrocardiography↗
PubMed1988

Ultrafiltration in the treatment of refractory congestive heart failure.

Artificial subtraction of fluids and solutes was evaluated in the course of acute and chronic heart failure when it became refractory to standard intensive medical treatment. A group of 19 patients (mean age 57 years), 9 with ischemic, 2 amyloidotic, 4 valvular, and 4 idiopathic cardiomyopathy, were treated. In 17 patients extracorporeal ultrafiltration (UF) by means of a polysulfonate ultrafilter was adopted along 125 sessions (105 assisted by a roller pump and 20 as a slow continuous ultrafiltrate). In two patients continuous peritoneal dialysis was adopted. In every case UF was well tolerated. Ultrafiltrate volumes ranged from 1680 to 3500 ml for every session with corresponding Na losses ranging from 194 to 434 mEq/session. Improved clinical and functional status with reduction of edema was observed in 17 of 19 patients. In 12 patients UF could be discontinued due to restored response to diuretics; 5 of these patients could subsequently undergo heart surgery (1 transplant, 3 valve replacement, 1 coronary bypass). The remaining 7 patients survived on medical therapy alone for an average of 228 days. In 7 of 19 cases, UF could not be discontinued, and these patients died after an average of 23 days of treatment. In conclusion, UF proved to be effective in eliminating salt-fluid overload and restoring response to medical treatment. Patients who are potential surgical candidates seem to be the most suitable for UF.

Adult↗
PubMed1988

[Results of coronary artery bypass surgery. Surgical mortality, survival and follow-up functional state. Multivariate discriminant analysis of relative risk factors].

Clinical results of coronary artery bypass surgery, have been evaluated by analyzing operative mortality, late survival, late functional results and their related risk factors. Four hundred and thirty-seven consecutive patients who underwent coronary artery bypass surgery between January, 1979, and December, 1983, were the clinical material of this study. The gender of patients was male in 89% of the cases; age ranged from 34 to 78 years with a mean of 54.8 +/- 8.2 (SD). Patients with combined surgical procedures were excluded. Follow-up averaged 55.7 months; 404 survivors have been contacted (97% of the total study population, if operative and late deaths are added); 218 patients underwent a control exercise test; postoperative employment status was determined for 242 individuals. The operative mortality was 5.49% (24 patients). Death was due to cardiac causes in 75% of the cases. The overall actuarial survival rate was 85 +/- 1.9% after 5 years and 83.4 +/- 2.2% after 7 years. When non-cardiac related deaths were excluded the actuarial rates were 88 +/- 1.7% and 87.2 +/- 1.9% after 5 and 7 years respectively. Actuarial freedom from all ischemic events (cardiac related death, late myocardial infarction or recurrence of angina) was 66.1 after five years, and was 70.2% if operative deaths were excluded. Actuarial freedom from recurrence of angina for patients alive at follow-up was 78.7% after five years, actuarial freedom from myocardial infarction was 93.5%. The mortality hazard showed a diphasic response, being higher perioperatively and constant in the following 5 years of follow-up. All ischemic events, both singularly and together, showed an accelerated rate of occurrence at the first and after the fifth postoperative year, the slope of the curve being quite flat during the 1 to 5 year interval. The control exercise test was negative for 62.8% of the patients, positive for 33.5% and undeterminable in 3.7%. Employment status was postoperatively unaffected in 49.6% of the cases, while 27.3% of the patients retired: the remaining individuals had already retired before surgery. Statistical analysis (stepwise logistic regression) identified age (p = 0.002) and cross-clamp time (p = 0.016) as significant risk factors of operative mortality. The ejection fraction showed a value close to statistical significance (p = 0.06).(ABSTRACT TRUNCATED AT 400 WORDS)

Actuarial Analysis↗
PubMed1986

Use of radionuclide angiography and an electrocardiographic stress test to diagnose multivessel disease after a first episode of uncomplicated myocardial infarction.

Sixty consecutive patients who were symptom free 2-12 months after an uncomplicated acute myocardial infarction underwent maximal treadmill exercise testing, radionuclide angiography before and during submaximal bicycle stress test, and coronary angiography. The results of the non-invasive procedures were compared with those of coronary angiography. The sensitivity and specificity of electrocardiogram stress test for detection of multivessel disease were 40% and 77% respectively. Failure of left ventricular ejection fraction to increase at least 5% with exercise identified 20 of the 25 patients with multivessel disease (sensitivity 80%) and 23 of the 35 patients with no additional coronary artery stenosis (specificity 66%). In patients with anterior Q waves the sensitivity was 78% and the specificity 50%, whereas in the presence of inferior Q waves these values were 81% and 87% respectively. Loss of left ventricle synchronicity during effort, as indicated by failure of the standard deviation of the phases to decrease during exercise, demonstrated a radionuclide angiography sensitivity of 80% (77% for anterior myocardial infarction and 81% for inferior myocardial infarction) and a specificity of 50% (33% for anterior myocardial infarction and 64% for inferior myocardial infarction). When the test was considered to be positive if either the ejection fraction or the standard deviation of the phases criteria were positive, the sensitivity was 100% and specificity 46% (30% for anterior myocardial infarction and 65% for inferior myocardial infarction). It is concluded that in patients who are free from angina 2-12 months after an episode of uncomplicated myocardial infarction, a simple exercise electrocardiogram cannot be relied upon to detect residual ischaemia. An abnormal ejection fraction response or an increased standard deviation of the phases during exercise nuclear angiography or both identified all the patients with multivessel disease. None of the patients in whom radionuclide angiographic criteria were negative had multivessel disease.

Coronary Disease↗
PubMed1984

Severe electrocardiographic abnormalities during arfonad administration.

Severe and reversible electrocardiographic abnormalities (first degree atrioventricular block, left bundle branch block, ventricular fibrillation), were induced by the administration of Arfonad in a patient with type III acute aortic dissection previously chronically treated with alpha-methyl-dopa. Any other possible cause of the electrocardiographic changes was excluded on the basis of clinical findings and laboratory studies. The explanation of the electrocardiographic abnormalities induced by Arfonad are not readily apparent, also on careful review of the literature. We suggest a strict electrocardiographic monitoring during Arfonad administration especially in patients with cardiac conduction defects and previous administration of cardiac cathecholamines depleting drugs.

Adult↗