Cardiac hemodynamics in alcoholic patients with chronic liver disease and a presystolic gallop.

10 male subjects with chronic liver disease and with normal cardiovascular findings, except for the presence of a presystolic gallop, underwent right and left heart catheterization. In general, all of the patients had a high resting cardiac output, narrow arteriovenous oxygen difference, a low peripheral vascular resistance, and normal left ventricular end-diastolic pressures and volumes. The plasma volume was increased in the seven patients in which it was determined. On exercise, all of the patients demonstrated a significant increase in the left ventricular end-diastolic pressure and mean pulmonary artery pressure, while the stroke index remained the same or fell in seven of the subjects. It appears logical to assume that the excessive intake of alcohol is associated with an impairment in the metabolic and contractile properties of the left ventricle and the resultant hemodynamic effects may not be readily discerned in the resting state. However, upon exercise these patients, with a congested circulation, can show abnormal cardiac dynamics.

[Proposal of a detoxication program for drug dependency in pregnancy]. / Proposta di un programma di disintossicazione nella farmacodipendenza in gravidanza.

One of the main problems the physician has to handle in managing pregnancy complicated by the maternal intake of opiates is represented by the programming of adequate detoxication treatment that allows in particular for possible pharmacological repercussions on the foetus. On the basis of many years' experience, a therapeutic proposal is put forward as a general guideline, from which an individual approach can be obtained for the treatment of drug dependency in pregnancy.

Epirubicin/vinorelbine as first line therapy in metastatic breast cancer.

This study was aimed at investigating the toxicity and activity of the combination epirubicin and vinorelbine in chemotherapy-naive patients with metastatic breast cancer. Fifty-one patients with measurable or evaluable metastatic breast cancer entered the study. The regimen consisted of epirubicin 90 mg/m2 as a slow i.v. infusion on day 1, followed by vinorelbine 25 mg/m2 by 30-minute intravenous infusion on days 1 and 8; the courses were repeated every 21 days for a maximum of 8 cycles. All the patients were assessable for toxicity and 47 were evaluable for response according to the World Health Organization (WHO) criteria. Objective responses were observed in 33 out of 47 evaluable patients (70.2%; 95% C.I. 55.1%-82.6%) with 4 complete (8.5%) and 29 partial responses (61.7%); 11 patients had stable disease (23.4%) and 3 patients progressed while on treatment. The median time to progression was 10 months (range 1-21) and the median overall survival was 23 months (range 2 - 32+). Neutropenia was the most frequent toxicity: a grade 4 neutropenia (WHO) was reported in 70% of 252 courses with a median duration of 3 days (range 1-6). Seventeen episodes of febrile neutropenia were observed but only 1 patient required hospital admission. Other hematologic toxicities were negligible. One patient experienced a paralytic ileus requiring hospitalization; no peripheral neuropathy such as muscle weakness or paresthesia was observed. No treatment-related cardiotoxicity was reported. The encouraging response rate achieved with epirubicin/vinorelbine, the easily manageable toxicities of the combination, and its feasibility in an outpatient setting make this combination worthy of further comparative trials with standard regimens.

Drug addiction in pregnancy: the HIV infection.

From January 1986 to December 1990 70 HIV-seropositive pregnant women were seen at the Department of Obstetrics and Gynecology, Rome, Italy. All of them delivered in our Hospital Center and their babies were enrolled in pediatric follow-up. Sixty-five patients (93%) were drug-addicted, only 6 of them showing signs of HIV infection (lymphoadenopathy). The authors report the results of a clinical study demonstrating that asymptomatic HIV infection did not affect the regular course of pregnancy. Moreover, they show that there was no progression of disease during pregnancy, vertical transmission was 24%, the infected babies were of low birth weight (2,586 +/- 527 vs. 3,100 +/- 470 g) and the incidence of premature delivery was higher (30 vs. 8%) than in noninfected controls.