Acute effects of chewable nifedipine on hemodynamic responses to upright exercise in patients with prior myocardial infarction and effort angina.

To evaluate the hemodynamic effects of nifedipine on anginal patients during exercise in the upright position, a placebo (P) and 20 mg of nifedipine were administered in a double-blind random sequence to ten patients presenting with exertional angina and a healed myocardial infarction. All patients had previously undergone coronary angiography. The effects of nifedipine in the upright position at rest, at the anginal threshold, and at the maximal level of exercise were studied. Nifedipine decreased systemic vascular resistances in upright position and increased the cardiac index. It reduced the severity of angina and allowed a higher physical work capacity without anginal symptoms. The most important beneficial effect of nifedipine appears to be the reduction in afterload, but an improvement of left ventricular function cannot be ruled out.

[Drug combinations in the treatment of primary arterial hypertension]. / Le associazioni farmacologiche nel trattamento dell'ipertensione arteriosa primitiva

A number of pathogenetic moments have been identified in primary or essential hypertension in recent years. Marked variations have been noted in plasma volume, cardiac output, neurosympathetic tone, the renin-angiotensin system, and the aldosterone-adrenal neurosympathetic regulation system. Biological and clinical studies have underscored the action of the individual hypotensive drugs at present available commercially and their synergic or, in some instances, antagonist effects when associated. The fact that the disease has different stages and that different points of attack can be chosen is an ecouragement to the combination and simultaneous employment of two or more hypotensive drugs. Known associations, such as reserpine (with or without sympathicoplegics) or vasodilators and the diuretics, are examined, together with more recent combinations, such as propranolol, hydralgine and the diuretics, and spirolactone and the diuretics.

[Proposal for a computerized record of ergometric tests]. / Proposta di un protocollo computerizzato per i tests ergometrici.

A codified approach to the collection of data obtained from an ergometric test is proposed and the need for such a codification, arising from the necessity to check and organise data collected during clinical examinations, is discussed. Practical questions regarding the chosen model are also discussed. The essential feature is a hierarchy of data enabling information to be represented generally and in detail, a modular structure, in other words, whose basic element is simplicity of compilation and codification.

[Indications and contraindications for surgery in coronary insufficiency]. / Indicazioni e controindicationi alla chirurgia dell'insufficienza coronarica

The indications to aortocoronary by-pass technique have during the last two years developed thanks to surgical, emodinamic and clinical exsperiences. The mortality of patients in whom surgery is limited electively to the intervention of aorto-coronary by-pass is at present around 4%. The principal indications to surgery are: a) existence of more than one coronary artery disease; b) a good diameter of the by-passing artery (more than 1 mm) corresponding to the site of the by-pass graft; c) a left ventricular telediastolic pressure lower than 20 mm of Hg; d) left ventricular function with ejection fraction not lesser than 0,40; e) absence of any associated severe and irreversible damages. The comparative data obtained recently from coronary patients medically and surgically treated would show at 4 years a survival rate higher than in those who underwent aorto-coronary by-pass.

[Ergometric tests in cardiology. Indications and appraisal parameters]. / Prove ergometriche in cardiologia. Indicazioni e parametri da misurare.

An assessment was made of the ability of an ergometric test to detect coronary patients in evaluating the reliability of the effort test, which is mainly important when it gives the percentage of coronary patients that can be discovered at an early stage during screening. The concept of sensitivity and specificity is analysed with respect to the diagnostic criteria employed. Blood pressure, heart rate and oxygen consumption are discussed in their rôle of leading parameters and the appraisal made of the diagnostic significance of a below-normal ST level in the literature is examined. Junctional falls in level and depression of the J point are also discussed. Cases in which a below-normal ST segment level is not associated with coronary disease are examined.

[Ergometric tests in cardiology. Diagnosis of coronary insufficiency: methods and evaluated parameters]. / Prove ergometriche in cardiologia. Diagnosi di insufficienza coronarica: metodi seguiti e parametri valutati

The historical development of the stress-test in the diagnosis of coronary insufficiency has been examined from the first observations about 1930 regarding changes in the repolarization phase during effort in coronary patients, up to modern tests with the ergometer bicycle and treadmill. Starting from the consideration that Master's Test is still the most commonly used in clinical practice, the limitations of tests of this type are highlighted and the discussion also covers the techniques and parameters now considered of greatest importance in cardiopathy diagnosis and evaluated by means of modern maximal stress tests. The results of a first period of work involving tests using the treadmill are reported. The methodology is discussed and the symptoms or ECG data that had suggested the test be used are related to the patient's origin (out-patient or hospitalized) and with the test's positivity or negativity. The high incidence of unstable ST syndrome, especially in the female sex, is also stressed. If this is not thoroughly investigated functionally (hyperventilation, Valsalva, etc.) it could be the cause of a large number of false positives. The lack of danger in the maximal stress test, even in cardiopaths, is confirmed together with the extreme ease with which nearly all patients manage to perform the test on the treadmill. Stress is also laid on the fact that the stress test is functional, unlike coronarography which is purely morphological, and the two examinations are thus complementary in the diversity of information they provide.

[An information survey on the automatic operation of intensive therapy units in Italy]. / Indagine conoscitiva sulla gestione automatica delle sale di terapia intensiva in Italia.

A fact finding study was carried out in 58 resuscitation centres and 78 intensive care units to evaluate the current application of computerised techniques in the monitoring and processing of various parameters relating to hospitalised patients. The enquiry revealed a marked interest in the use of computerised systems, particularly in the electrophysiological and haemodynamic field. Promising results were reported from some centres. Some adverse criticisms and points of discussion still exist. International and national experiences matured so far, however, while primarily directed towards scientific research and technological development, open up significant perspectives for the future, for the rational handling of the data collected, and the extension of current knowledge on matters of physiopathology, electrophysiology, and pharmacokinetics.

[Kinetics of beta-methyl-digoxin in different degrees of renal function (author's transl)]. / Cinética de la beta-metil-digoxina en los diversos grados de funcionalismo renal.

Creatinine clearance was evaluated in individuals with varying degrees of renal function following the administration of beta-methyl-digoxin. From the results of the experiment it can be deduced that significantly increased hematic values and renal clearance values definitely lower than normal appear only in patients of a creatinine clearance of less than 50 ml/min. Furthermore, a positive correlation between creatinine clearance values and beta-methyl-digoxin levels was noticed. This correlation was in proportion to the amount of serum albumin. The degree of distribution of free digitalis and digitalis bound to proteins within the vascular system played an important role in the complex kinetics of digoxin. This relationship is suggested as an indirect index of the proportions of free beta-methyl-digoxin and of beta-methyl-digoxin bound to plasma proteins.