[Relationship between late ventricular potentials and ventricular arrhythmias in patients in chronic dialysis treatment]. / Relazione tra potenziali tardivi ventricolari e aritmie ventricolari nei pazienti in trattamento dialitico cronico.

BACKGROUND: Arrhythmias are frequent pathology in patients with chronic hemodialysis. We evaluated whether a relatively new technique, signal averaging, could be useful in predicting the development of complex arrhythmias in these patients. METHODS: Thirty-three patients, 18 male and 15 female, subjected to thrice weekly chronic hemodialytic treatment with various dialysis techniques, were studied. Exclusion criteria were the presence of antiarrhythmic and inotropic treatment. The following examinations were carried out in all patients: a Holter dynamic electrocardiography for a duration of 24 hours, begun on the day of dialysis, high resolution ECG pre- and post-dialysis to find out if there were any ventricular late potential (VLP). Four hundred beats were examined in order to obtain a background noise of less than 0.7 microV and a better definition of the signal. The following parameters were considered significant for the presence of VLP: a) filtered QRS duration > 120 msec; b) the root mean square of the signal expressed in the terminal portion of QRS (RMS) < 25 microV) high frequency low amplitude signals duration (HFLA) > 40 msec. A positive value in two of these parameters was considered indicative of the presence of VLP. In addition various pre and post-dialysis indices of dialytic efficiency and a mono and two-dimensional echocardiogram with pulsed and color Doppler were carried out. Of the 33 patients studied, ten were excluded because they presented too high a background noise at the high resolution ECG. Of the remaining 23 patients, 13 (56%) presented VLP and nine of these (69%) presented complex arrhythmias. Of the ten patients without VLP, 5 (50%) presented complex arrhythmias. The incidence of arrhythmias was highest during the last two hours of dialysis and in the two hours following it. The patients were then divided into two groups (A and B) according to the ejection fraction (EF) found at the echocardiogram. Group A was composed of 17 patients of whom 8 (47%) presented complex arrhythmias; group B (EF < 45%) was composed of the remaining six patients, who all presented complex arrhythmias. In group A nine patients (53%) out of 17 had LVP, in group B four out of six (66%) had it. All the patients except one presented an increase in the thickness of the ventricular wall and alterations of Doppler transmitral filling rate. Left ventricular hypertrophy was diagnosed in 22 out of the 23 patients. Four patients also had chronic ischaemic heart disease; of these three had LVP. There was no correlation between the presence of LVP and the hemodialytic indices and between the latter and complex arrhythmias. CONCLUSIONS: Our study showed that arrhythmias are more frequent in patients with LVP before dialysis than in those without. The difference was statistically significant (p < 0.006); the incidence of arrhythmias was higher in patients with FE < 45% (p < 0.001). The majority of patients (95%) had left ventricular hypertrophy; only four (17%) had ischaemic heart disease too. It is highly probable that the presence of LVP in our patients can be attributed to hypertension and subsequent left ventricular hypertrophy. As patients with LVP at the end of dialysis had a greater incidence of arrhythmias than those without LVP, we suggest that this method could be useful as a first screening in dialysed patients.

[Pseudoaneurysm of the left ventricle: a report of 2 cases]. / Pseudoaneurisma del ventricolo sinistro: descrizione di due casi.

Two cases of left ventricular pseudoaneurysm following myocardial infarction are presented. In the first patient a two-dimensional echocardiography study revealed a small posterior echo-free space that appeared to communicate with the left ventricle through a small defect in the left ventricular posterior wall. Conventional Doppler echocardiography and colour flow imaging demonstrated flow between the left ventricle and the paraventricular chamber. In the other patient, the same study detected an enormous false aneurysm. We found a large extramyocardial echo-free space within the pericardial cavity. The site of this space was posterolateral and communicating with the left ventricular cavity. Cardiac catheterization and surgery confirmed the diagnosis. A postoperative echocardiographic study demonstrated a persistent but smaller saccular echo-free space and a residual shunt through one site of repair in the first patient; in the other, after surgical treatment there was no residual flow, but a left ventricular dysfunction was detected. Two dimensional and color Doppler echocardiography is the best technique among the noninvasive methods, for detecting and following up left ventricular pseudoaneurysms.

[Atrial natriuretic factor in patients with cardiac decompensation before and after chronic therapy with an angiotensin-converting enzyme inhibitor]. / Fattore natriuretico atriale in pazienti con scompenso cardiaco prima e dopo terapia cronica con un inibitore dell'enzima di conversione.

BACKGROUND: Patients with severe congestive heart failure often have high plasma Atrial Natriuretic Factor (ANF) and neurohormonal activation. Ace inhibitors give clinical and hemodynamic benefits and lower plasma angiotensin and norepinephrine levels. The interactions between ANF and the Ace inhibitors are mainly modulated via the renin angiotensin system. METHODS: Plasma ANF, renin activity, urinary aldosterone and catecholamine levels were evaluated in 10 patients with congestive heart failure (at baseline, after 15 days of adequate treatment with digoxin and diuretics, and after 45 days of enalapril) in order to assess the changes of ANF and vasoconstrictor neurohormones with chronic Ace inhibitor therapy. RESULTS: ANF increased significantly in the congestive heart failure group compared to a normal subject control group (P < 0.001). After digoxin and diuretic therapy NHYA class improved significantly, but no significant hormonal changes were found. On the contrary, the addition of enalapril caused a significant decrease of plasma ANF and urinary aldosterone and catecholamines (P < 0.05). CONCLUSIONS: The relationship between the renin angiotensin system and catecholamines is complex but our findings indicate that: 1) Traditional therapy is effective in improving symptoms, but cannot induce a decrease of vasoconstrictive neurohormones; 2) ACE inhibitor therapy reduces ANF and neurohormonal activation. 3) ANF is a useful marker in evaluating the response to treatment.

[Study of the arrhythmia in patients with chronic uremia in periodic hemodialysis with Holter dynamic electrocardiography]. / Studio delle aritmie negli uremici cronici in emodialisi periodica mediante elettrocardiografia dinamica secondo Holter.

For the purpose of evaluating cause, frequency, type and seriousness of arrhythmias in dialysis patients, 14 chronic uremics, 8 on bicarbonate-dialysis, 6 on acetate-dialysis underwent a basal ECG, echocardiography and a Holter dynamic electrocardiography (ECGD) for a duration of 96 hours. Before and after dialysis PAO, body weight, serum electrolytes and arterial pH were controlled. In 11 patients (78%) supraventricular and ventricular arrhythmias were discovered of equal frequency and seriousness both in the inter and intra dialytic phase, even if more frequent in ventricular hypertrophic patients (IVSn) the complex ventricular arrhythmias (Lown greater than 2). The seriousness and frequency of ventricular and supraventricular arrhythmias in the dialytic phase did not seem to depend either on the type of tampon or on the presence or absence of cardiopathies while in the inter-dialytic phase the seriousness of ventricular arrhythmias seems to depend upon the presence of cardiopathies. The Authors conclude that the pathogenesis of arrhythmias in uremic patients on dialysis is multifactorial and that their elevated incidence makes the use of a Holter in these patients recommendable.

Reduction of complex ventricular arrhythmias after enalapril treatment in patients with advanced stable heart failure.

We studied, by 48-hour Holter monitoring, 33 patients with chronic stable heart failure (radionuclide ejection fraction less than 35%), complex ventricular arrhythmias and no electrolyte abnormalities, after a period during which they were treated with digoxin and diuretics. Before Holter monitoring blood samples were analyzed for serum concentration of sodium, potassium, magnesium, urea, creatinine, digoxin, aldosterone and for plasmatic renin activity in addition to urinary aldosterone and catecholamines determination. After these investigations in 23 patients, 5-20 mg of enalapril were progressively added to the conventional therapy, while 10 patients continued the previous therapy. After 8 weeks 30 patients were subjected to a second 48-hour Holter monitoring and to the same biochemical and hormonal tests. One patient died and 2 were lost to follow up. Only the enalapril group showed a significant decrease in the number of premature ventricular complexes (PVC) (p less than 0.01), and the frequency of couplets and episodes of ventricular tachycardia (VT) declined significantly (P less than 0.01). In the two groups there were no significant changes in digoxin, sodium, or magnesium, while potassium concentration increased in both groups (p less than 0.01). In the enalapril group heart rate and systolic and diastolic pressure declined significantly (p less than 0.01), and New York Heart Association class (NYHA) improved (p less than 0.001). In the other group there were no significant changes in these parameters. Enalapril caused a significant increase in the plasmatic renin activity (p less than 0.01) and a significant fall of plasma and urinary aldosterone (p less than 0.01; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Correlation between QT interval, ventricular arrhythmias and left ventricular function in chronic alcoholics]. / Correlazione tra l'intervallo QT, le aritmie ventricolari e la funzione ventricolare sinistra negli etilisti cronici.

Prolonged QT interval and arrhythmias have been reported to occur in chronic alcoholics. To investigate the role of chronic alcohol consumption in the onset of arrhythmias and the development of the preclinical left ventricular dysfunction, in a group of 12 asymptomatic chronic alcoholics with no clinical evidence of heart disease, with histologically proven hepatic damage, after a week of abstinence from alcohol, the following investigations were performed: measurements of the corrected QT interval (QTc), 24-hours Holter monitoring, systolic time intervals, M-mode echocardiograms. The results were compared to those of 10 normal subjects. Our data suggested no difference in QTc interval between chronic alcoholics and normal persons. The distribution of arrhythmias was not statistically different in the two groups, particularly frequent and complicated arrhythmias occurred in only one subject in each group. Preejection period corrected for heart rate (PEPI) was significantly longer in alcoholics (132 +/- 16 vs 119 +/- 11, p less than 0.05). All echocardiographic parameters examined were not significantly different in the two groups. On the basis of our results, our impression is that the arrhythmogenic role of alcohol, not under acute ingestion, is relatively unimportant and further studies are needed to become a definitive conclusion about subclinical alcoholic cardiomyopathy.

[Thickening of the bronchial wall in asthma and asthma-like bronchitis]. / L'ispessimento della parete bronchiale nell'asma e nella bronchite asmatiforme.

Small ring-shaped images, related to 2nd or 3rd bronchial walls are seen in prahilar lung region in 80% of chest Xray films, when a bronchus in seen "end on". This bronchial wall thickening (greater than 0.3 mm) is present in numerous lung diseases such as silicosis, bronchiectasis and pulmonary edema. In order to evaluate the significance of such bronchial wall thickening in chronic obstructive bronchitis and bronchial asthma, 78 patients suffering from these diseases have been studied correlating bronchial wall-thickening with the major clinical and bio-humoral indices of broncho obstruction a significant correlation was found between bronchial wall thickening and Tiffeneau index (p less than 0.05), the PaO2 (p less than 0.01), and the E.S.R., expressed as Katz index (p less than 0.001). No correlation was observed between bronchial wall thickening and positivity to allergological tests. It follows that the bronchial wall thickening is an expression of mucous membrane edema and/or endobronchial mucous or purulent hypersecretion. This aspect, though not usefull in the differential diagnosis between chronic obstructive bronchitis and paroxysmal bronchial asthma due to topical inhalants, is indicative of an acute phase in the inflammation process in such patients.

[Epidemiology of arterial hypertension in students at the University of Nice]. / Epidémiologie de l'hypertension artérielle des étudiants de l'Université de Nice.

These students, as representative of french population, were examined in 1983. Right humeral arterial blood pressure was measured three times on dorsal decubitus with a mercury manometer by a medical doctor. People with a systolic arterial pressure greater than or equal to 150 mmHg and/or diastolic arterial pressure greater than or equal to 90, were considered as hypertensive. These hypertensive people came then for a new complete examination, six months later. A witness group, drawn by lot, were examined in the same conditions. Systolic, diastolic and mild arterial blood pressures (in mmHg) were for: (table; see text) Prevalence of hypertension is 2.2 p. 100 (46) for girls and 11.9 p. 100 (184) for boys. The most important difference between high blood pressure people and normal blood pressure people lies in morphological characters. (Table: see text). Sport activities, coffee and diet concerning sodium are identical in the two groups. High blood pressure people smoke less than normal blood pressure people. Previous history of hypertension are more frequent in high blood pressure people than normal blood pressure people. Upright posture induce modification in pressure on high blood pressure people. Meanwhile, stress induced by mental arithmetic, does not bring more elevation pressure about high blood pressure people than normal blood pressure people. Six months later: 58 p. 100 of high blood pressure group have still a high blood pressure, 26 p. 100 have a borderline blood pressure (systolic greater than or equal to 140, diastolic greater than or equal to 85).(ABSTRACT TRUNCATED AT 250 WORDS)

Osteoporosis and decline of gonadal function in the elderly male.

The bone mineral content was evaluated in 30 male subjects aged between 60 and 90 years using the relief of the percent cortical area (PCA) at the level of the second phalanx of the left-hand index finger, by Garn's method. This was to evaluate the rate of bone loss with increasing age. Testosterone, androstenedione, estrone, 17 beta-estradiol plasma levels were determined in all subjects by the RIA method. 60% of our patients showed increased bone resorption (PCA less than 55%); in these subjects testosterone and androstenedione plasma levels were significantly lower than in subjects not affected by osteoporosis. A positive linear correlation is evident between PCA and testosterone, androstenedione and estrone plasma levels. Thus, like in women, decline of gonadic function determines an increased bone resorption in men too.

Rheological and clotting changes in chronic cor pulmonale.

53 patients with chronic or pulmonale and hospitalized for the occurrence of acute dyspnea were studied. The mean age was 67. The increase in blood and plasma viscosities is higher than the rise in hematocrit, total plasma proteins and fibrinogen. The levels of plasminogen and antithrombin III are significantly lower and the plasma euglobulin lysis time is shortened. On the contrary, fibrinogen levels are normal or near normal. This seems to confirm the frequent presence of clotting changes in chronic cor pulmonale facilitated by an altered pulmonary rheology.

[One case of acquired dyserythropoietic anemia: morphologic cytochemical study (author's transl)]. / Un caso di anemia diseritropoietica acquisita. Studio morfologico e citochimico.

A case of acquired dyserythropoietic anemia is described in a sixty-six year old patient: is characterized by a very considerable pancitopenia, and by the presence in the bone-marrow of notable morphologic atipia both in erythroblastic line and in granulocitopoietic one. The iron kinetics and erythrocitic surviving are highly altered. The citochimic study points out the presence of myelocites with perossidasis-deficit and the presence of PAS positive erythroblasts. These data indicate metabolic anomalies that seem to localize the primitive deficit in the stem-cells.