The impact of neonatologist performed echocardiography in an Italian neonatal unit.

BACKGROUND: The main goal of neonatologist performed echocardiography is to timely assess hemodynamic changes in order to properly manage unsteady neonates. Detailed structural heart assessment remains the domain of pediatric cardiologists. Nonetheless, many neonatologists take on an additional role in diagnosis of congenital heart defects, mostly compelled by the lack of in-house pediatric cardiology services. The experience of neonatologist performed echocardiography in an Italian neonatal unit was reported and the risk benefit profile of this practice was discussed. MATERIAL AND METHODS: We retrospectively reviewed the echocardiograms undertaken by the neonatologist on infants admitted to the neonatal unit and postnatal ward of the Hospital San Pio in Benevento, over a 2-year period. Details of scans and concordance between neonatologist and cardiologist were analyzed. RESULTS: A total of 160 echocardiographic studies were done by the neonatologist on 136 infants. The ECG was requested in a minority of infants. The most common reason for performing the echocardiogram was admission to the neonatal care unit. Around half of the echocardiograms were normal. The remaining scans resulted in functional and structural abnormalities, transitional changes, and doubtful findings. Cardiac anomalies were significantly more likely found in cases of echocardiograms performed for fetal indications. Only 28 patients were eventually referred to the cardiology services. The inter-rater agreement was satisfactory. CONCLUSIONS: The hemodynamic assessment of sick infants, as well as triaging and referral of neonates with structural heart diseases are valuable advantages of the echocardiography run by neonatologists.Collaboration with pediatric cardiologists and robust training and accreditation programs are essential to ensure safety and quality service.

[Giant cell arteritis and necrosis of the small intestine. Report of a case]. / Artérite giganto-cellulaire et nécrose du grêle. A propos d'un cas.

We report a case of giant cell arteritis involving the temporal and mesenteric arteries, revealed by necrosis of the small bowel in a 75-year-old woman. The literature concerning similar cases is discussed.

[Dose-response study of bunazosin in the treatment of light-to-moderate arterial hypertension]. / Studio dose-risposta sulla bunazosina nel trattamento dell'ipertensione arteriosa lieve-moderata.

INTRODUCTION: The antagonists of alpha-adrenergic receptors were introduced in the therapy of arterial hypertension in 1950, but have had limited use due to the poor efficacy and safety of some drugs belonging to this pharmacological class. A recent molecule from this class, bunazosin, is a highly selective alpha 1-antagonist, whose long half-life allows a single daily administration. The aim of this study was to identify the minimum effective dose of bunazosin in the treatment of mild-moderate arterial hypertension. MATERIALS AND METHODS: Patients of both sexes, aged over eighteen years, suffering from mild/moderate essential arterial hypertension were admitted to the study. The experimental design was controlled between patients; and the study was carried out in accordance with the principles of Helsinki anf Tokyo. Dosage was of 3 and 6 mg/day per os; after 2 weeks' treatment, if DBP in clinostatism > or = 95 mmHg, the dose was doubled. Treatment lasted four weeks. RESULTS: At the end of treatment, in the group of patients initially treated with 3 mg/day, SBP, in clinostatism fell by 10.0% and DBP by 8.4% (p < 0.01 between times); in the group of patients initially treated with 6 mg/day, the reductions were of 9.2% and 6.5% respectively (p < 0.01 between times). Heart rate, electrocardiograph traces and laboratory parameters showed no clinically significant modifications. The safety profile of the treatment was excellent in 80% of the patients treated overall. DISCUSSION: This study allowed the minimum effective dose of bunazosin, equal to 3-6 mg/day, to be identified, as well as confirming the antihypertensive efficacy of the drug and its ample safety margin. In fact, this range of daily dosage led to a fall in pressure values, without causing clinically significant alterations of heart rate, electrocardiograph traces and laboratory parameters. CONCLUSIONS: In conclusions, in mild/moderate arterial hypertension, bunazosin in monotherapy at the dosage of 3-6 mg/day, is an effective and safe treatment.

Effects of angiotensin converting enzyme inhibitors on left ventricular hypertrophy.

It is well known that, in patients with essential hypertension, left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular disease. However, it has been demonstrated that normalisation of arterial pressure, by therapy with antihypertensive drugs, is associated with regression of LVH, although the extent and time-course of this phenomenon depend on the antihypertensive drug used. In particular, angiotensin converting enzyme (ACE) inhibitors seem capable of inducing a faster and more complete reversal of LVH in patients with essential hypertension than other antihypertensive drugs. The mechanisms underlying this property of ACE inhibitors remain unclear, although 2 features of ACE inhibitors may be particularly relevant. The first is their ability to improve large artery compliance, this being a major determinant of LVH. Arterial compliance is reduced in essential hypertension, resulting in increased left ventricular end-systolic stress, which then contributes to the development of LVH. The second possible mechanism by which ACE inhibitors reverse LVH to a greater degree than other antihypertensive drugs may relate to their ability to interfere with the cardiopulmonary receptor control of the circulation. Thus, ACE inhibitors may counteract the neural and hormonal abnormalities that contribute to the maintenance of LVH in hypertensive patients.