C-reactive protein and coronary composition in patients with percutaneous revascularization.

BACKGROUND: C-Reactive Protein (CRP) is considered a predictive factor for cardiovascular events and its serum levels have been shown to correlate with thin cap coronary plaques in sudden coronary death. Whether serum CRP levels are associated with in vivo atherothrombotic features is unclear. We thus analysed samples from coronary atherectomy specimens obtained during percutaneous coronary intervention. MATERIALS AND METHODS: Patients with coronary artery disease undergoing directional atherectomy, distinguished by unstable versus stable coronary syndrome diagnosis, provided coronary specimens from culprit lesions. Assessment was conducted by means of conventional histology, morphometry and immunohistochemistry. Specific antibodies against erythrocyte-specific protein glycophorin A, endothelial and macrophage antigens were also used. RESULTS: There were 51 patients with unstable coronary disease and 47 patients with stable angina. Serum CRP levels >/= 1 mg L(-1) were detected in 24/98 patients, and were significantly associated with hypercellularity, macrophage infiltrates, neoangiogenesis and intraplaque haemorrhage (all P < 0.05). Furthermore, coronary plaques from patients with unstable angina contained larger atheromas, more hypercellular plaques, with abundant macrophages, neoangiogenesis and intraplaque haemorrhages and lesser fibrous tissue (all P < 0.05). CONCLUSIONS: We observed a positive correlation between increased serum CRP levels and typical pathological features of complex atherothrombotic coronary disease, confirming in vivo the mechanistic role of CRP in coronary atherothrombosis.

[The superior vena cava obstruction syndrome after the implantation of a permanent pacemaker: a clinical case report]. / Sindrome da ostruzione della vena cava superiore dopo impianto di pacemaker permanente: descrizione di un caso clinico.

Occlusion of the superior vena cava is a rare but serious complication of transvenous endocardial pacing. We describe 1 case of superior vena cava obstruction associated with permanent transvenous DDD pacemaker, following local infection. Thrombolytic therapy was initially effective, resulting in relief of signs of obstruction. However systemic infection occurred 3 months later. The patient was subsequently submitted to surgical removal of the infected pacemaker apparatus. Several therapeutical options described in previous papers are reviewed: anticoagulants, thrombolytics, percutaneous dilatation, surgical removal of the catheter. In conclusion, when a chronic process induced by local infection is present, surgical treatment is the best therapeutical approach.

[Prehospital management of acute myocardial infarct in an experimental metropolitan system of medical emergencies]. / Gestione preospedaliera dell'infarto miocardico acuto nell'ambito di un sistema di emergenza medica metropolitano sperimentale.

BACKGROUND: Feasibility, safety and efficacy of prehospital management of acute myocardial infarction (AMI) and prehospital thrombolysis have been widely demonstrated. On this background, in March 1992 we started up an Emergency Medical Service (EMS)--Servizio per le Emergenze Cardiologiche Territoriali, SECT--aimed to prehospital care of overall cardiac emergencies (CE), including AMI. The Service, operating in the metropolitan area of Turin (130 Km2, 964,000 inhabitants), is based on a properly equipped ambulance, manned with a physician and a nurse, skilled in treatment of CE. METHODS: From March 1992 to December 1994, 5000 missions were performed, 2586 (51.7%) for chest pain, 1383 (53.5%) of presumed cardiac origin. Within the latter group, 426 (30.8%) cases of AMI, 109 (7.9%) cases of suspected AMI and 848 (61.3%) cases of angina were identified and treated. Decision time in AMI patients (pts) was 189.4 +/- 289.5 min (median 73), longer in pts over 70 years and in women. By means of a direct phone line between Emergency Communication System and metropolitan Coronary Care Units (CCU), 303/423 (71.6%) AMI pts, were directly admitted to CCU. Prehospital thrombolysis (PT) was performed in 211/426 pts (49.5%), with delay from symptom onset of 126.8 +/- 106.1 min (median 93). A rtPA "front loaded" regimen was used, with a full heparin and ASA as adjunctive therapy. Exclusion criteria for PT in 215 pts were: age > 75 years in 109 pts (50.7%), delay from symptom onset > 6 hrs in 55 (25.6%), ST depression in 33 (15.3%), contraindications to thrombolysis in 18 (8.4%). Eligibility to PT was 8.1% in chest pain pts and 43.5% in pts with AMI diagnosis at discharge. Another group of 38 pts underwent thrombolysis in hospital, after a review of inclusion criteria, with a longer delay of 231 +/- 184 min (median 150). RESULTS: Out-of-hospital diagnosis was confirmed in 91% of both AMI pts and PT pts, and in 56.7% of suspected AMI pts. Overall complication rate was 32.1%, with similar rates in PT treated pts and not PT treated pts. Prehospital mortality rate was 0.7%. In-hospital mortality rate was 5.2% in PT pts with confirmed AMI, and 16.2% in not PT pts with confirmed AMI. CONCLUSIONS: Our experience confirm efficacy of out-of-hospital management of AMI within an EMS designed to treat overall CE, considering successful treatment of complications and early thrombolysis with reduction of time delay. Inclusion of SECT in the growing up "118" Emergency Medical System raises logistic questions. Process will be completed when the "medical final authority" will submit each intervention to a full evaluation in terms of efficiency and efficacy, and will not only prepare, as now happens, dispatch and intervention protocols.

[The effects of growth hormone in children with a GH deficiency: a report of 5 cases]. / Effetti dell'ormone della crescita nei bambini con deficit di GH: presentazione di 5 casi.

The authors describe 5 cases, 3 boys and 2 girls, with idiopathic growth hormone deficiency in prepubertal age, treated with human growth hormone. In four of five cases the response to treatment with GH was relevant. Only in one case (F1) the response was negative. The results of this study confirm that rhGH is a safe and effective therapy in children with GHD.

[Out-of-hospital cardiac arrest in an experimental model of the management of cardiologic emergencies in a metropolitan area]. / L'arresto cardiaco extraospedaliero in un modello sperimentale di gestione delle emergenze cardiologiche in un'area metropolitana.

Since March 1992, an emergency medical system--EMS--(Servizio Emergenze Cardiologiche Territoriale, SECT) operates in the metropolitan area of Turin (130, 16 Km2), for a population of 964,000 inhabitants. SECT is based on a mobile intensive care unit, staffed with a physician and a nurse, trained in advanced cardiopulmonary resuscitation (CPR) and equipped to treat all cardiac emergencies. According to the "Utstein Style" we report the demographic and clinical features of the patients (pts) suffering Cardiac Arrest (CA) and the impact of SECT on out-of-hospital CA. During 26 months of activity, SECT performed 3,648 missions (most important among these: 457 acute myocardial infarction, 723 angina, 523 arrhythmias, 270 acute heart failure, 154 cardiac arrest), and managed 207 confirmed CA (154 calls for CA, 53 CA occurred after team arrival because of other symptoms). Resuscitation was attempted in 135 pts, in 72 pts medical personnel accerted an irreversible death state. 86% of CA occurred at home. In all cases a cardiac etiology was presumed. All CA were witnessed: 53 by EMS personnel, 82 by lay bystander. In 53 EMS witnessed CA, ventricular tachycardia (VT) or ventricular fibrillation (VF) was showed in 47.2%, asystole in 43.4%, other rhythms (Oth) in 9.4%. Return of spontaneous circulation (ROSC) was obtained in 52.8% pts, 76% in VT/VF Group. 43.4% were admitted alive to intensive care unit (ICU), 68% in VT/VF Group. 37.7% were discharged alive, 64% in VT/VF Group. In 82 lay witnessed CA initial rhythm was VT/VF in 31.7%, asystole in 59.7%, Oth. In 8.6%. CPR was attempted by lay bystander in 28% of cases. ROSC was obtained in 18.3%. CPR was attempted by lay bystander in 28% of cases. ROSC was obtained in 18.3% pts, 42.3% in VT/VF Group. 15.8% were admitted alive to ICU, 34.6% in VT/VF Group. 9.7% pts were discharged alive, 23% in VT/VF Group. Discharged alive rate in lay attempted CPR cases was 17.4%. The collapse-EMS CPR interval was 16 +/- 6.13 min (range 4-29), with a collapse-call receipt interval of 8.57 +/- 5.75 min (range 1-23) and a call receipt-EMS CPR interval of 8.06 +/- 3.56 min (range 2-19). The same intervals are significantly longer in not attempted CPR cases: respectively 26.53 +/- 10.73 min (range 10-65) -p < 0.001-, 19.29 +/- 11.3 min (range 5-60) -p < 0.001- and 8.26 +/- 3.96 (range 3-25) -p = NS-. Although far from the international effectiveness standards, SECT seemed to improve the out-of-hospital CA prognosis. High rate of CA occurred at home, time delay in early access link, better trend in survival in lay bystander attempted CPR cases and lack in early defibrillation lead to strategies for system improvement through targeted CPR training as well as semiautomatic external defibrillators introduction.

[Wiskott-Aldrich syndrome: description of a clinical case]. / Sindrome di Wiskott-Aldrich: descrizione di un caso clinico.

A case of Wiskott-Aldrich syndrome is reported. At 2 months of age the infant was hospitalized because of petechiae, and a low platelet count was noted (range 30.000/90.000/mmc). During his stay in the Hospital he developed pneumonia, which lasted several weeks in spite of therapy. Subsequently he presented eczema and a defect of cell-mediated immunity, and the Wiskott-Aldrich syndrome was diagnosed. A short review of clinical and functional findings in this syndrome is reported.

[Synpolydactyly: unusual features and variable expression in 5 generations of an Italian family]. / Sinpolidattilia: caratteri peculiari ed espressività variabile in cinque generazioni di una famiglia italiana.

The Authors report a family with synpolydactyly (or syndactyly type II) present in eleven out of thirty four members in five generations. Affected members do not show any other anomalies so that chromosomal or other genetic syndromes may be excluded. The possible mode of inheritance, the variability in expression, the penetrance in five generations are discussed. The peculiar bone deformities of hands and feet already reported by Cross et Al. are confirmed. The Authors presume that the present report is the first observation of synpolydactyly in an Italian family.

[Hyperthyroidism in childhood. Description of a case]. / L'ipertiroidismo nell'infanzia. Descrizione di un caso.

The authors report some personal clinical observations. The polymorphic clinical course, the diagnostic procedure and the therapeutical management of the infantile Grave's disease are discussed. Pathogenesis is not clarified. Genetic factors are also analysed.

[Cutis marmorata telangiectasica congenita. Description of 2 further cases]. / Cutis marmorata telangiectasica congenita. Descrizione di due nuovi casi.

We report two cases of C.M.T.C., a rare cutaneous vascular anomaly, which is manifested at birth. It is a rare birth defect of unknown etiology; usually occurs sporadically. There is an association of C.M.T.C. with other congenital anomalies in at least 50% of the patients. On the basis of two cases, the clinical features of cutis marmorata telangiectasica congenita are described and the differential diagnosis discussed.

[Tumor markers in colorectal neoplasm pathology: our experience of the diagnostic and prognostic importance of CEA antigen]. / I markers tumorali nella patologia neoplastica del colon-retto: nostra esperienza sul significato diagnostico e prognostico dell'antigene CEA.

It is well known that the presence of a tumour may be accompanied by production and release into the serum of a substantial number of protein and/or hormonal substances. Only relatively recently, however, have investigators begun to identify which of these supposed markers may actually be clinically useful. A picture is thus gradually emerging of a number of markers (in actual fact only very few) which are already clinically useful, as well as others which are clinically promising and numerous markers which require more thorough clinical evaluation. Prominent among those already in clinical use is undoubtedly CEA. Carcinoembryonic antigen (CEA) is a glycoprotein isolated for the first time by Gold and Friedman in 1965. Very recently, sensitive radioimmune and immuno-enzymatic assays have made it possible to determine serum levels lower than 3 ng/ml. Though high plasma levels of CEA do not indicate the presence of a tumour with certainty, very high levels are, however, to some extent indicative of its existence. In view of the fact that CEA possesses neither the sensitivity nor the specificity to be able to diagnose the presence or otherwise of a tumour, its use is generally recommended when formulating a prognosis or for monitoring surgical and/or medical therapy (chemotherapy and radiotherapy) in asymptomatic patients. We therefore carried out tests in 357 patients on file as having undergone surgery for neoplasms of the colon-rectum-anus, monitored in our colostomy outpatients' department, which was started up in 1980. 188 of these patients had already been submitted to CEA assay prior to surgery. The data are analyzed in relation to the site, stage and grade of differentiation of the neoplasm, the supposed radicality of the operation and the period of follow-up in these patients.

[Space and time in rooming-in: a survey among mothers]. / Spazi e tempi del Rooming-in: un'inchiesta fra le madri.

From a psychological point of view as well as in regard to facilitating breast-feeding, the practise of rooming-in is most favorable to the wellbeing of the mother-newborn relationship. An important but little researched point is whether the mother may accept rooming-in in respect to time periods, space and the manner in which it is carried out. The results of this study have made evident that time demand by the mother for contact between mother and newborn is inferior to that which is provided by the hospital, this is probably due to the lack of private space available.

Investigation on the pattern of polar lipids extracted from different strains of cultured cells.

The polar lipid patterns of several cell strains (EUE, L929, MT, RAG and TAZA) were compared by TLC separation in order to identify a typical lipid profile as a possible "strain marker". Phospholipids and sulfolipids were tested by colorimetric procedures. EUE and L929 contain smaller amounts of sulfolipids (2.4-3.9; 3.0-4.5) than RAG (4.4-12.0) or MT (10.5) (micrograms x 10(-6)/cell). MT and RAG contain higher phospholipid P concentration than other strains. (MT:14.0 whilst EUE 1.3-1.8 micrograms phospholipidic P x 10(-6)/cell). The patterns of lipidograms in the characterization of two cell strains are discussed in terms of their usefulness as rapid "fingerprint" in biochemical and histochemical analysis.