Comparison of 12-lead repolarization parameters during follow-up study in middle-aged sportsmen and in patients during acute myocardial infarction.

Consecutive electrocardiographic (ECG) analysis is very useful in acute coronary ischemia, but it is known that ECG patterns can be misleading in subjects with left ventricular hypertrophy, mainly during the repolarization phase. An automated system was developed to collect, store, and follow-up all heterogeneous data concerning a cohort of 1,898 subjects (1,039 men), 45-65 years old, 50% of whom were physically active. The reliability of several ECG markers of ischemia was tested during chronic follow-up study (1993-1995) in 23 healthy sedentary men without hypertension (group 1) recorded in our database, as well as in 9 subjects performing regular sporting activity (SA) (group 2). The same parameters were evaluated in the intensive care unit in nine patients affected by coronary artery disease, during either successful or unsuccessful thrombolytic therapy of acute myocardial infarction (AMI) (group 3). Twelve-lead ECGs were recorded, analyzed by the Hannover ECG system program, compressed, and stored according to the Standard Communication Protocol in each of the three groups. The changes in ST amplitude 20, 60, and 80 ms alter the J point were very small in each subject of groups 1 and 2, while upsloping from 1 to 10 mm in several leads was observed slowly, rapidly, or intermittently in group 3 patients during ischemia. The ST slope and the concordance of the T wave and ST amplitude were helpful in differentiating normal and SA subjects from AMI patients. These results, obtained in resting conditions, underline that the difference among ST-T abnormalities in subjects with left ventricular hypertrophy due to SA are consistently different from those observed in patients with AMI. The serial digital ECG can be helpful to underline these differences.

Phase II study of interferon alpha-2a and dacarbazine in advanced melanoma.

Based on the report of some activity of combination therapy with dacarbazine (DTIC) and interferon alpha-2a (rIFN alpha-2a) in disseminated melanoma, we conducted a phase II study to determine the feasibility and efficacy in a large series of patients. DTIC was administered in 79 patients at the dose of 800 mg/m2 every 3 weeks and rIFN alpha-2a was given daily at the dose of 9 X 10(6) IU for the first 10 weeks and three times a week thereafter. Among the 75 evaluable patients, 25% achieved an objective response, with 8% complete and 17% partial remissions. The regression occurred within a mean time of 1.9 +/- 1.03 months from starting therapy and the mean duration of response was 8.2 +/- 4.2 months. The major side effects were vomiting, anorexia, fever, fatigue, and myalgia. There was one death related to sepsis after myelosuppression. In the other patients bone marrow and liver toxicities were not remarkable. Our data reveal that a combination regimen of rIFN alpha-2a with a cytotoxic agent has some therapeutic activity in the management of advanced malignant melanoma.