[Cat scratch pneumonia: a case report]. / Un caso di polmonite secondaria a graffio di gatto.

Pasteurella multocida infections can be caused by scratches or bites of many animals including pets. An unrecognized infection can lead to severe complications such as arthritis, osteomyelitis, respiratory infections and even meningitis or endocarditis. We present the case of a woman affected by soft tissue infection caused by Pasteurella multocida complicated by bacteremia and pneumonia.

[Dipyridamole test and myocardial scintigraphy with Tl-201 in the diagnosis of myocardial ischemic pathology]. / Il test al dipiridamolo e la scintigrafia miocardica con 201-Tl nella diagnosi della patologia ischemica miocardica.

We studied 19 consecutive subjects affected by effort angina using following tests: ecg stress test, stress 201-Tl scan, coronary arteriography; 201-Tl scan, coronary arteriography, hemodynamic, echo 2 D, ecgraphic monitoring during Dipyridamole test (D). Basing on coronary arteriography results we divided patients; in the group A (10 patients with significant stenoses greater than or equal to 50%) stress ecg and scintigraphy were positive in 9 patients; Dipyridamole test induced angor and ecgraphic changes in 5 patients and in 4 left ventricle wall motion disorders, 201-Tl scan was positive in all 9 patients tested. In the group B (9 subjects with no significant stenosis) ecgraphic changes were observed in 2 subjects and 201-Tl scan was positive in 6 subjects; D induced in 2 cases angor, in 1 case ecgraphic changes, in 1 case left ventricle wall motion disorders and the same 201-Tl defects in 6 previously individualized patients. In both groups we observed at coronary arteriography during D identical findings in comparison with the immediately before performed. In our experience D infusion is confirmed as provocative test of ischemia. The same ischemic pattern observed at stress and Dipyridamole scintigraphy in patients with no significant coronary stenosis suggests as pathogenetic mechanism the regional lack of dilatory reserve.

[Diagnostic use of myocardial scintiscanning with thallium-201 in myocardial infarct]. / Utilita' diagnostica della scintigrafia miocardica con tallio-201 nell'infarto del miocardio.

Myocardial scintigraphy shows to have diagnostic ability after latest proposal to use Thallium-201. Thus we verified its iconographic effectiveness in 10 normal subjects and 25 patients with myocardial infarction variously localized. In both groups we obtained adequate and expressive results: the former showed omogeneous images and continuous outlines, whereas the latter showed "cold areas" in agreement with the localization provided by electrocardiography. The further utilization of myocardial imaging with Thallium-201 in 2 patients with prior infarction, in whom present ecg is equivocal, provided scintigraphic evidence of prior necrotic lesion. This emphasizes diagnostic sensitivity of myocardial scintigraphy with Thallium-201 encouraging its use in those patients in whom electrocardiography is not able to give its usual diagnostic contribution.

Effects of left bundle branch block on left ventricular function in apparently normal subjects. Study by equilibrium radionuclide angiocardiography at rest.

To determine the independent effects of left bundle branch block (LBBB) on global and regional left ventricular (LV) function we performed equilibrium radionuclide angiocardiography at rest in 3 patients with chronic LBBB (group I, mean age 53.6 years and in 6 patients with intermittent LBBB (group II, mean age 41.5 years). All patients were judged to have an apparently normal heart. In 2 of 3 patients of group I a LV ejection fraction lower than 50% was observed, and in all 3 patients septal motion abnormalities were present. In all patients of group II the global LV ejection fraction was normal during normal conduction and decreased during LBBB; the inferoapical regional ejection fraction decreased in 5 of 6 cases and the posterolateral regional ejection fraction in 3 of 6 cases. Moreover, septal hypokinesis was observed both during normal and abnormal conduction in all group II patients. These findings seem to confirm that LBBB, chronic or intermittent, is able to deteriorate LV performance at rest, even in patients with an otherwise normal heart.

The role of indium-111 antimyosin (Fab) imaging as a noninvasive surveillance method of human heart transplant rejection.

The identification of rejection after heart transplantation in patients receiving cyclosporine immunosuppressive therapy requires the endomyocardial biopsy, an invasive method associated with a finite morbidity. To evaluate the role of indium-111 antimyosin (Fab) scintigraphy as a noninvasive surveillance method of heart transplant rejection, the Fab fragment of murine monoclonal antimyosin antibodies labeled with indium-111 was administered intravenously in 30 scintigraphic studies to 10 consecutive heart transplant recipients. Endomyocardial biopsy specimens were obtained 72 hours after each scintigraphic study. Nineteen scintigraphic studies had negative findings; no false negative finding was obtained. Eleven antimyosin scintigraphic studies had positive findings, and in these studies endomyocardial biopsy revealed mild rejection in two cases, moderate acute rejection with myocyte necrosis in two cases, myocyte necrosis as a consequence of ischemic injury in six cases, and possibly cytotoxic damage in one case. Antimyosin scintigraphy may represent a reliable screening method for the surveillance of heart transplant patients. In the presence of a negative finding from antimyosin scintigraphy, it may be possible to avoid endomyocardial biopsy. Conversely, in patients who have a positive finding from antimyosin scintigraphy, the endomyocardial biopsy is mandatory to establish the definitive diagnosis by histologic examination of the myocardium.

Effects of uncomplicated coronary artery bypass graft surgery on global and regional left ventricular function at rest. Study by equilibrium radionuclide angiocardiography.

To evaluate the effects of uncomplicated revascularization surgery on resting global and regional left ventricular function we studied 34 patients, enrolled consecutively, by radionuclide angiocardiography. After surgery, we found no significant change in global left ventricular ejection fraction; this was true even in the subgroup of 14 patients who developed paradoxical septal motion. This finding indicates that the development of paradoxical septal motion after uncomplicated cardiac surgery does not compromise global left ventricular function. Both in the subgroup of patients with paradoxical septal motion and in the subgroup without paradoxical septal motion regional ejection fraction calculations showed the same postoperative pattern consisting of increase of the proximal and distal posterolateral regional ejection fraction, increase in the inferoapical regional ejection fraction and unchanged proximal and distal septal regional ejection fraction. In our patients paradoxical septal motion is not due to pericardial effusion, conduction disturbance, septal ischemia or infarction. Our data suggest that the anteromedial translation of the entire heart during systole, due to surgical removal of constraints, may account for both the false improvement of posterolateral and inferoapical regional wall motion and the development of paradoxical septal motion.

[Contribution of M-mode echocardiography and myocardial scintigraphy for study of ECG pattern of left ventricular hypertrophy with giant negative T waves (author's transl)]. / Contributo dell'ecocardiografia M-mode e della scintigrafia miocardica allo studio del quadro elettrocardiografico di ipertrofia ventricolare sinistra con onde T negative giganti.

Eight normotensive patients with electrocardiographic criteria for left ventricular hypertrophy with giant negative T waves were studied with Thallium-201 imaging and M-mode echocardiography. In all the patients Thallium scanning demonstrated increased thickness of the left ventricular walls. In five of the above cases areas of increased uptake were noted in the apical region which had increased thickness as compared to the rest of the left ventricular wall. Echocardiography showed in one subject obstructive hypertrophic myocardiopathy and in another two asymmetric septal hypertrophy. In the remaining patients there was always present septal and posterior wall hypertrophy. Reliable echocardiograms of the apex were done in five subjects and in these hypertrophy was noted. The results of the two techniques were compared and correlated clinically and with the literature. The authors conclude in agreement with other studies that the picture of electrocardiographic left ventricular hypertrophy with giant negative T waves is indicative of hypertrophic myocardiopathies. Specifically, for us, the apical hypertrophy may be the only feature of the myocardiopathy or be part of a generalized left ventricular hypertrophy which is usually asymmetric septal hypertrophy.