A fixed combination of metoprolol slow-release and chlorthalidone, given once daily, in the long-term treatment of arterial hypertension.

A fixed combination of metoprolol slow-release 200 mg and chlorthalidone 25 mg was given once daily over a 3 months period in forty out-patients with mild-to-moderate arterial hypertension stage I or II WHO. The combination elicited a clear-cut antihypertensive effect lasting at least 24 hours after drug. As compared with pre-treatment values, systolic and diastolic blood pressures were gradually reduced within the first month of treatment, remaining nearly constant in the following 2 months. Treatment was well tolerated by all patients. Neither serum potassium nor any other laboratory test (creative, glucose, uric acid, etc) showed significant changes. In conclusion, slow-release metoprolol fixed association with chlorthalidone provides a safe and effective treatment of arterial hypertension even on a long-term basis. The once daily dosing schedule may considerably improve patient's compliance.

[Traumatic mitral insufficiency secondary to ruptured chordae tendineae. Discussion of one case (author's transl)]. / Insufficienza mitralica post-traumatica secondaria a rottura delle corde tendinee del lembo posteriore. Presentazione di un caso.

One case of mitral insufficiency due to traumatic rupture of the posterior chordae is described. The most consistent clinical and non-invasive cardiovascular findings were: previous non-penetrating thorax trauma; rapidly progressing congestive heart failure; loud apical systolic murmur; sinus rhythm; normal radiological evidence of the left atrium; echocardiographic disorderly movement and coarse fluttering of posterior leaflet, systolic fluttering of mitral valve, diastolic additional echoes between mitral leaflets and systolic ones into the left atrium (due to ruptured chordae?). This patient underwent a valvular replacement surgery. When attempting a diagnosis of this accident, while haemodynamic and angiographic data are helpful mainly in the definition of retrograde mitral flow severity, the echocardiographic findings appears to be more important to state precisely the site and the kind of the lesion.

[Echocardiographic findings in dystrophia myotonica (Steinert's disease)]. / Reperti ecocardiografici nella distrofia miotonica (malattia di Steinert).

Ten patients with myotonic dystrophy have been studied by M-mode and 2-dimensional echocardiography. Six patients had echocardiographic abnormalities: mitral valve prolapse, hypertrophy of the papillary muscles (2 cases); impaired regional left ventricular relaxation, probably due to "cardiac myotonia" (4 patients); and dilatative cardiomyopathy in the sole patient with overt heart disease. There seems to be no relation between involvement of skeletal and cardiac muscle. It is likely, although not proved, that myocardial involvement in myotonic dystrophy occur initially as "myotonia", followed by a "dystrophic" phase with severe dilatative cardiomyopathy, not unlike the skeletal muscle.