[Echocardiographic assessment of alcohol consumers in different clinical stages]. / Valutazione ecocardiografica di alcolisti in differenti stadi clinici.

In relation to the importance of cardiac damage in alcohol drinkers this study aims to check the modifications of some cardiac sonographic parameters in drinkers examined at different stages of alcohol intoxication. Seventy-seven male subjects (43 +/- 9 years old) were divided into 3 groups in relation to the biohumoral alterations used for the diagnosis of chronic alcoholism (increase of GGT and MGV). EF, interventricular septum hypertrophy, LVEdD and the presence of left ventricular diastolic failure were considered. All these cardiac sonographic parameters "in toto" were first compared with the same parameters of a group of normal subjects and then the differences of these sonographic parameters between the 3 groups of drinkers were evaluated. These data confirm the early onset of cardiac damage and also that the cardiac alterations may occur before the modifications of the biohumoral parameters considered too. The alterations of the cardiac sonographic parameters considered in this study seem to be a good marker for the identification, quantification and staging of cardiac damage. Interventricular septum hypertrophy, EF and EDV (in this sequence) are to be considered usefull for the diagnosis of cardiac damage in alcohol drinkers. However also LVEdD and the presence of left ventricular diastolic failure are to be evaluated before any therapy.

[Platelet hyperaggregation premonitory of myocardial infarct? A clinical case report]. / Iperaggregabilità piastrinica permonitrice di infarto del miocardio? Relazione su un caso clinico.

In a patient, treated with antiplatelet drugs because of two previous TIA episodes, an occasional control in apparent welfare, just 4 hours before the onset an IMA, showed a sudden considerable increase of spontaneous aggregation. Two weeks after the infarction all haematological findings, including aggregation, were back to normal. Platelet adhesiveness, evaluated for the first time, was nevertheless considerably increased. A treatment with an association of low doses of acenocoumarine and ASA was useful to take aggregation and adhesiveness firmly back to normal values that persist 22 month after the episode. Spontaneous platelet hyperadhesion, occasionally recorded a few hours before IMA, bears out the importance of the role played by platelets in vascular coronary accident. Authors suggest that it is therefore advisable to evaluate platelet adhesiveness too, regardless of the specific meaning of this test; it is worth investigating whether this monitoring should lead to some attempt whatsoever enabling to prevent recurrent crisis, adding to antiaggregant therapy, a management with anticoagulating drugs, administered with low dosage.

[Spontaneous platelet aggregation after experimental focal ischemia in the rabbit. "Sensitivity", "specificity" and value of the test used]. / Considerazioni sull'aggregabilità piastrinica spontanea dopo ischemia focale sperimentale nel coniglio. "Sensibilità", "specificità" e validità del test impiegato.

Within the framework of an investigation at present under way at the Neurological Clinic of Pavia on experimental focal ischaemia, the peculiarities of platelet aggregation observed, have led to a more accurate assessment of both the phenomenon itself and the validity of the method used. In a group of 30 rabbits (17 of them submitted to embolization by means of microspheres introduced into the carotid and 13 used as controls), biohumoral electrical and histological parameters were examined. The spontaneous platelet aggregation test proved significantly related to the extent of changes taking place, as measured by PDS levels and QEEG "delta" activity (respectively, P less than 0.005 and P less than 0.05). Platelet aggregation, in relation to the occurrence or absence of focal ischaemia, revealed a "sensitivity" of 80% and a "specificity" of 92.3%. When not only the onset of but also the increase in aggregation is taken into account, the "sensitivity" figure appears to go up to 93.3%. Endothelial damage and "cascade" platelet aggregation appeared to be a prerequisite for the occurrence of the changes found. In these changes, the pathogenetic role of the regional vasospasm as opposed to mere mechanical obstruction seems to be confirmed. On the basis of these findings, it is concluded that the identification of spontaneous platelet aggregation using K. Breddin's method and its quantification based on Born's turbidimetric principle, may be usefully employed to assess the risk factor constituted by an abnormal tendency to platelet hyperaggregation.

[Early ECG changes after experimental focal cerebral ischemia. A pathogenetic hypothesis of the brain-heart syndrome]. / Alterazioni ecgrafiche precoci dopo ischemia focale cerebrale sperimentale. Una ipotesi patogenetica della sindrome cerebro-cardiaca.

Primary CVT alterations and arrhythmias, occurring one hour after embolization were detected in several experiments about focal cerebral ischaemia in rabbits. 62 animals were fed on a standard diet and 15 on an atherogenic diet. Primary CVT alterations and arrhythmias occurred in 4 rabbits fed on a standard diet and in 6 rabbits fed on an atherogenic diet. These results gave statistic evidence of a relationship between more frequent and serious electrocardiographic alterations and an atherogenic diet. The information coming out of these experiments are discussed. Considering the data coming out of other experiments and the data of the literature it is supposed that the pathogenesis of "the cerebro-cardiac syndrome" is linked to several biohumoral alterations occurring after the stroke. If these alterations occur in animals (or in subjects) with damaged coronary arteries cardiac alterations occurring after the stroke are greater and more important than the cardiac alterations occurring in the same conditions in the animals in which coronary arteries are not jet damaged.

[Changes in spontaneous platelet aggregation induced by the ambient temperature]. / Modificazioni indotte dalla temperatura ambiente sulla aggregabilità piastrinica spontanea.

The diagnostic meaning of the functional platelets modifications (particularly those of spontaneous platelet aggregation = P.A.) in cardiovascular pathology has been recalled. It is emphasized that, in order to have significantly predictable data on eventual pathological alterations in case of deviations of values considered normal, one has to use methods that do not differ from the real haemorheological conditions. A research has therefore been made with the purpose to evaluate the influence that variations of temperature may have on the samples collected and left to sediment (for the separation of the PRP) and the subsequent modifications of P.A. The research has been made in double on plasma sedimented at 37 degrees C and at room-temperature on 731 subjects, 289 of which were the casuistic groups for the subsequent statistic elaboration. With similar modalities in other 8 patients the eventual variations in excretion of beta-TG were looked for. The results have shown that there are important variations of the spontaneous P.A. rates, that the difference is always statistically very significant and that lowering the temperature of the samples favors an increase in beta-TG excretion . The Authors think therefore that only the sedimentation at 37 degrees C issues a plasma usefull for the further performing of platelets tests, while in the plasma obtained with sedimentation at room-temperature the platelets are perhaps already stimulated to an activation (and subsequently an aggregation) higher than the real one. Data obtained from a homogeneous group of subjects, healthy from a clinical point of view, allowed to fix the new range of normal values within 3% of aggregability . The mechanisms that lead to such different results are discussed. Emphasis is put on the fact that the spontaneous P.A. determined by the means mentioned seems satisfactorily near to the real clinical conditions. That's why the hypothesis arises that also other tests concerning platelet functions could be negatively influenced if they have room-temperature as a condition for plasma separation.

Considerations on pulsoplethysmographic changes in fingers due to iontophoresis with methacholine in subjects with Raynaud's phenomenon.

This paper presents a study of plethysmographic changes induced by methacholine (a derivative of acetylcholine) administered via iontophoresis in a population of 41 young women with apparently primary Raynaud's disease. All patients presented with a very clear statistically significant sphygmic increment, obviously connected with the vasodilatation caused by methacholine. Moreover, in nearly half of the 23 cases whose reaction to passive postural variations was successively examined by plethysmography, the district circulatory response was characterised by persistent neurogenous vasoconstriction due to methacholine or by inadequate vasomotor EDRF mediated modulation. The authors believe that their findings serve as further evidence of the pathogenetic mechanisms of Raynaud's disease. This is because they highlight the role played by "balance of vessel motility" which would guarantee district circulatory homeostasis. Concrete proof thus corroborates well known indirect evidence that a pathological vasospasm can be triggered and persist when two fundamental conditions are met: a) intense vasoconstriction initially of neurological origin and successively reinforced by biohumoural synergic stimuli; b) the breakdown of the capacity for EDRF mediated intrinsic vasomotor modulation. It is suggested that the prevalence of one or the other factor would lead to a variety of clinical pictures denoting vascular acrosyndromes of this type. The ability to single out such clinical pictures by adding the iontophoresis test with methacholine to routine screening procedures for the presence of Raynaud's disease, would allow physicians to make more accurate diagnosis and improve therapy.

[Type A behavior and cardiovascular reactivity. Preliminary findings]. / Tipo comportamentale "A" e reattività cardiovascolare. Rilievi preliminari.

In view of reports of a connection between ischaemic cardiopathies and "A" type behaviour, the response of certain cardiocirculatory parameters to given physical stimuli was investigated in a group of people doing high stress work. The data did in fact reveal a tendency to more pronounced cardiovascular reactivity in the A group, a difference that was statistically significant in the cold pressor and cold tests. The possible links between enhanced vasomotor response and increased risk of coronary heart disease are pointed out with emphasis on recent hypotheses about the possible pathogenic role of enhanced 5-OH-tryptamine release and particular alterations in the alpha/beta adrenergic receptor balance.

[Multicenter study of the effectiveness and tolerance of clotiazepam in cardiology]. / Studio policentrico sull'efficacia e tollerabilità del clotiazepam in cardiologia.

In a phase IV study with clotiazepam 9 cardiologists were involved to treat 86 patients (52 female, 32 male, mean age 51 years) effected by cardiovascular diseases and anxiety. The dosage was 5-10 mg TID, and the treatment lasted for 3 weeks. Variations of the dosage were requested in 21% of patients and generally at the 2nd week of treatment. The safety of clotiazepam was good: only in the 14% of patients side-effects were observed (especially drowsiness 9.3% and asthenia 2.3%). Clotiazepam was judged to be effective in 75% of patients. The Hamilton psychiatric rating scale for anxiety showed a progressive decrease both of the total score and of the scores of every item; the cardiovascular symptoms particularly improved at both the controls.

[Occupational vascular acrosyndromes. Considerations on plethysmographic changes in the fingers resulting from postural variations of the arms: do they have diagnostic relevance or just physiopathologic significance?]. / Acrosindromi vascolari professionali. Riflessioni sulle modificazioni pulsopletismografiche digitali da variazioni posturali degli arti superiori: hanno valore diagnostico o solo significato fisiopatologico?

334 subjects all with anamnesis indicating a vascular acrosyndrome (mostly due to their working conditions) were studied using the pulsoplethysmographic method to evaluate whether a relationship exists between the absence of increases to physiological acral posture and the presence of Raynaud's disease successively induced by Cold Test. The results obtained showed marked correlation (which for some of the subgroups examined was also statistically significant) between the lack of postural regolation and abnormal or frankly phatological plethysmographic findings following the Cold Test. The results appeared to be of some relevance in the physiopathologic interpretation of vascular acrosyndromes. According to the authors, the findings constitutive further proof of the reole played by changes in the "balance of vessel motility" in maintaining district circulatory homeostasis and may indicate the prevalence of vasoconstriction over endotelially mediated vasodilation. Consequently, the adoption of a routine test to evaluate postural sphygmic changes, before the traditional Cold Test, would allow more precise diagnosis and prognosis, particularly in the area of professional angiopathies.

[Occupational exposure to vibration: Raynaud's phenomenon and the vascular response to methacholine iontophoresis]. / Esposizione professionale a vibranti: fenomeno di Raynaud e risposta vascolare a ionoforesi con metacolina.

A homogeneous group of 34 subjects exposed to occupational vibratory stress were studied to determine their vasodilatory response to methacoline. The methacoline was administered by iontophoresis. Methacoline is an acetylcholine derivate with the same pharmacological properties of acetylcholine. The 34 study subjects were divided into 3 groups according to their plethysmographic response to a preliminary cold test: group 1, had a typical Raynaud's response; group 2 had normal response to cold, and group 3 had an "intermediate" response. The subjects in group 1 did not respond to methacoline with vasodilation, suggesting endothelial damage at the arterial and arteriolar level, those in group 2 responded with clear vasodilation, and those in group 3 had an intermediate plethysmographic response to methacoline--modest, slowed vasodilation. Based on the results obtained, the authors believe that the true pathogenetic mechanism is an alteration in the vasomotor stability. This change in circulatory homeostasis occur after a vasoconstrictive stimulus, due to vascular endothelium disfunction, in its turn damaged by vibratory microtrauma. This would be the basis for diminished autonomic vascular regulation, mediated by EDRF at the arterial and arteriolar level. It is also probable that the pathogenesis of Raynaud's syndrome in workers exposed to physical or chemical stress has a similar mechanism.

[Angiopathy caused by vibrating tools: cold test and prostaglandin balance]. / Angiopatia da vibranti: cold test e bilancia prostaglandinica.

A study was made on a group of workers occupationally exposed to tools producing medium-to-low frequency vibrations, and on a comparable control group. The subjects underwent a plethysmographic examination with the cold test, which revealed a greater number of sphygmic alterations in the exposed group; at the same time spontaneous platelet aggregation, blood levels of 6-K-PGF-1 alpha and TXB2 and urinary levels of BTGU were determined in basal conditions and after the cold test. Except for the slight, and not statistically significant, increase in TXB2, the results did not reveal any alterations in the constituents of the prostaglandin balance after the cold test. This therefore indicates that biohumoral changes of this type were not involved in producing cold-induced vasomotor alterations in the group under study. However, further investigations are recommended which will take account of the age and working history of the subjects, and particularly of the physical characteristics of the vibrations produced by the tools used, especially the Hz number.