SARS-CoV2 RNA detection in a pancreatic pseudocyst sample.

The involvement of gastrointestinal system in SARS-CoV2 related disease, COVID-19, is increasingly recognized. COVID-19 associated pancreatic injury has been suggested, but its correlation with pancreatic disease is still unclear. In this case report, we describe the detection of SARS-CoV2 RNA in a pancreatic pseudocyst fluid sample collected from a patient with SARS-CoV2 associated pneumonia and a pancreatic pseudocyst developed as a complication of an acute edematous pancreatitis. The detection of SARS-CoV2 within the pancreatic collection arise the question of whether this virus has a tropism for pancreatic tissue and whether it plays a role in pancreatic diseases occurrence.

Markers of Cardiotoxicity in Early Breast Cancer Patients Treated With a Hypofractionated Schedule: A Prospective Study.

PURPOSE: To evaluate, in a series of early breast cancer (BC) patients treated with hypofractionated adjuvant radiotherapy (RT), whether N-terminal-pro hormone B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I assay measurements can predict acute clinical or preclinical cardiotoxicity. PATIENTS AND METHODS: The study comprised 44 consecutive patients, who underwent conservative surgery with or without (neo)adjuvant chemotherapy and hypofractionated adjuvant RT. The RT schedule consisted in a total dose of 42.4 Gy in 16 fractions administered 5 days per week. Twenty-one patients received a subsequent boost to the tumor bed consisting of a total dose of 10 Gy in 4 fractions delivered via a direct electron field. All patients underwent 12-lead electrocardiogram, echocardiogram, and cardiac clinical examinations before RT to assess cardiovascular risk factors; these examinations were repeated yearly for 5 consecutive years. High-sensitivity cardiac troponin I and NT-proBNP were analyzed from serum samples at baseline, after delivery of the fourth and 16th RT fractions, and 12 months after treatment completion. RESULTS: No increase in cardiac troponin I and B-type natriuretic peptide levels related to left breast irradiation was observed. No statistical difference in NT-proBNP and high-sensitivity troponin I levels between left- and right-sided BC was found. An increase was observed of B-type natriuretic peptide levels at baseline, during treatment, and until 12 months after RT related to hypertension, with the P value near to the .05 threshold for age and chemotherapy. CONCLUSION: Conformational hypofractionated RT in left-sided BC may not cause acute myocardial damage. Early cardiac screening may be used to identify patients with cardiologic risk factors, patients who are older than 60 years, and patients who received chemotherapy that could result in clinically relevant cardiac pathologies.

Recurrent episodes of syncope in a patient with cerebral arteriovenous malformation.

As there are a number of possible causes of syncope, differentiation between cardiovascular disease, neurogenic disease and other disorders is mandatory. Cerebral arteriovenous malformations (AVMs) are tangled anastomoses of blood vessels of varying calibre in which arteriovenous shunting occurs in a central nidus, which is the area towards which multiple feeding arteries converge and from which enlarged veins drain. We describe a clinical case of syncope caused by a large AVM discovered in a 66-year-old woman. The symptoms were probably related to an epileptogenic mechanism since the syncope disappeared following the administration of antiepileptic therapy. The anatomical, pathological and clinical aspects of AVMs are discussed.

Double-blind trial with oral versus intravenous clomipramine in primary depression.

Intravenous clomipramine and oral clomipramine at a daily dose of 2 mg/kg body weight were compared in a double-blind study of 40 inpatients with primary depressive illness. No significant differences between the two routes of clomipramine administration were found, either in response or in side effects. Steady state was not attained at the 4th week of treatment in 30% of patients. However, combined plasma levels of clomipramine (CI) plus desmethylclomipramine (DMCI) were similar in the two groups at all stages of treatment. The only significant pharmacokinetic difference that was found was in the ratio of DMCI to CI, which was higher among the patients who received the drug orally, but this did not correlate with clinical response. Conversely, Day 28 plasma concentrations of CI, DMCI, and the sum CI + DMCI were significantly related to clinical outcome in the patients treated orally. Among the patients who received the drug intravenously only CI was significantly associated with the percentage reduction of symptoms. By pooling the two groups, CI, DMCI, and their sum all bore relationships to clinical response significant at the 0.01 level.

Prevalence of left-sided obstructive lesions in patients with atrioventricular canal without Down's syndrome.

Ninety consecutive patients with atrioventricular canal were studied to identify the association between left-sided obstructive lesions and Down's syndrome. Three groups were recognized: Group I, 76 patients with atrioventricular canal and no left-sided obstructions; Group II, nine patients with atrioventricular canal and left-sided inlet obstructions; Group III, five patients with atrioventricular canal and left-sided outlet obstructions. Of the 90 patients studied, 47 had Down's syndrome and only one of these had a left-sided obstructive lesion. Of 43 without Down's syndrome, 13 or 30% had left-sided obstructive lesions with predominating lesions at the inlet level caused by right ventricular dominance.

Pathologic evidence of arrhythmogenic cardiomyopathy and myocarditis in two siblings.

This report describes the case of two siblings who underwent heart transplantation with a clinical diagnosis of mildly dilated cardiomyopathy. Pathological examination of the hearts revealed arrhythmogenic (right ventricular) cardiomyopathy, adipose type, associated with biventricular myocarditis in both the recipients' hearts. Family history revealed the occurrence of dilated cardiomyopathy and myocarditis in their father and his sister. To our knowledge, this is the first pathological demonstration of arrhythmogenic cardiomyopathy and myocarditis in siblings. We think this report substantiates a genetic ground for the relationship between these two heart conditions.

Idiopathic dilated cardiomyopathy associated with coeliac disease: the effect of a gluten-free diet on cardiac performance.

An increased incidence of coeliac disease has recently been reported in patients with idiopathic dilated cardiomyopathy. This report deals with three patients with idiopathic dilated cardiomyopathy and coeliac disease who underwent clinical and laboratory evaluation to establish the effect of a gluten-free diet on cardiac performance. Two patients observed the gluten-free diet regimen very strictly, and, after a 28-month follow-up period, showed an improvement in echocardiographic parameters as well as in cardiological features and quality of life, as evaluated by the Minnesota Living with Heart Failure questionnaire and the Gastrointestinal Symptom Rating Scale questionnaire. The third patient did not observe the gluten-free diet and presented a worsening in the echocardiographic parameters and cardiological symptoms which required supplementary drug therapy. These preliminary data appear to suggest that the gluten-free diet may have a beneficial effect on cardiac performance in patients with idiopathic dilated cardiomyopathy.

Multisystem evaluation in one case of pure autonomic failure.

Pure autonomic failure (PAF) is a rare syndrome characterized by a primitive failure of the autonomic nervous system (ANS). We have studied a 53-year old woman suffering from PAF by using ANS provocative tests investigating the cardiovascular system (standing up test, controlled ventilation, Valsalva manoeuvre, handgrip test, cold pressor test, mental stress test, plasma catecholamine levels), tests investigating the intrinsic ocular innervation (pupil reactivity), and the bladder function (urodynamic tests). Our results have shown abnormalities of all the studied parameters and they have also confirmed that these patients need a multidisciplinary autonomic evaluation to correctly identify the syndrome.

Endogenous evoked potentials and vigilance levels variations.

The authors consider the possible relationship between the autonomic functions and the contingent Negative Variation (CNV). This relationship has been found both in psychopathological conditions and after the administration of psychotropic drugs. Some preliminary data are reported on the correlations observed between CNV and the autonomic activation (R-R interval) during a sodium lactate infusion.

Endothelin-1 circulating levels increase in patients with orthotopic heart transplantation and in chronic therapy with cyclosporine.

BACKGROUND: The aim of the study was to investigate the behaviour of plasma levels of endothelin-1 (ET-1), an endothelial peptide with vasoconstrictive and proliferative actions, in patients with cardiac transplantation and in chronic treatment with cyclosporine A, some of whom became hypertensive after cardiac transplantation. METHODS: We studied: 1) 18 consecutive patients (15 M, 3F; mean age 53 +/- 7 yrs) who underwent cardiac transplantation about six months ago at least (range 6-108 months); 2) 15 patients with essential arterial hypertension (10 M, 5 F; mean age 42 +/- 15 yrs) without organ damage; 3) 21 normal subjects (15 M, 6 F; mean age 31 +/- 12 yrs). Plasma levels of ET-1 (RIA), haemodynamic and functional renal parameters were determined in all groups and plasma levels of cyclosporine were measured in patients with cardiac transplantation. RESULTS: ET-1 was higher in patients with cardiac transplantation than in the other two groups (p < 0.05); instead there was no difference between patients with essential arterial hypertension and controls (p>0.05). A statistical difference was found between circulating ET-1 in hypertensive transplanted patients. In heart transplanted patients a positive and significative correlation was found between plasma levels of ET-1 and systolic (r=0.525; p<0.037) blood pressure.

Herpes simplex pneumonia in a heart transplant recipient.

An unusual case of Herpes simplex virus (HSV) pneumonia in a heart transplant recipient receiving chronic immunosuppressive therapy is reported. This infection presented an indolent course manifested by a chronic left pulmonary infiltrate unresponsive to antibiotic therapy and mild hypoxemia. Death eventually occurred as a consequence of an other infectious complication of the postoperative period. The HSV etiology of the necrotizing pneumonia observed at autopsy was established on the basis of histologic findings.

Cardiovascular reactions to physiological stimuli in the elderly and the relationship with the autonomic nervous system.

In order to evaluate age-related differences in autonomic nervous system control of the cardiovascular system, we studied two groups of healthy subjects of different ages by means of an autonomic function test, the posture test, applied before and after meals. Our results suggest that the reactions of the cardiovascular system to physiological stimuli such as meals or standing up, differ in elderly compared with young people, partly because age modifies the balance between the parasympathetic and the orthosympathetic nervous systems. In the elderly there is a progressive decline in parasympathetic function, which controls the initial heart rate response to standing up. Splanchnic blood pooling and possible hormonal secretions after meals may produce a drop in blood pressure due to cardiovascular modifications in the elderly. Other factors contributing to the different patterns found in the elderly may be reduced compliance of the vascular tree, a decreased baroreceptor response and decreased sympathetic activity.

Prevalence of coeliac disease in idiopathic dilated cardiomyopathy.

We examined 52 patients with idiopathic cardiomyopathy (IDCM) for coeliac disease. Three of them had coeliac disease, suggesting that prevalence of coeliac disease in IDCM patients is increased.

Fatal leptospiral myocarditis.

Clinical, instrumental and post-mortem studies were carried out in a patient with intractable cardiac failure, whose death was attribute to Weil's syndrome. A post-mortem examination showed the presence of numerous petechiae on the heart layers and diffuse lymphomonocytic infiltrates in the myocardium, epicardium and endocardium. We suggest that in patients affected by leptospirosis--an endemic disease with a possible fatal outcome--it is necessary to determine carefully any involvement of the cardiovascular system which may play a determinant role in the evolution of the disease.

[Kinetics of erythrocyte populations in newborn infants with hyperbilirubinemia]. / Cinetica delle popolazioni eritrocitarie in neonati con iperbilirubinemia.

Determinations of erythrocyte glucose-6-phosphate dehydrogenase, pyruvate kinase and glucose-phosphate isomerase activities have been carried out in jaundiced and non-jaundiced newborn infants at birth and after 5 days of life. Only hyperbilirubinemias of unknown etiology have been considered. Previous investigations have demonstrated that erythrocyte age dependent enzyme activities decrease in the healthy newborn during the first week of life. Following the results of the present paper, jaundiced newborns do not show such a decrease, since a statistically significant difference between paired data of glucose-6-phosphate dehydrogenase and pyruvate kinase in jaundiced and non-jaundiced newborns have been found. It is likely that the lack of decrease of enzyme activities in the jaundiced infants depend upon the loss of oldest red cells with low glucose-6-phosphate dehydrogenase and pyruvate kinase. Our observation suggests the occurrence of a slight hemolysis in newborn infants with hyperbilirubinemia of unknown etiology.

[Methemoglobinemia and acidosis during the first week of life]. / Metaemoglobinemia ed acidosi durante la prima settimana di vita.

Recently attention has been called on the possible role of acidosis in the increased methemoglobin formation in the erythrocyte of newborn infant. In the present paper the relations between acidosis and methemoglobin content in the red cells of newborns has been investigated. No significant differences between the percent of methemoglobin in the normal newborns and percent of methemoglobin in the newborns with acidosis has been found. In addition, no correlations between the base excess and percent of methemoglobin has been observed. On the contrary, two newborns with low glucose-6-phosphate dehydrogenase activity demonstrated a significantly increased methemoglobin content in their red cells. The results of our study do not confirm a key role of acidosis in the mechanism of methemoglobin formation in the neonate. It is likely than impairment of red cell metabolism should be the main factor in the formation of methemoglobin in the first days of life.

[The correlation between left ventricular segmental kinesis and a Selvester QRS analysis in stabilized myocardial infarct]. / Correlazione tra alterazioni della cinesi segmentale ventricolare sinistra e analisi del QRS secondo Selvester nell'infarto miocardico stabilizzato.

We have studied the relationship between left ventricular segmental wall motion evaluated by means of biplane left ventricular cineangiography and the myocardial infarct size estimated using Selvester's scoring system based on the QRS of the electrocardiogram. Seventy consecutive patients with old myocardial infarction were recruited. All patients underwent diagnostic retrograde left heart catheterization including left ventriculography and selective coronary arteriography. Nineteen patients were excluded from the study due to intraventricular conduction disturbances and left ventricular hypertrophy. Of the remaining 51 patients, aged 33-76 years (mean 56 years), 31 had inferior or postero-inferior myocardial infarction (Group 1); 7 patients had combined anterior and inferior myocardial infarction (Group 2); 13 patients had anterior or antero-septal myocardial infarction (Group 3). The analysis of left ventricular segmental wall motion was performed according to the Collaborative Studies in Coronary Artery Surgery assigning at hypokinesia, akinesia and dyskinesia 1, 2 and 3 points, respectively. The values of statistical correlations between QRS scoring system and ventricular scoring were: r = 0.85 (Group 1); r = 0.78 (Group 2); r = 0.70 (Group 3). Our data indicate that Selvester's scoring system may provide useful information on functional status and on the extent of left ventricular wall motion abnormalities in patients with previous myocardial infarction.

[Orbital apex syndrome as a result of fibrous dysplasia of the skull with malignant evolution]. / Sindrome dell'apice orbitario da displasia fibrosa del cranio ad evoluzione maligna.

The authors present a case of syndrome of the orbital apex subsequent to a fibrous dysplasia in malignant evolution; they underline the usefulness of T.A.C. in the case, generally extremely rare, of such transformation.