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Biomedical subjects

S Lino

Publications and source records attributed to S Lino.

15 recordsLinked to original sources

Role of echocardiography in acute chest pain syndrome.

Fewer than one third of patients presenting to the emergency department with complaints of chest pain have an acute coronary syndrome. The electrocardiogram provides a specific diagnosis only in 40% of patients with acute myocardial infarction. The presence of regional wall-motion abnormalities at echocardiography in patients without known coronary artery disease is a moderate indicator of an increased likelihood of acute myocardial ischemia or myocardial infarction with a positive predictive accuracy of about 50%. More important, the absence of regional wall-motion abnormalities identifies a subset of patients unlikely to have a myocardial infarction with a negative predictive accuracy of about 95%. Echocardiography can provide incremental prognostic information to identify patients at risk of early or late cardiac events, even after consideration of clinical, historical, and electrocardiographic variables. The application of new contrast agents to echocardiography will probably allow an early and more accurate evaluation of patients with chest pain of uncertain significance.

Acute Disease↗

Transient phase locking patterns among respiration, heart rate and blood pressure during cardiorespiratory synchronisation in humans.

The interactions between respiration, heart rate and blood pressure variability (HRV, BPV), are considered to be of paramount importance for the study of the functional organisation of the autonomic nervous system (ANS). The aim of the reported study is to detect and classify the intermittent phase locking (PL) phenomena between respiration, HRV and BPV during cardiorespiratory synchronisation experiments, by using the following time-domain techniques: Poincaré maps, recurrence plots, time-space separation plots and frequency tracking locus. The experimental protocol consists of three stages, with normal subjects in paced breathing at 15, 12 and 8 breaths min-1. Transient phenomena of coordination between respiration and the major rhythms of HRV and BPV (low and high frequency, LF and HF) have been detected and classified: no interaction between LF and HF rhythms at 15 breaths min-1; short time intervals of stable 1:2 frequency and phase synchronisation during the 12 breaths min-1 stage; 1:1 PL during the 8 breaths min-1 stage. 1:1 and 1:2 PL phenomena occurred when the respiration frequency was quite close to the LF frequency or when it was about twice the LF frequency, respectively. The complex organisation of the ANS seems to provoke transient rather than permanent PL phenomena between the co-ordinating components of respiration and cardiovascular variability series.

Adult↗

Spontaneous fluctuations of human pupil reflect central autonomic rhythms.

Aim of this study is to assess whether and to what extent LF and HF rhythms contribute to spontaneous pupil diameter fluctuations at rest and during sympathetic activation by Head-Up Tilt Test 70 degrees. ECG, Finapres and Respiration data from 10 normal subjects were recorded simultaneously to spontaneous pupil diameter fluctuations (SPDF). The respiratory rhythm and the LF component were clearly detected in all the SPDF series. The cross-spectrum analysis gave significant results (> 0.5) in HF band. During tilt, a reduction in the total variability with a relative increase of the LF component was observed in HR, BP and SPDF signals. The multivariate analysis of the SPDF and of the cardiovascular variability series allows new insights into the physiology of pupil neural control. The effect of tilting on SPDF spectra and the physiological background of the pupil control are consistent with the hypothesis that pupil fluctuations reflect a generalized increase of the sympathetic tone.

Adult↗

[Cardiovascular neuroregulation and rhythms of the autonomic nervous system: frequency domain analysis].

Studies using spectral analysis of cardiovascular variability series, as a non invasive tool for assessing the autonomic nervous system activity, have attracted growing interest in the last 20 years. Short-term recordings of heart rate variability distinguish two main spectral components: a high-frequency (HF) component (ranging between 0.15-0.40 Hz), and a low-frequency (LF) component (ranging between 0.04-0.15 Hz), respectively considered markers of parasympathetic and sympathetic control. Spectral analysis of microcirculatory blood flow, by using laser Doppler flowmetry, recently disclosed the presence of similar rhythms. Although a general agreement about the amplitude and frequency of these spectral components has not been gained yet, evidences of an autonomic nervous system role have been collected. Also the pupil diameter spontaneously fluctuates in the HF range. The aim of this study was to design an experimental set up for the simultaneous and continuous recording of heart rate, blood pressure, respiratory activity, peripheral blood flow, and pupil diameter fluctuations in order to investigate whether common spontaneous rhythms could be detected into the variability series. We enrolled 10 normal volunteers (range 24-28 years). The variability series of heart rate, blood pressure, respiratory activity, peripheral blood flow and pupil diameter were obtained at rest and during sympathetic activation by head-up tilt test 70 degrees. Subjects were instructed to breath at 15 breath/min following an audio signal and adjusting their tidal volume to a comfortable level. Peripheral blood flow was non invasively monitored with laser Doppler technique, with the two probes located in the palmar site of the hand and in the sternum. We continuously assess the pupil diameter fluctuations by a custom, portable, infrared TV pupillometer. Spectral density was estimated by autoregressive modeling on 250-point segments. The respiratory rhythm was clearly detected in all the variability series. Oscillations in the LF band were detected in heart rate, blood pressure and in the laser Doppler signals of the hand, as well as in the pupil diameter, but not always in the laser Doppler flow of the sternum. In this last signal an harmonic component at 0.16-0.17 Hz was detected. A reduction in the total variability, with a relative increase in the LF component was observed during head-up tilt test in the heart rate, blood pressure, peripheral blood flow and pupil diameter signals. These findings are consistent with the increased sympathetic modulation induced by the head-up tilt test. These data confirm previous findings and observations, collected with different techniques and for different purposes. Whether these rhythms can be expression of central common oscillators or reflex mechanical factors is of primary importance for possible clinical applications of this approach.

Adult↗

Cardiac autonomic dysfunction in patients with Alzheimer disease: possible pathogenetic mechanisms.

We studied a possible correlation between autonomic cardiac activity and the level of the red blood cell acetylcholinesterase (AChE) in patients with probable Alzheimer disease (AD). The influence of cholinesterase inhibitor treatment on this autonomic activity was evaluated. Twelve patients satisfying the NINCDS-ADRDA criteria of probable AD and 10 healthy controls were studied. Autonomic cardiac activity was evaluated by means of power spectral analysis (PSA) of heart rate variability (HRV) using an autoregressive algorithm on 250 consecutive electrocardiographic R-R intervals. All patients received oral eptastigmine, a new cholinesterase inhibitor, for 1 month. Before treatment, a simultaneous recording of the electrocardiographic and respiratory activities was performed at rest and subsequently during head-up tilt test at 700. Recording was repeated on the last day of treatment. The level of AChE activity during each recording was also evaluated. Spectrum power was calculated in three main frequency bands: high frequency (HF), 0.15-0.4 Hz; low frequency (LF), 0.04-0.15 Hz; very low frequency (VLF), <0.04 Hz. In addition, we calculated the total spectrum power (TSP) and the LF/HF ratio. The TSP and the absolute value of each spectral component were significantly lower in AD patients than in controls. In contrast with controls, AD patients did not show any significant change before treatment in either the LF and HF components or in the LF/HF ratio during the tilt test. However, the modification in the LF component, induced by tilting, showed a significant correlation with the level of AChE activity (p < 0.03). During the tilt test, the treatment caused changes in LF and HF components and in the LF/HF ratio similar to those observed in controls. These results suggest that the presence of autonomic cardiac dysfunction in AD patients might be due to a cholinergic deficit in the peripheral autonomic nervous system. Some aspects of this autonomic dysfunction can be normalized by cholinesterase inhibitor treatment.

Acetylcholinesterase↗

Respiratory sinus arrhythmia and cardiovascular neural regulation in athletes.

Studies using spectral analysis of cardiovascular variability as a noninvasive means for assessing autonomic nervous system activity have provided controversial results in athletes. One reason is that a slow breathing rate--a common feature in athletes--affects spectral estimation because it causes the low-frequency (LF) and high-frequency (HF) components to overlap. Low-frequency power increases during sympathetic activation; high-frequency corresponds to respiratory sinus arrhythmia. In this study, to assess how controlled respiration influences autonomic nervous system activity, we determined the effect of controlled and uncontrolled breathing conditions on cardiovascular variability. Our aim was to identify a standard respiratory rate for spectral estimation of cardiovascular neural control in athletes. During electrocardiographic recordings, subjects lay supine and breathed at their spontaneous frequency and at rates of 15, 12, and 10 to 14 (random) breaths x min(-1). Uncontrolled and random breathing rates significantly altered spectral sympathetic indices; conversely, 15 and 12 breaths x min(-1) redistributed respiratory related power through the HF, thus yielding correct LF power estimation. None of the breathing conditions significantly changed mean heart rate, arterial blood pressure, or spectral total power of cardiovascular variability. In conclusion, when power spectral analysis is used for assessing autonomic activity in athletes, respiration should be standardized at 15 breaths x min(-1). Controlled respiration at this rate leaves autonomic nervous system activity unchanged.

Adolescent↗

Sympathetic-parasympathetic activation during spontaneous attacks of cluster headache: evaluation by spectral analysis of heart-rate fluctuations.

Twenty-four hour ECG Holter and blood-pressure monitorings were performed in eight patients suffering from cluster headache. Spectral analysis of heart-rate fluctuation was used to assess the autonomic balance under basal conditions, after head-up tilt, and during a spontaneous attack. Normal autonomic balance was found at rest and during sympathetic activation obtained with head-up tilt in the interparoxysmal period. Before the onset of headache, an increase in the low-frequency (LF) component of the power spectrum was apparent in all patients. This sign of sympathetic activation was followed by an increase in the high-frequency (HF) component that developed about 2000 beats after the onset of headache and rapidly overcame the LF component until the end of pain. Significant differences were found when comparing the spectral parameters [total spectral values (TP), power of the LF and HF components and LF/HF ratio] obtained before, during and after headache. During the attack, blood pressure increased and heart rate decreased in all subjects. There appears to be a primary activation of both sympathetic and parasympathetic functions in cluster headache attacks. The sympathetic component seems to be involved mostly in the development of the attack, whereas the parasympathetic activation seems to occur, following the onset of the attack, independently of the pain.

Adult↗

Carbohydrate-deficient transferrin in alcohol and nonalcohol abusers with liver disease.

Carbohydrate-deficient transferrin (CDT) has been demonstrated to be a marker of prolonged heavy alcohol consumption. We compared this marker with gamma-glutamyltranspeptidase (GGT) and mean corpuscular volume (MCV) in alcohol and nonalcohol abusers with liver disease. Our results confirm that the sensitivity of CDT in alcoholics is high, although lower than that of GGT and MCV; however, the specificity of CDT was higher than that of the other two markers. This finding supports the notion that CDT is only partially influenced by the presence of liver damage, whereas increases of GGT and MCV are greatly affected by several factors, including liver damage and drugs. Moreover, we observed that the sensitivity and the specificity of CDT were greater than those of GGT and MCV in younger drinkers.

Adult↗

[Study of thyroid function in patients chronically treated with amiodarone].

The authors studied thyroid function by dosage of total T3 and T4, corresponding free portions, thyroid binding globulin (TBG), thyroid stimulating hormone (TSH) and reverse T3 (rT3) in 68 clinically euthyroid patients, treated with amiodarone, divided in two groups including 25 subjects treated for less than one month and 43 subjects in therapy for more than one month. The data obtained in the first group have been compared with the second one and with data obtained in a group of 40 healthy subjects. The statistical analysis of results showed a reduction of total T3 and free T3 and an increase of TSH, total T4, free T4 and rT3 in each of two groups of treated patients compared with control group, while there was no difference in comparison between the two treated group.

Amiodarone↗

[Isoenzymes of creatine kinase and prostate-specific antigen in the monitoring of prostatic carcinoma].

We have valued serum levels of the prostatic specific antigen and of the creatine-kinase isoenzymes (MM-BB) in 30 patients with prostatic carcinoma at C and D stage. Our results demonstrate that these markers are useful for monitoring and for checking of metastasis. But the isoenzymes seem to us predictive in the monitoring of metastasis. The isoenzymes' determination was executed by electrophoretic method (Helena) which is sensitive, specific and swift.

Antigens, Neoplasm↗

[Hemofiltration and hemoperfusion performed in series for the purpose of removing beta 2 microglobulin].

With the objective to develop most efficient method for Beta-2-microglobulin elimination, the authors, using extracorporeal circulation placed behind the haemofilter a capsule containing 70 g of collodion coated with activated medicinal charcoal. This combination was used in 3 haemofilters made from different membranes. The results showed polysulphon to be the highest efficiency membrane out of those tested for Beta-2 microglobulin elimination. In combination with haemoperfusion, its efficiency increases significantly. Even if haemoperfusion increases efficiency by considerable percentage, the Beta-2 microglobulin elimination using other types of membranes lasts long and the total clearance remains low.

Adult↗

[A comparative evaluation of tumor markers (TPA and CEA) in various malignant neoplasms at an advanced stage].

Radioimmunology was used to measure serum levels of CEA (carcinoembryonic antigen) in 108 patients with a variety of different advanced malignant neoplasms and in a control group of 60 healthy subjects. TPA proved more sensitive as a tumour marker than CEA, since increased TPA was found in 76% of the cancer cases compared to 42% for CEA. No significant increase in diagnostic sensitivity was obtained by using both markers rather than PTA alone.

Antigens, Neoplasm↗

Autonomic nervous activity during sleep in middle cerebral artery infarction.

No data are available on the autonomic system during sleep in patients with stroke. The purpose of this study was to determine the influence of acute ischemic stroke on the autonomic cardiovascular system during sleep, and to correlate autonomic activity with the clinical status of patients. Ten patients with ischemic stroke in the middle cerebral artery were studied by means of an all-night polysomnographic recording within the 1st week of the onset of symptoms and at the 3-week follow-up examination. Power spectrum analysis of the heart rate variability was performed using an autoregressive algorithm in 180 consecutive electrocardiographic RR intervals. Spectral power was calculated in 3 main frequency bands: high frequency (HF), 0.15-0.4 Hz; low frequency (LF), 0.04-0.15 Hz; very low frequency (VLF), < 0.04 Hz. The data were compared with those of 10 age-matched controls. A significant increase in VLF (p < 0.0005) and a decrease in HF (p < 0.0002) components were found in ischemic stroke patients. The sympathetic-parasympathetic balance (VLF + LF/HF) was higher in patients than controls (p < 0.005). However, these components changed significantly during sleep, revealing a physiological pattern. These power spectral data were still present at the 3-week follow-up. The 4 patients who developed cardiac arrhythmias showed higher sympathetic-parasympathetic balance than patients without arrhythmias (p < 0.05). These data suggest a sympathetic predominance in patients with acute ischemic stroke during sleep. However, the flexible and dynamic properties of the autonomic nervous system are preserved. Cardiac arrhythmias following stroke may be related to the degree of sympathetic predominance.

Aged↗

[Cavitated pulmonary condensation by Rhodococcus equi, in an HIV seropositive individual].

The first clinical case described in Portugal of a human infection by Rhodococcus equi in a 35 year-old HIV1 seropositive i.v. drug user is presented. The patient was admitted to hospital due to clinical and radiological suspicion of tuberculosis. While in hospital, a Rhodococcus equi cavitated lung infection was diagnosed. By applying a triple antibiotic therapy with erythromycin, rifampin and teicoplanin along with surgical excision of the lower lobe of the right lung, we were able to clinically resolve the pulmonary infection. A brief review of Rhodococcus equi infections, especially those associated to HIV1 infected individuals is also presented with particular emphasis on the therapeutic approach.

AIDS-Related Opportunistic Infections↗