[Arterial hypertension in perimenopausal women; tolerability of etozolin]. / Ipertensione arteriosa in donne in età perimenopausale; indagine di tollerabilità dell'etozolina.

Twenty women aged 45-55 years with mild-moderate hypertension were treated for 12 months with etozolin, a new loop diuretic. All patients concluded the study; resting systolic pressure was reduced from 164 +/- 3 to 145 +/- 3 mmHg; diastolic blood pressure dropped from 103 +/- 2 mmHg to 90 +/- 1 mmHg. No changes of blood glucose, blood nitrogen, serum Na+, K+, creatinine, cholesterol, triglycerides were observed, nor serious adverse reaction appeared. In conclusion, etozolin is a safe and effective antihypertensive agent in a selection of hypertensive patients highly sensitive to pharmacological side effects.

[Evaluation of the cholesterol-lowering effectiveness of pantethine in women in perimenopausal age]. / Valutazione dell'efficacia ipocolesterolemizzante di pantetina in donne in età perimenopausale.

Cardiovascular diseases are the main cause of death also in women. Their incidence, rapidly growing in the peri-menopausal period, is related to serum levels of total cholesterol and its LDL fraction. It was also shown that the peroxidation of LDL is an additional factor in the genesis of atherosclerotic vascular disease. As long-term treatments with synthetic lipid-lowering drugs may cause undesirable side effects, while pantethine is known to be well tolerated, we treated 24 hypercholesterolemic women (total serum cholesterol greater than or equal to 240 mg/dl), in perimenopausal age (range: 45-55 years, mean +/- SD = 51.6 +/- 2.4) with 900 mg/day of pantethine. This is a precursor of coenzyme A, with an antiperoxidation effect in vivo, and our aim was to confirm its lipid lowering activity in this particular type of patients. After 16 weeks of treatment, significant reductions of total cholesterol, LDL-cholesterol and LDL-C/HDL-C ratio could be observed. No remarkable changes of the main laboratory parameters (fasting blood sugar, B.U.N., creatinine, uric acid) were seen. Efficacy percentages of the treatment were about 80%. None of the patients complained of adverse reactions due to the treatment with pantethine. In conclusion, we suggest that pantethine should be considered in the long-term treatment of lipid derangements occurring in the perimenopausal age.

Reversible alteration of myocardial function in gestational diabetes.

Left ventricular function was evaluated in 24 women who developed impaired glucose tolerance only during their pregnancy, i.e. patients with gestational diabetes. The results were compared with those of 25 normal pregnant women and with those of 17 pregnant women with clinical diabetes. The method of systolic time intervals was applied. At the third trimester of pregnancy, both the women with overt diabetes and those with gestational diabetes, when compared with normal pregnant subjects, had a more prolonged pre-ejection period (PEP) and a shorter left ventricular ejection time (LVET) and, consequently, a higher PEP/LVET ratio. Five weeks after delivery, abnormalities of systolic time intervals persisted in patients with clinical diabetes, but there were no differences at this time between patients with gestational diabetes and those in the control group. It is concluded that when a cardiac load is superimposed on patients who develop diabetes only under conditions of stress, as in pregnancy (gestational diabetes), abnormalities of myocardial function appear, which revert to normal when the stressful event is removed.

[Cardiac valvular disease and pregnancy. Haemodynamic aspects and importance of decubitus]. / Cardiopatie valvolari e gravidanza. Aspetti emodinamici ed importanza del decubito.

During the 3rd trimester of pregnancy, 26 women with aortic or mitral valve disease (II class NYHA) have undergone bedside right heart catheterization. Total pulmonary resistances (RPT) have been studied in supine (DS) and lateral (DL) decubitus. The results are compared with those of 7 normal women. It is known that the change from the supine to the lateral posture increases venous return (and cardiac output) by removing the compression which the pregnant uterus causes to the inferior vena cava. This is achieved without increasing the mean pulmonary pressure (PPM) and total pulmonary resistances (RPT); women with mitral and aortic stenosis have little or no increase of cardiac output but always a marked increase of PPM and RPT; the response in patients with aortic and mitral incompetence is closer to normal; an intermediate response was observed in patients with a mitral stenosis and insufficiency. The valvular heart diseases with stenosis badly tolerate the increased cardiovascular burden of pregnancy and are unable to accommodate the increased venous return induced by postural changes, which induces marked elevation of pulmonary pressure and resistances.

[Preliminary data on the pharmacokinetics of digoxin in pregnancy]. / Dati preliminari sulla farmacocinetica della digossina in gravidanza.

The pharmacokinetics of digoxin were investigated in 8 pregnant women (2-3 months before delivery), in three women 3 months after delivery, and in 3 non-pregnant women, after i.v. injection of 500 microgram. Digoxin was evaluated in serum with the radioimmunoassay method. In pregnant women C1 (concentration of digoxin in the first compartment) and V1 (volume of the first compartment) were higher and C2, K1-2, K2-1 (exchange constants) and Kel (elimination constant) were all lower than the values obtained in both post-partum and non-pregnant women. Our data lead us to think that the exchange (both uptake and release) between the first and second compartment is lowered in pregnancy.