Effects of tilt and exercise on signal-averaged electrocardiogram after acute myocardial infarction

To determine whether enhanced sympathetic activity could altera non-invasive index of cardiac instability, we analysed theeffects of 90° head-up tilt and submaximal exercise stresstest on high amplification signal-averaged electrocardiogramin 64 patients after acute myocardial infarction. At rest, ventricularlate potentials were detected in 25% of patients, characterizedby a significant prolongation of filtered QRS complex (137 ±3vs 115 ±2 ms) and of its components smaller than 40 fiV(38 ±2 vs 16 ±1 ms), as well as by a reduced rootmean square voltage calculated for the terminal 40 ms of QRScomplex (RMS40 voltage) (19 ± 1 vs 75 ± 9µV)in comparison to patients without micropotentials. Sympathetic activation induced by tilt caused a significantincrease in heart rate (from 67 ±3 to 79 ±3 beatsmin^–1) but did not modify either the incidence of ventricularlate potentials or the values of any of the signal-averagedelectrocardiogram parameters considered. In 19 patients, recordingswere also obtained during a submaximal bicycle exercise stresstest at a heart rate of 114 ±4 beats min^–1 andwith systolic arterial blood pressure at 153 ±6 mmHg.No effect on signal-averaged electrocardiogram parameters wasdetectable during this experimental intervention. These data indicate that after myocardial infarction, sympatheticactivation does not seem to modify signal-averaged electrocardiogramparameters.     

Exploratory factor analysis of the Brazilian OHIP for edentulous subjects

Summary The use of seven domains for the Oral Health Impact Profile (OHIP)‐EDENT was not supported for its Brazilian version, making data interpretation in clinical settings difficult. Thus, the aim of this study was to assess patients’ responses for the translated OHIP‐EDENT in a group of edentulous subjects and to develop factor scales for application in future studies. Data from 103 conventional and implant‐retained complete denture wearers (36 men, mean age of 69·1 ± 10·3 years) were assessed using the Brazilian version of the OHIP‐EDENT. Oral health‐related quality of life domains were identified by factor analysis using principal component analysis as the extraction method, followed by varimax rotation. Factor analysis identified four factors that accounted for 63% of the 19 items total variance, named masticatory discomfort and disability (four items), psychological discomfort and disability (five items), social disability (five items) and oral pain and discomfort (five items). Four factors/domains of the Brazilian OHIP‐EDENT version represent patient‐important aspects of oral health‐related quality of life.     

Ten-year survival in 290 patients with endometrial cancer: prognostic factors and therapeutic approach

Summary. Between 1970 and 1976, 290 patients with endometrial cancer were treated at the 1st Obstetrics and Gynecology Clinic of the University of Milan. The median age was 62 years. Surgery was completed in 262 (90.3%) patients. Abdominal hysterectomy was used in 158 (70.9%) stage I and 40 (71.4%) stage II/III patients; vaginal hysterectomy in 55 (24.7%) stage I and nine (16.1%) stage II/III patients. Resection of the upper vagina was performed in 168 patients. Postoperative external beam radiotherapy was used in stage II/III patients and in 44 (19.7%) stage I high-risk patients. Ten-year survival, determined by the life-table method, was 84.8% in stage I (223 patients), 53.4% in stage II (37 patients), 64.4% in stage III (19 patients), and 9.1% in stage IV (11 patients). Factors associated with poorer prognosis were: late age at diagnosis (P<0.001); deep myometrial invasion (P<0.001); poorly differentiated histological grade ( P =0.11); lack of resection of the upper vagina ( P = 0.13). The role and importance of surgery is discussed, with special emphasis on the selective use of the vaginal route in aged, obese and medically high-risk patients.     

Calvarial Doughnut Lesions with Osteoporosis,Multiple Fractures,Dentinogenesis Imperfecta and Tumorous Changes in the Jaws. (Report of a Case)

A case of calvarial doughnut lesions with osteoporosis, multiple fractures, dentinogenesis imperfecta and tumorous changes in the jaws in a 21 year old man observed since infancy is reported. This is the youngest and most severe case of calvarial doughnut lesions ever described. In the opinion of the authors calvarial doughnut lesions are not always benign but may be an expression of a generalised, severe bone disease.     

Periprocedural Management and In-Hospital Outcome of Patients with Indication for Oral Anticoagulation Undergoing Coronary Artery Stenting

Purpose: In patients on oral anticoagulation (OAC) undergoing coronary stenting (PCI-S), procedural management and in-hospital outcome have never been specifically and prospectively investigated. Also, the contribution of early bleeding to the relevant hemorrhagic rate reported at follow-up with triple therapy of OAC, aspirin, and clopidogrel is largely unknown.
Methods: Consecutive patients with indication for OAC undergoing PCI-S at 5 centers were enrolled and prospectively evaluated.
Results: Out of 3410 patients undergoing PCI-S in the study period, indication for OAC was present in 4.8%. Femoral approach and bare metal stents were the most frequently used. During PCI-S, OAC was continued in about 30% of patients, whereas in about 20% heparin bridging was carried out. Glycoprotein IIb/IIIa inhibitors were rarely used (11%), whereas a standard bolus of unfractionated heparin was given in 93% of cases. Major adverse cardiovascular events (MACE) occurred in 4.8% of patients and major bleeding in 4.3%. No predictors of MACE or bleeding were identified, although the femoral approach was of borderline significance for major bleeding (OR 4.6, 95% CI 1.0–20.8; P = 0.05). A history of previous hemorrhage (OR 5.3, 95% CI 1.6–18.1; P = 0.007) predicted Carbofilm™-coated stent implantation.
Conclusions: A limited, albeit clinically relevant, proportion of patients undergoing PCI-S has indication for OAC. Procedural management appears not substantially different from that of common patients. In-hospital major bleeding is relevant and should be taken into account when evaluating the overall hemorrhagic rate at a medium- to long-term follow-up.     

Parental age and risk of complete and partial hydatidiform mole

Summary. The relation between age of parents and the risk of complete and partial hydatidiform mole was examined using data from a casecontrol study conducted in Northern Italy of 149 histologically confirmed complete moles, 45 partial moles and 306 controls subjects who delivered normal babies. Compared to women aged 21 to 35, the relative risk (RR) of complete mole was elevated for teenage women (RR = 1·9) and for those aged 36–40 (RR = 1·9) or over 40 (RR = 7·5). There was no association between women's age and partial mole. Likewise, older paternal age (>45) was related with the risk of complete mole (RR = 4·9, though allowance for women's age reduced this point estimate to 2·9), but not of partial mole. The present findings indicate that there are important differences in the epidemiology of complete and partial hydatidiform mole.     

Invasive cervical cancer in young women

Summary. Between 1970 and 1979, 103 women below 35 years of age with invasive cervical cancer were treated at the First Obstetrics and Gynaecology Clinic of the University of Milan. Nine patients were pregnant or less than 3 months postpartum. Estimated 10–year disease–free survival, determined by the life–table method, was 100% in stage IA (37 patients), 79% in stage IB (45 patients), 67% in stage 11 (15 patients), 0% in stages III (5 patients) and IV (1 patient). Prognosis was also strongly associated with lymph–node involvement, 10–year actuarial survival decreasing from 93% in lymph–node–negative to 44% in lymph–node– positive patients ( P 相似文献   

Radiofrequency Catheter Ablation of the Slow Reentrant Pathway of Sustained Ventricular Tachycardia

The article reports the cases of two patients with severe coronary artery disease and associated recurrent sustained ventricular tachycardia successfully treated with radiofrequency catheter ablation. In the first patient, two different types of ventricular tachycardia (one incessant) were eliminated. In all procedures, an area of slow conduction critical for tachycardia maintenance was localized by endocardial mapping techniques. Radiofrequency energy delivered to this area could permanently modify the anatomical substrate of the arrhythmia. After single follow-ups of 19, 14, and 13 months regarding the arrhythmic entities, the patients are well and free from spontaneous recurrences.     

Maternal and paternal moderate daily alcohol consumption and unexplained miscarriages

Summary. The relation between parental moderate alcohol consumption and the risk of miscarriage was analysed using data from a casecontrol study in Milan between January 1987 and June 1988. Cases were 94 women who had two or more 'unexplained' miscarriages (after exclusion of genetic, endocrine and Miillerian factors) and without full-term pregnancies, admitted or referred to the First Obstetric and Gynecologic Clinic of the University of Milan. A total of 176 women admitted for normal delivery on selected days to the same university clinic and without previous miscarriages were chosen as controls. Compared with non-drinkers the risk of recurrent miscarriage was 0·9 for regular drinkers. The point estimates were 0·9 for women reporting one drink per day and 0·8 for those reporting two or more. Compared with non-drinkers, the relative risk estimates for drinking by fathers were slightly above unity, being 1·7 for less than three drinks and 1·4 for three or more drinks per day, but the trend in risk was not statistically significant.