81 research outputs found
Large sphenocavernous meningiomas: Is there still a role for the intradural approach via the pterional-transsylvian route?
No full textTreatment of hypertension associated with stable angina pectoris: favourable interaction between new metoprolol formulation (OROS) and nifedipine.
No full textThis was a double-blind, within-patient, crossover study to evaluate the effects of a new formulation of metoprolol on blood pressure (BP) and myocardial ischemia. Twenty outpatients with mild to moderate essential arterial hypertension, chronic stable angina pectoris and positive exercise test, after a 2-week baseline placebo period, were randomized to receive long-acting metoprolol (OROS) 14/190 mg o.d., nifedipine SR 20 mg b.i.d. or their combination in a sequence of a 3 x 3 Latin square design. Two patients withdrew from the study (1 for adverse event during metoprolol and 1 for rise of BP during nifedipine). Nifedipine, metoprolol and their combination significantly reduced the weekly number of angina attacks and nitroglycerin consumption with respect to baseline. The total number of ischemic events (at 24-hour ECG monitoring) significantly decreased after each treatment with respect to baseline. Twenty-four hours mean systolic and diastolic BP were reduced by both nifedipine alone and metoprolol alone; the combination of the two drugs led to a further decrease in both systolic and diastolic BP. The duration of silent ischemic episodes was significantly reduced by nifedipine and combination but not by metoprolol. On the other hand 24 hours symptomatic attacks/patient were significantly reduced by beta-blocker and combination, but not by nifedipine. Metoprolol alone and administered with nifedipine caused a decrease, with respect to placebo baseline, in 24-hour mean heart rate (HR) and reduced the increase of HR and systolic BP at the onset of ST depression during symptomatic ischemic episodes. The effort time and time to ST = -1 mm at treadmill were significantly increased by treatment with nifedipine alone, with metoprolol alone and with their combination, but the combination was more effective than the individual therapies. ST depression at peak exercise was significantly reduced by each treatment. The slopes of correlations between the ST-segment variation and systolic BP, HR and rate-pressure product during exercise, significantly decreased after all treatments with respect to placebo baseline, more with the combination therapy than with nifedipine alone and metoprolol alone. In conclusion, based on our results the favourable interaction of metoprolol OROS and nifedipine given concomitantly, is likely to be due to a better control, respect to each individual therapy, of the pathogenetic mechanism of myocardia ischemia: BP and HR increases during exercise and during symptomatic ischemic episodes are controlled by the beta-blocker and coronary vasoconstriction during silent ischemia is prevented by the calcium-antagonist
A double-blind comparison of nicorandil and metoprolol in stable effort angina pectoris.
No full textThe antianginal activities of nicorandil, 10 and 20 mg bid, and metoprolol, 100 mg bid, were compared in patients with stable effort angina pectoris in a randomized, double-blind parallel group study lasting 7 weeks. Twenty patients were enrolled into the trial and 16 patients completed the study. To evaluate the anti-ischemic effects of the two drugs, a treadmill exercise test was performed after a 1-week placebo run-in period and 6 weeks of treatment. On the same occasions, weekly sublingual nitroglycerin consumption and the number of anginal attacks were also recorded in the patient's diary. The total duration of exercise increased significantly with both nicorandil, 10 and 20 mg, and metoprolol (p < 0.01). Similar improvements were observed in the time to onset of ischemia with both treatments (p < 0.01). The double product at maximal comparable workload (MAX 1) was reduced with the two drugs (p < 0.05 for nicorandil and p < 0.01 for metoprolol), while at the maximal exercise time (MAX 2) it was reduced with metoprolol (p < 0.01) and slightly but not significantly increased with both doses of nicorandil. Weekly sublingual nitroglycerin consumption and anginal attacks were also significantly reduced a similar manner by both treatments (p < 0.01). In conclusion, nicorandil, 10 and 20 mg bid, exerted an anti-ischemic effect comparable with that of metoprolol in patients with stable effort angina pectoris
The role of intraoperative sonography in reducing invasiveness during surgery for spinal tumors.
No full textThe authors describe the ultrasound-guided surgical approach to 20 spinal tumors (13 extramedullary and 7 intramedullary). Intraoperative sonography (IOS) is important to reduce the extent of the laminectomy and dural opening, thus avoiding useless removal of bone structures. In cases of intramedullary tumors, IOS defines the extent of the posterior myelotomy, the presence of syringomyelic cavities caudal and/or cranial to the tumor and the deep extension of the tumor to the anterior cord surface. For these reasons, the routine use of IOS during surgery for spinal tumors reduces the surgical invasivity of this approach. The advantages and limits of the ultrasound-guided spinal surgery and the operative ultrasonographic findings of different spinal neoplasms are discussed
Subfrontal approaches
No full textAmong the different transcranial approaches routinely used for the management of anterior cranial base lesions, the subfrontal approach is one of the most common and versatile surgical procedures, with the unilateral or bilateral alternative, according to the lesion's extension and size. © 2010 Springer-Verlag Milan
Favourable interaction of calcium antagonist plus ACE inhibitor on cardiac haemodynamics in treating hypertension: Rest and effort evaluation
No full textThe aim of the study was to evaluate the effects of verapamil sustained release (SR) 240 mg, enalapril and their combination on blood pressure (BP) and cardiac haemodynamics at rest and during exercise in 20 patients with moderate essential hypertension (seven men and 13 women, mean age ± s.d. 53.7 ± 15.8 years). After a 4 week placebo run-in period, patients were randomly allocated to received verapamil SR 240 mg once daily or enalapril 20 mg once daily for 4 weeks in a double-blind fashion. Patients whose diastolic blood pressure (DBP) was still ≥ 95 mm Hg at the end of this period received verapamil SR plus enalapril for an additional 4 weeks. At the end of the placebo, single and combined treatment periods, resting and exercise (bicycle ergometry) haemodynamics were evaluated by radionuclide ventricular angiography (technetium-99m) and the following parameters were assessed: BP, heart rate, double product, systemic vascular resistances (SVR), cardiac output (CO), stroke volume (SV), ejection fraction (EF) mean ejection rate (mER) and peak filling rate (PFR). Both verapamil SR and enalapril monotherapies significantly reduced resting and exercise BP (P < 0.01), with a BP normalisation (DBP ≤ 95 mm Hg) of five of 10 and 4 of 10 patients respectively. A greater BP fall and a normalisation of 11 of 11 patients was obtained in non-responders to monotherapy, when treated with verapamil SR and enalapril (P < 0.01). Verapamil SR also reduced heart rate at rest and during exercise (-11.8% and -18.4%, respectively, P < 0.05). Double product was significantly reduced at rest and during exercise in the verapamil group (P < 0.01); enalapril alone and verapamil plus enalapril reduced double product only at rest (P < 0.01). Resting and exercise SVR significantly decreased in the verapamil, enalapril and combined treatment groups (rest -16%, -13% and -15%; exercise -19%, -18% and -15%, respectively, P < 0.01). Left ventricular function showed a trend towards improvement after monotherapies; CO, EF and mER significantly improved with the combined regimen. In conclusion, verapamil SR and enalapril in a once a day administration were effective in the treatment of moderate hypertension, their anti-hypertensive effect was associated with a significant reduction of SVR. A further BP reduction was obtained with the combination of the two drugs that induced a reduction of SVR with a good tolerability profile. The better BP reduction obtained with the combination of the two drugs was associated with an improvement of left ventricular function particularly during effort where, for any reduction in DBP, there was more improvement in SV and CO
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