Role of telecardiology in the assessment of angina in patients with recent acute coronary syndrome.

We compared two models of assistance (telecardiology versus usual care) for patients discharged after acute coronary syndrome (ACS), in the assessment of angina. Two hundred patients were randomized into two groups at discharge for ACS: Group A to telecardiology and Group B to usual care. Early hospital readmission (in the first month) occurred in 16 patients (seven in Group A and nine in Group B). Six of Group A were readmitted for a cardiac cause (non-cardiac in one). Angina was the only cardiac cause. Five of the Group B patients were readmitted for a cardiac cause (non-cardiac in four). The results of the present study emphasize that patients with ACS suffer from a definite rate of cardiac symptoms within the first month (63%). Angina occurs more frequently within the first two weeks (68% of cases). Telecardiology slightly reduces hospital readmissions (telecardiology 44% versus usual care 56%), but better identifies true angina.

Diagnostic and prognostic value of dipyridamole and dobutamine stress echocardiography in patients with Q-wave acute myocardial infarction.

The aim of this study was to compare dipyridamole and dobutamine stress echocardiography, performed early in patients with acute myocardial infarction (AMI) to evaluate residual ischemia, viability, and prognosis. Fifty patients (mean age 55 +/- 9 years, 47 men, 3 women) with AMI, all treated with thrombolytic therapy, underwent standard dipyridamole and dobutamine tests, within the fifth day of the event. Wall motion score index and the 16 segments model were used to evaluate contractility. Forty-seven patients underwent coronary angiography within the tenth day of the event. The mean follow-up was 24 +/- 12 months. No side effects occurred during both tests. Both dipyridamole and dobutamine tests were positive for ischemia, in 32 and 33 of 47 patients, respectively (sensitivity 73% and 75%; specificity 67% and 67%); these tests induced an improvement of contractility in 23 and 38 of 139 abnormal segments at baseline, respectively (sensitivity 52% and 86%; specificity 100% and 100%). Cardiac events occurred in 26 of 50 patients, 22 with a positive dipyridamole test and 21 with positive dobutamine test. Thus, both tests were feasible, safe, and useful to evaluate residual ischemia, viability, and prognosis. No significant differences were found in sensitivity and specificity between tests.

Attitudes and clinical practice of Italian gynecologists towards prophylactic oophorectomy during hysterectomy for benign conditions.

OBJECTIVES: To evaluate the attitudes of Italian gynecologists towards prophylactic oophorectomy in women who underwent hysterectomy for benign conditions. METHODS: A postal questionnaire was sent to 490 physicians in charge in 42 obstetric and gynecologic centres affiliated to the Association of Italian Obstetrics and Gynecologists. RESULTS: About 80% of gynecologists perform prophylactic oophorectomy for women aged more than 50, but this percentage decreases to 50% for patients aged 45-50. Most gynecologists avoid prophylactic oophorectomy in women aged less than 40. CONCLUSIONS: This study confirms the wide variability in attitudes of gynecologists towards prophylactic oophorectomy in women aged 40-50 who undergo hysterectomy for benign conditions.

Nimesulide in the treatment of pelvic inflammatory diseases. A multicentre clinical trial conducted in Campania and Sicily.

400 patients aged 18 to 71 years took part in a multicentre noncomparative study designed to assess the clinical efficacy and tolerability of nimesulide in gynaecological inflammatory disease: adnexitis (72 patients), cervicitis (78 patients), endometritis (18 patients), myometritis (22 patients), and combined disorders (210 patients). All patients were treated with nimesulide 100mg twice daily in granular form for an average of 19.5 days. The treatment produced good results in all types of diseases considered, with a significant decrease in severity of symptoms being observed. The drug was well tolerated.

[Sequential approach to the diagnosis of ischemic cardiopathy]. / Approccio sequenziale alla diagnosi della cardiopatia ischemica.

The detection and the assessment of ischaemic heart disease require the utilization of several diagnostic techniques and skills; non-invasive tools, like echo-doppler cardiography and nuclear cardiology, are gaining more and more importance. This paper describes a sequential approach to the diagnosis of several manifestations of ischaemic heart disease--angina, unstable angina, post-infarction angina, pump failure, arrhythmias--, purposing a sequence of tests for each manifestation, starting from the simplest techniques to end with more complex investigations. Indications to coronary angiography and to medical or surgical therapy are also discussed.

[Multicenter study in the Campania region on the clinical effectiveness and tolerance of nimesulide in gynecologic inflammatory diseases]. / Studio policentrico della Regione Campania sull'efficacia clinica e la tollerabilità della nimesulide nelle affezioni flogistiche ginecologiche.

Two-hundred and twenty patients, aged between 18 and 71 years, participated in a multicenter study in order to assay the efficacy and tolerability of nimesulide in gynecological inflammatory diseases. Forty and two patients were affected by adnexitis, 37 by cervicitis, 12 by endometritis, 9 by myometritis and 120 patients presented more pathologies associated. All the patients were treated with nimesulide 100 mg granular (sachets) b.i.d. for a mean period of 19.5 days. The treatment with nimesulide produced good results in all pathologies, significantly reducing the intensity of symptomatology. The tolerability of the drug resulted to be good.

Diagnostic and therapeutic approach to minimal breast cancer.

The term "Minimal Breast Cancer" includes different neoplastic changes, the common characteristic of which is an high survival rate (90% of cases) when the treatment is early started. In all patients with palpable nodules and in patients "at risk", thermography, mammography, xerography, echography and cytological examination by suction-needle, must be performed to rule out the existence of a "Minimal Breast Cancer". The methods of treatment preferred by the Authors, according to the different types of pathological changes, are the following: a) through follow-up or, alternatively, subcutaneous mastectomy when a "lobular carcinoma in situ"; b) subcutaneous mastectomy and axillary emptying when the diagnosis is found in "intraductal carcinoma"; c) mastectomy, performed according to Patey's technique, or removal of all the involved breast quadrant, axillary emptying and radiotherapy of the residual glandular parenchyma in case of ductal carcinoma or invasive lobular carcinoma less than 0.5 cm in diameter.