Clinical significance of abnormal electrocardiographic patterns in trained athletes.

BACKGROUND-The prevalence, clinical significance, and determinants of abnormal ECG patterns in trained athletes remain largely unresolved. METHODS AND RESULTS-We compared ECG patterns with cardiac morphology (as assessed by echocardiography) in 1005 consecutive athletes (aged 24+/-6 years; 75% male) who were participating in 38 sporting disciplines. ECG patterns were distinctly abnormal in 145 athletes (14%), mildly abnormal in 257 (26%), and normal or with minor alterations in 603 (60%). Structural cardiovascular abnormalities were identified in only 53 athletes (5%). Larger cardiac dimensions were associated with abnormal ECG patterns: left ventricular end-diastolic cavity dimensions were 56. 0+/-5.6, 55.4+/-5.7, and 53.7+/-5.7 mm (P<0.001) and maximum wall thicknesses were 10.1+/-1.4, 9.8+/-1.3, and 9.3+/-1.4 mm (P<0.001) in distinctly abnormal, mildly abnormal, and normal ECGs, respectively. Abnormal ECGs were also most associated with male sex, younger age (<20 years), and endurance sports (cycling, rowing/canoeing, and cross-country skiing). A subset of athletes (5% of the 1005) showed particularly abnormal or bizarre ECG patterns, but no evidence of structural cardiovascular abnormalities or an increase in cardiac dimensions. CONCLUSIONS-Most athletes (60%) in this large cohort had ECGs that were completely normal or showed only minor alterations. A variety of abnormal ECG patterns occurred in 40%; this was usually indicative of physiological cardiac remodeling. A small but important subgroup of athletes without cardiac morphological changes showed striking ECG abnormalities that suggested cardiovascular disease; however, these changes were likely an innocent consequence of long-term, intense athletic training and, therefore, another component of athlete heart syndrome. Such false-positive ECGs represent a potential limitation to routine ECG testing as part of preparticipation screening.

[Embolism in an elderly diabetic patient following hyperosmolar coma]. / Emiballismo in paziente diabetica anziana insorto dopo coma iperosmolare.

The authors report a case of hemiballismus in an old patient with diabetes and hypertension, developed after a non ketotic hyperosmolar coma episode. In agreement with the recent literature, the syndrome is not always caused by a single Luys body lesion, but also by complex scattered lesions demonstrable only by RMN. A possible pathogenetic role of the recent non ketotic hyperosmolar diabetic coma and the good prognosis indicate that the vascular aetiology, even if prevalent, could not be the only one. The role of institutionalization of the patient during the development of the syndrome has also been discussed.

Seizures during concomitant treatment with theophylline and ranitidine: a case report.

H2-antagonists such as cimetidine and ranitidine are metabolized by cytochrome P-450. In this way they may interfere with theophylline metabolism. Cimetidine is known to have this effect and frequently to induce a theophylline toxic effect, while data concerning ranitidine are more uncertain. In this paper, we report the case of a 67-year-old woman with non-insulin dependent diabetes. She was taking aminophylline for respiratory failure and after ranitidine infusion exhibited generalized convulsions. Theophylline values which were monitored within the therapeutic range, increased toxic levels after ranitidine therapy and epileptic episodes. The increase in theophylline levels was associated with a further reduction in the clearance rate of the bronchodilator. We think that ranitidine may combine with other clinical factors known to reduce theophylline metabolism mainly in the elderly and severely ill patients. Theophylline-induced seizures may occur when theophylline serum levels are slightly above the therapeutic range, as in our case report.

Thiol containing antioxidant drugs and the human immune system.

The over production of toxic oxygen species (TOS) by the phagocytic cells involved in inflammatory processes plays a crucial role in generating the immune defects which characterize both infections and neoplastic diseases. Since the thiol containing drugs, and N-acetylcysteine possess a high capacity for scavenging and inhibiting TOS, the question of whether these substances are able to protect, in vivo as well as in vitro, the function of lymphocytes isolated from the peripheral blood in patients suffering from chronic pulmonary diseases (CPD) was investigated. The lymphocytes isolated from healthy donors as well as those from CPD patients exposed in vitro to TOS showed a reduced viability and an impairment of functions in: (a) the ability to express HLA Class II and TAC antigens and (b) the capacity to stimulate and proliferate in allogenic (MLR) and autologous mixed lymphocyte reactions (AMLR). The presence of NAC or CAT blocked this toxicity. Cells isolated from healthy donors and patients following treatment with NAC were less sensitive to the in vitro toxicity of TOS.

Effects of a new heterocyclic glucocorticoid, deflazacort (DFC), on the functions of lymphocytes from patients with rheumatoid arthritis (RA).

Deflazacort (DFC) is a new glucocorticoid which, when compared with prednisone (PDN), has similar anti-inflammatory actions, but lacks several unwanted side effects on mineral and carbohydrate metabolism. DFC is more efficient than PDN in inducing immunomodulatory effects. This study concerns twelve patients with classical RA who required corticosteroid therapy because of the ineffectiveness of other drugs. Six patients received 12 mg/day of PDN from day 1 to day 21 and 15 mg/day of DFC from day 29 to day 50. The second group of six patients received DFC initially followed by the PDN dosing regimen. At various times (4, 8, 24, 48 and 72 h) after the first administration of steroid, and 7, 14 and 21 days after the beginning of the treatment with PDN or DFC the following tests were performed the phenotype of T lymphocytes isolated from peripheral blood; the evaluation of the expression of HLA Class 2 antigens by PHA primed T cells; and the analysis of cell behavior in mixed lymphocyte reactions. The data reported in this paper show that the oral administration of DFC to patients with RA affects the in vitro behavior of their lymphocytes. This immunomodulatory effect of DFC concerns both the phenotype and function of RA lymphocytes. Moreover it differs in both intensity and kinetic characteristics from the immunomodulating effect observed with PDN (control).

Deficiency of the autologous mixed lymphocyte reactions of non-T/T and T/T type in intravenous drug abusers infected by the human immunodeficiency virus (HIV).

In the present study both responsiveness and stimulatory capacity in autologous mixed lymphocyte reactions (AMLRs) of non-T/T and T/T type, as well as in allogeneic mixed lymphocyte reaction (MLR), were evaluated in 30 intravenous drug abusers (IDAs) infected by the human immunodeficiency virus (HIV) and in 10 HIV-negative IDAs. The production of interleukin 2 (IL2), and the expression of HLA Class II antigens and IL2 receptors by PHA-activated T lymphocytes were also evaluated. A severe impairment of both responsiveness and stimulatory capacity in MLR and AMLRs was found in the HIV-positive IDAs and not in the HIV-negative IDAs. The HIV-positive IDAs showed also a defective expression of HLA Class II antigens, whereas the IL2 production and the IL2 receptor expression were in the normal range. The present data are consistent with similar observations in male homosexuals with AIDS-related complex and confirm that the HIV infection induces a broad spectrum of immunological abnormalities leading to a progressive derangement of the immunocompetence.

Na+/K+-dependent adenosinetriphosphatase activity in the skin, kidney and muscle in Xenopus laevis (Daud.) adult specimens under different experimental conditions.

Xenopus laevis adult specimens were exposed to environmental changes simulating those undergone by these animals in their natural "habitat". After keeping groups of animals under dry conditions, some of them were returned to water. In both cases some parameters were compared with those of control animals kept in water. A lower activity in the Na+/K+-dependent ATPase of the epidermis and striated muscle was detected in "dry" animals with respect to the control ones or those rehydrated whereas the same ATPase activity in the kidney was higher in "dry" animals than in those from the other groups.