Coronary vasospasm as a source of false positive results during dobutamine echocardiography.

BACKGROUND: Several studies have demonstrated a consistently high sensitivity of dobutamine echocardiography whereas test specificity in these series has been variable. The aim of this study was to evaluate whether coronary vasospasm--elicited by alpha1 adrenoreceptor stimulation--may be a significant source of false positive responses during dobutamine stress. METHODS: From the data bank of four institutions we selected 113 patients (75 males, 38 females, mean age 55 +/- 12 years) with dobutamine echocardiography performed (up to 40 micrograms/kg/min and atropine 1 mg if needed) before a coronary angiography showing normal or near normal (visually assessed stenosis severity < 50%) coronary arteries. The following variables--which were previously reported influencing dobutamine echo specificity--entered the multivariate statistical analysis: age, sex, heart rate at baseline and at peak stress, baseline echo, hypertension, site of asynergy, and spasm at coronary angiography. RESULTS: Twenty-five patients had a positive dobutamine test. The positivity occurred in the left coronary territory in 15 and in the right coronary territory in 10 cases. All the 6 patients with spontaneous spasm during angiography had a false positive stress test result. By multivariate analysis only coronary artery spasm during angiography (p = 0.0015) and history of hypertension (p = 0.0031) were significant predictors of false positive results of dobutamine stress echocardiography. CONCLUSIONS: Coronary artery spasm may be an important source of false positive results during dobutamine stress echocardiography.

[Pulmonary involvement in a case of CREST syndrome]. / Interessamento polmonare in un caso di sindrome CREST.

The paper describes the clinical, X-ray and functional aspects of lung involvement in a case of CREST syndrome, a variant of systemic sclerosis. The characteristic signs of the disease were associated in this patient with lung involvement in the form of widespread interstitial fibrosis complicated by the presence of alveolar cysts in the lower lobes. The state of severe chronic respiratory insufficiency was the most unfavourable factor in the prognosis for this patient, in particular in the light of the disappointing response to corticosteroid therapy.

[Cytological exam of the pleural fluid in the diagnosis of neoplastic pleuritis. Cases contribution]. / L'esame citologico del liquido pleurico nella diagnostica delle pleuriti neoplastiche. Contributo casistico.

The relevance of cytologic procedures in the diagnosis of malignant pleural effusions is evaluated. Pleural fluid sample obtained from 48 patients with malignant disease (39 metastatic tumors, 9 mesotheliomas), were studied to search for cancer cells. The results were: 32 (66.6%) patients had a cytologic diagnosis of malignant pleural effusions; 16 malignant specimens were not confirm by pleural fluid cytologic analysis. In our experience the cytologic diagnosis of malignant pleural effusions are more frequent in metastatic disease, especially in lung cancer.

[Evaluation of the bronchial tonus, basal and following bronchodilators, in subjects with allergic rhinitis]. / Valutazione del tono bronchiale, basale e dopo broncodilatatore, in soggetti con rinite allergica.

Data emerging from forced, basal and postbronchodilator expirograms in asymptomatic allergic rhinitis patients have been compared with those from a group of normal controls. Basal averages and average percentage variations after the bronchodilator show that MEF 75, FEF 25-75 and, to a lesser extent, FEV1 are able to differentiate atopic rhinitis patients from the normal. Comparison between percentages in patients arbitrarily considered bronchodilator positive in the two groups reveals significant differences in MEF 75 and FEF 25-75 but not in FVC and FEV1. Atopic rhinitis patients feature increased basal bronchial tone largely maintained by latent bronchospasm. Measurement of forced, basal and postbronchodilator flows can supply useful indications for the study of allergic rhinitis patients.

Breathing pattern assessment in normocapnic and hypercapnic patients in chronic obstructive pulmonary disease.

Thirty-six patients, 24 normocapnic (mean age +/- SD: 60 +/- 10) and 12 hypercapnic (mean age +/- SD: 64 +/- 9) were compared with a control group (10 volunteers, mean age +/- SD: 46 +/- 8) for the following patterns of respiratory drive and respiratory timing: (1) mean inspiratory flow (Vt/Ti); (2) mouth occlusion pressure 100 ms after the onset of inspiration (P 0.1) and minute ventilation (Ve); (3) inspiratory duty cycle Ti/Tt). The data suggest COPD "respiratory patterns" which may be characterized by the following features: (1) increased mean inspiratory flow (Vt/Ti); (2) increased P 0.1 (in absolute values), P 0.1/Ve and P 0.1/Vt/Ti; (3) reduction in inspiratory duty cycle (Ti/Tt). Changes are more evident in inspiratory duty cycle among hypercapnic pts. When respiratory obstruction becomes worse and hypercapnia appears, the Ti/Tt decrease could be explained by a reduction in diaphragm muscle work, that can prevent the failure of diaphragmatic contractility.

[A case of spasmophilic syndrome]. / Osservazioni su un caso di sindrome spasmofilica.

The case is described of a 43 year old woman with spasmophilic syndrome. For 12 years she had suffered from fainting fits, marked morning asthenia, anxiety, depression, widespread arthromyalgia, blood pressure fluctuations, precordial pains, paresthesia and painful nocturnal cramp. This clinical picture appeared in a subject with a double left kidney and stones in the supernumerary ureter, enlargement of the pancreatic head and tail revealed by a CAT scan and an earlier cholecystectomy. Given the multiplicity of symptoms diagnosis was necessarily by a process of elimination. The data providing grounds for optimism were a positive Chvostek's sign, stable calcium phosphorus profiles, a reduction in ionised calcium and favourable eletromyographic readings.

[A case of amyloidosis associated with a solitary micromolecular plasmocytoma]. / Considerazioni su un caso di amiloidosi associata a plasmocitoma micromolecolare solitario.

Amyloidosis associated with myeloma and its current classification are examined. The clinical example is reported of a patient with isolated micromolecular plasmocytoma in whom the amyloidosis appeared during the remission of the primary disease. The patient was not seen until a late stage when he was admitted to hospital with severe cardiac decompensation. Echocardiography revealed the location to be the cardiac muscle. The increase in left ventricular mass revealed by the ECG was in contrast with the low ECG voltages. Biopsy showed involvement of the oral cavity. The condition resisted all treatment and the patient died a few months after the onset of the amyloidosis. The view that amyloidosis associated with plasma cell dyscrasias should be classified with primary amyloidosis is supported.