[Acute myocardial infarction in the elderly. A case-control study with a younger population and review of literature]. / L'infarto miocardico acuto nell'ultrasettantacinquenne. Studio caso-controllo con una popolazione più giovane e rassegna della letteratura.

BACKGROUND: ST elevation myocardial infarction (STEMI) in old and old-old patients presents several peculiarities in natural history, delay of hospitalization and response to treatment. Aim of this retrospective case control study was to determine presentation, complications and management of elderly patients with STEMI compared to a younger population. METHODS: 462 patients (205 M and 257 F) aged > or =75 years, hospitalized in CCU between 1999 and 2003 for STEMI, were evaluated. The control group consisted of 490 consecutive patients (268 M and 222 F) aged 50-70 years. Attention was focused on clinical presentation, complications, management and outcome in elderly compared with younger patients. RESULTS: The mean interval between the onset of symptoms and the arrive in CCU was of 9 hour in the elderly compared to 4,5 hour in the control. Chest pain was less frequent (50% vs 90%) in the elderly; the prevalence of dyspnoea and neurological symptoms was higher in patients >75 years (30% vs. 15% and 25% vs. 10%). In the elderly, previous angina and AMI, cerebral and peripheral vascular diseases, peripheral and renal failure were frequent. Early severe complications prevailed in the elderly. Thrombolysis was performed only in 39% of the elderly compared to 65% of the control. Significantly higher was cerebral haemorrhage after thrombolysis (4.9% vs. 1.8%). Comparable were the mayor extra cranial bleedings. Primary or facilitated PTCA was performed in few patients in the last year. Two weeks mortality was 20%, compared to 6.5% in the control group. CONCLUSION: The patients >75 years with STEMI were hospitalized later, had atypical presentation with less chest pain and more cardiac failure, were less likely to receive thrombolysis, had more complications and more cerebral bleedings. Elderly had more associated diseases and in-hospital mortality was higher.

[Epidemiology of acute coronary syndrome in Campania]. / Epidemiologia delle sindromi coronariche acute in Campania.

Recent observational studies have pointed out many problems regarding the pre-hospital and in-hospital management of patients with acute coronary syndrome (ACS). The present study analyses the epidemiology of ACS in Campania Region. It has enrolled the 92.3% of coronary care units (CCU) of the Campania. The results indicate that 77% of patients admitted in CCU have ACS and the time of admission in CCU is still too long. Moreover the vast majority of patients arrive at the hospital without emergency ambulance and 48% of patients admitted in CCU for ACS with elevated ST segment do not receive any reperfusion therapy; compared with the 35.1% of patients included in the BLITZ study. The challenge of the SSN in the next future is to improve the "decision making" in the management of patients with ACS. This goal could be reached by an optimal organization of the hospital and out-of-hospital emergency services creating an integrated network of cardiological assistance.

[Large mediastinal mass of heterotopic thyroid tissue: a case report and review of literature]. / Voluminosa massa mediastinica di tessuto tiroideo eterotopico: caso clinico e review della letteratura.

Incidental detection of a mediastinal mass in a asymptomatic patient poses a not easy diagnostic problem. For solid masses or cysts, histology or cytology is often necessary. Although substernal extension of a cervical goiter is common, totally intrathoracic primary thyroidal mass is unusual. We describe a rare case of heterotopic accessory mediastinal thyroid in a patient completely asymptomatic both for signs of thyroid dysfunction and mechanical compression. Radiological and hormonal 6 and 12 months follow-up is reported.

Effectiveness of tirofiban for failed thrombolysis during acute myocardial infarction.

The clinical outcome of 48 consective patients with myocardial infarction who received tirofiban for unsuccessful thrombolysis was compared with that of 48 patients matched for age, gender, and infarct location who did not receive rescue treatment. Those who received tirofiban had more successful reperfusions, and there were few bleeding complications.

[Partial atrio ventricular septal defect diagnosed in adult age: description of a case in a 67 years old woman]. / Difetto settale atrio ventricolare parziale diagnosticato in età adulta: descrizione di un caso in una paziente di 67 anni.

Authors describe a case of partial atrio ventricular septal defect--cushion defect--with only a mitral valve cleft and mild valvular insufficiency. There were present also, since the childhood, an atrio ventricular primary block, and a left axis deviation. Late appeared a RBBB. The correct diagnosis has been done at the age of 67 years. The patient refers mean rhythm disorders and effort dyspnea. She refused surgical correction successful also in the late age.

[Pharmacologic therapy in failed thrombolysis: sequential infusion of tirofiban. Pilot study with 47 patients]. / La terapia farmacologica nella trombolisi fallita: infusione sequenziale di tirofiban. Studio pilota in 47 pazienti.

Glycoprotein IIb/IIIa inhibitors have been recently proposed as a bridge to rescue transluminal coronary angioplasty in ST elevation myocardial infarction patients in whom thrombolysis fails; but data in its feasibility, safety and efficacy are still limited. In 47 consecutive acute myocardial infarction patients in whom thrombolysis failed to achieve 90 minute reperfusion, tirofiban was given at full regimen. Our results have been compared with those obtained in a control group of 48 consecutive acute myocardial infarction patients admitted two years before, period in which tirofiban and rescue angioplasty were not available in our hospital. Our preliminary data suggest this approach is feasible and safe, with possible clinical benefit in this high-risk subgroup of patients.

[Spontaneous dissection of 2 coronary branches in a young man. Report of a clinical case]. / Dissezione spontanea di due rami coronarici in un giovane maschio. Descrizione di un caso clinico.

Spontaneous coronary dissection is responsible for acute coronary syndromes particularly in females during and in the peri-partum period. It rarely occurs in patients without atherosclerotic coronary plaques. We report a particular clinical course of a 39-year-old patient with spontaneous dissection of two coronary arteries. His clinical course suggested only medical treatment, with aspirin, beta-blockers and ACE-inhibitors. At 3 months of follow-up the patient is free of symptoms.