Transdermal nitroglycerin efficacy in patients with chronic stable angina pectoris as related to sympathetic and renin-angiotensin-aldosterone activity.

The aim of this study was to evaluate the acute effects of transdermal nitroglycerin on the sympathetic and renin-angiotensin-aldosterone systems activity, in a group of patients with stable exercise induced angina pectoris. Eighteen outpatients (15M, 3F, age range 47-65 years) were included in this double-blind, randomized, crossover trial comparing the antianginal effects of a transdermal system delivering 20 mg.day-1 of nitroglycerin to an identical placebo. Plasma renin activity, plasma aldosterone and catecholamine concentrations were measured in resting basal conditions and at 4, 8, 24, and 32 h post-dosing. Patients were subdivided in two groups according to the increase in exercise duration after patch application greater than 30% (responders, n = 8) and less or equal to 30% (non-responders, n = 10) in respect to placebo. In responders plasma norepinephrine was slightly increased during transdermal nitroglycerin administration in comparison to placebo while no change was observed in plasma adrenaline and aldosterone concentrations and in plasma renin activity. In non-responders plasma norepinephrine levels significantly increased during nitroglycerin treatment in comparison with placebo. Multiple comparisons showed that this increase was significant at 4, 8 and 24 h post-dosing. Plasma epinephrine and aldosterone concentrations and plasma renin activity were also increased after nitroglycerin administration. In the population as a whole, a significant inverse correlation was found between the percent increase in exercise duration (active drug vs placebo) and the absolute values of plasma norepinephrine and aldosterone, 4 h post-dosing.(ABSTRACT TRUNCATED AT 250 WORDS)

[Post-traumatic pseudoaneurysm of the mitral-aortic intervalvular fibrosa]. / Pseudoaneurisma post-traumatico in corrispondenza della continuità fibrosa mitro-aortica.

The case of a patient with large pseudoaneurysm of the mitral-aortic intervalvular fibrosa following a blunt chest trauma is presented. A two dimensional echocardiographic study revealed a large aneurysmal sac situated between the posterior aortic root and the left atrium, which expanded in systole and partially collapsed in diastole. An echo-free space which represented the mouth of the aneurysm was seen just below the posterior aortic cusp in the junctional zone between the two valves, called mitral-aortic intervalvular fibrosa. Nuclear magnetic resonance imaging showed a better resolution of the echocardiographic feature. Cardiac catheterization and surgery confirmed the diagnosis.

[Role of ambulatory electrocardiography in the evaluation of interventions: rehabilitation of a patient who has undergone surgery]. / Ruolo dell'elettrocardiografia dinamica nella valutazione degli interventi: nella riabilitazione del paziente operato.

The authors relate their own experience with 24 hr Holter monitoring in course of cardiac rehabilitation after coronary bypass surgery as well as after valvular replacement. As regards patients after coronary surgery they report the experience they got in the evaluation of heart rate trend and cardiac arrhythmias as well as in silent ischemia study. About this last problem 116 patients with signs of ischemia both in stress test and in Holter recording are considered out of 491 who had undergone coronary surgery. Ischemia during 24 hr Holter monitoring develops at an heart rate lower than effort ischemia. Holter monitoring proves to be very useful also in patients after valvular replacement to study arrhythmias and to check drugs' efficacy. After displaying the results concerning arrhythmias of 24 hr Holter electrocardiograms recorded in 207 randomized patients who had undergone valvular replacement 15 days before, the authors dwell upon the use of Holter electrocardiography in 82 valvular patients after pharmacological cardioversion and show that major arrhythmias get a clear reduction thanks to rehabilitation.

Treatment of dyslipidaemia with a simple low fat diet and with a combination of a low fat diet and a formulation containing soybean protein.

The first approach to treatment of dyslipidaemia is with diet. Currently, modified soybean protein is often included in the diet. A study was made of 32 patients with types IIa and IIb dyslipidaemia to see what changes in blood lipids could be induced by a simple low fat diet and a diet with modified soybean protein substituted for part of the animal protein. After six weeks on the initial low fat diet, all of the patients had lower total cholesterol and triglyceride levels, but there were no significant changes in the high density lipoprotein-cholesterol levels. The same diet was continued for eight weeks by 19 of the patients, who continued to improve. The 13 patients who had shown the least response to the initial simple low protein diet were given a diet in which the animal protein was partially replaced with modified soybean protein. This diet further decreased the total cholesterol.

Comparative evaluation of the effect of two doses of Nitroderm TTS on exercise-related parameters in patients with angina pectoris.

The effectiveness of Nitroderm TTS 5 and Nitroderm TTS 10 in stable effort-induced angina pectoris was assessed by measuring the tolerance of 20 selected in-patients to cycloergometric symptom-limited tests. During the week preceding the trial previous anti-anginal treatment was gradually withdrawn except for short-acting nitrates. Patients were also familiarized with ergometric laboratory environment. The trial started with a 24-h control period when placebo was given single-blind to each patient. A double-blind cross-over design was then followed, two groups of 10 patients each being subjected successively to two sequences of therapy. By means of the double-dummy technique, Nitroderm TTS 5 or Nitroderm TTS 10 and matching placebos were applied simultaneously once daily for 24 h on two different days. Resting heart rate and blood pressure were measured before starting each exercise test, which was performed 3 h after placebo as well as 3 and 24 h after Nitroderm TTS application. The results of the tests were evaluated in terms of maximum workload, duration of exercise and total work performed for each of the two doses administered and compared with the corresponding baseline values. When compared with placebo both Nitroderm TTS doses produced a significant change (P less than 0.01) in the assessment variables. After application of the active treatment, duration of exercise, total work performed and maximal workload were increased while lying and standing blood pressures were decreased. There was no significant difference between the two doses of Nitroderm TTS in the assessment variables, except for systolic blood pressure and lying heart rate 3 and 24 h, respectively, post-dosing.(ABSTRACT TRUNCATED AT 250 WORDS)

A simple and rapid test for the quantification of osmotic fragility of red blood cells.

We have developed a simple and rapid nephelometric test for the quantification of the osmotic fragility of red blood cells. 10 microliters of whole blood are mixed with hypotonic NaCl solutions under mechanical stirring while the hemolysis curve is continuously recorded for 1 min. In our preliminary studies, this test was reproducible, time-saving, easy to set up and to standardize. No false-positive or false-negative results have been recorded so far. Moreover, it seems that this test can differentiate heterozygous beta-thalassemic patients from patients with sideropenic anemia, which was hardly possible with previously proposed assays.

Efficacy of Dilazep in patients with previous myocardial infarction participating in a cardiac rehabilitation programme.

The present investigation was undertaken to evaluate the effects of Dilazep, a new antiplatelet and coronary dilating drug, on the exercise tolerance of patients who had suffered previous myocardial infarction and were participating in a cardiac rehabilitation programme. Seventy-two patients were enrolled in the study. They were randomly allocated to two groups of 36 subjects; patients in group A took Dilazep, 300 mg daily; patients in group B took acetylsalicylic acid, 100 mg daily, or dipyridamole, 300 mg daily. Before and after treatment all patients underwent two maximal or symptom limited cycloergometer stress tests, respectively 30 and 60 days after the episode of acute myocardial infarction. Total exercise time, maximum workload reached, heart rate, blood pressure, double product and oxygen pulse were measured. In both groups a significant increase in both total exercise time and maximum workload reached was recorded at the second stress test; this may reflect a greater degree of physical conditioning due to the rehabilitation programme. In group A patients total exercise time increased from 457.12 +/- 5.36 sec to 588.28 +/- 8.24 sec (p less than 0.005), in group B patients it increased from 459.18 +/- 6.11 sec to 547.43 +/- 7.47 sec (p less than 0.005). The mean values of maximum workload reached increased in group A from 4512.14 +/- 116.47 kgm to 5288.57 +/- 145.38 kgm (p less than 0.005), and in group B from 4522.22 +/- 108.42 kgm to 5098 +/- 137.51 kgm (p less than 0.005). Thus the exercise tolerance improved more in patients taking Dilazep than in those taking acetylsalicylic acid or dipyridamole.(ABSTRACT TRUNCATED AT 250 WORDS)

Management of immune-mediated and paraproteinemic diseases by membrane plasma separation and cascade filtration.

Membrane plasma separation was utilized in the management of 19 patients with autoimmune, immune complex or paraproteinemic diseases. In these patients 34 procedures were carried out employing a new filter composed of polyvinyl alcohol hollow fibers with a nominal pore size of 0.4 micrometer. Cascade filtration was performed in 23 procedures using a second filter built up with ethylenevinylalcohol copolymer hollow fibers with a nominal pore size of 0.1-0.2 micrometer. Both filters employed showed a very good biocompatibility, and no untoward effect was observed. Using the differential sieving effect of cascade filtration it was possible to eliminate circulating immune complexes and immunoglobulin M without the loss of necessary plasma components.