Feasibility of vaccination in preventing secondary cases of hepatitis A virus infection.

Although the secondary transmission of hepatitis A virus (HAV) infection is preventable through vaccination, it is not known whether the vaccination of household contacts is feasible. To this end, we conducted a prospective cohort study among the household contacts, 40 years of age or less, of all persons infected with primary HAV infection (index cases) and admitted to eight hospitals in southern Italy within 7 days of onset. Household contacts were vaccinated, and serum samples were taken at vaccination and after 14 and 45 days. Secondary cases were defined as those with IgM seroconversion occurring at least two weeks after enrollment. Coprimary cases were those assumed to have had the same exposure as the index case. Susceptible cases were those who were negative for both IgG and IgM. A total of 495 household contacts participated (acceptance rate of 65%); 65% were vaccinated within 4 days of admission of the index case and 95% within 7 days. At enrollment, 196 (39.6%) household contacts were immune (IgG-positive serum). During follow-up, 19 (3.8%) were IgM-positive: 13 (2.6%) were coprimary cases and 6 (1.2%; 95% CI: 0.2-3.2) secondary cases (5 identified at 14 days from vaccination and 1 at 45 days). Of the 241 susceptible cases, 192 (79.7%) had developed IgG antibodies at 14 days and only 3 (1.2%) did not develop IgG antibodies at 45 days. The 65% acceptance rate and the finding that 95% of the participating household contacts were vaccinated within 7 days of the index case's hospitalization indicate that timely vaccination is indeed feasible. The necessity of returning for the collection of blood samples probably decreased the acceptance rate.

[Regression of left ventricular hypertrophy in obese hypertensive patients treated with diet and pharmacologic therapy]. / Regressione dell'ipertrofia ventricolare sinistra in ipertesi obesi trattati con terapia farmacologica e dietetica.

Thirty-five obese (Body Mass Index: BMI > 30) hypertensive (diastolic blood pressure > 100 mmHg) patients were studied for 6 months. 18 patients (10 males, mean age 52 +/- 6 years) were treated with captopril 50 mg b.i.d. (Group 1); 17 patients, matched by age, sex and BMI were treated with captopril 50 mg b.i.d. and hypocaloric diet (Group 2). During follow-up a good control of blood pressure levels (< 150/90 mmHg) and a significant reduction in body weight (> 10%) were achieved in all patients of Group 2. Left heart anatomy was accessed by 2D guided M-mode echocardiogram before starting treatment and after 6 months. In Group 1 Interventricular Septal Thickness (ST), Posterior Wall Thickness (PWT) and Left Ventricular Mass (LVM) decreased significantly (p < 0.01). In Group 2 not only ST, PWT and LVM decreased significantly (p < 0.01 for ST and PWT, p < 0.001 for LVM), but also left atrial dimension (p < 0.05) and left ventricular diastolic dimension (p < 0.01). The percent reduction in AD, LVDD and LVM was significantly higher (p < 0.01) in Group 2. In obese hypertensives relevant weight loss can improve the effect of captopril treatment on left ventricular hypertrophy; the decrease of AD and LVDD is probably secondary to a reduction of the volume overload present in obese patients.

Haemodynamic and neurohormonal responsiveness to different stress tests in mitral valve prolapse.

In this study the blood pressure, heart rate, plasma noradrenaline and plasma adrenaline responses to various forms of sympatho-neural stress were evaluated in patients with mitral valve prolapse (MVP). Sympathetic reactivity in different subgroups of MVP were related to the degree of ventricular arrhythmia. Thirty-eight patients with mitral valve prolapse and 17 healthy controls were studied. All underwent 24-h ECG recording, 2-D echocardiography, head-up tilt to 60 degrees, pressor tests (sustained handgrip, mental arithmetic, cold pressor) and psychological assessment. The blood pressure, noradrenaline and adrenaline response to stress in patients without premature ventricular contraction were similar to those of the controls. In patients with unifocal premature ventricular contraction (PVC) less than 300/h, responses were similar to normal but were associated with higher plasma noradrenaline levels in the basal state and a diminished response to isometric stress. In patients with more than 300/h unifocal premature ventricular contraction, pairs of premature ventricular contraction, or runs of ventricular tachycardia there were lower blood pressure values in the basal state with reduced blood pressure, heart rate and plasma noradrenaline and adrenaline responses to head-up tilt and sustained handgrip, but marked increases in blood pressure, heart rate and plasma noradrenaline levels during the cold pressor test. Our data suggest different degrees of autonomic involvement in mitral valve prolapse which may be related to the various degrees of arrhythmia which seem to contribute to their symptoms.

[Lipoprotein (a) [Lp(a)] and ischemic cardiopathy: correlation between radial immunodiffusion (RID) and radioimmunoassay methods (RIA)]. / Lipoprotéine (a) [Lp(a)] et cardiopathie ischémique: corrélation entre les méthodes d'immunodiffusion radiale (RID) et d'immunoradioactivité (RIA).

The anomalous lipemic values are considered as a risk factor in coronarial pathology. We are separately studying different lipemic factors, Lp(a) in the present paper. May be our 38 clinical cases are still a too small number to demonstrate any correlation between Lp(a) haematic content and arterial pathology, and we will continue this study in the evolution of the pathology, eventually until the infarctus. For the moment, we established the significance of correlation between two methods in two laboratories of ours (in Pavia, Italy, and in Lisboa, Portugal). Correlation is more than 0.9. Assays were done on the same air mailed samples.

Angiosarcoma of the heart: report of a case in a 9-year-old boy.

A 9-year-old boy with a myocardiac angiosarcoma is described; the tumor was diagnosed by echocardiography and the boy underwent surgery followed by radio and chemotherapy. Death occurred 5 months after surgery, probably due to abdominal hemorrhage from metastases. The young age of the patient, the acute and reversible hepatic damage, the use of echocardiography for diagnosis and the possible role of the extracorporeal circulation in determining the metastases are emphasized.

[Pharmacological tests in the polycardiography of valve defects]. / Le prove farmacologiche nella policardiografia dei vizi valvolari.

Pharmacological tests are often indispensable in non-invasive polycardiographic diagnosis. Their advantages include easy execution, repeatability, and the absence of significant side-effects. Amyl nitrate, angiotensin and isoproterenol are most commonly employed for this purpose. Cases in which such tests enabled a correct evaluation of valve disease, congenital heart disease, and malfunction of a valve prosthesis to be made are presented.

[Genesis of 5th sound. A comparative phonomechanographic and echographic study (author's transl)]. / Genesi del quinto tono. Studio comparato fonomeccanografico ed ecocardiografico.

846 children between the ages of 6 and 12 were examined by phonocardiogram. The 5th sound was noted in 30.8% of the subjects examined. It appeared as a single or double vibration of approximately 65 msec from the third sound and corresponds to a small wave "H" of apexcardiogram at approximately 50 msec from the end of "E" wave. From the comparative poligraphic and echocardiographic study, the 5th sound corresponds to one or more added waves (G and G1) between point F and point A of the echogram of the anterior mitral leaflet; they are in exact chronological correspondence with the "H" wave of the APG. The 5th sound is evident and also the added waves of the anterior mitral leaflet (G, g1) when the frequency of the heart is slow. When the frequency increase, the 5th sound blends with the 3rd that appears prolonged and G, G1 waves become a single wave until its disappearents.

[Phonomechanocardiographic diagnosis of the apparently "silent" mitral valve prolapse syndrome (author's transl)]. / La diagnosi fonomeccanocardiografica della sindrome apparentemente "silente" del prolasso della mitrale

Five cases with angiocardiographically diagnosed posterior mitral valve prolapse and without ausculatotory findings of midsystolic click or late systolic murmur were studied with phonocardiographic technique employing pharmacological tests and postural changes. A midsystolic click was thus obtained. Isoprenaline was the must helpful drug to achieve it. The accompanying electrocardiographic and coronarographic features of this syndrome are described and discussed.