[Myocarditis in legionellosis. A case report]. / Miocardite in corso di legionellosi. Descrizione di un caso.

Cardiac involvement during Legionnaires' disease has been rarely described; few cases of myocarditis, pericarditis and endocarditis were reported. We describe a case of myocarditis associated to pneumonia, with high antibody title suggesting a disease due to Legionella pneumophila. The patient had severe myocardial damage, with overt heart failure and important ECG and Doppler-echocardiographic abnormalities, without associated multiorgan involvement.

[Diagnosis of pulmonary thromboembolism by transesophageal echocardiography. Report of a case]. / Diagnosi di tromboembolia polmonare mediante ecocardiografia transesofagea. Descrizione di un caso.

We describe the case of a 73-year-old man, admitted after several days of moderate dyspnea, followed by sincopal episode. Transesophageal echocardiography clearly demonstrated a high resolution image indicating thromboembolus of the proximal right main pulmonary artery. The patient's clinical conditions were moderately impaired; a treatment with heparin followed by warfarin was started. At 15 and 30 days interval, TEE controls were performed, showing an incomplete but evident resolution of pulmonary thromboembolism, associated to an improvement of clinical ECG and scintigraphic parameters. Our TEE observation, in accordance with the small number of similar observations reported in literature, showed a clear direct visualization with high resolutive diagnostic possibilities for pulmonary thromboembolism; successful resolution was confirmed by repeated TEE studies.

[Female gender and acute myocardial infarction: what role does it play in the early and late prognosis]. / Sesso femminile ed infarto miocardico acuto: quale ruolo nella prognosi a breve e medio termine?

The primary purpose of this study is to examine the influence of the female gender on the early and 1-year post-discharge prognosis after acute myocardial infarction (AMI). Moreover, the therapeutic approaches are compared between the two sexes during the early phase of AMI. We performed a retrospective cohort study of 341 patients, 219 men and 122 women, consecutively admitted to the coronary care unit with AMI. Among the baseline characteristics, the age greater than 70 years, the systemic hypertension and the diabetes mellitus are more represented in women; on the contrary cigarette smoking is prevalent in the male gender. The analysis of laboratory and clinical parameters does not show any statistic differences between the two sexes, except the ejection fraction and the coronary reperfusion. The first turns out to be lower in the females and the second one is more often observed in the males. As for the intra-hospital complications, the cardiogenic shock is prevalent in the female gender, the early mortality gets to 26% in women and 11% in men (p < 0.01). The late mortality during the follow-up does not present any difference between the two sexes. From our data, we conclude that transmural AMI, cardiogenic shock, ventricular fibrillation and 2-3 degree atrio-ventricular blocks are significantly bound to a higher early mortality in women. In them the atrial fibrillation is the only predictor of 1-year mortality. Finally, thrombolysis, beta-blockers and significantly aspirin and heparin (p < 0.05), are less used in the female patients, while diuretics and digoxin are more employed.(ABSTRACT TRUNCATED AT 250 WORDS)

[The effect of age on early and late mortality after an acute myocardial infarct]. / Influenza dell'età sulla mortalità precoce e tardiva dopo infarto miocardico acuto.

The purpose of this study is to define the importance of age as predictor of early and late mortality following acute myocardial infarction (AMI). At the same time, effects coming from the use of various therapeutic approaches are considered. We have studied 341 patients, 188 aged < 70 years and 153 > or = 70 years, consecutively admitted to the coronary care unit with diagnosis of AMI. Our findings show that age > or = 70 years, female gender, cardiogenic shock, ventricular fibrillation and early post-infarction angina are significantly connected to higher intra-hospital mortality. As for predictors of 1-year mortality, they turned out to be the age > or = 70 years, indirect signs of more extensive infarction as previous necrosis, acute heart failure, cardiogenic shock, new bundle branch blocks and pre-discharging lower ventricular ejection fraction. In patients aged > or = 70 years, especially in ultra eighty-year old men, thrombolysis, heparin, beta-blockers and aspirin are significantly less employed. All drugs used in the early hours of AMI turned out to be bound to beneficial effects with reduced mortality, except diuretics and antiarrhythmics. The only drugs correlated with an improved 1 year survival are betablockers, aspirin and thrombolysis. On the contrary, the use of diuretics and digoxin is limited to patients with a greater clinical dysfunction. These drugs are associated to a higher late mortality. The present study confirms the finding that elderly patients with AMI who are submitted to less aggressive therapeutic approaches and are more frequently represented by women, have a higher mortality.

[Circadian variations in the incidence of transient ischemic myocardial episodes during hospitalization for acute myocardial infarct]. / Variazioni circadiane nell'incidenza di episodi di ischemia miocardica transitoria nel periodo pre-dimissione dopo infarto miocardico acuto.

The aim of this research was to evaluate the incidence and circadian variation of episodes of transient myocardial ischemia in the predischarge period after acute myocardial infarction (AMI). One hundred and ninety patients were selected in stable clinical condition, 83 with inferoposterior AMI, 61 with anterior AMI, 12 with lateral AMI (34 patients with non Q AMI). The patients with unstable clinical course during the first 48 hours after admission were excluded. All patients underwent dynamic electrocardiography (Pathfinder 3 Reynolds Medicals) between the tenth and the fifteenth day of the in-hospital phase. Sixteen/190 patients showed ECG changes due to transient myocardial ischemia, with a length higher than 60 sec and with an interval between episodes higher than 60 sec. Ten patients had ST depression, 6 patients had ST elevation. In total, the ischemic episodes were 25, silent 21 and symptomatic 4, with incidence from 1 to 4 during 24 hours, with a length from 1 to 17 min (mean 8 min); mean heart rate increased during ischemic episodes. Seventeen/25 ischemic episodes occurred between the twelfth and the twenty-fourth hours. A follow-up of 15 +/- 3 months was carried-out: 1 patient died after reinfarction, 1 patient died of non cardiac cause, 6 patients showed unstable angina (in 4 of them myocardial revascularization procedure was performed), 8 patients were asymptomatic; on the contrary, 32/174 patients without episodes of myocardial ischemia presented cardiac events, with lesser incidence than ischemic patients (p < 0.01). This retrospective analysis showed higher evidence of episodes due to transient myocardial ischemia during the afternoon and evening hours in the in-hospital phase after AMI.(ABSTRACT TRUNCATED AT 250 WORDS)

[Repeated venesection in pseudoporphyria cutanea tarda of hemodialysis (author's transl)]. / Salasso ripetuto nella pseudoporfiria cutanea tarda del dializzato.

Cutaneous syndrome called porphyria tarda-like of dialyzed patients may involve risk of infections besides aesthetic complications. We have described a very serious case of which the therapeutic problem has become oppressive inducing various attempts, already used for porphyria cutanea tarda or completely new. The only treatment which brought improvement in symptomatology was repeated venesection. Aminoacidic loss during dialysis appears as possible pathogenetic hypothesis for this syndrome.

[Osteomalacia from phosphate-binding substances (author's transl)]. / Osteomalacia grave in uremico in trattamento con chelanti del fosforo in dosi eccessive

A case is told with osseous fractures occurred during uremia in a periodically dialyzed man treated with phosphate-binding substances in excessive doses. The healing time is studied to value the effectiveness of normalized phosphatemia and the vitamin D treatment necessity.