Giant coronary artery aneurysm in association with systemic arterial ectasia. A case report.

Since the advent of coronary angiography, coronary artery aneurysm has been diagnosed with increased frequency. The etiology of coronary artery aneurysm is atherosclerosis in 50%, followed by other causes. In a 71-year-old man with previously documented abdominal aortic aneurysm of 6 cm diameter and ectasia of both left and right middle cerebral arteries, thoracic magnetic resonance imaging (MRI) demonstrated a large hollow para-cardiac mass (maximum diameter of 7 cm) lying in the anterior-lateral part of the atrio-ventricular sulcus. Coronary arteriography confirmed the aneurysmatic nature of the proximal tract of left anterior descending (LAD) artery lesion. Screening for laboratory signs of vasculitis was negative and other vascular and systemic diseases were excluded, suggesting an atherosclerotic aetiology of the aneurysm. In the absence of current cardiac symptoms, conservative management has been chosen and the patient is still well 2 years after presentation.

Bronchial reactivity in subjects with urticaria.

BACKGROUND: Respiratory symptoms (rhinitis, asthma) accompany some skin diseases with a proven immunological or allergic pathogenesis whereas the immunological and allergological findings are sometimes negative in subjects with chronic urticarial skin symptoms and no cause can be found. This paper explores the possibility of airway inflammation in cases of this kind. METHODS: Nonspecific bronchostimulation with methacholine was carried out in 12 subjects with a clinical history of urticaria and negative immunological and allergological findings. RESULTS: All subjects displayed normal bronchoreactivity (mean PD20 1400 micrograms). The bronchostimulation test (evaluated from the FEV1) was always negative. In the control group the mean PD20 was 720 micrograms. CONCLUSIONS: The fact that these eleven subjects did not display bronchial hyperreactivity suggests that monitoring of their respiratory function is not required.

[Muscle fatigue and dyspnea]. / Fatica muscolare e dispnea.

Calm breathing requires little effort on the part of the inspiratory muscles to overcome the elastic and non-elastic resistances of the chest-lung system. Spontaneous expiration is passive and does not engage the respiratory muscles. In the event of restriction or obstruction, however, there are changes in these two types of resistance and their distribution. Extra work is required and the blood flow through the muscles has a decisive influence on their performance. Histologically detectable differences in the number of fast or slow, glycolytic or oxidative fibres in the respiratory muscles correspond to functional differences. Some muscles are required to supply the force or energy of contraction, others are concerned with endurance and others with intermediate situations. The diaphragm is mainly composed of slow-oxidative fibres. It is thus characterised by its strength, low tension, high repetitive capacity and incredible endurance. This brief review describes the main concepts of the physiology of the respiratory muscles. Reference is also made to the mechanisms of muscle fatigue and dyspnea, two independent or associated clinical situations that point to the risk of progression to respiratory insufficiency.

[Pruritus. Physiopathology, clinical features, and treatment]. / Il prurito. Fisiopatologia, clinica e terapia.

Pruritus is a subjective disturbance that accompanies many dermatological, allergic and internal medicine disorders. It may well be the only symptom that leads a patient to consult a doctor. In situations of this kind, the cause of the complaint is very hard to determine and the tests employed often fail to give a clear-cut answer. This paper stresses the complexity of the hypotheses advanced to illustrate the pathogenesis of pruritus and reviews its many chemical mediators. An account is also given of the pathogenetic pointers that can be drawn from the conditions, including some within the compass of internal medicine, most commonly associated with pruritus and taken into consideration in the planning of individual treatment regimens.