Hemodynamic study of intravenous propionyl-L-carnitine in patients with ischemic heart disease and normal left ventricular function.

Propionyl-L-carnitine was given intravenously to ten patients with chronic ischemic heart disease who had normal left ventricular function and had not had a previous myocardial infarction. Subsequently, pulmonary and systemic circulation, left ventricular function, and the relationship between the ventricle and afterload were evaluated. This drug, at a dose of 15 mg/kg, improves ventricular function by easing the load and by enhancing cardiac efficiency. The ejection impedance is reduced with a consequent increase in stroke volume as a result of a) a decrease in systemic and pulmonary resistance and b) an increase in arterial compliance. Arterial pressure is maintained due to an increase in total external heart power. Since the tension time index shows a proportionally smaller increase in the energy requirement, it follows that cardiac efficiency has been improved and ventricle-afterload matching is optimal. These results suggest but do not prove that propionyl-L-carnitine exhibits a positive inotropic property.

[Effects of gallopamil on coronary blood flow and vasomotility]. / Effetti del gallopamil sul flusso e sulla vasomotilità coronarica.

Using quantitative coronary arteriography, the luminal area was measured in the proximal, middle and distal third of a normal coronary vessel in basal condition and 15 min after 0.005 mg/Kg ic gallopamil (Group 1); 15 min after ic placebo (Group 2); 15 and 30 min after iv gallopamil at a dose of 0.03 mg/Kg (Group 3A) and 0.05 mg/Kg (Group 3B). A significant (p less than 0.001) vasodilation was observed in all segments in Group 1 and only in distal segment (p less than 0.05) in Group 3B. Neither did the heart rate, systolic blood pressure nor the coronary driving pressure show any changes. In the second section of this study, we analyzed the effects of the drug on coronary blood flow and resistance in 8 patients without clinical and/or objective evidence of coronary artery disease. Using thermodilution technique, the coronary sinus blood flow (CSBF) and coronary resistance (CR) were measured in basal condition and 5, 10, 15 and 30 min after 0.05 mg/Kg iv gallopamil. We observed a significant (p less than 0.001) increase of CSBF after 10 min and a significant decrease of CR after 10 min (p less than 0.001) and 15 min (p less than 0.05). In conclusion, our results suggest that the anti-ischemic effect of gallopamil can be related not only to the reduction of myocardial oxygen requirement, but also to an improvement of coronary blood flow with a decrease in coronary resistance.

[Abnormal coronary vasomotility in subjects with normal coronary arteries and reduced reserve of coronary flow]. / Abnorme vasomotilità coronarica in soggetti con coronarie normali e ridotta riserva di flusso coronarico.

A reduced coronary flow reserve has been reported in patients with ischemia-like symptoms and normal coronary arteries. In 13 such subjects both coronary vasomotion and flow reserve were studied. The luminal area of the proximal and distal third of the left anterior descending and left circumflex artery were determined by biplane quantitative coronary arteriography using a computer-assisted system. Subjects were studied at rest, during submaximal supine bicycle exercise (4.0 min, 116 W) and 5 min after sublingual administration of 1.6 mg nitroglycerin. Heart rate, mean pulmonary and aortic pressure as well as the percent change of both proximal and distal luminal area were determined. In 10 of the 13 subjects, coronary sinus blood flow was measured by coronary sinus thermodilution technique at rest and after dipyridamole infusion (0.5 mg/Kg in 15 min) 10 +/- 5 days after quantitative coronary arteriography. Coronary flow ratio (dipyridamole/rest) and coronary resistance ratio (rest/dipyridamole) were determined in these subjects. Subjects were divided into 2 groups according to the behaviour of the coronary vessels during exercise (vasodilation = Group 1, vasoconstriction = Group 2). Coronary vasodilation of the proximal (luminal area + 26%; p less than 0.001) and distal (+ 45%; p less than 0.001) artery was observed in 7 subjects (Group 1) during exercise and after sublingual nitroglycerin (+46%; p less than 0.001 and +99%; p less than 0.001, respectively). In Group 2 (n = 6), however, there was coronary vasoconstriction of the distal vessel segments (-24%; p less than 0.001) during exercise, whereas the proximal coronary artery showed vasodilation (+ 26%; p less than 0.001) during exercise. Following sublingual nitroglycerin, both vessel segments elicited vasodilation (distal coronary + 44%; p less than 0.001, proximal coronary artery +47%; p less than 0.001). Coronary flow ratio amounted to 2.5 in Group 1 and to 1.2 in Group 2 (p less than 0.05) and coronary resistance ratio to 2.7 in Group 1 and to 1.2 in Group 2 (p less than 0.05), respectively. Thus, among subjects with ischemia-like symptoms and normal coronary arteries there is a subgroup of patients (Group 2) with an abnormal dilator response of the distal coronary arteries to the physiologic dilator stimulus of exercise and a reduced dilator capacity of the resistance vessels after dipyridamole (= abnormal coronary vasodilator syndrome). The nature of this exercise-induced distal coronary vasoconstriction is not clear but might be due to an abnormal neurohumoral tone which may cause or contribute to the blunted vascular response during exercise.

Right ventricular dysplasia: angiographic study.

At the moment, the most reliable method for diagnosing right ventricular dysplasia is considered to be angiography. Morphological alterations such as the presence of akinetic/dyskinetic areas, aneurysmatic dilatations and deep anteroapical fissuring, not necessarily associated with an increase in ventricular volume, are understood to be angiographic criteria indicating dysplasia. To verify their diagnostic value, these abnormalities have been evaluated in: (1) 33 patients suspected of having dysplasia because of PVBs with LBBB morphology and with 'borderline' involvement of the right ventricle or without instrumental evidence of cardiac disease (Group A); (2) 16 subjects with no arrhythmia and normal left ventricular angiography, coronary and bioptic findings (Group B); (3) 36 patients with a clinical, angiographic and bioptic diagnosis of dilated idiopathic cardiomyopathy (Group C). In 48.5% of the patients in Group A, angiography showed localized akinesia/dyskinesia (12 patients), small conical outpouchings persisting during systole (10 patients) and apical deep fissuring (two patients). In 81% of these patients, endomyocardial biopsy showed the presence of fibrous and/or adipose tissue in at least 20% of the examined sample. Angiographic abnormalities suggesting dysplasia were found in none of the normal subjects and only in two of the 36 patients with dilated cardiomyopathy (5.5%).

Responsabilidade do fator hemodinâmico na gênese da síndrome do túnel do carpo nos pacientes hemodialisados / Haemodynamic factor responsibility in the genesis of the carpal tunnel syndrome in haemodialyzed patients

A patologia esquelética representa uma complicaçäo importante no paciente dialisado a longo prazo, sendo numerosas as síndromes clínico-radiológicas de osteoartropatia com ela relacionadas. Entre essas, a síndrome de túnel do carpo é, sem dúvida, a mais importante e frequente. Muitos fatores säo mencionados como responsáveis na gênese da CTS no paciente dialisado crônico. Tendo presente o problema etiopatogênico, até hoje discutido, e considerando alguns dados clínicos verificados em 80 pacientes tratados na Divisäo de Cirurgia Plástica, iniciou-se um estudo com a finalidade de evidenciar o possível papel patogênico do fator hemodinâmico na gênese da síndrome do túnel do carpo no paciente hemodialisado. Os autores, com base nos resultados de um estudo retrospectivo, realizaram um estudo controlado, evidenciando o papel do fator hemodinâmico na gênese da síndrome do túnel do carpo no paciente hemodialisado. Os autores, com base nos resultados de um estudo retrospectivo, realizaram um estudo controlado, evidenciando o papel do fator hemodinâmico sobre os agentes etiológicos, no sentido de facilitar a determinaçäo da síndrome do túnel do carpo

Extensäo profilática da ligamentotomia ao membro contralateral nos pacientes hemodialisados afetados por síndrome do túnel do carpo / Prophilactic extension of ligamentotomy of the contralateral member in hemodialysed patients affected by the carpal tunnel syndrome

Dentro do contexto das patologias esqueléticas observadas com frequência no paciente dialisado, a síndrome do túnel do carpo ocupa os primeiros lugares na taxa de incidência. Embora seja relatada com percentagens diversas por vários autores, geralmente a mesma aparece de 5 a 8 anos após a hemodiálise, com um percentual de 50 por cento após 15 anos e de 100 por cento após 20 anos. Os A.A., examinando os dados relevados pela casuística própria e aqueles relatados na literatura, voltaram sua atençäo para a maior incidência das síndromes monolaterais do lado do acesso vascular e para a precocidade do aparecimento das mesmas. Com base nessas premissas, formularam a hipótese da possibilidade de uma intervençäo profilática ou de um rígido follow-up a nível do membro contralateral nos pacientes submetidos a ligamentotomia do membro sede do acesso vascular, visto que a intervençäo eletiva de ligamentotomia, mesmo sendo resolutiva para a sintomatologia álgica, näo permite a recuperaçäo morfo-funcional do nervo mediano