[Chronobiology of acute pulmonary edema in an emergency service]. / Cronobiologia dell'edema polmonare acuto in un Dipartimento di Emergenza.

Some diseases like acute myocardial infarction, sudden death and stroke have been reported to disclose daily, weekly or annual incidence fluctuations. We analyzed the rhythm of pulmonary edema occurrence. We considered 105 consecutive subjects (mean age 73.7 +/- 9.7 years) who came to an Emergency Department because of acute pulmonary edema during a solar year. Chronobiologic analysis was performed using Halberg single cosinor test. Pulmonary edema incidence was higher during the night with an acrophase at 2:14 a.m. (p < 0.001). No significant weekly or circannual rhythms were detected. We discuss the possible relations with diminished heart output, increase in sympathetic tone or partial baroceptor desensitization, occurring at night.

[Short term changes in risk factors of cerebrovascular diseases. A failure of preventive measures?]. / Modificazioni nel breve termine dei fattori di rischio delle malattie cerebrovascolari. Un insuccesso degli interventi di prevenzione?

BACKGROUND AND PURPOSE: Stroke is the third main cause of death in western countries. To evaluate its ever-changing characteristics and the impact of recent public campaigns on cardiovascular risk factors (CRFs) in stroke morbidity and mortality, we carried out a retrospective investigation on subjects with cerebrovascular disease in different periods. METHODS: All clinical data of patients with acute cerebrovascular disease (TIA or stroke) admitted to a regional hospital (Padua, Italy) during two distinct years (1985 and 1992) were examined (381 in 1985 and 440 in 1992). In every case the characteristics of the episode, clinical course, concomitant CRFs and relevant biochemical and instrumental examinations were recorded. RESULTS: Altogether Transient Ischemic Attack (TIA) represented almost half the records; remaining cases could be classified as ischemic stroke (66% vs 55%), Intracerebral Haemorrhage (17% vs 26%) and subarachnoideal haemorrhage (17% vs 19%) (1985 vs 1992, respectively). The mean hospitalization period was longer in the most recent year, particularly in haemorrhagic patients (H-P, subarachnoid + intracerebral haemorrhage); the in-hospital case fatality rate was reduced in HP while it was significantly increased in those with Cerebral Ischemia (CI-P, TIA + ischemic stroke). The prevalence of blood hypertension, atrial fibrillation and dyslipidaemias rose significantly in 1992 compared to 1985. High plasma lipids were more frequently present in CI-P than in H-P; their 7-year increase was particularly related to combined forms, rather then isolated hypercholesterolemia or hypertriglyceridemia. CONCLUSIONS: These results do not agree with an hypothetical improvement in the prognosis of stroke in the period we considered. Besides the efforts aiming at reducing CRFs in the short term have not shown to be successful.

"Cyto-assisted", ultrasound-guided biopsy in the diagnosis of focal disease of the abdomen.

From May 1988 to June 1990, 260 patients with abdominal focal disease underwent ultrasonically guided percutaneous fine needle biopsy. The technique of so-called "FNAB-CYT" is described. The procedure entailed very few complications: the mortality rate was 0% and the morbidity rate was 1.5%. The specificity of the technique was 100%, and sensitivity was 93.43%. False-negative diagnoses were made in 8 cases, and in 5 patients the cytologic diagnoses were uncertain. There were no false-positives. The possibility of an immediate control of the collected material by the pathologist avoids the risk of inadequate samples and reduces the number of biopsies for the patient. Comparison among diagnoses on rapid and definitive preparations and histologic ones was carried out to evaluate the diagnostic efficiency of the cytologic procedure. In our experience, a rapid staining of the smears allowed a correct cytologic diagnosis in 87.7% of the cases within approximately 5 min of the biopsy. On the basis of our experience, the authors recommend FNAB-CYT as a routine first-level (less invasive) procedure for diagnosis of abdominal focal disease.