Carotid Sinus Syndrome: a review of the literature and our experience using carotid sinus denervation.

BACKGROUND: The Carotid Sinus Syndrome (CSS) is a rare condition causing spontaneous syncopal attacks or marked dizziness. METHODS: We studied 28 patients affected by CSS from January 1991 to October 1996. Eleven patients affected by cardioinhibitory type were treated by pace-maker (PM) implant. Seventeen patients had mixed type and all, but one who refused any treatment, entered this study. Carotid Sinus Denervation (CSD) was first performed in 2 of 10 patients who remained symptomatic after PM and in 6 patients as first choice therapy. RESULTS: At a mean follow-up of 30 months no patient submitted to CSD had recurrent syncopal attacks or dizziness. CONCLUSIONS: CSD is a safe and simple technique to abolish either the cardioinhibitory or the vasodepressor response in CSS.

[Incessant ectopic atrial tachycardia in pregnancy: radiofrequency catheter ablation in immediate postpartum with disappearance of tachycardia-related dilated cardiomyopathy]. / Tachicardia atriale ectopica incessante in corso di gravidanza: ablazione transcatetere mediante radiofrequenza nell'immediato post-partum con risoluzione del relativo quadro di cardiomiopatia dilatativa.

A 29-year-old woman presented with incessant atrial tachycardia and tachycardia-related cardiomyopathy during the last weeks of pregnancy. At 40 weeks of gestation a healthy infant was delivered by Cesarean section. Various medical treatments and two attempts of electrical cardioversion were ineffective in restoring sinus rhythm. Electrophysiologic study with endocardial activation mapping confirmed the diagnosis and thereafter radiofrequency transcatheter ablation of the ectopic focus was successfully carried out and sinus rhythm was restored. Serial 24-h Holter monitoring at 1, 3, and 6 months showed the persistence of sinus rhythm. Echocardiographic examinations demonstrated a very rapid recovery of both left ventricular diameters and ejection fraction to normal limits within two weeks after ablation. In this case-report the potential role of pregnancy and recent advances in the understanding and treatment of ectopic atrial tachycardia are summarized. Although endocardial mapping is difficult, radiofrequency catheter ablation appears to be the elective technique for the treatment of this particular arrhythmia, often refractory to antiarrhythmic drugs. Moreover, this case highlights that tachycardia-related cardiomyopathy should be seriously considered in any patient with apparently end-stage dilated cardiomyopathy and persistent tachycardia.

[Serum prolactin in obese subjects with and without glucose intolerance]. / Comportamento della prolattinemia nei soggetti obesi con e senza intolleranza ai carboidrati.

Basal values of H-Prl have been assayed with reproducible RIA in two accurately selected group of subjects: 1) obese with latent glucose intolerance; 2) obese without glucose intolerance. In these patients have been valued also IRI and blood glucose (GOD-POD Biochemia). The data reported in this paper show that therein't correlation between basal H-Prl values and difference obese -- normal of IRI concentrations neither in non-diabetics nor in pre-diabetics obese. It indicate that the H-Prl not plays a controinsular role in obese-prediabetics subjects. No difference in basal values of H-Prl we found in the examined patient obese pre- and not-diabetics.

[Anti-ammonemic activity of the gamma-ethyl ester of glutamic acid. Controlled clinical study]. / Attività antiammoniemica del gamma-etilestere dell'acido glutammico. Studio clinico controllato.

A controlled clinical trial was made of the anti-ammoniaemic properties of gamma-ethylester glutamic acid, arginine and placebo in a series of 45 patients with hepatic insufficiency characterized by hyperammonemia (excluding cases of pre-coma and coma) randomly assigned to three groups for treatment with: gamma-ethylester of glutamic acid (25 g), l-arginine (25 g) and physiological solution in identical 500 ml bottles. Various parameters were controlled. The results obtained were assessed with different statistical techniques, depending on the parameter concerned and the aims of the trial. Blood ammoniaemia was significantly decreased by both-ethylester of glutamic acid and arginine though the former was more effective quantitatively and in terms of time. SGOT and BSF values also followed the same pattern.

[Cystic lymphangioma of the spleen associated with hypersplenism]. / Linfangioma cistico della milza associato ad ipersplenismo.

A rare case of cystic lymphangioma of the spleen accompanying hypersplenism syndrome is described. After stressing the importance of certain examinations such as arteriography and splenic scintigraphy in diagnosis the condition, the many ways in which cystic lymphangioma of the spleen may present clinically are reviewed; these go from asymptomatic to straightforward splenomegaly, with or without clinical signs, up to a clear-cut hypersplenism syndrome. The present case merits consideration for three reasons: 1) The absolutely exceptional nature of cystic lymphangioma of the spleen; 2) Exceptional association with hypersplenism syndrome; 3) Remission of the syndrome following splenectomy. It is concluded that, notwithstanding the condition's rarity, cystic lymphangioma of the spleen should be considered in the differential diagnosis of splenomegalic syndromes when these are also accompanied by hypersplenism.