Biofiltration, a new method of short hemodiafiltration: preliminary report.

Four patients previously treated by traditional dialysis (HD, 240 min) were switched to biofiltration (BF, 180-210 min) and followed for twelve months. Before and at the end of this period, clinical and biochemical data were assessed for each patient. Patients treated for 180 min by BF presented no increase in BUN but a significant increase of predialytic phosphorus. The 210 min BF schedule achieved the same pattern of depuration as HD. Acidosis was corrected better in all patients during BF. No hypoxemia and no change of WBC count were observed during BF. Cardiac function, assessed by echocardiography, improved similarly with each session of both methods. BF is a useful alternative treatment procedure for patients with endstage renal failure.

[Holter-detected myocardial ischemia. Impact for prognosis and decision making after acute myocardial infarction]. / Ischemia all'Holter. Impatto prognostico e decisionale nel post infarto.

BACKGROUND: Aim of the study was to evaluate the prognostic and decision making value of Holter detected myocardial ischemia after acute myocardial infarction in comparison with clinically detected postinfarction angina and exercise test. METHODS: To this aim the patients consecutively admitted to our coronary care unit with acute myocardial infarction during one year were retrospectively evaluated. One hundred and eighty-nine patients (age 70+/-11 years, 137 male and 51 female) had a 24 hour Holter monitoring. One-year follow up of these patients was obtained. RESULTS: Myocardial ischemia was detected by Holter monitoring in 21 patients (11%), 4 with and 17 without angina. Symptom limited exercise test was obtained before discharge in 116 patients (62%): 45% were positive, 42% non-diagnostic and 13 negative for myocardial ischemia. Post infarction angina was present in 15 patients (9%). Patients with Holter detected myocardial ischemia were older (73+/-10 vs 66+/-11 years, p<0.05) and had higher prevalence of both angina and positive exercise test (p<0.01). One-year follow up was obtained in 186 patients. Holter detected myocardial ischemia positive predictive value for death or reinfarction was 15%, negative predictive value was 90%, similar to the absence of angina (90%) and the absence of positive exercise test (93%). Angina and exercise test identified 62% of patients with Holter detected myocardial ischemia. Residual myocardial ischemia was exclusively observed by Holter monitoring in 4% of the population, particularly in 1 patients with and 7 without exercise test. CONCLUSIONS: The additive contribution of Holter detected myocardial ischemia in the prognosis and decision making of post infarction patients is rather scanty.

[Stress imaging in coronary artery disease: state of the art]. / Stress imaging nella cardiopatia ischemica: stato dell'arte.

To date, several diagnostic tools allow an accurate non-invasive evaluation of coronary artery disease; this is due to the great progress in echocardiographic and nuclear imaging techniques in the last 10 years. The large availability of different stress imaging techniques allows to choose the most appropriate technique for each patient according to the clinical characteristics. This paper presents the state of the art of echocardiographic and nuclear stress imaging for the diagnosis of coronary artery disease and for the prognostic stratification of infarcted patients. Advantages and limits of the different techniques are described rather than putting in competition echo and nuclear cardiology as has often been done in the past. Cardiologists should select among the various techniques on the basis of clinical characteristics of single patients, center's experience and an objective evaluation of economical aspects.

Pulsed Doppler verification of atrial contribution to ventricular filling in sequential pacing.

We have used pulsed Doppler to ascertain effective atrial contribution to ventricular filling in sequential pacemaker rhythm. The technique is particularly valuable when electrocardiographic evidence of atrial capture is uncertain.