[Identification of patients with acute myocardial infarction that may be discharged early: prospective evaluation with simple clinical and instrumental indicators]. / Identificazione di pazienti con infarto miocardico acuto dimissibili precocemente: valutazione prospettica mediante semplici indicatori clinici e strumentali.

BACKGROUND: The hospital stay for "uncomplicated" acute myocardial infarction (AMI) is often too long. A reduction in the length of hospitalization, if proven to be safe, is advantageous in terms of costs and health organization. Accordingly the aims of the present, prospective study, were to evaluate: 1) the patients with AMI eligible for early discharge; 2) the incidence of adverse cardiovascular events within 2 weeks of myocardial infarction; 3) the incidence of cardiovascular mortality at 6-month follow-up. METHODS: On the fifth day after AMI, 331 of 526 patients, consecutively admitted to our coronary care unit between March 1997 and August 1999, were assigned to "complicated" and "uncomplicated" AMI groups, according to clinical and non-invasive criteria. Uncomplicated myocardial infarction eligible for early discharge was defined in patients < 75 years, as the absence of a high risk personality, stroke, left bundle branch block, transient myocardial ischemia after the first 24 hours from AMI, clinical signs or echocardiographic evidence of left ventricular dysfunction (ejection fraction < 40%), ventricular fibrillation, sustained ventricular tachycardia, symptomatic bradyarrhythmias after the first 48 hours from AMI, cardioversion or defibrillation (after the first 48 hours) or the need for coronary angioplasty or coronary artery bypass grafting. Uncomplicated patients were discharged on the sixth day after AMI (hospital stay 6.5+/-0.72 days). A symptom-limited ergometric stress test was planned in the uncomplicated group 14 days after AMI. "Hard" (death, reinfarction) and "non-hard" (unstable angina, myocardial revascularization) adverse cardiovascular events were monitored at 2 weeks of follow-up, and cardiovascular mortality at 6-month follow-up. RESULTS: Four (1.2%) hard (0.3% exitus and 0.9% reinfarction) and 7 (2.1%) non-hard adverse events occurred among patients with uncomplicated AMI at 2 weeks of follow-up. Patients with uncomplicated AMI who developed adverse events, presented during the primary coronary event creatine kinase (CK) and CK-MB serum levels which were significantly lower than those observed in patients who did not present adverse events. In the complicated group (hospital stay 9.9+/-1.79 days), from day 6 to 14 after AMI, 65 (33%) hard and non-hard events occurred. A significant reduction in mortality between the uncomplicated and complicated group (2.11 vs 27.17%, p < 0.0001) was observed at 6-month follow-up. Multivariate analysis showed a statistically significant difference for age and thrombolytic treatment. CONCLUSIONS: This first Italian prospective study demonstrated the possibility of identifying, 5 days after AMI and on the basis of simple criteria and without a stress test, a low risk population of patients eligible for early discharge.

[Serum tumor markers in lung neoplasms (correlation with histological types)]. / Utilizzazione di alcuni markers tumorali sierici nelle neoplasie del polmone (rapporto con i quadri istologici).

The AA. have tested serum levels of ferritin, alpha-1-antitripsyn, C4 and Phosphohexoseisomerase (PHI) in 50 patients affected by primary lung cancer, 40 patients affected by chronic lung diseases and a control group of 40 healthy males and females. All the test have a percentage of pathological case higher in the group of neoplasms than in the group of chronic diseases and ferritin seems to have the highest sensitivity. Obtained results have been correlated also to the morphoradiological and histological kind of neoplasm. "Peripheral" morphoradiological kind and III WHO histological kind are the group with more pathological cases. All the data have been statistically controlled.

[Comparison of two methods for measuring human serum immunoglobulins (laser-nephelometry and radial immunodiffusion)]. / Confronto fra due metodi di dosaggio delle immunoglobuline sieriche uwane (laser-nefelometria e immunodiffusione radiale).

The AA. have tested 50 serum samples for immunoglobulins (IgG, IgA, IgM) with two different methods: laser-nephelometry (LN) and radial immunodiffusion (RID). Mean values of IgG and IgA are almost the same in the two tested methods and there is a good correlation between LN and RID (IgG: r = 0,98; IgA: = 0,96). Also IgM have showed a good correlation (r = 0,987) but mean values obtained with LN are just a few lower than those obtained with RID. Regression lines, calculated for all the Ig, confirm these conclusions. The AA. conclude affirming that the obtained difference for IgM is due to the different standards used for LN and RID determinations.

[Serum levels of GPI, AAT and CEA in primary lung neoplasms and chronic bronchopneumopathies]. / I livelli sierici di GPI, A1AT e CEA nelle neoplasie polmonari primitive e nelle broncopneumopatie croniche.

The Authors have tested serum levels of alpha-1-antitrypsin (A1AT), phosphohexose-isomerase (GPI) and carcinoembryonic antigen (CEA) in 133 patients affected with primary lung cancer, not treated with any drug, and in 183 patients affected with not neoplastic lung diseases or healthy, to control the utility of these markers in the early diagnosis of lung cancer. In many patients all the tests have been made at the same time. The three tumoral markers have been also examined in connection with the histological kinds of lung cancer. Results show that is suitable to test GIP and A1AT at the same time because they are percentually more pathological; serum levels of CEA, that are not very elevated in the pathological cases, seem in correlation with the histological kind of cancer.