Carotid intimal-media thickness and endothelial function in young patients with history of myocardial infarction.

AIM: The aim of the study was to evaluate the prevalence of carotid atherosclerosis and endothelial dysfunction in 45 young patients (38 mens and 7 females) with myocardial infarction (MI), age 29-45, mean age 42+/-3 years, to verify its possible role as a marker of coronary atherosclerosis. METHODS: Vascular echography was performed to verify the presence of carotid atherosclerosis and/or endothelial dysfunction in 45 young patients with MI and in 45 healthy control subjects well matched for age and sex. RESULTS: We observed a normal intima media thickness (IMT) only in 30% of patients with juvenile myocardial infarction (JMI) compared with 66% in the control group (P<0.0001) and 34% of patients showed an increased IMT compared with 24% of healthy subjects (P<0.0001). Compared with control subjects, patients with JMI had lower flow-mediated reactivity of the brachial arteries (P<0.05). There was a negative linear relationship between flow-mediated dilation and IMT (P<0.001). The severity of coronary artery disease (CAD) was correlated with increased IMT and with a lower flow-mediated dilation. Finally, multiple regression analysis, demonstrated that both brachial-artery reactivity and carotid IMT were significantly and independently correlated with severity of CAD. CONCLUSIONS: Structural (carotid atherosclerosis) and functional changes (endothelial dysfunction) were present at an early age in the arteries of persons with history of JMI.

In-hospital stay of patient with acute coronary syndrome with or without diabetes mellitus.

AIM: Type 2 diabetes is associated with an increase in the risk of coronary heart disease, by a factor of two to four. The scientific community has suggested that all patients with diabetes could be treated as if they had a prior coronary heart disease. METHODS: A computer review of 11-year prevalence (from 1991 to 2002) of type 2 diabetes among 3242 patients admitted to the Intensive Coronary Care Unit of the Division of Cardiology of the University Hospital ''Paolo Giaccone'', Palermo, was carried out, with the diagnosis of ST elevation myocardial infarction (STEMI) (51%), non ST elevation myocardial infarction (NSTEMI) (6%) or unstable angina (UA) (43%). RESULTS: Prevalence of type 2 diabetes was 31.5% on the overall population; in particular, a higher prevalence was found among STEMI affected patients (37% of the diabetic patients). The average number of days of an in-hospital stay was of 10.4+/-3.1 for diabetic patients without complications (N.=602) and of 15.9+/-4.4 for diabetic patients with clinical complications (N.=421) as compared with non diabetic patients non complicated (N.=1821) or complicated (N.=398), with an average in-hospital stay of 7.4+/-1 and 12.8+/-3.2 days respectively; P<0.005. CONCLUSIONS: Diabetic patients with acute coronary syndrome had more clinical complications (41.1% vs 17.9%, P=0.0001) and a longer in-hospital stay period, resulting in an increased management costs, in comparison with non diabetic patients.

Short term prognostic role of NT-proBNP in patients after myocardial infarction.

AIM: The clinical and prognostic role of cardiac natriuretic peptides (CNP) in patients with heart failure is well known; recently, several studies have evaluated the possibility of using CNP to evaluate their potential prognostic role in patients with acute coronary syndromes (ACS). The aim of this study was to evaluate the short term prognostic value of NT-proBNP in 70 patients admitted for ACS. METHODS: The authors studied 70 patients with ACS, evaluating, at admission, clinical-anamnestic, instrumental and laboratory characteristics including NT-proBNP plasma levels. Patients were monitored in a 6-month-follow-up to record adverse fatal events and their possible correlation with baseline characteristics. RESULTS: The incidence of adverse events during the follow-up period was 28% (10 patients). In patients with adverse events, the authors observed lower left ventricle ejection fraction (P=0.01), higher prevalence of ST elevation myocardial infarction (P=0.03) and higher NT-proBNP levels (P=0.03), compared to those without adverse events. Moreover, the logistic regression analysis underlined how ST elevation myocardial infarction (P=0.05) and higher NT-proBNP levels (P=0.05) were the only predictive variables for adverse events during the follow up period. CONCLUSIONS: This study demonstrates the short term prognostic role of NT-pro BNP in patients admitted for ACS.

Prognostic role of endothelial dysfunction and carotid intima-media thickness in patients undergoing coronary stent implantation.

AIM: Impaired endothelial function and increased carotid intima-media thickness are key events in the atherosclerotic process and predict future cardiovascular events in subjects with and without coronary artery disease. The purpose of this study was to investigate whether the vasodilator response to increased flow in the brachial artery and the presence of carotid lesions may have a prognostic significance for in-stent restenosis in patients undergoing coronary angioplasty. METHODS: The study population included 58 patients undergoing percutaneous coronary intervention (PCI) with stenting and at least 10 months of follow-up. All patients underwent ultrasound detection of brachial artery reactivity 30 days after PCI. Flow mediated dilatation (FMD) was investigated after 5 minutes of occlusion of the artery and nitroglycerin mediated dilation (NMD) was investigated after administration of sublingual nitrates. Vascular echography was performed to measure intima media thickness (IMT) of carotid arteries. At baseline we evaluated all the established traditional cardiovascular risk factors. We also subdivided our study cohort according to values of FMD in patients with FMD above and patients below the median value. RESULTS: Patients with FMD above the median value showed higher prevalence of hypertension (P=0.002), diabetes (P=0.02) and carotid IMT (P=0.006) than those below the median. Brachial FMD was inversely correlated (P=0.001) to carotid IMT. At the end of follow-up clinical events occurred in nine patients. In a multivariate analysis, including all the variables evaluated at baseline, carotid IMT (P=0.02), level of glycemia (P=0.001), a lower FMD (P=0.005) and presence of carotid plaque remained the only variables predictive of restenosis. CONCLUSIONS: Evaluation of FMD and carotid IMT may provide important prognostic information in patients undergoing PCI.

Carotid and peripheral atherosclerosis in patients who underwent primary percutaneous coronary intervention and outcome associated with multifocal atherosclerosis.

AIM: The aim of our study was to determine if patients with multifocal atherosclerosis have a worse prognosis than patients with atherosclerosis only in the coronary bed. METHODS: We studied 45 subjects admitted to intensive coronary care unit of the Division of Cardiology with the diagnosis of acute myocardial infarction (AMI). Traditional cardiovascular risk factors were investigated and laboratory analysis included measurement of plasma lipids, glycemia, fibrinogen and high-sensitivity-C-reactive protein (hs-CRP). Each patient underwent coronary-angiography as well as carotid and peripheral arterial ultrasound examination. A follow-up of 13+/-2 months was performed. RESULTS: We found that the severity of coronary atherosclerosis is significantly associated with the presence of carotid (P<0.05) and peripheral atherosclerosis (P<0.005). Markers of inflammation, hs-CRP (P<0.005) and fibrinogen (P<0.05), were significantly associated with multifocal atherosclerosis. We have shown that an increased number of coronary vessels with atherosclerotic stenosis is associated with a higher value of carotid (P<0.0001) and peripheral intima media thickness (P<0.0001). During 13 months of follow-up the incidence of fatal or non fatal events was 18%. The multivariate analysis showed that the variables independently associated with fatal and non fatal events were: male sex (P<0.001), family history of cardiovascular disease (P<0.005), hypertension (P<0.01), diabetes mellitus (P<0.05), higher levels of total cholesterol (P<0.05), smoking habit (P<0.05), and multifocal atherosclerosis (P<0.05). CONCLUSIONS: The ultrasound examination of carotid and peripheral atherosclerotic lesions may be useful in placing patients with AMI in a category of higher risk of cerebrovascular and cardiovascular events. Moreover, the precocious identification of patients at risk can suggest a more aggressive pharmacological treatment and a more accurate follow-up in order to avoid future events.

[Palliative endoscopic intubation of esophago-gastric neoplastic stenosis: analysis of factors that may influence immediate results]. / Intubazione palliativa endoscopica delle stenosi tumorali esofago-gastriche: analisi dei fattori che possono influenzare i risultati immediati.

The paper examines a series of 172 patients undergoing endoscopic intubation with plastic stent due to unoperable esophago-gastric tumoral stenoses during the period 1980-1991. An analysis of the data enabled the following conclusions to be drawn: (1) The majority of perforations occur during the treatment of distal stenoses (15%), anastomotic stenosis (20%) and extrinsic compression stenoses (23% vs 7% in the case of stenosing primary esophageal neoplasia). (2) Severe respiratory problems may occur during treatment of cervical stenoses. (3) Malfunctioning of prostheses is more frequent in the treatment of cardias stenosis (10%). Having a few technical comments on the subject of passing the guide thread through the most twisting and narrow stenoses, the authors express the wish that expandable metal prostheses will be more widely used in order to render the method less traumatic, increase the percentage of success (extending the indications regarding the site and type of stenosis) and reduce severe complications.

[Liver injury in abdominal trauma. Review of the literature and personal observations]. / Danno epatico nei traumi addominali. Revisione della letteratura e casistica personale.

In patients who suffered abdominal trauma, the liver is the most frequently involved organ, except the spleen. The % rises from 1520% to 30% if trauma is closed or open. Liver injury may spread from a simple parenchymal contusion to a break in vessels or biliary ducts. Life risk is related to hemorrhage. The mortality is due to: 1) extension of the injured liver surface, 2) possible damage to big vessels, 3) intra or extra abdominal associated injury in case of multiple trauma. It is important to known the kind of injury to choose the best therapy, not necessary surgical. The authors report on 15 patients with thoracoabdominal trauma and liver damage, comparing their cases with literature observations.

[Creation of a colostomy using a circular mechanical stapler]. / Confezionamento di ano praeter-naturale con suturatrice meccanica circolare.

The paper describes the method used to create a preternatural anus in terminal stomas using a mechanical circular stapler (Model EEA-31). Two methods are put forward: Chung's and Burke's methods (the latter of which was used by our department). A mechanical circular stapler has been used several times (13) to perform this type of stoma, with excellent esthetic and functional results, both immediate and long-term. It was only necessary to reoperate in one case in order to suspend the affected colic loop.

[Lesions of the duodenum from closed abdominal injury. A case report]. / Lesioni del duodeno da trauma addominale chiuso. Un caso.

Following a review of the literature, the paper reports a case of duodenal injury. This rare pathology most frequently affects the second half of the organ and may cause damage ranging from a simple hematoma to parietal laceration with peritonitis and/or retroperitonitis. Symptoms are often confusing and delayed, and together with chemical and instrumental tests do not always allow an early diagnosis to be made. Treatment varies according to the type of lesion and its location, and is often secondary to the general condition of the patient. Postoperative mortality appears to be limited to 11% if laparatomy is performed early (within 24 hours).

[Popliteal artery entrapment syndrome. Discussion of a case]. / La sindrome da entrapment dell'arteria poplitea. Discussione di un caso.

The paper reports a case of popliteal artery entrapment syndrome (3rd type) associated with poststenotic aneurysm with a single painful ischemic attack. Diagnosis was made following an accurate anamnesis and clinical examination using invasive and non-invasive instruments. Surgical therapy consisted of resection of the gastrocnemius muscle followed by a graft to the self inverted saphena vein.

[Use of the rendez-vous technique in endoscopic insertion of biliary prosthesis in malignant obstructive jaundice]. / Impiego del rendez-vous per l'inserimento endoscopico di protesi biliari nell'ittero ostruttivo maligno.

The paper describes the Authors' personal experience of the use of the rendez-vous technique (using a combined endoscopic-transhepatic route) for the endoscopic insertion of biliary prosthesis in cases of malignant obstructive jaundice. Having illustrated the series of cases, the paper proposes the use of this technique in the event of endoscopic failure due to the smaller incidence of complications compared the use of a wholly transhepatic route.

Penetrating wound of the right ventricle with intracardiac retention of the foreign body.

The rare case of a penetrating cardiac wound with fortuitous outcome caused by a disintegrating rotating electric saw at the patient's home is described. The patient was successfully treated in two stages: Emergency treatment in the nearest hospital, where no extracorporeal circulation facilities were available, to stop the bleeding, followed by transport to, an cardiac surgery in university hospital, where a foreign body in the right ventricle was removed. Pathophysiology of heart wounds and their surgical treatment are discussed.

[Primary sclerosing cholangitis]. / La colangite sclerosante primitiva

A case of intermittent cholostatic icterus has been observed at the Civil Hospital of Castellamonte. Clinical and laboratory examinations did not permit precise diagnosis, hence the decision to carry out exploratory surgery. The finding was hepato-choledochic fibrosis with severe stenosis of the lumen and patency of Vater's tubercle, with no calculosis or previous bile way operations. Transcholedochic and transpapillary biliary drainage was therefore performed with a T tube. The patient is in good condition about two years after the operation and cholangiocarcinoma can be excluded. It is therefore considered that the case can be classified as a "primary sclerosing cholangitis".