Coronary collateral circulation behaviour and myocardial viability in chronic total occlusion treated with coronary angioplasty.

AIMS: We explored the role of microcirculation integrity following the chronic occlusion of an infarct-related artery to assess the behaviour of collateral circulation during and after reperfusion by coronary angioplasty METHODS AND RESULTS: Eighteen patients with a proximally occluded left anterior descending artery and firm evidence of intercoronary collateral circulation were studied with selective coronary angiography and selective intracoronary myocardial contrast echocardiography, before coronary angioplasty, and at 5 and 15 min and 12 h later. Myocardial enhancement during myocardial contrast echocardiography was evaluated with a semiquantitative score (0-3), which was correlated to basal and 6 months' regional left ventricular wall motion results. 16/18 procedures were successfully performed; four patients with an inadequate acoustic window were excluded. Restenosis was evident at the 6 months' follow-up in two patients. Basal myocardial contrast echocardiography indicated that 81/192 segments from the left anterior descending coronary artery and 90/192 from the right coronary artery were perfused; no perfusion was observed in 21 segments either before or after coronary angioplasty. After coronary angioplasty, the angiographic intercoronary collateral circulation immediately disappeared, and myocardial contrast echocardiography revealed that there was a progressive reduction of segments perfused by the right coronary artery and an increase in segments perfused by the left anterior descending coronary artery. Regional left ventricular wall motion analysis demonstrated that there was abnormal motion in 51/192 segments. There was no improvement in segments with score 0 and abnormal motion after 6 months (100% sensitivity), but 16/17 segments with score 3 did show an improvement (98% specificity). The predictive value of intermediate scores (1-2) in detecting long-term improvement, was only 43%. CONCLUSION: These data show that the adaptive mechanism observed in the behaviour of epicardial and microvascular circulation after reperfusion of a chronic occluded infarct-related artery can vary. In addition, this study clearly shows that microvascular integrity detected by myocardial contrast echocardiography can provide myocardial viability.

Lambert-Eaton myasthenic syndrome. Report of two cases.

Two cases of Lambert-Eaton myasthenic syndrome, in female patients whose neoplasm investigation was negative, are reported. Repetitive stimulation of ulnar nerve showed an incremental response (+187% and +198%). Needle EMG was normal in one of them, however, the other patient showed fibrillation potentials, positive sharp waves, potentials of low amplitude and short duration. The authors discuss the clinical, electrophysiological, and pathological features of the disease, as well as some aspects of the treatment and follow-up of these patients.

Nimesulide in the treatment of advanced cancer pain. Double-blind comparison with naproxen.

In a clinical double-blind study, the analgesic efficacy and the side-effects of nimesulide (Aulin, CAS 51803-78-2) and naproxen administered to 68 patients affected by advanced cancer pain were compared. Patients were treated with non-steroidal anti-inflammatory drugs according to the first step of the pharmacological analgesic scale of the WHO. The dose administered was 200 mg b.i.d. (every 12 h) for nimesulide and 500 mg b.i.d. (every 12 h) for naproxen. From this study the analgesic effect and the tolerability of the two drugs appeared to be similar. Both drugs resulted to be effective with a low incidence of adverse events that may be related to their use.

[Comparison of the efficacy of famotidine and cimetidine in in prophylaxis of Mendelson's syndrome in elective surgery]. / Confronto tra l'efficacia di Famotidina e Cimetidina nella profilassi della sindrome di Mendelson in chirurgia di elezione.

The Authors compared the effects of two H2-antagonist drugs (Famotidine and Cimetidine) on both volume and acidity of gastric secretions. Patients were assigned to three randomized groups, which received respectively: (1) Famotidine 40 mg P.O. the evening before the surgical act; (2) Cimetidine 300 mg P.O. in the same way and Cimetidine 300 mg I.M. 90 min before the induction of anaesthesia; (3) no drug with H2-antagonist effect. Compared with the control group, the treatment with Famotidine and Cimetidine decreases both volume and acidity of the gastric secretions. In the Famotidine group no patient showed pH less than 2.5 and gastric secretions volume greater than 25 ml.

[Treatment by human chorionic gonadotropin in maldescended testes. (Synthesis of our experience)]. / Il trattamento del criptorchidismo con gonadotropina corionica (Sintesi della nostra esperienza).

87 prepuberal children, 2-15 years old, 58 with unilateral and 29 with bilateral cryptorchidism, were treated intramuscularly with Human Chorionic Gonadotropin (HCG). HCG was administered in 16 children in single dose (5.000 IU/m2), in 11 children every other day for one week (3 x 1,500 IU) and in 60 children twice a week (2 x 1,000 IU) for 3-7 weeks. Treatment was successful in 31% of children. The most effective HCG dosage ranged between 10,000 and 14,000 IU (2 x 1,000 IU once a week for 5-7 weeks). The best therapeutic response was obtained in inguinal cryptorchid testes (39,3%), in unilateral cryptorchidism (34,5%) and in children aged 5-10 years (42,3%). The observed androgenic side effects (32%) subsided within 3-12 months after therapy suspension. The HCG therapy appears of particular value in cryptorchidism treatment. Surgical management is indicated in cases of true ectopic testes and after failure of HCG therapy.

[Serial evaluation of blood polyamines in children treated with growth hormone]. / Valutazione seriata delle poliamine ematiche in bambini trattati con l'ormone della crescita.

Blood polyamines were evaluated in normal children of various ages (from infancy to adolescence). Polyamines show a distinctive pattern: maximal values were observed during infancy; they decrease during childhood and again increase at puberty. After i.m. injection of Human Growth Hormone (HGH), polyamine concentrations increase significantly in the first 60 minutes. Polyamines increase more in patients previously untreated or treated intermittently with HGH than in patients under continuous treatment. The results suggest that in humans as well as in animals, polyamines could be involved in the growth processes and that the effect of HGH probably consists in a stimulation of polyamine synthesis.

Traumatic hypopituitarism associated with bitemporal hemianopia in a prepuberal child.

The case of a boy affected by post-traumatic hypopituitarism associated with bitemporal hemianopia is described. While traumatic bitemporal hemianopia is not an extraordinary occurence, traumatic injuries have been rarely reported among the causes of hypopituitarism. This may be because the cranial trauma in most of the cases is too severe to permit survival. After having considered the diagnostic problems the authors briefly review the peculiar vascular supply to the chiasma and anterior diencephalon and try to consider the pathogenetic mechanism of the syndrome. Direct contusion necrosis and direct intraparenchymal hemorrage in the chiasma and in the hypophysis or hypothalamus are considered the most probable causal factors; however, the concomitant occurence of chiasmal and hypopituitary injury might be explained by a single transient compressive mechanism either on the tubero-hypophysial arteries or on the smaller vessels of the infundibular network. The difficulty of ascertaining both the pathogenetic mechanism and the seat of the endocrine lesions on the basis of the clinical signs is stressed.