Adeno-tonsillar surgery in Italy.

Indications to surgery for adeno-tonsillar inflammatory disorders and analysis of the effectiveness of surgical treatment, compared with watchful waiting strategy, continue to be the subject of scientific debate. The present investigation focuses on the surgical activity of 14 Italian Otorhinolaryngological Units between 1999 and 2004. Surgical interventions (adeno-tonsillectomy, adenoidectomy, tonsillectomy) on 26915 children (age range: 2-11 years) were considered. Data on adeno-tonsillar interventions were analysed in relation to other interventions of ENT interest, performed in the same units and in the same period. Adeno-tonsillar interventions accounted for 35.4% of all operations of ENT interest. Adeno-tonsillectomy accounted for 56.6% of overall adeno-tonsillar operations, adenoidectomy 31.6%, tonsillectomy 11.8%. The percentage for the three interventions was homogeneous in the period of the study and in the recruited units. The percentage of children who underwent adeno-tonsillar surgery in paediatric units was higher as compared to general units, as far as concerns the overall number of operations performed. In southern Italy, the number of adeno-tonsillar interventions, in general, and of adeno-tonsillectomy, in particular, was higher compared to that in northern Italy. Results of the present study suggest that environmental factors, cultural issues and local health demands, may influence indications and, therefore, the different incidence of the operations under consideration in the units taking part in the investigation.

[Physical training of patients with ischemic heart disease. Effects on diastolic time]. / L'allenamento fisico in pazienti affetti da cardiopatia ischemica. Effetti sul tempo diastolico.

In patients (pt) with coronary artery disease diastolic duration is an important determinant of myocardial oxygen supply. To assess the effects of physical training on diastolic duration, twelve male pt with previous infarction were studied. During 12 month training program the physical exercise was of progressively increasing intensity, duration and frequency. Training induced a significant reduction in heart rate. Both systolic and diastolic blood pressure were unchanged. The mean values of electromechanical systole were lower after training. On the contrary, the training induced a lengthening of diastolic duration expressed as percentage of cardiac cycle (% diastole) from 51.4 +/- 2.6 to 57.5 +/- 3.8% (p < 0.001). Thus, this results validate the hypothesis that physical exercise training can improve myocardial perfusion through an increase in diastolic duration, partially independent of bradycardia.

Diastolic time at ischemic threshold in patients with syndrome X.

The patients with so-called syndrome X experience true myocardial ischaemia in spite of their anatomically normal coronary arteries. The pathogenetic mechanism of the effort-induced ischaemia in these patients should be obviously different from that of patients with atherosclerotic coronary artery lesions. An inadequate coronary dilatory capacity in response to increased oxygen demand has been proposed as mechanism responsible of ischaemic response to effort (Canon et al., 1983; Canon et al., 1985). Since diastolic duration expressed as percentage of the cardiac cycle has implications with the myocardial oxygen demand/supply ratio (Boudoulas et al., 1982; Maseri et al., 1977), the purpose of this study has been to evaluate the behaviour of this parameter at the outcome of the ischaemic electrocardiographic changes during stress testing in the patients with syndrome X.

Exercise-induced impairment of diastolic time in patients with X syndrome.

Since an abnormal shortening of diastolic duration during exercise in the patients with coronary artery disease was demonstrated, time course of diastolic period (cardiac cycle minus electromechanical systole) calculated from polycardiographic recording has been assessed in patients with X syndrome and in normal age-matched subjects during supine ergometer exercise. All patients with X syndrome had positive exercise stress response (more than 0.1 mV of ST segment depression). Duration of diastole expressed as percent of cardiac cycle was significantly shorter at the intermediate steps and at the peak of exercise in patients with X syndrome compared with normal subjects (p less than 0.05). When the relationship between heart rate and diastolic time was examined, an inverse nonlinear regression was found both in normal subjects and in patients with X syndrome. The exercise values of diastolic time observed in patients with X syndrome were significantly shorter than those predicted as normal diastolic time heart rate relation. Thus the patients with X syndrome demonstrated abnormalities in the decrement of diastolic time with exercise. We hypothesized that this disproportionate shortening, by reducing subendocardial blood flow, might induce a worsening of ischemic response to exercise.

Alinidine in chronic stable angina: the effect on diastolic perfusion time.

The present study has been performed to assess the effects of alinidine on diastolic duration during exercise in chronic coronary artery disease. Twelve male patients with stable effort angina and without previous myocardial infarction were studied. They received alinidine or placebo in a double-blind randomized crossover trial for 3 days after a wash-out period of 4 days. Alinidine was administered at a dosage of 30 mg 3 times a day. At the end of each treatment the patients underwent upright bicycle exercise. Left ventricular time intervals were obtained by means of carotid thermistor plethysmography. Diastolic duration was calculated by subtracting the electromechanical systole from the R-R interval and expressed as a percentage of the cardiac cycle (%D). Alinidine increased both total exercise duration from 246.7 +/- 120.7 to 346.6 +/- 114.1 s (p less than 0.05) and time to 0.1-mV ST segment depression from 98.3 +/- 53 to 187.2 +/- 105 s (p less than 0.05). Similarly the drug induced a reduction of the rate-pressure product and of the extent of ischemic ST segment depression during exercise. %D was increased by alinidine both at rest and during exercise. A direct linear regression between R-R and %D was found after both alinidine and placebo treatments either at rest or during exercise. Nevertheless, no difference was observed between both slopes and intercepts. Therefore, since the relationship between R-R interval and %D was unaffected by alinidine, it was possible to hypothesize that the changes in diastolic duration were due only to the bradycardic action of the drug.

Non-invasive assessment of left ventricular performance in patients with coronary artery disease after chronic diltiazem therapy.

To evaluate the effects of diltiazem (240 mg/day) on the left ventricular function, we studied 13 patients with coronary artery disease (CAD). Comparison with placebo was made in a double-blind randomized crossover study. Both placebo and diltiazem were administered for 5 weeks. We assumed left ventricular systolic time intervals assessed by polycardiography as parameter of ventricular function. Diltiazem induced a significant decrease in pre-ejection period (p less than 0.01) as well as pre-ejection period/left ventricular ejection time ratio (p less than 0.01). Thus, our results suggest that diltiazem improves the contractile state of ischemic myocardium in CAD patients.

[Influence of posture on exercise-induced electrocardiographic and hemodynamic changes in patients with stable effort angina pectoris]. / Influenza della postura sulle modificazioni elettrocardiografiche ed emodinamiche incruente indotte dall'esercizio in pazienti con angina stabile da sforzo.

The present work was performed in order to assess the differences in electrocardiographic and hemodynamic responses to supine and upright dynamic exercise of patients with coronary artery disease. Changes in heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, rate-pressure product (RPP) and ST segment depression during supine and upright bicycle stress test were compared in twenty patients suffering from stable effort angina and without previous myocardial infarction. In the supine posture lower values of HR were observed at rest, during stress test and during three minutes of the recovery period. Conversely, in all patients both SBP and DBP were higher during the stress test in the supine position decubitus. No significant changes in RPP was observed between the two different postures. Finally, ST segment didn't show differences at rest between the upright and supine position. All the patients had a lower ischemic threshold during exercise in the supine position than in the upright one. In fact an ST segment depression greater than 1 mm was observed during stress test in the supine position at lower work-load levels and at lesser HR values. Consequently for given HR, SBP and DBP ST segment, depression was greater in the supine rather than in the upright position.

Early diastolic time intervals during hypertensive pregnancy.

Early diastolic time intervals have been assessed by means of the echopolycardiographic method in 17 pregnant women who developed hypertension during pregnancy (HP) and in 14 normal pregnant women (N). Systolic time intervals (STI), stroke volume (SV), ejection fraction (EF), and mean velocity of myocardial fiber shortening (VCF) were also evaluated. Recordings were performed in the left lateral decubitus (LLD) and then in the supine decubitus (SD). In LLD, isovolumic relaxation period (IRP) was prolonged in the hypertensive pregnant women compared with normal pregnant women (HP 51 +/- 12.5 ms, N 32.4 +/- 15 ms p less than 0.05), whereas time of the mitral valve maximum opening (DE) was not different in the groups. There was no difference in SV, EF, and mean VCF, whereas STI showed only a significant (p less than 0.05) lengthening of pre-ejection period (PEP) in HP. When the subjects shifted from the left lateral to the supine decubitus position, left ventricular ejection time index (LVETi) and SV decreased significantly (p less than 0.05) in both normotensive hypertensive pregnant women. IRP and PEP lengthened significantly (p less than 0.05) only in normals, whereas they were unchanged in HP. DE time did not vary in either group. In conclusion, hypertension superimposed on pregnancy induces lengthening of IRP, as well as of PEP, and minimizes the effects of the postural changes in preload on the above-mentioned time intervals.