Plasma NT-proBNP levels and the risk of atrial fibrillation after major lung resection.

AIM: Supraventricular tachyarrhythmias, most frequently atrial fibrillation (AF), occur in 8-30% of patients undergoing major pulmonary resection. The aim of this study was to characterize a biochemical marker in order to identify subjects at higher risk of postoperative AF. The authors tested the hypothesis that elevated preoperative plasma levels of N-terminal brain-type natriuretic peptide (NT-pro-BNP) may predict the occurrence of postoperative AF. METHODS: Fifty-five consecutive patients undergoing elective major thoracic surgery were selected. All patients had 12-lead electrocardiogram and transthoracic echocardiographic evaluation at entry. Plasma NT-pro BNP levels were determined both at baseline and at the first postoperative day. Patients were monitored thereafter to detect the occurrence of AF. For statistical analysis, an unpaired Student t test was used to compare continuous variables, chi(2) tests or Fischer exact tests were used for categorical variables, as needed. RESULTS: Eight (14.54%) of the 55 patients developed AF with a peak incidence on postoperative days 2 to 3. Baseline NT-pro-BNP was more than two fold higher in patients who developed AF (506.1+/-108.4 pg/mL versus 197.7+/-54.9 pg/mL; P=0.001). Other relevant clinical and diagnostic parameters were not different in the two groups. Patients with NT-pro-BNP level above the median (113.0 pg/mL) had 8-fold increase risk of postoperative AF. CONCLUSION: A preoperative elevated plasma NT-pro-BNP level was associated with the occurrence of AF in patient undergoing major thoracic surgery. Baseline NT-pro-BNP levels may be proposed as a biochemical marker to detect patients at higher risk of postoperative AF who could benefit from prophylactic therapeutic medication.

[Acute myocardial infarct in HIV-positive patients in treatment with protease inhibitors]. / Infarto miocardico acuto in paziente HIV-positivo in trattamento con inibitori delle proteasi.

We report the case of a 40-year-old HIV-positive man, undergoing three-drug antiretroviral therapy for 2 years that included a protease inhibitor (ritonavir). The patient was admitted to our Coronary Care Unit with an acute anterior myocardial infarction. He smoked 20 cigarettes/day and had a family history of hypertension. At the time of hospitalization, triglyceride levels were found to be high (290 mg/dl). Metabolic alterations associated with the prolonged use of protease inhibitors, such as insulin resistance, dyslipidemia and lipodystrophy, have recently been described. This side effect may lead to premature coronary artery disease. Therefore it is mandatory to be aware that treatment with protease inhibitors in HIV-positive patients, despite survival prolongation and lowering of AIDS complications, may accelerate atherosclerosis and precipitate acute coronary events, especially in patients with pre-existing cardiovascular risk factors.

Musculoskeletal and adipose tissue hydatidosis based on the iatrogenic spreading of cystic fluid during surgery: report of a case.

Hydatidosis or echinococcosis is a parasitic disease caused by Echinococcus granulosus or E. multilocularis, which forms cysts in the liver and lung after penetrating the duodenal mucosa and entering the portal circulation. The liver and lung act as a filter but some embryos enter the general circulation and disseminate throughout the body. Musculoskeletal involvement is a rare manifestation of hydatidosis, which is usually reported to affect a single muscle. We report here a rare case of a 68-year-old man with widespread hydatidosis of the retroperitoneum and the subcutaneous adipose tissue, and with multiple muscle involvement in the absence of liver, lung, and spleen involvement. The patient underwent surgical excision of a subcutaneous hydatid cyst 7 years earlier. It is likely that the large dissemination of parasites resulted from accidental rupture of the primary focus during surgery with consequent release and spreading of scolices via lymphatics.

Thyrotoxicosis, unstable angina and normal coronary angiogram.

It is well known that thyrotoxicosis may elicit acute myocardial ischemia even in patients with angiographically normal coronary vessels. The involved mechanisms are not clearly defined although some hypothesis have been suggested. We report a case of a 54-year-old woman affected by Graves' disease with thyrotoxicosis which was referred to our Institute because of unstable angina. During hospitalization a two dimensional echocardiogram, performed during chest discomfort, showed left ventricular apical akinesis and impaired global systolic function. A subsequent coronary angiography revealed normal epicardial vessels. She was successfully treated with high-dose methimazole and propranolol and a repeat echocardiogram evaluation showed normalization of left ventricular systolic function. Six months later, because of the appearance of paroxysmal atrial fibrillation, the patient underwent total thyroidectomy and a substitutive therapy with L-T4 (100 micrograms/die) was started. The authors review the possible mechanisms involved in the pathogenesis of myocardial ischemia during thyrotoxicosis.

[Characteristics of Italian thermal parks and gardens: explorative study; therapeutic possibilities. I]. / Entità e caratteristiche di parchi e giardini termali italiani: censimento esplorativo; possibilità in terapia. Parte I.

There are reported the results of a research about thermal parks and thermal gardens own to 27 italian Spas. The considerable areas of green around Spas, the correct ratio with the number of subjects in thermal treatment and others arguments represent favourable elements for italian Medical Hydrology. The importance of green around Spas in Thermal Medicine and in Ecology il stressed.

Noninvasive assessment of myocardial involvement in patients with systemic sclerosis: role of signal averaged electrocardiography.

OBJECTIVE: To assess the role of late ventricular potentials (LVP) in detecting early myocardial involvement in patients with systemic sclerosis (SSc). METHODS: Seventy-seven patients with SSc (68 women, 9 men, mean age 50 +/- 13 yrs) and 33 control subjects (18 women, 15 men, mean age 46 +/- 10 yrs) underwent resting electrocardiogram (ECG), 24 h Holter monitoring, complete echocardiographic and Doppler echocardiographic examination, and signal averaged ECG at high pass setting of 40 Hz, with the low pass fixed at 250 Hz. Patients with SSc underwent resting myocardial scintigraphy and radionuclide angioventriculography. RESULTS: The prevalence of LVP at 40 Hz was 20.5%. Compared to control subjects, patients with SSc showed higher prevalence of septal infarction pattern (p = 0.05), complex ventricular arrhythmias (p = 0.03), pulmonary arterial hypertension (p < 0.001), and LVP (p = 0.02). Forty-four patients with SSc (57.1%) had resting perfusion defects by myocardial scintigraphy. Fourteen of 15 patients with LVP showed perfusion defects compared to 29 of 58 without LVP (p = 0.002). Linear regression analysis showed that myocardial perfusion defect score was significantly correlated to either the filtered QRS duration, or the duration of low amplitude signals < 40 microV of the terminal QRS, or the root mean square voltage of the last 40 ms of the QRS complex. After a mean followup period of 20 months, 8 patients died. In 2 patients who died suddenly, LVP were present. CONCLUSION: Signal averaged ECG is a sensitive and inexpensive technique in the clinical assessment and followup of patients with SSc.

[Extension and features of parks and gardens around spas in Italy: explorative census; possible therapeutic usefulness II]. / Entità e caratteristiche di parchi e giardini termali italiani: censimento esplorativo; possibilità in terapia. Parte II.

There are described the results of a census about parks and gardens own to 27 italian Spas. The considerable areas of green around Spas, the correct ratio whith the number of subjects in thermal treatment and other arguments represent favourable elements for italian medical Hydrology. In our census the found plants generally are in conformity with their correct geographical placing. Moreover they are in order to cause favourable effects for environmental Psychology and Therapeutics. The species of recommended plants for the increase and for improvement of green around italian Spas are mentioned. The importance of green around Spas in thermal Medicine and in Ecology is stressed.

[Thermal-spring parks within the ambit of protected areas: general trends in morphology and botany]. / Parchi termali nell'ambito delle aree protette: orientamenti generali di morfologia e botanica.

It is remembered that, in contemporary era, the thermal parks arose in U.S.A. and in Canada: they represent the first example of national parks in the world. Are described legislation, classifications and various types of protected areas. The species of recommended plants for the formation, increase and/or improvement of italian thermal are mentioned.

[Polymyalgia rheumatica associated with myelodysplasia]. / Polimialgia reumatica associata a mielodisplasia.

In this paper we describe a patient, female 76 years aged, who showed typical symptomatic, haematologic and instrumental findings of polymyalgia rheumatica. The patient also showed myelodysplastic syndrome and peripheral signs of vasculitis, which some authors refer in association with PMR. The improvement obtained with steroidal therapy confirmed the clinical picture of case.

[Ecology and thermal parks in the context of the environment. Psychological and possible therapeutic aspects: trends in medicine]. / Comprensori e parchi termali nel contesto ambientale. Aspetti "psicologici" e possibilità terapeutiche: orientamenti in medicina.

Thermal parks are considered whether on account of their favourable effects on human well-being or as possible patterns of qualificated areas. Information on italian so called "thermal" ecology are given. In according to viewpoint of environmental psychology, the various natural side effects are remembered; the influences exerted by wood and park lands--also as meteorological factors--on human beings are stressed. The possible trends in the treatment of some psychosomatic, cardiovascular, digestive and metabolic diseases are pointed.

[Current orientation on medical therapy of Crohn disease]. / Moderni orientamenti di terapia medica del morbo di Crohn.

The Crohn's disease has an increasing incidence and prevalence in the western countries and also in Italy; genetic, familiar and enviromental factors, but, above all, altered immunity have pathogenetic effects for the chronic flogosis and damage of gastroenteric tract. With ulcerative rettocolitis, the Crohn's disease is part of the chronic inflammatory bowel disease. In the present paper the medical therapy of Crohn's disease is especially studied; it is based on the use of corticosteroids and SASP or its active metabolite 5-ASA. Other pharmacs are reviewed as: immunosuppressors, antibiotics, antimetabolites and symptomatic or substitutive therapy. At the end the authors pointed out therapeutic lines in relation to acute or chronic stage and gravity of the disease.