Effective immunosuppressive therapy in a patient with primary pulmonary hypertension.

The case history is described of a young woman who presented with primary pulmonary hypertension and non-specific inflammatory signs. The patient received prolonged immunosuppressive treatment with low dose methotrexate and prednisone without any vasodilator agent. After one year the pulmonary artery pressure fell from a mean value of 47 mm Hg to 30 mm Hg and there was a corresponding clinical response. This case suggests that, in patients with pulmonary hypertension of unknown origin, immunopathogenetic factors should be sought in order to consider the utility of immunosuppressive therapy.

Prevention of atrial tachyarrhythmias after non-cardiac thoracic surgery by infusion of magnesium sulfate.

The possible role of magnesium sulfate (MgSO4) infusion in the prevention of atrial tachyarrhythmias after non-cardiac thoracic surgery was evaluated through a prospective study of two hundred patients who underwent non-cardiac thoracic surgery. The patients (who fulfilled the following requirements among others: no myocardial infarction in the previous six months, normal renal function, no use of digitalis or antiarrhythmic drugs, not undergone emergency operations or video-assisted thoracic surgery), were randomly assigned to receive MgSO4 infusion in all circumstances (Mg group), or either no treatment or, if aged over 70 or in cases of pneumonectomy or an intrapericardial procedure, application of digoxin starting on the day of operation (control group). 95 patients were enrolled in the Mg group and 105 in the control group. 93 patients in the Mg group and 101 in the control group were evaluated. Post-operative atrial tachyarrhythmias, mainly atrial fibrillation, occurred in 10 patients (10.7%) in the Mg group and in 27 (26.7%) patients in the control group (chi 2 = 7.009, df = 1. p = 0.008). It is concluded that infusion of MgSO4 is an effective means of reducing the incidence of atrial tachyarrhythmias after non-cardiac thoracic surgery.

Lung resections concomitant to coronary artery bypass grafting.

From 1980 through 1993 ten patients underwent concomitant coronary artery bypass grafting and lung resection via median sternotomy. In eight patients a lung malignancy was resected, of which one was a small cell lung cancer. The lung resection was carried out before cardiopulmonary bypass in eight patients and during cardiopulmonary bypass in two. Coronary artery bypass grafting was performed using saphenous vein in eight patients; internal mammary artery was used as arterial conduit in two patients. There was one postoperative death while postoperative complications during hospital stay occurred in two patients. Pulmonary bleeding did not occur in any patient in whom lung resection was performed either before or during cardiopulmonary bypass. Both the patients who had internal mammary artery grafting experienced complications related to an associated lobectomy. A staged procedure is advisable if internal mammary artery has to be used and a lobectomy is required. The long-term survival in the patients with lung cancer was less than expected but the number of patients is too small to draw definite conclusions.

[Cholelithiasis in childhood. Case study contribution]. / La colelitiasi in età pediatrica. Contributo casistico.

Two cases of cholesterinic cholelithiasis in paediatric age are reported and the literature on the subject reviewed.