Long-term survival effect of metoprolol in dilated cardiomyopathy. The SPIC (Italian Multicentre Cardiomyopathy Study) Group.

OBJECTIVE: To evaluate the additive effect of metoprolol treatment on long-term incidence of fatal and non-fatal cardiac events in idiopathic dilated cardiomyopathy. DESIGN: 586 patients with idiopathic dilated cardiomyopathy were prospectively enrolled in a multicentre registry and followed up for a mean (SD) of 52 (32) months. Metoprolol, carefully titrated to the maximum tolerated dose, was added to conventional heart failure treatment in 175 patients. RESULTS: Survival and transplant-free survival at seven years were significantly higher in the 175 metoprolol treated patients than in the remaining 411 on standard treatment (81% v 60%, p < 0.001, and 69% v 49%, p < 0.001, respectively). By multivariate analysis, metoprolol independently predicted survival and transplant-free survival (relative risk reduction values for all cause mortality and combined mortality or transplantation 51% (95% confidence interval 21% to 69%), p = 0.002, and 34% (5% to 53%), p = 0.01, respectively). New York Heart Association class, left ventricular end diastolic diameter, and pulmonary wedge pressure were also predictive. Seven year survival (80% v 62%, p = 0.004) and transplant-free survival (68% v 51%, p = 0.005) were significantly higher in 127 metoprolol treated cases than in 127 controls selected from the entire control cohort and appropriately matched. Metoprolol was associated with a 30% reduction in all cause mortality (7% to 48%, p = 0.015) and a 26% reduction in mortality or transplantation (7% to 41%, p = 0.009). CONCLUSIONS: The addition of metoprolol to standard heart failure treatment, including angiotensin converting enzyme inhibitors, was effective in the long-term, reducing both all cause mortality and transplantation in patients with idiopathic dilated cardiomyopathy.

[Primary extranodal non-Hodgkin's lymphoma of the head and neck]. / Linfoma non-Hodgkin extranodale primitivo del capo e del collo.

Primitive extranodal head and neck non-Hodgkin's lymphoma represents 10% of total non-Hodgkin's Lymphomas and 5% of total head and neck malignant tumors, preferably 55-65 years old males. The aim of this study was to review the literature and to compare the available data with our cases, particularly referring to the results of therapy. We studied 7 cases of primitive extranodal head and neck non-Hodgkin's lymphoma (5 male and 2 females, mean age 58 years) observed between 1989 and 1994. All patients were treated with polychemotherapy, 2 of them with combined therapy. After a mean follow-up of 44 months, 6 patients (85.7%) still are in complete remission. Primary extranodal head and neck non-Hodgkin's lymphomas present peculiar clinical features compared to other lymphomas. The best treatment is the polychemotherapy (including anthracycline) associated (combined) with radiotherapy. A minimal follow-up of 5 years is required, also considering nodal and extranodal relapses not adjacent to the beginning site.