Thrombolytic therapy in selected patients with impending myocardial reinfarction.

BACKGROUND: In selected patients with postinfarction angina and impending reinfarction, thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) or streptokinase is highly effective in avoiding a new myocardial infarction. METHODS: To avoid major cardiac events, we treated 14 consecutive patients with thrombolytic therapy because of impending reinfarction with ECG ST-segment elevation. Thirteen patients received rt-PA (100 mg over 3 hours), and one patient received streptokinase (1.5 million IU over 1 hour). All patients had failed to respond to maximal medical therapy with intravenous nitrates, beta-blockers, Ca-antagonists, heparin, and opiates. RESULTS: In all patients, clinical and ECG signs of acute ischemia resolved completely within 1 hour after beginning thrombolysis, and no patient developed biochemical markers of myocardial infarction. Ten patients underwent coronary angiography: five had three-vessel disease, two had two-vessel disease, and three had one-vessel disease. The culprit lesion was located in the left anterior descending artery in eight cases and the right coronary artery in two. No patient showed intracoronary thrombus. Four patients underwent successful, semiurgent percutaneous transluminal coronary angioplasty; three received an elective and two an urgent coronary artery bypass graft. CONCLUSIONS: Thrombolysis (or repeated thrombolysis) is effective in selected patients with clinical ECG signs of impending reinfarction. It can temporarily stabilize the condition of many patients, thus allowing safer mechanical revascularization to be performed.

Treatment of dyslipidaemia with a simple low fat diet and with a combination of a low fat diet and a formulation containing soybean protein.

The first approach to treatment of dyslipidaemia is with diet. Currently, modified soybean protein is often included in the diet. A study was made of 32 patients with types IIa and IIb dyslipidaemia to see what changes in blood lipids could be induced by a simple low fat diet and a diet with modified soybean protein substituted for part of the animal protein. After six weeks on the initial low fat diet, all of the patients had lower total cholesterol and triglyceride levels, but there were no significant changes in the high density lipoprotein-cholesterol levels. The same diet was continued for eight weeks by 19 of the patients, who continued to improve. The 13 patients who had shown the least response to the initial simple low protein diet were given a diet in which the animal protein was partially replaced with modified soybean protein. This diet further decreased the total cholesterol.

Efficacy of atenolol in the short and long-term treatment of patients with effort stable angina.

A double-blind, crossover, randomized placebo controlled study involving 15 patients with effort stable angina, was carried out to assess atenolol (A) 100 mg during an 8-week period. Thereafter, atenolol antianginal efficacy was evaluated in a 6-month follow-up open non-comparative study. No antianginal drugs other than A were administered except for isosorbide dinitrate 5 mg when necessary. At the end of the 2-week wash-out period, and at the end of each 2-week period during the crossover phase of the study, and every 12 weeks during the 6-month follow-up, an ergometric test was performed and the following parameters were evaluated: HR, SBP, DP, Total Work Load (TWL) and S-T changes. The Barlett's test was performed to assess variance homogeneity, while the Tukey Hd test was used to evaluate the parameters during the treatments. During atenolol, the reduction in SBP was close to statistical significance, HR and S-T were significantly reduced (p less than or equal to 0.05) whereas TWL was significantly increased (p less than or equal to 0.05). During long-term atenolol treatment, all cardiovascular parameters clearly improved in comparison to the placebo period, confirming the antianginal efficacy of atenolol, even in the long-term treatment.

[Modifications of the respiratory mechanism induced by administration of 18, 19, 20-trinor-17-cyclohexyl-13, 14-dehydro PGF 2 alpha methyl ester]. / Modificazioni della meccanica respiratoria indotte dalla somministrazione di 18,190,20-trinor-17-cicloesil-13,14-deidro PGF 2 alfa metilestere.

The effects on pattern of breathing, on compliance and respiratory resistances of PGF 22 were investigated in anaesthetized pigs before and after vagosympathectomy. A marked increase in respiratory resistance and a decrease in lung compliance simultaneously with a pulmonary congestion were observed. The respiratory changes were considered secondary both to a vagal reflex and to the hemodynamic impairment.

[18,19,20-trinor-17-cyclohexyl-13,14-dehydro PGF 2 alpha methylester as the cause of hypertension in pulmonary circulation]. / Il 18,19,20-trinor-17-cicloesil-13,14-deidro PGF 2 alfa metilestere quale causa di ipertensione nel circolo polmonare.

The hemodynamic effects of a synthetic compound of PGF 2 alpha have been studied before and after vagosympathectomy. Synthetic PGF 2 alpha caused a marked hypertension in the pulmonary circulation linked with the vasoconstrictor action of this substance on the small lung vessels. A slight hypotension was observed in the denervated animal where the highest values of pulmonary pressure were reached. The authors conclude that this fact may be due to an inhibition of the vasoconstrictor systemic tone secondary to the pulmonary hypertensive state.

Antihypertensive activity of a new ACE-inhibitor, SCH 33844, during repeated administration in spontaneously hypertensive rats.

The antihypertensive activity of SCH 33844, a new angiotensin converting enzyme inhibitor, was investigated in conscious spontaneously hypertensive rats during a 3-week treatment regimen and for 1 week following drug withdrawal. SCH 33844 was given once daily at 2 dose levels (1 and 5 mg/kg orally) and its effects were compared with those of captopril (60 mg/kg orally). Systolic blood pressure was recorded twice weekly just before administration and at varying time intervals up to 6 hr after dosing; recordings were continued for 1 week after drug withdrawal. SCH 33844 was found to produce dose-related antihypertensive effects. Given at 1 mg/kg, the compound elicited small but significant blood pressure changes during the treatment. After drug withdrawal, systolic blood pressure returned to pre-drug levels within 1 week. SCH 33844 at 5 mg/kg, and captopril at 60 mg/kg, both reduced blood pressure markedly and to a similar extent. After each administration the effect was rapid in onset, lasted for over 6 hr and was not subject to tolerance. Drug withdrawal resulted in a gradual return of systolic blood pressure toward pre-treatment levels within 1 week, with no evidence of rebound phenomena. These results indicate that SCH 33844, like captopril, produces an effective antihypertensive action throughout a repeated dosing.

[Sepsis and endocarditis: two rare complications following pacemaker implantation. Description of a case and review of the literature]. / Sepsi ed endocardite: due rare complicanze conseguenti all'impianto di pacemaker. Descrizione di un caso e revisione della letteratura.

A case of Staphylococcus aureus tricuspid valve endocarditis in a patient with permanent transvenous VVI pacemaker and recurrent febrile episodes is described. Medical treatment was not effective, and only with surgical removal of the lead was the infection successfully treated.