FLT3-targeted therapy restores GATA1 pathway function in NPM1/FLT3-ITD mutated acute myeloid leukaemia.

One-third of newly diagnosed adult acute myeloid leukaemia (AML) carry FLT3 mutations, which frequently occur together with nucleophosmin (NPM1) mutations and are associated with worse prognosis. FLT3 inhibitors are widely used in clinics with limitations due to drug resistance. AML cells carrying FLT3 mutations in both mouse models and patients present low expression of GATA1, a gene involved in haematopoietic changes preceding AML. Here, we show that FLT3 inhibition induces cellular responses and restores the GATA1 pathway and functions in NPM1/FLT3-ITD mutated AML, thus providing a new mechanism of action for this drug.

OCT-guided photodynamic therapy for angiographic occult CNV in pathologic myopia.

PURPOSE: Pathologic myopia (PM) is frequently complicated by choroidal neovascularization (CNV). Diagnosis is mainly clinical and angiographic but in recent years optical coherence tomography (OCT) has been noted to add important information. The authors report on the successfully OCT-guided photodynamic therapy (PDT) of an angiographic occult CNV complicating PM. METHODS: Observational case report. Fluorescein angiography with a confocal SLO (HRA, Heidelberg Engineering, Germany) and OCT Stratus (Carl Zeiss Meditec, Inc.) imaging were used for diagnosis and monitoring of the CNV. Standard PDT was performed. RESULTS: A highly myopic 17-year-old girl complained of a drop in visual acuity (VA) in left eye (LE), dating back a few weeks. Her best-corrected (BC) VA was 20/40 in the LE, with some metamorphopsia. No hemorrhage or evident signs of CNV were visible either at fundus or at dynamic fluorescein angiography. OCT scans indicated a slight elevation of the RPE-choriocapillary complex with rarefaction of neuroretinal tissue that has been interpreted as CNV. PDT was then performed. LE BCVA had improved to 20/25, metamorphopsias disappeared, and at OCT examination no retinal morphologic modification was evident. Nine months later, BCVA and ophthalmoscopy are still stable. CONCLUSIONS: In this case, OCT was the fundamental tool for the correct diagnosis and posttherapymonitoring of CNV-complicated PM. The CNV, not clearly detectable using angiographic imaging, was treated with PDT, and results in terms of VA and anatomic resolution were good.

Atrial natriuretic factor and mitral valve prolapse syndrome.

Mitral valve prolapse (MVP), is the most frequent valvulopathy, although it is difficult to evaluate its incidence since this pathology is often asymptomatic. However, in some patients a rich variety of symptoms such as chest pain, dyspnea, palpitations, syncope, dizziness, panic attacks and autonomic dysfunctions have been found. The pathogenesis of these symptoms, incompletely understood, appears to be multifactorial, related to altered autonomic function, adrenergic responsiveness and to combinations of these factors. In patients with MVP a variety of neuroendocrine anomalies has been found: high epinephrine and norepinephrine plasma levels, altered rennin-angiotensin-aldosteron (RAA) response to volume depletion and orthostatic stimulation, and high plasma levels of atrial natriuretic factor (ANF) especially in hypovolaemic individuals. The role of ANF could be important in the genesis of MVP syndrome, it could contribute to determine: the imbalance between the sympathetic and parasympathetic system, the altered RAA response to orthostatic stimulus, the volemic and venous flow reductions (with a direct action, other than diuretic and natriuretic action). Factors that can determine ANF secretion abnormality in MVP could be: 1) Mitral regurgitation; 2) increased heart rate and the high incidence, in MVP syndrome, of arrhythmias; 3) central nervous system neuroendocrine imbalance; 4) increased catecholamines secretion.

[TNF alpha and heart failure]. / TNF alpha e scompenso cardiaco.

Tumor necrosis factor alpha (TNF alpha) is a cytokine with proinflammatory properties which produces negative inotropic effects on the heart. It is produced in a variety of conditions such as septic shock, acute myocarditis, reperfusion injury, and congestive hear failure (CHF). This production is probably due to activation of immune elements localized in the heart or periphery, or both. TNF alpha acts by binding to two specific receptors: TNF-R1 and TNF-R2. These two proteins have different effects. TNF-R1 has cytotoxic and antiviral activity, induces fibroblast proliferation, and mediates apoptosis. TNF-R2 is involved in septic shock and in lymphocyte proliferation. They both have negative inotropic effect on the heart. It has been showed that these receptors are down-regulated in congestive heart failure, while their soluble forms (sTNF-R1 and sTNF-R2) increase with the severity of symptoms. However the significance of this increase is still unclear. The role of Fas, a receptor protein that induces apoptosis, is also examined. Fas and its ligand have homologies respectively with TNF alpha and TNF-R. Also the soluble form of Fas (sFas) increases in relation to heart failure and is related to soluble forms of the similar receptor family, therefore it is possible that the same stimuli lead the three receptors to act together. SFas, as well as sTNF receptors, may play an important role in CHF.

Electrophysiologic significance of leftward QRS axis deviation in bifascicular and trifascicular blocks.

BACKGROUND: Intraventricular conduction disturbances determine complete impairment of impulse propagation along the right or left bundle branch or the two left fascicles. HYPOTHESIS: This study was undertaken to investigate the electrophysiologic significance of QRS axis (QRSA) orientation in bifascicular and trifascicular blocks. METHODS: A group of 76 subjects, 43 with right bundle-branch block (RBBB) and left anterior hemiblock (LAH) (Group A), and 33 with left bundle-branch block (LBBB) (Group B), was submitted to electrophysiologic evaluation. RESULTS: In Group A, QRSA was inversely related only to intraventricular conduction, while in Group B, QRSA inversely related to infrahisal conduction times. A value of < -60 degrees was considered the cut-off point for determining subjects with a considerable leftward QRSA deviation. Of the 27 Group A patients with a QRSA < -60 degrees, 38.5% developed an infrahisal second-degree atrioventricular (AV) block during incremental atrial stimulation (IAS) in comparison with 11.1% of those with QRSA > -60 degrees. Of the 9 Group B patients with a QRSA < -60 degrees, 44.4% exhibited severe impairment of infrahisal conduction at baseline and 66.6% developed an infrahisal second-degree AV block during IAS, whereas among the remaining 24 with a QRSA > -60 degrees, in only 8.3% were both infrahisal (HV1 and HV2) intervals dangerously prolonged, and 23.8% encountered an infrahisal second-degree AV block during IAS. In Group A, atrioventricular conduction time > 200 ms exhibited a better predictive accuracy than QRSA < -60 degrees for the development of an infrahisal second-degree AV block during IAS, whereas the latter appeared the best noninvasive predictor in Group B with a slightly lesser predictive accuracy than HV > 80 ms. CONCLUSION: The degree of leftward QRSA deviation seems to reflect the entity of intraventricular conduction delay in patients with RBBB + LAH, while it appears to be directly related to infrahisal conduction prolongation in those with LBBB.

A motorized hand piece for injectable lenses.

Foldable lenses represent a major breakthrough in the effort to achieve ever smaller incisions. The plate-haptic or "taco-style" lenses are folded and implanted by a device called an injector. Although customized for each manufacturer's lens, the injectors all have a common design principle: the intraocular lens (IOL) is folded within a funnel-like structure of the tip and is advanced by a plunger that pushes and delivers the lens. To maintain optimal hand stabilization and injector management, both hands are usually required. This does not leave a hand to help with IOL positioning. To improve handling, a simple, mechanized system has been created for a new injector system that allows the delivery of the plate-haptic lens with one hand, in a pen-like fashion.

[Electrophysiological analysis of atrioventricular and intraventricular conduction in bi- and tri-fascicular blocks]. / Analisi elettrofisiologica della conduzione atrioventricolare ed intraventricolare nei blocchi bi- e tri fascicolari.

We have evaluated, at baseline and during incremental atrial pacing (AP), intracardiac conduction features of 53 patients with electrocardiographic diagnosis of bifascicular or trifascicular block, free from any pharmacological treatment potentially able to affect atrioventricular (AV) conduction system properties. The patients have been subdivided in the following groups: group A (13 patients), with LBBB and a PQ interval > or = 200 msec; group B (14 patients), with RBBB, LAH with a PQ interval > or = 200 msec; group C (8 patients), with LBBB and a PQ < 200 msec; group D (15 patients), with RBBB, LAH and a PQ < 200 msec; group E (3 patients), with RBBB, LPH and a PQ < 200 msec. In group A, 31% presented a long AH interval (> 140 msec), while 85% showed an increased infra-his conduction time (HV > 55 msec). During AP, only 38.5% maintained a 1:1 AV conduction ratio up to 140 bpm, while 30.8% developed an infra-his Mobitz 2 2nd degree AV block. 15.4% an infrahis 2:1 2nd degree AV block, 15.4% an AV nodal Mobitz 2 2nd degree AV block. In group B, 64% and 29% exhibited respectively an AV nodal and an infrahis conduction delay. During AP, 57.1% maintained a 1:1 AV conduction ratio up to 140 bpm, 14.3% developed an AV nodal Mobitz 1 2nd degree AV block, 14.3% an infrahis Mobitz 1 2nd degree AV block, 7.1% an AV nodal 2:1 2nd degree AV block, 7.1% an infrahis Mobitz 2 2nd degree AV block. In group C, no patient manifested a prolonged AH interval, while 50% exhibited a HV > 55 msec. 62.5% maintained a 1:1 AV conduction ratio up to 140 bpm, 25% developed an AV nodal Mobitz 1 2nd degree AV block and 12.5% an infrahis 2:1 2nd degree AV block. In group D, no patient showed an increased AH interval and only 13% presented a HV interval exceeding 55 msec. During AP, 86.7% maintained a 1:1 AV conduction ratio up to 140 bpm, 6.6% developed an AV nodal Mobitz 1 2nd degree AV block, 6.6% an infrahis 2:1 2nd degree AV block. In group E, no patient showed a prolonged AH interval, while 2/3 (66.6%) exhibited an infrahis conduction delay. During AP, 100% developed an infrahis 2:1 2nd degree AV block. Considering all patients with LBBB (groups A+C) and with RBBB+LAH (groups B+D), no differences were found in terms of PQ, PA and AH intervals, even though, concerning patients with a long PQ (group A vs group B), AH interval resulted significantly longer in patients with RBBB+LAH (121.85 +/- 36.4 msec vs 163.29 +/- 55.96 msec, p = 0.031). Infrahis conduction, independently from the measurement adopted (HVI interval: from the beginning of the His to the onset of the ventricular electrogram recorded at the His region; HV2 interval: from the beginning of the His to the onset of the surface QRS), resulted more compromised in patients with LBBB than in patients with RBBB+LAH (HVI: 75.24 +/- 40.23 msec vs 50.79 +/- 25.16 msec, p = 0.011; HV2: 77.24 +/- 38.12 msec vs 53.92 +/- 29.3 msec, p = 0.015). Such a difference became even more significant when comparing the percentage of patients with a prolonged HV interval (average value > 55 msec) in the above mentioned groups: 71.4% in case of LBBB, 20.7% in case of RBBB+LAH (p < 0.001). Regarding intraventricular conduction (IV), no statistically significant differences were found. In patients with RBBB+LAH, IV was not related to infrahis conduction time and PQ interval appeared more related to AH (r = 0.838, p < 0.001) than to HV (PQ-HV1: r = 0.381, p = 0.041, PQ-HV2: r = 0.474, p = 0.009). Conversely, in patients with LBBB infrahis and IV conduction appeared linearly related (HVI-V: r = 0.416, p = 0.06; HV2-V: r = 0.445, p = 0.043). As for PQ interval, it resulted more closely related to infrahis conduction (PQ-HVI: r = 0.626, p = 0.002; PQ-HV2: r = 0.674, p < 0.001), than to AH (r = 0.533, p = 0.013). In conclusion, infrahis conduction resulted more impaired in patients with LBBB. In this group, differently from patients with RBBB+LAH, infrahis conduction seems to affect the degree of IV conduction delay. (ABST

[Sotalol, propafenone, and flecainide: compared multiparametric analysis of ventricular repolarization in subjects without organic cardiopathy]. / Sotalolo, propafenone e flecainide: analisi comparata multiparametrica della ripolarizzazione ventricolare in soggetti esenti da cardiopatie organiche.

Antiarrhythmic drugs are known to affect depolarization and repolarization time in a different fashion. The aim of the present study was to compare the effects of sotalol, flecainide and propafenone on some common (mean QT and QTc, mean JT and JTc), or uncommon (QTc dispersion, T-peak to T-end interval-Tp-Te) electrocardiographic parameters in order to evaluate the effects of these antiarrhythmic drugs on repolarization time. QTc dispersion, defined as the difference between maximum and minimum QTc calculated from the standard 12 ECG leads, and the average Tp-Te interval, reflect regional variation in ventricular repolarization. We have analyzed retrospectively the standard 12-lead electrocardiograms of 28 patients (15 females and 13 males, age 36.11 +/- 16 years, range 11-67 years), recorded in the free-drug state and at the steady state after oral treatment with sotalol (160 mg/ die), flecainide (200 mg/die) and propafenone (450 mg/die). These drugs were prescribed, separately, for the treatment of patients with supraventricular tachycardia without underlying structural heart disease. Sotalol treatment prolongs ventricular repolarization times (QT, p = 0.0001; JT, p = 0.0001 and JTc, p = 0.0001) in an homogeneous fashion, as showed by the significant decrease in QTc dispersion (p = 0.026) and Tp-Te interval (p = 0.011). On the contrary, flecainide treatment is associated with an increase in QTc dispersion (p = 0.039) and Tp-Te interval (p = 0.0001), mean QT (p = 0.0001), QTc (p = 0.0001) and QRS (p = 0.0001), with no significant changes in JT and JTc (NS). Propafenone treatment does not affect repolarization time indexes, affecting only depolarization time as expressed by an increase in QRS (p = 0.046).

[Evolution of pacing modes in patients with implanted pacemakers. Personal considerations on a case load of 171 patients]. / Evoluzione della modalità di stimolazione nei pazienti portatori di pace-maker. Considerazioni personali su una casistica di 171 casi.

In this study retrospectively analyse pacemaker-implantation activity carried out during the last 5 years at the Laboratory of Electrophysiology, affiliated with the Cattedra di Cardiologia of the University of Naples--II Ateneo. Evolution in pacing modes is considered with regard to the patient age, the underlying pathologies and the technical progress in the field. The study has been performed in our laboratory, which is fit up for electrophysiologic studies and implantation of either temporary or permanent pacemakers. Patients included in this study have been implanted in our laboratory either for urgency or for election. They have been retrospectively divided into two groups (age < 65 yrs, 129 patients, and age < 65 yrs, 42 patients); in addition the patients have been classified according to the pathology leading to the implantation: atrio-ventricular block (second degree or third degree), low frequency fibrillation, sick sinus syndrome and carotid sinus syndrome. 171 patients have been examined, of whom 129 > 65 yrs. and 42 < 65 yrs. As for the pacing indication, 54 were atrio-ventricular block (56.1%), 50 were sick sinus syndrome (31.6%), 20 low frequency fibrillation (11.7%), and 1 was carotid sinus syndrome (0.6%). The ratio between single- and dual-chamber pacemakers has been progressively changing: in 1987 we implanted 33 single-chamber and no dual-chamber pacemaker, compared to 7 single- and 23 dual-chamber pacemaker implanted in the last year. This trend is in good agreement with literature data.

[ST elevation during ergometric test: correlation with coronary angiography]. / Sopraslivellamento del tratto ST durante test ergometrico: correlazione con l'angiografia coronarica.

BACKGROUND: ST elevation during ergometric stress test (EST) is relatively rare. Its prevalence depends upon the tested population but occurs more frequently in patients who have had myocardial infarction or variant angina. This phenomenon is very rare in patients with typical exertional angina and its pathogenesis is still unclear. MATERIAL AND METHODS: We studied a group of 75 consecutive patients with exertional angina who underwent EST and coronary angiography. A symptom limited EST was performed in the upright position on a cycloergometer with load increases of 25 watts every 3 minutes and 12 leads were monitored during all test. Coronary angiography was performed according to Judkins technique. From these patients, according to Froelicher's criteria, a group of 49 patients (age 32-68, mean 51.6 years), without myocardial infarction and/or left ventricular asynergy, was selected. RESULTS: All patients had a coronary artery disease (16 patients with 3 vessels, 11 patients with 2 vessels and 22 patients with 1 vessel disease). The EST was positive for ST depression in 31 patients (63.3%) and for ST elevation in 5 patients (10.1%), while 13 patients (26.6%) had a non diagnostic EST. The ST elevation occurs in V1-V2 and it was associated in all cases with a stenosis in the left anterior descending (LAD) artery. Therefore we divided the 19 patients with LAD stenosis into two subgroups: subgroups A (9 patients, mean age 49.6 years) with LAD stenosis > or = 90% and subgroups B with LAD stenosis between 70% and 90%. ST elevation occurs in 5 patients (55.5%) of subgroup A and in no patient of the subgroup B. Moreover, in the subgroup A ST elevation seems to be related to the anatomic localization of the stenosis: in fact it appears in 83.3% of patients with LAD stenosis located before the onset of the first diagonal branch. CONCLUSIONS: From these data it can be desumed that ST elevation in V1-V2 that occurs in patients with exertional angina and without myocardial infarction or variant angina is strongly predictive of a very important LAD stenosis.

Excimer laser photorefractive keratectomy for myopia: results in 1165 eyes. Italian Study Group.

BACKGROUND: We report the results of a prospective study conducted in Italy to evaluate the efficacy, safety, predictability, and complications of excimer laser photorefractive keratectomy for the correction of myopia. METHODS. Photorefractive keratectomy was performed on 1236 myopic sighted eyes in 16 centers, using the Summit Excimed 193 nm excimer laser. The attempted correction ranged from -0.80 to -25.00 diopters (mean, -7.83 +/- 3.88 D). The population was divided into three groups of attempted correction: between -0.80 and -6.00 D, between -6.10 and -9.90 D, and between -10.00 and -25.00 D. We report the data of 1165 eyes at 1 month, 970 eyes at 3 months, 752 at 6 months, and 330 at 12 months. At each visit, we evaluated (1) the refractive changes over time; (2) the difference between attempted and achieved correction; (3) uncorrected and best spectacle corrected visual acuity; and (4) haze. RESULTS: Twelve months after surgery, the spherical equivalent refractive error in 146 eyes with attempted correction of -0.80 to -6.00 D was -0.52 +/- 1.04 D; 104 eyes (71.2%) were within +/- 1.00 D of attempted correction. In 145 eyes with attempted correction of -6.10 to -9.90 D, the spherical equivalent refractive error was -1.66 +/- 1.88 D; 50 eyes (34.5%) were within +/- 1.00 D of attempted correction. The spherical equivalent refractive error in 39 eyes with attempted correction of -10.00 to -25.00 D was -1.86 +/- 3.47 D; 11 eyes (28.2%) were within +/- 1.00 D of attempted correction. Eight eyes (2.4%) lost two or more Snellen lines of best spectacle corrected visual acuity. None of the treatments caused severe postoperative complications, or scarring. CONCLUSIONS: Photorefractive keratectomy proved safe and effective, but highly predictable only in the correction of myopia up to -6.00 D.

The erodible mask in photorefractive keratectomy for myopia and astigmatism.

This paper reports a new approach for performing photorefractive keratectomy (PRK) that uses an erodible mask to control shape transfer processes. The advantages of this technique, when compared to conventional PRK performed with mechanical diaphragm, are 1) the possibility of transferring almost any shape onto corneal surface; 2) a smoother corneal surface following photoablation; 3) easier eye fixation; and 4) a controlled humidified environment over ablation zone. We report our experimental study on scanning electron microscopy of polymethylmethacrylate (PMMA) plates ablated using conventional technique versus erodible mask technique; the results showed a smoother surface in the PMMA plate ablated using the erodible mask. We also report our preliminary clinical results of four eyes treated for the correction of myopia combined with astigmatism. Myopia ranged from -2.00 to -10.00 D, and astigmatism ranged from -1.50 to -2.50 D. Three months after surgery, all four eyes were within +/- 1.00 D of myopic attempted correction, but astigmatism was completely corrected only in one eye. No complications or scarring have been reported. We believe the erodible mask could be effective in the correction of myopia and myopic astigmatism, but further improvements are necessary to allow easier alignment of the mask over the eye. All commonly available excimer laser devices produce photorefractive keratectomy as a concentric ablation of the corneal stroma, deeper in the center than in the peripheral part; this is produced by means of an iris or diaphragm which, depending on the type of laser, progressively opens or closes, allowing a greater laser beam delivery in the center.(ABSTRACT TRUNCATED AT 250 WORDS)

Randomized study of single vs double exposure in myopic PRK.

Multizone PRK has been suggested to increase the predictability of higher myopic corrections. The technique consists of dividing the intended correction between two or three different concentric ablation zones, achieving less depth and a smoother ablation profile. We randomized 24 eyes with refractions between -6.00 and -9.00 D for single or double ablation-zone PRK. At 1 year no significant difference in refraction and complications were found between the two treatments. The multizone PRK technique may be safely employed to reduce the maximum central depth of the keratectomy in high myopics.

Efficacy of corticosteroids in reversing regression after myopic photorefractive keratectomy.

Topical corticosteroids are given commonly after photorefractive keratectomy (PRK). We present six eyes treated for correction of myopia ranging between -6.00 and -8.00 D, to whom corticosteroid drops were given and then suspended. Each eye had an increase in myopia with a mean of 2.00 D (range 1.00 to 3.50 D). All were then treated with topical dexamethasone (0.1%) four times per day for at least 15 days, and all showed decreases in myopia with partial or complete recovery of the intended correction (mean: 1.625 D; range 1.00 to 3.50 D). All of these refractive variations were documented by corneal topography. In one eye, refractive and topographic variations were detected by 3 days after corticosteroid treatment was initiated and they increased for 15 days. We believe corticosteroids can modulate refractive changes after PRK.

Bifocal versus monofocal intraocular lenses in bilateral pseudophakia.

After a mean follow up of 19 months, the visual characteristics of eyes with bifocal diffractive intraocular lenses (IOLs) ("bifocals") in one eye were compared with those of fellow eyes with monofocal IOLs ("monofocals") in 29 bilateral pseudophakic patients. All of the eyes had a distance-corrected acuity of 0.6 or more, but 24.1% of the bifocals and 48.3% of the monofocals had an acuity of 1.00. Near acuity with distance correction was J2 or more in 93.1% of the bifocals and in 17.4% of the monofocals (without correction: 79.3% and 41.4%, respectively). In 55.2% of the bifocals and 20.7% of the monofocals, the combined uncorrected acuity was 0.5 or more for distance and J2 or more for near. Fogging revealed a similar depth of focus in the monofocals and a similar distance focus in the bifocals. The bifocals had two peaks of acuity but no "plateau" between them. The eye with the monofocal IOL was preferred by 37.9% and the eye with the bifocal IOL by 10.3%. Vision in no eye was rated "poor." Visual disturbances were more frequent in the bifocals. No glasses were prescribed for 20.7% of all of these patients; 65.5% required bifocal glasses; 44.8% managed most of daytime without glasses.

Excimer laser ablation of a corneal protuberance.

The ablation of a post-traumatic superficial corneal nodule with an argon fluoride excimer laser is reported. Three months postoperatively the area had a smooth surface with no distortion of adjacent cornea.

Unilateral proliferative diabetic retinopathy and uveitis in the fellow eye: report of a case.

We report the case of a young man with a 20-year history of insulin-dependent diabetes mellitus, proliferative diabetic retinopathy OD, and uveitis OS. None of the common reported causes contributing to this difference between eyes was present. No features of diabetic retinopathy appeared OS after a follow-up of 36 months. This is the first case, to our knowledge, in which uveitis appeared to be associated with an asymmetric presentation in diabetes.

[EGG and arrhythmia in subjects with implanted dual-chamber VDD and DDD pacemakers]. / ECG e aritmie in soggetti portatori di stimolatori bicamerali VDD e DDD.

The ECGs of four patients with implanted dual chamber VDD and DDD PMKs are shown to demonstrate the difficulty of their interpretation and show some arrhythmias related to dual chamber pacing. In the first patient the DDD PMK caused a high ventricular frequency synchronizing on the atrial fibrillation "f" waves which occurred suddenly some time after PMK implantation; this problem was solved by programming the PMK in VVI. The second and third case, with implanted DDD and VDD PMK respectively, exemplify atrial sensing dysfunction due to atrial catheter displacement. In the fourth patient, with implanted VDD PMK, VDD stimulation periods and VVI ones alternated due to non-adjusted programming. Therefore, the paper re-emphasizes the need for accurate and periodic controls of patients with implanted PMK to correct dysfunction or undesirable patterns of stimulation.

Thalamic hemorrhage imitating hyperventilation.

A 52-year-old woman developed subjective right hemiparesthesias over a two-day period. Because of a paucity of physical findings, apparent anxiety with tachypnea, and a respiratory alkalosis with hypocapnia, a diagnosis of hyperventilation syndrome was considered. However, because of the unilateral symptoms, a computed tomography scan was performed, demonstrating a left posterior thalamic infarct. Most reports of thalamic infarct indicate altered mental status, vertical gaze palsies, or sensorimotor hemiparesis with sensory involvement predominant. The case of a patient with thalamic hemorrhage who presented with only hemiparesthesia is reported to heighten clinicians' awareness of this diagnosis.

[The diagnosis of the cardiologic risk in patients destined for lung removal surgery]. / Diagnosi del rischio cardiologico in pazienti destinati a chirurgia di exeresi polmonare.

The expanding role of pulmonary surgery could be expected to lead to an increase in postoperative morbidity and mortality unless surgical risk factors are identified by means of a careful preoperative assessment. A careful and intelligent preoperative evaluation can reduce the morbidity and mortality after lung resection by ensuring the appropriate selection of patients and a rational choice of operative procedure. To evaluate the cardiologic risk in patients undergoing lung resection, 18 of them underwent a diagnostic protocol based on non invasive analysis including ECG, stress test with basal and exercise blood gas analysis, M- and B-mode and Doppler echocardiography. This protocol was able to identify possible cardiologic risk in the perioperative period without applying invasive techniques and with a good cost-benefits ratio.