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Biomedical subjects

V Piazza

Publications and source records attributed to V Piazza.

At least 37 records · Page 2Linked to original sources
PubMed1995

Transient myocardial ischemia detected by Holter monitoring during the early post-infarction period.

BACKGROUND: On the basis of extensive studies concerning the prognostic value of Holter monitoring in patients with angina, we evaluated the clinical outcome of patients with transient ischemic episodes soon after myocardial infarction. METHODS: The incidence and clinical significance of myocardial ischemia, detected in the acute phase of myocardial infarction, were evaluated in 87 patients. Twenty-four-hour Holter recordings were obtained on the 2nd, 4th, 6th, and 12th hospital day. RESULTS: Myocardial ischemia was detected during at least one of the four recording periods in 28 patients (32%). A total of 157 ischemic episodes were documented. The proportion of recordings that showed transient myocardial ischemia progressively declined from 20% on the 2nd day to 5% on the 12th post-infarction day. Of the 157 ischemic episodes, 132 (84%) were silent and 25 (16%) were symptomatic. Transient ST-segment elevation was present in 99 of the 157 episodes (63%), while transient ST-segment depression occurred in the remaining 58 of the 157 cases (37%). One or more in-hospital cardiac events (reinfarction, acute pulmonary edema, ventricular tachycardia or fibrillation, cardiac death) were more frequent in patients with (group I) than in those without (group II) transient myocardial ischemia [nine out of 28 (32%) versus six out of 59 (10%); P < 0.03]. At follow-up (mean 11.5 +/- 2 months) the incidence of cardiac events (angina, reinfarction, heart failure, ventricular tachycardia or fibrillation, revascularization procedures, cardiac death, sudden death) was comparable in the two groups [four out of 24 (17%) versus 10 out of 49 (20%); NS]. Predischarge exercise testing, performed in 64 patients (74%), showed myocardial ischemia in 50%; the percentage did not vary significantly between group I and group II patients. Moreover, a positive exercise test was not predictive of major cardiac events at follow-up. CONCLUSION: Transient myocardial ischemia, frequently silent, is not uncommon in the acute phase of myocardial infarction and progressively decreases during the in-hospital stay. Its recognition in the subacute phase of myocardial infarction may lead to the identification of a subset of patients at the highest risk of early major complications, who may benefit from aggressive diagnostic and therapeutic strategies.

Case-Control Studies↗
PubMed1995

Uraemic pruritus is not related to plasma histamine concentrations.

Pruritus is a common symptom in uraemic patients and its aetiology is poorly understood, although several factors have been implicated, including high histamine plasma levels. The aim of the study was to evaluate plasma levels of histamine in patients on maintenance haemodialysis in relation to the presence of itching (35 pruritic patients = group A; 50 non-pruritic patients = group B). Furthermore, we compared the values obtained with those of a healthy control group (64 subjects). We observed increased plasma histamine levels in uraemic patients compared with healthy controls. However, no relationship was found between plasma histamine values and itching because groups A and B showed overlapping values and there was no correlation between the intensity of pruritus and plasma histamine concentrations in group A patients. In conclusion, we suggest that there is no evidence for plasma histamine playing a significant part in uraemic pruritus.

Adolescent↗
PubMed1994

Value of low-dose echodobutamine in the diagnosis of patency of the infarct related coronary artery.

The resumption of contractility of asynergic segments in survivors after acute myocardial infarction (AMI) may be detected in viable myocardial areas. We have correlated the detection of viable myocardium, assessed with low dose dobutamine testing, with coronary angiography and clinical outcome in 66 consecutive survivors of AMI using the echocardiographic evidence of left ventricular wall motion abnormalities. The test enabled the identification of two groups: group A, comprising 32 patients (pts) demonstrating wall motion recovery at dobutamine infusion and group B, comprising 34 pts without wall motion recovery. The mean basal asynergy score index was 5.8 +/- 4.2 in group A and 6.0 +/- 4.2 in group B (p = ns). With dobutamine testing the score decreased to 2.8 +/- 3.6 in group A (p < 0.001 with respect to basal value), while it did not change significantly in group B. Left ventricular end diastolic volume (ml) was similar in the two groups (114 +/- 35 vs 107 +/- 79, p = NS). The infarct related artery (IRA) patency rate was 87.5% in group A, vs 26.5% in group B (p < 0.001). After a mean follow-up of 11 +/- 5 months, group A pts had basal asynergy score improvement (2.6 +/- 3.1, p < 0.001) and mild left ventricular end diastolic volume (ml) reduction, (108 +/- 32, p = NS), while group B pts had left ventricle end diastolic volume enlargement (130 +/- 38, p < 0.05), without score asynergy modification. Moreover all pts who experienced heart failure at follow-up were in group B.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Hepatitis C virus (HCV) core serotypes in chronic HCV infection.

Recently, two distinct hepatitis C virus (HCV) serologic types have been identified on the basis of amino acid variations in the core region. The two serologic types can readily discriminate between genotypes I-II-V (serotype 1) and III-IV (serotype 2), according to the Okamoto classification. We compared HCV core serotyping with genotyping with sera from 363 anti-HCV-positive patients (309 HCV RNA positive by PCR) using a synthetic core peptide-based enzyme immunoassay and PCR amplification of core region sequences with type-specific primers, respectively. Serologic responses to HCV serotypes were successfully identified in 164 (45%) patients, of whom 153 were viremic. Eighty-nine patients had evidence of exposure to serotype 1: 8 of these were infected with genotype I, 50 were infected with genotype II, 2 were infected with genotype III, 7 were infected with genotype V, 13 had infections with mixed genotypes, 3 were infected with an indeterminate genotype, and 6 were nonviremic. Seventy-four patients had been exposed to serotype 2: 64 were infected with genotype III, 3 were infected with mixed genotypes, 2 were infected with an indeterminate genotype, and 5 were nonviremic. The serum of one patient, infected with genotype III, showed reactivity to both serotypes. Comparative evaluation of HCV core region serotyping and genotyping with sera from 294 viremic patients infected with a known HCV genotype showed a remarkable concordance between HCV core region genotyping and serotyping, with only 2 apparently discordant serum samples (both from patients with genotype III infection) of 148 (1.4%) successfully serotyped samples. Serotype 1 infection was more frequently observed in patients with overt chronic liver disease and accounted for all successfully serotyped samples from intravenous drug abusers. In contrast, serotype 2 was more prevalent in subjects with biochemically silent HCV infection (alanine aminotransferase, < 45 U/liter), in agreement with previous findings at the molecular level. HCV core serologic typing is a simple, inexpensive, and highly reproducible assay that can be applied to more than 50% of viremic HCV antibody carriers prior to the use of more sophisticated molecular typing techniques. Moreover, it may be helpful in tracking transmissions routes, particularly for incorrectly stored samples in which the RNA has degraded or for subjects who have cleared the virus and therefore have only antibodies remaining to testify to a remote infection. The lack of recognition of the core sequence from residues 67 to 81, which contains a minor B-cell epitope used to detect type-specific immunoreactivity, may explain the negative serologic findings for half of the patients.

Adolescent↗
PubMed1994

[Heart failure and arrhythmia: modalities and indications of prevention of thromboembolism].

Patients with atrial fibrillation are at risk for peripheral embolism. Congestive heart failure, a history of hypertension, previous arterial embolism or myocardial infarction are related to an increased risk for thromboembolism. Left ventricular enlargement and dysfunction, focal akinesia, protruding and mobile thrombi, spontaneous echo contrast are echocardiographic predictors of thromboembolism in patients with atrial fibrillation. Clinical trials have shown that antithrombotic therapy can reduce the rate of embolic events. In patients with heart failure the efficacy of antithrombotic therapy has not been tested in randomized, prospective trials. However in these patients oral anticoagulants are recommendable in the following conditions: atrial fibrillation; rheumatic mitral valve disease; previous thromboembolism; left ventricular enlargement and dysfunction; mobile and/or protruding thrombi; spontaneous echo contrast. The target INR in treated patients should be maintained within a range of 2 to 3 times the control. A more intense range of intensity of anticoagulation is indicated for patients with mechanical prosthetic valves or with relapsing thromboembolism. Current estimates of the effects of aspirin vary too much to allow any conclusions.

Anticoagulants↗
PubMed1993

Virological features of hepatitis C virus infection in hemodialysis patients.

The clinical and epidemiological relevance of circulating antibodies to hepatitis C virus (HCV) in hemodialysis patients is uncertain, since clinical signs of infection are often mild or absent, with alanine aminotransferase (ALT) values that are virtually always normal, and liver biopsies are only rarely performed. Determination of HCV RNA in serum is therefore critical for distinguishing chronic HCV infection from previous exposure to the virus. We studied HCV viremia by reverse transcription polymerase chain reaction (RT-PCR) in the 5'-noncoding region of the viral genome in 77 dialysis patients who were screened for anti-HCV by a second-generation enzyme-linked immunosorbent assay (the enzyme immunoassay II; Ortho HCV, 2nd generation, Ortho Diagnostic Systems Raritan, N.J.) and a second-generation recombinant immunoblot assay (Chiron Corporation and Ortho Diagnostic Systems) and prospectively evaluated for ALT elevations over a period of 5 years. Of 77 patients tested, 29 (38%) had active infection as shown by a positive PCR assay result, and of these, 26 were anti-HCV positive. Although a good correlation was found between circulating anti-HCV and HCV RNA in serum, 10 (28%) of 36 anti-HCV-positive patients were HCV RNA negative by PCR, suggesting either low levels of viremia or past exposure to HCV and subsequent recovery. On the other hand, 3 (7.3%) of 41 anti-HCV-negative patients had HCV RNA in their sera, indicating seronegative HCV infection. The ALT level had no predictive value for HCV infection, because it was repeatedly normal in 18 (62%) of 29 viremic patients. HCV genotyping was also performed and indicated that all four known genotypes of HCV were present in our group. In conclusion, serological assays are reliable for detecting exposure to HCV in hemodialysis patients; however, direct identification of the viral genome is required to document current infection.

Adolescent↗
PubMed1993

Variations in erythropoiesis and serum ferritin during erythropoietin therapy for anaemia of end-stage renal disease.

In order to study the relationship between erythropoiesis and serum ferritin (SF) during erythropoietin (rHuEPO) therapy in the anaemia of end-stage renal disease (ESRD), 19 patients were followed without iron supplementation and at a fixed dose of the drug (40 U/kg). Twelve patients failed to attain the target haemoglobin (Hb) value, 7 of whom due to the appearance of iron deficiency. Erythropoiesis, as measured by the serum transferrin receptor concentration, increased from 12 to 120% of the basal value. This increment was not constantly associated with a proportional rise of Hb or reticulocyte count. SF decreased exponentially from a median value of 221 micrograms/dl (range 42-470) to a median value of 54 micrograms/dl (range 20-172). Halving of the basal SF value (SF-T50) was reached at the 18th-95th day of therapy (median = 43), representing a iron shift of 3.4-11.6 mg/day (median = 5.4). SF-T50 was not correlated with the Hb increase, but with that of erythropoiesis (r = 0.78; p = 0.003). The minimum SF (MSF) value attained was not correlated with the appearance of iron deficiency. The conclusion is that the rate of SF decrease during rHuEPO in ESRD is a reliable measure of iron mobilisation for erythropoiesis, but not for haematologic response. The MSF value reached during therapy is not representative of available iron for erythropoiesis.

Adolescent↗
PubMed1993

[Diagnostic value and safety of dobutamine echocardiography in the diagnosis of coronary disease].

To assess the safety and diagnostic value of dobutamine stress-echocardiography (DSE), we studied 109 patients with ischemic heart disease: 78 patients with recent myocardial infarction, 31 patients with chest pain (14 patients without and 17 patients with previous myocardial infarction). Echocardiograms were recorded during dobutamine infusion in 5-minute stages to a maximum dose of 40 mcg/kg/min. The test was considered positive when dobutamine infusion induced a new wall motion abnormality. In 95 pts with recent or previous myocardial infarction new asynergies were classified as being within the infarct zone or outside the infarct zone based on the relation with vascular zones at coronary angiography. All patients underwent exercise stress test (EST) according to the Bruce protocol, and coronary angiography within one week from the test: significant coronary artery disease was defined as > or = 50% diameter stenosis for left main artery and > or = 70% for the other vessels. Five patients (4.6%) had ventricular arrhythmias and 3 patients (2.7%) had systolic blood pressure increase > or = 200 mm Hg in the first stage of DSE, without new wall motion abnormalities, and were excluded from diagnostic value analysis. DSE had a sensitivity of 86% vs 56% of EST (p < 0.001); both had specificity of 94% and positive prognostic value of 98%; diagnostic accuracy of DSE was 87% vs 62% of EST (p < 0.001); negative predictive value was not statistically different. Sensitivity of DSE in single vessel disease (78%) was significantly lower (p < 0.05) than sensitivity in multivessel disease (95%). Sensitivity of DSE in detecting multivessel disease in patients with myocardial infarction was 80% vs 55% of EST (p < 0.05); specificity 96% vs 63% (p < 0.001); diagnostic accuracy 90% vs 60% (p < 0.001); positive predictive value 93% vs 48% (p < 0.001); negative predictive value 89% vs 70% (p < 0.05). At the ischemic threshold, EST caused the achievement of higher heart rate and rate-pressure product; in patients with single vessel disease heart rate was higher than in multivessel disease (141 +/- 19 vs 117 +/- 21, p < 0.001). No differences were detected during DSE in heart rate, blood pressure, rate-pressure product; the dose of dobutamine infused at the ischemic threshold in patients with multivessel disease was significantly lower than in those with single vessel disease (15.2 +/- 5.4 vs 19.4 +/- 6 mcg/kg/min, p < 0.05).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1992

Recombinant human erythropoietin reduces free erythrocyte protoporphyrin levels in patients on chronic dialysis.

We studied the significance of free erythrocyte protoporphyrin (FEP) in relation to iron status, aluminum levels and anemia in uremic patients on chronic dialysis. All but 1 patient showed high FEP values closely related to the degree of anemia. Increased FEP levels are due to a defective heme synthesis, not related to iron deficiency or aluminum overload. Treatment of anemia with recombinant human erythropoietin reduced FEP values. We therefore hypothesize that recombinant human erythropoietin ameliorates an enzymatic defect in heme synthesis.

Aluminum↗
PubMed1992

High prevalence of antibodies to hepatitis C virus in hemodialysis units using a second generation assay.

We studied the prevalence and significance of antibodies to hepatitis C virus (HCV) in patients and staff from 3 dialysis units, using a 2nd generation assay (2nd g.a.; Ortho HCV). Of 277 patients, 151 (55%) were positive by 2nd and 85 (31%) by 1st g.a. Significant associations with the anti-HCV carrier status were: blood transfusions, retrospective finding of elevated ALT and duration of dialysis treatment, independently of transfusions. Of the 74 staff members, 5 were positive by 2nd and 3 by 1st g.a. Our data suggest that the 2nd g.a. is more sensitive in detecting HCV exposure in dialysis units and that duration of dialysis is a significant factor in acquiring HCV infection.

Ambulatory Care Facilities↗
PubMed1991

Abnormal alanine aminotransferase activity reflects exposure to hepatitis C virus in haemodialysis patients.

Prospective studies have shown that the annual incidence of non-A, non-B (NANB) hepatitis may be high in haemodialysis patients. To assess whether hepatitis C virus (HCV), the major causative agent of post-transfusion and community-acquired NANB hepatitis, has a role in the pathogenesis of liver disease in dialysed patients, we have studied the prevalence and significance of antibodies to HCV in a cohort of patients with end-stage renal disease on chronic haemodialysis treatment. Seventy-four (30%) had circulating antibodies to HCV. Statistically significant associations with the anti-HCV carrier status were duration of haemodialysis treatment, blood transfusions, and the finding of abnormally elevated ALT on retrospective analysis. In contrast, only one of 103 dialysis staff members showed transient positivity for anti-HCV, suggesting a low risk of professional exposure to HCV. These findings suggests that HCV infection is relatively frequent in haemodialysis patients and may be responsible for a significant proportion of liver disease in this clinical setting.

Adolescent↗
PubMed1986

Acid-base balance and respiratory response during biofiltration with polyacrylonitrile membrane.

To further elucidate the mechanisms responsible for the hypoxemia we studied ventilation, pulmonary gas exchanges, blood gas pressures and exchanges of CO2-T, CO2-D and HCO-3 in six patients during AD and BD on 1 m2 cuprophan filter and during BF on 1.2 m2 polyacrylonitrile filter. Blood passing through the dialyzer lost 172.8 mM/h of CO2-T in AD, 149.2 mM/h in BF and gained 25.6 mM/h in BD. In AD VE, VA and PaO2 decreased significantly after 30 and 60 min., in BF for the whole duration of dialysis. PoO2 showed a significant decrease both in AD and BF after 60 min. In AD PaCO2 was significantly reduced after 120 and 180 min. All the above parameters remained unchanged in BD. VCO2 remained unchanged in all. VCO2 and R decreased both in AD and BF. However, when VCO2 was corrected for CO2 loss across the dialyzer, overall CO2 loss (ventilated plus filtered) and R returned to basal values. In AD, HCO-3 and pH fell in the first 120 min., while in BD and BF they increased from the beginning of dialysis. In AD hypoventilation, hypoxemia and inadequate correction of acid-base balance were due to the loss of HCO-3 across the filter. In BF also hypoventilation and hypoxemia were due to the loss of HCO-3 across the filter but the acid-base balance was adequately corrected by HCO-3 reinfusion. In BD, there was HCO-3 gain across the filter which induced a gradual correction of acid-base balance without impairment of ventilation.

Acid-Base Equilibrium↗
PubMed1985

Cadralazine, a new vasodilator, in addition to a beta-blocker for long-term treatment of hypertension.

51 hypertensive outpatients, whose diastolic blood pressure exceeded 100 mmHg after a 2-week period on atenolol alone (100 mg once daily) participated in this long-term study. They received, in addition to atenolol, the vasodilator cadralazine (ISF 2469; 10 to 30 mg once daily) for a standard period of 24 weeks, according to an open design. Cadralazine caused a progressive and important decrease in both systolic and diastolic blood pressure, from 173/111 mmHg (end of atenolol alone) to 154/99 mmHg (12th week, p less than 0.01/p less than 0.01; mean dose, 24.5 mg/day). At this time a diuretic was added as a third-step drug in 15/51 initial patients (29%), and final blood pressure in all patients was 150/96 mmHg (p less than 0.01/p less than 0.01), with positive results in 88% of the cases. During cadralazine treatment, heart rate was always significantly lower than before atenolol alone; the most common side effects, many of which were already present during treatment with atenolol alone, included headache, asthenia, dizziness, palpitation and flushing, and tended to disappear spontaneously as therapy progressed. Routine laboratory tests did not show important changes; sodium excretion was not reduced. In conclusion, the therapeutic efficacy of cadralazine, its low or absent salt and water retention effects, its good tolerability, and the high compliance obtained with once daily administration allowed the use of this vasodilator as a second-step drug for long-term treatment of hypertension.

Adrenergic beta-Antagonists↗