[Primary angioplasty in acute myocardial infarct with or without a stent implant: the experience and results at 6 months in the first 200 patients]. / Angioplastica primaria nell'infarto miocardico acuto con o senza impianto di stent: esperienza e risultati a sei mesi nei primi 200 pazienti.

BACKGROUND: Although it is superior to thrombolysis, primary PTCA does have some limitations, both in hospital (recurrent ischemia and reinfarction due to reocclusion of the infarct-related artery) and at the six-month follow-up (high rate of late restenosis). Coronary stenting is a promising way of solving some of these problems, even if its use in patients with acute myocardial infarction could prove to be controversial because of intracoronary thrombus. In this study, we propose two procedural strategies in the treatment of the infarct-related artery (IRA): the search for optimal angiographic results after PTCA ("stent-like result"--SLR--with residual stenosis < or = 20%--no dissection--TIMI III flow) or intracoronary stenting when SLR was not obtained after a second inflation. METHODS AND RESULTS: From December 1995 to May 1998, 200 patients with AMI underwent direct PTCA or rescue PTCA because of failed thrombolysis. There were 143 men and 57 women, mean age 65 (range 36-84). Nineteen patients were in cardiogenic shock and 25 were in Killip class > II. Recanalization of the IRA was achieved in 196 patients (98%). In four patients, it was not possible to cross total occlusion with the guide-wire. SLR post-PTCA was achieved in 40 patients (20%). Stents were placed in 147 patients (75%), with "elective" implantation in 73 lesions because of suboptimal results after PTCA in 41, and early loss or coronary dissection with threatening occlusion in 33. In nine patients without SLR, stenting was not performed because of diffuse disease of the IRA. In-hospital complications included ten deaths (8 of 19 patients with cardiogenic shock at admission and 2 with multivessel disease and severe left ventricular dysfunction). None of the patients required emergency coronary bypass for procedural complications. One patient had a subacute thrombosis on the third day after bail-out stent implantation (re-PTCA). Five patients required elective bypass surgery to complete revascularization for multivessel disease with ten days after the surgical procedure. At the six-month follow-up, one patient had died of cardiogenic shock. Eleven (5%) patients with bail-out procedures underwent coronary bypass surgery or PTCA. Thirty-one patients (31/168) had recurrence of ischemia: 15 patients in the stent group, 11 in SLR group and 5 in the non-SLR group. Re-PTCA was performed in 20 patients, CABG in five and medical therapy in six. Other patients were angina-free at follow-up. CONCLUSIONS: Based on our experience, seeking optimal angiographic results with or without (SLR) stent implantation is a safe and effective operative approach to achieve the best procedural and clinical outcome and reduce complications in patients undergoing PTCA for AMI.

Transcatheter management of cardiac and pericardial metastatic involvement.

We performed percutaneous balloon pericardiotomy and pulmonary valvuloplasty in a woman affected with cardiac and pericardial involvement from a primary pulmonary adenocarcinoma. Pericardial window was indicated for a recurrent, symptomatic, pericardial effusion. Valvular stenosis was severe and related to metastatic infiltration of cardiac tissue. Open surgery was avoided and the procedures were completed in two steps under local anesthesia in less than 60 min. The patient had no recurrence of pulmonary stenosis or pericardial effusion at 7 months post treatment. Transcatheter techniques are successful in helping to manage malignant diseases with cardiac metastasis, particularly in critically-ill patients. It may become the preferred treatment for avoiding a more invasive procedure for patients with a limited life expectancy.

[The use of myoglobin for the early diagnosis of reperfusion in acute myocardial infarct]. / Impiego della mioglobina per la diagnosi precoce di riperfusione nell'infarto miocardico acuto.

Myoglobin (Mb) is an intracardiac protein known to be rapidly released after onset of reperfusion. The new automated latex-enhanced nephelometric immunoassay is an interesting fast alternative to the other methods. Therefore we sought to assess the accuracy of rapid rise of Mb concentration to predict the success of reperfusion. Thirty consecutive patients, admitted to the coronary care unit for first acute Q-wave myocardial infarction, were prospectively studied. They underwent thrombolysis 126 +/- 45 min (range 30-180) after onset of symptoms. Mb determinations were obtained before starting therapy and, thereafter, hourly for 5 hours, and after 8 and 12 hours. The usual non invasive markers of reperfusion were considered, and coronary arteriography was performed in all patients at 5.5 +/- 0.9 days (range 1-6). In 23 patients (77%) patent infarct-related artery (IRA) (TIMI II-III) and in 7 (23%) occluded IRA (TIMI 0-I) was observed at coronary arteriography. We modified the judgment in 3 cases (10%) with occluded IRA. All reperfused patients (Group A) showed a rapid rise of Mb concentration with a mean time to peak occurring 133 +/- 80 min (range 60-180) after therapy. Mean value of unreperfused patients (Group B) was 330 +/- 173 min (range 180-420). We retrospectively stated a time to peak of Mb concentration within 180 min as diagnostic threshold for reperfusion. Sensitivity was 100%, specificity 50%, positive predictive value 93%, negative predictive value 100%. The results of this study confirm that Mb release kinetics may play an interesting role in the early prediction of patency of IRA in acute myocardial infarction after thrombolysis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparison of mannitol and traditional methods in the preparation of the large intestine for barium enema]. / Confronto tra mannitolo e metodica tradizionale nella preparazione del grosso intestino al clisma opaco.

The authors point-out the importance of a good bowel preparation for radiological researches. After an evaluation of the results of so-called "traditional methods" and an oral Mannitol method, the Authors conclude that a mannitol preparation is easily accepted by the patient for his effectiveness and tolerance and should be widely used.

[Hyperhistaminemia in neoplasms of the breast]. / L'iperistaminemia nelle neoplasie della mammella.

The authors analyse the course of the total haematic hystamine rate in 13 women with breast cancer. They find that neoplasm take a significant increase of the histamine rate in comparison with the controls, while the mastectomy quickly is followed by the normalization of these values. They conclude that, as already suggested for others kinds of neoplasms of the lung and gastroenteric tract, also in the neoplastic pathology of the breast, the haematic hystamine dosage is a useful parameter for the monitoring the course of the illness.

[The hematic histamina in malignant tumors of alimentary canal and respiratory apparatus (author's transl)]. / L'istamina ematica nei tumori maligni del tubo digerente e dell'apparato respiratorio.

The Authors estimated the blood histamine level in 39 subjects with malignant tumors of the lung (19), Sthomac (11) and colon (9) and found a significant increase with respect to normal values. Among the groups investigated, the subjects with gastric tumors presented the greatest values. The results show a significant relationship between tumor and hyperhistaminemia as demonstrated by other Authors in experimental animals.

[Total hematic histamine in gastrectomized patients]. / L'istamina ematica totale in pazienti gastroresecati.

The Authors estimated the blood histamine in 15 patients after gastric-resection and found a significant decrease in all the cases with respect either to basal valus or to normal subjects. The autors suppose it is due to a lower presence of istidin-decarbojlase, owing to removal of gastric tissue where such enzime is placed.

[Long term treatment with acebutolol in hypertension (author's transl)]. / Impiego a lungo termine dell'acebutololo nella terapia dell'ipertensione arteriosa.

Acebutolol, a new cardioselective beta-adrenoceptor antagonist, has been studied in 40 hypertensive patients (pts.) for a period of 6 months, 25 patients (group A) had never taken any antihypertensive agent, 15 pts. (group B) were previously treated with antihypertensives. This two groups are statistically different for the age (39.8 y. group A; 49.6 y. group B) for the values of basal blood pressure (BP) (175/105 mmHg group A; 197/114 mmHg group B) and for disease duration (9.9 months group A; 39.0 months group B). A significant antihypertensive response was obtained already at the 15th therapy day for the two groups, treated with acebutolol. Further, a little reduction of BP was obtained at the 3rd month going on with therapy; then the BP values showed non significant variation till the end of the study. Orthostatic hypotension were not remarked. After 3 months, acebutolol treatment 41% pts. rised diastolic BP (DBP) below 90 mmHg and 35% pts. had a DBP between 90 and 100 mmHg. The average values of heart rate have been significantly reduced after 15 days of therapy with sligh variations during the following month. The optimal mean daily dosages of the drug were obtained with titration in three months (540 mg/day group A and 740 mg/day group B). Regarding side effects rised during therapy, one patient showed "paradox hypertension" and another bradycardia which justified the interruption of the treatment. In our opinion, on the basis of the results obtained acebutolol shows a good efficacy in the treatment of hypertension and a very high tollerability.