Usefulness of 2-dimensional echocardiography in emergency surgical treatment. Description of a case of metastatic sarcoma of the right ventricle

A case of metastatic tumor, occupying a large part of right ventricular cavity, is reported. An accurate diagnosis was allowed by 2-D echocardiography and the patient was immediately sent to cardiac surgery. 2-D echo was also useful in the postoperative evaluation of surgical results.     

Early changes induced in the left ventricle by pressure overload. An experimental study on swine heart

The purpose of this study was to evaluate the early changes in sarcoplasmic reticulum (SR) function and the parallel morphological and hemodynamic modifications occurring in the heart following pressure overload. As regards SR function, we also explored the levels of acylphosphatase, an enzyme which might have a regulatory effect on the SR Ca(2+) pump by hydrolyzing the phosphorylated intermediate of this transport system. Pigs subjected to pressure overload by aortic stenosis for 6, 12, 24, 48, 72, and 96 h were compared to sham-operated controls. At each of the considered times both SR Ca(2+)-ATPase activity and Ca(2+) uptake, as well as acylphosphatase activity, were significantly enhanced in the pressure overloaded compared to the control hearts, with a maximal increase at 6 h; moreover, a positive and significant correlation was found between these parameters. The modifications in the activities of Ca(2+)-ATPase and acylphosphatase reflected an increased expression of these proteins, while phospholamban did not show significant changes in its concentration nor in its phosphorylation status. As for hemodynamic parameters, rapid changes in the left ventricular function were observed and especially the early hours following the aortic stenosis appeared to be crucial for the adjustment of heart function. The most relevant morphological finding was a focal disarrangement of the myofibrillar pattern which was very evident at 6 h, and progressively attenuated at later times. Taken together our data suggest that an early adaptation to the increased hemodynamic working overload is a consistent activation of the contractile apparatus which reflects, at least in part, an enhanced SR function. Besides the changes in Ca(2+) pump protein expression, increased acylphosphatase levels might also contribute to this effect.     

Proposal for an informed consent form for hormonal replacement therapy in ambulatory care]

Hormonal Replacement Therapy (HRT) represents a valid therapeutic approach for menopausal symptoms and for the prevention of cardiovascular disease and osteoporosis. Nevertheless, an informed consent, after a complete information, must be obtained from the patient. This procedure is generally adopted in any medical activity, but the modality of the consent in the HRT administration is not well established (verbal or written?, timing of administration?). The authors propose an informed written consent model to be utilized in menopausal centers; this model synthetically informs about HRT benefits and risks and must be red and signed by the patient. The written consent should be explained through a verbal detailed discussion about it, during which the patient's comprehension must be assured. The informed consent procedure should be renewed every year in long term-users. The influence of the HRT informed consent in menopausal centers must be analyzed in particular as far as women compliance is concerned.     

Long distance transport of ragweed pollen as a potential cause of allergy in central Italy.

BACKGROUND: Ambrosia pollen is an important allergen in North America and, as recently discovered, in some European countries. In Italy, the most affected area is the northeast, whereas ragweed has not been reported in the central and southern parts of the country. OBJECTIVE: To identify the source of ragweed pollen detected in Florence and Pistoia in central Italy. METHODS: Ragweed pollen data were collected in Florence and Pistoia for a 6-year period (1999-2004). The relationship between pollen counts and local ground prevalent wind directions was evaluated with analysis of variance and the least significant difference test. Weather conditions were also evaluated on a large-scale circulation pattern by analyzing weather maps and air mass back trajectories. RESULTS: A highly statistically significant relationship between daily prevailing wind direction and pollen count was found in the period under investigation; the ragweed pollen peaks were recorded when winds from northeast in Florence and north-northeast in Pistoia were observed. The synoptic weather situation and the path of back trajectories suggest an area around southern Hungary as a possible source of Ambrosia pollen. Furthermore, the pollen count was above the clinical threshold several times in both Florence and Pistoia. CONCLUSIONS: Several factors indicate that the detection of ragweed pollen in central Italy is due to long distance transport. Taking into consideration the high allergenicity of Ambrosia pollen, the present findings, if confirmed, suggest that the number of sensitized individuals might significantly increase in the near future.     

CMV-DNA detection in parenchymatous organs in cases of SIDS

A nested PCR approach has been developed especially for the detection of small amounts of cytomegalovirus (CMV) DNA in autopsy samples. Lung tissue and submandibular glands in 118 cases of infant death (92 SIDS cases, 13 natural deaths due to other defined causes and 13 unnatural deaths) were investigated by this technique and compared to the results obtained by other CMV detection methods (histology, immunohistochemistry, in situ hybridization and PCR). CMV-DNA could be detected in the lung tissue in 7 cases of SIDS using nested PCR. Compared to conventional PCR (3 positive cases in lung tissue) the nested approach always gave glear results and showed less additional bands. In all cases where CMV could be detected in the lungs, positive results were also obtained in the submandibular glands. The nested PCR method proved to be a more sensitive technique than the other detection methods including PCR and hot start, and. even minimal amounts of target DNA could be detected in the presence of human and bacterial background DNA.     

Management of oral anticoagulant therapy in the real practice of an anticoagulation clinic: focus on atrial fibrillation.

Oral anticoagulant treatment (OAT) is increasingly used for preventing venous thromboembolic and cardiovascular disease. Our study was aimed to evaluate the efficacy and safety of OAT management in a real-practice situation, in particular in non-valvular atrial fibrillation (NVAF) patients. Among 1,596 consecutive unselected patients (follow-up, 3,364 patient-years) referring to the Anticoagulation Clinic, 558 (follow-up, 958 patient-years) suffered from NVAF. Total bleeding events were recorded in 39/558 NVAF patients (rate, 4.2/100 patient-years) and in 132/1,038 of all other patients (rate, 5.4/100 patient-years) (P<0.003). The rate of major bleeding and thrombotic complications was not different between NVAF patients and all the other patients. Considering NVAF patients, the rate of major bleeding was slightly higher in females than in males (P=0.06). NVAF females showed a higher rate of stroke than males (P=0.004). In NVAF patients the rate of bleeding complications was not different in relation to age; instead, total and major thrombotic events occurred more frequently in patients >or= 75 years than in younger patients (P=0.05 and P=0.01, respectively). NVAF patients on OAT show a low rate of complications. However, females show a trend to higher risk of bleeding complications and suffered more frequently from stroke with respect to males in spite of therapy.     

Diastolic time intervals before and after nadolol in patients with hypertrophic cardiomyopathy

In 9 patients with hypertrophic cardiomyopathy, diastolic function was evaluated by noninvasive measurements of diastolic time intervals before and after nadolol administration. No significant variation of the intervals was observed after therapy. The method therefore appears scarcely useful in the evaluation of beta-blocker therapy in these patients.     

Usefulness of pulsed doppler echocardiography in the diagnosis and medical therapy of patent ductus arteriosus in the newborn with respiratory distress

In preterm infants patent ductus arteriosus (PDA) may worsen the clinical course of Respiratory Distress Syndrome (RDS). Indomethacin is usually effective in producing duct closure in the first days of life, but clinical diagnosis is often difficult to perform in these patients. In recent years Pulsed Doppler Cross-Sectional Echocardiography (PD-CSE) has made it possible to identify the duct and to assess noninvasively the characteristics of blood flow within it. The aim of this study was to verify the utility of PD-CSE in the early diagnosis of PDA and to provide the basis for a more effective drug therapy. Among 51 patients with RDS, a significant PDA was evidenced in 20 with PD-CSE and in only 8/20 with physical and E-TM examination (p less than 0.01). Indomethacin administration produced duct closure in 19/20 patients (95%). In this study PD-CSE has been more sensitive than the other noninvasive procedures in the diagnosis of PDA; moreover, the success with drug therapy demonstrates the utility of this procedure in providing the basis of a more effective treatment of the duct.