RESUMO
A comprehensive pilot study was carried out to experimentally assess the potential of newly developed treatment trains integrating two-stage AOPs and biofiltration to reach potable reuse water quality standards from municipal wastewater. The processes consisted of a two-stage AOPs with (carbon or limestone) biofiltration, the first AOP (O3/H2O2) serving as pre-treatment to biofiltration and the second AOP (UV254/H2O2) serving as post-biofiltration finishing step to ensure advanced disinfection. A comprehensive monitoring campaign was put in place resulting from the combination of targeted, non-targeted and suspect screening measurements. It was found that 13 organic micropollutants were detected from a list of 219 suspects although at ng/L level only. For the treatment conditions piloted in this study (O3â¯=â¯13⯱â¯0.5â¯mg/L, H2O2â¯=â¯11⯱â¯0.4â¯mg/L for the O3/H2O2 process, and UVâ¯=â¯410⯱â¯63.5â¯mJ/cm2, H2O2â¯=â¯5â¯mg/l for the UV254/H2O2 process), it was possible to estimate the overall removal efficacy for each unit process, which was found to follow this order: RO (99%)⯠>â¯BAC (87%) >â¯O3-H2O2 (78%)⯠>â¯BAL (67%) â¯>â¯UV/H2O2 (43%)⯠>â¯AOP contact chamber (19%)⯠>â¯UF(0%), with the treatment train integrating two AOPs and granular biofiltration with activated carbon (O3/H2O2 + BAC + UV254/H2O2) showing superior performance with a 99% abatement in total micropollutants. No ecotoxicologically-positive response was generally observed for any of the effluent samples from the tested trains, even when pre-concentration factors up to 100-1000 times were employed to increase the sensitivity of the bioassay methods.
Assuntos
Água Potável/química , Filtração/métodos , Águas Residuárias/química , Poluentes Químicos da Água/análise , Purificação da Água/métodos , Carvão Vegetal/química , Desinfecção , Peróxido de Hidrogênio/química , Oxirredução , Ozônio/química , Projetos Piloto , Raios UltravioletaRESUMO
AIMS: The histological modification produced by neoadjuvant chemoradiation on primary rectal cancer has been investigated by many authors, and a prognostic value of tumor regression grade (TRG) has been identified. Tumor regression grade on metastatic mesorectal lymphnodes has been never evaluated. The purpose of this study is to analyse the TRG on mesorectal lymphnodes (lymphnode regression grade, LRG) after preoperative chemoradiation in rectal cancer patients and to determine the correlation with TRG of primary tumor. METHODS: Surgical specimens from 35 patients who underwent chemoradiation were included. LRG on mesorectal lymphnodes was assessed by immunohistochemistry. Response to treatment was evaluated by a 5-point LRG based on the ratio of residual tumor to fibrosis. RESULTS: Complete pathologic response (LRG 1) was observed in 18 patients (51%). In 4 patients (11%) no regression was observed (LRG 5). In 4 cases only reactive lymphnodes were found. LRG on lymphnodes significantly correlated with TRG on primary tumor (p<0.05). CONCLUSIONS: Neoadjuvant chemoradiation determines a tumor regression on mesorectal lymphnodes as on primary tumor; further studies are needed to evaluate the prognostic value of LRG.
Assuntos
Linfonodos/patologia , Terapia Neoadjuvante , Neoplasias Retais/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Fracionamento da Dose de Radiação , Feminino , Fibrose , Humanos , Metástase Linfática/patologia , Metástase Linfática/prevenção & controle , Masculino , Estadiamento de Neoplasias , Neoplasia Residual/patologia , Peritônio , Radioterapia Adjuvante , Neoplasias Retais/patologia , Reto , Indução de Remissão , Estudos Retrospectivos , Resultado do TratamentoRESUMO
AIMS: To evaluate the cytoplasmic and nuclear expression of hepatic growth hormone receptor (GHR) in different stages (S0, S1, S3 and S4, according to Knodell's classification) of chronic liver disease (CLD) and in hepatocellular carcinoma (HCC). METHODS AND RESULTS: Liver specimens from 31 patients with hepatitis C virus-related CLD, five patients with HCC and nine controls were examined for expression of hepatic GHR by immunohistochemistry with MAb 263. Cytoplasmic and nuclear staining were evaluated as a percentage of positively stained cells. The cytoplasmic expression of GHR was comparable between normal liver and S0 hepatitis, while it progressively decreased in S1, S3 and S4 CLD (P < 0.01). Conversely, nuclear GHR showed increased expression in S3 and S4 CLD (P < 0.05). No differences were observed between HCC and normal liver in terms of GHR immunoreactivity. CONCLUSIONS: This is the first study to show that the subcellular expression of hepatic GHR changes with the progression of CLD. The increase in nuclear expression of GHR with advanced stages of CLD suggests that GH may act directly at the nuclear level to promote hepatocyte proliferation/regeneration.
Assuntos
Carcinoma Hepatocelular/patologia , Hepatite C Crônica/patologia , Neoplasias Hepáticas/patologia , Fígado/patologia , Receptores da Somatotropina/análise , Adulto , Idoso , Carcinoma Hepatocelular/metabolismo , Núcleo Celular/química , Citoplasma/química , Progressão da Doença , Feminino , Hepatite C Crônica/metabolismo , Humanos , Imuno-Histoquímica , Fígado/química , Neoplasias Hepáticas/metabolismo , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: The main purpose of this study was to compare efficacy, tolerability and influence on quality of life (QOL) of nifedipine gastrointestinal therapeutic system (NI) 30-60 mg once a day vs amlodipine (AM) 5-10 mg once a day in elderly patients with mild-moderate hypertension. DESIGN: This was a randomized, double-blind, parallel-group, multicenter study. After a 2-week single-blind placebo run-in, patients were randomized to either NI 30 mg or AM 5 mg. Responders continued on the same dosage for 16 additional weeks, while non-responders were titrated to 60 mg NI or 10 mg AM. METHODS: Blood pressure was measured by mercury sphygmomanometer and efficacy equivalence of NI and AM tested by covariance analysis. Diastolic blood pressure (DBP) was the primary efficacy parameter, its baseline value being taken as covariate while centers effect and treatment interaction were included as fixed effects in the analysis model. The secondary efficacy variables systolic blood pressure (SBP) and scores for QOL were analyzed according to the same model. RESULTS: At the end of the study, overall mean DBPs, calculated as least-square means (LSMEANS), in the "by protocol" population were 87.5 mmHg for NI and 86.7 for AM (difference 0.8 mmHg with 90% CI -1.2 to 2.8 mmHg). In the "by intention to treat" (ITT) population LSMEANS were 87.6 mmHg for NI and 86.4 mmHg for AM (difference 1.2 mmHg with 90% CI -0.6 to 3.1 mmHg). SBP LSMEANS in the "by protocol" population were 147.7 mmHg for NI and 147.3 mmHg for AM (difference 0.3 mmHg, with 90% CI -3.7 to 4.3); corresponding values in the "by ITT" population were 148.0 mmHg for NI and 147.2 for AM (difference 0.8 mmHg, with 90% CI -2.8 to 4.6). Mean values for QOL parameters were not significantly different. A total of 173 episodes of adverse events were documented in 54 patients (26 NI and 28 AM), dropouts were 15 (20% of group) on NI and 21 (28%) on AM. CONCLUSIONS: NI 30-60 mg was shown to be as efficacious and safe as AM 5-10 mg in elderly patients with mild-moderate hypertension. QOL improved compared to baseline with no significant difference between the two drugs, thus confirming a positive class effect for calcium antagonists.
Assuntos
Anlodipino/administração & dosagem , Bloqueadores dos Canais de Cálcio/administração & dosagem , Hipertensão/tratamento farmacológico , Nifedipino/administração & dosagem , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Anlodipino/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Bloqueadores dos Canais de Cálcio/efeitos adversos , Método Duplo-Cego , Humanos , Hipertensão/complicações , Pessoa de Meia-Idade , Nifedipino/efeitos adversos , Equivalência TerapêuticaRESUMO
In the following article three cases of supravalvular aortic stenosis are presented: the first two cases refer to two brothers. The older, a 22-year-old man presenting with palpitations, underwent echocardiography and Doppler that showed an hour-glass supravalvular aortic stenosis with a peak gradient of 115 mmHg, associated with dilation of the left main coronary artery and stenosis of the left carotid artery at its origin. The patient's family was evaluated by echocardiography, and an 18-year-old brother was similarly found to have an hour-glass supravalvular aortic stenosis, graded mild to moderate (peak gradient 40 mmHg). Both cases are probably familiar forms of supravalvular aortic stenosis with normal facies and intelligence (autosomal dominant transmission). The elder brother, with severe stenosis, underwent surgical replacement of the ascending aorta. The third patient was a 23-year-old woman with a previous diagnosis of congenital aortic stenosis. Her characteristic elfic facies induced us to suspect the syndrome of Williams-Beuren; transthoracic and transesophageal echocardiographic examination showed an hour-glass supravalvular aortic stenosis with a peak gradient of 60 mmHg. Magnetic resonance imaging showed hypoplasia of the descending aorta and the iliac arteries. Since she was asymptomatic and presented only with a moderate gradient, the patient was not referred to surgical therapy. In this manuscript we present the three cases and review the histopathological, clinical, genetic, diagnostic and therapeutic aspects of this disease and its natural history.
Assuntos
Estenose Aórtica Supravalvular/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Masculino , UltrassonografiaRESUMO
This report describes the case of a 60-year-old patient, affected by alcoholic hypokinetic dilated cardiomyopathy, drug refractory, without surgical indication for ischemic and valvular diseases, implanted with a biventricular pacemaker. The implant was followed by a rapid clinical improvement which allowed the patient's discharge in satisfactory conditions and with strongly reduced diuretic therapy. Ventricular pacing became only left due to increased right ventricular threshold. As a consequence a remarkable decrease in cardiocirculatory compensation was observed, with a new hospitalization due to worsening dyspnea and edema. The instrumental evaluation showed a worsening of the parameters linked to interventricular delay, particularly the interventricular septum activation delay and the reduction in its kinesis. An increase in the ventricular stimulation amplitude led again to a complete capture in both ventricles, with an improvement of interventricular synchronization parameters and septal kinesis. This fact turned into a rapid recovery of satisfactory cardiocirculatory compensation with subsequent patient's discharge.
Assuntos
Estimulação Cardíaca Artificial , Eletrocardiografia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Free-wall rupture of the heart is the second most common cause of death in acute myocardial infarction (AMI), following pump failure. Acute rupture is more common and rapidly fatal, while subacute rupture, which accounts for about 30% of total cases of mortality in AMI, can be diagnosed early by clinical signs with the support of echocardiography in coronary intensive care units. METHODS: From March 1996 to December 1997, 293 patients diagnosed with acute myocardial infarction were admitted to the coronary intensive care unit of our hospital. Of these patients, 71 (23.8%) were treated with thrombolysis within 6 hours of onset of symptoms. All patients were observed daily with M-2D color Doppler echocardiography and in the event of renewed chest pain, electrocardiogram changes, abrupt hypotension, syncope or clinical signs of low output syndrome. RESULTS: We observed 11 cases (3.8%) of free-wall rupture of the heart in acute myocardial infarction with echocardiography, 6 females and 5 males, with a mean age of 74.2 +/- 7.8 years (min. 56-max 84), none of whom had prior AMI. Six of them received thrombolytic therapy, six were hypertensive (54.5%) and three were diabetics (27.2%). Surgical repair was performed in two patients with subacute rupture, but one died a few days later. The echocardiography data at bedside for diagnosis of cardiac rupture were confirmed in 5 patients with autopsy and intraoperatively in two of them. CONCLUSIONS: Routine use of echocardiography in coronary intensive care units allows prompt diagnosis of cardiac rupture in acute myocardial infarction, and in the event of subacute rupture it can accelerate surgical decision-making.
Assuntos
Cuidados Críticos , Ecocardiografia Doppler em Cores/métodos , Ecocardiografia/métodos , Ruptura Cardíaca Pós-Infarto/diagnóstico por imagem , Idoso , Unidades de Cuidados Coronarianos , Eletrocardiografia , Feminino , Fibrinolíticos/uso terapêutico , Ruptura Cardíaca Pós-Infarto/patologia , Ruptura Cardíaca Pós-Infarto/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Proteínas Recombinantes/uso terapêutico , Estreptoquinase/administração & dosagem , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêuticoRESUMO
This article reports a case of infective endocarditis in a patient with a permanent pacemaker 15 months after the generator had been replaced. The patient had Staphylococcus epidermidis isolated in several blood cultures. No interventional or clinical procedure with any risk of bacteremia was performed, nor was any infective complication of the pocket observed. Thus, the portal of entry of the etiologic agent is unclear. The role of transesophageal echocardiography in detecting pacemaker-induced endocarditis is very important and therapy of choice involves removal of the pacemaker system as soon as possible.
Assuntos
Endocardite Bacteriana/diagnóstico por imagem , Marca-Passo Artificial/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Estafilocócicas/diagnóstico por imagem , Staphylococcus epidermidis , Idoso , Idoso de 80 Anos ou mais , Antibacterianos , Doença Crônica , Terapia Combinada , Quimioterapia Combinada/uso terapêutico , Ecocardiografia , Eletrodos/efeitos adversos , Endocardite Bacteriana/terapia , Humanos , Masculino , Infecções Relacionadas à Prótese/terapia , Retratamento , Infecções Estafilocócicas/terapia , Valva Tricúspide/diagnóstico por imagemRESUMO
We describe the case of a 67-year-old patient, who had a stroke with subsequent right hemiparesis two years before coming under our observation. Afterwards he had no more pathological manifestation until he had sudden dyspnoea and marked cyanosis, following a prolonged immobilization due to intervention for slipped disc. Symptomatology regressed rapidly, and few hours later, the patient came under our observation in relatively fair conditions. Echocardiography evidenced moderate enlargement of right heart cavities; by subcostal view we visualized the presence of thrombotic material crossing the foramen ovale. Color Doppler showed moderate tricuspid regurgitation. Pulmonary artery systolic pressure was estimated about 55 mm Hg. The patient was immediately anticoagulated firstly by heparin, and secondly by warfarin, maintaining good clinical conditions. After a treatment of two more weeks he could be discharged with prescription of indefinite anticoagulation. Before discharge an echo examination showed the thrombus was no longer present. Pulmonary systolic pressure was estimated about 40 mm Hg. This is one of the rare cases of direct visualization of impending paradoxical embolus documented in the cardiologic literature.
Assuntos
Ecocardiografia , Tromboembolia/diagnóstico por imagem , Idoso , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/tratamento farmacológico , Quimioterapia Combinada , Septos Cardíacos/diagnóstico por imagem , Heparina/uso terapêutico , Humanos , Masculino , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/tratamento farmacológico , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , Tromboembolia/tratamento farmacológico , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/tratamento farmacológico , Varfarina/uso terapêuticoRESUMO
Two cases of cardiac glycogen storage disease type II are described: the first one, male aged 3 months, presented with generalized muscular hypotonia and decreased deep tendon reflexes; a 2/6 systolic murmur was audible at the left sternal border; chest X-ray and ECG were consistent with left ventricular hypertrophy; an echocardiogram disclosed an impressive and diffuse cardiac hypertrophy; the pump function appeared preserved and the estimated ejection fraction was about 70%. Pulsed wave Doppler demonstrated a normal envelope of mitral flow with E/A ratio = 1.27 in averaged 20 beats. The patient died suddenly at 6 months of age. The second patient was a female 4 months old with generalized muscular hypotonia. ECG and chest X-ray were consistent with left ventricular hypertrophy; 2D echocardiogram showed diffuse hypertrophy with estimated ejection fraction of 68% and an almost normal aspect of the mitral flow curve, with E/A ratio of 1.18. This child died at 13 months of age of cardiopulmonary insufficiency. In both cases the diagnosis was made by muscular biopsy and biochemical tests (alpha 1-4 glucosidase deficiency). We stress the fact that, despite the severe and diffuse hypertrophy, the pump function and the ventricular filling did not seem compromised.
Assuntos
Cardiomegalia/diagnóstico por imagem , Ecocardiografia Doppler , Ecocardiografia , Doença de Depósito de Glicogênio Tipo II/diagnóstico por imagem , Cardiomegalia/etiologia , Eletrocardiografia , Feminino , Doença de Depósito de Glicogênio Tipo II/complicações , Humanos , Lactente , MasculinoRESUMO
A seven-month-old girl had subaortic stenosis caused by a single intracavitary rhabdomyoma unassociated with tuberous sclerosis. Diagnosis was formulated on the basis of two-dimensional echocardiography and Doppler technique findings alone, and surgery was successful.
Assuntos
Doenças da Aorta/complicações , Estenose da Valva Aórtica/etiologia , Rabdomioma/complicações , Doenças da Aorta/diagnóstico , Doenças da Aorta/cirurgia , Estenose da Valva Aórtica/diagnóstico , Ecocardiografia , Ecocardiografia Doppler , Feminino , Humanos , Lactente , Rabdomioma/diagnóstico , Rabdomioma/cirurgiaRESUMO
The goal of shortening dialysis treatment time has stimulated the development of new, highly efficient dialytic strategies. In this study the Authors compared four different short dialysis treatments in terms of efficiency, clinical tolerance, technological investment and costs: 1) Rapid bicarbonate dialysis with 1.5 sq.m. cuprophane membrane; 2) High flux biofiltration with 1.2 sq.m. AN69S hollow fiber membrane; 3) Hemodiafiltration with 1.2-1.9. sq.m. polysulphonic hollow fiber hemodiafilters, and 4) High flux hemodiafiltration with two serial hemodiafilters with AN69s membrane (total 2.4 sq.m.). Hydraulic properties and solute clearances at different blood flows (300-500 ml/min) were tested for each technique. Once the optimal operative level was established three patients were treated with each technique for at least six months. Since BUN clearance averaged 310 ml/min, the treatment duration varied from 120 to 180 min/session with KT/V always higher than 1. The average protein catabolic rate was 0.9 g/kg/24h. Clinical tolerance was generally good, slightly better in treatments with a high convective component. Despite the greater efficiency of treatment No. 4, the technological requirements and costs are such that the others are currently more feasible and acceptable in clinical routine. The study demonstrates that reduction of dialysis treatment time is possible in all centres in a selected population with adequate blood access. Treatment No. 1 can even be performed with standard equipment and cuprophan membranes, while bicarbonate in the dialysate is mandatory. The real limit to shortening treatment time seems to be related to the maximal rate of ultrafiltration achievable in the patient during dialysis.
Assuntos
Hemofiltração/métodos , Diálise Renal/métodos , Adulto , Bicarbonatos/administração & dosagem , Velocidade do Fluxo Sanguíneo , Nitrogênio da Ureia Sanguínea , Humanos , Membranas Artificiais , Pessoa de Meia-Idade , Fatores de Tempo , Ultrafiltração , Ureia/sangueRESUMO
Idarubicin (IDA) is an anthracycline analog which differs from the parent compound by the substitution of a C4 methoxyl group with an hydrogen atom in the aglycone moiety. This drug has shown greater potency and activity in experimental and human leukemias and lymphomas by intravenous and oral routes of administration together with less cardiotoxicity than doxorubicin (DX) and daunorubicin (DNR). We have treated 15 patients with advanced multiple myeloma (MM) refractory or relapsed to standard chemotherapy regimens. The treatment schedule consisted of idarubicin 40 mg/m2 orally on day 1 every 3 weeks for 6-8 months. We obtained 8/14 partial response, 4/14 minor response and 2 progressions. One patient was not evaluable for the response because of liver toxicity not related to IDA administration. The median duration of response was 8 months with a minimum of 2 and a maximum of 12 months. Hematologic toxicity occurred in about 20% of patients and no treatment was delayed. Cardiotoxicity, defined as impairement of left ventricular ejection fraction (LVEF), was observed in one case. The major systemic toxicity observed was nausea in 80% of patients and vomiting in 40%. Hair loss resulting was socially acceptable. These results indicate that IDA is useful as a single agent, easy to administer, not cross resistant with DX and recommended for a combination regimen.
Assuntos
Antibióticos Antineoplásicos/uso terapêutico , Daunorrubicina/análogos & derivados , Mieloma Múltiplo/tratamento farmacológico , Adulto , Idoso , Antibióticos Antineoplásicos/efeitos adversos , Daunorrubicina/efeitos adversos , Daunorrubicina/uso terapêutico , Avaliação de Medicamentos , Feminino , Humanos , Idarubicina , Leucopenia/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Trombocitopenia/induzido quimicamenteRESUMO
The Authors describe two cases of double mitral valve orifice associated with complete atrioventricular canal. The first patient, 10 month-old male, affected by type A complete atrioventricular canal, underwent surgical repair which was performed in association with division of the tissue bridge between the two orifices. The patient died the day after because of severe mitral insufficiency and pulmonary oedema. The second patient, 3.5 year-old female, affected by type A complete atrioventricular canal with pulmonary banding, underwent a surgical procedure without division of the tissue bridge. In the postoperative period a suture dehiscence occurred which caused severe mitral regurgitation, and another intervention had to be performed; subsequently the patient did well and was discharged in good condition. The Authors discuss the possible role of two dimensional and Doppler echocardiography in the diagnosis of this uncommon condition; they also discuss the related surgical problems and stress the necessity to repair with a proper compromise between residual mitral insufficiency and a mitral stenosis.
Assuntos
Anormalidades Múltiplas/cirurgia , Comunicação Interatrial/cirurgia , Valva Mitral/anormalidades , Pré-Escolar , Ecocardiografia Doppler , Feminino , Humanos , Lactente , Masculino , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/etiologia , Complicações Pós-Operatórias , Edema Pulmonar/etiologia , Deiscência da Ferida OperatóriaRESUMO
We describe the case of a diastolic mitral and tricuspid regurgitation in a patient affected by acute myocardial infarction Ecg showed inferior myocardial infarction complicated by atrioventricular block and a junctional rhythm with frequent premature ventricular beats; the mean heart rate was of about 60 per minute. 2D echocardiogram disclosed akinesia of the apical segments of the inferior septum and anterior and infero-lateral walls. Pulsed and continuous wave Doppler showed mild to moderate mitral and tricuspid systolic regurgitation and diastolic regurgitation through both atrioventricular valves. The diastolic regurgitation always occurred during prolonged diastoles, soon after the blocked P waves. The possible mechanism of this finding and its clinical significance are discussed, drawing the conclusion that the atrioventricular diastolic regurgitation is not diagnostic of a specific valvular disease but can be secondary to other conditions, especially the atrioventricular block.
Assuntos
Ecocardiografia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Tricúspide/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Feminino , Bloqueio Cardíaco/complicações , Humanos , Insuficiência da Valva Mitral/etiologia , Infarto do Miocárdio/complicações , Insuficiência da Valva Tricúspide/etiologiaRESUMO
We describe the case of a patient 4 months old transferred to our hospital for evaluation of occasionally detected cardiac alterations: ecg showed abnormal Q and negative T waves in D1 - aVL leads and chest x-ray was consistent with enlargement of the left ventricular cavity. After admission, 2D echocardiographic examination disclosed, in the left ventricular cavity, a large mass extending from the papillary muscles to the outflow tract. The mass was of uniform density and easily recognizable as a tumor. Although asymptomatic, the patient underwent operation 10 months later because of the risk of occurrence of severe conduction disturbances or arrhythmias. Histological examination demonstrated that the mass was a fibroma. At post-op echocardiographic and angiographic evaluation the left ventricle appeared abnormally dilated with a large aneurysm of the lateral wall and very poor pump function. Nevertheless the patient did well in the following months until a ventricular fibrillation occurred at home. He was immediately brought to hospital and resuscitation was attempted unsuccessfully. We discuss the role of 2D echocardiography in the diagnosis of cardiac tumors, the indication of the early surgical removal and the possible limitations of the technique we used in this case.